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Poor Bipolar Outcome

Poor Bipolar Outcome

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Poor Bipolar Outcome

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  1. Poor Bipolar Outcome The Effect of Substance Abuse On Bipolar Disorder • Phillip Long M.D.

  2. What Are The Most Common Disabilities? • In developed countries, the ten leading causes of lost years of healthy life at ages 15-44 are: • 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

  3. The Most Common Disabilities Are Mental Disorders • Notice that 8 of these 10 leading causes of disability are mental disorders: • 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

  4. Bipolar Disorder • The 6thleading cause of disability (ages 15-44) is Bipolar Disorder, which presents with symptoms identical to cocaine intoxication: • 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

  5. Drug Addiction • The 7thleading 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. • 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. • Am J Drug Alcohol Abuse. 1989;15(3):291-5. Drug abuse in schizophrenia and bipolar disorder. Miller FT et al

  6. Poor Bipolar Outcome With Substance Abuse • 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.

  7. “Clean + Dry” Bipolar Sibling

  8. Substance Abusing Bipolar Sibling

  9. Does Cannabis Trigger Schizophrenia? Swedish research found that cannabis users were 6.7 times more likely to be hospitalized for Schizophrenia than non-users. • This study started with a 1969-70 survey of Swedish conscripts (>97% of the country's male population aged 18-20). There was a 15 year follow-up study of the conscripts medical records. • 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. • 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

  10. Schizophrenia And Work Disability • For patients with schizophrenia in Oslo, Norway: • 94% were unemployed • 47% were socially isolated • Psychiatr Serv. 2000 Feb;51(2):223-8. Social functioning of patients with schizophrenia in high-income welfare societies. Melle I et al • Current medical treatment for schizophrenia is literally life-saving and usually prevents psychiatric rehospitalization and the return of psychosis. • Unfortunately, neurological impairments in concentration, memory, problem-solving, and motivation prevent the vast majority of individuals with schizophrenia from returning to the workforce.

  11. Substance Abuse Worsens Prognosis • It is essential that we appreciate how destructive substance abuse is in worsening Bipolar Disorder and Schizophrenia. • My research showed that non-substance abusing Bipolar I Disorder patients can expect an excellent response to their medications. • However, substance abusing Bipolar I Disorder patients can expect almost no benefit from their medications.