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Qadhi OA, Mohammed Alasmari M, Nasser Alsulaihim I, Syed W, Al-Rawi MBA. Evaluation of clinical knowledge of drugs causing addiction and associated social determinants among male pharmacy and nursing students in Riyadh, Saudi Arabia - A Cross-Sectional study. Prev Med Rep 2024; 38:102606. [PMID: 38375160 PMCID: PMC10874849 DOI: 10.1016/j.pmedr.2024.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Drug abuse is a rising psychological concept in many countries, and its use among individuals is increasing. Therefore, this study aimed to assess the Knowledge and demographic factors associated with drug abuse among male pharmacy and nursing students at King Saud University, Riyadh, Saudi Arabia. This study used a cross-sectional design targeting male entry-level pharmacy and nursing students in their first and second years of Bachelor of Nursing and Doctor of Pharmacy courses. Of them, 85.3 % of the pharmacy and 75.3 % of nursing students thought that cocaine causes drug addiction, followed by heroin (pharmacy 80.7 %; nursing students 71 %), and morphine (pharmacy 75.2 %; nursing students 59.1 %). In this study, 52 % (n = 105) claimed low awareness, whereas 48 % (n = 97) indicated good understanding regarding drug addictions. Furthermore, the mean knowledge score among pharmacy students was higher (7.073 ± 2.570) in comparison to nursing (5.806 ± 2.494) (t = 3.540; p = 0. 0001). In addition, the father's occupation was found to be significantly associated with the mean knowledge score of drug addiction (F = 2.667; p = 0.034). According to the findings, 52 % of male students had insufficient knowledge about drugs that cause addiction. Age, course of study, and father's occupation all had a substantial impact on knowledge scores. The knowledge score on the complications of addictive substances was not significantly associated with the characteristics of the students (p = 0.05). As a result, we advocate for the introduction of educational initiatives that educate students about the harmful consequences of drug addiction and how to avoid issues.
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Affiliation(s)
- Omaimah A. Qadhi
- Department of Medical-Surgical College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Moadeyah Mohammed Alasmari
- Department of Maternity and Child Health, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Nasser Alsulaihim
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mahmood Basil A. Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Gasparyan A, Maldonado Sanchez D, Navarrete F, Sion A, Navarro D, García-Gutiérrez MS, Rubio Valladolid G, Jurado Barba R, Manzanares J. Cognitive Alterations in Addictive Disorders: A Translational Approach. Biomedicines 2023; 11:1796. [PMID: 37509436 PMCID: PMC10376598 DOI: 10.3390/biomedicines11071796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/30/2023] Open
Abstract
The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption. Improving our understanding of the molecular and cellular alterations associated with cognitive decline could be essential to developing specific therapeutic strategies for its treatment. Developing animal models to simulate drug abuse-induced learning and memory alterations is critical to continue exploring this clinical situation. The main aim of this review is to summarize the most recent evidence on cognitive impairment and the associated biological markers in patients addicted to some of the most consumed drugs of abuse and in animal models simulating this clinical situation. The available information suggests the need to develop more studies to further explore the molecular alterations associated with cognitive impairment, with the ultimate goal of developing new potential therapeutic strategies.
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Affiliation(s)
- Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | | | - Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Ana Sion
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Psychology, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Daniela Navarro
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Gabriel Rubio Valladolid
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Department of Psychiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rosa Jurado Barba
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Faculty of Health, Universidad Camilo José Cela, 28001 Madrid, Spain
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, 03550 San Juan de Alicante, Spain
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
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Redžepagić Š, Ladas AI. Prospective Memory, Sustained Attention and Response Inhibition in Poly-Substance Users Stable on Methadone Maintenance Treatment. Subst Use Misuse 2023; 58:397-405. [PMID: 36645818 DOI: 10.1080/10826084.2023.2165410] [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] [Indexed: 01/17/2023]
Abstract
Background: Prospective memory and response inhibition are interrelated constructs, though studied separately in the drug addiction literature. Also, although sustained attention underlies response inhibition, its role in the relation between these functions has been largely neglected. The limited research on the cognitive effects of methadone-maintenance treatment (MMT) further stresses the importance of investigating these effects. Objective: Therefore, the current study focused on possible effects of MMT combined with long-term drug abuse on all these functions. Thirty five long term opiate/poly-substance users in MMT and thirty four drug-free controls were screened for socioeconomic status, anxiety, depression and general, non-verbal intelligence and then tested on a self-report measure of prospective memory and on the Go/No-Go task. Results: Compared to controls, the MMT group scored worse in all functions assessed. Prospective memory scores were also negatively related to Go/NoGo accuracy scores. Conclusion: As predicted, (a) the MMT participants show impairments in prospective memory, sustained attention and response inhibition and (b) prospective memory, response inhibition and sustained attention are related constructs. The results of this study could inform current rehabilitation and relapse prevention cognitive training practices.
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Affiliation(s)
- Š Redžepagić
- Psychology Department, Sheffield University's International Faculty CITY College, Thessaloniki, Greece
| | - A I Ladas
- Psychology Department, CITY College, University of York Europe Campus, Thessaloniki, Greece
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Ayoub SM, Piscitelli F, Silvestri C, Limebeer CL, Rock EM, Smoum R, Farag M, de Almeida H, Sullivan MT, Lacroix S, Boubertakh B, Nallabelli N, Lichtman AH, Leri F, Mechoulam R, Di Marzo V, Parker LA. Spontaneous and Naloxone-Precipitated Withdrawal Behaviors From Chronic Opiates are Accompanied by Changes in N-Oleoylglycine and N-Oleoylalanine Levels in the Brain and Ameliorated by Treatment With These Mediators. Front Pharmacol 2021; 12:706703. [PMID: 34603019 PMCID: PMC8479102 DOI: 10.3389/fphar.2021.706703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/23/2021] [Indexed: 12/18/2022] Open
Abstract
Rationale: The endocannabinoidome mediators, N-Oleoylglycine (OlGly) and N-Oleoylalanine (OlAla), have been shown to reduce acute naloxone-precipitated morphine withdrawal affective and somatic responses. Objectives: To determine the role and mechanism of action of OlGly and OlAla in withdrawal responses from chronic exposure to opiates in male Sprague-Dawley rats. Methods: Opiate withdrawal was produced: 1) spontaneously 24 h following chronic exposure to escalating doses of morphine over 14 days (Experiments 1 and 2) and steady-state exposure to heroin by minipumps for 12 days (Experiment 3), 2) by naloxone injection during steady-state heroin exposure (Experiment 4), 3) by naloxone injection during operant heroin self-administration (Experiment 5). Results: In Experiment 1, spontaneous morphine withdrawal produced somatic withdrawal reactions. The behavioral withdrawal reactions were accompanied by suppressed endogenous levels of OlGly in the nucleus accumbens, amygdala, and prefrontal cortex, N-Arachidonylglycerol and OlAla in the amygdala, 2-arachidonoylglycerol in the nucleus accumbens, amygdala and interoceptive insular cortex, and by changes in colonic microbiota composition. In Experiment 2, treatment with OlAla, but not OlGly, reduced spontaneous morphine withdrawal responses. In Experiment 3, OlAla attenuated spontaneous steady-state heroin withdrawal responses at both 5 and 20 mg/kg; OlGly only reduced withdrawal responses at the higher dose of 20 mg/kg. Experiment 4 demonstrated that naloxone-precipitated heroin withdrawal from steady-state exposure to heroin (7 mg/kg/day for 12 days) is accompanied by tissue-specific changes in brain or gut endocannabinoidome mediator, including OlGly and OlAla, levels and colonic microbiota composition, and that OlAla (5 mg/kg) attenuated behavioural withdrawal reactions, while also reversing some of the changes in brain and gut endocannabinoidome and gut microbiota induced by naloxone. Experiment 5 demonstrated that although OlAla (5 mg/kg) did not interfere with operant heroin self-administration on its own, it blocked naloxone-precipitated elevation of heroin self-administration behavior. Conclusion: These results suggest that OlAla and OlGly are two endogenous mediators whose brain concentrations respond to chronic opiate treatment and withdrawal concomitantly with changes in colon microbiota composition, and that OlAla may be more effective than OlGly in suppressing chronic opiate withdrawal responses.
