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.