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Khanjani MS, Younesi SJ, Abdi K, Mardani-Hamooleh M, Sohrabnejad S. Prevalence of and Factors Influencing Suicide Ideation, Attempt, and Completion in Heroin Users: A Systematic Review and Meta-Analysis. ADDICTION & HEALTH 2023; 15:119-127. [PMID: 37560393 PMCID: PMC10408759 DOI: 10.34172/ahj.2023.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/15/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND Suicide is considered a fundamental problem in discussions on public and global health. Thus, the current study aimed to review the prevalence of and reasons for successful suicide attempts in heroin users. METHODS This study was conducted by systematically searching the electronic databases of PubMed, Scopus, Web of Science, and PsycINFO from 1960/1/1 to 2021/11/1 based on the PRISMA checklist and using MeSH keywords with no temporal or linguistic limitations. The primary and secondary impacts of suicide were identified, and all studies following an observational design (cohort, case-control, and cross-sectional studies) were included in the research. Data analysis was performed using Stata version 13. Finally, 17 studies were included in the work process for systematic review and meta-analysis. FINDINGS The results showed the most frequent reasons for suicide among the studied individuals were gender (being female), youngness, heroin overdose, multi-drug abuse, history of repeated suicide attempts, history of psychiatric disorder (especially depression), joblessness, homelessness, distorted family relationships, etc. Moreover, the results of synthesizing the studies revealed the prevalence of suicide attempts equaled the effect size (95% CI=0.3 [0.23-0.37]) among these individuals, and the prevalence of successful suicides approached the effect size (95% CI=0.03 [0.01-0.05]). CONCLUSION The results of the present study showed the high prevalence of suicidal thoughts and suicide attempts among the heroin-abusing population. Furthermore, according to the findings, the prevalence of unsuccessful suicide attempts was ten times more than that of successful ones in the target population.
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Affiliation(s)
- Mohammad Saeed Khanjani
- Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sayed Jalal Younesi
- Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kianoush Abdi
- School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Marjan Mardani-Hamooleh
- School of Nursing and Midwifery, Nursing Care Research Center Health Management, Iran University of Medical Sciences, Tehran, Iran
| | - Sajad Sohrabnejad
- Department of Counseling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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2
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Pani PP, Maremmani AGI, Pacini M, Trogu E, Gessa GL, Ruiz P, Maremmani I. Delineating the Psychic Structure of Substance Use and Addictions, from Neurobiology to Clinical Implications: Ten Years Later. J Clin Med 2020; 9:jcm9061913. [PMID: 32570932 PMCID: PMC7356689 DOI: 10.3390/jcm9061913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of substance use disorder is currently based on the presence of specifically identified behavioral symptoms. In addition, other psychiatric signs and symptoms accompany addictive behavior, contributing to the full picture of patients’ psychopathologic profile. Historically, such symptoms were confined within the framework of “comorbidity”, as comorbid psychiatric disorders or personality traits. However, an alternative unitary view of the psychopathology of addiction, inclusive of related psychiatric symptoms, has been claimed, with the support of epidemiological, neurobiological, and neuropsychological evidence. In the present article, we highlight the research advancements that strengthen this unified perspective. We then give an account of our group’s definition of a specific SCL-90-based construct of the psychopathology of addiction. Lastly, we discuss the benefits that can be expected to be acquired in the evaluation and treatment of patients with a longitudinal approach including psychological/psychiatric predisposing features, addictive behavior, and psychiatric manifestations.
