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Loreto BBL, Sordi AO, de Castro MN, Ornell F, Guarnieri EP, Roza TH, Schuch JB, Cima MDS, Pechansky F, Grevet EH, Grassi-Oliveira R, von Diemen L, Kessler FHP. Proposing an integrative, dynamic and transdiagnostic model for addictions: dysregulation phenomena of the three main modes of the predostatic mind. Front Psychiatry 2024; 14:1298002. [PMID: 38274436 PMCID: PMC10808830 DOI: 10.3389/fpsyt.2023.1298002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Several theories have been proposed to explain the complex diagnostic aspects related to addiction disorders and their development. Recent frameworks tend to focus on dimensional perspectives of symptoms rather than categorical systems, since substance use disorders are frequently comorbid with other psychiatric and especially personality disorders. However, useful transdiagnostic models that could integrate clinical evaluation derived from neuroscientific theories are lacking. In the present manuscript, the authors propose a model based on a new paradigm, in an attempt to better explain this complex, multifaceted phenomenon. The new paradigm presupposes that emotions and behavior are a response to risk prediction. Individuals make choices and engage in actions to manage potential risks/rewards in order to seek or maintain homeostasis in their internal and external environments - a mechanism that the authors call predostatic (predictive mechanism with homeostatic purpose). The model considers three main modes of the predostatic mind: (1) Alarm Mode, activated by high and/or imminent risk prediction; (2) Seek Mode, activated by long-term risk or reward prediction; and (3) Balance Mode, a self-regulating state of mind related to low risk prediction, a soothing system and a calm state. Addiction is seen as a chronic dysregulation of organism systems leading to internalizing or externalizing phenomena mainly related to the Seek and Alarm Modes, which are persistently activated by reward and risk prediction, respectively, thus hindering Balance. Addiction neuroscience research has shown that chronic drug use or engagement in addictive behaviors can lead to neuroadaptations in the brain reward circuitry, disrupting normal balance and the regulation of reward processes. This dysregulation can contribute to persistent drug-seeking/addictive behaviors despite negative consequences. This newly proposed dynamic and integrative model, named dysregulation based on externalizing and internalizing phenomena of the three main modes of the predostatic mind (DREXI3), proposes six dysregulation dimensions with basic emotional and behavioral symptoms, such as neurophysiological alterations, impulsivity, compulsion, cognitive impairment/psychosis, mood, and anxiety/anger. In this paper, the authors explain the rationale behind DREXI3 and present some hypothetical clinical examples to better illustrate the use of the model in clinical practice. The development of this innovative model could possibly guide tailored treatment interventions in the addiction field.
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Affiliation(s)
- Bibiana Bolten Lucion Loreto
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Anne Orgler Sordi
- Addiction and Forensic Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Melina Nogueira de Castro
- Addiction and Forensic Psychiatry Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Felipe Ornell
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eduardo Pegoraro Guarnieri
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jaqueline Bohrer Schuch
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marcos da Silveira Cima
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flavio Pechansky
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eugênio Horácio Grevet
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Department of Clinical Medicine, Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark
| | - Lisia von Diemen
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Felix Henrique Paim Kessler
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Sutradhar B, Mukherjee D, Pathak K. An observational study on deliberate self-harm in individuals with alcohol dependence syndrome. Ind Psychiatry J 2023; 32:369-374. [PMID: 38161452 PMCID: PMC10756610 DOI: 10.4103/ipj.ipj_50_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 01/03/2024] Open
Abstract
Context Comorbidities in alcohol dependence syndrome (ADS) are often associated with poor treatment outcomes and high service utilization. Deliberate self-harm (DSH) in India is a silent epidemic. There is a shortage of research on individuals with ADS, psychiatric comorbidities, and DSH. Aim To study DSH and psychiatric comorbidity in persons with ADS. Settings and Design A cross-sectional study of 1-year duration is conducted in out patient department/indoor patient department of a tertiary care hospital. Methods and Material Eighty-one individuals with ADS were selected purposefully. A semi-structured pro forma, the severity of alcohol dependence questionnaire, Mini-International Neuropsychiatric Interview (MINI), and Deliberate Self-Harm Inventory were administered for assessment. The statistical analysis used is as follows: correlation statistics and logistic regression. Results Most subjects were married, belonged to upper-middle socioeconomic status, had at least secondary education, and had moderate alcohol dependence severity. Almost 3/4th of the subjects had at least one lifetime psychiatric disorder. A past episode of major depressive disorder was found in 47%. Nearly 20% of study subjects had a history of DSH, which was significantly associated with unmarried status, and earlier age of alcohol dependence. Marital status, educational level, and age of onset of alcohol dependence explain 64.3% of the variance in DSH attempts. Suicidality was significantly related to the presence of DSH. Conclusions The study found a high prevalence of psychiatric disorders and a history of DSH in individuals with ADS. The study confirmed the association between DSH and suicidality and indicated a specific subpopulation of ADS who need thorough clinical assessments to recognize these psychiatric comorbidities and DSH.
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Affiliation(s)
- Bikram Sutradhar
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India
| | - Diptadhi Mukherjee
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India
| | - Kangkan Pathak
- Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), Tezpur, India
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Tarantino G, Cataldi M, Citro V. Could Alcohol Abuse and Dependence on Junk Foods Inducing Obesity and/or Illicit Drug Use Represent Danger to Liver in Young People with Altered Psychological/Relational Spheres or Emotional Problems? Int J Mol Sci 2022; 23:ijms231810406. [PMID: 36142317 PMCID: PMC9499369 DOI: 10.3390/ijms231810406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and display greater sensitivity to the reinforcing properties of “pleasurable stimuli”, specifically in those situations in which an enhanced dopamine release is present. Alcoholic beverages, foods rich in sugar and fat, and illicit drug use are pleasurable feelings associated with rewards. Research shows that there is a link between substance abuse and obesity in brain functioning. Still, alcohol excess is central in leading to obesity and obesity-related morbidities, such as hepatic steatosis, mainly when associated with illicit drug dependence and negative eating behaviours in young people. It is ascertained that long-term drinking causes mental damage, similarly to drug abuse, but also affects liver function. Indeed, beyond the pharmacokinetic interactions of alcohol with drugs, occurring in the liver due to the same metabolic enzymes, there are also pharmacodynamic interactions of both substances in the CNS. To complicate matters, an important noxious effect of junk foods consists of inducing obesity and obesity-related NAFLD. In this review, we focus on some key mechanisms underlying the impact of these addictions on the liver, as well as those on the CNS.
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Affiliation(s)
- Giovanni Tarantino
- Department of Clinical Medicine and Surgery, “Federico II” University Medical School of Naples, 80131 Naples, Italy
- Correspondence:
| | - Mauro Cataldi
- Section of Pharmacology, Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University of Naples, 80138 Naples, Italy
| | - Vincenzo Citro
- Department of General Medicine, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy
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