Objectives: The comorbidity of alcohol use disorder (AUD) and bipolar disorder (BD) has been repeatedly associated with poorer clinical outcomes than BD without AUD. We aimed to extend these findings by focusing on the characteristics associated with the sequence of onset of BD and AUD. Methods: 3,027 outpatients from the Fondamental Advanced Centres of Expertise were ascertained for BD-1, BD-2 and AUD diagnoses, including their respective ages at onset (AAOs, N =2,804). We selected the variables associated with both the presence and sequence of onset of comorbid AUD using bivariate analyses corrected for multiple testing to enter a binary regression model with the sequence of onset of BD and AUD as the dependent variable (AUD first - which also included 88 same-year onsets, vs. BD first). Results: BD patients with comorbid AUD showed more severe clinical profile than those without. Compared to BD-AUD (N =269), AUD-BD (N =276) was independently associated with a higher AAO of BD (OR =1.1, p <0.001), increased prevalence of comorbid cannabis use disorder (OR =2.8, p <0.001) a higher number of (hypo)manic/mixed BD episodes per year of bipolar illness (OR =3, p <0.01). Limitations: The transversal design prevents from drawing causal conclusions. Conclusion: Increased severity of BD with AUD compared to BD alone did not differ according to the sequence of onset. A few differences, though, could be used to better monitor the trajectory of patients showing either one of these disorders.

目的：与没有AUD的BD相比，酒精使用障碍（AUD）和双相情感障碍（BD）的合并症一再与较差的临床结局相关。我们的目的是通过关注与BD和AUD发作序列相关的特征来扩展这些发现。方法：确定3027名来自Fondamental高级专业技术中心的门诊患者的BD-1，BD-2和AUD诊断，包括其各自的发病年龄（AAO，N = 2804）。我们使用经过多重测试校正的双变量分析，选择了与共病性AUD的存在和发作顺序相关的变量，以输入以BD和AUD的发作序列为因变量的二元回归模型（AUD首先-还包括88同年发作，vs。BD首先）。结果：合并AUD的BD患者的临床表现比没有AUD的患者更为严重。与BD-AUD（N = 269）相比，AUD-BD（N = 276）与BD的较高AAO独立相关（OR = 1.1，p <0.001），并发大麻使用障碍的流行率增加（OR = 2.8， p <0.001）每年躁郁症（低）躁狂/混合性BD发作的发生率更高（OR = 3，p <0.01）。局限性：横向设计无法得出因果结论。结论：与单独的BD相比，AUD引起的BD严重程度增加没有根据发作顺序而有所不同。但是，可以使用一些差异来更好地监视显示这些疾病之一的患者的运动轨迹。