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Gao Y, Su B, Ding L, Qureshi D, Hong S, Wei J, Zeng C, Lei G, Xie J. Association of Regular Opioid Use With Incident Dementia and Neuroimaging Markers of Brain Health in Chronic Pain Patients: Analysis of UK Biobank. Am J Geriatr Psychiatry 2024:S1064-7481(24)00320-8. [PMID: 38702251 DOI: 10.1016/j.jagp.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES We aimed to investigate the association of regular opioid use, compared with non-opioid analgesics, with incident dementia and neuroimaging outcomes among chronic pain patients. DESIGN The primary design is a prospective cohort study. To triangulate evidence, we also conducted a nested case-control study analyzing opioid prescriptions and a cross-sectional study analyzing neuroimaging outcomes. SETTING AND PARTICIPANTS Dementia-free UK Biobank participants with chronic pain and regular analgesic use. MEASUREMENTS Chronic pain status and regular analgesic use were captured using self-reported questionnaires and verbal interviews. Opioid prescription data were obtained from primary care records. Dementia cases were ascertained using primary care, hospital, and death registry records. Propensity score-matched Cox proportional hazards analysis, conditional logistic regression, and linear regression were applied to the data in the prospective cohort, nested case-control, and cross-sectional studies, respectively. RESULTS Prospective analyses revealed that regular opioid use, compared with non-opioid analgesics, was associated with an increased dementia risk over the 15-year follow-up (Hazard ratio [HR], 1.18 [95% confidence interval (CI): 1.08-1.30]; Absolute rate difference [ARD], 0.44 [95% CI: 0.19-0.71] per 1000 person-years; Wald χ2 = 3.65; df = 1; p <0.001). The nested case-control study suggested that a higher number of opioid prescriptions was associated with an increased risk of dementia (1 to 5 prescriptions: OR = 1.21, 95% CI: 1.07-1.37, Wald χ2 = 3.02, df = 1, p = 0.003; 6 to 20: OR = 1.27, 95% CI: 1.08-1.50, Wald χ2 = 2.93, df = 1, p = 0.003; more than 20: OR = 1.43, 95% CI: 1.23-1.67, Wald χ2 = 4.57, df = 1, p < 0.001). Finally, neuroimaging analyses revealed that regular opioid use was associated with lower total grey matter and hippocampal volumes, and higher white matter hyperintensities volumes. CONCLUSION Regular opioid use in chronic pain patients was associated with an increased risk of dementia and poorer brain health when compared to non-opioid analgesic use. These findings imply a need for re-evaluation of opioid prescription practices for chronic pain patients and, if further evidence supports causality, provide insights into strategies to mitigate the burden of dementia.
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Affiliation(s)
- Yaqing Gao
- Nuffield Department of Population Health (YG, DQ), University of Oxford, Oxford, UK
| | - Binbin Su
- School of Population Medicine and Public Health (BS), Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Lei Ding
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases (LD), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Danial Qureshi
- Nuffield Department of Population Health (YG, DQ), University of Oxford, Oxford, UK
| | - Shenda Hong
- National Institute of Health Data Science (SH), Peking University, Beijing, China; Institute of Medical Technology (SH), Peking University Health Science Center, Beijing, China
| | - Jie Wei
- Department of Orthopaedics (JW, CZ, GL), Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics (JW, CZ, GL), Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics (JW, CZ, GL), Xiangya Hospital, Central South University, Changsha, China.
| | - Junqing Xie
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS (JX), University of Oxford, Oxford, UK.
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Herath H, Lutchman NG, Jeffries M, Saleh M, Naidu L, Wimalaratna S. MRI changes in chronic crystal methamphetamine abuse. Pract Neurol 2024; 24:80-81. [PMID: 37643840 DOI: 10.1136/pn-2023-003849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Hmmtb Herath
- Consultant Neurologist, Kettering General Hospital, Kettering, UK
| | | | - Mark Jeffries
- Consultant Neurologist, Kettering General Hospital, Kettering, UK
| | - May Saleh
- Consultant Radiologist, Kettering General Hospital, Kettering, UK
| | - Leena Naidu
- Consultant Radiologist, Kettering General Hospital, Kettering, UK
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Gaudreault PO, King SG, Malaker P, Alia-Klein N, Goldstein RZ. Whole-brain white matter abnormalities in human cocaine and heroin use disorders: association with craving, recency, and cumulative use. Mol Psychiatry 2023; 28:780-791. [PMID: 36369361 PMCID: PMC9911401 DOI: 10.1038/s41380-022-01833-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022]
Abstract
Neuroimaging studies in substance use disorder have shown widespread impairments in white matter (WM) microstructure suggesting demyelination and axonal damage. However, substantially fewer studies explored the generalized vs. the acute and/or specific drug effects on WM. Our study assessed whole-brain WM integrity in three subgroups of individuals addicted to drugs, encompassing those with cocaine (CUD) or heroin (HUD) use disorder, compared to healthy controls (CTL). Diffusion MRI was acquired in 58 CTL, 28 current cocaine users/CUD+, 32 abstinent cocaine users/CUD-, and 30 individuals with HUD (urine was positive for cocaine in CUD+ and opiates used for treatment in HUD). Tract-Based Spatial Statistics allowed voxelwise analyses of diffusion metrics [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)]. Permutation statistics (p-corrected < 0.05) were used for between-group t-tests. Compared to CTL, all individuals with addiction showed widespread decreases in FA, and increases in MD, RD, and AD (19-57% of WM skeleton, p < 0.05). The HUD group showed the most impairments, followed by the CUD+, with only minor FA reductions in CUD- (<0.2% of WM skeleton, p = 0.05). Longer periods of regular use were associated with decreased FA and AD, and higher subjective craving was associated with increased MD, RD, and AD, across all individuals with drug addiction (p < 0.05). These findings demonstrate extensive WM impairments in individuals with drug addiction characterized by decreased anisotropy and increased diffusivity, thought to reflect demyelination and lower axonal packing. Extensive abnormalities in both groups with positive urine status (CUD+ and HUD), and correlations with craving, suggest greater WM impairments with more recent use. Results in CUD-, and correlations with regular use, further imply cumulative and/or persistent WM damage.
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Affiliation(s)
- Pierre-Olivier Gaudreault
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sarah G King
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Pias Malaker
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Nelly Alia-Klein
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rita Z Goldstein
- Psychiatry and Neuroscience Departments, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Dousset C, Chenut C, Kajosch H, Kornreich C, Campanella S. Comparison of Neural Correlates of Reactive Inhibition in Cocaine, Heroin, and Polydrug Users through a Contextual Go/No-Go Task Using Event-Related Potentials. BIOLOGY 2022; 11:biology11071029. [PMID: 36101410 PMCID: PMC9312501 DOI: 10.3390/biology11071029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/05/2022]
Abstract
Simple Summary Witnessing the current increase in the use of substances in society and considering the associated pervasive relapse rate, the management of addictions remains a significant challenge. The identification of biomarkers that are linked to specific profiles of consumption would allow a more targeted, and therefore, more effective care. In this view, the present study evaluates and compares the cognitive performance usually associated with substance use disorder—inhibitory control, attentional bias, and error detection—of heroin, cocaine, and polydrug users to matched healthy controls. Simultaneously, the addition of measurement of the modulation of brain activity during the task (event-related potentials technique) offers a reliable representation of the neuronal mechanisms underlying cognitive functioning. The results reveal substance-specific neural patterns of response, notably a more deleterious impact on polydrug use, and, despite nonsignificant results, suggest a more drastically affected cognitive functioning in cocaine users. Such evidence refines our knowledge of the specific mode of action of each substance. Ultimately, knowing their neural signature will lead to the implementation of more targeted interventions, thereby allowing specific needs to be addressed. Abstract Recent global data indicates a worldwide increase in polydrug use associated with a shift from recreational to productive habits of consumption. Such non-responsible abuse of substances (alcohol, cocaine, heroin, etc.) is likely to lead to addictive disorders that are characterized by various neuropsychopharmacological effects. A main cognitive function involved in the onset and long-term maintenance of addiction is reactive inhibition, i.e., the ability to withhold a prepotent motor dominant response. In the present study, 63 (poly)drug user patients who were undergoing a detoxification program, in addition to 19 healthy controls matched for gender, age, and education, were subjected to a “contextual Go/No-Go task” with concomitant electroencephalography. Stimuli were superimposed on three contextual backgrounds: control (black screen), drug-unrelated (neutral pictures), or drug-related (pictures related to drug consumption). Of these patients, 23 were cocaine users (CU), 21 were heroin users (HU), and 19 were polydrug users (PDU). The main results showed that (1) at the behavioral level, more commission errors occurred with the PDU patients compared to the healthy controls; (2) at the neurophysiological level, specific alterations were found on classical event-related potentials that index reactive inhibition. Indeed, the higher rate of errors in the PDU group was subtended by both reduced amplitude and latency on the ∆N2 component and increased ∆P3 latency compared to controls. These data clearly suggest a more deleterious impact of polydrug use on inhibitory functions. In addition, our results provide evidence of reduced ERN amplitude in cocaine users, suggesting that impaired performance monitoring and error-processing may support impaired awareness, thereby preventing these patients from changing their behaviors.
