Dual diagnosis and chronology of illness in treatment-seeking Italian patients dependent on heroin.

University of Pisa, Via Roma 67, 56100-PISA, Italy.
Journal of Addictive Diseases (Impact Factor: 1.46). 04/2011; 30(2):123-35. DOI: 10.1080/10550887.2011.554779
Source: PubMed

ABSTRACT Although there are studies describing the prevalence of patients with drug addiction and dual diagnosis, there is a paucity of data regarding the progression from psychiatric disorders to drug addiction or vice versa. A total of 1,090 patients dependent on heroin were interviewed to examine the presence of dual diagnosis and the progression from psychiatric disorders to drug dependence or vice versa. A total of 574 patients met the criteria for a dual diagnosis. A total of 362 patients progressed from substance abuse disorders to psychiatric disorders (SUD-PR) and 144 patients progressed from psychiatric disorders to drug addiction (PSY-PR). SUD-PR patients are more frequently affected by mood disorders. PSY-PR patients were more frequently diagnosed as psychotic or affected by anxiety disorders. The authors' findings suggest that the self-medication theory of dual diagnosis was relevant only for those with existing diagnoses of schizophrenia or anxiety disorders. When treating patients with a dual diagnosis, clinicians should ensure that the same attention is given to the treatment of drug dependence as it is to the treatment of comorbid psychiatric conditions.

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    ABSTRACT: Objectives: Comorbidity between substance use disorder (SUD) and attention deficit hyperactivity disorder (ADHD) in adulthood has been reported in epidemiological and clinical samples. With the aim of assessing the impact of comorbid ADHD, we have investigated the prevalence, clinical and epidemiological features associated with that comorbidity in a sample of adult patients diagnosed with SUD. Methods: A total of 109 outpatients (aged 18-65 years) with SUD (high prevalence of heroin addicts) were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for the explora-tion of the criteria of major Axis I and Axis II diagnoses, according to DSM-IV criteria. The DCTC also includes the Clinical Global Impression Bipolar (CGI-BP) scale, Global Assessment of Functioning (GAF) scale and the Sheehan Dis-ability Scale (SDS). Results: Twenty patients out of 109 (18.35%) fulfilled both DSM-IV and ASRS criteria for ADHD. No significant differences were observed between ADHD and non-ADHD patients in age, sex, marital status, employ-ment, education or type(s) of substance used. ADHD patients showed a higher prevalence of Bipolar Disorder (80% vs 43.2%, chi-square = 8.84, p=.003) and of current manic or mixed episode at the time of observation (40% vs 16.9%, chi-square=3.29, p=.027) than non-ADHD patients. No significant difference between ADHD and non-ADHD patients were observed in terms of prevalence of comorbid Anxiety Disorders and Impulse Control Disorders. "Treatment resist-ance" (15% vs 3.4%, chi-square= 4.25, p=.039) and "irritability" (35% vs 15.7%, chi-square=3.90, p=.048) in response to previous treatment with antidepressants were more frequently reported by ADHD than by non-ADHD patients. Con-clusion: In patients with SUD (with high prevalence of heroin addicted patients) the presence of comorbid adult ADHD influences a patient's course, prognosis and therapeutic management. Patients with SUD and adult ADHD present high rates of comorbid BD. Patients with ADHD, SUD and BD seems to be a distinct phenotype characterized by early onset and mood instability. Further research is needed to confirm our findings, and the clinical and therapeutic implications of SUD-ADHD-BD comorbidity.
    International Clinical Psychopharmacology 01/2012; 28. DOI:10.1097/01.yic.0000423297.00530.84 · 3.10 Impact Factor
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    ABSTRACT: Abstract In an effort to inquiry 'self-medication hypothesis' in chronic psychosis and bipolar disorder heroin dependent patients a naturalistic comparative cohort study was designed with the aim of comparing, according to the presence of dual diagnosis, the clinical characteristics of heroin-dependent patients presenting for their first AOT. The main finding was that addictive (heroin) illness was more severe in bipolar 1 patients and less severe in chronic psychotic patients when compared with heroin-dependent patients without dual diagnosis. In the case of chronic psychotic patients, these differences do not allow us to exclude a therapeutic heroin use, at least at the beginning of their toxicomanic career, with limited progression of their addictive disease. This occurrence seems to be excluded for bipolar 1 heroin-dependent patients, who come to their first AOT with a more severe addictive disease.
    Journal of Addictive Diseases 11/2014; DOI:10.1080/10550887.2014.975608 · 1.46 Impact Factor
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    ABSTRACT: Background: Recent celebrity deaths have been widely reported in the media and turned the public attention to the coexistence of mood, psychiatric and substance-abuse disorders. These tragic and untimely deaths motivated us to examine the scientific and clinical data, including our own work in this area. The self-medication hypothesis states that individuals with psychiatric illness tend to use heroin to alleviate their symptoms. This study examined the correlations between heroin use, mood and psychiatric disorders, and their chronology in the context of dual diagnosis. Methods: Out of 506 dual diagnosed heroin addicts, 362 patients were implicated in heroin abuse with an onset of at least one year prior to the associated mental disorder (HER-PR), and 144 patients were diagnosed of mental illness at least one year prior to the associated onset of heroin use disorder (MI-PR). The retrospective cross-sectional analysis of the two groups compared their demographic, clinical and diagnostic characteristics at univariate and multivariate levels. Results: Dual diagnosis heroin addicts whose heroin dependences existed one year prior to their diagnoses (HER-PR) reported more frequent somatic comorbidity (p r0.001), less major problems at work (p ¼0.003), more legal problems (p¼ 0.004) and more failed treatment for their heroin dependence (po 0.001) in the past. More than 2/3 reached the third stage of heroin addiction (p¼ o 0.001). Their length of dependence was longer (p¼0.004). HER-PR patients were diagnosed more frequently as affected by mood disorders and less frequently as affected by psychosis (p¼ 0.004). At the multivariate level, HER-PR patients were characterized by having reached stage 3 of heroin dependence (OR ¼2.45), diagnosis of mood disorder (OR ¼2.25), unsuccessful treatment (OR ¼ 2.07) and low education (OR ¼1.79). Limitations: The main limitation is its retrospective nature. Nonetheless, it does shed light on what needs to be done from a clinical and public health perspective and especially prevention. Conclusions: The data emerging from this study, does not allow us to determine a causal relation between heroin use and mental illness onset. However, this data, even if requiring longitudinal studies, suggest that self-medication theory, in these patients, can be applied only for chronic psychoses, but should not be applied to patients with mood disorders using heroin. & 2015 Published by Elsevier B.V.
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May 20, 2014