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Affiliation(s)
- Pier Paolo Pani
- Social-Health Services, Azienda Tutela Salute Sardegna (Sardinia Health Trust), 09128 Cagliari, Italy;
| | - Angelo G. I. Maremmani
- Department of Psychiatry, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, 55049 Viareggio, Italy;
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Italy
- PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy
| | - Matteo Pacini
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy;
| | | | - Gian Luigi Gessa
- Emeritus of Neuropharmacology, University of Cagliari, 09124 Cagliari, Italy;
| | - Pedro Ruiz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Icro Maremmani
- PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy;
- Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-050-993045
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3
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Aggressive Behavior and Substance Use Disorder: The Heroin Use Disorder as a Case Study. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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4
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Kun B, Urbán R, Paksi B, Griffiths MD, Richman MJ, Demetrovics Z. The Effects of Trait Emotional Intelligence on Adolescent Substance Use: Findings From a Hungarian Representative Survey. Front Psychiatry 2019; 10:367. [PMID: 31231253 PMCID: PMC6567882 DOI: 10.3389/fpsyt.2019.00367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/13/2019] [Indexed: 11/13/2022] Open
Abstract
Previous research has emphasized the importance of emotions in the development of adult and adolescent substance use. There is substantial evidence for deficits in emotional processing among teenagers with substance use, but few studies have investigated the association between emotional intelligence and adolescent substance use. The aim of the present study was to examine the relationship between the use of tobacco, alcohol, and illicit drugs and level of emotional intelligence among adolescents. A representative sample of high school students participated in the study (N = 2,380). Substance use patterns were assessed using data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) Survey, and emotional intelligence was assessed with the Bar-On Emotional Quotient Inventory Youth Version. Self-esteem and depressive symptomatology were also assessed to compare their effects on the frequency of substance use with the effect of emotional intelligence. Results demonstrated that greater difficulty in stress management and empathy predicted a higher frequency of tobacco, alcohol, and cannabis use. However, the level of emotional intelligence showed only a weak relationship to substance use habits. Latent profile analyses supported the hypothesis that different emotional patterns and problems underlie different types of psychoactive substances. Using a multiple linear regression model, the present study found that although emotional intelligence is not a key factor underlying substance use habits, it has an individual effect on substance use beyond depressive tendencies and self-esteem. These results can be applied to both drug prevention programs and interventions in substance abuse treatment.
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Affiliation(s)
- Bernadette Kun
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Borbála Paksi
- Institute of Education, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Mara J Richman
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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5
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Kovatch M, Feingold D, Elkana O, Lev-Ran S. Evaluation and comparison of tools for diagnosing problematic prescription opioid use among chronic pain patients. Int J Methods Psychiatr Res 2017; 26:e1542. [PMID: 27774717 PMCID: PMC6877121 DOI: 10.1002/mpr.1542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/10/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022] Open
Abstract
Prescription opioid medications are commonly used for the treatment of chronic pain. Assessments of problematic opioid use among pain patients are inconsistent across studies, partially due to differences between various measures. Therefore, the most appropriate measure to use is often unclear. In this study we assessed problematic opioid use in a sample of 551 individuals receiving treatment for chronic pain, using three questionnaires: the Alcohol Use Disorder and Associated Disabilities Interview Schedule - Fourth Edition (AUDADIS-IV), the Current Opioid Misuse Measure (COMM) questionnaire and Portenoy's criteria (PC). These questionnaires yielded discordant positive rates of problematic use: 52.6%, 28.7%, and 17.1%, respectively, which did not change substantially when excluding AUDADIS-IV criteria of physical symptoms of tolerance and withdrawal. Although these three questionnaires share some statistically correlated content-based congruent questions, positive response rates to them were significantly different based on construction features, including questionnaires' referred time-frame, wording of questions and response alternatives. The findings of the present study illustrate strengths and limitations of the AUDADIS-IV, COMM and PC in diagnosing problematic opioid use in a population of adults suffering from chronic pain, and highlight the importance of recognizing and addressing specific questionnaire and question-related differences when identifying problematic opioid use in this population.
