- Email: [email protected]
Bipolar spectrum disorders in substance use disorders
Asian Journal of Psychiatry 21 (2016) 33–36
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Letter to Editor Bipolar spectrum disorders in substance use disorders Dear Editor, Bipolar spectrum disorders are a group of chronically recurring disorders of varying and fluctuating intensity, characterized by intermittent or prolonged affective instability, states of inhibition and excitement of various mental functions such as mood, cognition and psychomotor activity (Akiskal, 1996). In our diagnostic systems (ICD-10/DSM–IV) contribution of bipolar spectrum disorders (BPSD) to the addictive process is often clinically missed as attenuated and subclinical expressions of mood disorders are not recognised (Maremmani et al., 2006). The objective of our study was to study detection of unrecognized bipolar spectrum disorders among patients with a current diagnosis of substance use disorders. The participants in this non-interventional study were from outpatients from the Drug De-addiction and Treatment Centre (DDTC) at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The study protocol and the text of informed consent were approved by the Ethics Review Board of the Institute. The inclusion criteria were: a current diagnosis of substance use disorder as per the International Classification of Diseases, 10th Revision (ICD-10), and age from 18 to 65 years. The exclusion criteria were: not consenting for the study, and not able to read Hindi or English questionnaire. The Bipolar Spectrum Diagnostic Scale (BSDS) is a descriptive story that captures subtle features of bipolar illness. The scale has
good sensitivity and specificity for bipolar types (Phelps and Ghaemi, 2006). To facilitate self administration the questionnaire was translated and back translated from English into Hindi by bilingual experts (Subodh et al., 2014). The study was conducted from 20th Sep 2013 to 31st Dec 2013. During this period 663 patients visited as outpatient to our centre. Among them 181 patients were randomly selected by convenient sampling method. Analysis was done by using SPSS-14 (Statistical Package for the Social Sciences, 2005, Chicago, IL, USA). Among 181 patients interviewed 21.5% (N = 39) were BSDS positive (scored 13 or more on BSDS). The mean BSDS score of the whole group was 8.88 05.50, with a range of 0–24. The mean age of the whole group was 32.66 09.89 years with a range of 19–66 years and there was no difference in the BSDS positive and negative group. In BPSD positive group alcohol dependence syndrome (53.8%) is the most common first diagnosis followed by opioid dependence syndrome (41.0%) compared to BPSD negative group where opioid dependence syndrome (48.6%) was the first diagnosis followed by alcohol dependence (38.7%). BPSD positive group had more impairment in occupation related (r = 9.231; p = 0.026), legal related (r = 9.422; p = 0.024), family related (r = 13.432; p = 0.001), and marital related aspects (r = 9.055; p = 0.029) compared to BPSD negative group. There was no significant difference in socio-demographic profile, clinical profile of BPSD positive and BPSD negative group in other profile (Table 1) This is the first study from this region to report the prevalence of bipolar spectrum disorders in substance use disorders patients. The prevalence reported in our study is 21.5% which is similar to
Table 1 BSDS scores, sociodemographic and clinical variable. BSDS scores Scores
Variable BSDS score (categorical) No risk (0–6) Low risk (7–12) Moderate risk (13–18) High risk (19–25)
72 70 27 12
BSDS Positive Negative
(39.8%) (38.7%) (14.9%) (06.6%)
39 (21.5%) 142 (78.5%)
Variable
Whole group N = 181
BSDS positive N = 39
BSDS negative N = 142
BSDS +ve vs. BSDS ve groups (p value) Chi square value/t-test
BSDS score (Mean SD)
8.88 05.50
17.36 02.90
6.56 3.32
0.588 (p = 0.444)
Socio-demographic profile Age (mean SD) Gender
32.66 09.89
31.69 08.69
32.93 10.20
1.627 (p = 0.204)
http://dx.doi.org/10.1016/j.ajp.2016.02.010 1876-2018/ß 2016 Elsevier B.V. All rights reserved.
