Table_2_Preventive Medication Patterns in Bipolar Disorder and Their Relationship With Comorbid Substance Use Disorders in a Cross-National Observational Study.pdf

ObjectiveThe potential role of sub-optimal pharmacological treatment in the poorer outcomes observed in bipolar disorder (BD) with vs. without comorbid substance use disorders (SUDs) is not known. Thus, we investigated whether patients with BD and comorbid SUD had different medication regimens than those with BD alone, in samples from France and Norway, focusing on compliance to international guidelines.MethodsSeven hundred and seventy patients from France and Norway with reliably ascertained BD I or II (68% BD-I) were included. Medication information was obtained from patients and hospital records, and preventive treatment was categorized according to compliance to guidelines. We used Bayesian and regression analyses to investigate associations between SUD comorbidity and medication. In the Norwegian subsample, we also investigated association with lack of medication.ResultsComorbid SUDs were as follows: current tobacco smoking, 26%, alcohol use disorder (AUD), 16%; cannabis use disorder (CUD), 10%; other SUDs, 5%. Compliance to guidelines for preventive medication was lacking in 8%, partial in 44%, and complete in 48% of the sample. Compliance to guidelines was not different in BD with and without SUD comorbidity, as was supported by Bayesian analyses (highest Bayes Factor = 0.16). Cross national differences in treatment regimens led us to conduct country-specific adjusted regression analyses, showing that (1) CUD was associated with increased antipsychotics use in France (OR = 2.4, 95% CI = 1.4–3.9, p = 0.001), (2) current tobacco smoking was associated with increased anti-epileptics use in Norway (OR = 4.4, 95% CI = 1.9–11, p < 0.001), and (3) AUD was associated with decreased likelihood of being medicated in Norway (OR = 1.2, 95% CI = 1.04–1.3, p = 0.038).ConclusionSUD comorbidity in BD was overall not associated with different pharmacological treatment in our sample, and not related to the level of compliance to guidelines. We found country-specific associations between comorbid SUDs and specific medications that warrant further studies.

研究目的：在伴有与不伴有共病物质使用障碍（SUDs）的双相情感障碍（BD）患者中，亚优化的药物治疗在观察到的较差预后中所起的作用尚不明确。因此，本研究旨在探讨法国和挪威样本中，BD伴共病SUD的患者是否具有与单独患有BD的患者不同的药物治疗方案，重点关注对国际指南的依从性。研究方法：纳入了来自法国和挪威的770名BD I或II型（68%为BD-I型）患者。通过患者和医院记录获取药物治疗信息，并根据对指南的依从性对预防性治疗进行分类。使用贝叶斯分析和回归分析研究SUD共病与药物治疗之间的关联。在挪威亚组中，还研究了与未接受药物治疗之间的关联。研究结果：共病SUDs包括：当前吸烟，26%，酒精使用障碍（AUD），16%；大麻使用障碍（CUD），10%；其他SUDs，5%。预防性药物治疗指南的依从性在样本中缺乏的占8%，部分依从的占44%，完全依从的占48%。贝叶斯分析表明，BD伴有与不伴有SUD共病的患者对指南的依从性没有差异（最高贝叶斯因子=0.16）。治疗方案的跨国差异促使我们进行针对特定国家的调整回归分析，结果显示：（1）在法国，CUD与抗精神病药的使用增加相关（OR=2.4，95%CI=1.4–3.9，p=0.001）；（2）在挪威，当前吸烟与抗癫痫药的使用增加相关（OR=4.4，95%CI=1.9–11，p<0.001）；（3）在挪威，AUD与接受药物治疗的可能性降低相关（OR=1.2，95%CI=1.04–1.3，p=0.038）。结论：在本研究中，BD中的SUD共病与不同的药物治疗并无显著关联，也未与对指南的依从性水平相关。我们发现共病SUDs与特定药物之间的国家特异性关联，这需要进一步研究。