Publications by authors named "Manuel G Carbone"

3 Publications

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Can the migration process influence the clinical expression of heroin use disorder in migrants to Italy?

CNS Spectr 2021 02 23;26(1):62-70. Epub 2020 Jan 23.

Drug Addiction Unit, Italian NHS, Region of Latium, ASL Roma 1, Rome, Italy.

Background: For some time now, there has been a strong consensus that the migration process can influence the onset, course, development, outcome, and clinical aspects of psychiatric pathologies.

Methods: In this study, we have analyzed the influence of the migration process on the clinical expression of heroin use disorder (HUD). In a naturalistic case-control study, we compared, both at univariate and multivariate level, 30 migrant HUD (M-HUD) patients with 30 age/gender-matched Italian HUD (IT-HUD) patients. We also analyzed demographic data, drug addiction history, psychopathological symptoms, addictive behavior, and emotional reactivity to life events.

Results: Compared with IT-HUD pairs, at HUD Agonist Opioid Treatment, M-HUD patients were characterized by inadequate income and the presence of legal problems. They were more frequently at stage 3 of heroin addiction, with a concomitantly less frequent use of stimulants. Their age at the onset of heroin use was greater than that of subjects in the IT-HUD group. HUD post-traumatic stress disorder spectrum was present and was more severe in all M-HUD patients, but grief reactions and maladaptive behavior were the most discriminant traits. No differences were found in terms of addictive behaviors related to heroin craving or with respect to the severity/typology of psychopathology specific to HUD.

Conclusions: The migratory process does not seem to be correlated with addictive behaviors or with psychopathology specific to HUD. It partly affects HUD history, and specifically correlates with emotional reactivity to loss and traumatic life events, so suggesting that in M-HUD individuals, the link between the migratory syndrome and HUD is very close.
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February 2021

Potentially traumatic events, post-traumatic stress disorder and post-traumatic stress spectrum in patients with fibromyalgia.

Clin Exp Rheumatol 2019 Jan-Feb;37 Suppl 116(1):39-43. Epub 2018 Apr 24.

Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Italy.

Objectives: Fibromyalgia (FM) is defined as a severe, chronic, non-articular rheumatic condition characterised by widespread musculoskeletal pain, hyperalgesia and generalised tender points, in the absence of inflammatory or structural musculoskeletal abnormalities. Pain is the predominant symptom, allodynia and hyperalgesia are common signs. Extreme fatigue, impaired cognition and non-restorative sleeping difficulties coexist in addition to other somatic symptoms. Several studies suggest there is a meaningful relationship between FM and the psychological symptoms of depression and post-traumatic stress disorder (PTSD). PTSD is a mental disorder that can develop after a person has been exposed to a traumatic event, characterised by a specific set of symptoms including re-experiencing of the event, avoidance and numbing and arousal. The present study investigates the impact of lifetime potentially traumatic events, including losses, and of post-traumatic stress symptoms on the severity of illness in patients with fibromyalgia (FM).

Methods: Sixty-one patients with FM, diagnosed according to the American College of Rheumatology criteria, were consecutively enrolled at the Unit of Rheumatology, University of Pisa, Italy. Assessments included: the SCID-5 and the Trauma and Loss Spectrum Self-Report (TALS-SR) lifetime version.

Results: 21.3% of the subjects (n=13) met the criteria for "partial" PTSD: 57.4% criterion B, 42.6% criterion C, 31.1 criterion D and 44.3% criterion E. Fibromyalgia patients without PTSD reported significantly lower scores in all domains compared to the patients with partial PTSD, the latter ones reporting significantly lower scores in all domains compared to full PTSD with the exception of domain I. In particular, these differences were noticeable in Domain VI and Domain VIII.

Conclusions: The results of the study show that fibromyalgic patients with PTSD report more potentially traumatic events, avoidance symptoms, numbing, arousal, maladaptive coping and personality characteristics compared to patients with partial or without PTSD; these results could indicate that loss and/or trauma events represent a risk factor for the development of symptoms of FM in genetically predisposed individuals.
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May 2019

Polysubstance and Behavioral Addictions in a Patient with Bipolar Disorder: Role of Lifetime Subthreshold Autism Spectrum.

Case Rep Psychiatry 2018 22;2018:1547975. Epub 2018 Feb 22.

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

This case report draws attention to the potential relevance of undetected autism spectrum symptoms in a bipolar patient with high work functioning showing a peculiar addictive profile with impulsive and antisocial behaviors. A 23-year-old man with a diagnosis of Bipolar Disorder (BD) and Substance Use Disorder (SUD) was hospitalized at the Psychiatric Clinic of the University of Pisa for diuretics and -2 adrenergic agonist abuse in a remission phase of benzodiazepines and substance abuse. He reported a history of behavioral addictions in the framework of a global high work functioning with particular skills in computer science. When assessed for adult autism spectrum symptoms, despite not fulfilling a DSM-5 diagnosis of Autism Spectrum Disorder (ASD), he reported a score of 93/240 at the Ritvo Autism and Asperger Diagnostic Scale (RAADS-r) and of 88/160 at the Adult Autism Subthreshold Spectrum (AdAS Spectrum), both indicative of ASD. We argue the possible role of adult subthreshold autism spectrum features, generally disregarded in adult psychiatry, in the peculiar addictive profile developed by this patient with BD that may deserve appropriate treatment.
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February 2018