Allostasts as a conceptual framework linking bipolar disorder and addiction

作者：Pettorruso Mauro^*; De Risio Luisa; Di Nicola Marco; Martinotti Giovanni; Conte Gianluigi; Janiri Luigi

来源：Frontiers in Psychiatry, 2014, 5: 173.

DOI：10.3389/fpsyt.2014.00173

• bipolar disorders
• addiction vulnerability
• allostasis and allostatic load
• comorbidity
• hedonic tone and anhedonia
• dopaminergic system
• reward system
• CRF/HPA axis and stress system

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.

• 出版日期2014-12-3