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Pleil KE, Grant KA, Cuzon Carlson VC, Kash TL. Chronic alcohol consumption alters sex-dependent BNST neuron function in rhesus macaques. Neurobiol Stress 2024; 31:100638. [PMID: 38737421 PMCID: PMC11088190 DOI: 10.1016/j.ynstr.2024.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Repeated alcohol drinking contributes to a number of neuropsychiatric diseases, including alcohol use disorder and co-expressed anxiety and mood disorders. Women are more susceptible to the development and expression of these diseases with the same history of alcohol exposure as men, suggesting they may be more sensitive to alcohol-induced plasticity in limbic brain regions controlling alcohol drinking, stress responsivity, and reward processing, among other behaviors. Using a translational model of alcohol drinking in rhesus monkeys, we examined sex differences in the basal function and plasticity of neurons in the bed nucleus of the stria terminalis (BNST), a brain region in the extended amygdala shown to be a hub circuit node dysregulated in individuals with anxiety and alcohol use disorder. We performed slice electrophysiology recordings from BNST neurons in male and female monkeys following daily "open access" (22 h/day) to 4% ethanol and water for more than one year or control conditions. We found that BNST neurons from control females had reduced overall current density, hyperpolarization-activated depolarizing current (Ih), and inward rectification, as well as higher membrane resistance and greater synaptic glutamatergic release and excitatory drive, than those from control males, suggesting that female BNST neurons are more basally excited than those from males. Chronic alcohol drinking produced a shift in these measures in both sexes, decreasing current density, Ih, and inward rectification and increasing synaptic excitation. In addition, network activity-dependent synaptic inhibition was basally higher in BNST neurons of males than females, and alcohol exposure increased this in both sexes, a putative homeostatic mechanism to counter hyperexcitability. Altogether, these results suggest that the rhesus BNST is more basally excited in females than males and chronic alcohol drinking produces an overall increase in excitability and synaptic excitation. These results shed light on the mechanisms contributing to the female-biased susceptibility to neuropsychiatric diseases including co-expressed anxiety and alcohol use disorder.
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Affiliation(s)
- Kristen E. Pleil
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, 10065, USA
- Department of Pharmacology and Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA
| | - Kathleen A. Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Verginia C. Cuzon Carlson
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Thomas L. Kash
- Department of Pharmacology and Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA
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Pleil KE, Grant KA, Carlson VCC, Kash TL. Chronic alcohol consumption alters sex-dependent BNST neuron function in rhesus macaques. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.11.589120. [PMID: 38659781 PMCID: PMC11042223 DOI: 10.1101/2024.04.11.589120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Repeated alcohol drinking contributes to a number of neuropsychiatric diseases, including alcohol use disorder and co-expressed anxiety and mood disorders. Women are more susceptible to the development and expression of these diseases with the same history of alcohol exposure as men, suggesting they may be more sensitive to alcohol-induced plasticity in limbic brain regions controlling alcohol drinking, stress responsivity, and reward processing, among other behaviors. Using a translational model of alcohol drinking in rhesus monkeys, we examined sex differences in the basal function and plasticity of neurons in the bed nucleus of the stria terminalis (BNST), a brain region in the extended amygdala shown to be a hub circuit node dysregulated in individuals with anxiety and alcohol use disorder. We performed slice electrophysiology recordings from BNST neurons in male and female monkeys following daily "open access" (22 hr/day) to 4% ethanol and water for more than one year or control conditions. We found that BNST neurons from control females had reduced overall current density, hyperpolarization-activated depolarizing current (Ih), and inward rectification, as well as higher membrane resistance and greater synaptic glutamatergic release and excitatory drive, than those from control males, suggesting that female BNST neurons are more basally excited than those from males. Chronic alcohol drinking produced a shift in these measures in both sexes, decreasing current density, Ih, and inward rectification and increasing synaptic excitation. In addition, network activity-dependent synaptic inhibition was basally higher in BNST neurons of males than females, and alcohol exposure increased this in both sexes, a putative homeostatic mechanism to counter hyperexcitability. Altogether, these results suggest that the rhesus BNST is more basally excited in females than males and chronic alcohol drinking produces an overall increase in excitability and synaptic excitation. These results shed light on the mechanisms contributing to the female-biased susceptibility to neuropsychiatric diseases including co-expressed anxiety and alcohol use disorder.
