The long-term outcomes of heroin dependent-treatment-resistant patients with bipolar 1 comorbidity after admission to enhanced methadone maintenance.
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).


METHODS
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.


CONCLUSIONS
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.
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy; AU-CNS, Association for the Application of Neuroscientific Knowledge to Social Aims, Pietrasanta, Lucca, Italy. Electronic address: maremman@med.unipi.it.
Angelo Giovanni Icro
AGI
Maremmani
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy.
Luca
L
Rovai
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy.
Silvia
S
Bacciardi
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy.
Fabio
F
Rugani
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.
Matteo
M
Pacini
Social and Health Services, Health District 8 (ASL 8), Cagliari, Italy.
Pier
P
Paolo Pani
Department of Clinical and Experimental Medicine, University of Pisa, Italy.
Liliana Dell'
LD
Osso
International Mood Centre, University of California, San Diego, CA, USA.
Hagop
H
Akiskal
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy; AU-CNS, Association for the Application of Neuroscientific Knowledge to Social Aims, Pietrasanta, Lucca, Italy; G. De Lisio Institute of Behavioural Sciences, Pisa, Italy.
Icro
I
Maremmani
D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D003932:Heroin / Q000627:therapeutic use; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D009294:Narcotics; D003932:Heroin; D008691:Methadone
Dual diagnosis; High-threshold methadone maintenance programme; Long-term outcome; Methadone maintenance