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.

本研究旨在探讨亚优药理治疗在双相情感障碍（BD）患者中，与合并物质使用障碍（SUDs）或无合并SUDs相比，是否会导致较差的治疗结果。因此，我们调查了法国和挪威样本中，BD合并SUD患者与仅患有BD的患者是否具有不同的药物治疗方案，重点关注对国际指南的遵守程度。
研究方法：纳入了来自法国和挪威的770名确诊为BD I型或II型（其中68%为BD-I型）的患者。通过患者和医院记录获取药物信息，并根据对指南的遵守情况对预防性治疗进行分类。我们运用贝叶斯分析和回归分析，探究SUD合并症与药物之间的关联。在挪威亚样本中，我们还调查了与缺乏药物治疗的关联。
研究结果：合并的SUDs包括：当前吸烟，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%。在样本中，对预防性药物指南的遵守情况为：8%缺乏遵守，44%部分遵守，48%完全遵守。贝叶斯分析表明，BD合并SUD与不合并SUD的患者在遵守指南方面没有差异（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与药物治疗的可能性降低相关（OR = 1.2，95% CI = 1.04–1.3，p = 0.038）。
结论：在我们的样本中，SUD合并症与BD患者不同的药理治疗总体上没有关联，并且与对指南的遵守程度无关。我们发现，特定国家的SUD合并症与特定药物之间存在关联，这需要进一步研究。