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

Published online by Cambridge University Press:  23 January 2020

Icro Maremmani Open the ORCID record for Icro Maremmani [Opens in a new window] ,
Manuel G. Carbone ,
Claudia Tagliarini ,
Marina Ricci ,
Anna M. Lupi ,
Lucia Sarandrea ,
Angela Ceban ,
Angelo G.I. Maremmani  and
Pietro Casella
Icro Maremmani*
Affiliation:
Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy G. De Lisio Institute of Behavioural Sciences, Pisa, Italy Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, Pisa, Italy
Manuel G. Carbone
Affiliation:
School of Psychiatry, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
Claudia Tagliarini
Affiliation:
School of Psychiatry, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
Marina Ricci
Affiliation:
Drug Addiction Unit, Italian NHS, Region of Latium, ASL Roma 1, Rome, Italy
Anna M. Lupi
Affiliation:
Drug Addiction Unit, Italian NHS, Region of Latium, ASL Roma 1, Rome, Italy
Lucia Sarandrea
Affiliation:
Drug Addiction Unit, Italian NHS, Region of Latium, ASL Roma 1, Rome, Italy
Angela Ceban
Affiliation:
Drug Addiction Unit, Italian NHS, Region of Latium, ASL Roma 1, Rome, Italy
Angelo G.I. Maremmani
Affiliation:
Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy G. De Lisio Institute of Behavioural Sciences, Pisa, Italy Department of Psychiatry, Tuscany Region National Health System, Viareggio, Lucca, Italy
Pietro Casella
Affiliation:
Drug Addiction Unit, Italian NHS, Region of Latium, ASL Roma 1, Rome, Italy
*
Icro Maremmani, MD, Email: [email protected]
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Abstract

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.

Keywords

Migrationheroin use disorderaddiction
Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 1 , February 2021 , pp. 62 - 70
Copyright
© Cambridge University Press 2020

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References

Médecins Sans Frontières. Neglected trauma: asylum seekers in Italy: an analysis of mental health distress and access to healthcare; 2016. https://reliefweb.int/report/italy/neglected-trauma-asylum-seekers-italy-analysis-mental-health-distress-and-access. Accessed May 20, 2019.Google Scholar
Pacini, M. La Sindrome Migratoria. Massa, Italy: Edizioni Clandestine; 2018.Google Scholar
Kesebir, S, Vahip, S, Akdeniz, F, Yuncu, Z, Alkan, M, Akiskal, H. Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: a controlled study. J Affect Disord. 2005;85(1–2):127–133.CrossRefGoogle ScholarPubMed
Koukopoulos, A, Sani, G, Koukopoulos, AE, Albert, MJ, Girardi, P, Tatarelli, R. Endogenous and exogenous cyclicity and temperament in bipolar disorder: review, new data and hypotheses. J Affect Disord. 2006;96(3):165–175.CrossRefGoogle ScholarPubMed
Akiskal, HS, Cassano, GB, Musetti, L, Perugi, G, Tundo, A, Mignani, V. Psychopathology, temperament, and past course in primary major depressions. 1. Review of evidence for a bipolar spectrum. Psychopathology. 1989;22(5):268–277.CrossRefGoogle ScholarPubMed
Akiskal, HS, Placidi, GF, Maremmani, I, et al. TEMPS-I: delineating the most discriminant traits of the cyclothymic, depressive, hyperthymic and irritable temperaments in a nonpatient population. J Affect Disord. 1998;51(1):7–19.CrossRefGoogle Scholar
Akiskal, HS, Hantouche, EG, Allilaire, JF. Bipolar II with and without cyclothymic temperament: "dark" and "sunny" expressions of soft bipolarity. J Affect Disord. 2003;73(1–2):49–57.CrossRefGoogle ScholarPubMed
Bustamante, LHU, Cerqueira, RO, Leclerc, E, Brietzke, E. Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review. Braz J Psychiatry. 2018;40(2):220–225.CrossRefGoogle ScholarPubMed
Elbogen, EB, Wagner, HR, Fuller, SR, et al. Correlates of anger and hostility in Iraq and Afghanistan war veterans. Am J Psychiatry. 2010;167(9):1051–1058.CrossRefGoogle ScholarPubMed