34
Letter to Editor / Asian Journal of Psychiatry 21 (2016) 33–36
Table1 (Continued ) Variable
Whole group N = 181
BSDS positive N = 39
BSDS negative N = 142
BSDS +ve vs. BSDS ve groups (p value) Chi square value/t-test
Male Female Marital status Single Married Widowed Divorced Separated Education Upto matric Beyond matric Occupation Skilled Unskilled Student Unemployed Family type Nuclear Non-nuclear Family income Nil Upto 19,575 Above 19,575 Locality Urban Rural Referred by Self Relative Medical professionals Others
180 (99.4%) 001 (00.6%)
39 (100.0%) 00 (00.0%)
141 (99.3%) 001 (00.7%)
0.276 (p = 0.599)
059 117 002 001 002
13 25 00 00 01
46 92 02 01 01
(32.4%) (64.8%) (01.4%) (00.7%) (00.7%)
1.792 (p = 0.774)
Clinical profile Duration of use in months (Mean SD) Duration of dependence in months (Mean SD) Main substance Alcohol Opium Cannabis Benzodiazepine Nicotine Volatile substances Type of substances Alcohol IMFL CML Both Opioids Natural Heroin Others (Synthetic preparations) Mixed Tobacco Smoking Smokeless Both IV drug use 1st Diagnosis (main substance) Alcohol dependence syndrome Opioid dependence syndrome Cannabis dependence syndrome Benzodiazepine dependence syndrome Nicotine substance dependence Volatile substance dependence 2nd Diagnosis Alcohol dependence syndrome Opioid dependence syndrome Cannabis dependence syndrome Nicotine substance dependence Alcohol harmful use Alcohol currently abstinent Opioid currently abstinent Cannabis currently abstinent Nicotine currently abstinent 3rd Diagnosis
(32.6%) (64.6%) (01.1%) (00.6%) (01.1%)
(33.3%) (64.1%) (00.0%) (00.0%) (02.6%)
91 (50.3%) 90 (49.7%)
19 (48.7%) 20 (51.3%)
72 (50.7%) 70 (49.3%)
0.048 (p = 0.826)
37 89 18 37
11 18 05 05
26 71 13 32
(18.3%) (50.0%) (09.2%) (22.5%)
3.384 (p = 0.336)
(20.4%) (49.2%) (09.9%) (20.4%)
(28.2%) (46.2%) (12.8%) (12.8%)
68 (37.6%) 113 (62.4%)
14 (35.9%) 25 (64.1%)
54 (38.0%) 88 (62.0%)
0.059 (p = 0.808)
53 (29.3%) 70 (38.7%) 58 (32.0%)
10 (25.6%) 19 (48.7%) 10 (25.6%)
43 (30.3%) 51 (35.9%) 48 (33.8%)
2.158 (p = 0.340)
88 (48.6%) 93 (51.4%)
19 (48.7%) 20 (51.3%)
69 (48.6%) 73 (51.4%)
0.000 (p = 0.989)
61 79 26 15
11 16 07 05
50 63 19 10
5.370 (p = 0.251)
(33.7%) (43.6%) (14.4%) (08.3%)
(28.2%) (41.0%) (17.9%) (12.8%)
(35.2%) (44.4%) (13.4%) (07.0%)
140.91 102.78 97.18 84.61
139.64 89.14 101.59 72.27
141.26 106.51 95.97 87.89
1.212 (p = 0.272) 0.534 (p = 0.466)
76 85 03 01 15 01
21 16 01 00 01 00
55 69 02 01 14 01
