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.

本研究旨在探讨在双相情感障碍（BD）患者中，合并物质使用障碍（SUDs）对药物治疗效果的影响尚不明确。因此，本研究对法国和挪威的BD患者样本进行了调查，以探究合并SUDs的BD患者是否具有与仅患BD的患者不同的药物治疗方案，并重点关注了患者对国际指南的遵从性。研究方法包括：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，通过患者及医院记录获取药物信息，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来探究SUDs合并症与药物治疗之间的关联。在挪威亚样本中，还调查了与药物缺乏的关联。研究结果显示：合并SUDs包括：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缺失者占8%，部分遵从者占44%，完全遵从者占48%。贝叶斯分析显示，BD合并SUDs与未合并SUDs在药物治疗方案上的遵从性无显著差异（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，当前吸烟者与抗癫痫药物的使用增加相关（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：在本研究样本中，SUDs合并症与BD的药物治疗无显著关联，且与对指南的遵从程度无关。我们发现，特定国家中合并SUDs与特定药物之间存在关联，这需要进一步研究。