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Bipolar Patients with Alcohol Consumption Will Have More Relapses? a 5 Year Follow-Up Study

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Bipolar Patients with Alcohol Consumption Will Have More Relapses? a 5 Year Follow-Up Study FACULTY OF MEDICINE Bipolar patients with alcohol consumption will have more relapses? A 5 year follow-up study. END OF TERM PROJECT Francisca da Costa Jácome Vasconcelos, 6th year medical student Tutor: Dr. Domènec Serrano, psychiatrist Psychiatry Department, Hospital Santa Caterina, Parc Hospitalari Marti i Julià Facultat de Medicina de Universitat de Girona Girona, November 2015 Bipolar patients with alcohol consumption will have more relapses? A 5 year follow-up study Francisca da Costa Jácome Vasconcelos Acknowledgements This end of term project could not have been done without the precious knowledge and help of Dr. Domènec Serrano, Dra. Núria Rigau, Dra. Maria del Mar Garcia and the whole UDPD team 2 Bipolar patients with alcohol consumption will have more relapses? A 5 year follow-up study Francisca da Costa Jácome Vasconcelos Index ABSTRACT ..............................................................................................................................................................4 ABBREVIATIONS ..................................................................................................................................................5 INTRODUCTION ....................................................................................................................................................6 Bipolar Disorder.........................................................................................................................................................................6 Definition ............................................................................................................................................................................................6 Epidemiology ....................................................................................................................................................................................6 Diagnostic and clinical features ...............................................................................................................................................7 Prognosis..............................................................................................................................................................................................8 Treatment……………………………………………………………………………………………………………………………………........9 Alcohol use disorder ..............................................................................................................................................................10 Definition ..........................................................................................................................................................................................10 Epidemiology ..................................................................................................................................................................................10 Diagnostic and clinical features..............................................................................................................................................11 Clinical course and prognosis...................................................................................................................................................12 Treatment…………………………………………………………………………………………………………………………………….....12 Dual Diagnosis (Relation between Alcohol Use Disorder and Bipolar Disorder ........................................13 Definition ..........................................................................................................................................................................................13 Epidemiology ..................................................................................................................................................................................13 Pathophisiology..............................................................................................................................................................................15 Pathogenesis…………………………………………………………………………………………………………………………………...16 Diagnostic……………………………………………………………………………………………………………………………………….17 Clinical course of the illness……………………………………………………………………………………………………………..17 Treatment as determinant factor of the course of Bipolar Disorder………………………………………………….18 JUSTIFICATION ...................................................................................................................................................20 HYPOTHESIS .......................................................................................................................................................21 OBJECTIVES .........................................................................................................................................................21 METHODOLOGY .................................................................................................................................................22 STUDY DESIGN ..............................................................................................................................................................................22 STUDY SUBJECTS ..........................................................................................................................................................................22 SAMPLE SELECTION .................................................................................................................................................................…22 SAMPLE SIZE ................................................................................................................................................................................23 STUDY VARIABLES ......................................................................................................................................................................23 DATA COLLECTION ......................................................................................................................................................................26 MEASURING INSTRUMENTS .......................................................................................................................................................26 STATISTICAL ANALYSIS ..................................................................................................................................29 ETHICAL AND LEGAL CONSIDERATIONS ...................................................................................................30 STUDY LIMITATIONS .......................................................................................................................................31 WORK PLAN ........................................................................................................................................................33 CHRONOGRAM ...................................................................................................................................................37 AVAILABLE MEANS TO DEVELOP THE STUDY……………………………………………………………………...38 IMPACT OF THE PROJECT ON THE NATIONAL HEALTH SYSTEM ......................................................39 BUDGET ................................................................................................................................................................40 REFERENCES .......................................................................................................................................................41 APPENDICES ........................................................................................................................................................44 APPENDIX 1: DSM-5 DIAGNOSTIC CRITERIA FOR Bipolar I Disorder .................................................................................44 APPENDIX 2: DSM-5 DIAGNOSTIC CRITERIA FOR Alcohol Use Disorder ...........................................................................49 APPENDIX 3: HAMILTON RATING SCALE FOR DEPRESSION (HRS-D) .................................................................................51 APPENDIX 4: YOUNG MANIA RATING SCALE (YMRS) ..................................................................................................................55 APPENDIX 5: CAGE QUESTIONNAIRE ..................................................................................................................................................57 APPENDIX 6: HOLMES AND RAHE STRESS SCALE..........................................................................................................................58 APPENDIX 7: INFORMATION FORM AND INFORMED CONSENT FORM ..............................................................................59 APPENDIX 8: CASE REPORT FORM........................................................................................................................................................65 3 Bipolar patients with alcohol consumption will have more relapses? A 5 year follow-up study Francisca da Costa Jácome Vasconcelos Abstract Title. Bipolar patients with alcohol consumption will have more relapses? A 5 year follow-up study. Background. Alcohol use disorder (AUD) occurs at high rates in Bipolar disorder (BD). However, the reasons of this co-occurrence are unknown. It is estimated that 46.2% of bipolar I patients had a lifetime history of AUD. Alcohol is strongly associated with maintaining or developing affective symptoms and could act as course or
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