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Affiliation(s)
- Samantha M Ayoub
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Fabiana Piscitelli
- Institute of Biomolecular Chemistry, Endocannabinoid Research Group Consiglio Nazionale delle Richerche, Pozzuli, Italy
| | - Cristoforo Silvestri
- Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculty of Medicine, Centre NUTRISS, Université Laval, Québec City, QC, Canada
| | - Cheryl L Limebeer
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Erin M Rock
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Reem Smoum
- Institute of Drug Research, School of Pharmacy, Medical Faculty, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mathew Farag
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Hannah de Almeida
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Megan T Sullivan
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Sébastien Lacroix
- Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculty of Medicine, Centre NUTRISS, Université Laval, Québec City, QC, Canada
| | - Besma Boubertakh
- Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculty of Medicine, Centre NUTRISS, Université Laval, Québec City, QC, Canada
| | - Nayudu Nallabelli
- Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculty of Medicine, Centre NUTRISS, Université Laval, Québec City, QC, Canada
| | - Aron H Lichtman
- Department of Pharmacology and Toxicology, Medical College of Virginia Campus Virginia Commonwealth University, Richmond, VA, United States
| | - Francesco Leri
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
| | - Raphael Mechoulam
- Institute of Drug Research, School of Pharmacy, Medical Faculty, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vincenzo Di Marzo
- Institute of Biomolecular Chemistry, Endocannabinoid Research Group Consiglio Nazionale delle Richerche, Pozzuli, Italy.,Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Faculty of Medicine, Centre NUTRISS, Université Laval, Québec City, QC, Canada.,Faculty of Agriculture and Food Science, INAF, Université Laval, Québec City, QC, Canada.,Canada Excellence Research Chair on the Microbiome/Endocannabinoidome Axis in Metabolic Health, Québec City, QC, Canada
| | - Linda A Parker
- Department of Psychology and Collaborative Neuroscience, University of Guelph, Guelph, ON, Canada
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Cognitive Impairment in Opium Use Disorder. Behav Neurol 2021; 2021:5548623. [PMID: 34373762 PMCID: PMC8349248 DOI: 10.1155/2021/5548623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
This cross-sectional study is aimed at assessing the effects of opium use disorder (OUD) on attention, working memory, and information-processing speed. Thirty outpatients with OUD and 20 healthy controls (HCs) were assessed using a neuropsychological battery consisted of Auditory Verbal Learning Test-Revised (AVLT-R), Brief Visuospatial Memory Test-Revised (BVMT-R), Digit Forward and Backward Tests (DFT and DBT), and WAIS-R Digit Symbol Substitution Test (DSST). The most affected cognitive functions in patients with OUD were detected by DBT and DSST. However, we found no significant difference between patients according to the route of administration. Within patients with OUD, DBT score was associated with opium use quantity (OUQ) (r = −0.385), and DBT (r = 0.483) and DSST (r = 0.542) scores were correlated with duration of use. Our findings indicated that working memory and information-processing speed are the most affected domains of cognitive functioning. DBT and DSST could be used as brief assessments in clinical settings to screen for cognitive deficits in patients with OUD.
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Singh A, Rao R, Chatterjee B, Mishra AK, Kaloiya G, Ambekar A. Cognitive functioning in patients maintained on buprenorphine at peak and trough buprenorphine levels: An experimental study. Asian J Psychiatr 2021; 61:102697. [PMID: 34030027 DOI: 10.1016/j.ajp.2021.102697] [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: 01/20/2021] [Revised: 02/28/2021] [Accepted: 05/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the cognitive functions in participants maintained on buprenorphine for opioid dependence at peak and trough buprenorphine levels. METHODS This was a double-blind, randomized, experimental study. Sixty participants maintained on buprenorphine were matched for age and education and randomly allocated to "peak" group or "trough" group. The "peak" group received buprenorphine two hours before assessment, whereas the trough group received placebo. The cognitive domains of attention, learning and memory, and executive function including fluency, working memory, response inhibition and set shifting were tested. RESULTS The two groups were comparable on socio-demographic, substance use profile and opioid agonist treatment-related characteristics. Significant differences in performance of peak and trough group were observed on Wisconsin Card Sorting Test parameters of number of correct responses (U = 289.00, p = 0.03), number of errors (t = 02.26, df = 58, p = 0.03), and perseverative errors (U = 301.50, p = 0.04). CONCLUSIONS The time since buprenorphine dose has significant relation on specific cognitive tasks in patients maintained on buprenorphine for opioid dependence.
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Affiliation(s)
- Amit Singh
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ravindra Rao
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Biswadip Chatterjee
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Gaurishanker Kaloiya
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
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Nazarian A, Negus SS, Martin TJ. Factors mediating pain-related risk for opioid use disorder. Neuropharmacology 2021; 186:108476. [PMID: 33524407 PMCID: PMC7954943 DOI: 10.1016/j.neuropharm.2021.108476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/03/2020] [Accepted: 01/23/2021] [Indexed: 12/23/2022]
Abstract
Pain is a complex experience with far-reaching organismal influences ranging from biological factors to those that are psychological and social. Such influences can serve as pain-related risk factors that represent susceptibilities to opioid use disorder. This review evaluates various pain-related risk factors to form a consensus on those that facilitate opioid abuse. Epidemiological findings represent a high degree of co-occurrence between chronic pain and opioid use disorder that is, in part, driven by an increase in the availability of opioid analgesics and the diversion of their use in a non-medical context. Brain imaging studies in individuals with chronic pain that use/abuse opioids suggest abuse-related mechanisms that are rooted within mesocorticolimbic processing. Preclinical studies suggest that pain states have a limited impact on increasing the rewarding effects of opioids. Indeed, many findings indicate a reduction in the rewarding and reinforcing effects of opioids during pain states. An increase in opioid use may be facilitated by an increase in the availability of opioids and a decrease in access to non-opioid reinforcers that require mobility or social interaction. Moreover, chronic pain and substance abuse conditions are known to impair cognitive function, resulting in deficits in attention and decision making that may promote opioid abuse. A better understanding of pain-related risk factors can improve our knowledge in the development of OUD in persons with pain conditions and can help identify appropriate treatment strategies. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'.
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Affiliation(s)
- Arbi Nazarian
- Department of Pharmaceutical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA.
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Thomas J Martin
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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KHODARAHIMI S, GHADAMPOUR E, HEIDARYANI L, KARAMI A. The Efficacy of Quality of Life-Therapy on Cognitive Flexibility and Family Cohesiveness in Outpatients with Opioid Use Disorder. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2020. [DOI: 10.24193/jebp.2020.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Amir KARAMI
- Psychology Department, Lorestan University, Khorramabad, Iran
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Neurologic and cognitive outcomes associated with the clinical use of xenon: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesth 2018; 65:1041-1056. [PMID: 29858987 DOI: 10.1007/s12630-018-1163-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/18/2018] [Accepted: 05/25/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Xenon has been shown to have positive neurologic effects in various pre-clinical models. This study systematically reviewed the randomized-controlled trials (RCTs) investigating neurologic and cognitive outcomes associated with the clinical use of xenon. METHODS We searched PubMed, CENTRAL, EMBASE, CINAHL, elibrary.ru (for Russian studies), Google Scholar (for Russian studies), and Wanfang (for Chinese studies) for appropriate RCTs comparing neurologic or cognitive outcomes after clinical use of xenon with control treatment or with other anesthetic agents. RESULTS Seventeen RCTs met the inclusion criteria. Two studies investigated the effects of xenon plus therapeutic hypothermia to treat neonatal asphyxia or out-of-hospital cardiac arrest. Compared with therapeutic hypothermia alone, xenon and therapeutic hypothermia reduced cerebral white matter abnormalities after cardiac arrest but had no effect on neurocognitive outcome and mortality. Xenon had no added value when used to treat neonatal asphyxia. Thirteen RCTs compared neurocognitive effects of xenon with other anesthetic agents in surgical patients. While xenon may be associated with improved short-term (< three hours) cognitive outcome, no medium-term (six hours to three months) advantage was observed, and longer-term data are lacking. No differences in biochemical (S-100β, neuron-specific enolase) and neuropsychologic (attentional performance) outcomes were found with xenon compared with other anesthetic drugs. Finally, two studies suggest that brief, intermittent administration of sub-anesthetic doses of xenon to patients during the acute phase of substance withdrawal may improve neurocognitive outcomes. CONCLUSIONS Despite promising pre-clinical results, the evidence for positive clinical neurologic and cognitive outcomes associated with xenon administration is modest. Nevertheless, there is some evidence to suggest that xenon may be associated with better neurologic outcomes compared with the standard of care therapy in certain specific clinical situations. More clinical trials are needed to determine any potential benefit linked to xenon administration.
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Abstract
Chronic use of mind altering substances can lead to a wide variety of neuropsychological deficits, affecting the domains of attention, learning, memory, reasoning. Executive functions such as working memory, cognitive flexibility and inhibitory control may specifically be impaired. These deficits can impact engagement in effective psychosocial interventions. Mild to moderate cognitive dysfunction may not be picked up in routine clinical examination or through commonly used tests like the mini-mental state examination (MMSE). Detailed neuropsychological tests, although extremely valuable, are time and human-resource intensive and are not readily available to the clinician. This study attempted to devise a brief cognitive screen (BCS- AUD) for alcohol use disorders. Ninety subjects who fulfilled ICD-10 criteria for alcohol use disorders were assessed on the MMSE and selective tests from the NIMHANS neuropsychological battery. While 79 (87.78%) of patients had adequate scores on the MMSE (>25), cognitive deficits were noted with relatively high frequency on finger tapping (92.22-93.33%), auditory verbal learning test delayed recall AVLTDR (37-63%) and Tower of London 5 move subtest (42%). Statistically significant associations were found between MMSE and Digit symbol total time (0.05), Finger tapping right hand (0.01), Tower of London total number of problems solved with minimum moves (TNPSMM) (0.05), Verbal working memory two back hits (VM2BKHIT) (0.01), AVLTDR (0.01), and complex figure test-copy (0.01). Principal component analysis helped to identify three tests that merited inclusion in the BCS-AUD, namely Finger Tapping Test, Verbal Working Memory N Back Test and Auditory Verbal Test (AVLT). The utility of the BCS-AUD in identifying cognitive dysfunction in other substance use disorders needs to be examined. Patients rating positive on the cognitive screener would require in-depth evaluation, monitoring and remediation.
