Objective: A link between panic disorder and substance use is established on epidemiological grounds, but it has not been ascertained whether panic disorder is primitive or substance-induced. Aim of this paper is to test different hypotheses of the relationship between the two disorders, on the basis of literature findings. Methods: Authors reviewed the body of research focusing on the neurobiology of panic disorder, established its plausible connection with the neurochemistry of substance abuse (alcohol, cannabis, opiates, ecstasy, and cocaine), and controlled for the consistency of findings as related to comorbidity patterns, the self-medication hypothesis and evidence of substance-induced panic disorder subtypes. Results: Authors found no definite evidence to support the assumption that possibly anxiogenic substances may induce panic disorder without any previous disposition to it. Moreover, the density of subjects with panic disorder may increase in populations of people with substance abuse according to shared proneness factors. As regards self-medication, some subjects may resort to anxiolytic substances to manage the cognitive symptoms of panic, that is phobia, which may favour the onset of addiction through intense and regular use. However, once addiction has developed, the original self-medication dynamics appear not to make any difference in terms of course of addiction, prognosis, or therapeutic response. A different view might be that a common genetic or acquired factor may favour the onset of both substance abuse and panic disorder, independently of one another. The bipolar spectrum as such may be one likely link. Conclusions: On therapeutic grounds, it is unlikely that antipanic drugs can be sought-after as a means to treat substance abuse, even if a history of self-medication is ascertained. On the other hand, compounds with a cannabinoid or opiate mechanism of action, with no abuse liability, may be regarded as promising agents against panic attacks and agoraphobia.
Disturbo di Panico ed uso di sostanze: Significato clinico e dinamiche psicopatologiche
Maremmani, Angelo G. I.;
2008-01-01
Abstract
Objective: A link between panic disorder and substance use is established on epidemiological grounds, but it has not been ascertained whether panic disorder is primitive or substance-induced. Aim of this paper is to test different hypotheses of the relationship between the two disorders, on the basis of literature findings. Methods: Authors reviewed the body of research focusing on the neurobiology of panic disorder, established its plausible connection with the neurochemistry of substance abuse (alcohol, cannabis, opiates, ecstasy, and cocaine), and controlled for the consistency of findings as related to comorbidity patterns, the self-medication hypothesis and evidence of substance-induced panic disorder subtypes. Results: Authors found no definite evidence to support the assumption that possibly anxiogenic substances may induce panic disorder without any previous disposition to it. Moreover, the density of subjects with panic disorder may increase in populations of people with substance abuse according to shared proneness factors. As regards self-medication, some subjects may resort to anxiolytic substances to manage the cognitive symptoms of panic, that is phobia, which may favour the onset of addiction through intense and regular use. However, once addiction has developed, the original self-medication dynamics appear not to make any difference in terms of course of addiction, prognosis, or therapeutic response. A different view might be that a common genetic or acquired factor may favour the onset of both substance abuse and panic disorder, independently of one another. The bipolar spectrum as such may be one likely link. Conclusions: On therapeutic grounds, it is unlikely that antipanic drugs can be sought-after as a means to treat substance abuse, even if a history of self-medication is ascertained. On the other hand, compounds with a cannabinoid or opiate mechanism of action, with no abuse liability, may be regarded as promising agents against panic attacks and agoraphobia.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
