qualita' della vita e psicopatologia nei disturbi da...
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QUALITA' DELLA VITA E PSICOPATOLOGIA NEI DISTURBI
DA USO DI EROINA
Prof. L Janiri, Dott. V Fiumana, Dott. M De Nicola.
From July to September 20142 database fot two study
1050 .ca pz
Opioid Use Disorders attending methadone or buprenorfine
Taking place
UdineBolzano MantovaMonseliceMestreTrevisoLegnanoEsteRovigoDoloOderzoVillafranca
VerbaniaZevioUdine BisBannoRimini BolognaPisogneBassanoPordenone
Nord Est Italia 21 Ser.D.
Quality of Life in Heroin Users Attending Substitution Treatment: A Multicenter Study in Italy
Valerio Fiumana, Lorenzo Zamboni, Marianna Mazza, Luigi Janiri, Mauro Cibin, Fabio Lugoboni and GICS.
Aims: Quality of life (QoL) is an important measure to verify the effectiveness of therapy in substance use disorders (SUD). In this cross-sectional, multicenter study QoL has been measured in 1057 , Opioid Use Disirders (OUD) attending SerDs in the Nord Est of Italy taking Opioid Substitution Treatments (OST). QoL was correlated with demographic variables and drug treatment, one of these was the place of living, Urban or Suburban city.
Methods: QoL has been measured by using GHQ-12 (12-item General Health Questionnaire), a self-administered questionnaire whose value is inversely correlated with the QoL.
Qualità di Vita (QoL)un paramatro essenziale nella valutazione
delle cure fornite
WHO: “la percezione individuale della personale posizione nella vita, nel contesto dei sistemi di coltura e
di valori in cui si vive e in relazione ai propri obiettivi, alle aspettative, norme e preoccupazioni.
● physical health,● psychological state,● level of autonomy, ● social relationships,● personal beliefs and● relationship with the
environment.
Qol letteratura
● La maggior parte degli studi precedenti si concentravano su indici di benessere fisico
● Molti mostravano una QoL nei OUD inferiore
● Le variabili sociodemografiche (residenza, occupazione, soddisfazione amorosa)
influenzano notevolmente i risultati
● Opinioni contrastanti
DemograficiMedian age 38 years (IQ 30 -46)
75.4% men ;
66.5% patients were single, 15.8% married, 15.1% separated/ divorced, and 2.6% widow
primary school 618 (58.5%), secondary school 411 (38.9%) bachelor’s degree in 28 patients
employed (61.9%)
students. (39.1%)
br0ken!!90% tobacco smokers
61.6% were recruited in URBAN and 38.4% in SUBURBAN
Trattamento farmacologico
98% Substituscion terapy
76,5% Methadone21,5% Buprenorphine
39% psychiatric drug
252 anxiol./hypnotics49 antidepressants,
70 more than one drug
GHQ-12
General Health Questionnaire 12-item, Likert, (0-36 points) identify two main problem categories:
● inability to function normally ● the presence of new stress factors.
(“less than usual” (0 points), “no morethan usual” (1 point), “a little more than usual” (2 points), and “much more than usual” (3 points).
<15 show no discomfort ≥15 were considered cases on the GHQ-12>20 suffering from a severe psychosocial disorder.
GHQ-12
E' stato preferito ad altri test (SF36) in quanto unicamente incentrato su variabili
psicologiche
È stato considerato solo il valore complessivo della scala
Risultati GHQ12: 60% non discomfort
Results QoL 2Measuring QoL:
The median value of GHQ-12 in the study population was 12 (interquartile range [IQ] 9 - 18): 640 patients (60.6%) scored <15 which relates with a sufficiently good QoL, 257 (24.3%) scored between 15 - 20, and 160 (15.1%) scored >20 points at the GHQ-12, which relates with a bad QoL.
