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Addiction: what did we learn in 2020?

Every year several thousand scientific papers on alcohol, drugs, and nicotine are published. The picking of five papers must obviously be arbitrary and subjective. However, the scientific literature of 2020 cannot be regarded without acknowledging the many papers concerning the COVID-19 pandemic. Some studies on alcohol, drug, and nicotine show a small increase, some a small decrease, but many no change. The addiction consequences of the pandemic and the societal lockdowns may thus be less dramatic than feared. This is true even if many papers reported higher mental distress during the pandemic and there is a close relationship between mental distress and substance use, a relationship that has been further confirmed in studies from the past year. Furthermore, a review concerning the addictive potential of cannabis has further alarmed us of the current liberalization also affecting Europe. A new figure of “1 in 3” cannabis users getting hooked may possibly replace the old “1 in 10”. Furthermore, the year has brought even more solid knowledge of the transition from substance-induced psychosis (SIP) to schizophrenia, teaching psychiatrists in acute psychiatry an important lesson on how to view SIP. As many as 1 in 3 patients with SIP will eventually receive a diagnosis of schizophrenia, making SIP the most powerful risk factor for schizophrenia known. Lastly, the lecture will present a very novel and unexpected finding regarding alcohol elimination, that may change how we treat intoxications with different alcohols.

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Abstract: Biomarkers for diagnosis and treatment of Bipolar Disorder: hope or hype?

Professor Allan Young, Centre for Affective Disorders, IoPPN, KCL London, SE5 8AF.

allan.young@kcl.ac.uk

The use of “biomarkers” (biological markers) in basic and clinical research as well as in clinical practice has become so commonplace in many areas of medicine that their presence as primary endpoints in clinical trials is now widely accepted. In clinical disciplines where specific biomarkers have been well characterized and repeatedly shown to correctly predict relevant clinical outcomes across a variety of treatments and populations, this use is entirely justified and appropriate. However, the validity of biomarkers in most psychiatric disorders continues to be evaluated. This lecture will review the current conceptual status of biomarkers as clinical and diagnostic tools for bipolar disorder and as surrogate endpoints in clinical research in bipolar disorder. The conceptual background in terms of current diagnostic categories and research domain criteria will be discussed and the various approaches with putative value (e.g., brain imaging, genetics, and neuroendocrinology) reviewed (1, 2). The lecture will end with a discussion of approaches to evaluating biomarkers of lithium response (3).

References:

Wise et al, Mol Psychiatry. 2016 May 24. doi: 10.1038/mp.2016.72. [Epub ahead of print];

Young AH. Harv Rev Psychiatry. 2014 Nov-Dec;22(6):331-3

Bellivier F, Young AH, et al, Bipolar Disord. 2020 Oct 23. doi: 10.1111/bdi.13023. Online ahead of print.