(38.7%) (48.6%) (01.4%) (00.7%) (09.9%) (00.7%)
4.798 (p = 0.441)
(42.0%) (47.0%) (01.7%) (00.6%) (08.3%) (00.6%)
(53.8%) (41.0%) (02.6%) (00.0%) (02.6%) (00.0%)
50 (27.6%) 17 (09.4%) 34 (18.8%)
12 (30.8%) 07 (17.9%) 05 (12.8%)
38 (26.8%) 10 (07.0%) 29 (20.4%)
4.387 (p = 0.112)
46 17 19 22
(25.4%) (09.4%) (10.5%) (12.2%)
08 02 03 08
(20.5%) (05.1%) (07.7%) (20.5%)
38 15 16 14
(26.8%) (10.6%) (11.3%) (09.9%)
4.772 (p = 0.189)
85 42 24 06
(47.0%) (23.2%) (13.3%) (03.3%)
22 06 03 03
(56.4%) (15.4%) (07.7%) (07.7%)
63 36 21 03
(44.4%) (25.4%) (14.8%) (02.1%)
3.445 (p = 0.179)
76 85 03 01 15 01
(42.0%) (47.0%) (01.7%) (00.6%) (08.3%) (00.6%)
21 16 01 00 01 00
(53.8%) (41.0%) (02.6%) (00.0%) (02.6%) (00.0%)
55 69 02 01 14 01
(38.7%) (48.6%) (01.4%) (00.7%) (09.9%) (00.7%)
4.798 (p = 0.441)
01 03 02 25 00 00 00 00 00
(02.6%) (07.7%) (05.1%) (61.5%) (00.0%) (00.0%) (00.0%) (00.0%) (00.0%)
11 (07.7%) 04 (02.8%) 02 (01.4%) 88 (62.0%) 03 (02.1%) 04 (02.8%) 02 (01.4%) 01 (00.7%) 02(01.4%)
8.554 (p = 0.381)
12 (06.6%) 07 (03.9%) 04 (02.2%) 112 (61.9%) 03 (01.7%) 04 (02.2%) 02 (01.1%) 01 (00.6%) 02 (01.1%)
2.972 (p = 0.085)
Letter to Editor / Asian Journal of Psychiatry 21 (2016) 33–36
35
Table1 (Continued ) Variable
Whole group N = 181
BSDS positive N = 39
BSDS negative N = 142
BSDS +ve vs. BSDS ve groups (p value) Chi square value/t-test
Alcohol dependence syndrome Opioid dependence syndrome Cannabis dependence syndrome Nicotine substance dependence Alcohol currently abstinent Opioid currently abstinent Benzodiazepine currently abstinent Family h/o dependence Co-morbid medical illness Impairments due to substance use Health related Mild Moderate Severe Nil Occupation related Mild Moderate Severe Nil Finance related Mild Moderate Nil Legal related Mild Moderate Severe Nil Family related Mild Moderate Nil Marital related Mild Moderate Severe Nil Social related Mild Moderate Nil
02 04 03 21 03 04 03 60 31
01 00 00 06 00 01 01 15 05
(02.6%) (00.0%) (00.0%) (15.4%) (00.0%) (02.6%) (02.6%) (38.5%) (12.8%)
01 04 03 15 03 03 02 45 26
4.431 (p = 0.619)
21 (11.6%) 07 (03.9%) 01 (00.6%) 152 (84.0%)
05 00 00 34
(12.8%) (00.0%) (00.0%) (87.2%)
16 (11.3%) 07 (04.9%) 01 (00.7%) 118 (83.1%)
2.321 (p = 0.508)
92 13 06 70
22 02 04 11
(56.4%) (05.1%) (10.3%) (28.2%)
70 11 02 59
(49.3%) (07.7%) (01.4%) (41.5%)
9.231 (p = 0.026)
(01.1%) (02.2%) (01.7%) (11.6%) (01.7%) (02.2%) (01.7%) (33.1%) (17.1%)
(50.8%) (07.2%) (03.3%) (38.7%)
None. Funding None.
