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.

目的：在双相情感障碍（BD）患者中，相较于单纯性BD，合并物质使用障碍（SUDs）患者所观察到的较差预后与亚优药理治疗之间的潜在作用尚不清楚。因此，本研究旨在探究合并SUDs的BD患者与单纯性BD患者在法国和挪威的样本中是否存在不同的药物治疗方案，并重点关注对国际指南的遵从性。方法：纳入了来自法国和挪威的770名确诊为BD I或II型（其中68%为BD-I型）的患者。通过患者及医院记录获取药物治疗信息，并根据对指南的遵从性将预防性治疗进行分类。采用贝叶斯分析和回归分析，研究SUDs合并症与药物治疗之间的关联。在挪威亚组中，我们还研究了缺乏药物治疗与关联。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%。样本中预防性药物治疗对指南的遵从性分别为：缺乏遵从性8%，部分遵从性44%，完全遵从性48%。贝叶斯分析显示，BD合并与不合并SUDs的患者在药物治疗方案对指南的遵从性上并无显著差异（最高贝叶斯因子为0.16）。治疗方案的跨国差异促使我们进行特定国家调整的回归分析，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与未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：在我们的样本中，SUDs合并症与BD的药物治疗并未显示出显著关联，且与对指南的遵从程度无关。我们发现，特定国家内的SUDs合并症与特定药物之间存在关联，这需要进一步研究。