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Affiliation(s)
- Clémence Dousset
- Laboratoire de Psychologie Médicale et d’Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten, 1020 Brussels, Belgium; (C.D.); (H.K.); (C.K.)
| | - Christie Chenut
- Substance Abuse Unit 73, CHU Brugmann, 4 Place Vangehuchten, 1020 Brussels, Belgium;
| | - Hendrik Kajosch
- Laboratoire de Psychologie Médicale et d’Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten, 1020 Brussels, Belgium; (C.D.); (H.K.); (C.K.)
| | - Charles Kornreich
- Laboratoire de Psychologie Médicale et d’Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten, 1020 Brussels, Belgium; (C.D.); (H.K.); (C.K.)
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d’Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (ULB), 4 Place Vangehuchten, 1020 Brussels, Belgium; (C.D.); (H.K.); (C.K.)
- Correspondence: or ; Tel.: +32-477-28-51
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Hall SA, Bell RP, Gadde S, Towe SL, Nadeem MT, McCann PS, Song AW, Meade CS. Strengthened and posterior-shifted structural rich-club organization in people who use cocaine. Drug Alcohol Depend 2022; 235:109436. [PMID: 35413558 PMCID: PMC9948276 DOI: 10.1016/j.drugalcdep.2022.109436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND People with cocaine use disorder (CUD) often have abnormal cognitive function and brain structure. Cognition is supported by brain networks that typically have characteristics like rich-club organization, which is a group of regions that are highly connected across the brain and to each other, and small worldness, which is a balance between local and long-distance connections. However, it is unknown whether there are abnormalities in structural brain network connectivity of CUD. METHODS Using diffusion-weighted imaging, we measured structural connectivity in 37 people with CUD and 38 age-matched controls. We identified differences in rich-club organization and whether such differences related to small worldness and behavior. We also tested whether rich-club reorganization was associated with caudate and putamen structural connectivity due to the relevance of the dopamine system to cocaine use. RESULTS People with CUD had a higher normalized rich-club coefficient than controls, more edges connecting rich-club nodes to each other and to non-rich-club nodes, and fewer edges connecting non-rich-club nodes. Rich-club nodes were shifted posterior and lateral. Rich-club reorganization was related to lower clustered connectivity around individual nodes found in CUD, to increased impulsivity, and to a decrease in caudate connectivity. CONCLUSIONS These findings are consistent with previous work showing increased rich-club connectivity in conditions associated with a hypofunctional dopamine system. The posterior shift in rich-club nodes in CUD suggests that the structural connectivity of posterior regions may be more impacted than previously recognized in models based on brain function and morphology.
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Affiliation(s)
- Shana A. Hall
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences. Campus Box 102848, Durham, NC 27710, USA
| | - Ryan P. Bell
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences. Campus Box 102848, Durham, NC 27710, USA
| | - Syam Gadde
- Brain Imaging and Analysis Center, Duke University Medical Center. Campus Box 3918, Durham, NC 27710, USA
| | - Sheri L. Towe
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences. Campus Box 102848, Durham, NC 27710, USA
| | - Muhammad Tauseef Nadeem
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences. Campus Box 102848, Durham, NC 27710, USA
| | - Peter S. McCann
- Duke University Hospital. 2301 Erwin Rd, Durham, NC 27710, USA
| | - Allen W. Song
- Brain Imaging and Analysis Center, Duke University Medical Center. Campus Box 3918, Durham, NC 27710, USA
| | - Christina S. Meade
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences. Campus Box 102848, Durham, NC 27710, USA.,Brain Imaging and Analysis Center, Duke University Medical Center. Campus Box 3918, Durham, NC 27710, USA
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Michels L, Moisa M, Stämpfli P, Hirsiger S, Baumgartner MR, Surbeck W, Seifritz E, Quednow BB. The impact of levamisole and alcohol on white matter microstructure in adult chronic cocaine users. Addict Biol 2022; 27:e13149. [PMID: 35394690 PMCID: PMC9287079 DOI: 10.1111/adb.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/16/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
Previous brain imaging studies with chronic cocaine users (CU) using diffusion tensor imaging (DTI) mostly focused on fractional anisotropy to investigate white matter (WM) integrity. However, a quantitative interpretation of fractional anisotropy (FA) alterations is often impeded by the inherent limitations of the underlying tensor model. A more fine-grained measure of WM alterations could be achieved by measuring fibre density (FD). This study investigates this novel DTI metric comparing 23 chronic CU and 32 healthy subjects. Quantitative hair analysis was used to determine intensity of cocaine and levamisole exposure-a cocaine adulterant with putative WM neurotoxicity. We first assessed the impact of cocaine use, levamisole exposure and alcohol use on group differences in WM integrity. Compared with healthy controls, all models revealed cortical reductions of FA and FD in CU. At the within-patient group level, we found that alcohol use and levamisole exposure exhibited regionally different FA and FD alterations than cocaine use. We found mostly negative correlations of tract-based WM associated with levamisole and weekly alcohol use. Specifically, levamisole exposure was linked with stronger WM reductions in the corpus callosum than alcohol use. Cocaine use duration correlated negatively with FA and FD in some regions. Yet, most of these correlations did not survive a correction for multiple testing. Our results suggest that chronic cocaine use, levamisole exposure and alcohol use were all linked to significant WM impairments in CU. We conclude that FD could be a sensitive marker to detect the impact of the use of multiple substances on WM integrity in cocaine but also other substance use disorders.
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Affiliation(s)
- Lars Michels
- Department of NeuroradiologyUniversity Hospital ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
| | - Marius Moisa
- Zurich Center for Neuroeconomics, Department of NeuroeconomicsUniversity of ZurichZurichSwitzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Sarah Hirsiger
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Markus R. Baumgartner
- Center of Forensic Hair Analytics, Institute of Forensic MedicineUniversity of ZurichZurichSwitzerland
| | - Werner Surbeck
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Erich Seifritz
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
- Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Boris B. Quednow
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
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The neurobiology of drug addiction: cross-species insights into the dysfunction and recovery of the prefrontal cortex. Neuropsychopharmacology 2022; 47:276-291. [PMID: 34408275 PMCID: PMC8617203 DOI: 10.1038/s41386-021-01153-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
A growing preclinical and clinical body of work on the effects of chronic drug use and drug addiction has extended the scope of inquiry from the putative reward-related subcortical mechanisms to higher-order executive functions as regulated by the prefrontal cortex. Here we review the neuroimaging evidence in humans and non-human primates to demonstrate the involvement of the prefrontal cortex in emotional, cognitive, and behavioral alterations in drug addiction, with particular attention to the impaired response inhibition and salience attribution (iRISA) framework. In support of iRISA, functional and structural neuroimaging studies document a role for the prefrontal cortex in assigning excessive salience to drug over non-drug-related processes with concomitant lapses in self-control, and deficits in reward-related decision-making and insight into illness. Importantly, converging insights from human and non-human primate studies suggest a causal relationship between drug addiction and prefrontal insult, indicating that chronic drug use causes the prefrontal cortex damage that underlies iRISA while changes with abstinence and recovery with treatment suggest plasticity of these same brain regions and functions. We further dissect the overlapping and distinct characteristics of drug classes, potential biomarkers that inform vulnerability and resilience, and advancements in cutting-edge psychological and neuromodulatory treatment strategies, providing a comprehensive landscape of the human and non-human primate drug addiction literature as it relates to the prefrontal cortex.
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Brust JC. Stroke and Substance Abuse. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tolomeo S, Steele JD, Ekhtiari H, Baldacchino A. Chronic heroin use disorder and the brain: Current evidence and future implications. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110148. [PMID: 33169674 DOI: 10.1016/j.pnpbp.2020.110148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/10/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
The incidence of chronic heroin use disorder, including overdose deaths, has reached epidemic proportions. Here we summarise and evaluate our knowledge of the relationship between chronic heroin use disorder and the brain through a narrative review. A broad range of areas was considered including causal mechanisms, cognitive and neurological consequences of chronic heroin use and novel neuroscience-based clinical interventions. Chronic heroin use is associated with limited or very limited evidence of impairments in memory, cognitive impulsivity, non-planning impulsivity, compulsivity and decision-making. Additionally, there is some evidence for certain neurological disorders being caused by chronic heroin use, including toxic leukoencephalopathy and neurodegeneration. However, there is insufficient evidence on whether these impairments and disorders recover after abstinence. Whilst there is a high prevalence of comorbid psychiatric disorders, there is no clear evidence that chronic heroin use per se causes depression, bipolar disorder, PTSD and/or psychosis. Despite the growing burden on society from heroin use, knowledge of the long-term effects of chronic heroin use disorder on the brain remains limited. Nevertheless, there is evidence for progress in neuroscience-based interventions being made in two areas: assessment (cognitive assessment and neuroimaging) and interventions (cognitive training/remediation and neuromodulation). Longitudinal studies are needed to unravel addiction and neurotoxic mechanisms and clarify the role of pre-existing psychiatric symptoms and cognitive impairments.
