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: Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the geographical area. The highest number of positive cases was identified in the month of October, whereas the smallest numbers were identified in July and December. The annual trend of consumption revealed a significant decrease in the analysed substances in 2011. Conclusions. Our study has determined the presence of a specific pattern of consumption in different geographical areas - a result that suggests the need for more targeted prevention programmes, addressing local particularities in consumption behaviours. A significant decrease in the identification of drugs of abuse in the third year of our study, combined with data attesting the significant increase in the consumption of legal highs suggests that the forensic toxicology laboratories need to be equipped with apparatus able to detect these newer substances of abuse more efficiently.
    Heroin Addiction and Related Clinical Problems 01/2014; 16(3):7-13. · 0.35 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; 34(1). 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.
    Journal of Affective Disorders 04/2015; 179:156-160. DOI:10.1016/j.jad.2015.03.046 · 3.71 Impact Factor


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May 20, 2014