Better in country?No significant difference in GHQ-12 results with a similar median test value urban centers vs suburban centers (12 [IQ 9 - 17]vs. 13 [IQ 9 - 19], p = 0.20, respectively)
a comparable proportion of patients with <15 (61.1% vs. 59.6%, p = 0.62), >15 <20 (25.0% vs. 23.2%, p = 0.48) and >20 score (17.2% vs. 13.8%, p = 0.13)
Predictors of GHQ
Results and discussion
● Il 60% non rivela discomfort
● La buprenorfina sembra avere un ruolo protettivo, ma viene generalmente prescritta a casi media gravità
● La doppia diagnosi è espressione di maggior sofferenza
● Avere un Lavoro ed essere sposati sono fattori sociali determinanti
● Il genere femminile riferisce una peggior qualità di vita (14 vs. 12), pur rimanendo negli stessi cut-off della scala.
Gender e QoL
Psicopatologia
Women usually reporting multiple medical comorbidities
higher craving levels, significant socio-relational impairment
psychopathological symptoms
comorbidities such as mood, anxiety, trauma-related and personality
disorders,
Are strong predictors of poor treatment outcome in OUD
including lower rates of treatment retention and higher rates of relaps
Gender-Related Psychopathology in Opioid Use Disorder: Results from a Representative Sample of Italian Addiction Services
Beniamino Leone, Marco Di Nicola°, Lorenzo Moccia, Mauro Pettorruso, Lorenzo Zamboni, Luigi Janiri,
Mauro Cibin, Fabio Lugoboni, & on behalf of GICS*
Aims: Gender and psychiatric comorbidity seem to influence patients’ inter-individual
response to Opioid Substitution Treatments (OST) in Opioid Use Disorder (OUD)
management. The aim of the study was to assess psychopathological dimensions in an
Italian sample of OUD individuals entering a methadone/buprenorphine maintenance
program; secondary we evaluated the possible gender-specific differences within the
psychopathological profiles, to identify the variables that could predict psychopathology.
Methods: In a cross-sectional study, we recruited 1052 (792 male; 260 female) OUD1052 (792 male; 260 female) OUD
subjects subjects receiving OSTreceiving OST. All patients underwent a clinical and psychometric evaluation
assessing demographics, psychiatric history, psychopathological features via the Symptom
Checklist-90-Revised (SCL-90-R), and were prescribed psychopharmacological treatments.
DemographicsMedian age 38
75.3 % men
married 32,9%; a minority reported having children 16,3%; N=171)
41,6 % had completed high school education.
employed (61,9%; N=651)
90% current smoker
Trattamento farmacologico
98% Substituscion terapy77,5% Methadone
22,5% Buprenorphine
39% psychiatric drug
37% anxiolytics12,3% antidepressants 13,2% more than one
SCL 90
Symptoms Checklist-90-Revised (SCL-90-R ) 5-point Likert scale of distress.
These items can be clustered in ten dimensions: somatization, obsession-
compulsion, interpersonal sensitivity, depression, anxiety, anger-hostility, phobic
anxiety, paranoid ideation, psychoticism and sleep.
Four global scores can be calculated: 1) Total SCL-90 score (sum of all items);2) General Symptomatic Index (GSI), the mean score of all recorded items; 3) Positive Symptoms Total (PST), the number of items rated positively; 4) Positive Symptom Distress Index (PSDI)
DemograficiTotal Men Women Sig.
N. (%) 1052 (100%) 792 (75.3%) 260 (24.7%)
Age; mean (SD) 38.4 (10.1) 38.6 (9.9) 37.7 (10.5) 0.189
Married; n (%) 347 (32.9%) 247 (31.2%) 100 (38.5%) 0.030
Having children; n (%) 171 (16.3%) 114 (14.4%) 57 (21.9%) 0.004
Employment; n (%) 651 (61.9%) 505 (63.8%) 146 (56.2%) 0.028
High school; n (%) 438 (41.6%) 303 (38.3%) 135 (51.9%) 0.001
Psychopharmachotherapy; n (%) 408 (38.8%) 292 (36.9%) 116 (44.6%) 0.026
Current smokers; n (%) 945 (89.8%) 711 (89.8%) 234 (90.3%) 0.830
Methadone; n (%) 815 (77.5%) 609 (76.9%) 206 (79.2%) 0.434
Buprenorphine; n (%) 237 (22.5%) 183 (23.1%) 54 (20.8%) 0.434
Daily methadone dose. mg; mean (SD) 60.7 (67.8) 60.8 (65.9) 60.6 (73.3) 0.850
Daily buprenorphine dose. mg; mean (SD) 8.9 (7.1) 8.5 (6.9) 10.6 (7.6) 0.045
Socio demographic differences
Women● having completed high-school 51,9% vs. 38,3%
● more likely to be married and having children 21,9%
vs. 14,4%;
● less likely to report current employment 56,2% vs.
