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Annals of General Psychiatry
Published in: Annals of General Psychiatry 1/2012

Open Access 01-12-2012 | Primary research

Clinical presentations of substance abuse in bipolar heroin addicts at time of treatment entry

Authors: Icro Maremmani, Angelo Giovanni Icro Maremmani, Fabio Rugani, Luca Rovai, Matteo Pacini, Silvia Bacciardi, Joseph Deltito, Liliana Dell’Osso, Hagop S Akiskal

Published in: Annals of General Psychiatry | Issue 1/2012

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Abstract

Background

Studies on the ‘self-medication hypothesis’ have focused on substance abuse as an attempt to alleviate emotional suffering.

Methods

We have investigated concomitant substances of abuse in 150 bipolar heroin addicts clustered according to their clinical presentation at treatment entry (depressive episode, hypomanic episode, manic episode and mixed episode). Bipolar heroin addicted patients were chosen because they tend to have a concomitant poly-substance abuse and because, as compared with patients suffering for other mental illnesses, they more clearly reveal a variety of identifiable affective states.

Results

Patients with a depressive episode more frequently used non-prescribed anxiolytic-hypnotics. They were found to use cocaine-amphetamines more frequently during a hypomanic episode, whereas the use of cannabis and cocaine-amphetamines occurred more frequently during a manic episode. The associated use of alcohol, cocaine-amphetamines and cannabinoids was more frequently encountered during a mixed episode. Limitations: apart from the difficulty in determining whether the substance use modifies the mood or the mood state determines the substance used, this is a report on a retrospective analysis, rather than a study specifically designed to elucidate the issue; in addition, no information was available on the temperament of our subjects. Assessments of the same subject in various clinical presentations would have provided a better level of information.

Conclusions

Besides one expected result – the prominent use of CNS stimulants during a depressive phase of bipolar patients – this study supports the hypothesis that mood elation is a pleasurable, rewarding experience that, in bipolar patients, can be started or prolonged by means of CNS stimulant drugs. Stimulant use was, therefore, more prevalent during the ‘up’ rather than the ‘down’ phase of the illness.
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Metadata
Title
Clinical presentations of substance abuse in bipolar heroin addicts at time of treatment entry
Authors
Icro Maremmani
Angelo Giovanni Icro Maremmani
Fabio Rugani
Luca Rovai
Matteo Pacini
Silvia Bacciardi
Joseph Deltito
Liliana Dell’Osso
Hagop S Akiskal
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2012
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/1744-859X-11-23

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