medwireNews: Alcohol use disorders (AUDs) have a high rate of comorbidity with bipolar disorder in both men and women, according to findings from a recent systematic meta-analysis of both epidemiologic and clinical studies.
While men with and without bipolar disorder do tend to have a greater prevalence of AUDs, Arianna Di Florio (Cardiff University School of Medicine, United Kingdom) and colleagues also found that “comorbidity with AUDs in women with [bipolar disorder] is clinically relevant with more than one in five reporting lifetime AUDs.”
As reported in European Psychiatry, the authors reviewed 58 studies of adults with bipolar disorder that assessed AUD rates and had a study population greater than 50 individuals. Data were aggregated based on lifetime comorbidity, gender, and geographic location.
All epidemiologic studies conducted in Western countries found that AUD prevalence was significantly increased among patients with bipolar disorder. However, the one epidemiologic study conducted in Asia reported that bipolar disorder had no effect on the 12-month prevalence of AUDs.
Thirty-one of the clinical trials, involving 8309 patients with bipolar disorder (primarily bipolar I disorder), assessed lifetime prevalence of AUDs. Di Florio and colleagues determined that the pooled lifetime prevalence of AUDs in these studies was 35.1%.
Gender influenced the relationship between bipolar disorder and AUDs, according to the pooled results of 17 clinical studies, with a lifetime prevalence rate of 43.9% in men and 22.1% in women. However, there was significant heterogeneity associated with gender overall, and some of the studies individually reported no significant effect of gender on AUD comorbidity.
The authors note that there were several limitations with their analysis. They only focused on papers where bipolar disorder was the primary rather than the secondary diagnosis, and they were not able to conduct separate analyses for both alcohol addiction (alcoholism) and problem drinking/alcohol abuse. They also note that the association between bipolar disorder and AUDs may be influenced by the duration of bipolar disorder and the presence/absence of comorbid anxiety disorder.
Despite this, the researchers stress that “clinicians should be aware of the high comorbidity of AUDs not only in men, but also in women with [bipolar disorder]. Patients with [bipolar disorder] should be assessed for current and previous alcohol use and misuse.”
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