Substance-abuse disorders mania with

Bipolar patients with substance abuse disorders are more likely to have an earlier onset of illness, mixed states, higher relapse rates, poorer response to treatment, higher suicide risk, and more hospitalizations. Approximately 10% to 15% of adolescents with recurrent major depressive episodes subsequently have an episode of mania or hypomania. 

Bipolar I disorder affects men and women equally bipolar II seems to be more common in women. Rapid cycling and mixed mania occur more often in women. Individuals with bipolar disorder commonly have another psychiatric disease with 78% to 85% reporting another Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis during their lifetime. The most common comorbid conditions include anxiety, substance abuse, and eating disorders.2... 

Divalproex sodium is comprised of sodium valproate and valproic acid. The delayed-release and extended-release formulations are converted in the small intestine into valproic add, which is the systemically absorbed form. It was developed as an antiepileptic drug, but also has efficacy for mood stabilization and migraine headaches. It is FDA-approved for the treatment of the manic phase of bipolar disorder. It is generally equal in efficacy to lithium and some other drugs for bipolar mania. It has particular utility in bipolar disorder patients with rapid cycling, mixed mood features, and substance abuse comorbidity. Although not FDA-approved for relapse prevention, studies support this use, and it is widely prescribed for maintenance therapy. Divalproex can be used as monotherapy or in combination with lithium or an antipsychotic drug.31... 

Valproate is as effective as lithium and olanzapine for pure mania, and it can be more effective than lithium for rapid cycling, mixed states, and bipolar disorder with substance abuse. It reduces the frequency of recurrent manic, depressive, and mixed episodes. 

Patients whose first episodes of mania or bipolar depression occur between ages 30 to 60 years appear to have clearer episodes of mood disorder, have mania characterized by euphoria and irritability (rather than irritability alone), and be less likely to develop substance addiction (though they may engage in substance abuse as part of their acute episodes). Although psychosis occurs frequently and can be severe, in such late-onset cases confusion with other disorders is usually not a problem. Finally, this more classical presentation is generally responsive to lithium (Carlson, 2000). 

Substance abuse can directly cause or contribute to a wide array of psychiatric symptoms depression, anxiety disorders, psychosis, mania, and so on. Not only can the use of recreational drugs produce psychological symptoms, but frequently such substances markedly interfere with psychological or psychiatric treatment. A common... 

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