Table_3_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：探讨在伴有或不伴有共病物质使用障碍（SUDs）的双相情感障碍（BD）患者中，亚优药物治疗的潜在作用是否会导致较差的临床结局，目前尚不清楚。因此，本研究旨在调查法国和挪威样本中，BD合并SUDs的患者是否具有与仅患有BD的患者不同的药物治疗方案，重点关注对国际指南的遵从性。
研究方法：纳入了来自法国和挪威的770名可靠确诊为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，并将预防性治疗根据对指南的遵从性进行分类。采用贝叶斯分析和回归分析探讨SUD共病与药物治疗之间的关联。在挪威亚样本中，还调查了与未接受药物治疗之间的关联。
研究结果：共病SUDs包括：当前吸烟者，26%；酒精使用障碍（AUD），16%；大麻使用障碍（CUD），10%；其他SUDs，5%。样本中预防性药物对指南的遵从性在8%的患者中不足，44%为部分遵从，48%完全遵从。贝叶斯分析结果显示，BD合并SUDs与BD不合并SUDs的患者在遵从性方面无显著差异（最高贝叶斯因子为0.16）。治疗方案的跨国家差异促使我们进行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）。
研究结论：在样本中，SUDs共病与不同的药物治疗并无总体关联，且与对指南的遵从程度无关。我们发现，SUDs共病与特定药物之间存在特定国家的关联，这值得进一步研究。