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Affiliation(s)
- Merav Kovatch
- Behavioral Sciences, Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel
| | - Daniel Feingold
- Ariel University, Ariel, Israel.,Addiction Medicine and Dual Diagnosis Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel
| | - Shaul Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Addiction Medicine and Dual Diagnosis Services, Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
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6
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Williams SC, Davey-Rothwell MA, Tobin KE, Latkin C. People Who Inject Drugs and Have Mood Disorders-A Brief Assessment of Health Risk Behaviors. Subst Use Misuse 2017; 52:1181-1190. [PMID: 28574740 PMCID: PMC5578394 DOI: 10.1080/10826084.2017.1302954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders. OBJECTIVES Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs. METHODS With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n = 113) or depression (n = 237) to a comparison group with no history of diagnosed mental illness (n = 446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms. RESULTS While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance: People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.
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Affiliation(s)
| | | | - Karin E Tobin
- a Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - Carl Latkin
- a Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
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7
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Costa LDS, Alencar ÁP, Nascimento Neto PJ, dos Santos MDSV, da Silva CGL, Pinheiro SDFL, Silveira RT, Bianco BAV, Pinheiro RFF, de Lima MAP, Reis AOA, Rolim Neto ML. Risk factors for suicide in bipolar disorder: a systematic review. J Affect Disord 2015; 170:237-54. [PMID: 25261630 DOI: 10.1016/j.jad.2014.09.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/18/2014] [Accepted: 09/02/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bipolar disorder confers the highest risk of suicide among major psychological disorders. The risk factors associated with bipolar disorder and suicide exist and are relevant to clinicians and researchers. OBJECTIVE The aim of the present study was to conduct a systematic review of articles regarding the suicide risk factors in bipolar disorder. METHODS A systematic review of articles on suicide risk factors in bipolar disorder, published from January 1, 2010 to April 05, 2014, on SCOPUS and PUBMED databases was carried out. Search terms were "Suicide" (medical subject headings [MeSH]), "Risk factors" (MeSH), and "Bipolar" (keyword). Of the 220 retrieved studies, 42 met the eligibility criteria. RESULTS Bipolar disorder is associated with an increased rate death by suicide which contributes to overall mortality rates. Studies covered a wide range of aspects regarding suicide risk factors in bipolar disorder, such as risk factors associated to Sociodemographic conditions, Biological characteristics, Drugs Relationships, Psychological Factors, Genetic Compound, Religious and Spirituals conditions. Recent scientific literature regarding the suicide risk factors in bipolar disorder converge to, directly or indirectly, highlight the negative impacts of risk factors to the affected population quality of life. CONCLUSION This review demonstrated that Bipolar disorders commonly leads to other psychiatric disorders and co-morbidities involving risk of suicide. Thus the risk factors are relevant to have a better diagnosis and prognosis of BD cases involving risk of suicide.
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Affiliation(s)
- Lucas da Silva Costa
- Laboratório de Escrita Científica, Faculdade de Medicina, Universidade Federal do Cariri, UFCA, Barbalha, Ceará, Brazil.
