Low healthcare engagement in bipolar patients who drive under the influence

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09 February 2010

MedWire News: Persistent driving under the influence (DUI) offenders with bipolar disorder have high rates of comorbid mental conditions and have little engagement with the healthcare system, the results of a US study indicate.

Rates of bipolar disorder are increased in people with substance use disorder (SUD) and DUI offenders. Also, bipolar disorder patients with SUD have a high prevalence of other psychiatric disorders and low rates of treatment engagement.

To investigate further, Mark Albanese, from Cambridge Health Alliance in Somerville, Massachusetts, and colleagues administered the Composite International Diagnostic Interview to 729 repeat DUI offenders attending a 2-week inpatient treatment program.

In all, 7.3% of participants qualified for a lifetime diagnosis of bipolar disorder, of whom 45.3% also had a major depressive episode (MDE) in their lifetime. Of patients with both lifetime bipolar disorder and MDE, 54.2% experienced an MDE first, 12.5% had a manic episode first, and 33.3% experienced their first episodes of both disorders within the same year.

Bipolar disorder was found to be associated with increased lifetime prevalence of drug dependence, alcohol dependence, attention deficit hyperactivity disorder, generalized anxiety disorder, and post-traumatic stress disorder, with bipolar disorder a significant predictor for all of those psychiatric disorders, aside from alcohol dependence, on logistic regression analysis.

Interestingly, the team reports in the Journal of Affective Disorders that 13% of participants with bipolar disorder had not discussed mania with a professional, 49.1% had received treatment in the last 12 months, and 54.7% reported having had helpful treatment for mania during their lifetime.

Albanese and co-authors write: “Participants with bipolar disorder in this recidivist DUI population demonstrated high prevalence of other psychiatric disorders. In addition, a significant portion of these people with bipolar disorder were not in active treatment.

“Both clinicians and policy makers will need to develop policies and programs to address this risky population.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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