Trastorno bipolar y adicciones: abordaje preventivo dual y asistencial en la sociedad actual

Abstract

The comorbidity between bipolar disorder and substance use disorder is one of the most relevant within the spectrum of dual pathology due to its prevalence and comprehensive management. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the criteria for "substance-related mood disorder" and "mood disorder due to medical illness" (i.e., criteria defining which symptoms should be emphasized) were developed in a similar format. Extreme mood swings, with cycles of depression, mania, hypomania, or a combination of both, are a hallmark of bipolar disorder. Between 60 and 65 percent of people with bipolar disorder are dependent on legal or illegal psychoactive substances, especially alcohol, tobacco, cannabis, cocaine, heroin, and hallucinogens. In addition, the use of these substances in predisposed individuals often coincides with psychiatric disorders, anticipating their onset, exacerbating symptoms, and significantly impeding the pharmacological and psychosocial treatment of the patient. Early medical efforts to reduce, regulate, treat, and prevent episodes of substance abuse are significant; these measures are considered essential to prevent bipolar disorder from deteriorating from a manageable illness to a disabling and treatment-resistant condition. Physicians strive to provide comprehensive treatment that addresses the pharmacological and psychotherapeutic aspects of bipolar disorder, including prescription of appropriate medications, regular patient follow-up, education about the illness, and family and social support