Psychiatry Research EG

Background Both bipolar I and bipolar II disorders are highly comorbid with substance use disorders (SUD), and this comorbidity is associated with a more severe illness course and early mortality. Individuals with both disorders have a more severe course of bipolar disorder, including earlier onset, more frequent episodes and more complications, including anxiety- and stress-related disorders, aggressive behavior, legal problems and suicide. Objectives To recognize the impact of comorbid substance use on the severity of manic episodes in a sample of Egyptian bipolar I disorder (BD I) patients and their clinical outcomes. Participants and methods In the current cross-sectional study, a sample of 30 patients was selected with a diagnosis of BD I from the Inpatient Psychiatric Units of the Institute of Psychiatry, Ain Shams University. Patients in manic relapse according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), irrespective of their sex, aged between 18 and 55 years and who could read and write to be able to undergo the needed assessments were selected. They were subdivided into two groups: group I included patients without comorbid SUD and group II included patients with comorbid SUD. They were assessed using (a) a structured Clinical Interview for DSM-IV, (b) the Young Mania Rating Scale (YMRS), and (c) the Anger, Irritability, and Assault Questionnaire (AIAQ). In addition, those with comorbid substance use were further assessed by (d) the Addiction Severity Index. Results Statistical analysis of the data was carried out. Results revealed the presence of a positive relation between AIAQ (indirect assault patient rating and direct assault caregiver rating) and YMRS scores. On examining the sociodemographic characteristics, no significant difference was found between both groups regarding their age, educational level, employment as well as their marital status. The age of onset was higher in group II; a positive family history and medication noncompliance as well as suicidal attempts were positive in group II with statistical significance. YMRS and AIAQ showed higher scores in group II in all domains with a highly statistically significant difference. Conclusion Our results showed impaired functioning and a worse general psychiatric outcome in patients with BD I and comorbid SUD. This has implications for current treatment programs and should lead to more research into the underlying psychopathological mechanisms. Keywords: aggression, anger, bipolar disorder, irritability, substance use