Jakupcak, M, Conybeare, D, Phelps, L, et al. Anger, hostility, and aggression among Iraq and Afghanistan War veterans reporting PTSD and subthreshold PTSD. J Traum Stress. 2007;20(6):945–954.CrossRefGoogle ScholarPubMed
Brown, PJ, Stout, RL, Gannon-Rowley, J. Substance use disorder-PTSD comorbidity. Patients’ perceptions of symptom interplay and treatment issues. J Subst Abuse Treat. 1998;15(5):445–448.CrossRefGoogle ScholarPubMed
Brown, PJ, Wolfe, J. Substance abuse and post-traumatic stress disorder comorbidity. Drug Alcohol Depend. 1994;35(1):51–59.CrossRefGoogle ScholarPubMed
Maremmani, I, Pani, PP, Pacini, M, et al. Subtyping patients with heroin addiction at treatment entry: factors derived from the SCL-90. Ann Gen Psychiatry. 2010;9(1):15.CrossRefGoogle Scholar
Pani, PP, Trogu, E, Vigna-Taglianti, F, et al. Psychopathological symptoms of patients with heroin addiction entering opioid agonist or therapeutic community treatment. Ann Gen Psychiatry. 2014;13(1):35.CrossRefGoogle ScholarPubMed
Pani, PP, Maremmani, AGI, Trogu, E, et al. Psychopathological symptoms in detoxified and non-detoxified heroin-dependent patients entering residential treatment. Heroin Addict Relat Clin Probl. 2015;17(2–3):17–24.Google Scholar
Pani, PP, Maremmani, AGI, Trogu, E, et al. Psychic structure of opioid addiction: impact of lifetime psychiatric problems on SCL-90-based psychopathologic dimensions in heroin-dependent patients. Addict Disord Their Treat. 2016;15(1):6–16.CrossRefGoogle Scholar
Pani, PP, Maremmani, AGI, Trogu, E, et al. Psychopathology of addiction: may a SCL-90 based five dimensions structure be applied irrespectively of the involved drug? Ann Gen Psychiatry. 2016;15:13.CrossRefGoogle ScholarPubMed
Maremmani, AGI, Lovrecic, M, Lovrecic, B, Maremmani, I. Ethnicity and specific psychopathology of addiction. Comparison between Slovenian and Italian heroin use disorder patients. Heroin Addict Relat Clin Probl. 2019;21(4):35–39.Google Scholar
Carbone, MG, Tagliarini, C, Ricci, M, et al. Ethnicity and specific psychopathology of addiction. Comparison between migrant and Italian heroin use disorder patients. Heroin Addict Relat Clin Probl. 2019;21(5):61–66. http://www.heroinaddictionrelatedclinicalproblems.org/harcp-archives.php.Google Scholar
Maremmani, I, Castrogiovanni, P. Drug Addiction History Questionnaire (DAH-Q)—Heroin Version. Pisa, Italy: University Press; 1989.Google Scholar
Lovrecic, B, Lovrecic, M, Rovai, L, et al. Ethnicity and drug addiction. A comparison between Italian and Slovenian heroin addicts. Heroin Addict Relat Clin Probl. 2012;14(2):5–18.Google Scholar
Derogatis, LR, Lipman, RS, Rickels, K. The Hopkins Symptom Checklist (HSCL). A self report symptom inventory. Behav Sci. 1974;19:1–16.CrossRefGoogle ScholarPubMed
Maremmani, AGI, Rovai, L, Maremmani, I. Heroin addicts’ psychopathological subtypes. Correlations with the natural history of illness. Heroin Addict Relat Clin Probl. 2012;14(1):11–22.Google Scholar
Maremmani, AGI, Rovai, L, Bacciardi, S, et al. An inventory for assessing the behavioural covariates of craving in heroin substance use disorder. Development, theoretical description, reliability, exploratory factor analysis and preliminary construct validity. Heroin Addict Relat Clin Probl. 2015;17(5):51–60.Google Scholar
Dell’Osso, L, Carmassi, C, Rucci, P, et al. A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR). Comprehens Psychiatry. 2009;50(5):485–490.CrossRefGoogle Scholar
Dell’Osso, L, Shear, MK, Carmassi, C, et al. Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS). Clin Pract Epidemiol Mental Health. 2008;4:2.CrossRefGoogle Scholar
Dell’Osso, L, Massimetti, E, Rugani, F, et al. Life events (loss and traumatic) and emotional responses to them in acute catastrophe survivors and long-lasting heroin use disorder patients never exposed to catastrophic events. Heroin Addict Relat Clin Probl. 2015;17(6):49–58.Google Scholar