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Affiliation(s)
- Kristen E. Pleil
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY 10065
- Department of Pharmacology and Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC 27514
| | - Kathleen A. Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Verginia C. Cuzon Carlson
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006
| | - Thomas L. Kash
- Department of Pharmacology and Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC 27514
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Hurzeler T, Watt J, Logge W, Towers E, Suraev A, Lintzeris N, Haber P, Morley KC. Neuroimaging studies of cannabidiol and potential neurobiological mechanisms relevant for alcohol use disorders: a systematic review. J Cannabis Res 2024; 6:15. [PMID: 38509580 PMCID: PMC10956336 DOI: 10.1186/s42238-024-00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/03/2024] [Indexed: 03/22/2024] Open
Abstract
The underlying neurobiological mechanisms of cannabidiol's (CBD) management of alcohol use disorder (AUD) remains elusive.Aim We conducted a systematic review of neuroimaging literature investigating the effects of CBD on the brain in healthy participants. We then theorise the potential neurobiological mechanisms by which CBD may ameliorate various symptoms of AUD.Methods This review was conducted according to the PRISMA guidelines. Terms relating to CBD and neuroimaging were used to search original clinical research published in peer-reviewed journals.Results Of 767 studies identified by our search strategy, 16 studies satisfied our eligibility criteria. The results suggest that CBD modulates γ-Aminobutyric acid and glutamate signaling in the basal ganglia and dorso-medial prefrontal cortex. Furthermore, CBD regulates activity in regions associated with mesocorticolimbic reward pathways; salience, limbic and fronto-striatal networks which are implicated in reward anticipation; emotion regulation; salience processing; and executive functioning.Conclusion CBD appears to modulate neurotransmitter systems and functional connections in brain regions implicated in AUD, suggesting CBD may be used to manage AUD symptomatology.
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Affiliation(s)
- Tristan Hurzeler
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Translational Research in Alcohol, Edith Collins Centre, Sydney Local Health District, Sydney, Australia
| | - Joshua Watt
- Translational Research in Alcohol, Edith Collins Centre, Sydney Local Health District, Sydney, Australia
| | - Warren Logge
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Translational Research in Alcohol, Edith Collins Centre, Sydney Local Health District, Sydney, Australia
| | - Ellen Towers
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Translational Research in Alcohol, Edith Collins Centre, Sydney Local Health District, Sydney, Australia
| | - Anastasia Suraev
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Lintzeris
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Paul Haber
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Translational Research in Alcohol, Edith Collins Centre, Sydney Local Health District, Sydney, Australia
| | - Kirsten C Morley
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Translational Research in Alcohol, Edith Collins Centre, Sydney Local Health District, Sydney, Australia.
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Xiao T, Roland A, Chen Y, Guffey S, Kash T, Kimbrough A. A role for circuitry of the cortical amygdala in excessive alcohol drinking, withdrawal, and alcohol use disorder. Alcohol 2024:S0741-8329(24)00034-X. [PMID: 38447789 DOI: 10.1016/j.alcohol.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Alcohol use disorder (AUD) poses a significant public health challenge. Individuals with AUD engage in chronic and excessive alcohol consumption, leading to cycles of intoxication, withdrawal, and craving behaviors. This review explores the involvement of the cortical amygdala (CoA), a cortical brain region that has primarily been examined in relation to olfactory behavior, in the expression of alcohol dependence and excessive alcohol drinking. While extensive research has identified the involvement of numerous brain regions in AUD, the CoA has emerged as a relatively understudied yet promising candidate for future study. The CoA plays a vital role in rewarding and aversive signaling and olfactory-related behaviors and has recently been shown to be involved in alcohol-dependent drinking in mice. The CoA projects directly to brain regions that are critically important for AUD, such as the central amygdala, bed nucleus of the stria terminalis, and basolateral amygdala. These projections may convey key modulatory signaling that drives excessive alcohol drinking in alcohol-dependent subjects. This review summarizes existing knowledge on the structure and connectivity of the CoA and its potential involvement in AUD. Understanding the contribution of this region to excessive drinking behavior could offer novel insights into the etiology of AUD and potential therapeutic targets.
