Maremmani Angelo G I, Gazzarrini Denise, Fiorin Amelia, Cingano Valeria, Bellio Graziano, Perugi Giulio, Maremmani Icro
Department of Psychiatry, North-Western Tuscany Region Local Health Unit, Versilian Zone, Viareggio, Italy.
Association for the Application of Neuroscientific Knowledge To Social Aims (AU-CNS), Pietrasanta, Italy.
Ann Gen Psychiatry. 2018 Jan 16;17:3. doi: 10.1186/s12991-018-0173-7. eCollection 2018.
In the Gambling Disorder (GD), there is no exogenous drug administration that acts as the central core of the traditional meaning of addiction. A specific psychopathology of Substance Use Disorders has been proposed recently. In a sample of Heroin Use Disorder (HUD) patients entering opioid agonist treatment, it became possible to identify a group of 5 mutually exclusive psychiatric dimensions: Worthlessness-Being trapped (W-BT), Somatic Symptoms (SS), Sensitivity-Psychoticism (SP), Panic Anxiety (PA) and Violence-Suicide (VS). The specificity of these dimensions was suggested by the absence of their correlations with treatment choice, active substance use, psychiatric comorbidity and the principal substance of abuse and by the opportunity, through their use, of fully discriminating HUD from Major Depression patients and, partially, from obese non-psychiatric patients. To further support this specificity in the present study, we tested the feasibility of discriminating HUD patients from those affected by a non-substance-related addictive behaviour, such as GD. In this way, we also investigated the psychopathological peculiarities of GD patients.
We compared the severity and frequency of each of the five aspects found by us, in 972 (83.5% males; mean age 30.12 ± 6.6) HUD and 110 (50% males; average age 30.12 ± 6.6) GD patients at univariate ( test; Chi square) and multivariate (discriminant analysis and logistic regression) level.
HUD patients showed higher general psychopathology indexes than GD patients. The severity of all five psychopathological dimensions was significantly greater in HUD patients. Discriminant analysis revealed that SS and VS severity were able to discriminate between HUD (higher severity) and GD patients (lower severity), whereas PA and SP could not. W-BT severity was negatively correlated with SS and VS; GD patients were distinguished by low scores for SS and VS low scores associated with high ones for W-BT. Psychopathological subtypes characterized by SS and VS symptomatology were better represented in HUD patients, whereas PA symptomatology was more frequent in GD individuals. No differences were observed regarding the W-BT and SP dimensions. At multivariate level, the one prominent characteristic of HUD patients was the presence of SS (OR = 5.43) as a prominent qualification for psychopathological status.
Apart from the lower severity of all psychopathological dimensions, only the lower frequency of SS typology seems to be the prominent factor in GD patients. The SCL90-defined structure of opioid addiction seems to be useful even in non-substance-related addictive disorders, as in the case of GD patients, further supporting the possible existence of a psychopathology specific to addiction.
在赌博障碍（GD）中，不存在作为传统成瘾意义核心的外源性药物使用情况。最近有人提出了物质使用障碍的一种特定精神病理学。在进入阿片类激动剂治疗的海洛因使用障碍（HUD）患者样本中，有可能识别出一组5个相互排斥的精神维度：无价值感 - 被困感（W - BT）、躯体症状（SS）、敏感 - 精神病性（SP）、惊恐焦虑（PA）和暴力 - 自杀（VS）。这些维度的特异性表现在它们与治疗选择、当前物质使用、精神共病以及主要滥用物质均无相关性，并且通过使用这些维度，能够将HUD患者与重度抑郁症患者完全区分开来，部分程度上也能与肥胖非精神科患者区分开来。为了在本研究中进一步支持这种特异性，我们测试了区分HUD患者与受非物质相关成瘾行为（如GD）影响的患者的可行性。通过这种方式，我们还研究了GD患者的精神病理学特点。
我们在单变量（t检验；卡方检验）和多变量（判别分析和逻辑回归）水平上比较了我们在972名（83.5%为男性；平均年龄30.12±6.6岁）HUD患者和110名（50%为男性；平均年龄30.12±6.6岁）GD患者中发现的五个方面各自的严重程度和频率。
HUD患者的总体精神病理学指标高于GD患者。所有五个精神病理学维度的严重程度在HUD患者中显著更高。判别分析显示SS和VS严重程度能够区分HUD患者（严重程度更高）和GD患者（严重程度更低），而PA和SP则不能。W - BT严重程度与SS和VS呈负相关；GD患者的特点是SS得分低以及VS得分低且W - BT得分高。以SS和VS症状学为特征的精神病理亚型在HUD患者中表现更明显，而PA症状学在GD个体中更常见。在W - BT和SP维度上未观察到差异。在多变量水平上，HUD患者的一个突出特征是存在SS（比值比=5.43）作为精神病理状态的突出特征。
除了所有精神病理学维度的严重程度较低外，似乎只有SS类型的较低频率是GD患者的突出因素。阿片类成瘾的SCL90定义结构似乎在非物质相关成瘾障碍（如GD患者）中也有用，进一步支持了可能存在特定于成瘾的精神病理学。