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Affiliation(s)
- Serenella Tolomeo
- Department of Psychology, National University of Singapore (NUS), Singapore.
| | - J Douglas Steele
- School of Medicine, University of Dundee and Department of Neurology, NHS Tayside, Ninewells Hospital and Medical School, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA
| | - Alex Baldacchino
- Division of Population and Behavioural Sciences, University of St Andrews, Fife, Scotland, United Kingdom
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Conrad F, Hirsiger S, Winklhofer S, Baumgartner MR, Stämpfli P, Seifritz E, Wegener S, Quednow BB. Use of levamisole-adulterated cocaine is associated with increased load of white matter lesions. J Psychiatry Neurosci 2021; 46:E281-E291. [PMID: 33844483 PMCID: PMC8061741 DOI: 10.1503/jpn.200057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Cocaine use has been associated with vascular pathologies, including cerebral white matter hyperintensities. Street cocaine is most often adulterated with levamisole, an anthelminthic drug that may also be associated with vascular toxicity. However, whether levamisole exposure from cocaine consumption further accelerates the development of white matter lesions remains unknown. Methods We investigated the association of cocaine and levamisole exposure with white matter hyperintensities in 35 chronic cocaine users and 34 healthy controls. We measured cocaine and levamisole concentrations in hair samples, which reflected exposure up to 6 months previously. We assessed the number and total surface area of the white matter hyperintensities using structural MRI (FLAIR sequence). Using generalized linear models, we analyzed the contributions of cocaine and levamisole to the number and area of white matter hyperintensities, accounting for several confounding factors. Results Analysis using generalized linear models revealed that cocaine users had more white matter hyperintensities in terms of total surface area, but not in terms of number. Further generalized linear models that included cocaine and levamisole hair concentrations (instead of group) as predictors indicated that levamisole exposure was strongly associated with more and larger white matter hyperintensities, suggesting that the elevated white matter hyperintensities in cocaine users were driven mainly by levamisole exposure. Finally, white matter hyperintensities in levamisole-exposed cocaine users were located primarily in the periventricular and juxtacortical white matter. Limitations The sample size was moderate, and blood pressure was not systematically assessed. Conclusion As an adulterant of cocaine, levamisole appears to increase the risk of white matter injury.
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Affiliation(s)
- Florian Conrad
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Sarah Hirsiger
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Sebastian Winklhofer
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Markus R Baumgartner
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Philipp Stämpfli
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Erich Seifritz
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Susanne Wegener
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Boris B Quednow
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
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Rizk MM, Herzog S, Dugad S, Stanley B. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. CURRENT ADDICTION REPORTS 2021; 8:194-207. [PMID: 33747710 PMCID: PMC7955902 DOI: 10.1007/s40429-021-00361-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Recent Findings Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Summary Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
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Affiliation(s)
- Mina M. Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt, Egypt
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
| | - Sanjana Dugad
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
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12
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Riley ED, Chow FC, Josephson SA, Dilworth SE, Lynch KL, Wade AN, Braun C, Hess CP. Cocaine Use and White Matter Hyperintensities in Homeless and Unstably Housed Women. J Stroke Cerebrovasc Dis 2021; 30:105675. [PMID: 33677311 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cocaine use has been linked to stroke in several studies. However, few studies have considered the influence of cocaine use on stroke mechanisms such as small vessel disease (SVD). We conducted a study to assess associations between the toxicology-confirmed use of multiple drugs, including cocaine, and a marker of SVD, white matter hyperintensities (WMH). MATERIALS AND METHODS We conducted a nested case-control study (n = 30) within a larger cohort study (N = 245) of homeless and unstably housed women recruited from San Francisco community venues. Participants completed six monthly study visits consisting of an interview, blood draw, vital sign assessment and baseline brain MRI. We examined associations between toxicology-confirmed use of multiple substances, including cocaine, methamphetamine, heroin, alcohol and tobacco, and WMH identified on MRI. RESULTS Mean study participant age was 53 years, 70% of participants were ethnic minority women and 86% had a history of cocaine use. Brain MRIs indicated the presence of WMH (i.e., Fazekas score>0) in 54% (18/30) of imaged participants. The odds of WMH were significantly higher in women who were toxicology-positive for cocaine (Odd Ratio=7.58, p=0.01), but not in women who were toxicology-positive for other drugs or had several other cerebrovascular risk factors. CONCLUSIONS Over half of homeless and unstably housed women showed evidence of WMH. Cocaine use is highly prevalent and a significant correlate of WMH in this population, while several traditional CVD risk factors are not. Including cocaine use in cerebrovascular risk calculators may improve stroke risk prediction in high-risk populations and warrants further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Felicia C Chow
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA; University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - S Andrew Josephson
- University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - Samantha E Dilworth
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Kara L Lynch
- University of California, San Francisco, Department of Laboratory Medicine, San Francisco, CA, USA.
| | - Amanda N Wade
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Carl Braun
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Christopher P Hess
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA.
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13
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He Q, Li D, Turel O, Bechara A, Hser YI. White matter integrity alternations associated with cocaine dependence and long-term abstinence: Preliminary findings. Behav Brain Res 2019; 379:112388. [PMID: 31783090 DOI: 10.1016/j.bbr.2019.112388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 01/19/2023]
Abstract
Cocaine dependence has been associated with deficits in white matter (WM) integrity. Nevertheless, what happens to WM integrity after long-term abstinence is not fully understood. To bridge this gap, changes in WM integrity were examined with diffusion tensor imaging (DTI) applied to 39 participants: 12 participants who used cocaine in the last year (CURRENT USERS), 20 who were at different stages of cocaine abstinence (ABSTINENCE) [five with 1-5 years of abstinence (ABS1), five with 6-10 years of abstinence (ABS2), and 10 with over 10 years of abstinence (ABS3)], and 7 healthy controls (CONTROLS). The CONTROL group had higher fractional anisotropy (FA) compared to CURRENT USERS in frontal cortex tracts, including the bilateral corpus callosum, bilateral superior longitudinal fasciculus, bilateral inferior fronto-occipital fasciculus, left internal capsule, left middle cingulum, and left ventral and dorsal medial frontal regions. The ABSTINENCE group also had higher FA compared to CURRENT USERS in frontal cortex tracts, such as the bilateral corpus callosum, bilateral superior longitudinal fasciculus, left inferior longitudinal fasciculus, left uncinate fasciculus, left inferior fronto-occipital fasciculus, and the left ventral and dorsal medial frontal regions. Tractography analysis showed (1) deficits in terms of number of fibers and fiber length in these regions, and that (2) while there was some recovery of white matter in dorsolateral regions during abstinence, duration of abstinence was not associated with such recovery. The results identified WM differences among cocaine users, cocaine abstinent participants, and controls. These preliminary findings point to WM tracts that recover, and some that do not, after long-term abstinence from cocaine.
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Affiliation(s)
- Qinghua He
- Faculty of Psychology, Southwest University, Beibei, Chongqing, China; Brain and Creativity Institute and Department of Psychology, University of Southern California, Los Angeles, CA, USA.
| | - Dandan Li
- Faculty of Psychology, Southwest University, Beibei, Chongqing, China
| | - Ofir Turel
- Brain and Creativity Institute and Department of Psychology, University of Southern California, Los Angeles, CA, USA; Information Systems and Decision Sciences, California State University, Fullerton, CA, USA
| | - Antoine Bechara
- Brain and Creativity Institute and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Center for Advancing Longitudinal Drug Abuse Research, University of California, Los Angeles, CA, USA
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Regional elevations in microglial activation and cerebral glucose utilization in frontal white matter tracts of rhesus monkeys following prolonged cocaine self-administration. Brain Struct Funct 2019; 224:1417-1428. [PMID: 30747315 DOI: 10.1007/s00429-019-01846-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 02/06/2019] [Indexed: 12/18/2022]
Abstract
It has been shown that exposure to cocaine can result in neuroinflammatory responses. Microglia, the resident CNS immune cells, undergo a transition to an activated state when challenged. In rodents, and possibly humans, cocaine exposure activates microglia. The goal of this study was to assess the extent and magnitude of microglial activation in rhesus monkeys with an extensive history of cocaine self-administration. Male rhesus monkeys (N = 4/group) were trained to respond on a fixed-interval 3-min schedule of food or 0.3 mg/kg/injection cocaine presentation (30 reinforcers/session) for 300 sessions. At the end of the final session, monkeys were administered 2-[14C]deoxyglucose intravenously and 45 min later euthanized. Brain sections were used for autoradiographic assessments of glucose utilization and for microglia activation with [3H]PK11195, a marker for the microglial 18-kDa translocator protein. There were no group differences in gray matter [3H]PK11195 binding, while binding was significantly greater in cocaine self-administration animals as compared to food controls in 8 of the 11 white matter tracts measured at the striatal level. Binding did not differ from control at other levels. There were also significant increases in white matter local cerebral glucose utilization at the striatal level, which were positively correlated with [3H]PK11195 binding. The present findings demonstrate an elevation in [3H]PK11195 binding in forebrain white matter tracts of nonhuman primates with a prolonged history of cocaine self-administration. These elevations were also associated with greater cerebral metabolic rates. These data suggest that white matter deficits may contribute to behavioral, motivational, and cognitive impairments observed in cocaine abusers.
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Defining the place of habit in substance use disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:22-32. [PMID: 28663112 PMCID: PMC5748018 DOI: 10.1016/j.pnpbp.2017.06.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 12/20/2022]
Abstract
It has long been suggested that alcohol or substance use disorders could emerge from the progressive development and dominance of drug habits. Like habits, drug-related behaviors are often triggered by drug-associated cues. Like habits, addictive behaviors are strong, rigid and "hard to break". Like habits, these behaviors are insensitive to their outcome and persist despite negative consequences. "Pathological habit" thus appears as a good candidate to explain the transition to compulsive drug use. However, drug use could also be considered as a goal-directed choice, driven by the expectation of drug outcomes. For example, drug addicts may engage in drug-seeking behaviors because they view the drug as more valuable than available alternatives. Substance use disorders therefore may not be all about habit, nor fully intentional, and could be considered as resulting from an imbalance between goal-directed and habitual control. The main objective of this review is to disentangle the relative contribution of habit formation and impairment of goal-directed behavior in this unbalanced control of addictive behaviors. Although deficits in goal-directed behavior have been demonstrated in alcohol and substance use disorders, reliable demonstration of abnormal habit formation has been curtailed by the paucity of paradigms designed to assess habit as a positive result. Refining our animal and human model of habit is therefore required to precisely define the place of habit in substance use disorders and develop appropriate and adapted neurobehavioral treatments.
