TY - JOUR
T1 - Allostasis as a conceptual framework linking bipolar disorder and addiction
AU - Pettorruso, Mauro
AU - De Risio, Luisa
AU - Di Nicola, Marco
AU - Martinotti, Giovanni
AU - Conte, Gianluigi
AU - Janiri, Luigi
PY - 2014
Y1 - 2014
N2 - Bipolar disorders (BDs) and addictions constitute reciprocal risk factors and are best considered under a unitary perspective. The concepts of allostasis and allostatic load (AL) may contribute to the understanding of the complex relationships between BD and addictive behaviors. Allostasis entails the safeguarding of reward function stability by recruitment of changes in the reward and stress system neurocircuitry and it may help to elucidate neurobiological underpinnings of vulnerability to addiction in BD patients. Conceptualizing BD as an illness involving the cumulative build-up of allostatic states, we hypothesize a progressive dysregulation of reward circuits clinically expressed as negative affective states (i.e., anhedonia). Such negative affective states may render BD patients more vulnerable to drug addiction, fostering a very rapid transition from occasional drug use to addiction, through mechanisms of negative reinforcement. The resulting addictive behavior-related ALs, in turn, may contribute to illness progression. This framework could have a heuristic value to enhance research on pathophysiology and treatment of BD and addiction comorbidity.
AB - Bipolar disorders (BDs) and addictions constitute reciprocal risk factors and are best considered under a unitary perspective. The concepts of allostasis and allostatic load (AL) may contribute to the understanding of the complex relationships between BD and addictive behaviors. Allostasis entails the safeguarding of reward function stability by recruitment of changes in the reward and stress system neurocircuitry and it may help to elucidate neurobiological underpinnings of vulnerability to addiction in BD patients. Conceptualizing BD as an illness involving the cumulative build-up of allostatic states, we hypothesize a progressive dysregulation of reward circuits clinically expressed as negative affective states (i.e., anhedonia). Such negative affective states may render BD patients more vulnerable to drug addiction, fostering a very rapid transition from occasional drug use to addiction, through mechanisms of negative reinforcement. The resulting addictive behavior-related ALs, in turn, may contribute to illness progression. This framework could have a heuristic value to enhance research on pathophysiology and treatment of BD and addiction comorbidity.
KW - CRF/HPA axis and stress system
KW - addiction vulnerability
KW - allostasis and allostatic load
KW - bipolar disorders
KW - comorbidity
KW - dopaminergic system
KW - hedonic tone and anhedonia
KW - reward system
KW - CRF/HPA axis and stress system
KW - addiction vulnerability
KW - allostasis and allostatic load
KW - bipolar disorders
KW - comorbidity
KW - dopaminergic system
KW - hedonic tone and anhedonia
KW - reward system
UR - http://hdl.handle.net/10807/65179
U2 - 10.3389/fpsyt.2014.00173
DO - 10.3389/fpsyt.2014.00173
M3 - Article
SN - 1664-0640
VL - 5
SP - 173
EP - 173
JO - Frontiers in Psychiatry
JF - Frontiers in Psychiatry
ER -