Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con trastorno bipolar y un diagnóstico comórbido de trastorno por uso de sustancias

Ana González-Pinto, José Manuel Goikolea, Iñaki Zorrilla, Miquel Bernardo, Manuel Arrojo, Ruth Cunill, Xavi Castell, Elisardo Becoña Iglesias, Ana López Durán, Marta Torrens, Judit Tirado-Muñoz, Francina Fonseca, Belén Arranz, Marina Garriga, Pilar Alejandra Sáiz Martínez, Gerardo Florez, Luis San

Resumen


Esta revisión resume las intervenciones farmacológicos y psicosociales que se han realizado en trastorno bipolar (TB) y un diagnóstico comórbido de trastorno por uso de sustancias (TUS) y además proporciona recomendaciones clínicas respecto de cuáles elementos de intervención son útiles para hacer frente a los síntomas del uso de sustancias versus los síntomas de estado de ánimo en pacientes con estas afecciones concurrentes. Se utilizó la mejor evidencia de ensayos controlados aleatorizados para evaluar las opciones de tratamiento. La fuerza de las recomendaciones se describió mediante el enfoque GRADE. Muy pocos de los ensayos aleatorizados realizados hasta la fecha han proporcionado evidencia consistente para el manejo tanto de los síntomas de estado de ánimo como del uso de sustancias en pacientes con TB. No hay disponibilidad de ensayos clínicos para pacientes con TB que utilizan el cannabis. Algunos tratamientos han mostrado beneficios para los síntomas de estado de ánimo sin beneficios para el uso de alcohol o sustancias ilícitas. Nuestros resultados sugieren que 1) podemos (débilmente) recomendar el uso de ácido valproico o naltrexona adyuvante para aliviar los síntomas del trastorno por consumo de alcohol; 2) el tratamiento complementario con lamotrigina parece reducir los síntomas relacionados con la cocaína y, por tanto, es recomendable (fuerza moderada); y 3) la vareniclina es recomendable (débilmente) para mejorar la abstinencia de la nicotina. La terapia grupal integrada es el enfoque con más validación y eficacia sobre los resultados en el uso de sustancias cuando este uso es abordado durante la fase inicial de tratamiento.


Palabras clave


Trastorno bipolar; uso de sustancias; alcohol; cocaína; metanfetaminas; psicoestimulantes; nicotina.

Texto completo:

PDF PDF (English)

Referencias


Arias, F., Szerman, N., Vega, P., Mesías, B., Basurte, I. y Rentero, D. (2017). Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology. Adicciones, 29, 186–194. doi:10.20882/adicciones.782.

Arranz, B., Garriga, M., Bernardo, M., González-Pinto, A., Arrojo, M., Torrens, M., … San, L., (2021). Clinical practice guideline on pharmacological and psychological management of adult patients with schizophrenia spectrum disorders and a comorbid substance use. Adicciones. Advance publication online.

Balanzá-Martínez, V., Crespo-Facorro, B., González-Pinto, A. y Vieta, E. (2015). Bipolar disorder comorbid with alcohol use disorder: focus on neurocognitive correlates. Frontiers in Physiology, 6, 108. doi:10.3389/fphys.2015.00108.

Chengappa, K. N. R., Perkins, K. A., Brar, J. S., Schlicht, P. J., Turkin, S. R., Hetrick, M. L., ... George, T. P. (2014). Varenicline for smoking cessation in bipolar disorder: a randomized, double-blind, placebo-controlled study. Journal of Clinical Psychiatry, 75, 765–772. doi:10.4088/JCP.13m08756.

Clemente, A. S., Diniz, B. S., Nicolato, R., Kapczinski, F. P., Soares, J. C., Firmo, J. O. y Castro-Costa, É. (2015). Bipolar disorder prevalence: a systematic review and meta-analysis of the literature. Revista Brasileira de Psiquiatria, 37, 155-161. doi:10.1590/1516-4446-2012-1693.

Colom, F., Vieta, E., Daban, C., Pacchiarotti, I. y Sánchez-Moreno, J. (2006). Clinical and therapeutic implications of predominant polarity in bipolar disorder. Journal of Affective Disorders, 93, 13–17. doi:10.1016/j.jad.2006.01.032.

Garcia-Portilla, M. P., Garcia-Alvarez, L., Sarramea, F., Galvan, G., Diaz-Mesa, E., Bobes-Bascaran, T., ... Bobes, J. (2016). It is feasible and effective to help patients with severe mental disorders to quit smoking: An ecological pragmatic clinical trial with transdermal nicotine patches and varenicline. Schizophrenia Research176, 272–280. doi:10.1016/j.schres.2016. 05.011.

Gold, A. K., Otto, M. W., Deckersbach, T., Sylvia, L. G., Nierenberg, A. A. y Kinrys, G. (2018). Substance use comorbidity in bipolar disorder: A qualitative review of treatment strategies and outcomes. American Journal on Addictions, 27, 188–201. doi:10.1111/ajad.12713.

