title: Does dual diagnosis affect violence and moderate/superficial self-harm in heroin addiction at treatment entry?
abstract: OBJECTIVE
  The presence of aggressive and self-harm behaviors is common in heroin-addicted patients, but these frequent co-occurrences have been poorly investigated. Given the fact that self-harm may be seen as both a clear addictive behavior, with its opiate theory, and as part of psychiatric illness, such as psychosis and bipolar spectrum disorders, in this study, we intend to investigate which of the 2 models is more consistent.
  
  
  METHODS
  We compared dual diagnosis with the clinical features of 30 moderate/superficial self-harmed and 162 violent heroin-addicted patients who reported aggressive behavior in the month preceding their request to be treated. As control group, we selected 808 lifetime nonviolent heroin-addicted patients.
  
  
  RESULTS
  The presence of a bipolar spectrum diagnosis proved to be the highest risk factor (B = 4.33; exp(B) = 76.52; 95% confidence interval for exp(B) = 35.69-164.04; P < 0.001) for the presence of aggressive behavior (χ²= 433.05; df = 5; P < 0.001). The highest risk factor for the presence of moderate/superficial self-harm (χ² = 24.83; df = 2; P < 0.001) was a dual diagnosis for chronic psychosis (β = 1.46; exp(B) = 4.34); 95% confidence interval for exp(B) = 1.11-16.98; P < 0.001). The relationships between aggressive and/or self-harm behaviors and the natural history of addiction in heroin-addicted patients seemed to be less consistent.
  
  
  CONCLUSIONS
  Our data show a frequent co-occurrence of aggression and bipolar spectrum disorder in heroin-addicted patients, which is manifested as aggression directed toward others (violence). On the contrary, self-injurious behavior seems to be strongly correlated with psychotic disorders. Thus, aggressive behavior seems to be correlated, in heroin-addicted patients before entering treatment, with dual diagnosis rather than with a natural history of heroin addiction.
authors.affiliation: From the Vincent P. Dole Dual Diagnosis Unit (AGIM, FR, SB, LR, MP, IM), Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy, EU; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS) (AGIM, IM), Pietrasanta, Lucca, Italy, EU; G. De Lisio Institute of Behavioural Sciences (MP, IM), Pisa, Italy, EU; and Department of Clinical and Experimental Medicine (LD), University of Pisa, Italy, EU.
authors.forename: Angelo Giovanni Icro
authors.initials: AG
authors.lastname: Maremmani
authors.forename: Fabio
authors.initials: F
authors.lastname: Rugani
authors.forename: Silvia
authors.initials: S
authors.lastname: Bacciardi
authors.forename: Luca
authors.initials: L
authors.lastname: Rovai
authors.forename: Matteo
authors.initials: M
authors.lastname: Pacini
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology; D016739:Behavior, Addictive / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult