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Saggi, Studi e Ricerche

No. 55 (2020)

Clinical and psicodiagnostic comparison among patients in treatment affected by opiod-use disorder, bipolar disorder and both pathologies

DOI
https://doi.org/10.3280/mis55-2020oa10735
Submitted
novembre 18, 2020
Published
2021-07-08

Abstract

Introduction

The World Health Organization (WHO) defines Comorbidity or Double Diagnosis as the coexistence in the same individual of a disorder due to the consumption of psychoactive substances and another psychiatric disorder (WHO, 1995). Although somewhat criticized, this definition allows us to identify a population of patients whose psychopathological characteristics appear peculiar and very often difficult and not univocal diagnostic interpretation; these difficulties frequently lead to cultural ideological diatribes and real difficulties of therapeutic intervention which keep these people in a precarious equilibrium condition with high costs in terms of health and lack of work productivity. In the literature there are numerous works that try to combine ethiopathogenetic hypotheses of the psychiatric area with neurotransmitter pathways more typically associated with the world of pathological addictions, outlining a specific psychopathological culture that tries to give answers to difficult diagnostic questions. Among the various models that try to clarify the etiopathogenetic associations common to addictions and other mental disorders, the one that seems most complete is the hypothesis of "hedonic homeostatic dysregulation" (dyshedonia), a phenomenological correlation of addictions and mental illness which moment would explain the greater frequency of dependence in subjects with bipolar spectrum (also intended as a temperamental trait) as well as the lack of control of impulses or the inability to predict the consequences of their actions.Our study fits into this groove with the aim of providing a contribution to the creation of a neurobehavioral language specific to the world of addictions.

Purpose and Methods

The primary end point of our study is to identify specific symptom dimensions attributable to specific patient populations by frequency in the SCL-90R. Secondly, we investigated the possible existence of common psychopathological characteristics among patients with bipolar spectrum pathology and addiction; finally we evaluated the impact of the double diagnosis on the individual's overall functioning.

We enrolled three cohorts of patients: heroin addicts without other psychopathology, heroin addicts with bipolar disorder, patients with bipolar disorder without addiction, all from the Ser.D and DSM of the province of (...)The diagnosis was formulated through the criterion of clinical observation, supported by psychodiagnostic tools (MMPI-1, SCID 2) and laboratory tests (urinary toxicological tests).

The prevalent symptom dimensions were investigated with the SCL 90R.

Results

No significant data emerged relating to a specific psychopathological dimension for subjects suffering from substance use disorder. Among the subscales of SCL-90, ANX is the common dimension found among bipolar (dual diagnosis) and bipolar heroin addicts. In the comparison between the three groups (heroin addicts without comorbidities, bipolar heroin addicts, bipolar) evaluated globally, the least dysfunctional group was that of heroin addicts.

The small size of the samples examined does not allow us to reach definitive results requiring further studies in this sense.

 

References

  1. (1) Presidenza del Consiglio dei Ministri - Dipartimento Politiche Antidroga. SIND - Anni 2012-2018 Relazione annuale al Parlamento 2019 sullo stato delle tossicodipendenze in Italia.
  2. (2) Presidenza del Consiglio dei Ministri - Dipartimento Politiche Antidroga SIND - Anno 2018 Relazione annuale al Parlamento 2019 sullo stato delle tossicodipendenze in Italia.
  3. (3) World Health Organization. ICD-10 (1992). Classificazione internazionale delle malattie e dei problemi di salute correlati. Decima revisione. Ginevra: WHO.
  4. (4) American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: American Psychiatric Publishing. Edizione italiana a cura di M. Biondi (2014). American Psychiatric Association. Milano: Cortina.
  5. (5) Koob G.F., Le Moal M. (1997). Drug abuse: hedonic homeostatic dysregulation. Science, Oct., 3, 278(5335): 52-8.
  6. (6) Maremmani I., Pacini M., Perugi G., Akiskal H.S. (2005). Addiction and the bipolar spectrum. Dual diagnosis with a common substrate? Giornal Ital Psicopat, 11: 207-214.
  7. (7) De George F., Koob PhD., Nora D., Wolkow M.D. (2016). Neurobiology of addiction: a neurocircuitry analysis. Review. The Lancet Psychiatry, August, 3(8): 760-773.
  8. (8) Akiskal H.S. (1981). Subaffective disorders dysthymic, cyclothymic and bipolar II disorders in the borderline realm. Psychiatr Clin North Ann, 4: 25-46.
  9. (9) Maremmani I., Canoniero S., Pacini M., Lazzeri A., Placidi G.F. (2000). Opioids and cannabinoids abuse among bipolar patients. Heroin Add Rel Clin Probl, 2: 35-42.
  10. (10) Maremmani I., Capone M.R., Aglietti M., Castrogiovanni P. (1994). Heroin dependence and bipolar disorders. New Trends Exp Clin Psychiatry, X: 179-82.
  11. (11) Maremmani I., Pacini M., Lubrano S., Lovrecic M., Perugi G. (2003). Dual diagnosis heroin addicts. The clinical and therapeutic aspects. Heroin Add Rel Clin Probl, 5: 7-98.
  12. (12) Maremmani A.G.I., Pani P.P., Rovai I., Bacciardi S., Maremmani I. (2017). Toward the Identification of a Specific Psychopathology of Substance Use Disorders. Front Psychiatry, Apr 27(8): 68.
  13. (13) Maremmani A.G.I., Pani P.P., Trogu E., Vigna-Taglianti F., Mathis F., Diecidue R., Kirchmayer U., Amato L., Ghibaudi J., Camposeragna A., Saponaro. A, Davoli M., Faggiano F., Maremmani I. (2016). The impact of psychopathological subtypes on retention rate of patients with substance use disorder entering residential therapeutic community treatment. Ann Gen Psychiatry, Nov, 8(15): 29.
  14. (14) Maremmani A.G.I., Gazzarrini D., Fiorin A., Cingano V., Bellio G., Perugi G., Maremmani I. (2018). Psychopathology of addiction: Can the SCL90-based five-dimensional structure differentiate Heroin Use Disorder from a non-substance-related addictive disorder such as Gambling Disorder? Ann Gen Psychiatry, Jan, 16(17): 3.
  15. (15) Lg. 685/75 e 162/90.
  16. (16) Lg. 180 del 1978.
  17. (17) Di Petta G. (2009). “Nella terra di nessuno” Doppia diagnosi e trattamento integrato: l’approccio fenomenologico. Roma: Edizioni Universitarie Romane.
  18. (18) Balestrieri M., Baldacci S., Bellomo A., Bellantuono C., Conti L., Perugi G., Nardini M., Borbotti M., Viegi G. et all. (2007). Clinical vs. structured interview on anxiety and affective disorders by primary care physicians. understanding diagnostic discordance. Epidemiol Psichiatr Soc., Apr-Jun, 16(2): 144-51.
  19. (19) Derogatis L.R. (1992). SCL-90-R, administration, scoring and procedures manual-II for the R(revised) version and other instruments of the Psychopathology Rating Scale Series. Townson: Clinical Psychometric Research.
  20. (20) Cernovsky Z., Sadek G., Chiu S. (2015). Self-reports of illegal activity, SCL-90-R personality scales, and urine tests in methadone patients. Psychol Rep., Dec. 117(3): 643-8.
  21. (21) D’Egidio P., Da Fermo G., Vena G. (2003). SCL (Symptom Check List)-90-R e TCI (Temperament and Character Inventory) nella clinica della dipendenza da oppiacei. Mission, 7.
  22. (22) Pani P.P., Maremmani I., Trogu E., Gessa G.L., Ruiz P., Akiskal H.S. (2010). Delineating the psychic structure of substance abuse and addictions: Should anxiety, mood and impulse-control dysregulation be included? Journal of Affective Disorders, May, 185-197.
  23. (23) Department of Health (2002). Mental Health Policy Implementation Guide: Dual Diagnosis Good Practice Guide. London.
  24. (24) Baker K.D., Lubman D.I., Cosgrave E.M., Killackey E.J., Yuen H.P., Hides L., Baksheev G.N., Buckby G.A. (2007). Impact of cooccurring substance use on 6 month outcomes for young people seeking mental health treatment. Aust N Z J Psychiatry, 41: 896-902.
  25. (25) Lang K., Meyers J.L., Korn J.R., Lee S., Sikirica M., Crivera C., Dirani R., Menzin J. (2010). Medication Adherence and Hospitalization Among Patients With Schizophrenia Treated With Antipsychotics. Psychiatr Serv, 61: 1239-47.
  26. (26) Kelly T.M., Daley D.C., Douaihy A.B. (2012). Treatment of substance abusing patients with comorbid psychiatric disorders. Addict Behav, 37: 11-24.
  27. (27) Cuffel B.J., Shumway M., Chouljian T.L. (1994). A longitudinal study of substance use and community violence in schizophrenia. Hosp Community Psychiatriy, 44: 247-251.
  28. (28) Afuwape S.A. (2003). Where are we with dual diagnosis (substance misuse and mental illness): a review of literature. London: Rethink.
  29. (29) Schmit L.M., Hesse M., Lykke J. (2011). The impact of substance use disorders on the course of schizophrenia-a 15 years follow-up study: dual diagnosis over 15 years. Schizophr Res, 130: 228-33.
  30. (30) Drake R.E., Osher F.C., Wallach M.A. (1991). Homelessness and dual diagnosis. Am Psychol, 46: 1149-58.
  31. (31) Compton M.T., Weiss P.S., West J.C., Kaslow N.J. (2005). The associations between substance use disorders, schizophrenia spectrum disorders, and Axis IV psychosocial problems. Soc Psychiatry Epidemiol, 40: 939-46.

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