González-Ortega, I., Alberich, S., Echeburúa, E., Aizpuru, F., Millán, E., Vieta, E., …González-Pinto, A. (2015). Subclinical depressive symptoms and continued cannabis use: predictors of negative outcomes in first episode psychosis. PLoS One, 10, e0123707. doi:10.1371/journal.pone.0123707.

González-Pinto, A., Gutierrez, M., Ezcurra, J., Aizpuru, F., Mosquera, F., Lopez, P. y de Leon, J. (1998). Tobacco smoking and bipolar disorder. Journal of Clinical Psychiatry, 59, 225–228. doi:10.4088/jcp.v59n0503.

González-Pinto, A., Alberich, S., Barbeito, S., Alonso, M., Vieta, E., Martínez-Arán, A., … López, P. (2010). Different profile of substance abuse in relation to predominant polarity in bipolar disorder: The Vitoria long-term follow-up study. Journal of Affective Disorders, 124, 250–255. doi:10.1016/j.jad.2009.11.005.

González-Pinto, A., Barbeito, S., Alonso, M., Alberich, S., Haidar, M. K., Vieta, E., ... Lopez, P. (2011a). Poor long-term prognosis in mixed bipolar patients: 10-Year outcomes in the vitoria prospective naturalistic study in Spain. Journal of Clinical Psychiatry, 72, 671–676. doi:10.4088/JCP.09m05483yel.

González-Pinto, A., Alberich, S., Barbeito, S., Gutierrez, M., Vega, P., Ibáñez, B., … Arango, C. (2011b). Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophrenia Bulletin, 37, 631–639. doi:10.1093/schbul/sbp126.

González-Pinto, A., López-Peña, P., Bermúdez-Ampudia, C., Vieta, E. y Martinez-Cengotitabengoa, M. (2018). Can lithium salts prevent depressive episodes in the real world? European Neuropsychopharmacology, 28, 1351–1359. doi:10.1016/j.euroneuro.2018.09.008.

Gopalakrishna, G., Langendam, M., Scholten, R., Bossuyt, P. y Leeflang, M. (2013). Guidelines for guideline developers: a systematic review of grading systems for medical tests. Implementation Science, 8, 78. doi:10.1186/1748-5908-8-78.

Grant, B. F., Stinson, F. S., Hasin, D. S., Dawson, D. A., Patricia, S., June, W. y Huang, B. (2005). Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66, 1205–1215. doi:10.4088/JCP.v66n1001.

Guyatt, G. H., Oxman, A. D., Kunz, R., Woodcock, J., Brozek, J., Helfand, M., … Schünemann, H. J. (2011). GRADE guidelines: 8. Rating the quality of evidence--indirectness. Journal of Clinical Epidemiology, 64, 1303–1310. doi:10.1016/j.jclinepi.2011.04.014.

Helzer, J. E. y Pryzbeck, T. R. (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol, 49, 219–224.

Merikangas, K. R., Akiskal, H. S., Angst, J., Greenberg, P. E., Hirschfeld, R. M. A., Petukhova, M. y Kessler, R. C. (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of General Psychiatry, 64, 543–552.

Messer, T., Lammers, G., Müller-Siecheneder, F., Schmidt, R. F. y Latifi, S. (2017). Substance abuse in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Research, 253, 338–350. doi:10.1016/j.psychres.2017.02.067.

Nejtek, V. A., Avila, M., Chen, L.-A., Zielinski, T., Djokovic, M., Podawiltz, A., ... Rush, A. J. (2008). Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial. Journal of Clinical Psychiatry, 69, 1257–1266. doi:10.4088/JCP.v69n0808.

Oquendo, M. A., Currier, D., Liu, S. M., Hasin, D. S., Grant, B. F. y Blanco, C. (2010). Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 71, 902–909. doi:10.4088/JCP.09m05198gry.

Oxman, A. D., Schünemann, H. J. y Fretheim, A. (2006). Improving the use of research evidence in guideline development: 2. Priority setting. Health Research Policy and Systems, 4, 14. doi:10.1186/1478-4505-4-14.

Petrakis, I.L., Nich, C. y Ralevski, E. (2006) Psychotic spectrum disorders and alcohol abuse: a review of pharmacotherapeutic strategies and a report on the effectiveness of naltrexone and disulfiram. Schizophrenia Bulletin, 32, 644-654. doi:10.1093/schbul/sbl010.

Post, R. M. y Kalivas, P. (2013). Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation. British Journal of Psychiatry, 202, 172–176. doi:10.1192/bjp.bp.112.116855.

Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L. y Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA, 264, 2511–2518.

Salloum, I. M., Cornelius, J. R., Daley, D. C., Kirisci, L., Himmelhoch, J. M. y Thase, M. E. (2005). Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study. Archives of General Psychiatry, 62, 37–45. doi:10.1001/archpsyc.62.1.37.

