Journal of affective disorders · 2025
Cannabis and tobacco use in bipolar disorder: Associations with early onset, psychotic symptoms, and relapse risk (2015-2019).
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Olivier Luis, Andreu Helena, de Juan Oscar, Ochandiano Iñaki, Salmerón Sergi, Fernández-Plaza Tábatha, Colomer Lluc, Vieta Eduard, Giménez-Palomo Anna, Pacchiarotti Isabella
Аннотация
BACKGROUND: Substance use disorders (SUD) frequently occur alongside bipolar disorder (BD), with some studies indicating a 29 % comorbidity rate in Western populations [1]. The relationship between BD and SUD is intricate and bidirectional - drug misuse can increase the risk of developing BD, and individuals with BD have a higher risk of developing SUD. This complex interplay often leads to earlier BD onset, more hospitalizations, and reduced effectiveness of pharmacological treatments, particularly mood stabilizers. This work aims to describe the impact of drugs in the risk of relapse in BD and to approach the differences in the evolution in substance users compared to non-users.
METHODS: We conducted a prospective cohort study including the patients admitted to Hospital Clínic of Barcelona acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019. We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined.
RESULTS: The study, which included 279 patients, concluded that only tobacco users showed significantly higher rates of emergency room (ER) visits and hospital readmissions in the period study, while cannabis was only associated with earlier onset of illness, current manic polarity, the presence of psychotic symptoms and a higher likelihood of discontinuing treatment. Alcohol, cocaine and stimulants did not appear to have an association with the variables studied.
LIMITATIONS: Lack of follow-up information from people leaving the region or changing to private sector services, lack of detailed information around the pattern and history of consumption.
CONCLUSIONS: Tobacco seemed to have a clear negative association with the course of the illness. Cannabis, while its use was not associated with the relapse rate, was indirectly associated with variables suggesting a more severe symptomatology and a possible qualitatively different course of illness. More evidence is needed to define the mechanisms and patterns related to these effects.
METHODS: We conducted a prospective cohort study including the patients admitted to Hospital Clínic of Barcelona acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019. We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined.
RESULTS: The study, which included 279 patients, concluded that only tobacco users showed significantly higher rates of emergency room (ER) visits and hospital readmissions in the period study, while cannabis was only associated with earlier onset of illness, current manic polarity, the presence of psychotic symptoms and a higher likelihood of discontinuing treatment. Alcohol, cocaine and stimulants did not appear to have an association with the variables studied.
LIMITATIONS: Lack of follow-up information from people leaving the region or changing to private sector services, lack of detailed information around the pattern and history of consumption.
CONCLUSIONS: Tobacco seemed to have a clear negative association with the course of the illness. Cannabis, while its use was not associated with the relapse rate, was indirectly associated with variables suggesting a more severe symptomatology and a possible qualitatively different course of illness. More evidence is needed to define the mechanisms and patterns related to these effects.