0.633 (p = 0.426) 0.650 (p = 0.420)
75 (41.4%) 21 (11.6%) 85 (47.0%)
14 (35.9%) 08 (20.5%) 17 (43.6%)
61 (43.0%) 13 (09.2%) 68 (47.9%)
3.890 (p = 0.143)
12 (06.6%) 04 (02.2%) 08 (04.4%) 157 (86.7%)
03 00 05 31
09 (06.3%) 04 (02.8%) 03 (02.1%) 126 (88.7%)
9.422 (p = 0.024)
107 (59.1%) 17 (09.4%) 57 (31.5%)
33 (84.6%) 01 (02.6%) 05 (12.8%)
74 (54.1%) 16 (11.3%) 52 (36.6%)
13.432 (p = 0.001)
84 08 01 88
23 04 00 12
61 04 01 76
(43.0%) (02.8%) (00.7%) (53.5%)
9.055 (p = 0.029)
52 (36.6%) 05 (03.5%) 85 (59.9%)
2.281 (p = 0.320)
(46.4%) (04.4%) (00.6%) (48.6%)
70 (38.7%) 05 (02.8%) 106 (58.6%)
(07.7%) (00.0%) (12.8%) (79.5%)
(59.0%) (10.3%) (00.0%) (30.8%)
18 (46.2%) 00 (00.0%) 21 (53.8%)
that seen in other western literature (Weiss and Mirin, 1985; Weiss et al., 1988; Nunes et al., 1989). There are several studies in the west which have shown a higher prevalence of the bipolar spectrum disorders than ours (Wieland and Sola, 1970; Maremmani et al., 2000a, 2000b). It can be hypothesized that low prevalence may be true prevalence or may be due to convenient sampling design in our study. In terms of impairment due to substance related consequences, the present study has shown that BPSD positive patients had significant impairment in several (occupational, marital, familial and legal) domains compared to BPSD negative patients. It can be hypothesized that due to affective vulnerability BPSD positive patients might be landing in several problems when they use substances. Tertiary care set up and convenient sampling limits generalisabilty of the results. Future research can overcome these limitations. Conflict of interest statement
(00.7%) (02.8%) (02.1%) (10.6%) (02.1%) (02.1%) (01.4%) (31.7%) (18.3%)
Acknowledgement Mrs. Kiran W in helping in coding the data of the study. References Akiskal, H.S., 1996. The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J. Clin. Psychopharmacol. 16, 4S–14S. Maremmani, I., Canoniero, S., Pacini, M., 2000. Methadone dose and retention in treatment of heroin addicts with bipolar I disorder comorbidity. Preliminary results. Heroin Addict. Relat. Clin. Prob. 2, 39–46. Maremmani, I., Zolesi, O., Aglietti, M., et al., 2000. Methadone dose and retention in treatment of heroin addicts with axis I psychiatric comorbidity. J. Addict. Dis. 19, 29–41. Maremmani, I., Perugi, G., Pacini, M., et al., 2006. Toward a unitary perspective on the bipolar spectrum and substance abuse: opiate addiction as a paradigm. J. Affect. Disord. 93, 1–12. Nunes, E.V., Quitkin, F.M., Klein, D.F., 1989. Psychiatric diagnosis in cocaine abuse. Psychiatry Res. 28, 105–114. Phelps, J.R., Ghaemi, S.N., 2006. Improving the diagnosis of bipolar disorder: predictive value of screening tests. J. Affect. Disord. 92 (2–3), 141–148. Subodh, N.B., Grover, S., Grewal, M., et al., 2014. Interpersonal violence against wives by substance dependent men. Drug Alcohol Depend. 138 (1), 124–129. Weiss, R.D., Mirin, S.M., 1985. Substance abuse as an attempt at self medication. Psychiatr. Med. 3, 357–367. Weiss, R.D., Mirin, S.M., Griffin, M.L., et al., 1988. Psychopathology in cocaine abusers: changing trends. J. Nerv. Ment. Dis. 176, 719–725. Wieland, W.F., Sola, S., 1970. Depression in opiate addicts measured by objective tests. In: Proceedings of the III National Conference on Methadone Treatment, AMTA, New York, pp. 187–202.
36
Letter to Editor / Asian Journal of Psychiatry 21 (2016) 33–36
Debasish Basu Subodh Bhagyalakshmi Nanjayya * Kavita Nagpal Sudhir Mahajan Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
*Corresponding author. Tel.: +91 0172 2756814/ +91 0172 2756818; fax: +91 0172 2744401/+91 0172 2745078 E-mail address: [email protected] (B.N. Subodh).
