Drug abuse and bipolar disorder: comorbidity or misdiagnosis?

Bipolar disorder is a common, severe and cyclic psychiatric illness. A stro ng association between alcohol dependence and bipolar disorder has been rep orted in numerous studies. The abuse of other drugs including cocaine, amph etamines, opiates, cannabis, and prescription medications in bipolar patien ts is also an important public health concern and has been less extensively investigated. This review examines the abuse of drugs other than alcohol o r nicotine in people with bipolar disorder. The high rates of milder affect ive symptoms but not mania observed in patients in drug abuse treatment set tings suggests the symptoms may in many cases be associated with the drug u se. However, such patients presenting in psychiatric settings might be suff ering from cyclothymic and related attenuated bipolar disorders (type LI). Substance abuse may be associated with medication non-compliance, more mixe d or dysphoric mania and possibly an earlier onset of affective symptoms an d more hospitalizations. The pharmacotherapy of patients with bipolar disor der and drug abuse is examined, including evidence on the use of mood stabi lizers, neuroleptics and the newer atypical antipsychotics in this populati on. (C) 2001 Elsevier Science B.V. All rights reserved.