There is growing recognition that substance use is associated with the emergence of psychosis.Ele... more There is growing recognition that substance use is associated with the emergence of psychosis.Elements of post-modernity dominate contemporary social contexts and operate as existential background factors that contribute to the emergence of substance-related psychotic phenomena, particularly use of potent and highly rewarding novel psychoactive substances (NPS). About 25% of first-episode psychoses are substance-induced (SIP). DSM-5 SIP diagnosis is based on the assumption that symptoms are transient and disappear after sustained abstinence. This narrowed definition does not consider the issue of persistent SIP. There is a clear need for a new diagnostic framework that provides reliable, unambiguous clinical criteria to differentiate between comorbid conditions (i.e., schizophrenia patients with a substance use disorder) and substance-related psychoses. In the present contribution, we aim to outline a novel and separate clinical entity: substancerelated exogenous psychosis (SREP). W...
Introduction Gambling disorder (GD) is a major public health concern with currently no validated ... more Introduction Gambling disorder (GD) is a major public health concern with currently no validated and efficacious treatments approved. In this single case study, we report the short- and long-term effect of bilateral transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on craving and impulse control in a subject with GD. Methods The patient is a 26-year-old Caucasian male with an 8-year history of GD as well as alcohol and cocaine misuse. Treatment consisted of twice-a-day stimulation for 10 days. According to the literature, both the left (to control craving) and the right (to control emotional impulses) DLPFC were stimulated. Patients subsequently received tDCS once a week for 3 months and then once every 2 weeks for another 3 months. Results After 10 days of treatment, the subject reported improved psychiatric symptoms (depression, anxiety, and impulsivity), as well as reduced gambling craving symptom severity. After 3 and 6 months of treatment,...
Nalmefene is the first drug to be approved for reducing alcohol consumption in alcohol use disord... more Nalmefene is the first drug to be approved for reducing alcohol consumption in alcohol use disorder (AUD) patients at high drinking risk. In real-world settings, there is a high prevalence of concurrent psychiatric disorders in AUD subjects, with associated increased morbidity and worse prognosis. This study evaluated the use of nalmefene in AUD patients with stabilized psychiatric comorbidity previously treated unsuccessfully for alcohol dependence, and assessed craving reduction and safety. Sixty-five AUD outpatients treated with as-needed 18 mg nalmefene for 24 weeks were included. Primary outcome measures were: changes in heavy drinking days (HDDs) and total alcohol consumption (TAC, g/day). Secondary outcome measures were: changes in drinking risk level and craving (obsessive-compulsive drinking scale and visual analogue scale for craving). Forty-two AUD subjects (64.6%) had one or more stabilized psychiatric comorbidity. There was a significant reduction in HDDs, TAC and cravi...
valutazione in relazione alle sue differenti sfac-cettature. A questo proposito, è stato suggerit... more valutazione in relazione alle sue differenti sfac-cettature. A questo proposito, è stato suggerito un modello psicobiologico a tre vie in grado di differenziare nel craving tre componenti: reward (ricompensa), relief (sollievo) e obsessive (ossessione). Identificare la tipologia di craving può rappresentare una variabile importante in previsione o in corrispondenza di una terapia farmacologica anti-craving. In questo studio viene presentato e descritto lo strumento Craving Typology Questionnaire (CTQ), differenziato nelle sue com-ponenti e tradotto nella sua versione in lingua inglese. Summary Craving is commonly thought to play a crucial role both in the transition from controlled drinking to alcohol dependence and in the mechanism underlying re-lapse. However there is no consensus on its definition, and on its correct assessment. Another significant hindrance is that craving is almost certainly a multi-faceted construct. To this respect a three pathway psychobiological model able ...
