Table_1_Preventive Medication Patterns in Bipolar Disorder and Their Relationship With Comorbid Substance Use Disorders in a Cross-National Observational Study.docx

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：在双相情感障碍（BD）患者中，合并物质使用障碍（SUDs）与未合并SUDs的患者所观察到的较差预后之间，亚优药理治疗可能发挥的作用尚不明确。因此，本研究旨在探讨法国和挪威样本中，合并BD和SUDs的患者是否具有与仅患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名确诊为BD I或II型（68%为BD-I型）的患者。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将预防性治疗进行分类。运用贝叶斯分析和回归分析探究SUD合并症与药物治疗之间的关联。在挪威亚样本中，还探究了与药物缺乏的关联。研究结果：合并SUDs的情况如下：当前吸烟者占26%，酒精使用障碍（AUD）占16%，大麻使用障碍（CUD）占10%，其他SUDs占5%。预防性药物治疗对指南的依从性在样本中缺乏者占8%，部分依从者占44%，完全依从者占48%。贝叶斯分析（最高贝叶斯因子为0.16）表明，BD合并SUDs与未合并SUDs的患者对指南的依从性无显著差异。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与抗精神病药物使用增加相关（OR = 2.4，95% CI = 1.4–3.9，p = 0.001）；（2）在挪威，当前吸烟者与抗癫痫药物使用增加相关（OR = 4.4，95% CI = 1.9–11，p < 0.001）；（3）在挪威，AUD与药物治疗的概率降低相关（OR = 1.2，95% CI = 1.04–1.3，p = 0.038）。研究结论：在本次样本中，SUD合并症与BD的药物治疗无整体关联，且与对指南的依从程度无关。我们发现，不同国家SUD合并症与特定药物之间存在特定关联，这需要进一步研究。