Received 15 February 2016 Accepted 20 February 2016
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Letter to Editor Bipolar spectrum disorders in substance use disorders Dear Editor, Bipolar spectrum disorders are a group of chronically recurring disorders of varying and fluctuating intensity, characterized by intermittent or prolonged affective instability, states of inhibition and excitement of various mental functions such as mood, cognition and psychomotor activity (Akiskal, 1996). In our diagnostic systems (ICD-10/DSM–IV) contribution of bipolar spectrum disorders (BPSD) to the addictive process is often clinically missed as attenuated and subclinical expressions of mood disorders are not recognised (Maremmani et al., 2006). The objective of our study was to study detection of unrecognized bipolar spectrum disorders among patients with a current diagnosis of substance use disorders. The participants in this non-interventional study were from outpatients from the Drug De-addiction and Treatment Centre (DDTC) at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The study protocol and the text of informed consent were approved by the Ethics Review Board of the Institute. The inclusion criteria were: a current diagnosis of substance use disorder as per the International Classification of Diseases, 10th Revision (ICD-10), and age from 18 to 65 years. The exclusion criteria were: not consenting for the study, and not able to read Hindi or English questionnaire. The Bipolar Spectrum Diagnostic Scale (BSDS) is a descriptive story that captures subtle features of bipolar illness. The scale has
good sensitivity and specificity for bipolar types (Phelps and Ghaemi, 2006). To facilitate self administration the questionnaire was translated and back translated from English into Hindi by bilingual experts (Subodh et al., 2014). The study was conducted from 20th Sep 2013 to 31st Dec 2013. During this period 663 patients visited as outpatient to our centre. Among them 181 patients were randomly selected by convenient sampling method. Analysis was done by using SPSS-14 (Statistical Package for the Social Sciences, 2005, Chicago, IL, USA). Among 181 patients interviewed 21.5% (N = 39) were BSDS positive (scored 13 or more on BSDS). The mean BSDS score of the whole group was 8.88 05.50, with a range of 0–24. The mean age of the whole group was 32.66 09.89 years with a range of 19–66 years and there was no difference in the BSDS positive and negative group. In BPSD positive group alcohol dependence syndrome (53.8%) is the most common first diagnosis followed by opioid dependence syndrome (41.0%) compared to BPSD negative group where opioid dependence syndrome (48.6%) was the first diagnosis followed by alcohol dependence (38.7%). BPSD positive group had more impairment in occupation related (r = 9.231; p = 0.026), legal related (r = 9.422; p = 0.024), family related (r = 13.432; p = 0.001), and marital related aspects (r = 9.055; p = 0.029) compared to BPSD negative group. There was no significant difference in socio-demographic profile, clinical profile of BPSD positive and BPSD negative group in other profile (Table 1) This is the first study from this region to report the prevalence of bipolar spectrum disorders in substance use disorders patients. The prevalence reported in our study is 21.5% which is similar to
Table 1 BSDS scores, sociodemographic and clinical variable. BSDS scores Scores
Variable BSDS score (categorical) No risk (0–6) Low risk (7–12) Moderate risk (13–18) High risk (19–25)
72 70 27 12
BSDS Positive Negative
(39.8%) (38.7%) (14.9%) (06.6%)
39 (21.5%) 142 (78.5%)
Variable
Whole group N = 181
BSDS positive N = 39
BSDS negative N = 142
BSDS +ve vs. BSDS ve groups (p value) Chi square value/t-test
BSDS score (Mean SD)
8.88 05.50
17.36 02.90
6.56 3.32
0.588 (p = 0.444)
Socio-demographic profile Age (mean SD) Gender
32.66 09.89
31.69 08.69
32.93 10.20
1.627 (p = 0.204)
http://dx.doi.org/10.1016/j.ajp.2016.02.010 1876-2018/ß 2016 Elsevier B.V. All rights reserved.
34
Letter to Editor / Asian Journal of Psychiatry 21 (2016) 33–36
Table1 (Continued ) Variable
Whole group N = 181
BSDS positive N = 39
BSDS negative N = 142
BSDS +ve vs. BSDS ve groups (p value) Chi square value/t-test
Male Female Marital status Single Married Widowed Divorced Separated Education Upto matric Beyond matric Occupation Skilled Unskilled Student Unemployed Family type Nuclear Non-nuclear Family income Nil Upto 19,575 Above 19,575 Locality Urban Rural Referred by Self Relative Medical professionals Others
180 (99.4%) 001 (00.6%)
39 (100.0%) 00 (00.0%)
141 (99.3%) 001 (00.7%)
0.276 (p = 0.599)
059 117 002 001 002
13 25 00 00 01
46 92 02 01 01
(32.4%) (64.8%) (01.4%) (00.7%) (00.7%)
1.792 (p = 0.774)
Clinical profile Duration of use in months (Mean SD) Duration of dependence in months (Mean SD) Main substance Alcohol Opium Cannabis Benzodiazepine Nicotine Volatile substances Type of substances Alcohol IMFL CML Both Opioids Natural Heroin Others (Synthetic preparations) Mixed Tobacco Smoking Smokeless Both IV drug use 1st Diagnosis (main substance) Alcohol dependence syndrome Opioid dependence syndrome Cannabis dependence syndrome Benzodiazepine dependence syndrome Nicotine substance dependence Volatile substance dependence 2nd Diagnosis Alcohol dependence syndrome Opioid dependence syndrome Cannabis dependence syndrome Nicotine substance dependence Alcohol harmful use Alcohol currently abstinent Opioid currently abstinent Cannabis currently abstinent Nicotine currently abstinent 3rd Diagnosis
(32.6%) (64.6%) (01.1%) (00.6%) (01.1%)
(33.3%) (64.1%) (00.0%) (00.0%) (02.6%)
91 (50.3%) 90 (49.7%)
19 (48.7%) 20 (51.3%)
72 (50.7%) 70 (49.3%)
0.048 (p = 0.826)
37 89 18 37
11 18 05 05
26 71 13 32
(18.3%) (50.0%) (09.2%) (22.5%)
3.384 (p = 0.336)
(20.4%) (49.2%) (09.9%) (20.4%)
(28.2%) (46.2%) (12.8%) (12.8%)
68 (37.6%) 113 (62.4%)
14 (35.9%) 25 (64.1%)
54 (38.0%) 88 (62.0%)
0.059 (p = 0.808)
53 (29.3%) 70 (38.7%) 58 (32.0%)
10 (25.6%) 19 (48.7%) 10 (25.6%)
43 (30.3%) 51 (35.9%) 48 (33.8%)
2.158 (p = 0.340)
88 (48.6%) 93 (51.4%)
19 (48.7%) 20 (51.3%)
69 (48.6%) 73 (51.4%)
0.000 (p = 0.989)
61 79 26 15
11 16 07 05
50 63 19 10
5.370 (p = 0.251)
(33.7%) (43.6%) (14.4%) (08.3%)
(28.2%) (41.0%) (17.9%) (12.8%)
(35.2%) (44.4%) (13.4%) (07.0%)
140.91 102.78 97.18 84.61
139.64 89.14 101.59 72.27
141.26 106.51 95.97 87.89
1.212 (p = 0.272) 0.534 (p = 0.466)
76 85 03 01 15 01
21 16 01 00 01 00
55 69 02 01 14 01