Sarramea, F., Jaen-Moreno, M. J., Balanzá-Martínez, V., Osuna, M. I., Alcalá, J. Á., Montiel, F. J., ... Gutiérrez-Rojas, L. (2019). Setting the stage to quit smoking in bipolar disorder patients: brief advice in clinical practice. Adicciones, 31, 136–146. doi:10.20882/adicciones.1006.

Schünemann, H. J., Oxman, A. D., Brozek, J., Glasziou, P., Bossuyt, P., Chang, S., ... Guyatt, G. H. (2008). GRADE: assessing the quality of evidence for diagnostic recommendations. Evidence-based Medicina, 13, 162-163. doi:10.1136/ebm.13.6.162-a.

Sherwood Brown, E., Gorman, A. R. y Hynan, L. S. (2007). A randomized, placebo-controlled trial of citicoline add-on therapy in outpatients with bipolar disorder and cocaine dependence. Journal of Clinical Psychopharmacology, 27, 498–502. doi:10.1097/JCP.0b013e31814db4c4.

Sherwood Brown, E., Garza, M. y Carmody, T. J. (2008). A randomized, double-blind, placebo-controlled add-on trial of quetiapine in outpatients with bipolar disorder and alcohol use disorders. Journal of Clinical Psychiatry, 69, 701–705. doi:10.4088/JCP.v69n0502.

Sherwood Brown, E., Carmody, T. J., Schmitz, J. M., Caetano, R., Adinoff, B., Swann, A. C. y Rush, A. J. (2009). A randomized, double-blind, placebo-controlled pilot study of naltrexone in outpatients with bipolar disorder and alcohol dependence. Alcoholism, Clinical and Experimental Research, 33, 1863–1869. doi:10.1111/j.1530-0277.2009.01024.x.

Sherwood-Brown, E. y Gabrielson, B. (2012a). A randomized, double-blind, placebo-controlled trial of citicoline for bipolar and unipolar depression and methamphetamine dependence. Journal of Affective Disorders, 143, 257–260. doi:10.1016/j.jad.2012.05.006.

Sherwood Brown, E., Sunderajan, P., Hu, L. T., Sowell, S. M. y Carmody, T. J. (2012b). A randomized, double-blind, placebo-controlled, trial of lamotrigine therapy in bipolar disorder, depressed or mixed phase and cocaine dependence. Neuropsychopharmacology, 37, 2347–2354. doi:10.1038/npp.2012.90.

Stedman, M., Pettinati, H. M., Brown, E. S., Kotz, M., Calabrese, J. R. y Raines, S. (2010). A double-blind, placebo-controlled study with quetiapine as adjunct therapy with lithium or divalproex in bipolar I patients with coexisting alcohol dependence. Alcoholism, Clinical and Experimental Research, 34, 1822–1831. doi:10.1111/j.1530-0277.2010.01270.x.

Tolliver, B. K., Desantis, S. M., Brown, D. G., Prisciandaro, J. J. y Brady, K. T. (2012). A randomized, double-blind, placebo-controlled clinical trial of acamprosate in alcohol-dependent individuals with bipolar disorder: a preliminary report. Bipolar Disorders, 14(1), 54–63. https://doi.org/10.1111/j.1399-5618.2011.00973.x

Vornik, L. A. y Brown, E. S. (2006). Management of comorbid bipolar disorder and substance abuse. Journal of Clinical Psychiatry, 67 (Suppl 7), 24–30.

Weiss, R. D., Griffin, M. L., Jaffee, W. B., Bender, R. E., Graff, F. S., Gallop, R. J. y Fitzmaurice, G. M. (2009). A “community-friendly” version of integrated group therapy for patients with bipolar disorder and substance dependence: a randomized controlled trial. Drug and Alcohol Dependence, 104, 212–219. doi:10.1016/j.drugalcdep.2009.04.018.

Weiss, R. D., Griffin, M. L., Kolodziej, M. E., Greenfield, S. F., Najavits, L. M., Daley, D. C., ... Hennen, J. A. (2007). A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. American Journal of Psychiatry, 164, 100–107. doi:10.1176/ajp.2007.164.1.100.

Yatham, L. N., Kennedy, S. H., Parikh, S. V, Schaffer, A., Bond, D. J., Frey, B. N., ... Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20, 97–170. doi:10.1111/bdi.12609.

Zorrilla, I., Aguado, J., Haro, J. M., Barbeito, S., López Zurbano, S., Ortiz, A., ... y González-Pinto, A. (2015). Cannabis and bipolar disorder: Does quitting cannabis use during manic/mixed episode improve clinical/functional outcomes? Acta Psychiatrica Scandinavica, 131, 100–110. doi:10.1111/acps.12366.




DOI: https://doi.org/10.20882/adicciones.1528

Enlaces refback

  • No hay ningún enlace refback.