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Somaini L.,Addiction Treatment Center | Pacini M.,G Of Lisio Institute Of Behavioral Science | Maremmani I.,G Of Lisio Institute Of Behavioral Science | Maremmani I.,University of Pisa
Heroin Addiction and Related Clinical Problems | Year: 2010

The immune system is an organization of cells and molecules with specialized roles in defending against infection. Communication between the central nervous and the immune system lies at the hart of the neuroimmune axis. There are several data indicating that opioids drugs may influence the immune system. One of the main features of opioid induced alteration of immune function is the development of immunosuppression. However, evidence has been provided to suggest that different opioids drugs may have distinctive effects on the immune system. Methadone is a widely used synthetic 3,3-diphenylpropylamine opioid which primarily acts at the μ opioid receptor. Its most common use is in the therapy for opioid dependence. Besides to their therapeutic efficacy, opioids can produce several well known adverse events, and, as has recently been recognized, can positively interfere with the immune response. Infact, data obtain from animal and human studies have demonstrated that long acting opioids drugs such as methadone is devoid of any intrinsic immunosuppressive activity. This effect may partly depend on the ability of methadone to restore the HPA axis function, that is altered in heroin dependent patient, or by the long-lasting activation of opioid receptors both in the central nervous system and on immune competent cells. HIV and HCV infections are the most frequent infectious disease seen in drugs users. Opioids may facilitate the outbreak of infections through marked immunomodulating effects on the immune respsoses against a virus. The enrolment of heroin patient in MMT programs represents a particularly effective measure for the prevention of HCV and HIV virus transmission and the immunorestoring properties of methadone are particularly relevant in the treatment of concurrent infectious such as HCV frequently associated with heroin addiction. It is evident that the possibility to reach an adequate control of addiction and of concomitant infectious diseases choosing either immunosuppressive drugs or drugs characterized by immunoneutral or immunostimulating effects could represent an important point to be considered in the future in opioid therapy.

Maremmani I.,University of Pisa | Maremmani I.,G Of Lisio Institute Of Behavioral Science | Cibin M.,Local Health Authority | Pani P.P.,Social and Health Services | And 2 more authors.
International Journal of Environmental Research and Public Health | Year: 2015

Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is integrated treatment versus harm reduction. For years, these two divergent strategies have been considered to be opposite poles of different philosophies of intervention. One is bound to the searchfor methods that aim to lead the subject to complete abstinence; the other prioritizes a progressive decline in substance use, with maximum reduction in the damage that is correlated with curtailing that use. Reduction of alcohol intake does not require any particular setting, but does require close collaboration between the general practitioner, specialized services for addiction, alcohology services and psychiatry. In patients who reach that target, significant savings in terms of health and social costs can be achieved. Harm reduction is a desirable target, even from an economic point of view. At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, by attempting to remove the shadows of social judgment that, at present, are aiming for a course of treatment that is directed towards absolute abstention. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

Pani P.P.,Social Health Services | Maremmani A.G.I.,University of Pisa | Trogu E.,Psychiatric Unit 2 | Ruiz P.,University of Miami | And 3 more authors.
Heroin Addiction and Related Clinical Problems | Year: 2013

The frequency of the association between substance use and psychiatric disorders is higher than what might be expected as a result of chance alone; the most frequently associated psychiatric symptoms, syndromes and disorders pertain to the domains of mood, anxiety and impulsivity. There are several reasons for taking these psychiatric manifestations into account when evaluating clinical presentations of substance-use disorders. DSM nosology does not seem to grasp the complexity of the interaction between the psychic structures involved, and neurobiological and physiopathological processes activated by encounters with substances of abuse. Based on neurobiological, epidemiological and clinical indications, an integrated, unified perspective explaining the pathophysiology and phenomenology of addiction has been proposed. The lack of substantial changes in the approach to the psychiatric comorbidity of addiction in the DSM V, despite the plausibility of the hypothesis that there may be a close link between addiction and other specific psychiatric conditions, can be explained by the persistent insufficiency of aetiological and pathophysiological evidence which supports that kind of association. The validation of an articulated clinical condition, encompassing part of the grey area of symptomatology that exists between addiction itself and other 'independent' psychopathologies, certainly calls for special attention and specific research programmes.

Dell'Osso L.,University of Pisa | Rugani F.,University of Pisa | Maremmani A.G.I.,University of Pisa | Bertoni S.,University of Pisa | And 3 more authors.
Comprehensive Psychiatry | Year: 2014

Background Genetic, neurobiological, environmental and psychosocial mechanisms have received considerable attention in exploring the mechanisms that underlie comorbid PTSD and SUD. PTSD and SUD are not necessarily linked by a causal relationship, as the self-medication hypothesis had supposed. They might, in fact, both be caused by a third factor that predisposes these subjects to develop the two disorders (so allowing a unitary perspective). Methods Using a conceptualization of the PTSD spectrum, we studied the PTSD-SUD unitary perspective by testing the correlation between severity of heroin addiction, dose of opioid medication and severity of PTSD spectrum in 82 methadone-treated, heroin-dependent patients. Results Canonical correlation analysis (Wilks Lambda = 0.125 F = 1.41 p = 0.014), univariate and multivariate comparisons between subgroups, identified on the basis of addiction severity, showed a highly positive correlation between the PTSD spectrum and the severity of heroin addiction. In addition, negative correlations were found between PTSD spectrum severity and methadone dose (r = 0.225; p = 0.042). Conclusions This strength and breadth of the correlations encourage us to move towards a unified vision of the two disorders.

Pani P.P.,Sardinia Regional Dependence Coordination Unit | Maremmani I.,Santa Chiara University Hospital | Maremmani I.,G Of Lisio Institute Of Behavioral Science | Trogu E.,Sardinia Regional Dependence Coordination Unit | And 3 more authors.
Journal of Affective Disorders | Year: 2010

Current "official" nosology (e.g. DSM IV) is largely limited to physical manifestations of addiction that can be objectively observed and are suited to the maintaining of an "atheoretical" perspective. However, addicted subjects display additional psychiatric symptoms that affect their well-being and social functioning and, in accordance with DSM IV, are typically relegated to the domain of psychiatric "comorbidity." We contend that the relationship of these psychiatric symptoms with addiction is very close, as demonstrated by the high frequency of association observed. We further assert that substance use may modify pre-existing psychic structures such as temperament and related subthreshold conditions and lead to addiction as a specific mental disorder, inclusive also of symptoms pertaining to mood/anxiety, or impulse-control dimensions. The present contribution addresses the weaknesses of the current DSM-based nosology of addiction-related mental comorbidity. We highlight the overlap of the biological substrates and the neurophysiology of addictive processes and psychiatric symptoms associated with addiction, and propose the inclusion of specific mood, anxiety, and impulse-control dimensions in the psychopathology of addictive processes. We postulate that addiction reaches beyond the mere result of drug-elicited effects on the brain and cannot be peremptorily equated only with the use of drugs despite the adverse consequences produced. We infer that mood, anxiety and impulse-control dysregulation is at the very core of both the origins and clinical manifestations of addiction and should be incorporated into the nosology of the same, emphasising how addiction is a relapsing chronic condition in which psychiatric manifestations play a crucial role. To conclude, addictionology cannot be severed from its psychopathological connotations, in view of the undeniable presence of symptoms, of their manifest contribution to the way addicted patients feel and behave, and to the role they play in maintaining the continued use of substances. © 2009 Elsevier B.V.

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