| | - Átila Pereira Alencar
- Laboratório de Escrita Científica, Faculdade de Medicina, Universidade Federal do Cariri, UFCA, Barbalha, Ceará, Brazil
| | | | | | | | | | - Regiane Teixeira Silveira
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Bianca Alves Vieira Bianco
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | | | - Alberto Olavo Advincula Reis
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, USP, São Paulo, São Paulo, Brazil
| | - Modesto Leite Rolim Neto
- Líder de Grupo de Pesquisa em Suicidologia, Universidade Federal do Ceará, UFC/Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq, Faculdade de Medicina, Universidade Federal do Cariri, UFCA, Barbalha, Ceará, Brazil
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8
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Six-month outcome in bipolar spectrum alcoholics treated with acamprosate after detoxification: a retrospective study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12983-96. [PMID: 25514151 PMCID: PMC4276657 DOI: 10.3390/ijerph111212983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/25/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022]
Abstract
Background: Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, including major depressive disorders and bipolar disorders. We speculate that, using acamprosate, patients with bipolar depression (BIP-A) can take advantage of the anti-glutamate effect of acamprosate to “survive” in treatment longer than peers suffering from non-bipolar depression (NBIP-A) after detoxification. Method: We retrospectively evaluated the efficacy of a long-term (six-month) acamprosate treatment, after alcohol detoxification, in 41 patients (19 males and 22 females), who could be classified as depressed alcoholics, while taking into account the presence/absence of bipolarity. Results: During the period of observation most NBIP-A patients relapsed, whereas a majority of BIP-A patients were still in treatment at the end of their period of observation. The cumulative proportion of ‘surviving’ patients was significantly higher in BIP-A patients, but this finding was not related to gender or to other demographic or clinically investigated characteristics. The treatment time effect was significant in both subgroups. The treatment time-group effect was significant (and significantly better) for bipolar patients on account of changes in the severity of their illness. Limitations: Retrospective methodology and the lack of DSM criteria in diagnosing bipolarity. Conclusions: Bipolarity seems to be correlated with the efficacy of acamprosate treatment in inducing patients to refrain from alcohol use after detoxification (while avoiding relapses) in depressed alcoholics. Placebo-controlled clinical trials are now warranted to check the validity of this hypothesis.
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9
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Nyamathi A, Salem B, Farabee D, Hall E, Zhang S, Khalilifard F, Faucette M, Leake B. Predictors of High Level of Hostility among Homeless Men on Parole. JOURNAL OF OFFENDER REHABILITATION 2014; 53:95-115. [PMID: 25083121 PMCID: PMC4114043 DOI: 10.1080/10509674.2013.868388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
High levels of hostility present a formidable challenge among homeless ex-offenders. This cross-sectional study assessed correlates of high levels of hostility using baseline data collected on recently-released male parolees (N=472; age 18-60) participating in a randomized trial focused on prevention of illicit drug use and recidivism. Predictors of high levels of hostility included greater depressive symptomatology, lower self-esteem, having a mother who was treated for alcohol/drugs, belonging to a gang, more tangible support, having used methamphetamine and having a history of cognitive difficulties. These findings highlight the need to understand predictors of hostility among recently released homeless men and how these predictors may relate to recidivism. Research implications are discussed as these findings will shape future nurse-led harm reduction and community-based interventions.
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10
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The long-term outcomes of heroin dependent-treatment-resistant patients with bipolar 1 comorbidity after admission to enhanced methadone maintenance. J Affect Disord 2013; 151:582-589. [PMID: 23931828 DOI: 10.1016/j.jad.2013.06.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/28/2013] [Accepted: 06/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the long-term outcomes of treatment-resistant bipolar 1 heroin addicts with peers who were without DSM-IV axis I psychiatric comorbidity (dual diagnosis). METHOD 104 Heroin-dependent patients (TRHD), who also met criteria for treatment resistance - 41 of them with DSM-IV-R criteria for Bipolar 1 Disorder (BIP1-TRHD) and 63 without DSM-IV-R axis I psychiatric comorbidity (NDD-TRHD) - were monitored prospectively (3 years on average, min. 0.5, max. 8) along a Methadone Maintenance Treatment Programme (MMTP). RESULTS The rates for survival-in-treatment were 44% for NDD-TRHD patients and 58% for BIP1-TRHD patients (p=0.062). After 3 years of treatment such rates tended to become progressively more stable. BIP1-TRHD patients showed better outcome results than NDD-TRHD patients regarding CGI severity (p<0.001) and DSM-IV GAF (p<0.001). No differences were found regarding urinalyses for morphine between groups during the observational period. Bipolar 1 patients needed a higher methadone dosage in the stabilization phase, but this difference was not statistically significant. LIMITATIONS The observational nature of the protocol, the impossibility of evaluating a follow-up in the case of the patients who dropped out, and the multiple interference caused by interindividual variability, the clinical setting and the temporary use of adjunctive medications. CONCLUSIONS Contrary to expectations, treatment-resistant patients with bipolar 1 disorder psychiatric comorbidity showed a better long-term outcome than treatment-resistant patients without psychiatric comorbidity.