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16
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Hagerman RJ, Protic D, Rajaratnam A, Salcedo-Arellano MJ, Aydin EY, Schneider A. Fragile X-Associated Neuropsychiatric Disorders (FXAND). Front Psychiatry 2018; 9:564. [PMID: 30483160 PMCID: PMC6243096 DOI: 10.3389/fpsyt.2018.00564] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022] Open
Abstract
Fragile X syndrome (FXS) is caused by the full mutation (>200 CGG repeats) in the Fragile X Mental Retardation 1 (FMR1) gene. It is the most common inherited cause of intellectual disability (ID) and autism. This review focuses on neuropsychiatric disorders frequently experienced by premutation carriers with 55 to 200 CGG repeats and the pathophysiology involves elevated FMR1 mRNA levels, which is different from the absence or deficiency of fragile X mental retardation protein (FMRP) seen in FXS. Neuropsychiatric disorders are the most common problems associated with the premutation, and they affect approximately 50% of individuals with 55 to 200 CGG repeats in the FMR1 gene. Neuropsychiatric disorders in children with the premutation include anxiety, ADHD, social deficits, or autism spectrum disorders (ASD). In adults with the premutation, anxiety and depression are the most common problems, although obsessive compulsive disorder, ADHD, and substance abuse are also common. These problems are often exacerbated by chronic fatigue, chronic pain, fibromyalgia, autoimmune disorders and sleep problems, which are also associated with the premutation. Here we review the clinical studies, neuropathology and molecular underpinnings of RNA toxicity associated with the premutation. We also propose the name Fragile X-associated Neuropsychiatric Disorders (FXAND) in an effort to promote research and the use of fragile X DNA testing to enhance recognition and treatment for these disorders.
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Affiliation(s)
- Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Dragana Protic
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Akash Rajaratnam
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Maria J. Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Elber Yuksel Aydin
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
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17
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Fladt J, Kronlage C, De Marchis GM. Cerebral White Matter Hyperintensities and Microbleeds in Acute Ischemic Stroke: Impact on Recanalization Therapies. A Review of the Literature. Neurosci Lett 2018; 687:55-64. [PMID: 30194982 DOI: 10.1016/j.neulet.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/30/2022]
Abstract
Cerebral white matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are frequently seen on brain imaging acquired for acute ischemic stroke. Given the raising use of recanalization therapies - both intravenous and endovascular - the interest on the impact of WMH and CMBs on the risk of intracerebral hemorrhage and on functional outcome is growing. In this review, we will discuss the relevance of WMH and CMBs among patients with an acute ischemic stroke, focusing on the implications for recanalization therapies.
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Affiliation(s)
- J Fladt
- Department of Neurology, University Hospital Basel, Switzerland
| | - C Kronlage
- Department of Neurology, University Hospital Basel, Switzerland
| | - G M De Marchis
- Department of Neurology, University Hospital Basel, Switzerland.
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18
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Frontal cortex dysfunction as a target for remediation in opiate use disorder: Role in cognitive dysfunction and disordered reward systems. PROGRESS IN BRAIN RESEARCH 2018; 239:179-227. [DOI: 10.1016/bs.pbr.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Biernacki K, McLennan SN, Terrett G, Labuschagne I, Rendell PG. Decision-making ability in current and past users of opiates: A meta-analysis. Neurosci Biobehav Rev 2016; 71:342-351. [DOI: 10.1016/j.neubiorev.2016.09.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/04/2016] [Accepted: 09/15/2016] [Indexed: 02/06/2023]
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20
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Tolomeo S, Gray S, Matthews K, Steele JD, Baldacchino A. Multifaceted impairments in impulsivity and brain structural abnormalities in opioid dependence and abstinence. Psychol Med 2016; 46:2841-2853. [PMID: 27452238 DOI: 10.1017/s0033291716001513] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Chronic opioid exposure, as a treatment for a variety of disorders or as drug of misuse, is common worldwide, but behavioural and brain abnormalities remain under-investigated. Only a small percentage of patients who receive methadone maintenance treatment (MMT) for previous heroin misuse eventually achieve abstinence and studies on such patients are rare. METHOD The Cambridge Neuropsychological Test Automated Battery and T1 weighted magnetic resonance imaging (MRI) were used to study a cohort of 122 male individuals: a clinically stable opioid-dependent patient group receiving MMT (n = 48), an abstinent previously MMT maintained group (ABS) (n = 24) and healthy controls (n = 50). RESULTS Stable MMT participants deliberated longer and placed higher bets earlier in the Cambridge Gambling Task (CGT) and showed impaired strategic planning compared with healthy controls. In contrast, ABS participants showed impairment in choosing the least likely outcome, delay aversion and risk adjustment on the CGT, and exhibited non-planning impulsivity compared with controls. MMT patients had widespread grey matter reductions in the orbitomedial prefrontal cortex, caudate, putamen and globus pallidus. In contrast, ABS participants showed midbrain-thalamic grey matter reductions. A higher methadone dose at the time of scanning was associated with a smaller globus pallidus in the MMT group. CONCLUSIONS Our findings support an interpretation of heightened impulsivity in patients receiving MMT. Widespread structural brain abnormalities in the MMT group and reduced brain structural abnormality with abstinence suggest benefit of cessation of methadone intake. We suggest that a longitudinal study is required to determine whether abstinence improves abnormalities, or patients who achieve abstinence have reduced abnormalities before methadone cessation.
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Affiliation(s)
- S Tolomeo
- School of Medicine (Neuroscience),Ninewells Hospital and Medical School, University of Dundee,Dundee,UK
| | - S Gray
- NHS Fife Research and Development Department,Queen Margaret Hospital,Dunfermline,UK
| | - K Matthews
- School of Medicine (Neuroscience),Ninewells Hospital and Medical School, University of Dundee,Dundee,UK
| | - J D Steele
- School of Medicine (Neuroscience),Ninewells Hospital and Medical School, University of Dundee,Dundee,UK
| | - A Baldacchino
- School of Medicine (Neuroscience),Ninewells Hospital and Medical School, University of Dundee,Dundee,UK
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21
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Yip SW, DeVito EE, Kober H, Worhunsky PD, Carroll KM, Potenza MN. Anticipatory reward processing among cocaine-dependent individuals with and without concurrent methadone-maintenance treatment: Relationship to treatment response. Drug Alcohol Depend 2016; 166:134-42. [PMID: 27430401 PMCID: PMC5082418 DOI: 10.1016/j.drugalcdep.2016.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/21/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cocaine dependence among opioid-dependent methadone-maintained individuals is a significant public health problem and is particularly challenging to treat. The neurobiology of this clinically complex population has not been previously assessed using fMRI. METHODS fMRI data from cocaine-dependent, methadone-maintained (CD-MM) patients (n=24), cocaine-dependent (CD) patients (n=20) and healthy comparison (HC) participants (n=21) were acquired during monetary incentive delay task performance. All patients were scanned prior to treatment for cocaine dependence. Between-group differences in anticipatory reward and loss processing were assessed using whole-brain ANOVAs in SPM12 (pFWE<0.05). Correlations between durations of abstinence during treatment and BOLD responses within the insula and caudate were also explored. RESULTS Main effects of diagnostic group, primarily involving decreased BOLD responses among CD-MM patients in comparison to HCs, were observed during anticipatory reward and loss processing within regions of posterior cingulate cortex, precuneus, inferior frontal gyrus and dorsolateral prefrontal cortex. BOLD responses within the right caudate were negatively associated with percentage of cocaine-negative urines during treatment among CD-MM patients, but not among non-methadone-maintained CD patients. CONCLUSIONS These data suggest neurofunctional differences that may be related to treatment outcomes for behavioral therapies between cocaine-dependent individuals with and without methadone-maintenance treatment. These findings may relate to differences in treatment efficacies and to the elevated relapse rates observed in methadone-maintained populations.
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Affiliation(s)
- Sarah W. Yip
- National Center on Addiction and Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Corresponding author: 1 Church Street, 7th Floor, Room 730, New Haven, CT, 06510-3330; Tel: 203 737 4358; Fax: 203 737 3591;
| | - Elise E. DeVito
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Hedy Kober
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Patrick D. Worhunsky
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M. Carroll
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- National Center on Addiction and Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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22
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Agabio R, Campesi I, Pisanu C, Gessa GL, Franconi F. Sex differences in substance use disorders: focus on side effects. Addict Biol 2016; 21:1030-42. [PMID: 27001402 DOI: 10.1111/adb.12395] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 12/19/2022]
Abstract
Although sex differences in several aspects of substance use disorders (SUDs) have been identified, less is known about the importance of possible sex differences in side effects induced by substances of abuse or by medications used to treat SUDs. In the SUD field, the perception of certain subjective effects are actively sought, while all other manifestations might operationally be considered side effects. This article was aimed at reviewing sex differences in side effects induced by alcohol, nicotine, heroin, marijuana and cocaine and by medications approved for alcohol, nicotine and heroin use disorders. A large body of evidence suggests that women are at higher risk of alcohol-induced injury, liver disease, cardiomyopathy, myopathy, brain damages and mortality. The risk of tobacco-induced coronary heart disease, lung disease and health problems is higher for women than for men. Women also experience greater exposure to side effects induced by heroin, marijuana and cocaine. In addition, women appear to be more vulnerable to the side effects induced by medications used to treat SUDs. Patients with SUDs should be advised that the risk of developing health problems may be higher for women than for men after consumption of the same amount of substances of abuse. Doses of medications for SUD women should be adjusted at least according to body weight. The sex differences observed also indicate an urgent need to recruit adequate numbers of female subjects in pre-clinical and clinical studies to improve our knowledge about SUDs in women.
