TABAQUISMO Y TRASTORNO BIPOLAR

CONSUMO DE NICOTINA Y TOPOGRAFIA DE FUMAR EN FUMADORES CON TRASTORNO BIPOLAR.

Williams, J.M.; Gandhi, K.K.; Lu, S.E.; Steinberg, M.L.; Benowitz, N.L

Bipolar Disord 2012: 14: 618–627.

ABSTRAC:

OBJETIVOS:

 La conducta de fumar cigarrillos en el trastorno bipolar (BPD), incluidos los efectos de los medicamentos estabilizadores del ánimo, no han sido bien caracterizados.

METODO:

Se compararon niveles séricos de nicotina, niveles de metabolitos de nicotina y topografía de fumar (conjunto de características en el hábito de fumar)  en 75 fumadores con BPD a 86 fumadores de control (CON). Para algunas comparaciones, se incluyeron un grupo de control adicional de 75 fumadores con esquizofrenia (SCZ).

RESULTADOS:

No hubo diferencias entre los grupos BPD y CON en  las características basales de fumar o en los niveles séricos de nicotina o de Cotinina. Cincuenta y un fumadores con BPD (68,9%) estaban tomando uno de los siguientes estabilizadores del ánimo: ácido valproico, lamotrigina, carbamazepina, oxcarbazepina, litio o topiramato. La proporción de 3-hydroxycotinina-tocotinina, un marcador del citocromo P450 2A6 (CYP2A6) con actividad metabólica, fue significativamente mayor en BPD versus CON y versus SCZ (0.68 versus 0.49 versus 0,54; p = 0.002). La diferencia entre los grupos, sin embargo, no fue muy significativa cuando se repitió el análisis con los medicamentos inductores enzimáticos hepáticos (carbamazepina, oxcarbazepina y topiramato) incluido como una covariable. El tiempo entre bocanadas o intervalo interpuff (IPI), fue más corto en BPD versus CON un promedio de 3.0 seg (p < 0,05), aunque esto no fue tan significativo cuando hemos eliminado los fumadores para el análisis de los inductores de la enzima hepática.

CONCLUSIONES:

Los fumadores con BPD no son diferentes de CON en medidas de consumo de nicotina y topografía de fumar. Hemos encontrado un aumento en la tasa de metabolismo de la nicotina en los fumadores que toman estabilizadores de ánimo que son inductores de la enzima hepática, incluyendo carbamazepina, oxcarbazepina y topiramato. En los fumadores con un metabolismo rápido de la nicotina podría esperarse que  fumen más intensamente para compensar la desaparición más rápida de la nicotina en  sangre y cerebro y pueden tener más dificultad en dejar de fumar, aunque esto requiere más estudio.

©Bipolar Disorder 2012:14:618-627. © 2012 Los autores. Compilación de diario © 2012 John Wiley Sons & A/S

CAFE, CIGARRILLO Y SUICIDIO

Original Article
Coffee and cigarette use: association with
suicidal acts in 352 Sardinian bipolar disorder
patients

Baethge C, Tondo L, Lepri B, Baldessarini RJ.


Objective: Abuse of illicit drugs and alcohol is prevalent in bipolar disorder (BPD) patients, and is an adverse prognostic factor. Much less is known about correlates of nicotine and caffeine consumption, but tobacco smoking is tentatively associated with suicidal behavior.

Methods: Retrospective analysis of demographic and clinical factors among 352 longitudinally assessed DSM-IV types I and II BPD patients contrasted patients with versus without consumption of nicotine or caffeine, based on univariate comparisons and multiple regression modeling.

Results: Current smoking (46%) and coffee drinking (74% of cases) were common, and significantly and independently associated with suicidal acts [coffee: odds ratio (OR) = 2.42, 95% confidence interval (CI): 1.15–5.09; smoking: OR = 1.79, CI: 1.02–3.15; both p < rs =" 0.383;" rs =" 0.312;" p =" 0.008)."

Conclusions: This is the first report to associate suicidal acts with coffee consumption in BPD patients, and it confirmed an association with smoking. Pending further evidence, the findings underscore the importance of monitoring use of even legal and mildly psychotropic substances by BPD patients.

Coffee and cigarette use: association with suicidal acts in 352 Sardinian bipolar disorder patients.
Bipolar Disord 2009: 11: 494–503. ª 2009 The Authors. Journal compilation ª 2009 John Wiley & Sons A ⁄ S.

Trastorno Bipolar y Tabaco

Original Article

Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression

Diaz FJ, James D, Botts S, Maw L, Susce MT, de Leon J.


