Presence of co-morbid substance use disorder in bipolar patients worsens their social functioning to the level observed in patients with schizophrenia |
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| Authors: | Fabienne Jaworski Caroline Dubertret Jean Adès Philip Gorwood |
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| Affiliation: | 1. AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France;2. INSERM U675-U894, Center of Psychiatry and Neurosciences, Paris, France;3. University Paris 7 Denis Diderot, Faculty of Medicine, Paris, France;1. Université Paris Diderot, Sorbonne Paris Cité, CART, Inserm U965, 74575 Paris, France;2. AP–HP, Hôpital Lariboisière, Service de chirurgie digestive et cancérologique Clinique, 75475 Paris, France;3. Polyclinique Courlancy, 38 bis, rue de Courlancy, 51100 Reims, France;4. Clinique de l’Île Nou-Magnin, 1, rue RP-Roman, Nouméa, Nouvelle-Calédonie, France;1. Service de dermatologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France;2. Service de dermatologie, hôpital universitaire S. Maria alle Scotte, Viale Bracci 16, 53100 Siena, Italie;3. Service d’anatomopathologie, hôpital universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France;1. Service de médecine interne et maladies infectieuses, centre hospitalier de Périgueux, 80, avenue G. Pompidou, CS 61205, 24019 Périgueux cedex, France;2. Service d’hépatogastroentérologie, centre hospitalier de Périgueux, 80, avenue G. Pompidou, CS 61205, 24019 Périgueux cedex, France;3. Service de médecine interne et immunologie clinique, centre hospitalier universitaire de Bordeaux, 1, rue J. Burguet, 33076 Bordeaux cedex, France;1. Department of Radiology & Biomedical Imaging, University of California San Francisco, United States;2. Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, United States;3. Department of Clinical Sciences/ Child, and Adolescent Psychiatry, Umeå University, Umeå, Sweden;4. Department of Psychology, Stanford University, United States;5. Department of Biochemistry and Biophysics, University of California San Francisco, United States;6. Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden;7. Department of Psychiatry and Behavioral Sciences, Stanford University, United States;8. Department of Psychiatry, Amsterdam Neuroscience, VU University Medical Center, GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, The Netherlands;1. Service d’ophtalmologie, université Lyon-1, hôpital E.-Herriot, hospices civils de Lyon, CHU de Lyon, 5, place d’Arsonval, 69437 Lyon cedex 03, France;2. Service de pharmacie, université Lyon-1, hôpital E.-Herriot, hospices civils de Lyon, CHU de Lyon, 5, place d’Arsonval, 69437 Lyon cedex 03, France;1. Bipolar Collaborative Network, 5415 West Cedar Lane Suite 201B, Bethesda, MD 20814, USA;2. UCLA Mood Disorders Research Program and VA Medical Center, Los Angeles, CA, USA;3. Mayo Clinic Department of Psychiatry and Psychology, Mayo Clinic Depression Center, USA;4. Stanford University School of Medicine and V.A., Palo Alto Health Care System, Palo Alto, CA, USA;5. Lindner Center of Hope, Mason, OH, USA;6. Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA;7. University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands;8. VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands;9. Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK |
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| Abstract: | Bipolar disorder has been considered to have a better prognosis than schizophrenia at the very beginning of its definition. However, psychosocial functioning may vary not only because of the characteristics of the disorder, but also of co-morbid conditions, especially regarding substance use disorder (SUD). The purpose of this study was to compare the social adjustment level of patients with bipolar disorder with that observed in patients with schizophrenia, taking into account substance use disorder (SUD). Forty subjects with schizophrenia and 40 subjects with bipolar disorder, in the stable phase of the disorder, were matched for age, gender and presence of SUD (DSM-IV criteria). The social adjustment scale was completed with socio-demographic and clinical characteristics of illness. The global adaptation score of bipolar patients with SUD was poorer than bipolar patients without SUD, but was not observed as being significantly different from that of patients with schizophrenia, with or without associated SUD. Suicide attempts, poor compliance, longer hospitalisation, shorter remissions and criminal activity were also more frequently observed in the group of patients with bipolar disorder and SUD. Presence of substance use disorder seems to have a greater weight than the main diagnostic (schizophrenia versus bipolar disorder) to predict worse social adjustment and poorer outcome. |
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