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11
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Maremmani AGI, Rovai L, Rugani F, Pacini M, Lamanna F, Bacciardi S, Perugi G, Deltito J, Dell’Osso L, Maremmani I. Correlations between awareness of illness (insight) and history of addiction in heroin-addicted patients. Front Psychiatry 2012; 3:61. [PMID: 22787450 PMCID: PMC3391664 DOI: 10.3389/fpsyt.2012.00061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 06/03/2012] [Indexed: 11/17/2022] Open
Abstract
In a group of 1066 heroin addicts, who were seeking treatment for opioid agonist treatment, we looked for differences in historical, demographic, and clinical characteristics, between patients with different levels of awareness of illness (insight). The results showed that, in the cohort studied, a majority of subjects lacked insight into their heroin-use behavior. Compared with the impaired-insight group, those who possessed insight into their illness showed significantly greater awareness of past social, somatic, and psychopathological impairments, and had a greater number of past treatment-seeking events for heroin addiction. In contrast with other psychiatric illnesses, the presence of awareness appears to be related to the passing of time and to the worsening of the illness. Methodologies to improve the insight of patients should, therefore, be targeted more directly on patients early in their history of heroin dependence, because the risk of lack of insight is greatest during this period.
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Affiliation(s)
- Angelo Giovanni Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
- Association for the Application of Neuroscientific Knowledge to Social AimsLucca, Italy
| | - Luca Rovai
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
| | - Fabio Rugani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
| | - Matteo Pacini
- Association for the Application of Neuroscientific Knowledge to Social AimsLucca, Italy
| | | | - Silvia Bacciardi
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
| | - Giulio Perugi
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
| | - Joseph Deltito
- G. De Lisio Institute of Behavioural SciencesPisa, Italy
- Department of Psychiatry and Behavioural Science, New York Medical CollegeValhalla, NY, USA
| | - Liliana Dell’Osso
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
| | - Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of PisaPisa, Italy
- Association for the Application of Neuroscientific Knowledge to Social AimsLucca, Italy
- G. De Lisio Institute of Behavioural SciencesPisa, Italy
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12
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Pergolizzi JV, Gharibo C, Passik S, Labhsetwar S, Taylor R, Pergolizzi JS, Müller-Schwefe G. Dynamic risk factors in the misuse of opioid analgesics. J Psychosom Res 2012; 72:443-51. [PMID: 22656441 DOI: 10.1016/j.jpsychores.2012.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 02/16/2012] [Accepted: 02/18/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Identify the risk factors for prescription opioid misuse among patients taking prescription opioids to deal with chronic pain. METHODS We examined the literature for a variety of dynamic risk factors associated with opioid misuse among the chronic pain population in order to present a narrative review. Considered were: taking single or multiple opioids, pain intensity, mental health disorders, including a history of preadolescent sexual abuse, personal and familial history of substance abuse, a history of legal problems, being a crime victim, drug-seeking behaviors, drug craving, and age. RESULTS A variety of risk factors have been studied in the literature. Risk factors in chronic opioid therapy patients are dynamic in that they can change with disease progression, tolerance, changes in pain quality, mental health, comorbidities, other drug therapies or drug interactions, and changes in the patient's lifestyle. CONCLUSION Opioid analgesic therapy must be tailored to carefully monitor all patients in order to minimize misuse and abuse, since the risk is constant and dynamic and therefore every patient is at some degree of risk for opioid misuse.
