Impact of Preexisting Alcohol Use Disorder, Bipolar Disorder, and Schizophrenia on Ischemic Stroke Risk and Severity: A Lebanese Case-Control Study
Authors: Maalouf Elise , Hallit Souheil , Salameh Pascale , Hosseini Hassan 
Published: February 2023

Background: Stroke remains a major leading cause of morbidity and death globally. For ischemic stroke, the most frequent type of stroke, there are numerous risk models and risk assessments offered. Further research into potential risk factors or triggers is being sought to improve stroke risk models. Schizophrenia, bipolar disorder, and alcohol use disorder are all common causes of serious mental illnesses in the general population. Due to the tangled relationship between stroke and many chronic illnesses, lifestyle factors, and diet that may be present in a patient with a mental disease, the relationship between mental diseases and stroke requires further validation. Consequently, the purpose of this study is to assess the potential influence of bipolar disorder, schizophrenia, and alcohol use disorder on stroke patients as compared to non-stroke participants, after controlling for demographic, physical, and medical conditions. We aimed, as a secondary objective, to evaluate the impact of these pre-existing disorders on stroke severity levels. Methods: This research is a case-control survey study involving 113 Lebanese patients with a clinical diagnosis of ischemic stroke and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from several hospitals in Lebanon (April 2020–April 2021). Based on the participant’s consent, data was collected by filling out an anonymous paper-based questionnaire. Results: All of the odds ratios (ORs) generated by our regression model were greater than 1, indicating that the factors studied were associated with an increased risk of ischemic stroke. As such having schizophrenia (adjusted OR [aOR]: 6.162, 95% confidence interval [CI]: 1.136–33.423), bipolar disorder (aOR: 4.653, 95% CI: 1.214–17.834), alcohol use disorder (aOR: 3.918, 95% CI: 1.584–9.689), atrial fibrillation (aOR: 2.415, 95% CI: 1.235–4.721), diabetes (aOR: 1.865, 95% CI: 1.117–3.115), heart diseases (aOR: 9.890, 95% CI: 5.099–19.184), and asthma-COPD (aOR: 1.971, 95% CI: 1.190–3.263) were all involved with a high risk of developing an ischemic stroke. Moreover, obesity (aOR: 1.732, 95% CI: 1.049–2.861) and vigorous physical activity (aOR: 4.614, 95% CI: 2.669–7.978) were also linked to an increased risk of stroke. Moreover, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke alcohol use disorder (aOR: 1.719, 95% CI: 1.385–2.133), bipolar disorder (aOR: 1.656, 95% CI: 1.281–2.141), and schizophrenia (aOR: 6.884, 95% CI: 3.294–11.492) compared to people who had never had a stroke. Conclusion: The findings in our study suggest that individuals with schizophrenia, bipolar disorder, and alcohol use disorder may be at a higher risk for ischemic stroke and exhibit more severe symptoms. We believe that the first step toward creating beneficial preventative and treatment interventions is determining individuals with schizophrenia, bipolar disorder, or alcohol use disorder, assessing their risk of ischemic stroke, developing more integrated treatments, and closely monitoring the long-term outcome in the event of an ischemic stroke.