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Heroin Addiction and Related Clinical Problems: 2025, 27, 29

Psychotic Sensitivity in Heroin Addiction: Evidence for a Clinically Distinct Phenomenon

Angelo Giovanni Icro Maremmani, Filippo Della Rocca, Manuel Glauco Carbone, Andrea Saverio Spagnuolo, Ottone Baccaredda Boy, Andrea Ballerini, and Icro Maremmani

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-29

Summary: Background: Psychotic symptoms in substance users are often dismissed as transient effects of intoxication or attributed to comorbid primary psychosis. However, research on Heroin Use Disorder (HUD) suggests the existence of stable psychopathological dimensions, including the sensitivity/psychoticism (S/P) domain, characterised by paranoid ideation, interpersonal mistrust, and mild cognitive-perceptual disturbances. This study examined whether S/P symptoms define a clinically distinct subgroup of heroin-dependent individuals. Methods: We conducted a retrospective comparative analysis of three matched groups: HUD patients with predominant S/P features (HUD-S/P), HUD patients without S/P predominance (HUD), and non-addicted individuals with primary psychotic disorders (PSY-NSUD). Psychopathology was assessed using the SCL-90; data were analysed dimensionally and at the item level. Group comparisons were performed using multinomial logistic regression and linear discriminant analysis, following matching by sex and age. Results: Compulsive checking behaviour strongly predicted membership in the HUD group (OR = 4.66), while older age and feelings of being disliked were associated with PSY-NSUD (OR = 1.08 and 4.79, respectively). The belief of being watched or talked about was more characteristic of HUD-S/P than PSY-NSUD. Discriminant analysis identified two significant functions: the first distinguished PSY-NSUD patients based on paranoid and hostile ideation; the second differentiated HUD-S/P from HUD (compulsivity and control). Conclusions: Psychotic sensitivity in HUD appears to reflect a stable and specific psychopathological dimension, distinct from both transient intoxication effects and primary psychosis. Recognition of this profile may improve diagnostic precision and inform targeted treatment strategies.

Keywords: Heroin Use Disorder; Psychotic Sensitivity; SCL-90; Dimensional Psychopathology; Substance-Induced Symptoms; Discriminant Analysis