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Affiliation(s)
- Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology; University of Cagliari; Cagliari Italy
| | - Ilaria Campesi
- National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems; Osilo, Sassari Italy
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
| | - Claudia Pisanu
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology; University of Cagliari; Cagliari Italy
| | - Gian Luigi Gessa
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology; University of Cagliari; Cagliari Italy
- Neuroscience Institute, Section of Cagliari; National Research Council of Italy; Cagliari Italy
| | - Flavia Franconi
- National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems; Osilo, Sassari Italy
- Department of Biomedical Sciences; University of Sassari; Sassari Italy
- Assessorato alle Politiche per la Persona; Regione Basilicata Italy
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Welty LJ, Harrison AJ, Abram KM, Olson ND, Aaby DA, McCoy KP, Washburn JJ, Teplin LA. Health Disparities in Drug- and Alcohol-Use Disorders: A 12-Year Longitudinal Study of Youths After Detention. Am J Public Health 2016; 106:872-80. [PMID: 26985602 DOI: 10.2105/ajph.2015.303032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To examine sex and racial/ethnic differences in the prevalence of 9 substance-use disorders (SUDs)--alcohol, marijuana, cocaine, hallucinogen or PCP, opiate, amphetamine, inhalant, sedative, and unspecified drug--in youths during the 12 years after detention. METHODS We used data from the Northwestern Juvenile Project, a prospective longitudinal study of 1829 youths randomly sampled from detention in Chicago, Illinois, starting in 1995 and reinterviewed up to 9 times in the community or correctional facilities through 2011. Independent interviewers assessed SUDs with Diagnostic Interview Schedule for Children 2.3 (baseline) and Diagnostic Interview Schedule version IV (follow-ups). RESULTS By median age 28 years, 91.3% of males and 78.5% of females had ever had an SUD. At most follow-ups, males had greater odds of alcohol- and marijuana-use disorders. Drug-use disorders were most prevalent among non-Hispanic Whites, followed by Hispanics, then African Americans (e.g., compared with African Americans, non-Hispanic Whites had 32.1 times the odds of cocaine-use disorder [95% confidence interval = 13.8, 74.7]). CONCLUSIONS After detention, SUDs differed markedly by sex, race/ethnicity, and substance abused, and, contrary to stereotypes, did not disproportionately affect African Americans. Services to treat substance abuse--during incarceration and after release--would reach many people in need, and address health disparities in a highly vulnerable population.
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Affiliation(s)
- Leah J Welty
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Anna J Harrison
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Karen M Abram
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Nichole D Olson
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - David A Aaby
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Kathleen P McCoy
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Jason J Washburn
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
| | - Linda A Teplin
- Linda A. Teplin, Anna J. Harrison, Karen M. Abram, Nichole D. Olson, David A. Aaby, and Kathleen P. McCoy are with Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Leah J. Welty is with Department of Preventive Medicine and Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine. Jason J. Washburn is with Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, and Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL
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Abstract
INTRODUCTION White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated. METHODS Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17. RESULTS Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients. CONCLUSIONS Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.
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Savitz J, Morris HM, Drevets WC. Neuroimaging Studies of Bipolar Depression: Therapeutic Implications. BIPOLAR DEPRESSION: MOLECULAR NEUROBIOLOGY, CLINICAL DIAGNOSIS, AND PHARMACOTHERAPY 2016. [DOI: 10.1007/978-3-319-31689-5_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Hulka LM, Scheidegger M, Vonmoos M, Preller KH, Baumgartner MR, Herdener M, Seifritz E, Henning A, Quednow BB. Glutamatergic and neurometabolic alterations in chronic cocaine users measured with (1) H-magnetic resonance spectroscopy. Addict Biol 2016; 21:205-17. [PMID: 25600822 DOI: 10.1111/adb.12217] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cocaine addiction is a chronically relapsing disorder that is associated with harmful consequences. Relapses occur frequently and effective pharmacotherapies are currently sparse. Preclinical studies suggest that altered glutamatergic signaling is crucial for the maintenance of cocaine self-administration. However, the translational validity of these models is currently unknown. Therefore, we investigated potential differences of glutamate, glutamine and further metabolite levels in the pregenual anterior cingulate cortex (pgACC) and the right dorsolateral prefrontal cortex (rDLPFC) of chronic cocaine users and controls using the PRior knOwledge FITting 2.0 tool in combination with two-dimensional J-resolved single-voxel (1) H-magnetic resonance spectroscopy at 3T and voxel tissue composition and relaxation correction. Glutamate and glutamine levels did not differ between cocaine users and controls, but higher weekly cocaine use and higher cocaine hair concentrations were associated with lower glutamine/creatine ratios in the pgACC. Interestingly, cocaine users exhibited higher glucose/total creatine ratios than controls in the pgACC and higher choline/creatine ratios in the pgACC and rDLPFC. These results imply that cocaine use is associated with altered cortical glucose metabolism and membrane turnover. Finally, cocaine use over the past 6 months appears to decrease cortical glutamine levels indicating changes in glutamate cycling.
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Affiliation(s)
- Lea M. Hulka
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
| | - Milan Scheidegger
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
- Institute for Biomedical Engineering; University of Zurich and Swiss Federal Institute of Technology Zurich; Switzerland
| | - Matthias Vonmoos
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
| | - Katrin H. Preller
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
| | | | - Marcus Herdener
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
- Zurich Center for Integrative Human Physiology; University of Zurich; Switzerland
- Neuroscience Center Zurich; University of Zurich and Swiss Federal Institute of Technology Zurich; Switzerland
| | - Anke Henning
- Institute for Biomedical Engineering; University of Zurich and Swiss Federal Institute of Technology Zurich; Switzerland
- Zurich Center for Integrative Human Physiology; University of Zurich; Switzerland
- Neuroscience Center Zurich; University of Zurich and Swiss Federal Institute of Technology Zurich; Switzerland
- Max Planck Institute for Biological Cybernetics; Tübingen Germany
| | - Boris B. Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric Hospital; University of Zurich; Switzerland
- Zurich Center for Integrative Human Physiology; University of Zurich; Switzerland
- Neuroscience Center Zurich; University of Zurich and Swiss Federal Institute of Technology Zurich; Switzerland
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Vosoughi R, Schmidt BJ. Multifocal leukoencephalopathy in cocaine users: a report of two cases and review of the literature. BMC Neurol 2015; 15:208. [PMID: 26482228 PMCID: PMC4615875 DOI: 10.1186/s12883-015-0467-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/08/2015] [Indexed: 12/03/2022] Open
Abstract
Background Cocaine abuse is associated with several mechanisms of brain injury including ischemic, hemorrhagic and metabolic. Recently two case reports of leukoencephalopathy in cocaine users implicated a commonly used cocaine adulterant, levamisole. One well-documented adverse effect of levamisole, when used alone as antihelminthic or immunomodulatory drug, is multifocal inflammatory leukoencephalopathy. Therefore, immune mechanisms may also contribute to cocaine-induced brain injury. Case presentations Two cocaine users with multifocal leukoencephalopathy, treated with steroids and plasmapheresis, are described. The first is a 25-year-old man who presented with unilateral motor and sensory impairment progressing to bilateral deficits, dysphagia, dysarthria and confusion over several days. Serial MRI showed increasing abnormal FLAIR signal lesions with patchy restricted diffusion and heterogenous enhancement deep in the right and left hemispheres, including periventricular white matter as well as in the pons and cerebellar peduncle. The second patient is a 41-year-old woman who presented with confusion and impaired balance. MRI showed bilateral periventricular FLAIR lesions with scattered restricted diffusion and subtle gadolinium enhancement of some of the lesions. She initially stabilized with supportive care only, but after further cocaine use was re-admitted six weeks later with marked neurological deterioration and MRI showed prominent worsening of the lesions. Both patients received steroid and plasma exchange and showed substantial improvement clinically and on imaging, which was sustained during out-patient follow-up. Conclusion Multifocal leukoencephalopathy associated with cocaine use may have an inflammatory/immune basis, possibly related to levamisole contamination, at least in some patients. Three cases, including the present two, have been described wherein good neurological improvement was seen in association with steroid treatment. However, in the absence of appropriate clinical trials, it remains unknown whether immunotherapy is truly beneficial for these patients.
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Affiliation(s)
- Reza Vosoughi
- Section of Neurology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3A 1R9, Canada.
| | - Brian J Schmidt
- Section of Neurology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3A 1R9, Canada.
