Maremmani Icro, Perugi Giulio, Pacini Matteo, Akiskal Hagop S
Santa Chiara University Hospital, Psychiatric Unit 1, University of Pisa, Italy, EU.
J Affect Disord. 2006 Jul;93(1-3):1-12. doi: 10.1016/j.jad.2006.02.022. Epub 2006 May 3.
Bipolar spectrum disorders and addiction often co-occur and constitute reciprocal risk factors that the authors believe are best considered under a unitary perspective. In particular, we submit that patients whose disorders fall under the bipolar spectrum - and its hyperthymic and cyclothymic temperamental substrates are at increased risk for substance use, possibly moving towards addiction through exposure to intrinsically dependence-producing substances. In our experience, the contribution of bipolar spectrum disorders to the addictive process is often clinically missed, because attenuated and subclinical expressions of such mood disorders as bipolar II and cyclothymia are not adequately appreciated by our current formal diagnostic system (e.g. DSM-IV, as well as research and clinical practice based on it). The use of agonist treatment in dual diagnosis heroin addicts has allowed us to gather valuable knowledge about the intrinsic, and historically and clinically documented mood-regulating effects of opiates. From the therapeutic point of view, the challenge of double diagnosis requires double competence from clinicians. The combination of opiate agonists and mood stabilizers often produces results difficult to obtain with the use of the two types of drugs separately. We therefore submit that the present conceptualization of the link between bipolar spectrum and addictive disorders has not only heuristic and scientific values, but also an important message for the clinician.
双相谱系障碍与成瘾常常同时出现，构成相互的风险因素，作者认为最好从单一视角来考虑这些因素。特别是，我们提出，那些疾病属于双相谱系的患者——及其情感高涨和环性心境气质性基础——物质使用风险增加，可能通过接触本质上产生依赖的物质而走向成瘾。根据我们的经验，双相谱系障碍对成瘾过程的影响在临床上常常被忽视，因为双相II型障碍和环性心境障碍等此类情绪障碍的减弱和亚临床表现未被我们当前的正式诊断系统（如DSM-IV以及基于它的研究和临床实践）充分认识。在双重诊断的海洛因成瘾者中使用激动剂治疗使我们能够收集到关于阿片类药物内在的、有历史和临床记录的情绪调节作用的宝贵知识。从治疗角度来看，双重诊断带来的挑战要求临床医生具备双重能力。阿片类激动剂和心境稳定剂联合使用往往会产生单独使用这两种药物难以获得的效果。因此，我们提出，目前对双相谱系与成瘾性障碍之间联系的概念化不仅具有启发式和科学价值，对临床医生也有重要启示。