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Affiliation(s)
- Tiange Xiao
- Purdue University, Department of Basic Medical Sciences, College of Veterinary Medicine
| | - Alison Roland
- Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Yueyi Chen
- Purdue University, Department of Basic Medical Sciences, College of Veterinary Medicine
| | - Skylar Guffey
- Purdue University, Department of Basic Medical Sciences, College of Veterinary Medicine
| | - Thomas Kash
- Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adam Kimbrough
- Purdue University, Department of Basic Medical Sciences, College of Veterinary Medicine; Purdue Institute for Integrative Neuroscience; Purdue University, Weldon School of Biomedical Engineering; Purdue Institute of Inflammation, Immunology, and Infectious Disease.
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Gerhardt S, Berhe O, Moessnang C, Horning M, Kiefer F, Tost H, Vollstädt-Klein S. Lack of amygdala habituation to negative emotional faces in alcohol use disorder and the relation to adverse childhood experiences. Addict Biol 2023; 28:e13251. [PMID: 36577733 DOI: 10.1111/adb.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Aberrant limbic circuit reactivity to negative stimuli might be related to alterations in emotion processing and regulation in alcohol use disorder (AUD). The current study tested for the first time in AUD the hypothesis of aberrant amygdala habituation to repeated aversive stimuli-a robust and reliable neuroimaging marker for emotion processing. We explored the link between deficits in habituation to adverse childhood experience (ACE), a common risk factor for impaired emotion regulation and AUD. AUD individuals (N = 36) and healthy controls (HC; N = 26) participated in an observational case-control functional magnetic resonance imaging (fMRI) study. An established habituation index was used to investigate processing of aversive emotional faces of the amygdala. AUD individuals showed an overall deficit in amygdala habituation (right: t = 4.26, pFWE = 0.004; left: t = 4.79, pFWE ≤ 0.001). Amygdala habituation was significantly related to increased exposure to ACE in HC (t = 3.88, pFWE = 0.012), whereas this association was not observed in AUD individuals (T = 1.80, pFWE = 0.662). Further, a significant association between higher alcohol consumption and reduced amygdala habituation (right: R2 = -0.356, F = 8.736, p = 0.004; left: R2 = -0.309, F = 6.332, p = 0.015) was observed. We found novel evidence for neural alterations in emotion processing in AUD individuals, indexed by deficient amygdala habituation to negative emotional content. We replicated a prior report on a link between ACE and amygdala habituation, a well-established environmental risk factor for mental disorders and emotion dysregulation, in our control sample. Additionally, deficient amygdala habituation related to the amount of alcohol consumption in the overall sample might indicate a short-term substance effect.