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Affiliation(s)
- Arun Gupta
- Flinders Medical Centre, Bedford Park SA 5042, Australia
| | | | - Shobini Rao
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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Busardò FP, Pichini S, Pellegrini M, Montana A, Lo Faro AF, Zaami S, Graziano S. Correlation between Blood and Oral Fluid Psychoactive Drug Concentrations and Cognitive Impairment in Driving under the Influence of Drugs. Curr Neuropharmacol 2018; 16:84-96. [PMID: 28847293 PMCID: PMC5771389 DOI: 10.2174/1570159x15666170828162057] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/09/2017] [Accepted: 08/24/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effects of drugs on driving performance should be checked with drug concentration in the brain and at the same time with the evaluation of both the behavioural and neurophysiological effects. The best accessible indicator of this information is the concentration of the drug and/or metabolites in blood and, to a certain extent, oral fluid. We sought to review international studies on correlation between blood and oral fluid drug concentrations, neurological correlates and cognitive impairment in driving under the influence of drugs. METHODS Relevant scientific articles were identified from PubMed, Cochrane Central, Scopus, Web of Science, Science Direct, EMBASE up to April 2017. RESULTS Up to 2010, no epidemiological studies were available on this matter and International scientists suggested that even minimal amounts of parent drugs in blood and oral fluid could affect driving impairment. More recently, epidemiological data, systematic reviews and meta-analysis on drugged drivers allowed the suggestion of impairment concentration limits for the most common illicit drugs. These values were obtained comparing driving disability induced by psychotropic drugs with that of established blood alcohol limits. Differently from ethyl alcohol where both detection methods and concentration limits have been well established even with inhomogeneity of ranges within different countries, in case of drugs of abuse no official cut-offs have yet been established, nor any standardized analytical protocols. CONCLUSION Multiple aspects of driving performance can be differently affected by illicit drugs, and even if for few of them some dose/concentration dependent impairment has been reported, a wider knowledge on concentration/impairment relationship is still missing.
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Affiliation(s)
- Francesco Paolo Busardò
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Manuela Pellegrini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Montana
- Department “G.F. Ingrassia” – University of Catania, Catania, Italy
| | | | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Italy
| | - Silvia Graziano
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
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Role of orexin type-1 receptors in paragiganto-coerulear modulation of opioid withdrawal and tolerance: A site specific focus. Neuropharmacology 2017; 126:25-37. [DOI: 10.1016/j.neuropharm.2017.08.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/13/2017] [Accepted: 08/16/2017] [Indexed: 11/21/2022]
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13
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Piao C, Liu T, Ma L, Ding X, Wang X, Chen X, Duan Y, Sui N, Liang J. Alterations in brain activation in response to prolonged morphine withdrawal-induced behavioral inflexibility in rats. Psychopharmacology (Berl) 2017; 234:2941-2953. [PMID: 28762073 DOI: 10.1007/s00213-017-4689-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/03/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE The inability to stop a repetitive maladaptive behavior is a main problem in addictive disorders. Neuroadaptations that are associated with behavioral inflexibility may be involved in compulsive drug use. OBJECTIVES The aim of the present study was to investigate the pattern of behavioral inflexibility during morphine withdrawal and map brain activation that is linked to alterations in flexibility. METHODS We first analyzed the effects of chronic morphine exposure on reversal learning after 2-week (short-term) and 6-week (prolonged) morphine withdrawal. We then compared the level of neuronal activation using cFos immunohistochemistry in 15 brain areas between rats that underwent morphine withdrawal and saline-control rats after a test of reversal learning. RESULTS Only prolonged morphine withdrawal impaired reversal learning. Rats that exhibited impairments in reversal learning presented a significant decrease in cFos expression in the orbitofrontal cortex (OFC), including the medial, lateral, and ventral OFC. cFos expression significantly increased in the dorsomedial striatum and major subregions of the medial prefrontal cortex (mPFC) in the morphine group. Rats that underwent prolonged morphine withdrawal exhibited no significant changes in cFos expression in the dorsolateral striatum, nucleus accumbens, amygdala, paraventricular thalamic nucleus, or motor cortex. The rats that underwent short-term withdrawal did not present any changes in cFos expression in any of these brain regions. CONCLUSION Altogether, these data suggest that alterations in the function of the frontal cortex and its striatal connections during the late morphine withdrawal phase may underlie the disruption of inhibitory control in opioid dependence.
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Affiliation(s)
- Chengji Piao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Sino-Danish Center for Education and Research, Beijing, China
| | - Tiane Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lian Ma
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuekun Ding
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xingyue Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xing Chen
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ying Duan
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Nan Sui
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Jing Liang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China. .,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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14
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Bissonette GB, Roesch MR. Neural correlates of rules and conflict in medial prefrontal cortex during decision and feedback epochs. Front Behav Neurosci 2015; 9:266. [PMID: 26500516 PMCID: PMC4594023 DOI: 10.3389/fnbeh.2015.00266] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022] Open
Abstract
The ability to properly adjust behavioral responses to cues in a changing environment is crucial for survival. Activity in the medial Prefrontal Cortex (mPFC) is thought to both represent rules to guide behavior as well as detect and resolve conflicts between rules in changing contingencies. However, while lesion and pharmacological studies have supported a crucial role for mPFC in this type of set-shifting, an understanding of how mPFC represents current rules or detects and resolves conflict between different rules is unclear. Here, we directly address the role of rat mPFC in shifting rule based behavioral strategies using a novel behavioral task designed to tease apart neural signatures of rules, conflict and direction. We demonstrate that activity of single neurons in rat mPFC represent distinct rules. Further, we show increased firing on high conflict trials in a separate population of mPFC neurons. Reduced firing in both populations of neurons was associated with poor performance. Moreover, activity in both populations increased and decreased firing during the outcome epoch when reward was and was not delivered on correct and incorrect trials, respectively. In addition, outcome firing was modulated by the current rule and the degree of conflict associated with the previous decision. These results promote a greater understanding of the role that mPFC plays in switching between rules, signaling both rule and conflict to promote improved behavioral performance.
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Affiliation(s)
- Gregory B Bissonette
- Department of Psychology, University of Maryland, College Park College Park, MD, USA ; Program in Neuroscience and Cognitive Science, University of Maryland, College Park College Park, MD, USA
| | - Matthew R Roesch
- Department of Psychology, University of Maryland, College Park College Park, MD, USA ; Program in Neuroscience and Cognitive Science, University of Maryland, College Park College Park, MD, USA
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15
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Myers CE, Sheynin J, Balsdon T, Luzardo A, Beck KD, Hogarth L, Haber P, Moustafa AA. Probabilistic reward- and punishment-based learning in opioid addiction: Experimental and computational data. Behav Brain Res 2015; 296:240-248. [PMID: 26381438 DOI: 10.1016/j.bbr.2015.09.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 11/29/2022]
Abstract
Addiction is the continuation of a habit in spite of negative consequences. A vast literature gives evidence that this poor decision-making behavior in individuals addicted to drugs also generalizes to laboratory decision making tasks, suggesting that the impairment in decision-making is not limited to decisions about taking drugs. In the current experiment, opioid-addicted individuals and matched controls with no history of illicit drug use were administered a probabilistic classification task that embeds both reward-based and punishment-based learning trials, and a computational model of decision making was applied to understand the mechanisms describing individuals' performance on the task. Although behavioral results showed that opioid-addicted individuals performed as well as controls on both reward- and punishment-based learning, the modeling results suggested subtle differences in how decisions were made between the two groups. Specifically, the opioid-addicted group showed decreased tendency to repeat prior responses, meaning that they were more likely to "chase reward" when expectancies were violated, whereas controls were more likely to stick with a previously-successful response rule, despite occasional expectancy violations. This tendency to chase short-term reward, potentially at the expense of developing rules that maximize reward over the long term, may be a contributing factor to opioid addiction. Further work is indicated to better understand whether this tendency arises as a result of brain changes in the wake of continued opioid use/abuse, or might be a pre-existing factor that may contribute to risk for addiction.
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Affiliation(s)
- Catherine E Myers
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
| | - Jony Sheynin
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Tarryn Balsdon
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia
| | - Andre Luzardo
- School of Mathematics, Computing Sciences & Engineering at City University London, UK
| | - Kevin D Beck
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Lee Hogarth
- School of Psychology, University of New South Wales, Sydney, NSW, Australia; School of Psychology, University of Exeter, Exeter, UK
| | - Paul Haber
- Drug Health Services, Addiction Medicine, Central Clinical School, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia; Marcs Institute for Brain and Behaviour, University of Western Sydney, Sydney, NSW, Australia.
