title: Allostasis as a conceptual framework linking bipolar disorder and addiction.
abstract: Bipolar disorders (BDs) and addictions constitute reciprocal risk factors and are best considered under a unitary perspective. The concepts of allostasis and allostatic load (AL) may contribute to the understanding of the complex relationships between BD and addictive behaviors. Allostasis entails the safeguarding of reward function stability by recruitment of changes in the reward and stress system neurocircuitry and it may help to elucidate neurobiological underpinnings of vulnerability to addiction in BD patients. Conceptualizing BD as an illness involving the cumulative build-up of allostatic states, we hypothesize a progressive dysregulation of reward circuits clinically expressed as negative affective states (i.e., anhedonia). Such negative affective states may render BD patients more vulnerable to drug addiction, fostering a very rapid transition from occasional drug use to addiction, through mechanisms of negative reinforcement. The resulting addictive behavior-related ALs, in turn, may contribute to illness progression. This framework could have a heuristic value to enhance research on pathophysiology and treatment of BD and addiction comorbidity.
authors.affiliation: Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pettorruso
authors.affiliation: Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Risio
authors.affiliation: Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Nicola
authors.affiliation: Department of Neuroscience and Imaging, Institute of Psychiatry, "G. d'Annunzio" University of Chieti-Pescara , Chieti , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinotti
authors.affiliation: Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Conte
authors.affiliation: Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Janiri
keywords: CRF/HPA axis and stress system; addiction vulnerability; allostasis and allostatic load; bipolar disorders; comorbidity; dopaminergic system; hedonic tone and anhedonia; reward system