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,SRH University Heidelberg, Heidelberg, Germany
| | - Maibritt Horning
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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6
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Zhao Y, Skandali N, Bethlehem RAI, Voon V. Mesial Prefrontal Cortex and Alcohol Misuse: Dissociating Cross-sectional and Longitudinal Relationships in UK Biobank. Biol Psychiatry 2022; 92:907-916. [PMID: 35589437 DOI: 10.1016/j.biopsych.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/24/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol misuse is a major global public health issue. The disorder is characterized by aberrant neural networks interacting with environment and genetics. Dissecting the neural substrates and functional networks that relate to longitudinal changes in alcohol use from those that relate to alcohol misuse cross-sectionally is important to elucidate therapeutic approaches. METHODS To assess how neuroimaging data, including T1, resting-state functional magnetic resonance imaging, and diffusion-weighted imaging, relate to alcohol misuse cross-sectionally and longitudinally in the UK Biobank, this study analyzed range of alcohol misuse in a population-based normative sample of 24,784 participants, ages 45 to 81 years old, in a cross-sectional analysis and a sample of 3070 participants in a longitudinal analysis 2 years later. RESULTS Cross-sectional analysis showed that alcohol use is associated with a reduction in dorsal anterior cingulate cortex and dorsomedial prefrontal cortex gray matter concentration and functional resting-state connectivity (nodal degree: t24,422 = -12.99, p < 1 × 10-17). Reduced dorsal anterior cingulate cortex/dorsomedial prefrontal cortex functional connections to the ventrolateral prefrontal cortex, amygdala, and striatum relate to greater alcohol use. In a longitudinal analysis, higher resting-state nodal degree (t3036 = -3.27, p = .0011) and T1 gray matter concentration in the ventromedial prefrontal cortex relate to reduced alcohol intake frequency 2 years later. Higher ventromedial prefrontal cortex and frontoparietal executive network functional connectivity is associated with lower subsequent drinking longitudinally. CONCLUSIONS Dorsal versus ventromedial prefrontal regions are differentially related to alcohol misuse cross-sectionally or longitudinally in a large UK Biobank normative dataset. Our study provides a comprehensive understanding of the neurobiological substrates of alcohol use as a state or prospectively, thereby providing potential targets for clinical treatment.
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Affiliation(s)
- Ying Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Nikolina Skandali
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Valerie Voon
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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Vamvakopoulou IA, Fonville L, Hayes A, McGonigle J, Elliott R, Ersche KD, Flechais R, Orban C, Murphy A, Smith DG, Suckling J, Taylor EM, Deakin B, Robbins TW, Nutt DJ, Lingford-Hughes AR, Paterson LM. Selective D3 receptor antagonism modulates neural response during negative emotional processing in substance dependence. Front Psychiatry 2022; 13:998844. [PMID: 36339857 PMCID: PMC9627287 DOI: 10.3389/fpsyt.2022.998844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Negative affective states contribute to the chronic-relapsing nature of addiction. Mesolimbic dopamine D3 receptors are well placed to modulate emotion and are dysregulated in substance dependence. Selective antagonists might restore dopaminergic hypofunction, thus representing a potential treatment target. We investigated the effects of selective D3 antagonist, GSK598809, on the neural response to negative emotional processing in substance dependent individuals and healthy controls. Methodology Functional MRI BOLD response was assessed during an evocative image task, 2 h following acute administration of GSK598809 (60 mg) or placebo in a multi-site, double-blind, pseudo-randomised, cross-over design. Abstinent drug dependent individuals (DD, n = 36) comprising alcohol-only (AO, n = 19) and cocaine-alcohol polydrug (PD, n = 17) groups, and matched controls (n = 32) were presented with aversive and neutral images in a block design (contrast of interest: aversive > neutral). Whole-brain mixed-effects and a priori ROI analyses tested for group and drug effects, with identical models exploring subgroup effects. Results No group differences in task-related BOLD signal were identified between DD and controls. However, subgroup analysis revealed greater amygdala/insular BOLD signal in PD compared with AO groups. Following drug administration, GSK598809 increased BOLD response across HC and DD groups in thalamus, caudate, putamen, and pallidum, and reduced BOLD response in insular and opercular cortices relative to placebo. Multivariate analyses in a priori ROIs revealed differential effects of D3 antagonism according to subgroup in substantia nigra; GSK598809 increased BOLD response in AO and decreased response in PD groups. Conclusion Acute GSK598809 modulates the BOLD response to aversive image processing, providing evidence that D3 antagonism may impact emotional regulation. Enhanced BOLD response within D3-rich mesolimbic regions is consistent with its pharmacology and with attenuation of substance-related hypodopaminergic function. However, the lack of group differences in task-related BOLD response and the non-specific effect of GSK598809 between groups makes it difficult to ascertain whether D3 antagonism is likely to be normalising or restorative in our abstinent populations. The suggestion of differential D3 modulation between AO and PD subgroups is intriguing, raising the possibility of divergent treatment responses. Further study is needed to determine whether D3 antagonism should be recommended as a treatment target in substance dependence.