(38.7%) (48.6%) (01.4%) (00.7%) (09.9%) (00.7%)
4.798 (p = 0.441)
(42.0%) (47.0%) (01.7%) (00.6%) (08.3%) (00.6%)
(53.8%) (41.0%) (02.6%) (00.0%) (02.6%) (00.0%)
50 (27.6%) 17 (09.4%) 34 (18.8%)
12 (30.8%) 07 (17.9%) 05 (12.8%)
38 (26.8%) 10 (07.0%) 29 (20.4%)
4.387 (p = 0.112)
46 17 19 22
(25.4%) (09.4%) (10.5%) (12.2%)
08 02 03 08
(20.5%) (05.1%) (07.7%) (20.5%)
38 15 16 14
(26.8%) (10.6%) (11.3%) (09.9%)
4.772 (p = 0.189)
85 42 24 06
(47.0%) (23.2%) (13.3%) (03.3%)
22 06 03 03
(56.4%) (15.4%) (07.7%) (07.7%)
63 36 21 03
(44.4%) (25.4%) (14.8%) (02.1%)
3.445 (p = 0.179)
76 85 03 01 15 01
(42.0%) (47.0%) (01.7%) (00.6%) (08.3%) (00.6%)
21 16 01 00 01 00
(53.8%) (41.0%) (02.6%) (00.0%) (02.6%) (00.0%)
55 69 02 01 14 01
(38.7%) (48.6%) (01.4%) (00.7%) (09.9%) (00.7%)
4.798 (p = 0.441)
01 03 02 25 00 00 00 00 00
(02.6%) (07.7%) (05.1%) (61.5%) (00.0%) (00.0%) (00.0%) (00.0%) (00.0%)
11 (07.7%) 04 (02.8%) 02 (01.4%) 88 (62.0%) 03 (02.1%) 04 (02.8%) 02 (01.4%) 01 (00.7%) 02(01.4%)
8.554 (p = 0.381)
12 (06.6%) 07 (03.9%) 04 (02.2%) 112 (61.9%) 03 (01.7%) 04 (02.2%) 02 (01.1%) 01 (00.6%) 02 (01.1%)
2.972 (p = 0.085)
Letter to Editor / Asian Journal of Psychiatry 21 (2016) 33–36
35
Table1 (Continued ) Variable
Whole group N = 181
BSDS positive N = 39
BSDS negative N = 142
BSDS +ve vs. BSDS ve groups (p value) Chi square value/t-test
Alcohol dependence syndrome Opioid dependence syndrome Cannabis dependence syndrome Nicotine substance dependence Alcohol currently abstinent Opioid currently abstinent Benzodiazepine currently abstinent Family h/o dependence Co-morbid medical illness Impairments due to substance use Health related Mild Moderate Severe Nil Occupation related Mild Moderate Severe Nil Finance related Mild Moderate Nil Legal related Mild Moderate Severe Nil Family related Mild Moderate Nil Marital related Mild Moderate Severe Nil Social related Mild Moderate Nil
02 04 03 21 03 04 03 60 31
01 00 00 06 00 01 01 15 05
(02.6%) (00.0%) (00.0%) (15.4%) (00.0%) (02.6%) (02.6%) (38.5%) (12.8%)
01 04 03 15 03 03 02 45 26
4.431 (p = 0.619)
21 (11.6%) 07 (03.9%) 01 (00.6%) 152 (84.0%)
05 00 00 34
(12.8%) (00.0%) (00.0%) (87.2%)
16 (11.3%) 07 (04.9%) 01 (00.7%) 118 (83.1%)
2.321 (p = 0.508)
92 13 06 70
22 02 04 11
(56.4%) (05.1%) (10.3%) (28.2%)
70 11 02 59
(49.3%) (07.7%) (01.4%) (41.5%)
9.231 (p = 0.026)
(01.1%) (02.2%) (01.7%) (11.6%) (01.7%) (02.2%) (01.7%) (33.1%) (17.1%)
(50.8%) (07.2%) (03.3%) (38.7%)
None. Funding None.