Ritsner, M, Modai, I, Ponizovski, A. The stress-supportpatterns and psychological distress of immigrants. Stress Health. 2000;16(13):139–147.Google Scholar
Ritsner, M, Ponizovsky, A, Ginath, Y. Changing patterns of distress during the adjustment of recent immigrants: a 1-year follow-up study. Acta Psychiatr Scand. 1997;95(6):494–499.CrossRefGoogle ScholarPubMed
Llosa, EA, Ghantous, Z, Souza, R, et al. Mental disorders, disability and treatment gap in a protected refugees setting. Br J Psychiatry. 2014;204:208–213.CrossRefGoogle Scholar
Lester, H, Tait, L, England, E, Tritter, J. Patient involvement in primary care mental health: a focus group study. Br J Gen Pract. 2006;56:415–422.Google ScholarPubMed
Maremmani, I, Popovic, D. Heroin dependence. In: Maremmani, I, ed. The Principles and Practice of Methadone Treatment. Pisa, Italy: Pacini Editore Medicina; 2009.Google Scholar
Volkow, ND, Poznyak, V, Saxena, S, Gerra, G, and the UNODC-WHO Informal International Scientific Network. Drug use disorders: impact of a public health rather than a criminal justice approach. World Psychiatry. 2017;16(2):213–214.CrossRefGoogle ScholarPubMed
Volkow, ND, Medina-Mora Icaza, ME, Poznyak, V, Saxena, S, Gerra, G, UNODC-WHO Informal Scientific Network. Addressing the opioid crisis globally. World Psychiatry. 2019;18(2):231–232.CrossRefGoogle ScholarPubMed
Gerra, G, Somaini, L, Zaimovic, A, et al. Developmental traumatic experiences, PTSD and substance abuse vulnerability: the neurobiological link. In: Sher, L, Vilens, A, eds. Neurobiology of Post-Traumatic Stress Disorder. Hauppauge, NY: Nova Science Publishers, Inc.; 2010.Google Scholar
Jacobsen, LK, Southwick, SM, Kosten, TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry. 2001;158(8):1184–1190.CrossRefGoogle ScholarPubMed
Evren, C, Can, S, Evren, B, Saatcioglu, O, Cakmak, D. Lifetime posttraumatic stress disorder in Turkish alcohol-dependent inpatients: relationship with depression, anxiety and erectile dysfunction. Psychiatry Clin Neurosci. 2006;60(1):77–84.CrossRefGoogle ScholarPubMed
Dom, G, De Wilde, B, Hulstijn, W, Sabbe, B. Traumatic experiences and posttraumatic stress disorders: differences between treatment-seeking early- and late-onset alcoholic patients. Comprehens Psychiatry. 2007;48(2):178–185.CrossRefGoogle ScholarPubMed
Mills, KL, Lynskey, M, Teesson, M, Ross, J, Darke, S. Post-traumatic stress disorder among people with heroin dependence in the Australian treatment outcome study (ATOS): prevalence and correlates. Drug Alcohol Depend. 2005;77(3):243–249.CrossRefGoogle ScholarPubMed
Driessen, M, Schulte, S, Luedecke, C, et al. Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study. Alcohol Clin Exp Res. 2008;32(3):481–488.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archiv Gen Psychiatry. 2005;62(6):593–602.CrossRefGoogle ScholarPubMed
Khantzian, EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry. 1985;142:1259–1264.Google ScholarPubMed
Haller, M, Chassin, L. Risk pathways among traumatic stress, posttraumatic stress disorder symptoms, and alcohol and drug problems: a test of four hypotheses. Psychol Addict Behav. 2014;28(3):841–851.CrossRefGoogle ScholarPubMed
Breslau, N, Davis, GC, Schultz, LR. Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archiv Gen Psychiatry. 2003;60(3):289–294.CrossRefGoogle ScholarPubMed
Yehuda, R, McFarlane, AC, Shalev, AY. Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biol Psychiatry. 1998;44(12):1305–1313.CrossRefGoogle ScholarPubMed
Moreau, C, Zisook, S. Rationale for a posttraumatic stress spectrum disorder. Psychiatric Clin N Am. 2002;25(4):775–790.CrossRefGoogle ScholarPubMed