Objectives: This study compared the prevalence of tobacco smoking behaviors in patients with bipolar disorder with normal and psychiatric (schizophrenia and major depression) controls. The main goal was to establish that bipolar patients smoke more than normal controls. Differences with psychiatric controls were explored.

Methods: Samples of 424 patients (99 bipolar, 258 schizophrenia and 67 major depression) and 402 volunteer controls were collected in Central Kentucky. Smoking data for Kentucky_s general population were available. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to establish the strength of associations. Logistic regression was used to adjust ORs for confounding variables.

Results: Using epidemiological definitions of smoking behaviors and the general population as controls provided bipolar disorder unadjusted ORs of 5.0 (95% CI: 3.3–7.8) for current cigarette smoking, 2.6 (95% CI: 1.7–4.4) for ever cigarette smoking, and 0.13 (95% CI: 0.03–0.24) for smoking cessation. Using a clinical definition and volunteers as controls provided respective bipolar disorder adjusted ORs of 7.3 (95% CI: 4.3–12.4), 4.0 (95% CI: 2.4–6.7), and 0.15 (95% CI: 0.06–0.36). Prevalences of current daily smoking for patients with major depression, bipolar disorder, and schizophrenia were 57%, 66%, and 74%, respectively.

Conclusions: Bipolar disorder was associated with significantly higher prevalences of tobacco smoking behaviors compared with the general population or volunteer controls, independently of the definition used. It is possible that smoking behaviors in bipolar disorder may have intermediate prevalences between major depression and schizophrenia,
but larger samples or a combination of multiple studies (meta-analysis) will be needed to establish whether this hypothesis is correct.



Francisco J Diaz 1, Danielle James 2, Sheila Botts 2, Lorraine Maw 2,
Margaret T Susce 2 and Jose de Leon 2,3

1 Department of Statistics, Universidad Nacional, Medellin, Colombia,
2 University of Kentucky, Mental Health Research Center at Eastern State Hospital,
Lexington, KY, USA,
3 Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences,
University of Granada, Granada, Spain


Corresponding author: Jose de Leon, MD, Mental Health Research Center at Eastern State Hospital, 627 West Fourth Street, Lexington, KY 40508, USA.
Fax: 859-246-7019;
e-mail: jdeleon@uky.edu

Received 7 April 2008, revised and accepted for publication 20 June 2008

Bipolar Disord 2009: 11: 154–165. © 2009
The Authors Journal compilation © 2009
Blackwell Munksgaard

Espectro Bipolar y Abuso de Sustancias

Specificity of Bipolar Spectrum Conditions in
the Comorbidity of Mood and Substance Use Disorders

Results From the Zurich Cohort Study
Kathleen R. Merikangas, PhD; Richard Herrell, PhD; Joel Swendsen, PhD;
Wulf Ro¨ ssler, MD, MSc; Vladeta Ajdacic-Gross, PhD; Jules Angst, MD

Context: Although an association between mood disorders and substance use disorders has been well established, there is a lack of long-term prospective data on the order of onset and subtypes of mood disorders associated with specific substances and their progression.

Objective: To estimate the respective risks posed by subtypes of mood disorders or bipolar spectrum conditions for the subsequent development of substance use disorders.

Design: Six waves of direct diagnostic interviews were administered to a sample of young adults during a 20-
year period. Mood disorders and syndromes assessed at each interview were used to predict the cumulative incidences of substance use disorders at subsequent interview waves.

Participants:Wefollowed up 591 individuals (292 men and 299 women) who were selected at study enrollment from a representative sample of young adults in Zurich, Switzerland.

Main Outcome Measures: Structured Diagnostic Interview for Psychopathologic and Somatic Syndromes, a
semistructured clinical interview that collected data on the spectrum of expression of mood disorders and substance use and disorders for DSM-III-R and DSM-IV criteria.

Results: Individuals having manic symptoms were at significantly greater risk for the later onset of alcohol abuse/dependence, cannabis use and abuse/dependence, and benzodiazepine use and abuse/dependence. Bipolar II disorder predicted both alcohol abuse/dependence and benzodiazepine use and abuse/dependence. In contrast, major depresión was predictive only of later benzodiazepine abuse/dependence.

Conclusions: In comparison with major depression, bipolar II disorder was associated with the development
of alcohol and benzodiazepine use and disorders. There was less specificity of manic symptoms that tended to predict all levels of the substances investigated herein. The different patterns of association between mood disorders and substance use trajectories have important implications for prevention and provide lacking information about underlying mechanisms.

Arch Gen Psychiatry. 2008;65(1):47-52
(REPRINTED) ARCH GEN PSYCHIATRY/VOL 65 (NO. 1), JAN 2008
©2008 American Medical Association. All rights reserved.