title: Differentiating between the course of illness in bipolar 1 and chronic-psychotic heroin-dependent patients at their first agonist opioid treatment.
abstract: In an effort to inquiry the "self-medication hypothesis" in heroin-dependent patients suffering from chronic psychosis and bipolar disorder, 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 agonist opioid treatment. 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 diagnoses. 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 agonist opioid treatment with a more severe addictive disease.
authors.affiliation: a Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences , Santa Chiara University Hospital, University of Pisa , Italy.
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: Enrico
authors.initials: E
authors.lastname: Massimetti
authors.forename: Denise
authors.initials: D
authors.lastname: Gazzarrini
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; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology*; D002908:Chronic Disease; D015331:Cohort Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy / Q000523:psychology* / Q000652:urine; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology*; D012651:Self Medication / Q000523:psychology; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists
keywords: Dual-diagnosis heroin-dependent patients; bipolar 1 disorder; chronic psychosis; course and severity of addictive illness; “self-medication hypothesis”