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FrancoAngeli Journals

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.

 

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