The Journal of Neuropsychiatry and Clinical Neurosciences, 2014
Complete List of Authors: Pettorruso, Mauro; Catholic University of Sacred Heart, Institute of Ps... more Complete List of Authors: Pettorruso, Mauro; Catholic University of Sacred Heart, Institute of Psychiatry Di Nicola, Marco; Catholic University of Sacred Heart, Institute of Psychiatry De Risio, Luisa; Catholic University of Sacred Heart, Institute of Psychiatry Fasano, Alfonso; University of Toronto, Movement Disorders Center, TWH, UHN, Division of Neurology Martinotti, Giovanni; University "G. D'Annunzio", Department of Neurosciences and Imaging Conte, Gianluigi; Catholic University of Sacred Heart, Institute of Psychiatry Bentivoglio, Anna Rita ; Catholic University of Sacred Heart, Institute of Neurology Janiri, Luigi; Catholic University of Sacred Heart, Institute of Psychiatry
The co-occurrence of bipolar disorder (BD) and gambling disorder (GD), though of clinical and pub... more The co-occurrence of bipolar disorder (BD) and gambling disorder (GD), though of clinical and public health importance, is still scarcely investigated. Comorbid BD-GD subjects experience a more severe course of illness and poorer treatment outcome, due to a range of clinical and psychosocial factors that collectively impede remission and recovery. The aim of our paper is to review the role of pharmacotherapy in the treatment of comorbid BD-GD, in order to support clinical decisions according to the best available evidence. A qualitative systematic review of studies on pharmacological treatment in comorbid BD-GD was performed. A comprehensive literature search of online databases, bibliographies of published articles and gray literature was conducted. Data on efficacy, safety and tolerability were extracted and levels of evidence were assessed. We also provide a brief overview of current epidemiological, neurobiological and clinical findings, with the intention of proposing a dimensional approach to the choice of available drugs. The only drug with a high level of evidence is lithium. Considering the inclusion of GD in DSM-5 'Substance-related and Addictive Disorders' category, we discuss the use of other drugs with a high level of evidence currently used in BD subjects with co-occurring substance use disorders. Only few clinical trials are available and the population is limited; therefore no conclusive evidence can be inferred. Further randomized controlled trials are required to evaluate the efficacy of pharmacological treatment strategies in large samples of patients with comorbid BD-GD. Also, attempts should be made to identify other shared clinical and psychopathological domains that are amenable to treatment.
There is growing recognition that substance use is associated with the emergence of psychosis.Ele... more There is growing recognition that substance use is associated with the emergence of psychosis.Elements of post-modernity dominate contemporary social contexts and operate as existential background factors that contribute to the emergence of substance-related psychotic phenomena, particularly use of potent and highly rewarding novel psychoactive substances (NPS). About 25% of first-episode psychoses are substance-induced (SIP). DSM-5 SIP diagnosis is based on the assumption that symptoms are transient and disappear after sustained abstinence. This narrowed definition does not consider the issue of persistent SIP. There is a clear need for a new diagnostic framework that provides reliable, unambiguous clinical criteria to differentiate between comorbid conditions (i.e., schizophrenia patients with a substance use disorder) and substance-related psychoses. In the present contribution, we aim to outline a novel and separate clinical entity: substancerelated exogenous psychosis (SREP). W...
Introduction Gambling disorder (GD) is a major public health concern with currently no validated ... more Introduction Gambling disorder (GD) is a major public health concern with currently no validated and efficacious treatments approved. In this single case study, we report the short- and long-term effect of bilateral transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on craving and impulse control in a subject with GD. Methods The patient is a 26-year-old Caucasian male with an 8-year history of GD as well as alcohol and cocaine misuse. Treatment consisted of twice-a-day stimulation for 10 days. According to the literature, both the left (to control craving) and the right (to control emotional impulses) DLPFC were stimulated. Patients subsequently received tDCS once a week for 3 months and then once every 2 weeks for another 3 months. Results After 10 days of treatment, the subject reported improved psychiatric symptoms (depression, anxiety, and impulsivity), as well as reduced gambling craving symptom severity. After 3 and 6 months of treatment,...
