Psychopathological symptoms in detoxified and non-detoxified heroindependent patients entering residential treatment

Background: In a previous study, by evaluating patients entering an Outpatient Agonist Treatment, or a residential Therapeutic Community, through the use of SCL-90, a 5-factor solution was identified: a depressive 'worthlessness and being trapped' dimension, a 'somatization' dimension, a 'sensitivity-psychoticism' dimension, a 'panic anxiety' dimension, and a 'violence-suicide' dimension. Aim of the present study is to compare these dimensions between heroin-addicted patients that have already been detoxified (DTX) and those not yet detoxified (NDTX) from heroin at the time of entering a Therapeutic Community Treatment. Methods: The demographic and clinical variables of NDTX patients and DTX patients were first compared; all patients were then assigned to the appropriate SCL-90-based dimension among the five just identified ones. Differences in psychopathological dimensions were analysed at univariate and multivariate level. Results: Out of 1,015 subjects included in the study, 374 (36.8%) were DTX patients, while 641 (63.2%) were NDTX patients. Distribution of demographic and heroin addiction history variables between NDTX and DTX heroin-addicted patients at residential treatment entry were very similar. In the univariate analysis, the SCL-90 total score and all the SCL-90 factors showed higher statistical significance in NDTX than in DTX patients. In the discriminant analysis, severity of ‘somatic symptoms’ was the factor differentiating NDTX from DTX-patients, with 64.4% of the originally grouped cases shown to be correctly classified. Differences in qualities of psychopathological symptoms between NDTX and DTX patients were found regarding ‘somatic symptoms’ ‘sensitivity psychoticism’ and ‘panic anxiety’, the last two features being better represented in DTX patients. Conclusions: All the five aggregations of symptoms resulting from the application of Principal Component Analysis to the SCL-90 of opioid addicts were present in subjects actively involved with opioids as well as already detoxified ones. Although the severity of psychiatric damage was lower in the DTX than in the NDTX patients, the only dimension that successfully discriminated between the two groups of patients was that of ‘somatic symptoms’.