0.633 (p = 0.426) 0.650 (p = 0.420)
75 (41.4%) 21 (11.6%) 85 (47.0%)
14 (35.9%) 08 (20.5%) 17 (43.6%)
61 (43.0%) 13 (09.2%) 68 (47.9%)
3.890 (p = 0.143)
12 (06.6%) 04 (02.2%) 08 (04.4%) 157 (86.7%)
03 00 05 31
09 (06.3%) 04 (02.8%) 03 (02.1%) 126 (88.7%)
9.422 (p = 0.024)
107 (59.1%) 17 (09.4%) 57 (31.5%)
33 (84.6%) 01 (02.6%) 05 (12.8%)
74 (54.1%) 16 (11.3%) 52 (36.6%)
13.432 (p = 0.001)
84 08 01 88
23 04 00 12
61 04 01 76
(43.0%) (02.8%) (00.7%) (53.5%)
9.055 (p = 0.029)
52 (36.6%) 05 (03.5%) 85 (59.9%)
2.281 (p = 0.320)
(46.4%) (04.4%) (00.6%) (48.6%)
70 (38.7%) 05 (02.8%) 106 (58.6%)
(07.7%) (00.0%) (12.8%) (79.5%)
(59.0%) (10.3%) (00.0%) (30.8%)
18 (46.2%) 00 (00.0%) 21 (53.8%)
that seen in other western literature (Weiss and Mirin, 1985; Weiss et al., 1988; Nunes et al., 1989). There are several studies in the west which have shown a higher prevalence of the bipolar spectrum disorders than ours (Wieland and Sola, 1970; Maremmani et al., 2000a, 2000b). It can be hypothesized that low prevalence may be true prevalence or may be due to convenient sampling design in our study. In terms of impairment due to substance related consequences, the present study has shown that BPSD positive patients had significant impairment in several (occupational, marital, familial and legal) domains compared to BPSD negative patients. It can be hypothesized that due to affective vulnerability BPSD positive patients might be landing in several problems when they use substances. Tertiary care set up and convenient sampling limits generalisabilty of the results. Future research can overcome these limitations. Conflict of interest statement
(00.7%) (02.8%) (02.1%) (10.6%) (02.1%) (02.1%) (01.4%) (31.7%) (18.3%)
Acknowledgement Mrs. Kiran W in helping in coding the data of the study. References Akiskal, H.S., 1996. The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J. Clin. Psychopharmacol. 16, 4S–14S. Maremmani, I., Canoniero, S., Pacini, M., 2000. Methadone dose and retention in treatment of heroin addicts with bipolar I disorder comorbidity. Preliminary results. Heroin Addict. Relat. Clin. Prob. 2, 39–46. Maremmani, I., Zolesi, O., Aglietti, M., et al., 2000. Methadone dose and retention in treatment of heroin addicts with axis I psychiatric comorbidity. J. Addict. Dis. 19, 29–41. Maremmani, I., Perugi, G., Pacini, M., et al., 2006. Toward a unitary perspective on the bipolar spectrum and substance abuse: opiate addiction as a paradigm. J. Affect. Disord. 93, 1–12. Nunes, E.V., Quitkin, F.M., Klein, D.F., 1989. Psychiatric diagnosis in cocaine abuse. Psychiatry Res. 28, 105–114. Phelps, J.R., Ghaemi, S.N., 2006. Improving the diagnosis of bipolar disorder: predictive value of screening tests. J. Affect. Disord. 92 (2–3), 141–148. Subodh, N.B., Grover, S., Grewal, M., et al., 2014. Interpersonal violence against wives by substance dependent men. Drug Alcohol Depend. 138 (1), 124–129. Weiss, R.D., Mirin, S.M., 1985. Substance abuse as an attempt at self medication. Psychiatr. Med. 3, 357–367. Weiss, R.D., Mirin, S.M., Griffin, M.L., et al., 1988. Psychopathology in cocaine abusers: changing trends. J. Nerv. Ment. Dis. 176, 719–725. Wieland, W.F., Sola, S., 1970. Depression in opiate addicts measured by objective tests. In: Proceedings of the III National Conference on Methadone Treatment, AMTA, New York, pp. 187–202.
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Letter to Editor / Asian Journal of Psychiatry 21 (2016) 33–36
Debasish Basu Subodh Bhagyalakshmi Nanjayya * Kavita Nagpal Sudhir Mahajan Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
*Corresponding author. Tel.: +91 0172 2756814/ +91 0172 2756818; fax: +91 0172 2744401/+91 0172 2745078 E-mail address: [email protected] (B.N. Subodh).
Received 15 February 2016 Accepted 20 February 2016