Management of patients with bipolar mood disorder and substance dependence

Nine patients with bipolar mood disorder and concurrent substance dependenc e were treated in an 18-bed inpatient addiction unit over a 3-month period. A multidisciplinary team approach used a medicalized Minnesota model and s tressed the establishment of a positive diagnosis and individualization of management strategies for each patient. Clinically significant affective sy mptoms that required acute psychiatric intervention developed in several pa tients during hospitalization. Manic symptoms developed in three patients d uring sedative withdrawal, requiring the team to differentiate manic sympto ms from physiologic withdrawal; and two patients became severely depressed, requiring pharmacologic management and suicide-prevention strategies. Summary: Our experience with the patients in this case series supports the contention that there is no simple, uniform approach to the substance-depen dent patient with bipolar disorder. Treatment teams must be prepared to dif ferentiate complex syndromes and to manage manic, depressive, and addictive behaviors.