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16
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Bissonette GB, Roesch MR. Rule encoding in dorsal striatum impacts action selection. Eur J Neurosci 2015; 42:2555-67. [PMID: 26275165 DOI: 10.1111/ejn.13042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/13/2015] [Accepted: 08/11/2015] [Indexed: 12/22/2022]
Abstract
Cognitive flexibility is a hallmark of prefrontal cortical (PFC) function yet little is known about downstream area involvement. The medial dorsal striatum (mDS) receives major projections from the PFC and is uniquely situated to perform the integration of responses with rule information. In this study, we use a novel rule shifting task in rats that mirrors non-human primate and human studies in its temporal precision and counterbalanced responses. We record activity from single neurons in the mDS while rats switch between different rules for reward. Additionally, we pharmacologically inactivate mDS by infusion of a baclofen/muscimol cocktail. Inactivation of mDS impaired the ability to shift to a new rule and increased the number of regressive errors. While recording in mDS, we identified neurons modulated by direction whose activity reflected the conflict between competing rule information. We show that a subset of these neurons was also rule selective, and that the conflict between competing rule cues was resolved as behavioural performance improved. Other neurons were modulated by rule, but not direction. These neurons became selective before behavioural performance accurately reflected the current rule. These data provide an additional locus for investigating the mechanisms underlying behavioural flexibility. Converging lines of evidence from multiple human psychiatric disorders have implicated dorsal striatum as an important and understudied neural substrate of flexible cognition. Our data confirm the importance of mDS, and suggest a mechanism by which mDS mediates abstract cognition functions.
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Affiliation(s)
- Gregory B Bissonette
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA.,Program in Neuroscience and Cognitive Science, University of Maryland, College Park, MD, 20742, USA
| | - Matthew R Roesch
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA.,Program in Neuroscience and Cognitive Science, University of Maryland, College Park, MD, 20742, USA
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17
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The Effect of Drug Abstinence Program on Memory Functioning of Heroin Addicts. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2015. [DOI: 10.20286/ijtmgh-0303117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Liu X, Wang G, Pu H, Jing H. Abnormal intracellular calcium homeostasis associated with vulnerability in the nerve cells from heroin-dependent rat. Brain Res 2014; 1572:40-9. [DOI: 10.1016/j.brainres.2014.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/11/2014] [Accepted: 05/12/2014] [Indexed: 11/26/2022]
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19
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Rass O, Kleykamp BA, Vandrey RG, Bigelow GE, Leoutsakos JM, Stitzer ML, Strain E, Copersino ML, Mintzer MZ. Cognitive performance in methadone maintenance patients: effects of time relative to dosing and maintenance dose level. Exp Clin Psychopharmacol 2014; 22:248-256. [PMID: 24548244 PMCID: PMC4041803 DOI: 10.1037/a0035712] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the long-term nature of methadone maintenance treatment, it is important to assess the extent of cognitive side effects. This study investigated cognitive and psychomotor performance in 51 methadone maintenance patients (MMP) as a function of time since last methadone dose and maintenance dose level. MMP maintained on doses ranging from 40 to 200 mg (mean = 97 mg) completed a battery of psychomotor and cognitive measures across 2 sessions, during peak and trough states, in a double-blind crossover design. Peak sessions were associated with worse performance on measures of sensory processing, psychomotor speed, divided attention, and working memory, compared with trough sessions. The effects of maintenance dose were mixed, with higher dose resulting in worse performance on aspects of attention and working memory, improved performance on executive function, and no effects on several measures. Longer treatment duration was associated with better performance on some measures, but was also associated with increased sensitivity to time since last dose (i.e., worse performance at peak vs. trough) on some measures. The results suggest that cognitive functioning can fluctuate as a function of time since last dose even in MMP who have been maintained on stable doses for an extended time (mean duration in treatment = 4 years), but worsened performance at peak is limited to a subset of functions and may not be clinically significant at these modest levels of behavioral effect. For patients on stable methadone maintenance doses, maintenance at higher doses may not significantly increase the risk of performance impairment.
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Affiliation(s)
- Olga Rass
- Address correspondence to: Olga Rass, Department
of Psychiatry and Behavioral Sciences, Behavioral Biology Research Center, Johns
Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD
21224.
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20
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Absence of neurocognitive impairment in a large Chinese sample of HCV-infected injection drug users receiving methadone treatment. Drug Alcohol Depend 2014; 137:29-35. [PMID: 24508003 PMCID: PMC3961522 DOI: 10.1016/j.drugalcdep.2013.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/07/2013] [Accepted: 12/28/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prior research has demonstrated neuropsychological (NP) impairment in persons with histories of injection drug use (IDU), hepatitis C virus (HCV) infection, and methadone maintenance treatment (MMT), individually, but little is known about the NP effects of these three risk factors in combination. This issue is particularly important in China, which is addressing its highly HCV-comorbid IDU epidemic with widespread government sponsored MMT, especially in light of recent evidence suggesting that methadone may be neuroprotective in some circumstances. METHODS We administered a comprehensive NP test battery to 195 Chinese heroin IDU individuals taking MMT (IDU+ group), the majority of whom were also HCV+ (87%; n=169), and compared their NP performance to that of 198 demographically comparable, non-IDU Chinese controls (IDU- group). All participants in both groups tested negative for HIV infection, which is also a common comorbidity in the Chinese IDU population. RESULTS The IDU+ group did not have an increased rate of global NP impairment, or perform significantly worse on any individual NP test measure. Within the IDU+ group, liver disease characteristics and reported details of heroin use were not significantly associated with NP performance. CONCLUSION Failure to detect NP impairment in IDU+ subjects with or without HCV infection was surprising, particularly considering the previously demonstrated sensitivity of our NP battery to neurocognitive disorders associated with HIV infection in China. One possible explanation, which should be explored in future research, is the potential neuroprotective effect of methadone in the context of HCV infection and/or heroin withdrawal.
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21
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Zeng H, Lee TMC, Waters JH, So KF, Sham PC, Schottenfeld RS, Marienfeld C, Chawarski MC. Impulsivity, cognitive function, and their relationship in heroin-dependent individuals. J Clin Exp Neuropsychol 2013; 35:897-905. [DOI: 10.1080/13803395.2013.828022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Lyvers M, Carlopio C, Bothma V, Edwards MS. Mood, mood regulation expectancies and frontal systems functioning in current smokers versus never-smokers in China and Australia. Addict Behav 2013; 38:2741-50. [PMID: 23948698 DOI: 10.1016/j.addbeh.2013.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/03/2013] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Abstract
Indices of mood, mood regulation expectancies and everyday executive functioning were examined in adult current smokers and never-smokers of both genders in Australia (N = 97), where anti-smoking campaigns have dramatically reduced smoking prevalence and acceptability, and in China (N = 222), where smoking prevalence and public acceptance of smoking remain high. Dependent measures included the Depression Anxiety Stress Scales (DASS-21), the Negative Mood Regulation (NMR) expectancies scale, the Frontal Systems Behavior Scale (FrSBe), the Fagerström Test for Nicotine Dependence (FTND) and the Alcohol Use Disorders Identification Test (AUDIT). Multivariate analyses of covariance (MANCOVAs) controlling for demographic and recruitment related variables revealed highly significant differences between current smokers and never-smokers in both countries such that smokers indicated worse moods and poorer functioning than never-smokers on all dependent measures. Chinese smokers scored significantly worse on all dependent measures than Australian smokers whereas Chinese and Australian never-smokers did not differ on any of the same measures. Although nicotine dependence level as measured by FTND was significantly higher in Chinese than Australian smokers and was significantly correlated with all other dependent measures, inclusion of FTND scores as another covariate in MANCOVA did not eliminate the highly significant differences between Chinese and Australian smokers. Results are interpreted in light of the relative ease of taking up and continuing smoking in China compared to Australia today.
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Affiliation(s)
- Michael Lyvers
- Department of Psychology, Bond University, Gold Coast, Qld 4229, Australia.