63,8%
Confronto psicopatologia e OST
● GSI and sub-scales scores were significantly higher in women
than men (mean total GSI score of the whole sample was 0,8
(SD=0,6)
Women
.● Receiving a significantly higher dose of buprenorphine than
men (10,6mg vs. 8,5mg) (no significant gender differences were observed as regards to other OST,)
● More likely to display a comorbid psychiatric symptomatology
and more severe socio-relational impairment.
MALE
● Buprenorphine-maintained showed lower level of
psychopathology as compared to methadone maintenance
program.
● Having children, being unemployed, taking additional
psychopharmacotherapy and being on methadone
maintenance predictors of GSI
Conclusioni complessive
Psicopatologia e OUD
La Qualità della vita soggettiva misurata si è espressa come favorevole
In ambito di QoL, le differenze di efficacia tra Metadone e Buprenorfina risentono di alcune variabili sociodemografiche ma
anche da scelte cliniche
La popolazione femminile OUD appare generalmente come più fragile, e meno numerosa
Famiglia, figli e lavoro sono connesse a qualità di vita e a Psicopatologia, a volte con importanti differenze legate al genere
Gli aspetti psicopatologici maggiori, ravvisabili anche nel ricorso a terapie differenti si interfacciano notevolmente con quelli socio
demografici
Punti di forza e debolezza
Campione vasto (N 1050 .ca), ma concentrato in una specifica area regionale. Buona QoL e “molto” lavoro
Mancano variabili sulla gravità del disturbo da uso di Eroina, e sull' eventuale trattamento non
farmacologico presso i SerD (psicologici, gruppi AutoAiuto, etc).
Altro tasso di Responsività 68%
Ringraziamenti
Ringraziamo:Tutti i SerDs e il GICS
Dott. M. Cibin, Dott. L Zamboni, Dott.sa Mazza, Dott. F Lugoboni, Rigraziamenti particolari:Dott. Franco De Crescenzo, Dott.sa Coco WalstraeCentro Soranzo, cura residenziale breve per le dipendenze
Gics
Members of GICS active in collecting data include:
Arzillo C, Benigna L, Bersani N,Bersani P, Betti O, Biasin C, Bossi C, Bottazzo A, Bove A, Caccamo E, Cancian S, CantanchinF, Cantiero D, Canzian G, Cargnelutti D, Casalboni D, Casari R, Casarini R,Cibin M, Civitelli P, Cozzi T, De Cecco L, Del Zotto R, Dellantonio E, Dersini F, DurantiI, Faccini M, Fadelli M, Favero E, Fona B, Fontana N, Franceschini A, Gaiga E,Gardiolo M, Gentile N, Gervino D, Ghezzo N, Giacomin MA, Kashanpour H, Lietta P, Manera E, Manzato E, Mazzo M, Meneghello D, Mihalcea C, Milan E, Montresor M, Moratti E, Morbioli L, Musso D, Musso M, Pani A, Pavani V, Peroni F, Pellachin P, Piazza M, Pieri MC, Prosa D, Pupulin B, Rescigno B, Resentera C, Ricci C, Righetti P, Ripoli MA, Riscica P, Rizza C, Rizzetto V, Rossi A, Rovea A, Ruffato A, Ruzziconi C, Sabbion R, Santo E, Scarzella M, Sembianti N, Simonetto P, Smacchia C, Stellato M, Stimolo C, Suardi L, Vaiana A, Zavan V, Zerbetto E, Zerman M.
Prof. L Janiri, Dott. V Fiumana, Dott. M De Nicola.Institute of Psychiatry and Clinical Psychology, Policlinico Universitario A. Gemelli,
Rome, Italy.