Maremmani, AGI, Maiello, M, Carbone, MG, et al. Towards a psychopathology specific to substance use disorder: should emotional responses to life events be included? Compr Psychiatr. 2018;80:132–139.CrossRefGoogle Scholar
Kreek, MJ, Khuri, E, Fahey, L, et al. Long-term followup studies of the medical status of adolescent former heroin addicts in chronic methadone maintenance treatment: liver disease and immune status. NIDA Res Monogr. 1986;67:307–309.Google ScholarPubMed
Kreek, MJ Long-term pharmacotherapy for opiate (primarily heroin) addiction: opioid agonists. In: Schuster, CR, Kuhar, MJ, eds. Pharmacological Aspects of Drug Dependency. Toward an Integrated Neurobehavioral Approach. New York, NY: Springer; 1996.Google Scholar
Rutter, M. Annual research review: resilience—clinical implications. J Child Psychol Psychiatry Allied Disc. 2013;54(4):474–487.CrossRefGoogle Scholar
Bowes, L, Jaffee, SR. Biology, genes, and resilience: toward a multidisciplinary approach. Trauma Violence Abuse. 2013;14(3):195–208.CrossRefGoogle ScholarPubMed
Greenberg, MT. Promoting resilience in children and youth: preventive interventions and their interface with neuroscience. Ann N Y Acad Sci. 2006;1094:139–150.CrossRefGoogle ScholarPubMed
Sapienza, JK, Masten, AS. Understanding and promoting resilience in children and youth. Curr Opin Psychiatry. 2011;24(4):267–273.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Rugani, F, Maremmani, AG, Bertoni, S, Pani, PP, Maremmani, I. Towards a unitary perspective between post-traumatic stress disorder and substance use disorder. Heroin use disorder as case study. Comprehens Psychiatry. 2014;55(5):1244–1251.CrossRefGoogle ScholarPubMed
Gerra, G, Zaimovic, A, Giucastro, G, et al. Neurotransmitter-hormonal responses to psychological stress in peripubertal subjects: relationship to aggressive behavior. Life Sci. 1998;62(7):617–625.CrossRefGoogle ScholarPubMed
Gerra, G, Zaimovic, A, Mascetti, GG, et al. Neuroendocrine responses to experimentally-induced psychological stress in healthy humans. Psychoneuroendocrinology. 2001;26(1):91–107.CrossRefGoogle ScholarPubMed
Cottler, LB, Compton, WM IIIrd, Mager, D, Spitznagel, EL, Janca, A. Posttraumatic stress disorder among substance users from the general population. Am J Psychiatry. 1992;149(5):664–670.Google ScholarPubMed
Sinha, R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008;1141:105–130.CrossRefGoogle ScholarPubMed
Smith, SK, Zimmerman, S, Williams, CS, et al. Post-traumatic stress symptoms in long-term non-Hodgkin’s lymphoma survivors: does time heal? J Clin Oncol. 2011;29(34):4526–4533.CrossRefGoogle ScholarPubMed
Smith, SK, Zimmerman, S, Williams, CS, Preisser, JS, Clipp, EC. Post-traumatic stress outcomes in non-Hodgkin’s lymphoma survivors. J Clin Oncol. 2008;26(6):934–941.CrossRefGoogle ScholarPubMed
Sherr, L, Nagra, N, Kulubya, G, Catalan, J, Clucas, C, Harding, R. HIV infection associated post-traumatic stress disorder and post-traumatic growth—a systematic review. Psychol Health Med. 2011;16(5):612–629.CrossRefGoogle ScholarPubMed
Varela, VS, Ng, A, Mauch, P, Recklitis, CJ. Posttraumatic stress disorder (PTSD) in survivors of Hodgkin’s lymphoma: prevalence of PTSD and partial PTSD compared with sibling controls. Psychooncology. 2013;22(2):434–440.Google ScholarPubMed
Goncalves, V, Jayson, G, Tarrier, N. A longitudinal investigation of posttraumatic stress disorder in patients with ovarian cancer. J Psychosom Res. 2011;70(5):422–431.CrossRefGoogle ScholarPubMed
Geffen, DB, Blaustein, A, Amir, MC, Cohen, Y. Post-traumatic stress disorder and quality of life in long-term survivors of Hodgkin’s disease and non-Hodgkin’s lymphoma in Israel. Leuk Lymphoma. 2003;44(11):1925–1929.CrossRefGoogle ScholarPubMed
Ostacoli, L, Carletto, S, Borghi, M, et al. Prevalence and significant determinants of post-traumatic stress disorder in a large sample of patients with multiple sclerosis. J Clin Psychol Med Settings. 2013;20(2):240–246.CrossRefGoogle Scholar