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Affiliation(s)
- Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Maremmani I, Perugi G, Rovai L, Maremmani AGI, Pacini M, Canonico PL, Carbonato P, Mencacci C, Muscettola G, Pani L, Torta R, Vampini C, Akiskal HS. Are "social drugs" (tobacco, coffee and chocolate) related to the bipolar spectrum? J Affect Disord 2011; 133:227-33. [PMID: 21605911 DOI: 10.1016/j.jad.2011.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/21/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Across all ages and cultures, mankind has always used substances in order to induce pleasurable sensations or desirable psychophysical states. These substances, notably caffeine, tobacco, alcohol and chocolate, can be labeled 'social drugs'. METHODS We analyzed the social drug habits of 562 patients suffering from mood disorders, according to DSM-IV-R criteria (major depressive episode, recurrent depression, bipolar type I and II disorders and depression not otherwise specified). The sample was also divided into bipolar and non-bipolar according to Hypomania Check-list 32 (HCL-32), which proposes a broader concept of hypomania and soft bipolarity, comprising the spectrum of bipolar disorders proper, along with other, "softer" expressions of bipolarity intermediate between bipolar disorder and normality. RESULTS Using HCL-32 criteria, but DSM-IV-R criteria, a link was confirmed between bipolar spectrum and substance use including social drugs such as tobacco and coffee. LIMITATION Observational correlational study. CONCLUSION This study is in support of earlier theoretical formulations within the framework of the Pisa-San Diego collaboration.
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Affiliation(s)
- Icro Maremmani
- Department of Psychiatry, University of Pisa and G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.
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Abstract
Since the millennium, an expanding number of research articles have examined the relationship between emotional intelligence (EI) and physical and mental health. The relationship between EI and addictive disorders has, however, remained relatively well-hidden. We therefore systematically reviewed and critically evaluated the literature on this relationship. We identified 51 articles on the topic of which 36 fulfilled our inclusion criteria. Results indicate that a lower level of EI is associated with more intensive smoking, alcohol use, and illicit drug use and two components of EI play a key role in addictions: "decoding and differentiation of emotions" and "regulation of emotions."
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Affiliation(s)
- Bernadette Kun
- Institutional Group on Addiction Research, Eötvös Loránd University, Budapest, Hungary
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15
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Maremmani I, Pani PP, Pacini M, Bizzarri JV, Trogu E, Maremmani AGI, Gerra G, Perugi G, Dell'Osso L. Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90). Ann Gen Psychiatry 2010; 9:15. [PMID: 20388223 PMCID: PMC2861658 DOI: 10.1186/1744-859x-9-15] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 04/13/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions. METHODS Using the Self-Report Symptom Inventory (SCL-90), we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females) aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence. RESULTS A total of 150 (14.2%) patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4%) had somatisation symptoms, 205 (19.4%) interpersonal sensitivity and psychotic symptoms, 235 (22.3%) panic symptomatology, 208 (19.7%) violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology. CONCLUSIONS This study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.
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Affiliation(s)
- Icro Maremmani
- 'Vincent P Dole' Dual Diagnosis Unit, 'Santa Chiara' University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa, Italy
- AU-CNS, 'From Science to Public Policy' Association, Pietrasanta, Lucca, Italy
- 'G De Lisio', Institute of Behavioural Sciences, Pisa, Italy
| | - Pier Paolo Pani
- Social-Health Direction, Health District 8 (ASL 8), Cagliari, Italy
| | - Matteo Pacini
- 'Vincent P Dole' Dual Diagnosis Unit, 'Santa Chiara' University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa, Italy
- 'G De Lisio', Institute of Behavioural Sciences, Pisa, Italy
| | | | - Emanuela Trogu
- Social-Health Direction, Health District 8 (ASL 8), Cagliari, Italy
| | - Angelo GI Maremmani
- 'Vincent P Dole' Dual Diagnosis Unit, 'Santa Chiara' University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa, Italy