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Vosoughi R, Schmidt BJ. Multifocal leukoencephalopathy in cocaine users: a report of two cases and review of the literature. BMC Neurol 2015. [PMID: 26482228 DOI: 10.1186/s12883-015-0467-1"] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cocaine abuse is associated with several mechanisms of brain injury including ischemic, hemorrhagic and metabolic. Recently two case reports of leukoencephalopathy in cocaine users implicated a commonly used cocaine adulterant, levamisole. One well-documented adverse effect of levamisole, when used alone as antihelminthic or immunomodulatory drug, is multifocal inflammatory leukoencephalopathy. Therefore, immune mechanisms may also contribute to cocaine-induced brain injury. CASE PRESENTATIONS Two cocaine users with multifocal leukoencephalopathy, treated with steroids and plasmapheresis, are described. The first is a 25-year-old man who presented with unilateral motor and sensory impairment progressing to bilateral deficits, dysphagia, dysarthria and confusion over several days. Serial MRI showed increasing abnormal FLAIR signal lesions with patchy restricted diffusion and heterogenous enhancement deep in the right and left hemispheres, including periventricular white matter as well as in the pons and cerebellar peduncle. The second patient is a 41-year-old woman who presented with confusion and impaired balance. MRI showed bilateral periventricular FLAIR lesions with scattered restricted diffusion and subtle gadolinium enhancement of some of the lesions. She initially stabilized with supportive care only, but after further cocaine use was re-admitted six weeks later with marked neurological deterioration and MRI showed prominent worsening of the lesions. Both patients received steroid and plasma exchange and showed substantial improvement clinically and on imaging, which was sustained during out-patient follow-up. CONCLUSION Multifocal leukoencephalopathy associated with cocaine use may have an inflammatory/immune basis, possibly related to levamisole contamination, at least in some patients. Three cases, including the present two, have been described wherein good neurological improvement was seen in association with steroid treatment. However, in the absence of appropriate clinical trials, it remains unknown whether immunotherapy is truly beneficial for these patients.
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Affiliation(s)
- Reza Vosoughi
- Section of Neurology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3A 1R9, Canada.
| | - Brian J Schmidt
- Section of Neurology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3A 1R9, Canada.
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Birner A, Seiler S, Lackner N, Bengesser SA, Queissner R, Fellendorf FT, Platzer M, Ropele S, Enzinger C, Schwingenschuh P, Mangge H, Pirpamer L, Deutschmann H, McIntyre RS, Kapfhammer HP, Reininghaus B, Reininghaus EZ. Cerebral White Matter Lesions and Affective Episodes Correlate in Male Individuals with Bipolar Disorder. PLoS One 2015; 10:e0135313. [PMID: 26252714 PMCID: PMC4529150 DOI: 10.1371/journal.pone.0135313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of WML with clinical parameters in BD have been described, but not with the number of affective episodes, illness duration, age of onset and Body Mass Index in a well characterized group of euthymic bipolar adults. Herein, we aimed to evaluate the associations between bipolar course of illness parameters and WML measured with volumetric analysis. Methods In a cross-sectional study 100 euthymic individuals with BD as well as 54 healthy controls (HC) were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV, Hamilton-Depression, Young Mania Rating Scale and Beck’s Depression Inventory were evaluated. Results Individuals with BD had significantly more (F = 3.968, p < .05) WML (Mdn = 3710mm3; IQR = 2961mm3) than HC (Mdn = 2185mm3; IQR = 1665mm3). BD men (Mdn = 4095mm3; IQR = 3295mm3) and BD women (Mdn = 3032mm3; IQR = 2816mm3) did not significantly differ as to the WML-load or the number and type of risk factors for WML. However, in men only, the number of manic/hypomanic episodes (r = 0.72; p < .001) as well as depressive episodes (r = 0.51; p < .001) correlated positively with WML-load. Conclusions WML-load strongly correlated with the number of manic episodes in male BD patients, suggesting that men might be more vulnerable to mania in the context of cerebral white matter changes.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Nina Lackner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Robert Queissner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Martina Platzer
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Petra Schwingenschuh
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit at the University Health Network, University of Toronto, Toronto, Canada
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Muzar Z, Lozano R, Schneider A, Adams PE, Faradz SMH, Tassone F, Hagerman RJ. Methadone use in a male with the FMRI premutation and FXTAS. Am J Med Genet A 2015; 167:1354-9. [PMID: 25900641 DOI: 10.1002/ajmg.a.37030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/08/2015] [Indexed: 01/18/2023]
Abstract
The fragile X-associated tremor ataxia syndrome (FXTAS) is caused by the premutation in FMR1 gene. Recent reports of environmental toxins appear to worsen the progression of FXTAS. Here we present a case of male adult with FXTAS and a long history of methadone use. The patient shows a faster progression in both symptoms of disease and MRI changes compared to what is typically seen in FXTAS. There has been no research regarding the role of narcotics in onset, progression, and severity of FXTAS symptoms. However, research has shown that narcotics can have a negative impact on several neurodegenerative diseases, and we hypothesize that in this particular case, methadone may have contributed to a faster progression of FXTAS as well as exacerbating white matter disease through RNA toxicity seen in premutation carriers.
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Affiliation(s)
- Zukhrofi Muzar
- Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang, Central Java, Indonesia.,Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California
| | - Reymundo Lozano
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Patrick E Adams
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Sultana M H Faradz
- Center for Biomedical Research, Faculty of Medicine Diponegoro University Semarang, Central Java, Indonesia
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California at Davis, Davis, Califonia
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, UC Davis Medical Center, Sacramento, California
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New perspectives on using brain imaging to study CNS stimulants. Neuropharmacology 2014; 87:104-14. [PMID: 25080072 DOI: 10.1016/j.neuropharm.2014.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 11/23/2022]
Abstract
While the recent application of brain imaging to study CNS stimulants has offered new insights into the fundamental factors that contribute to their use and abuse, many gaps remain. Brain circuits that mediate pleasure, dependence, craving and relapse are anatomically, neurophysiologically and neurochemically distinct from one another, which has guided the search for correlates of stimulant-seeking and taking behavior. However, unlike other drugs of abuse, metrics for tolerance and physical dependence on stimulants are not obvious. The dopamine theory of stimulant abuse does not sufficiently explain this disorder as serotonergic, GABAergic and glutamagergic circuits are clearly involved in stimulant pharmacology and so tracking the source of the "addictive" processes must adopt a more multimodal, multidisciplinary approach. To this end, both anatomical and functional magnetic resonance imaging (MRI), MR spectroscopy (MRS) and positron emission tomography (PET) are complementary and have equally contributed to our understanding of how stimulants affect the brain and behavior. New vistas in this area include nanotechnology approaches to deliver small molecules to receptors and use MRI to resolve receptor dynamics. Anatomical and blood flow imaging has yielded data showing that cognitive enhancers might be useful adjuncts in treating CNS stimulant dependence, while MRS has opened opportunities to examine the brain's readiness to accept treatment as GABA tone normalizes after detoxification. A desired outcome of the above approaches is being able to offer evidence-based rationales for treatment approaches that can be implemented in a more broad geographic area, where access to brain imaging facilities may be limited. This article is part of the Special Issue entitled 'CNS Stimulants'.
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Terrett G, McLennan SN, Henry JD, Biernacki K, Mercuri K, Curran HV, Rendell PG. Prospective memory impairment in long-term opiate users. Psychopharmacology (Berl) 2014; 231:2623-32. [PMID: 24448901 DOI: 10.1007/s00213-014-3432-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE Opiate use is associated with a range of neurological and cognitive deficits. However, to date, no studies have assessed whether these cognitive deficits extend to the ability to perform intended actions in the future (i.e. prospective memory). Reduced ability in this area might be anticipated due to impaired executive functions and episodic memory associated with long-term opiate use. OBJECTIVES The main objectives of this study are to assess the performance of long-term opiate users on a laboratory measure of prospective memory which closely simulates the types of prospective memory tasks encountered in everyday life ('Virtual Week') and to investigate the extent to which prospective memory performance is related to executive functions and episodic memory ability. METHODS Twenty-six long-term heroin users enrolled in an opiate substitution program, and 30 controls with no previous history of drug use were tested on Virtual Week. Retrospective memory and executive functions were also assessed. RESULTS Long-term opiate users were significantly impaired on prospective memory performance compared with controls (p = 0.002, η(2) p = 0.17), and these deficits did not vary as a function of prospective memory task type (regular, irregular, event, time). The findings also suggest that retrospective memory difficulties contribute to the prospective memory difficulties seen in opiate users (r s = 0.78, p < 0.001) but that executive dysfunction is less influential. CONCLUSIONS Prospective memory is sensitive to long-term opiate use. Importantly, opiate users suffer from generalised deficits in prospective memory, regardless of the task demands, which may have significant implications for day-to-day functioning. These results may therefore contribute to the development of clinical intervention strategies to reduce the negative impact of prospective memory failures in daily life.