Van’t Veer, A, Carlezon, WA Jr. Role of kappa-opioid receptors in stress and anxiety-related behavior. Psychopharmacology. 2013;229(3):435–452.CrossRefGoogle ScholarPubMed
Bruchas, MR, Land, BB, Chavkin, C. The dynorphin/kappa opioid system as a modulator of stress-induced and pro-addictive behaviors. Brain Res. 2010;1314:44–55.CrossRefGoogle ScholarPubMed
Carroll, FI, Carlezon, WA Jr. Development of kappa opioid receptor antagonists. J Med Chem. 2013;56(6):2178–2195.CrossRefGoogle ScholarPubMed
Mazzetti, M. Trauma and migration: transactional analytic approach toward refugees and torture victims. Trans Anal J 2008;38:285–302. doi:10.1177/036215370803800404.Google Scholar
Bailey, CR, Cordell, E, Sobin, SM, Neumeister, A. Recent progress in understanding the pathophysiology of post-traumatic stress disorder: implications for targeted pharmacological treatment. CNS Drugs. 2013;27(3):221–232.CrossRefGoogle ScholarPubMed
Diaz-Marsa, M, Molina, R, Lozano, MC, Carrasco, JL. Biological basis of posttraumatic stress disorder. Actas Esp Psiquiatr. 2000;28(6):379–384.Google ScholarPubMed
Graef, FG. Biological basis of posttraumatic stress disorder. Braz J Psychiatry. 2012;25(Suppl. 1):21–24.Google Scholar
Sherin, JE, Nemeroff, CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13(3):263–278.Google ScholarPubMed
Sinha, R, Catapano, D, O’Malley, S. Stress-induced craving and stress response in cocaine dependent individuals. Psychopharmacology. 1999;142(4):343–351.CrossRefGoogle ScholarPubMed
Hoffman, L, Burges Watson, P, Wilson, G, Montgomery, J. Low plasma beta-endorphin in post-traumatic stress disorder. Austr N Z J Psychiatry. 1989;23(2):269–273.CrossRefGoogle ScholarPubMed
Holbrook, TL, Galarneau, MR, Dye, JL, Quinn, K, Dougherty, AL. Morphine use after combat injury in Iraq and post-traumatic stress disorder. N Engl J Med. 2010;362(2):110–117.CrossRefGoogle ScholarPubMed
Bruchas, MR, Land, BB, Chavkin, C. The dynorphin/kappa opioid system as a modulator of stressinduced and pro-addictive behaviors. Brain Res. 2010;1314:44–55.CrossRefGoogle Scholar
Knoll, AT, Carlezon, WA Jr. Dynorphin, stress, and depression. Brain Res. 2010;1314:56–73.CrossRefGoogle ScholarPubMed
Saladin, ME, Brady, KT, Dansky, BS, Kilpatrick, DG. Understanding comorbidity between PTSD and substance use disorders: two preliminary investigations. Addict Behav. 1995;20(5):643–655.CrossRefGoogle ScholarPubMed
Khozhenko, EV. Neuronal mechanisms underlying main clinical syndromes of post-traumatic stress disorder. Klin Med. 2009;87(4):4–9.Google ScholarPubMed
Schluger, JH, Borg, L, Ho, A, Kreek, MJ. Altered HPA axis responsivity to metyrapone testing in methadone maintained former heroin addicts with ongoing cocaine addiction. Neuropsychopharmacology. 2001;24:568–575.CrossRefGoogle ScholarPubMed
Kreek, MJ, Ragunath, J, Plevy, S, Hamer, D, Schneider, B, Hartman, N. ACTH, cortisol and beta-endorphin response to metyrapone testing during chronic methadone maintenance treatment in humans. Neuropeptides. 1984;5(1–3):277–278.CrossRefGoogle ScholarPubMed
Bryant, RA, Creamer, M, O’Donnell, M, Silove, D, McFarlane, AC. A study of the protective function of acute morphine administration on subsequent posttraumatic stress disorder. Biol Psychiatry. 2009;65(5):438–440.CrossRefGoogle ScholarPubMed
Stoddard, SL, Bergdal, VK, Conn, PS, Levin, BE. Increases in plasma catecholaùines during naturally elicited defensive behavior in the cat. J Auton Nerv Syst. 1987;19:189–197.CrossRefGoogle ScholarPubMed
Rugani, F, Maremmani, AGI, Rovai, L, et al. Life events (loss and traumatic) and emotional responses to them in heroin-dependent patients before and after the dependence age of onset. Heroin Addict Relat Clin Probl. 2011;13(3):17–26.Google Scholar