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Affiliation(s)
- Ioanna A. Vamvakopoulou
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Leon Fonville
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Alexandra Hayes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - John McGonigle
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Karen D. Ersche
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Remy Flechais
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Csaba Orban
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Anna Murphy
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Dana G. Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - John Suckling
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Eleanor M. Taylor
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Bill Deakin
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - David J. Nutt
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Anne R. Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Louise M. Paterson
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Ghetti C, Chen XJ, Brenner AK, Hakvoort LG, Lien L, Fachner J, Gold C. Music therapy for people with substance use disorders. Cochrane Database Syst Rev 2022; 5:CD012576. [PMID: 35532044 PMCID: PMC9082681 DOI: 10.1002/14651858.cd012576.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. OBJECTIVES To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. SEARCH METHODS We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -1.23 to -0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD -0.33, 95% CI -0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI -0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) -0.17, 95% CI -4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI -0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI -0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD -0.04, 95% CI -0.56 to 0.48; 3 studies, 232 participants), depression (MD -1.49, 95% CI -4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes. We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size. AUTHORS' CONCLUSIONS: Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.
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Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy, University of Bergen, Bergen, Norway
| | - Xi-Jing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China
| | - Annette K Brenner
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hospital Innlandet Trust, Brumunddal, Norway
| | - Jorg Fachner
- Cambridge institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
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Smart K, Worhunsky PD, Scheinost D, Angarita GA, Esterlis I, Carson RE, Krystal JH, O'Malley SS, Cosgrove KP, Hillmer AT. Multimodal neuroimaging of metabotropic glutamate 5 receptors and functional connectivity in alcohol use disorder. Alcohol Clin Exp Res 2022; 46:770-782. [PMID: 35342968 PMCID: PMC9117461 DOI: 10.1111/acer.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND People recovering from alcohol use disorder (AUD) show altered resting brain connectivity. The metabotropic glutamate 5 (mGlu5) receptor is an important regulator of synaptic plasticity potentially linked with synchronized brain activity and a target of interest in treating AUD. The goal of this work was to assess potential relationships of brain connectivity at rest with mGlu5 receptor availability in people with AUD at two time points early in abstinence. METHODS Forty-eight image data sets were acquired with a multimodal neuroimaging battery that included resting-state functional magnetic resonance imaging (fMRI) and mGlu5 receptor positron emission tomography (PET) with the radiotracer [18 F]FPEB. Participants with AUD (n = 14) were scanned twice, at approximately 1 and 4 weeks after beginning supervised abstinence. [18 F]FPEB PET results were published previously. Primary comparisons of fMRI outcomes were performed between the AUD group and healthy controls (HCs; n = 23) and assessed changes over time within the AUD group. Relationships between resting-state connectivity measures and mGlu5 receptor availability were explored within groups. RESULTS Compared to HCs, global functional connectivity of the orbitofrontal cortex was higher in the AUD group at 4 weeks of abstinence (p = 0.003), while network-level functional connectivity within the default mode network (DMN) was lower (p < 0.04). Exploratory multimodal analyses showed that mGlu5 receptor availability was correlated with global connectivity across all brain regions (HCs, r = 0.41; AUD group at 1 week of abstinence, r = 0.50 and at 4 weeks, r = 0.46; all p < 0.0001). Furthermore, a component of cortical and striatal mGlu5 availability was correlated with connectivity between the DMN and salience networks in HCs (r = 0.60, p = 0.003) but not in the AUD group (p > 0.3). CONCLUSIONS These preliminary findings of altered global and network connectivity during the first month of abstinence from drinking may reflect the loss of efficient network function, while exploratory relationships with mGlu5 receptor availability suggest a potential glutamatergic relationship with network coherence.