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23
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Strand MC, Fjeld B, Arnestad M, Mørland J. Can patients receiving opioid maintenance therapy safely drive? A systematic review of epidemiological and experimental studies on driving ability with a focus on concomitant methadone or buprenorphine administration. TRAFFIC INJURY PREVENTION 2013; 14:26-38. [PMID: 23259516 DOI: 10.1080/15389588.2012.689451] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To perform a systematic review of the present scientific literature on the treatment with methadone or buprenorphine related to (1) traffic accident risk in epidemiological studies and (2) their effects on cognitive and psychomotor functions of relevance to driving in experimental studies. METHODS Searches for corresponding literature were conducted in MEDLINE, EMBASE, and PsycINFO throughout March and June of 2010. The search strategy consisted of words colligated to accident risk and culpability, in addition to cognitive and psychomotor functions of relevance to driving, all in relation to methadone or buprenorphine administration. In total, 59 studies were included. RESULTS Early epidemiological studies found no substantial difference in motor vehicle accident risk between methadone maintenance therapy patients (MMPs) and control groups. However, more recent studies have found an increased risk of traffic accident involvement for both MMPs and buprenorphine maintenance therapy patients (BMPs). In experimental studies, impairments of cognitive and psychomotor functions have been observed among both MMPs and BMPs when compared to control groups. When comparing MMPs with BMPs, the latter appeared to be less impaired than MMPs, but this difference may be unrelated to the maintenance therapy. Further impairments have been observed among MMPs after single doses, after an additional versus regular daily dosing, in multiple versus single dosing, and after long-term treatment compared to baseline levels. All studies showed impairments among opioid-naïve subjects after the administration of a comparatively low and single dose of either methadone or buprenorphine. CONCLUSIONS Both methadone and buprenorphine were confirmed as having impairing potentials in opioid-naïve subjects. At least some opioid maintenance therapy patients are observed having only slight impairments of relevance to driving. Knowing this when approaching the question of ability to drive, an individual evaluation of the driving performance, pertaining to the opioid maintained patient, may be the most useful and conclusive procedure.
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Affiliation(s)
- Maren Cecilie Strand
- Division of Forensic Medicine and Drug Abuse Research, The Norwegian Institute of Public Health, Nydalen, Oslo, Norway.
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24
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Darke S, McDonald S, Kaye S, Torok M. Comparative patterns of cognitive performance amongst opioid maintenance patients, abstinent opioid users and non-opioid users. Drug Alcohol Depend 2012; 126:309-15. [PMID: 22726911 DOI: 10.1016/j.drugalcdep.2012.05.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 05/25/2012] [Accepted: 05/25/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND To compare the cognitive performances of maintenance patients (MAIN), abstinent ex-users (ABST) and healthy non-heroin using controls (CON). METHODS Case control study of 125 MAIN (94 subjects maintained on methadone, 31 on buprenorphine), 50 ABST and 50 CON. Neuropsychological tests measuring executive function, working memory, information processing speed, verbal learning and non-verbal learning were administered. RESULTS There were no differences between the cognitive profiles of those maintained on methadone or buprenorphine on any administered test. After controlling for confounders, the MAIN group had poorer performance than controls in six of the 13 administered tests, and were poorer than the ABST group in five. The MAIN group exhibited poorer performance in the Haylings Sentence Completion, Matrix Reasoning, Digit Symbol, Logical Memory (immediate and delayed recall), and the Complex Figure Test (immediate recall). There were no differences between the ABST and CON groups on any of the administered tests. CONCLUSIONS Poorer cognitive performance, across a range of test and domains, was seen amongst maintenance patients, regardless of their maintenance drug. This is a group that is likely might benefit from approaches for managing individuals with cognitive and behavioural difficulties arising from brain dysfunction.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
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25
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Soyka M, Limmer C, Lehnert R, Koller G, Martin G, Küfner H, Kagerer S, Haberthür A. A comparison of cognitive function in patients under maintenance treatment with heroin, methadone, or buprenorphine and healthy controls: an open pilot study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:497-508. [PMID: 21851203 DOI: 10.3109/00952990.2011.600381] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cognitive impairment has been reported in drug-dependent patients under opioid maintenance treatment. OBJECTIVES To compare cognitive functioning in healthy controls and in opioid-dependent patients treated with Buprenorphine, Heroin, or methadone maintenance. METHODS We used the standardized test battery ART-90 to study cognitive function in patients under long-term heroin treatment (n = 20), Bup (n = 22), or Met (n = 24) maintenance treatment and healthy controls (n = 25). RESULTS Patients receiving heroin performed significantly worse than healthy controls in most domains. Heroin patients performed worse than patients in the other two treatment groups in subtests measuring psychomotor performance under stress conditions and monotony. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Although a number of limitations must be taken into account, this study provides some preliminary evidence that cognitive function may be more impaired in patients under heroin maintenance treatment than in patients receiving Bup or Met and in healthy controls.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
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26
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[Reaction time in relation to duration of heroin abuse]. SRP ARK CELOK LEK 2011; 139:69-75. [PMID: 21568085 DOI: 10.2298/sarh1102069m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Consequences of heroin abuse include organic damage of cerebral structures. The level of impairments is in a direct and positive relation with the length of heroin abuse. OBJECTIVE The aim of this research was the evaluation of the reaction time with heroin addicts with different length of substance abuse. METHODS RESEARCH METHOD 90 examinees were divided into three groups with relation to the length of heroin abuse. Data collection included a questionnaire referring to socio-demographic and addictive characteristics. A specially designed programme was used for the evaluation of reaction time to audio/ visual signal. RESULTS In relation to the reaction time as overall model, the difference between examinees with different length of heroin abuse can be found on the marginal level of significance (F = 1.69; df = 12; p = 0.07). In visual modality, with the increase of length of heroin abuse leads to a significant prolongation of simple (the first visual sign: F = 3.29; df = 2; p = 0.04) and choice reaction time (the second visual sign: F = 4.97; df = 2; p = 0.00; the third visual sign: F = 3.08; df = 2; p = 0.05). Longer heroin consumption also leads to the prolongation of the simple (the first auditory task: F = 3.41; df = 2; p = 0.04) and the complex auditory reaction time (the second auditory task: F = 5.67; df = 2; p = 0.01; the third auditory task: F = 6.42; df = 2; p = 0.00). CONCLUSION Heroin abuse leads to the prolongation of both simple and choice reaction time in visual as well as auditory modality. The average daily dose of opiates was the most important predictor of the abovementioned cognitive dysfunction.
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Paterson NE. Translational research in addiction: toward a framework for the development of novel therapeutics. Biochem Pharmacol 2011; 81:1388-407. [PMID: 21216239 DOI: 10.1016/j.bcp.2010.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/13/2010] [Accepted: 12/15/2010] [Indexed: 12/16/2022]
Abstract
The development of novel substance use disorder (SUD) therapeutics is insufficient to meet the medical needs of a growing SUD patient population. The identification of translatable SUD models and tests is a crucial step in establishing a framework for SUD therapeutic development programs. The present review begins by identifying the clinical features of SUDs and highlights the narrow regulatory end-point required for approval of a novel SUD therapeutic. A conceptual overview of dependence is provided, followed by identification of potential intervention targets in the addiction cycle. The main components of the addiction cycle provide the framework for a discussion of preclinical models and their clinical analogs, all of which are focused on isolated behavioral end-points thought to be relevant to the persistence of compulsive drug use. Thus, the greatest obstacle to successful development is the gap between the multiplicity of preclinical and early clinical end-points and the regulatory end-point of sustained abstinence. This review proposes two pathways to bridging this gap: further development and validation of the preclinical extended access self-administration model; inclusion of secondary end-points comprising all of the measures highlighted in the present discussion in Phase 3 trials. Further, completion of the postdictive validation of analogous preclinical and clinical assays is of high priority. Ultimately, demonstration of the relevance and validity of a variety of end-points to the ultimate goal of abstinence will allow researchers to identify truly relevant therapeutic mechanisms and intervention targets, and establish a framework for SUD therapeutic development that allows optimal decision-making and resource allocation.
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Affiliation(s)
- Neil E Paterson
- Behavioral Pharmacology, PsychoGenics, Inc., 765 Old Saw Mill River Rd., Tarrytown, NY 10591, USA.
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28
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Fernández-Serrano MJ, Pérez-García M, Verdejo-García A. What are the specific vs. generalized effects of drugs of abuse on neuropsychological performance? Neurosci Biobehav Rev 2011; 35:377-406. [DOI: 10.1016/j.neubiorev.2010.04.008] [Citation(s) in RCA: 257] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 04/21/2010] [Accepted: 04/29/2010] [Indexed: 12/22/2022]
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Lyvers M, Tobias-Webb J. Effects of acute alcohol consumption on executive cognitive functioning in naturalistic settings. Addict Behav 2010; 35:1021-8. [PMID: 20655148 DOI: 10.1016/j.addbeh.2010.06.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 06/14/2010] [Accepted: 06/27/2010] [Indexed: 10/19/2022]
Abstract
Laboratory studies have demonstrated that acute alcohol intoxication can disrupt performance on neuropsychological tests of executive cognitive functioning such as the Wisconsin Card Sorting Test (WCST). However, the generalizability of such findings to typical self-regulated alcohol intake in social settings can be questioned. In the present study, 86 young adults were recruited at Australian bars to perform a computer version of the WCST. Participants displayed blood alcohol concentrations (BACs) across a range from 0 to 0.15%. Although self-report measures of typical alcohol consumption, impulsivity, and frontal lobe related everyday functioning were all intercorrelated in line with other recent findings, multiple regression indicated that these measures did not predict perseverative errors (PE) nor non-perseverative errors (NPE) on the WCST, whereas BAC uniquely predicted PE but not NPE. The results were consistent with a dose-dependent selective disruption of prefrontal cortical functioning by alcohol. There were no differences in performance between participants tested on the ascending limb of the BAC curve and those tested on the descending limb. Alcohol-associated perseveration may reflect the inhibitory effect of alcohol-induced dopamine release in the prefrontal cortex.
