Transcript Mental Health

Poor Bipolar Outcome
The Effect of Substance
Abuse On Bipolar Disorder

Phillip Long M.D.
What Are The Most Common Disabilities?
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In developed countries, the ten
leading causes of lost years of healthy
life at ages 15-44 are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Major Depressive Disorder
Alcohol Use
Road Traffic Accidents
Schizophrenia
Self-Inflicted Injuries
Bipolar Disorder
Drug Use
Obsessive-Compulsive Disorder
Osteoarthritis
Violence
"The Global Burden Of Disease" by C.J.L. Murray
and A.D. Lopez, World Health Organization, 1996,
Table 5.4 page 270
The Most Common Disabilities Are Mental Disorders
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Notice that 8 of these 10 leading
causes of disability are mental
disorders:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Major Depressive Disorder
Alcohol Use
Road Traffic Accidents
Schizophrenia
Self-Inflicted Injuries
Bipolar Disorder
Drug Use
Obsessive-Compulsive Disorder
Osteoarthritis
Violence
"The Global Burden Of Disease" by C.J.L. Murray and A.D.
Lopez, World Health Organization, 1996, Table 5.4 page 270
Bipolar Disorder
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The 6th leading cause of disability
(ages 15-44) is Bipolar Disorder,
which presents with symptoms
identical to cocaine intoxication:
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Inflated self-esteem or grandiosity
Decreased need for sleep
Being more talkative than usual
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed activity
(either socially, at work or school, or
sexually) or psychomotor agitation
Excessive involvement in
pleasurable activities that have a
high potential for painful
consequences
Drug Addiction

The 7th leading cause of
disability (ages 15-44) is Drug
Addiction.

Alcohol or drug problems and
noncompliance with medication
were the most important factors
related to frequency of
hospitalization.
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Am J Psychiatry. 1995 Jun;152(6):856-61. Predicting the
"revolving door" phenomenon among patients with
schizophrenic, schizoaffective, and affective disorders.
Haywood TW et al
Fifty percent of schizophrenic
patients and 25% of bipolar
patients abused one or more
drugs.
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Am J Drug Alcohol Abuse. 1989;15(3):291-5. Drug abuse
in schizophrenia and bipolar disorder. Miller FT et al
Poor Bipolar Outcome With Substance Abuse
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100
90
80
70
60
50
40
30
20
10
0
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Poor
Outcome
Fair
Outcome
Good
Outcome
Abuse
No
Abuse
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I compared the outcome of all
of the Bipolar I Disorder
outpatients I treated from
October 2004 to the present.
Two patients with dementia
were excluded.
47 patients were studied; 12
had substance abuse and 35
didn’t.
94.3% of non-substance
abusers had a good
outcome (asymptomatic,
back to work, adequate social
life).
8.3% of substance abusers
had a good outcome.
“Clean + Dry” Bipolar Sibling
Substance Abusing Bipolar Sibling
Does Cannabis Trigger Schizophrenia?
Swedish research found that cannabis
users were 6.7 times more likely to
be hospitalized for Schizophrenia
than non-users.
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This study started with a 1969-70
survey of Swedish conscripts (>97% of
the country's male population aged 1820). There was a 15 year follow-up
study of the conscripts medical
records.
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Cannabis use is associated with an
increased risk of developing
schizophrenia, consistent with a
causal relation. This association is
not explained by use of other
psychoactive drugs or personality
traits relating to social integration.
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BMJ. 2002 Nov 23;325(7374):1199. Self reported
cannabis use as a risk factor for schizophrenia in
Swedish conscripts of 1969: historical cohort study.
Zammit S et al
Schizophrenia And Work Disability
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For patients with schizophrenia
in Oslo, Norway:
 94% were unemployed
 47% were socially isolated
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Psychiatr Serv. 2000 Feb;51(2):223-8. Social
functioning of patients with schizophrenia in highincome welfare societies. Melle I et al
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Current medical treatment for
schizophrenia is literally life-saving
and usually prevents psychiatric
rehospitalization and the return of
psychosis.
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Unfortunately, neurological
impairments in concentration,
memory, problem-solving, and
motivation prevent the vast majority
of individuals with schizophrenia
from returning to the workforce.
Substance Abuse Worsens Prognosis
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It is essential that we appreciate how
destructive substance abuse is in
worsening Bipolar Disorder and
Schizophrenia.
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My research showed that nonsubstance abusing Bipolar I Disorder
patients can expect an excellent
response to their medications.
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However, substance abusing Bipolar I
Disorder patients can expect almost
no benefit from their medications.