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Affiliation(s)
- Kelly Smart
- Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Patrick D Worhunsky
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Biomedical Engineering, Yale School of Engineering & Applied Science, New Haven, Connecticut, USA
| | - Gustavo A Angarita
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard E Carson
- Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Biomedical Engineering, Yale School of Engineering & Applied Science, New Haven, Connecticut, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kelly P Cosgrove
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ansel T Hillmer
- Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Biomedical Engineering, Yale School of Engineering & Applied Science, New Haven, Connecticut, USA
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10
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Sinha R, Fogelman N, Wemm S, Angarita G, Seo D, Hermes G. Alcohol withdrawal symptoms predict corticostriatal dysfunction that is reversed by prazosin treatment in alcohol use disorder. Addict Biol 2022; 27:e13116. [PMID: 34856641 PMCID: PMC9872962 DOI: 10.1111/adb.13116] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 01/27/2023]
Abstract
Chronic alcohol use increases risk of alcohol withdrawal symptoms (AW) and disrupts stress biology and resilient coping, thereby promoting excessive alcohol intake. Chronic alcohol intake and multiple alcohol detoxifications are known to impair brain medial prefrontal cortex (mPFC) and striatal functioning, regions involved in regulating stress, craving and alcohol intake. In two related studies, we examined whether AW predicts this functional brain pathology and whether Prazosin versus Placebo treatment may reverse these effects. In Study 1, patients with Alcohol Use Disorder (AUD) (N = 45) with varying AW levels at treatment entry were assessed to examine AW effects on corticostriatal responses to stress, alcohol cue and neutral visual images with functional magnetic resonance imaging (fMRI). In Study 2, 23 AUD patients entering a 12-week randomised controlled trial (RCT) of Prazosin, an alpha1 adrenergic antagonist that decreased withdrawal-related alcohol intake in laboratory animals, participated in two fMRI sessions at pretreatment and also at week 9-10 of chronic treatment (Placebo: N = 13; Prazosin: N = 10) to assess Prazosin treatment effects on alcohol-related cortico-striatal dysfunction. Study 1 results indicated that higher AW predicted greater disruption in brain mPFC and striatal response to stress and alcohol cues (p < 0.001, family-wise error [FWE] correction) and also subsequently greater heavy drinking days (HDD) in early treatment (p < 0.01). In Study 2, Prazosin versus Placebo treatment reversed mPFC-striatal dysfunction (p < 0.001, FWE), which in turn predicted fewer drinking days (p < 0.01) during the 12-week treatment period. These results indicate that AW is a significant predictor of alcohol-related prefrontal-striatal dysfunction, and Prazosin treatment reversed these effects that in turn contributed to improved alcohol treatment outcomes.
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Affiliation(s)
- R Sinha
- Yale Stress Center, Yale University School of Medicine,Department of Psychiatry, Yale University School of Medicine, New Haven CT,Department of Neuroscience, Yale University School of Medicine, New Haven CT
| | - N Fogelman
- Yale Stress Center, Yale University School of Medicine,Department of Psychiatry, Yale University School of Medicine, New Haven CT
| | - S Wemm
- Yale Stress Center, Yale University School of Medicine,Department of Psychiatry, Yale University School of Medicine, New Haven CT
| | - G Angarita
- Department of Psychiatry, Yale University School of Medicine, New Haven CT
| | - D Seo
- Yale Stress Center, Yale University School of Medicine,Department of Psychiatry, Yale University School of Medicine, New Haven CT
| | - G Hermes
- Yale Stress Center, Yale University School of Medicine,Department of Psychiatry, Yale University School of Medicine, New Haven CT
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11
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Le TM, Malone T, Li CSR. Positive alcohol expectancy and resting-state functional connectivity of the insula in problem drinking. Drug Alcohol Depend 2022; 231:109248. [PMID: 34998254 PMCID: PMC8881788 DOI: 10.1016/j.drugalcdep.2021.109248] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
