Continued cannabis use at one year follow up is associated with elevated mood and lower global functioning in bipolar I disorder.

Levi Roestad Kvitland,Petter Andreas Ringen,Sofie Ragnhild Aminoff,Trine Vik Lagerberg,Christine Demmo,Ingrid Melle,Ole Andreas Andreassen

doi:10.1186/s12888-015-0389-x

Levi Roestad Kvitland, Petter Andreas Ringen + Show 5 more

Open Access

https://doi.org/10.1186/s12888-015-0389-x

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Abstract

BackgroundThere is limited knowledge about how environmental factors affect the course of bipolar disorder (BD). Cannabis has been proposed as a potential risk factor for poorer course of illness, but the role of cannabis use has not been studied in a first treatment BD I sample.MethodsThe present study examines the associations between course of illness in first treatment BD I and continued cannabis use, from baseline to one year follow up. Patients (N = 62) with first treatment DSM-IV BD I were included as part of the Thematically Organized Psychosis study (TOP), and completed interviews and self-report questionnaires at both baseline and follow up. Cannabis use within the last six months at baseline and use between baseline and follow up (“continued use”) was recorded.ResultsAfter controlling for confounders, continued cannabis use was significantly associated with elevated mood (YMRS) and inferior global functioning (GAF-F) at follow up. Elevated mood mediated the effect of cannabis use on global functioning.ConclusionsThese results suggest that cannabis use has clinical implications for the early course of BD by increasing mood level. More focus on reducing cannabis use in clinical settings seems to be useful for improving outcome in early phase of the disorder.

Highlights

There is limited knowledge about how environmental factors affect the course of bipolar disorder (BD)
The groups did not differ in any other features (Table 1), including the number in symptomatic remission at follow-up (3 (50%) in the continued cannabis use group vs 38 (68%) in the no continued cannabis use group, p = .601)
Four (67%) of the patients in the continued cannabis use group had not reached a level of functional recovery compared to 19 (29%) patients in the group without continued use; this difference was not statistically significant (p = .390)

Summary

Introduction

There is limited knowledge about how environmental factors affect the course of bipolar disorder (BD). Cannabis abuse has been shown to predict poorer medication adherence in BD patients [21] Most of these studies have included patients mainly in the chronic phase of illness after multiple mood episodes, and we cannot rule out the possibility that these findings are biased by a selection of patients with a more severe course, possibly being more prone to selfmedication with cannabis. Two follow-up studies of first time hospitalized patients with BD I indicate that patients with cannabis use spend more time in affective episodes and exhibit more rapid cycling over the first year of treatment [22], and that periods with cannabis use coincide with periods with manic and hypomanic episodes over a mean follow-up period of 4.5 years [6]. Both studies suggest that continued cannabis use in patients with recently

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Conclusion