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Fernández-Serrano MJ, Pérez-García M, Schmidt Río-Valle J, Verdejo-García A. Neuropsychological consequences of alcohol and drug abuse on different components of executive functions. J Psychopharmacol 2010; 24:1317-32. [PMID: 20007413 DOI: 10.1177/0269881109349841] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several studies have shown alterations in different components of executive functioning in users of different drugs, including cannabis, cocaine and heroin. However, it is difficult to establish a specific association between the use of each of these drugs and executive alterations, since most drug abusers are polysubstance abusers, and alcohol is a ubiquitous confounding factor. Moreover, in order to study the association between consumption of different drugs and executive functioning, the patterns of quantity and duration of drugs used must be considered, given the association between these parameters and the executive functioning alteration degree. Based on the multicomponent approach to executive functions, the aims of the present study were: (i) to analyse the differential contribution of alcohol versus cocaine, heroin and cannabis use on executive functions performance; and (ii) to analyse the contribution made by the severity of the different drugs used (quantity and duration patterns) on these functions in a sample of polysubstance abusers that requested treatment for cannabis-, cocaine- or heroin-related problems. We administered measures of fluency, working memory, analogical reasoning, interference, cognitive flexibility, decision-making and self-regulation to two groups: 60 substance-dependent individuals (SDIs) and 30 healthy control individuals (HCIs). SDIs had significantly poorer performance than HCIs across all of the executive domains assessed. Results from hierarchical regression models showed the existence of common correlates of the use of alcohol, cannabis and cocaine on verbal fluency and decision-making; common correlates of quantity of cannabis and cocaine use on verbal working memory and analogical reasoning; common correlates of duration of cocaine and heroin use on shifting; and specific effects of duration of cocaine use on inhibition measures. These findings indicate that alcohol abuse is negatively associated with fluency and decision-making deficits, whereas the different drugs motivating treatment have both generalized and specific deleterious effects on different executive components.
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Affiliation(s)
- María José Fernández-Serrano
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Granada, Campus de Cartuja, s/n, 18071 Granada, Spain.
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Majdzadeh R, Feiz-Zadeh A, Rajabpour Z, Motevalian A, Hosseini M, Abdollahi M, Ghadirian P. Opium consumption and the risk of traffic injuries in regular users: a case-crossover study in an emergency department. TRAFFIC INJURY PREVENTION 2009; 10:325-329. [PMID: 19593708 DOI: 10.1080/15389580902995380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The cause-specific annual death rate due to traffic injuries is around 30 in 100,000 in Iran. On the other hand, this country has the highest proportion of opiate users in the world. Little is known about the transient effect of opium on traffic injuries. The objective of this study was to explore the effect of opium consumption on traffic injuries in drivers who use opium. METHODS Seventy-five regular opium users who suffered traffic injuries were studied in a case-crossover investigation. The study subjects had been admitted to the single trauma emergency department in Kerman, a city in southeast Iran. The relative risk (RR) of short-term opium effect was estimated by considering frequency of driving after opium consumption during 6 hours before the accident in comparison to the usual frequency of driving after opium consumption by the same persons. Stratified data analysis was performed by the Mantel-Haenszel method. RESULTS The opium consumption of drivers up to 6 hours before the accident was associated with an increased RR = 3.2, 95 percent confidence interval (CI): 1.9, 5.4. The third hour after consumption had the greatest magnitude of effect considering RR = 4.29, 95 percent CI:2.65, 6.95. CONCLUSIONS These results suggest a heightened risk of traffic injuries after opium consumption in regular users. The RR in the third hour after consumption could be explained by considering the greater probability of driving compared to the immediate hours after use, rather than peak effect time of opiates. The results indicate necessity of regular assessment of all common drivers, especially truck and bus drivers, regarding use of opium.
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Affiliation(s)
- Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.
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The Role of Executive Cognitive Functions in Changing Substance Use: What We Know and What We Need to Know. Ann Behav Med 2009; 37:117-25. [DOI: 10.1007/s12160-009-9093-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Indexed: 10/21/2022] Open
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Carter A, Hall W. The issue of consent in research that administers drugs of addiction to addicted persons. Account Res 2009; 15:209-25. [PMID: 18972263 DOI: 10.1080/08989620802388689] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In addiction, impaired control over drug use raises questions about the capacity of addicted persons to consent to participate in research studies in which they are given their drug of addiction. We review the case for doing such research, and the arguments that addiction does, and does not, prevent addicted persons from consenting to such research. We argue for a more nuanced view that acknowledges that while in some situations addiction impairs decision-making capacity, it does not eliminate such capacity. We conclude with some suggestions for recruiting addicted subjects and designing experiments in ways to obtain free and informed consent.
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Affiliation(s)
- Adrian Carter
- The University of Queensland, Queensland Brain Institute, Queensland, Australia.
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Cannon R, Lubar J, Baldwin D. Self-perception and Experiential Schemata in the Addicted Brain. Appl Psychophysiol Biofeedback 2008; 33:223-38. [DOI: 10.1007/s10484-008-9067-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 09/17/2008] [Indexed: 11/25/2022]
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Abstract
Impulsivity has been identified as a behavioral precursor to addiction, and may be the manifestation of a neurological vulnerability. The present study investigated whether individual differences in impulsivity were associated with performance on the Iowa Gambling Task (IGT, a test of emotional decision making thought to be associated in part with ventromedial prefrontal cortex function) and the Wisconsin Card Sorting Task (WCST, a set-shifting thought to be associated in part with dorsolateral prefrontal cortex function). Subjects were screened for impulsivity using the BIS-11 (self-report) and a delay discounting questionnaire (a behavioral measure of impulsivity). High impulsivity was associated with poorer performance on the final block of trials of the IGT but was not significantly related to WCST performance. Both measures were significantly correlated with scores on the BIS. These results provide support for hypothesis that, in a nonclinical sample, impulsivity may vary systematically with performance on neuropsychological indicators of prefrontal function.
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A preliminary study: novelty seeking, frontal executive function, and dopamine receptor (D2) TaqI A gene polymorphism in patients with methamphetamine dependence. Compr Psychiatry 2008; 49:387-92. [PMID: 18555060 DOI: 10.1016/j.comppsych.2008.01.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 12/20/2007] [Accepted: 01/08/2008] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Dopamine receptor polymorphisms have been associated with specific patterns of novelty seeking (NS) temperamental nature and frontal executive function. In addition, carriers of dopamine receptor type 2 (DRD2)-TaqI A1 have been hypothesized to be potentially vulnerable to addictive behaviors. In the present study, the association between dopamine D2 polymorphisms, NS, and frontal executive function was studied. METHODS Thirty-seven methamphetamine (MA)-dependent subjects and 40 healthy comparison subjects participated in the current study. The severity of addiction, NS temperament, and frontal executive functions were measured using the Addiction Severity Index, the NS subscale in the Temperament and Character Inventory, and the Wisconsin Card Sorting Test, respectively. All subjects were genotyped with regard to DRD2-TaqI polymorphisms. RESULTS The prevalence of DRD2-TaqI A1 allele polymorphisms was greater in the MA-abuser group than in the comparison group. Patients with MA dependence also had higher NS characteristics and high scores in total trials, errors, and perseverative errors of the Wisconsin Card Sorting Test than comparison subjects. Within patients with MA dependence, the subgroup of DRD2-TaqI A1 carrier had greater NS scores relative to those without, whereas there was only a trend level of lower frontal executive function in the first subgroup. CONCLUSION In the present study, the MA-dependent patients with DRD2-TaqI A1 allele had significantly greater NS scores and lower frontal executive function with a trend level than those without. These preliminary results suggest that MA-dependent patients may have the possibility of genetic and biogenic vulnerability to MA.
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Bühringer G, Wittchen HU, Gottlebe K, Kufeld C, Goschke T. Why people change? The role of cognitive-control processes in the onset and cessation of substance abuse disorders. Int J Methods Psychiatr Res 2008; 17 Suppl 1:S4-S15. [PMID: 18543358 PMCID: PMC6879090 DOI: 10.1002/mpr.246] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The current effectiveness of preventative and therapeutic interventions for substance use disorders (SUDs) is less than satisfying. Progress in understanding the processes related to the onset, course, and cessation of SUDs merits top priority, given the high prevalence and the severe negative consequences. AIMS This position paper, after summarizing major factors related to onset and cessation processes, discusses the possible role of cognitive-control dysfunctions in the complex interaction between mechanisms of change (mediators) and risk factors (moderators). FINDINGS In past decades, research has expanded our knowledge about the impact of SUDs on human behaviour. Formal interventions are effective, but there is limited information about the mechanisms responsible for change during the onset and cessation of SUDs and for individual differences related to them. Preliminary results suggest that impairments in higher order control functions play a role in SUDs. CONCLUSIONS Deficiencies in our understanding of behaviour-change processes during the onset and cessation of SUDs require that research have a different focus. A better understanding of the relevance of impairments in executive-control functions might help to improve formal preventative and therapeutic interventions and social conditions. Such interventions might reduce the chances that a SUD will develop or increase the likelihood of recovery from it.