- AU-CNS, 'From Science to Public Policy' Association, Pietrasanta, Lucca, Italy
- 'G De Lisio', Institute of Behavioural Sciences, Pisa, Italy
| | - Gilberto Gerra
- Global Challenges Section, Human Security Branch, Division for Operations, United Nations Office on Drugs and Crime, Vienna
| | - Giulio Perugi
- 'Vincent P Dole' Dual Diagnosis Unit, 'Santa Chiara' University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa, Italy
- 'G De Lisio', Institute of Behavioural Sciences, Pisa, Italy
| | - Liliana Dell'Osso
- 'Vincent P Dole' Dual Diagnosis Unit, 'Santa Chiara' University Hospital, Department of Psychiatry, NPB, University of Pisa, Pisa, Italy
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Conrad R, Walz F, Geiser F, Imbierowicz K, Liedtke R, Wegener I. Temperament and character personality profile in relation to suicidal ideation and suicide attempts in major depressed patients. Psychiatry Res 2009; 170:212-7. [PMID: 19897251 DOI: 10.1016/j.psychres.2008.09.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 09/17/2008] [Accepted: 09/30/2008] [Indexed: 10/20/2022]
Abstract
To prevent suicidal behaviour, it is important to better understand those personality traits associated with suicidal ideation and suicide attempts. A sample of 394 consecutive major depressed outpatients admitted to Bonn University Hospital was subdivided into three groups: Lifetime suicide attempters (N=32; 8.1%), suicide ideators (N=133) and patients without suicide ideation (N=229). Psychodiagnostic measures embraced the Temperament and Character Inventory (TCI), the Symptom Checklist-90-R and the Hamilton Depression Rating Scale. Suicide attempters and ideators showed higher scores on emotional distress and depression. Analysis of covariance (covariates: age, gender, depression) revealed that suicide attempters score higher on the temperament dimension harm avoidance compared with non-attempters. Suicide ideators could be distinguished from non-ideators by character dimensions in terms of lower self-directedness and higher self-transcendence. Our findings suggest that high harm avoidance is a personality trait associated with suicide attempt in major depression, whereas low self-directedness and high self-transcendence are related to suicidal ideation. As temperament dimensions represent the "emotional core" and character dimensions the "cognitive core" of personality, we discuss whether Cloninger's psychobiological model might be helpful to distinguish between non-suicide ideators, patients who do think about suicide, and patients initiating suicidal behaviour.
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Affiliation(s)
- Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Germany.
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Maremmani I, Pacini M, Popovic D, Romano A, Maremmani AGI, Perugi G, Deltito J, Akiskal K, Akiskal H. Affective temperaments in heroin addiction. J Affect Disord 2009; 117:186-92. [PMID: 19201034 DOI: 10.1016/j.jad.2009.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 01/08/2009] [Accepted: 01/08/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Much of the literature has described personality disorder constructs for heroin addicts. Building on previous work we examine the relevance of affective temperament measures in these patients. METHODS 59 consecutive stabilized methadone treated heroin addicts, 34 with and 25 without psychiatric comorbidity, were compared, regarding affective temperaments, according to the Akiskal and Mallya formulation, with 58 healthy volunteers sharing similar social and regional demographics. RESULTS No differences were observed between heroin addicts and controls on either depressive or hyperthymic scales. Significant discrepancies were noted in cyclothymic and irritability scales, on which heroin addicts scored higher, regardless of the presence or absence of a dual diagnosis. In a multivariate discriminant analysis, mainly cyclothymic, and (to a lesser extent) irritable traits show a distinction between heroin addicts and controls, but not between heroin addicts with and without dual diagnoses. LIMITATION Cross-sectional study. CONCLUSION Our data suggest a new hypothesis. Cyclothymic, and to a lesser extent irritable traits (the "dark side"), could represent the temperamental profile of heroin addicts, largely irrespective of comorbidity, and tend to cohere with previous conceptualizations hypothesizing "sensation-seeking" (and "novelty-seeking") as the main personality characteristics of addiction.
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Affiliation(s)
- Icro Maremmani
- Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, 56100 Pisa Italy.
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