Positive alcohol expectancy (AE), a significant predictor of excessive alcohol consumption, is associated with heightened drinking motivation and reduced control. As the insula interacts with the limbic and prefrontal structures to integrate stimulus saliency, interoception, and cognitive control, the region may play a unique role in modulating AE. Here, we examined resting-state functional connectivity of the right and left insula in relation to AE in 180 adult drinkers. Whole-brain multiple regressions and path analysis were performed to delineate the inter-relationship between AE, insular connectivity, and drinking severity. We found that heightened AE was associated with diminished right insular connectivity with regions involved in negative emotion processing and self-control, including the amygdala, putamen, and ventromedial prefrontal cortex. In contrast, there was a positive relationship between AE and right insular connectivity with regions implicated in motivated responses to alcohol stimuli, including the superior parietal lobule, postcentral and superior frontal gyri. Path analysis showed that the two sets of right insular connectivity exhibited opposing associations with AE and that their net strength (i.e., "control minus motivation") was negatively correlated with AE and drinking severity. Analyses of the left insula seed, in contrast, did not yield regional connectivity in significant correlation with AE. These findings highlight the roles of right insula connectivity in motivational and regulatory processes that may differentially modulate drinking behavior. Recruitment of the motivational circuit and/or disengagement of the affective control circuit would be associated with heightened AE and heavier alcohol consumption.
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Affiliation(s)
- Thang M. Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA,Correspondence: Thang M. Le, Ph.D., Connecticut Mental Health Center, S105, 34 Park Street, New Haven, CT 06519-1109, USA, , Phone: 203-974-7360
| | - Tessa Malone
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, USA,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06520, USA,Wu Tsai Institute, Yale University, New Haven, CT, USA
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12
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McKenna BS, Anthenelli RM, Smith TL, Schuckit MA. Low versus high level of response to alcohol affects amygdala functional connectivity during processing of emotional stimuli. Alcohol Clin Exp Res 2022; 46:66-76. [PMID: 35064942 PMCID: PMC8820383 DOI: 10.1111/acer.14744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Low levels of response (low LR) to alcohol predict heavy drinking and alcohol problems. Functional magnetic resonance imaging (fMRI) studies of emotion processing have shown that low LR individuals exhibit lower activation in task-related brain regions following both placebo and alcohol administration, but these studies did not examine functional brain networks that might contribute to the phenomena. The current study expands upon the earlier results by evaluating whether functional connectivity differences between the amygdala and other brain regions modulated by emotional face processing are associated with LR. Based on prior findings, we hypothesized that low LR is related to lower functional connectivity in fronto-amygdalar functional circuits, which underlie the processing of emotional stimuli. METHODS Secondary analyses were conducted on data from a double-blind, placebo-controlled, within-subjects, cross-over study in 108 18-to-25-year-old low and high LR sex-matched pairs without alcohol use disorder at baseline. Participants performed modified emotional faces processing tasks after receiving placebo or approximately 0.7 ml/kg of ethanol. Psychophysiological interaction analyses examined functional connectivity between left and right amygdalae and related brain circuits using LR-by-alcohol general linear models. The data included 54 sex-matched pairs with 216 fMRI scans comprising alcohol and placebo conditions. RESULTS Compared with individuals with high LR, low LR subjects demonstrated lower functional connectivity between the amygdala and the frontal lobes, insula, and parietal regions, while processing angry and happy faces. Interactions showed lower connectivity following alcohol in low LR and higher connectivity in high LR groups. CONCLUSIONS Low LR individuals demonstrated lower functional connectivity in response both to placebo and a modest dose of ethanol. Attenuated connectivity among low LR individuals when processing emotional faces may contribute to an impaired ability to recognize alcohol intoxication in social situations and to appraise angry and happy emotions irrespective of whether alcohol is consumed.
