Abstract
Background:
Unlike schizophrenia, only a little attention has been paid to tobacco dependence in patients with bipolar disorder despite a similarly high prevalence and predisposition to health risks. The euthymic phase is especially suitable for tobacco screening by the treating psychiatrist. However, the validity of self-report for tobacco use in this patient population remains undetermined.
Aim:
The current study aims to assess the validity of self-reported tobacco use in euthymic bipolar disorder.
Method:
The psychiatric out-patients with DSM-IV TR diagnosis of bipolar type-I in remission who were males, ⩾ 18 years, and euthymic as established by current scores of < 7 on HAM-D and < 4 on YMRS. Patients were specifically asked for the recent use of tobacco in any form. Ten ml urine sample was obtained after informed consent and subjected to a quantitative cotinine estimation by direct enzyme-linked immunosorbent assay.
Results:
A total of 100 patients were screened, of which 79 were finally included. The self-report or recent tobacco use showed only a moderate concordance with urinary cotinine (k=0.518) and cotinine-creatinine ratio (k=0.492). Over 15% patients had denied the use of tobacco, but tested positive on urinary cotinine assessment. The sensitivity of self-report was 73.3% compared to urinary cotinine. The denial among users was 26.7% and denial among those with negative self-report was 30.8%.
Conclusion:
Mental health professionals should be vigilant for detection of tobacco dependence among remitted bipolar patients, who may not be so forthcoming about their tobacco use.
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