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Affiliation(s)
- Gill Terrett
- School of Psychology, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy, MDC, Melbourne, Victoria, 3065, Australia,
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Alaee A, Zarghami M, Farnia S, Khademloo M, Khoddad T. Comparison of brain white matter hyperintensities in methamphetamine and methadone dependent patients and healthy controls. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e14275. [PMID: 25035700 PMCID: PMC4090641 DOI: 10.5812/iranjradiol.14275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/08/2013] [Accepted: 01/05/2014] [Indexed: 01/29/2023]
Abstract
Background: Previous studies have proven the development of white matter hyperintensities (WMH) in methamphetamine and opioid users. Opiates and methamphetamines (MA) are the most common addictive agents in Iran. The adverse effects of drugs on the CNS is of concern to specialists and researchers, and given that the neurotoxicity associated with methamphetamine is greater than opioids, it is hypothesized that the severity of WMH in patients with methamphetamine dependence is more than opioid drug-dependent individuals. Objectives: To our knowledge, this is the first research comparing the effect of methamphetamine and methadone (M) on the brain. Patients and Methods: In a historical cohort study, we compared WMH in the brain MRI of 50 methamphetamine-dependent patients, 50 methadone-dependent patients and 50 healthy volunteers who were matched for age, sex and dominant hand. Results: WMH was detected in 18 methamphetamine users, in 12 methadone users and in seven controls (P = 0.038). The site of brain lesions in MA users was mostly in the frontal lobe in 17 cases, in M users in the frontal lobe in 12 cases and in the control group, it was in the parietal lobe in four cases (P=0.001). The frontal lobes were the predominant locations of WMH in MA and M groups (P = 0.001). The frequency of brain lesions was mostly in the deep WM in 18 cases in MA users, in 12 cases in M users and in two cases in the control group (P=0.007). Hyper-signal foci of deep WM in the MA group were grade I (punctuate) in 12 cases, grade II (beginning confluence) in five cases and grade III (large confluent) in four cases. In the M group, there were six cases in grade I, three cases in grade II and one case in grade III. In the control group, there were three grade I cases, two grade II cases, and no grade III cases. Except for periventricular WMH (P = 0.13), there were statistical significant differences in the deep WMH (P = 0.007) and subcortex WMH (P = 0.01) between the three groups. The history of using other drugs and the duration of MA and M consumption were similar. The prevalence of brain lesions was generally higher in both drug user groups compared with the healthy controls. Increased WMH in the MA group was higher than the M group. Conclusions: A greater number of blood flow defects and ischemic lesions in the brain of MA users compared to opiate users may explain the prevalence of psychiatric disorders in these patients.
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Affiliation(s)
- Abdulrasool Alaee
- Department of Radiology, Mazandaran University of Medical Sciences, Sari, Iran
- Corresponding author: Abdulrasool Alaee, Department of Radiology, Mazandaran University of Medical Sciences, Sari, Iran. Tel: +98-9111515116, Fax: +98 151 2202699, E-mail:
| | - Mehran Zarghami
- Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samaneh Farnia
- Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Khademloo
- Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Talayeh Khoddad
- Department of Traditional Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Regionally-specific alterations in myelin proteins in nonhuman primate white matter following prolonged cocaine self-administration. Drug Alcohol Depend 2014; 137:143-7. [PMID: 24529965 PMCID: PMC4000724 DOI: 10.1016/j.drugalcdep.2014.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/10/2014] [Accepted: 01/20/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neuroimaging studies of cocaine users have demonstrated white matter abnormalities associated with behavioral measures of impulsivity and decision-making deficits. The underlying bases for this dysregulation in white matter structure and function have yet to be determined. The aim of the present studies was to investigate the influence of prolonged cocaine self-administration on the levels of myelin-associated proteins and mRNAs in nonhuman primate white matter. METHODS Rhesus monkeys (N=4) self-administered cocaine (0.3mg/kg/inj, 30 reinforcers per session) for 300 sessions. Control animals (N=4) responded for food. Following the final session monkeys were euthanized and white matter tissue at three brain levels was processed for immunoblotting analysis of proteolipid protein (PLP) and myelin basic protein (MBP), as well as for in situ hybridization histochemical analysis of PLP and MBP mRNAs. RESULTS Both MBP and PLP immunoreactivities in white matter at the level of the precommissural striatum were significantly lower in tissue from monkeys self-administering cocaine as compared to controls. No significant differences were seen for either protein at the levels of the prefrontal cortex or postcommissural striatum. In addition, no differences were observed in expression of mRNA for either protein. CONCLUSIONS These preliminary findings, in a nonhuman model of prolonged cocaine self-administration, provide further evidence that compromised myelin may underlie the deficits in white matter integrity described in studies of human cocaine users.
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Abstract
This chapter will serve as a guide for the diagnosis of multiple sclerosis (MS). Primary aims include a review of both the common and atypical clinical manifestations of MS, a detailed discussion of the alternative diagnoses which can mimic MS, as well as a review of the current established diagnostic criteria and a history of their development. It will also review the distinct disease courses and MS variants. The goal of the chapter is to facilitate the diagnostic process for clinicians so that they may expedite early diagnosis and treatment in an effort to alter disease outcomes and ultimately improve patients' quality of life.
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Affiliation(s)
- Tracy M Deangelis
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Medical Center, New York, NY, USA
| | - Aaron Miller
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Medical Center, New York, NY, USA.
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Baker ST, Yücel M, Fornito A, Allen NB, Lubman DI. A systematic review of diffusion weighted MRI studies of white matter microstructure in adolescent substance users. Neurosci Biobehav Rev 2013; 37:1713-23. [DOI: 10.1016/j.neubiorev.2013.06.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/22/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023]
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The Relation Between Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Acquired During Operations Enduring Freedom and Iraqi Freedom. J Head Trauma Rehabil 2013; 28:1-12. [DOI: 10.1097/htr.0b013e318256d3d3] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mackey S, Paulus M. Are there volumetric brain differences associated with the use of cocaine and amphetamine-type stimulants? Neurosci Biobehav Rev 2012; 37:300-16. [PMID: 23253945 DOI: 10.1016/j.neubiorev.2012.12.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/06/2012] [Accepted: 12/05/2012] [Indexed: 12/21/2022]
Abstract
While a large number of studies have examined brain volume differences associated with cocaine use, much less is known about structural differences related to amphetamine-type stimulant (ATS) use. What is known about cocaine may help to interpret emerging information on the interaction of brain volume with ATS consumption. To date, volumetric studies on the two types of stimulant have focused almost exclusively on brain differences associated with chronic use. There is considerable variability in the findings between studies which may be explained in part by the wide variety of methodologies employed. Despite this variability, seven recurrent themes are worth noting: (1) loci of lower cortical volume (approximately 10% on average) are consistently reported, (2) almost all studies indicate less volume in all or parts of the frontal cortex, (3) more specifically, a core group of studies implicate the ventromedial prefrontal cortex (including the medial portion of the orbital frontal cortex) and (4) the insula, (5) an enlarged striatal volume has been repeatedly observed, (6) reports on volume differences in the hippocampus and amygdala have been equivocal, (7) evidence supporting differential interaction of brain structure with cocaine vs. ATS is scant but the volume of all or parts of the temporal cortex appear lower in a majority of studies on cocaine but not ATS. Future research should include longitudinal designs on larger sample sizes and examine other stages of exposure to psychostimulants.
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Affiliation(s)
- Scott Mackey
- Dept. Psychiatry, University of California, San Diego, La Jolla, CA 92037, United States.
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Abstract
Among cocaine users, men experience more adverse brain and vascular effects than their female counterparts. This could be caused by testosterone, which may potentiate some of cocaine's effects. We examined whether antiandrogen (flutamide, FL) pretreatment alters cocaine's acute behavioral, physiologic, and pharmacokinetic effects in men with histories of occasional cocaine use. Participants (N = 8) were pretreated with oral FL (250 mg) and placebo on separate study days followed by intravenous (IV) cocaine (0.4 mg/kg). Vital signs, subjective ratings, and blood samples for cocaine and metabolites were obtained at baseline and for 90 minutes after cocaine administration. FL, itself, had no effects on physiologic or subjective responses; however, after cocaine, heart rate recovered faster with FL pretreatment. Flutamide reduced peak plasma cocaine levels (Wilcoxon signed-rank z = 2.1, P < 0.04) and area under the curve (AUC; z = 1.96, P < 0.05). Additionally, FL reduced EME levels (z = 1.96, P < 0.05) and AUC for BE and EME (z = 2.38, P < 0.02 and z = 1.96, P < 0.05, respectively). These results suggest that FL may alter cocaine pharmacokinetics in men. Because cocaine and BE are vasoconstrictive, the data imply that FL might reduce some of cocaine's cardiovascular effects.
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Kovalevich J, Corley G, Yen W, Rawls SM, Langford D. Cocaine-induced loss of white matter proteins in the adult mouse nucleus accumbens is attenuated by administration of a β-lactam antibiotic during cocaine withdrawal. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:1921-7. [PMID: 23031254 DOI: 10.1016/j.ajpath.2012.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/02/2012] [Accepted: 08/15/2012] [Indexed: 01/04/2023]
Abstract
We report significantly decreased white matter protein levels in the nucleus accumbens in an adult mouse model of chronic cocaine abuse. Previous studies from human cocaine abuse patients show disruption of white matter and myelin loss, thus supporting our observations. Understanding the neuropathological mechanisms for white matter disruption in cocaine abuse patients is complicated by polydrug use and other comorbid factors, hindering the development of effective therapeutic strategies to ameliorate damage or compliment rehabilitation programs. In this context, our data further demonstrate that cocaine-induced loss of white matter proteins is absent in mice treated with the β-lactam antibiotic, ceftriaxone, during cocaine withdrawal. Other studies report that ceftriaxone, a glutamate transporter subtype-1 activator, is neuroprotective in murine models of multiple sclerosis, thereby demonstrating potential therapeutic properties for diseases with white matter loss. Cocaine-induced white matter abnormalities likely contribute to the cognitive, motor, and psychological deficits commonly afflicting cocaine abusers, yet the underlying mechanisms responsible for these changes remain unknown. Our observations describe an adult animal model for the study of cocaine-induced myelin loss for the first time, and highlight a potential pharmacological intervention to ameliorate cocaine-induced white matter loss.
