Stephen M Strakowski

Academic Director, Professor-Adjunct, UC Physicians, Volunteer, Professor
3200 One Stetson Square
513-558-4274
stephen.strakowski@uc.edu

Research Interests

Up to 60 of patients with bipolar disorder abuse drugs andor alcohol. This represents a major public health concern as comorbid substance abusehas been associated with poor outcome. Specific treatment interventionsfor this large patient population are undeveloped, in large part becausehow substance abuse influences the course of bipolar disorder is unknown. Recently, the phenomenon of behavioral sensitization has been suggestedto represent a model of the development and longitudinal course ofbipolar disorder, particularly with regard to the influence of stressors. As comorbid substance abuse is a particularly common and importantpsychosocial and biological stressor, this model provides a framework forexamining the effects of drug and alcohol abuse on thecourse of bipolardisorder. Specifically, this model predicts that comorbid substance abusewill increase the frequency, duration, and severity of affectiveepisodes. These effects are hypothesized to be clinically observable inpatients with substance abusecomorbidity as increased rates of rapid andcontinuous cycling, mixed-state episodes, and mood-incongruent psychosis. The objectives of this study are to prospectively and longitudinallyexamine these hypotheses to clarify how substance abuse effects thecourse of bipolar illness. To achieve this objective, 120-140 patients will be prospectivelyrecruited at the time of their first manic episode from the psychiatricinpatient and emergency services of the University of CincinnatiHospital. Patients will be carefully evaluated symptomatically, diagnostically, and functionally using structured and semi-structuredinterviews. The assessments of the bipolar illness and substance abusewill be independently obtained. Careful distinction will be made betweensubstance abuse and substance dependence. Patients will be re-evaluatedat 4 month intervals for up to 5 years. Multivariate regression andsurvival analysis models will be used to evaluate the relationshipsbetween substance abuse and operationally defined course andoutcomemeasures. The innovative aspects of this project are the prospective andlongitudinal assessment of the interaction of drug and alcohol abuse anddependence on clinical variables related to the course of bipolardisorder following a first manic episode. Specific hypotheses areexamined that have been developed from consideration of neurobiologicalmodel of behavioral sensitization.