Nalmefene is the first drug to be approved for reducing alcohol consumption in alcohol use disord... more Nalmefene is the first drug to be approved for reducing alcohol consumption in alcohol use disorder (AUD) patients at high drinking risk. In real-world settings, there is a high prevalence of concurrent psychiatric disorders in AUD subjects, with associated increased morbidity and worse prognosis. This study evaluated the use of nalmefene in AUD patients with stabilized psychiatric comorbidity previously treated unsuccessfully for alcohol dependence, and assessed craving reduction and safety. Sixty-five AUD outpatients treated with as-needed 18 mg nalmefene for 24 weeks were included. Primary outcome measures were: changes in heavy drinking days (HDDs) and total alcohol consumption (TAC, g/day). Secondary outcome measures were: changes in drinking risk level and craving (obsessive-compulsive drinking scale and visual analogue scale for craving). Forty-two AUD subjects (64.6%) had one or more stabilized psychiatric comorbidity. There was a significant reduction in HDDs, TAC and cravi...
valutazione in relazione alle sue differenti sfac-cettature. A questo proposito, è stato suggerit... more valutazione in relazione alle sue differenti sfac-cettature. A questo proposito, è stato suggerito un modello psicobiologico a tre vie in grado di differenziare nel craving tre componenti: reward (ricompensa), relief (sollievo) e obsessive (ossessione). Identificare la tipologia di craving può rappresentare una variabile importante in previsione o in corrispondenza di una terapia farmacologica anti-craving. In questo studio viene presentato e descritto lo strumento Craving Typology Questionnaire (CTQ), differenziato nelle sue com-ponenti e tradotto nella sua versione in lingua inglese. Summary Craving is commonly thought to play a crucial role both in the transition from controlled drinking to alcohol dependence and in the mechanism underlying re-lapse. However there is no consensus on its definition, and on its correct assessment. Another significant hindrance is that craving is almost certainly a multi-faceted construct. To this respect a three pathway psychobiological model able ...
The Journal of Neuropsychiatry and Clinical Neurosciences, 2014
Complete List of Authors: Pettorruso, Mauro; Catholic University of Sacred Heart, Institute of Ps... more Complete List of Authors: Pettorruso, Mauro; Catholic University of Sacred Heart, Institute of Psychiatry Di Nicola, Marco; Catholic University of Sacred Heart, Institute of Psychiatry De Risio, Luisa; Catholic University of Sacred Heart, Institute of Psychiatry Fasano, Alfonso; University of Toronto, Movement Disorders Center, TWH, UHN, Division of Neurology Martinotti, Giovanni; University "G. D'Annunzio", Department of Neurosciences and Imaging Conte, Gianluigi; Catholic University of Sacred Heart, Institute of Psychiatry Bentivoglio, Anna Rita ; Catholic University of Sacred Heart, Institute of Neurology Janiri, Luigi; Catholic University of Sacred Heart, Institute of Psychiatry
The co-occurrence of bipolar disorder (BD) and gambling disorder (GD), though of clinical and pub... more The co-occurrence of bipolar disorder (BD) and gambling disorder (GD), though of clinical and public health importance, is still scarcely investigated. Comorbid BD-GD subjects experience a more severe course of illness and poorer treatment outcome, due to a range of clinical and psychosocial factors that collectively impede remission and recovery. The aim of our paper is to review the role of pharmacotherapy in the treatment of comorbid BD-GD, in order to support clinical decisions according to the best available evidence. A qualitative systematic review of studies on pharmacological treatment in comorbid BD-GD was performed. A comprehensive literature search of online databases, bibliographies of published articles and gray literature was conducted. Data on efficacy, safety and tolerability were extracted and levels of evidence were assessed. We also provide a brief overview of current epidemiological, neurobiological and clinical findings, with the intention of proposing a dimensional approach to the choice of available drugs. The only drug with a high level of evidence is lithium. Considering the inclusion of GD in DSM-5 'Substance-related and Addictive Disorders' category, we discuss the use of other drugs with a high level of evidence currently used in BD subjects with co-occurring substance use disorders. Only few clinical trials are available and the population is limited; therefore no conclusive evidence can be inferred. Further randomized controlled trials are required to evaluate the efficacy of pharmacological treatment strategies in large samples of patients with comorbid BD-GD. Also, attempts should be made to identify other shared clinical and psychopathological domains that are amenable to treatment.
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Papers by Luisa Risio