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Affiliation(s)
- Jane Kovalevich
- Department of Neuroscience, Temple University School of Medicine, Philadelphia, PA, USA
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Lucantonio F, Stalnaker TA, Shaham Y, Niv Y, Schoenbaum G. The impact of orbitofrontal dysfunction on cocaine addiction. Nat Neurosci 2012; 15:358-66. [PMID: 22267164 PMCID: PMC3701259 DOI: 10.1038/nn.3014] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cocaine addiction is characterized by poor judgment and maladaptive decision-making. Here we review evidence implicating the orbitofrontal cortex in such behavior. This evidence suggests that cocaine-induced changes in orbitofrontal cortex disrupt the representation of states and transition functions that form the basis of flexible and adaptive 'model-based' behavioral control. By impairing this function, cocaine exposure leads to an overemphasis on less flexible, maladaptive 'model-free' control systems. We propose that such an effect accounts for the complex pattern of maladaptive behaviors associated with cocaine addiction.
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Affiliation(s)
- Federica Lucantonio
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Bora E, Yücel M, Fornito A, Pantelis C, Harrison BJ, Cocchi L, Pell G, Lubman DI. White matter microstructure in opiate addiction. Addict Biol 2012; 17:141-8. [PMID: 21070508 DOI: 10.1111/j.1369-1600.2010.00266.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Heroin addiction has been associated with impaired neuronal connectivity and cognitive deficits. One mechanism that potentially explains these findings is alterations in white matter connectivity secondary to chronic opiate use. However, few studies have quantitavely examined white matter deficits in opiate addiction (OA). Here, we investigated white matter microstructure in OA using diffusion tensor imaging (DTI). We performed voxel-wise analysis of fractional anisotropy (FA) in 24 participants with OA and 29 healthy controls. The OA group showed reduced FA in multiple pathways including the corpus callosum, thalamic radiation and inferior longitudinal fasciculus. This FA reduction was mainly the result of increased radial diffusivity (λ(⊥)), indicative of myelin pathology. Longer duration of OA was also associated with axonal diffusivity (λ(1)), most robustly in superior longitudinal fasciculi and right frontal white matter suggesting axonal injury in long-term users. Together, the findings indicate that chronic OA use has widespread and diverse effects on neuronal connectivity and function.
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Affiliation(s)
- Emre Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Australia.
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Weller RE, Stoeckel LE, Milby JB, Bolding M, Twieg DB, Knowlton RC, Avison MJ, Ding Z. Smaller regional gray matter volume in homeless african american cocaine-dependent men: a preliminary report. Open Neuroimag J 2011; 5:57-64. [PMID: 22135719 PMCID: PMC3227861 DOI: 10.2174/1874440001105010057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/12/2011] [Accepted: 05/13/2011] [Indexed: 01/23/2023] Open
Abstract
Models of addiction include abnormalities in parts of the brain involving executive function/inhibitory control. Although previous studies have reported evidence of structural abnormalities in cocaine-dependent individuals, none have specifically targeted the homeless. The present preliminary study investigated brain structure in such an understudied
group, homeless, crack-cocaine-dependent African American men (n = 9), comparing it to that in healthy controls (n = 8). Structural data were analyzed using voxel based morphometry (VBM) and a regions of interest (ROI) analysis. Homeless cocaine-dependent individuals had smaller gray matter volume in dorsolateral prefrontal cortex, anterior cingulate, the cerebellum, insula, and superior temporal gyrus. Most of these areas subserve executive function or inhibitory control.
These results are similar to those found in most previous studies of non-homeless cocaine-dependent individuals. Reduced gray matter in executive function/inhibitory control regions of the brain in cocaine-dependent individuals may be a preexisting risk factor for the development of addiction and/or a consequence of drug abuse.
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Affiliation(s)
- Rosalyn E Weller
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, London
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Zhang Y, Tian J, Yuan K, Liu P, Zhuo L, Qin W, Zhao L, Liu J, von Deneen KM, Klahr NJ, Gold MS, Liu Y. Distinct resting-state brain activities in heroin-dependent individuals. Brain Res 2011; 1402:46-53. [PMID: 21669407 DOI: 10.1016/j.brainres.2011.05.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/19/2011] [Accepted: 05/22/2011] [Indexed: 11/27/2022]
Abstract
Previous functional imaging studies on heroin addicts have focused on abnormal brain functions based on specific tasks, while few fMRI studies concentrated on the resting-state abnormalities of heroin-dependent individuals. In the current study, we applied the pattern classification technique, which employs the feature extraction method of non-negative matrix factorization (NMF) and a support vector machine (SVM) classifier. Its main purpose was to characterize the discrepancy in activation patterns between heroin-dependent individuals and healthy subjects during the resting state. The results displayed a high accuracy in the activation pattern differences of the two groups, which included the orbitofrontal cortex (OFC), cingulate gyrus, frontal and para-limbic regions such as the anterior cingulate cortex (ACC), hippocampal/parahippocampal region, amygdala, caudate, putamen, as well as the posterior insula and thalamus. These findings indicate that significant biomarkers exist among the network of circuits that are involved in drug abuse. The implications from our study may help explain the behavioral and neuropsychological deficits in heroin-dependent individuals and shed light on the mechanisms underlying heroin addiction.
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Affiliation(s)
- Yi Zhang
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi 710071, China
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Wang Y, Li W, Li Q, Yang W, Zhu J, Wang W. White matter impairment in heroin addicts undergoing methadone maintenance treatment and prolonged abstinence: A preliminary DTI study. Neurosci Lett 2011; 494:49-53. [DOI: 10.1016/j.neulet.2011.02.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/23/2011] [Accepted: 02/20/2011] [Indexed: 11/16/2022]
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Assessing white matter integrity as a function of abstinence duration in former cocaine-dependent individuals. Drug Alcohol Depend 2011; 114:159-68. [PMID: 21075564 PMCID: PMC3062648 DOI: 10.1016/j.drugalcdep.2010.10.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 09/20/2010] [Accepted: 10/04/2010] [Indexed: 01/09/2023]
Abstract
Current cocaine-dependent users show reductions in white matter (WM) integrity, especially in cortical regions associated with cognitive control that have been associated with inhibitory dysfunction. A key question is whether these white matter differences are present following abstinence from drug use. To address this, WM integrity was examined using diffusion tensor imaging (DTI) obtained on 43 cocaine abstinent patients (abstinence duration ranged between five days and 102 weeks) and 43 non-using controls. Additionally, a cross-sectional comparison separated the patients into three groups (short-term, mid-term and long-term) based upon duration of cocaine abstinence. The 43 cocaine abstinent patients showed lower fractional anisotropy (FA) in the left anterior callosal fibers, left genu of the corpus callosum, right superior longitudinal fasciculus, right callosal fibers and the superior corona radiata bilaterally when compared against non-using controls. Higher FA in the cocaine abstinent patients was observed in the splenium of the corpus callosum and right superior longitudinal fasciculus. Differences between the cocaine abstinent groups were observed bilaterally in the inferior longitudinal fasciculus, right anterior thalamic radiation, right ventral posterolateral nucleus of the thalamus, left superior corona radiata, superior longitudinal fasciculus bilaterally, right cingulum and the WM of the right precentral gyrus. The results identified WM differences between cocaine abstinent patients and controls as well as distinct differences between abstinent subgroups. The findings suggest that specific white matter differences persist throughout abstinence while other, spatially distinct, differences discriminate as a function of abstinence duration. These differences may, therefore, represent brain changes that mark recovery from addiction.
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Kalapatapu RK, Vadhan NP, Rubin E, Bedi G, Cheng WY, Sullivan MA, Foltin RW. A pilot study of neurocognitive function in older and younger cocaine abusers and controls. Am J Addict 2011; 20:228-39. [PMID: 21477051 DOI: 10.1111/j.1521-0391.2011.00128.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This pilot study compared basic neurocognitive functioning among older and younger cocaine abusers and control participants, as a preliminary assessment of whether specific cognitive deficits exist in an aged cocaine-abusing population. We hypothesized an interaction between aging and cocaine abuse, such that older cocaine abusers would exhibit decreased neuropsychological test performance relative to both younger cocaine abusers and older control participants. Four groups (n = 20 each) were examined: older cocaine abusers (ages 51-70), younger cocaine abusers (ages 21-39), and two non-illicit substance-using control groups. Basic neuropsychological and psychiatric measures were administered to all participants. Older participants performed more poorly than younger participants on the Mini-Mental State Examination (MMSE, p < .01), Digit Span Backward (p < .01), and Trail Making Test (TMT) Parts A and B (p < .01). Cocaine abusers performed more poorly than controls on TMT A (p < .01). Older and younger cocaine abusers used similar amounts of cocaine (p > .05). Older cocaine abusers performed more poorly than older control participants and younger cocaine abusers on the Digit Span Forward (p < .0125). Older cocaine abusers also performed more poorly than younger cocaine abusers on TMT A (p < .0125). This study provides preliminary evidence that older cocaine abusers use a significant amount of cocaine and that there is an interaction between aging and cocaine abuse on psychomotor speed, attention, and short-term memory. Future examination of neurocognitive function in older cocaine abusers is clearly warranted.
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Affiliation(s)
- Raj K Kalapatapu
- Substance Use Research Center, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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Bustamante JC, Barrós-Loscertales A, Ventura-Campos N, Sanjuán A, Llopis JJ, Parcet MA, Ávila C. Right parietal hypoactivation in a cocaine-dependent group during a verbal working memory task. Brain Res 2011; 1375:111-9. [DOI: 10.1016/j.brainres.2010.12.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 12/07/2010] [Accepted: 12/11/2010] [Indexed: 12/01/2022]
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