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Affiliation(s)
- Gerhard Bühringer
- Chair of Addiction Research, Institute of Clinical, Diagnostic and Differential Psychology, Technische Universitaet Dresden, Germany.
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Darrah JM, Stefani MR, Moghaddam B. Interaction of N-methyl-D-aspartate and group 5 metabotropic glutamate receptors on behavioral flexibility using a novel operant set-shift paradigm. Behav Pharmacol 2008; 19:225-34. [PMID: 18469540 PMCID: PMC2910418 DOI: 10.1097/fbp.0b013e3282feb0ac] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Behavioral flexibility or 'set-shifting' refers to the ability to modify ongoing behavior in response to changing goals or environmental contingencies. Impaired behavioral flexibility is associated with disorders such as schizophrenia and addiction. Hypofunction of N-methyl-D-aspartate (NMDA) receptors has been implicated in these impairments. Metabotropic glutamate 5 (mGlu5) receptors closely interact with NMDA receptors and may provide a feasible pharmacological target for indirect manipulation of NMDA receptor function in disease states. The aim of this study was to examine the impact of NMDA and mGlu5 receptors on set-shifting ability. We developed a computer-controlled, operant-based set-shifting task that requires rats to learn sequential discrimination rules based on two distinct perceptual dimensions. Using this task, we found that administration of the NMDA receptor antagonist MK801, both systemically and intracortically, significantly impaired task performance, whereas stimulation or inhibition of mGlu5 receptors did not impair task performance. However, when administered after MK801, potentiation of mGlu5 receptor function reduced the performance impairments observed with MK801 alone. These results suggest an interaction between NMDA and mGlu5 receptors in cognitive flexibility and may provide a novel therapeutic approach for treating disorders associated with aberrant NMDA function.
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Affiliation(s)
- Justin M Darrah
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
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Carter A, Hall W. Informed consent to opioid agonist maintenance treatment: recommended ethical guidelines. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:79-89. [PMID: 18077146 DOI: 10.1016/j.drugpo.2007.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/30/2007] [Accepted: 09/03/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some bioethicists have questioned whether opioid addicted individuals are able to provide free and informed consent to opioid agonist maintenance treatment. Conflicting motives for providing such treatment (e.g. improving the personal health of addicts and protecting public health and order) can also influence what individuals are required to consent to, and how that consent is obtained. We discuss both issues and attempt to specify the conditions for obtaining informed consent to agonist maintenance treatment for opioid addiction. METHODS We briefly review the neuroscientific literature on the effects of addiction on the autonomy and decision-making capacity of opioid dependent individuals, and ascertain how informed consent to the treatment of opioid addiction should be obtained. We also provide an ethical analysis of the competing social and medical forces that influence the consent process and make some recommendations on how to ensure that individuals enter maintenance treatment that is provided in an effective and ethical way. RESULTS Our analysis shows that whilst the autonomy of opioid dependent individuals is impaired by their addiction, they do retain the ability to consent to treatment provided they are not in acute withdrawal or intoxication. These symptoms should have abated, either by supervised withdrawal or stabilisation on agonist maintenance, before they are asked to consent to a detailed treatment contract. Once stabilised, individuals should be provided with detailed information about the risks and benefits of all treatments, and restrictions and regulations under which they are provided. CONCLUSION Informed consent is an important part of the treatment process that should be obtained in ways that increase the autonomy and decision-making capacity in opioid addicts.
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Affiliation(s)
- Adrian Carter
- Queensland Brain Institute, School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia.
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Tramullas M, Martínez-Cué C, Hurlé MA. Chronic administration of heroin to mice produces up-regulation of brain apoptosis-related proteins and impairs spatial learning and memory. Neuropharmacology 2008; 54:640-52. [DOI: 10.1016/j.neuropharm.2007.11.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 11/20/2007] [Accepted: 11/22/2007] [Indexed: 11/16/2022]
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Schiffer B, Peschel T, Paul T, Gizewski E, Forsting M, Leygraf N, Schedlowski M, Krueger THC. Structural brain abnormalities in the frontostriatal system and cerebellum in pedophilia. J Psychiatr Res 2007; 41:753-62. [PMID: 16876824 DOI: 10.1016/j.jpsychires.2006.06.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 06/07/2006] [Accepted: 06/20/2006] [Indexed: 12/13/2022]
Abstract
Even though previous neuropsychological studies and clinical case reports have suggested an association between pedophilia and frontocortical dysfunction, our knowledge about the neurobiological mechanisms underlying pedophilia is still fragmentary. Specifically, the brain morphology of such disorders has not yet been investigated using MR imaging techniques. Whole brain structural T1-weighted MR images from 18 pedophile patients (9 attracted to males, 9 attracted to females) and 24 healthy age-matched control subjects (12 hetero- and 12 homosexual) from a comparable socioeconomic stratum were processed by using optimized automated voxel-based morphometry within multiple linear regression analyses. Compared to the homosexual and heterosexual control subjects, pedophiles showed decreased gray matter volume in the ventral striatum (also extending into the nucl. accumbens), the orbitofrontal cortex and the cerebellum. These observations further indicate an association between frontostriatal morphometric abnormalities and pedophilia. In this respect these findings may support the hypothesis that there is a shared etiopathological mechanism in all obsessive-compulsive spectrum disorders.
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Affiliation(s)
- Boris Schiffer
- Department of Forensic Psychiatry, University Hospital Essen, University of Duisburg-Essen, Virchowstrasse 174, D-45147 Essen, Germany.
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Ersche KD, Sahakian BJ. The neuropsychology of amphetamine and opiate dependence: implications for treatment. Neuropsychol Rev 2007; 17:317-36. [PMID: 17690986 PMCID: PMC3639428 DOI: 10.1007/s11065-007-9033-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 06/22/2007] [Indexed: 01/08/2023]
Abstract
Chronic use of amphetamines and/or opiates has been associated with a wide range of cognitive deficits, involving domains of attention, inhibitory control, planning, decision-making, learning and memory. Although both amphetamine and opiate users show marked impairment in various aspects of cognitive function, the impairment profile is distinctly different according to the substance of abuse. In light of evidence showing that cognitive impairment in drug users has a negative impact on treatment engagement and efficacy, we review substance-specific deficits on executive and memory function, and discuss possibilities to address these during treatment intervention.
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Affiliation(s)
- Karen D Ersche
- School of Clinical Medicine, Department of Psychiatry, University of Cambridge, Brain Mapping Unit, Box 255, Addenbrooke's Hospital, Cambridge, UK.
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Stevens A, Peschk I, Schwarz J. Implicit learning, executive function and hedonic activity in chronic polydrug abusers, currently abstinent polydrug abusers and controls. Addiction 2007; 102:937-46. [PMID: 17523989 DOI: 10.1111/j.1360-0443.2007.01823.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The study seeks to evaluate impairments of implicit learning and executive function in chronic polydrug abusers. It was hypothesized that implicit learning and executive function correlate with anhedonia. DESIGN A cross-sectional group comparison. SETTINGS Department of Psychiatry, University of Tübingen, Germany. Participants A total of 25 male polydrug abusers with opiate dependence, n = 26 polydrug abusers abstinent for more than 3 months and n = 26 non-drug-using healthy males. SETTING Abstinent polydrug abusers were recruited from a community treatment centre, current polydrug abusers from local drug counselling services and controls through advertisements. MEASUREMENTS A psychological battery assessing implicit learning (serial reaction-time task), various executive functions (latent inhibition, delayed matching-to-sample, Trail Making Test, acquisition and modification of conditioned responses, figural reasoning) and verbal logic memory was administered. Hedonic thoughts and activities as well as depressive symptoms were assessed through questionnaires. FINDINGS In chronic polydrug abusers, there were moderate impairments of implicit learning, of acquisition, reversal and extinction of conditioned responses, of latent inhibition as well as anhedonia, while working memory was spared. In the abstinent group, cognitive performance was normal except for latent inhibition and more anhedonia and depression than in controls. CONCLUSIONS The findings suggest that current polydrug abusers suffer from impairment of many cognitive functions and from anhedonia. During abstinence, there is near normal cognitive function but still anhedonia. Anhedonia was correlated with implicit learning but not with executive function.
