Desfechos clínicos no transtorno bipolar com abuso de substâncias .

Abstract

Bipolar!disorder!has!a!high!rate!of!comorbidity!with!substance!abuse/dependence.!I!addition,! studies!have!suggested!that!this!comorbidity!could!contribute!to!illness!progression.!Thus,!the! aim! of! the! current! thesis!was! to! assess! the! clinical! characteristics! associated! to! the! bipolar! disorder!with!substance!abuse/dependence!comorbidity!in!a!community!sample!of!young!adults! from!Pelotas!(RS!–!BR),!as!well!as!in!an!outpatient!sample!of!children!and!adolescents!from!San! Antonio!(Texas!–!USA),!Chapel!Hill!(North!Carolina!5!USA),!and!Houston!(Texas!–!USA).!In!the! community! study!with!young!aduts,!we! found!higher! functional! impairment! in!subjects!with! bipolar! disorder,! independently! of! the! comorbidity,! as! compared! to! community! controls.! In! addition,!we!verified!higher!impairment!in!the!cognitive!domain!of!functioning!only!in!subjects! with!bipolar!disorder!and!substance!abuse/dependence!comorbidity!as!compared!to!controls.! No!diferences!were!found!in!this!domain!when!we!compared!bipolar!disorder!without!subtance! abuse/dependence! comorbidity! and! community! controls.! These! findings! suggest! that! the! bipolar!disorder!is!marked!by!a!functional!impairment!even!in!a!community!sample!of!young! adults,!with!few!time!of!disease!and!few!previous!interventions.!In!addition,!the!impairment!in! the!cognitive!domain!of!the!functioning!appears!to!be!a!marker!of!the!comorbidity!between! bipolar!disorder!and!substance!abuse/dependence.!In!the!study!performed!with!children!and! adolescents!at!the!three!institutions!from!USA,!we!found!that!youth!with!bipolar!disorder!and! substance!abuse/dependence!comorbidity!showed!a!later!onset!of!mood!disorder,!higher!rates! of!lifetime!suicide!attempts!and!hospitalization!as!compared!to!subjects!with!bipolar!disorder! without! substance! abuse/dependence! comorbidity.!Moreover,! the! study! showed! that! both! diagnosis!groups!(bipolar!disorder!with!and!without!substance!abuse/dependence!comorbidity)! presented!higher!functional!impairment!as!compared!to!controls.!Moreover,!bipolar!disorder! with! substance! abuse/dependence! comorbidity! presented! higher! functional! impairment,! as! compared! to! bipolar! disorder! without! substance! abuse/dependence! comorbidity.! These! findings! suggest! that! the! comorbidity! between! bipolar! disorder! and! substance! abuse/dependence!is!associated!to!worse!clinical!course!and!higher!functional!impairment.!It!is! important! to! highlight! that! the! comorbidity! between! bipolar! disorder! and! substance! abuse/dependence!was!associated!to!worse!clinical!course!and!functioning!impairment!more! evident!in!the!outpatient!sample!of!children!and!adolescents!than!in!the!community!sample!of! young! adults.! Possibly! the! impairment! is! more! apparent! in! the! sample! of! children! and! adolescents!due! to! the! sample! selection,!because! it! is!possible! that! the! subjects! selected! in! outpatient! clinics! are!more! suceptible! to! present! a! worse! clinical! course! that! the! subjects! selected!in!the!community,!which!frequently!are!receiving!the!diagnose!in!the!first!time,!being! 7! in!the!begin!of!illness,!without!evident!impairment!that!motivem!to!looking!for!treatment.!Thus,! the! impairment! associated! to! bipolar! disorder!with! substance! use! disorder! comorbidity! are! more!evidentes!in!the!sample!with!higher!severity!of!the!clinical!condiction,!independently!of! the!age!of!subjects.!