Addiction history indicates bipolar conversion risk from precursor disorders

Substance use and the presence of subthreshold affective symptoms may predict future bipolar disorder in young people with precursor conditions such as depression, research suggests.

The 52 patients included in the study were aged an average of 19.7 years, were mostly (85%) women, and had sought help for problems including depression (65%), anxiety (79%) and substance use disorder (37%).

Of the baseline disorders, only alcohol use disorder significantly predicted conversion to bipolar disorder, at an odds ratio of 33.0.

Four patients converted to bipolar disorder during 12 months of follow-up, with three developing type II bipolar disorder and one bipolar disorder not otherwise specified, report Aswin Ratheesh (Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia) and study co-authors.

Besides patients with baseline alcohol abuse, those with a family history of any substance abuse disorder and those with poor physical health quality of life were at an increased risk of converting to bipolar disorder.

In addition, having subthreshold hypomanic/manic symptoms on the Bipolar At-Risk (BAR) index also increased patients’ risk of converting, reports the team in the Journal of Affective Disorders.

The researchers note that the diversity of risk factors identified in their study suggest “that clusters of risk factors such as BAR could be more useful than individual risk factors in predicting onset of [bipolar disorder].”

Some variables with a previously reported association with bipolar disorder, such as a family history of the condition, did not predict conversion in the current study, which the team says could be due to the small number of patients studied.

They also found that, although not statistically significant, severity of depression and recent use of cannabis appeared to have a sizable effect on the likelihood of conversion, suggesting that these factors merit further study in larger groups of patients with longer follow-up.

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