UNIVERSITA’ DEGLI STUDI DI PISA FACOLTA’ DI MEDICINA E CHIRURGIA Corso di laurea specialistica in Medicina e Chirurgia TESI DI LAUREA: USO DI SOSTANZE E COMORBIDITÀ PER DISTURBI D’ANSIA IN PAZIENTI CON SCHIZOFRENIA E DISTURBO BIPOLARE Candidato: Relatore: Roberto Canozzi Chiar.mo Prof. Mauro Mauri ANNO ACCADEMICO 2007-2008
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UNIVERSITA’ DEGLI STUDI DI PISA
FACOLTA’ DI MEDICINA E CHIRURGIA
Corso di laurea specialistica in Medicina e Chirurgia
TESI DI LAUREA:
USO DI SOSTANZE E COMORBIDITÀ PER DISTURBI D’ANSIA IN PAZIENTI CON SCHIZOFRENIA E
DISTURBO BIPOLARE
Candidato: Relatore: Roberto Canozzi Chiar.mo Prof. Mauro Mauri
3 EPIDEMIOLOGIA USO DI SOSTANZE..................................26
4 EPIDEMIOLOGIA DELLA DOPPIA DIAGNOSI ................ ..29
5 DISTURBI D’ANSIA E USO DI SOSTANZE ...........................34
6 DISTURBO BIPOLARE ED USO DI SOSTANZE ..................36 6.1 EPIDEMIOLOGIA .............................................................................................. 36 6.2 IMPATTO DELLA DOPPIA DIAGNOSI SUL DB ................................................... 39 6.3 DOPPIA DIAGNOSI E DB: IPOTESI ETIOPATOGENETICHE.................................. 43 6.4 PROBLEMATICHE DI DIAGNOSI DIFFERENZIALE FRA DISTURBI DELL’UMORE E
USO DI SOSTANZE. ........................................................................................... 51
7 COMORBIDITÀ ANSIOSA NEL DISTURBO BIPOLARE. 56
8 PSICOSI ED ABUSO DI SOSTANZE........................................61
9 COMORBIDITÀ ANSIOSA NELLA SCHIZOFRENIA .........65
13.1 CARATTERISTICHE DEMOGRAFICHE DEI GRUPPI.............................................. 82 13.2 CONFRONTO DEL PATTERN DI USO DI ALCOOL E SOSTANZE NEI PAZIENTI CON
DB E SCH CON DUS. ..................................................................................... 82 13.3 COMORBIDITÀ CON DISTURBI D’ANSIA NEI PAZIENTI AFFETTI DA DB E SCH CON
E SENZA DUS ASSOCIATO. .............................................................................. 83
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RINGRAZIAMENTI In primo luogo vorrei ringraziare il Prof. Mauro Mauri ed il Dott. Alfredo Sbrana per la bella opportunità che mi hanno concesso, per la loro gentilezza e la loro grande professionalità. Un grazie al Dott. Massei ed al Dott. Piz per il tempo che mi hanno dedicato, in particolare a Jacopo anche per tutto l’aiuto “tecnico” ed i molti consigli che mi ha dato. Arrivato al termine di questo lungo percorso che va dalle elementari fino ad oggi, molte sono le persone che devo ringraziare, ognuna di essa è stata a suo modo importante per me, e mi ha permesso di arrivare fin qui con la serenità che oggi dimostro. I miei genitori Paolo e Oriana, veri artefici di questo risultato, per avermi dato la grande opportunità di arrivare dove sono oggi. Ma come avrei fatto senza di voi? Un sentito e dovuto ringraziamento va alla mia fidanzata Annalisa per questi anni meravigliosi che sembrano essere volati, per avermi sempre appoggiato in tutto quello che ho fatto, per il suo supporto morale (ultimamente, anche motorio!), per la sua comprensione e dolcezza, senza di lei non sarei arrivato fin qui, GRAZIE. Un grazie anche ai tanti amici e compagni di studio, che hanno allietato questi lunghi e faticosi anni. La classe del Liceo, alla quale sono ancora molto legato, in particolare a coloro che hanno scelto il mio stesso percorso di studi e di vita: il Magi (grazie anche per la gentilezza di questi ultimi giorni), la Claudia e la Silvia, oltre che per l’amicizia sempre dimostrata anche per le tonnellate di appunti che mi hanno sempre prestato, e il mitico Massi. Tutti i ragazzi e le ragazze miei compagni di corso all’ Università, per le belle mattinate passate insieme, in particolare il grande Fabio, mio compagno di studi degli ultimi e faticosi esami sostenuti. I vari coinquilini con i quali ho abitato in questi anni: mio fratello Francesco (a cui va un grazie particolare), il Massimo, il Claudio, il Magi (ancora), lo Stefani (a cui chiedo ancora scusa per aver mancato il suo matrimonio), il Cero (grazie anche per l’aiuto in questi giorni di
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disabilità) e il Sera, che mi hanno fatto perdere tanti pomeriggi di studio, ma quante risate... tra i coinquilini merita un posto anche l’Ale per le belle chiaccherate di questi anni. Tutti gli amici Garfagnini del Bar, troppi per elencarli, con i quali ho passato, e spero passerò anni splendidi, sempre pronti ad accogliermi tutte le volte che tornavo da Pisa con la loro allegria e simpatia, grazie per la vostra sincera amicizia. Un saluto ai miei compagni di squadra del grande River, purtroppo quest’anno dovrete vincere senza di me. Un saluto alla mia nonna Veronica che ci teneva tanto a vedermi laureato, ora per i nipotini non avere fretta! Un grazie anche ai vari Professori che in questi anni mi hanno dato molto in termini di conoscenza, in particolare ringrazio il Prof. Naccarato per avermi fatto comprendere il valore reale di questa laurea.