Are Bipolar Disorder Patients with Co-morbid Substance Use Disorder More Compromised in Social Functioning?

Marianna Mazza, Giuseppe Marano
European Psychiatric Review, 2009;2(2):30-33
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Abstract

Recent evidence indicates that social outcomes in bipolar disorder (BP) are poorer than previously assumed. It is clear that defining recovery in BP simply by the absence of clinical symptoms fails to acknowledge the social impact and functional consequences of this disorder. Research has consistently shown that co-occurring substance use disorders (SUDs) are correlated with negative effects on illness outcome, including more frequent and prolonged affective episodes, decreased compliance with treatment, a lower quality of life and increased suicidal behaviour. To treat only the acute symptoms of depression or mania is insufficient for an optimal and satisfactory result. It is necessary to give more consideration to the co-morbid conditions, first of all SUD, and to the social reintegration of the bipolar patient in the social arena. Given the high rate of SUD co-occurrence in BP, more research investigating clinical features and response to treatment in this population is needed.
Keywords
Bipolar disorder, substance use disorder, alcoholism, social functioning, social adjustment
Disclosure The authors have no conflicts of interest to declare.
Received: January 08, 2009 Accepted May 18, 2009
Correspondence: Marianna Mazza, Department of Psychiatry, Bipolar Disorders Unit, Catholic University of the Sacred Heart of Rome, Via Ugo De Carolis, 48 00136 Rome, Italy. E: mariannamazza@hotmail.com

The words ‘social functioning’ define the “ability to establish and maintain relationships with friends and family as well as to undertake work and leisure activities and to cope with day-to-day activities”.1,2

Bipolar disorder (BP) is a severe and recurrent mental disorder with an often devastating effect on the functional capacities, both social and occupational, of patients.3 Recent evidence indicates that social outcomes in BP are poorer than previously assumed.4 Research suggests that a persistent altered social adjustment has a high incidence, persisting for several years (if not the entire lifespan), and is capable of completely modifying the style and quality of life of those who suffer from BP. This has high consequential social and economic costs.5

Dickerson et al. demonstrated that social impairments in individuals with BP were similar in type and severity to those seen in individuals with schizophrenia.6 Coryell et al., in a very large study investigating specific areas of social adjustment in individuals with BP and unipolar disorders compared with healthy control subjects, showed that psychosocial impairments associated with mood disorders were pervasive and persistent even when individuals experienced sustained resolution of clinical symptoms.7 A review by MacQueen et al. confirmed a 30–60% prevalence of social and occupational adjustment problems in individuals with BP whether or not they had inter-episode symptoms.8

It is clear that defining recovery in BP simply by the absence of clinical symptoms fails to acknowledge the social impact and functional consequences of this disorder. Nevertheless, social adjustment is not an easy construct to measure, and many published studies have explored only the quality of functioning.4

A recent study by Pope et al. exploring determinants of the quality and quantity of social activity in patients with BP concluded that depressive symptoms may predict overall quality of social functioning, but also revealed that a personality measure – namely level of neuroticism – is significantly associated with social adjustment.4 In a cross-sectional study by Yen et al., a better insight and fewer residual affective symptoms were correlated with good psychosocial adjustment in patients with bipolar I disorder.9

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