الفهرس 
? Bipolar Affective DisorderOnly 14 pages are availabe for public view
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Abstract
B
AD In the World Health Organization Global Burden of Disease Study ranked sixth among all medical disorders in terms of years of life lost to death or disability (Godwin, 2003). It is a severe and often chronic disorder with lifetime prevalence rates up to 6.5% in the general population (Vornik and Brown, 2006). Studies have demonstrated that the annual costs of BAD to the society range from 1.8 to 45 billion US dollars; indirect costs due to work absence are the most important ones (Hakkaart et al., 2004).
BAD is defined by discrete episodes of mania and, almost invariably, depression; of course, patients can present in either of the two poles of illness (Kaplan and Sadock, 2009).
Rates of psychiatric co morbidity with BAD were high, with anxiety disorders, problematic substance use, and suicidality (Nicole Kozloff et al., 2010).
High rates of SUD have also been documented in both inpatient and outpatient populations of individuals with BAD. More than14 studies conducted with bipolar patients in both inpatient and outpatient psychiatric settings, reported that the lifetime rates of drug abuse or dependence for patients with bipolar disorder ranged from 14%–65% compared with rates of 6%–12% in the general population (Brown et al., 2001).
Co morbidity between SUDs and other psychiatric diseases seems to be the rule rather than the exception (Emmelkamp and Vedel, 2006).
BAD and SUD can both be conceptualized in part as disorders of systems regulating motivation, reward, and the initiation of behavior. BAD may be associated with increased susceptibility to rewarding effects of drugs. BAD and SUD are both associated with increased impulsivity. This increased impulsivity may contribute to the increased risks for violence and suicide associated with combined SUD and BAD (Swann, 2010).
There are a number of hypotheses that may explain the co morbidity between substance use and affective disorders (Kessler and Wang, 2008)
(a) SUD occurs as a symptom of BAD.
(b) SUD is an attempt to self medicates symptoms.
(c) SUD causes BAD.
(d) SUD and BAD share a common risk factor.
(Strakowsk and DelBello, 2000)
Psychiatric co morbidity is associated with more severe functional impairment, more interpersonal and social problems, a more chronic and protracted course of illness, and less likelihood of completing and benefiting from treatment (Schaferand Najavits, 2007). Also this co morbidity has been reported to lead to lower quality of life (QOL) ratings in patients with BAD (Singh et al., 2005).
BP patients with co-occurring SUD usually show a more severe course of the illness, characterized by higher rates of mixed or dysphoric mania, rapid cycling, increased symptom severity (Frye and Salloum, 2006).
SUD has been identified as potent risk factors for suicidal behavior in BAD. SUD appear to be particularly salient factors for increasing suicide risk in BAD-I, along with aggressive/impulsive traits. Future studies in BAD-I should target temporal relationships between illness phase, aggressive behavior, and SUD and suicide attempts. Successful clinical management of SUD in BAD-I may be critical to reduce the risk of suicidal behavior in this population (Elizabeth et al., 2008).
Patients with BAD and co-occurring SUD appear to be particularly at risk for medication non adherence (Perlis et al., 2010). A highly prevalent subgroup of BP patients with an elevated probability of poor medication adherence is represented by individuals with a co-occurring SUD (Manwani et al., 2007).
This study is a cross sectional, comparative, observational study and was designed aiming at covering the following areas in the theoretical part:
(1) Review of BAD epidemiology, etiology, diagnosis, co morbidities, course and outcome.
(2) Review of theories that explain the high co morbidity between BAD and SUD.
(3) Review of impact of SUD on the outcome of BAD.
The practical part aimed at:
1- To demonstrate the prevalence of SUD among our sample of 30 bipolar patients in manic relapse.
2- To demonstrate the differences between Group 1(without co morbid SUD) and Group 2 (with co morbid SUD) as regard socio demographic data, family history, medication, compliance, YMRS, AIAQ.
We hypothesized that SUD is overrepresented in BAD and has a negative effect on course and outcome of BAD.
The present investigation evaluated collectively 30 patients who were organized into two groups I (BAD only) and II (BAD+SUD). The study was carried out at the inpatient department of institute of psychiatry Ain Shams University.
We obtained an informed consent and inclusion criteria were insured before the study which included age between 15-65 years, male and female patients were in manic relapse.
The tools were carefully selected to serve for the purpose of the study, SCID1, Young Mania Rating Scale (YMRS), Addiction Severity Index (ASI), Anger, Irritability and Aggression Questionnaire (AIAQ).
The study proper was preceded by translation of AIAQ into Arabic. Then Arabic version was back translated into English. Then both translations were compared and they were almost similar.
All data gathered were recorded, tabulated and transferred on Statistical Package for Social Science (SPSS), using personal computer and the suitable statistical parameter were used. Results were displayed to answer question raised in the hypothesis of this study.
In our sample we found that 70% of cases had history of SUD, so we divided the sample into Group 1 without SUD and Group 2 with SUD.
As patients in Group 2 were males, single, non compliant, more suicide attempts, have sever manic relapse, more anger irritability and assault either before or during relapse and more combined medications are prescribed.
In our study we try to study how common is SUD co morbidity between the bipolar patients and how this co morbidity affect the course of illness here we focused on the severity of manic relapse and other socio demographic and some clinical characteristics.
The main findings of the present study are that patients with BAD had a significant increase of SUD co morbidity compared to the general population, and that substance use was associated with poorer functioning and poor outcome of the disorder.
So we proved our hypothesis that SUD negatively affect the outcome of bipolar patients.