Allostasis As a Conceptual Framework Linking Bipolar Disorder and Addiction

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2014 Dec 19

PMID 25520673

Citations 17

Authors

Mauro Pettorruso

Luisa De Risio

Marco Di Nicola

Giovanni Martinotti

Gianluigi Conte

Luigi Janiri

Affiliations

Soon will be listed here.

Abstract

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.

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