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Affiliation(s)
- Andreas Stevens
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Germany
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Verdejo-García A, Pérez-García M. Profile of executive deficits in cocaine and heroin polysubstance users: common and differential effects on separate executive components. Psychopharmacology (Berl) 2007; 190:517-30. [PMID: 17136401 DOI: 10.1007/s00213-006-0632-8] [Citation(s) in RCA: 210] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Structure of executive function was examined and we contrasted performance of substance dependent individuals (polysubstance users) and control participants on neuropsychological measures assessing the different executive components obtained. Additionally, we contrasted performance of polysubstance users with preference for cocaine vs heroin and controls to explore possible differential effects of the main substance abused on executive impairment. METHODS Two groups of participants were recruited: abstinent polysubstance users and controls. Polysubstance users were further subdivided based on their drug of choice (cocaine vs heroin). We administered to all participants a comprehensive protocol of executive measures, including tests of fluency, working memory, reasoning, inhibitory control, flexibility, and decision making. RESULTS Consistent with previous models, the principal component analysis showed that executive functions are organized into four separate components, three of them previously described: updating, inhibition, and shifting; and a fourth component of decision making. Abstinent polysubstance users had clinically significant impairments on measures assessing these four executive components (with effect sizes ranging from 0.5 to 2.2). Cocaine polysubstance users had more severe impairments than heroin users and controls on measures of inhibition (Stroop) and shifting (go/no go and category test). Greater severity of drug use predicted poorer performance on updating measures. CONCLUSION Executive functions can be fractionated into four relatively independent components. Chronic drug use is associated with widespread impairment of these four executive components, with cocaine use inducing more severe deficits on inhibition and shifting. These findings show both common and differential effects of two widely used drugs on different executive components.
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Affiliation(s)
- Antonio Verdejo-García
- Department Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Granada, Campus de Cartuja S/N, 18071, Granada, Spain.
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Lyvers M, Brooks J, Matica D. Effects of caffeine on cognitive and autonomic measures in heavy and light caffeine consumers. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2007. [DOI: 10.1080/00049530410001688119] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michael Lyvers
- Department of Psychology, School of Humanities and Social Sciences, Bond University, Gold Coast, Queensland, Australia
- Department of Psychology, School of Humanities and Social Sciences, Bond University, Gold Coast, Qld, 4229, Australia
| | - Janine Brooks
- Department of Psychology, School of Humanities and Social Sciences, Bond University, Gold Coast, Queensland, Australia
- Department of Psychology, School of Humanities and Social Sciences, Bond University, Gold Coast, Qld, 4229, Australia
| | - Deborah Matica
- Department of Psychology, School of Humanities and Social Sciences, Bond University, Gold Coast, Queensland, Australia
- Department of Psychology, School of Humanities and Social Sciences, Bond University, Gold Coast, Qld, 4229, Australia
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Verdejo-García A, Rivas-Pérez C, López-Torrecillas F, Pérez-García M. Differential impact of severity of drug use on frontal behavioral symptoms. Addict Behav 2006; 31:1373-82. [PMID: 16326022 DOI: 10.1016/j.addbeh.2005.11.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 10/31/2005] [Accepted: 11/01/2005] [Indexed: 01/17/2023]
Abstract
Increasing evidence indicates that substance abusers are impaired in cognitive-executive control tasks relying on different functional systems converging in the prefrontal cortex (PFC). Different PFC functional systems relevant to addiction have been described: the dorsolateral (DLC), orbitofrontal (OFC), and anterior cingulate (ACC) circuits. Each system is associated with different behavioral, cognitive, and emotional deficits, including apathy, disinhibition, and executive dysfunction. In this study, we examined the effects of severity of use of different drugs on apathy, disinhibition and executive dysfunction behavioral deficits as measured by the Frontal Systems Behavior Scale (FrSBe). The FrSBe, and a severity of substance use interview were administered to 32 poly-substance abusers. Multiple regression analyses showed that severity of cannabis use significantly predicted greater apathy and executive dysfunction behavior; and that severity of cocaine use significantly predicted greater disinhibition behavior. These results are consistent with previous studies using cognitive measures and support the notion that severity of substance use significantly affects behavioral symptoms associated with PFC systems functioning. These clinical symptoms should be specifically addressed during rehabilitation.
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Affiliation(s)
- Antonio Verdejo-García
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Granada, Campus de Cartuja S/N, 18071 Granada, Spain.
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Ersche KD, Clark L, London M, Robbins TW, Sahakian BJ. Profile of executive and memory function associated with amphetamine and opiate dependence. Neuropsychopharmacology 2006; 31:1036-47. [PMID: 16160707 PMCID: PMC1867318 DOI: 10.1038/sj.npp.1300889] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive function was assessed in chronic drug users on neurocognitive measures of executive and memory function. Current amphetamine users were contrasted with current opiate users, and these two groups were compared with former users of these substances (abstinent for at least one year). Four groups of participants were recruited: amphetamine-dependent individuals, opiate-dependent individuals, former users of amphetamines, and/or opiates and healthy non-drug taking controls. Participants were administered the Tower of London (TOL) planning task and the 3D-IDED attentional set-shifting task to assess executive function, and Paired Associates Learning and Delayed Pattern Recognition Memory tasks to assess visual memory function. The three groups of substance users showed significant impairments on TOL planning, Pattern Recognition Memory and Paired Associates Learning. Current amphetamine users displayed a greater degree of impairment than current opiate users. Consistent with previous research showing that healthy men are performing better on visuo-spatial tests than women, our male controls remembered significantly more paired associates than their female counterparts. This relationship was reversed in drug users. While performance of female drug users was normal, male drug users showed significant impairment compared to both their female counterparts and male controls. There was no difference in performance between current and former drug users. Neither years of drug abuse nor years of drug abstinence were associated with performance. Chronic drug users display pronounced neuropsychological impairment in the domains of executive and memory function. Impairment persists after several years of drug abstinence and may reflect neuropathology in frontal and temporal cortices.
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Affiliation(s)
- Karen D Ersche
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Luke Clark
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Experimental Psychology, University of Cambridge, Cambridge, UK
| | - Mervyn London
- Brookfields Hospital, Cambridge Drug & Alcohol Service, Cambridge, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Experimental Psychology, University of Cambridge, Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Correspondence: Professor BJ Sahakian, Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Box 189, Addenbrooke's Hospital, Cambridge, Cambridgeshire CB2 2QQ, UK, Tel: + 44 1223 331209, Fax: + 44 1223 336968, E-mail:
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Goudriaan AE, Oosterlaan J, de Beurs E, van den Brink W. Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls. Addiction 2006; 101:534-47. [PMID: 16548933 DOI: 10.1111/j.1360-0443.2006.01380.x] [Citation(s) in RCA: 314] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Neurocognitive functions in pathological gambling have relevance for the aetiology and treatment of this disorder, yet are poorly understood. This study therefore investigated neurocognitive impairments of executive functions in a group of carefully screened Diagnostic and Statistical Manual version IV (DSM-IV-TR) pathological gamblers. Performance was compared to a group of normal control participants. To study the specificity of these neurocognitive deficits, a substance dependence group (alcohol dependence) and an impulse control disorder group (Tourette syndrome) were included. DESIGN Cross-sectional study. SETTING Addiction and general mental health treatment centres. PARTICIPANTS Forty-nine pathological gamblers, 48 abstinent alcohol-dependent patients, 46 participants with Tourette syndrome and 49 normal control participants. MEASUREMENTS A comprehensive neuropsychological battery measuring executive functions as well as basic cognitive functions. FINDINGS Both the pathological gambling and the alcohol dependent groups were characterized by diminished performance on inhibition, time estimation, cognitive flexibility and planning tasks. The Tourette syndrome group showed deficits only on inhibition tasks. Basic cognitive functions were intact in all clinical groups. Comorbid attention deficit hyperactivity disorder, antisocial personality disorder and nicotine dependence influenced the impaired functions of the clinical groups only minimally. CONCLUSIONS Carefully screened groups of pathological gamblers and alcohol dependents were characterized by diminished executive functioning, suggesting a dysfunction of frontal lobe circuitry in these disorders. The resemblance between the pathological gambling group and the alcohol dependence group suggests a common neurocognitive aetiology for these disorders. Psychosocial treatment of these disorders could benefit from assessing and targeting deficits in executive functions, as they probably influence the course of these disorders negatively.
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Affiliation(s)
- Anna E Goudriaan
- Amsterdam Institute for Addiction Research and Academic Medical Centre, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.
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Abstract
Cognition denotes a relatively high level of processing of specific information including thinking, memory, perception, motivation, skilled movements and language. Cognitive psychology has become an important discipline in the research of a number of psychiatric disorders, ranging from severe psychotic illness such as schizophrenia to relatively benign, yet significantly disabling, non-psychotic illnesses such as somatoform disorder. Research in the area of neurocognition has started unlocking various secrets of psychiatric disorders, such as revealing the biological underpinnings, explaining the underlying psychopathology and issues related to course, outcome and treatment strategies. Such research has also attempted to uproot a number of previously held concepts, such as Kraepelin's dichotomy. Although the range of cognitive problems can be diverse, there are several cognitive domains, including executive function, attention and information processing, and working memory, which appear more frequently at risk. A broad range of impairment across and within the psychiatric disorders are highlighted in this oration. The oration summarizes the studies investigating cognitive processing in different psychiatric disorders. I will also discuss the findings of my own research on neurocognitive deficits in mood disorders, schizophrenia, obsessive-compulsive disorder, somatoform disorder, including studies on 'high-risk' individuals. Tracing the evaluation of neurocognitive science may provide new insights into the pathophysiology and treatment of psychiatric disorders.
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Affiliation(s)
- J K Trivedi
- Professor, Department of Psychiatry, King George Medical University, Lucknow 226006, Uttar Pradesh, e-mail: , , ,
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