Screening chronic opioid users for bipolar disorder

摘要

The relationship between bipolar disorder and substance use is a complex one, and various hypotheses have been offered to explain their common co-occurrence (Strakowski & DelBello, 2000). Notably, some data suggest that substance use by patients with bipolar disorder may be an attempt to self-medicate mood symptoms (Sonne, Brady, & Morton, 1994). Patients with bipolar I disorder have at least a 40% lifetime prevalence of substance use disorders, with the most often abused substances being alcohol, cannabis, cocaine, and opioids (Cerullo & Strakowski, 2007). Although hypomanic/manic reactions have been reported in some patients with bipolar disorder who took opioid analgesics (Schaffer, Nordahl, Schaffer, & Howe, 2007), biochemical evidence and clinical experience suggest both antimanic and antidepressant effects of opiate medications. (Gold, Pottash, Sweeney, Martin, & Extein, 1982) One published study documented the under-diagnosis of bipolar disorder in a substance abuse population, approximately one-fourth of whom had opioid dependence. (Albanese, Clodfelter, Pardo, & Ghaemi, 2006) We conducted a preliminary project to determine the rate of positive screens for bipolar disorder in patients receiving chronic opioid therapy.