Bipolar patients with dysphoric-psychotic mania were more likely to use both alcohol and cannabis | Research

The takeaway

Among 96 hospitalized bipolar manic patients, those with dysphoric-psychotic symptoms had higher rates of combined alcohol and cannabis use disorders and more suicide attempts than those with pure elevated mania.

Read this if you have bipolar disorder and use cannabis, especially if your manic episodes include psychotic features.

31.6% of dysphoric-psychotic manic patients had alcohol + cannabis disorders

What the researchers found

Researchers studied 96 inpatients hospitalized for bipolar manic episodes and identified two clusters of symptoms using factor and cluster analysis. Cluster 1 featured primarily elevated psychomotor activity (classic mania), while Cluster 2 was characterized by dysphoria (negative mood) and psychotic symptoms.

Substance use disorders differed significantly between clusters. In Cluster 1 (psychomotor elevation), 39% had alcohol use disorders alone. In Cluster 2 (dysphoric-psychotic), 31.6% had both alcohol and cannabis use disorders. Cluster 2 patients also had more suicide attempts: 47.4% had one attempt and 21.1% had two or more.

The authors suggested that patients with pure mania may self-medicate with alcohol's sedative effects, while the cannabis-psychosis association in dysphoric patients may reflect a causal relationship between cannabis and psychotic features.

Why it matters

Not all manic episodes are the same, and different presentations may have different relationships with substance use. Understanding that dysphoric-psychotic mania is specifically associated with cannabis use (and higher suicide risk) can guide more targeted clinical assessments.

The numbers in context

96 bipolar manic inpatients. Cluster 1 (psychomotor): 39% alcohol use disorder. Cluster 2 (dysphoric-psychotic): 31.6% combined alcohol and cannabis disorders. Cluster 2: 47.4% one suicide attempt, 21.1% two or more attempts.

How the study worked

Cross-sectional study of 96 inpatients hospitalized for bipolar manic episodes. Factor analysis of YMRS, MADRS, and SAPS items generated three factors. Hierarchical cluster analysis identified two patient subtypes. MAST assessed alcohol disorders. Substance use disorders and clinical variables were compared between clusters.

What this study cannot tell us

Cross-sectional design at a single hospital. Cannot determine whether cannabis caused the psychotic features or whether psychosis-prone patients are more likely to use cannabis. Small sample for subgroup analysis. Turkish population may not generalize.

How to read the evidence

Cross-sectional study with cluster analysis from a single hospital. Exploratory subtyping approach.

When this study was published

Published in 2015 from a Turkish psychiatric hospital.

The bigger picture

The intersection of bipolar disorder, cannabis use, and psychosis is complex. This study adds nuance by showing that the cannabis-mania association may be specific to dysphoric and psychotic presentations rather than universal across all mania subtypes.

Questions still open

Does cannabis use trigger the dysphoric-psychotic presentation, or do patients with this subtype preferentially use cannabis? Would treating cannabis use disorder improve mania outcomes in the dysphoric-psychotic subgroup?

Common questions

Is cannabis use linked to a specific type of mania?

In this study, cannabis use disorders were more common among bipolar patients with dysphoric (negative mood) and psychotic features during mania, compared to those with primarily elevated, energized mania.

Does cannabis increase suicide risk in bipolar disorder?

The cluster with higher cannabis use also had significantly more suicide attempts, but the study cannot determine whether cannabis directly increases suicide risk or whether shared underlying factors explain both.

Read the original research

Phenomenological subtypes of mania and their relationships with substance use disorders.

Journal of affective disorders, 174, 569-73

View on PubMed ↗Publisher’s paper ↗

Citation

Güclü, Oya; Şenormancı, Ömer; Aydın, Erkan; Erkıran, Murat; Köktürk, Firuzan. (2015). Phenomenological subtypes of mania and their relationships with substance use disorders.. Journal of affective disorders, 174, 569-73. https://doi.org/10.1016/j.jad.2014.11.016