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Affiliation(s)
- Benjamin S McKenna
- Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Robert M Anthenelli
- Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California, USA
| | - Tom L Smith
- Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California, USA
| | - Marc A Schuckit
- Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California, USA
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13
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Avegno EM, Gilpin NW. Reciprocal midbrain-extended amygdala circuit activity in preclinical models of alcohol use and misuse. Neuropharmacology 2022; 202:108856. [PMID: 34710467 PMCID: PMC8627447 DOI: 10.1016/j.neuropharm.2021.108856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/03/2023]
Abstract
Alcohol dependence is characterized by a shift in motivation to consume alcohol from positive reinforcement (i.e., increased likelihood of future alcohol drinking based on its rewarding effects) to negative reinforcement (i.e., increased likelihood of future alcohol drinking based on alcohol-induced reductions in negative affective symptoms, including but not limited to those experienced during alcohol withdrawal). The neural adaptations that occur during this transition are not entirely understood. Mesolimbic reinforcement circuitry (i.e., ventral tegmental area [VTA] neurons) is activated during early stages of alcohol use, and may be involved in the recruitment of brain stress circuitry (i.e., extended amygdala) during the transition to alcohol dependence, after chronic periods of high-dose alcohol exposure. Here, we review the literature regarding the role of canonical brain reinforcement (VTA) and brain stress (extended amygdala) systems, and the connections between them, in acute, sub-chronic, and chronic alcohol response. Particular emphasis is placed on preclinical models of alcohol use.
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Affiliation(s)
- Elizabeth M Avegno
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA,Department of Alcohol & Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA,Corresponding author: Correspondence should be addressed to Elizabeth Avegno, 1901 Perdido St, Room 7205, New Orleans, LA 70112,
| | - Nicholas W Gilpin
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA,Department of Alcohol & Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA,Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA,Southeast Louisiana VA Healthcare System (SLVHCS), New Orleans, LA
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14
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Wiśniewski P, Maurage P, Jakubczyk A, Trucco EM, Suszek H, Kopera M. Alcohol use and interoception - A narrative review. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110397. [PMID: 34224795 PMCID: PMC8380667 DOI: 10.1016/j.pnpbp.2021.110397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/31/2021] [Accepted: 06/29/2021] [Indexed: 01/29/2023]
Abstract
Interoception, defined as the ability to perceive and interpret body signals, may play an important role in alcohol use disorder (AUD). Earlier studies suggested an association between interoception impairment and known risk factors for AUD (e.g., alexithymia, emotion dysregulation, impulsivity, pain). Neurobiological studies show that the neurotoxicity of alcohol affects various elements of the interoceptive system (especially the insula) at structural and functional levels, with differential short/long term impacts. Conversely, primary interoceptive impairments may promote alcohol consumption and foster the evolution towards addiction. Despite convincing evidence demonstrating that interoception impairment may be an important contributor to the development and course of AUD, only a few studies directly evaluated interoceptive abilities in AUD. The research shows that interoceptive accuracy, the objective component of interoception, is lower in AUD individuals, and is correlated with craving and emotion dysregulation. Interoceptive sensibility is in turn higher in AUD individuals compared to healthy controls. Moreover, there is evidence that therapy focused on improving the ability to sense signals from the body in addiction treatment is effective. However, important methodological limitations in interoceptive measures persist, and it is therefore necessary to further investigate the associations between interoception and AUD.
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Affiliation(s)
- Paweł Wiśniewski
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
| | - Pierre Maurage
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Elisa M Trucco
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA; Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - Hubert Suszek
- Department of Psychology, University of Warsaw, Warsaw, Poland
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
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15
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Blair RJR, Bashford-Largo J, Zhang R, Mathur A, Schwartz A, Elowsky J, Tyler P, Hammond CJ, Filbey FM, Dobbertin M, Bajaj S, Blair KS. Alcohol and Cannabis Use Disorder Symptom Severity, Conduct Disorder, and Callous-Unemotional Traits and Impairment in Expression Recognition. Front Psychiatry 2021; 12:714189. [PMID: 34616316 PMCID: PMC8488132 DOI: 10.3389/fpsyt.2021.714189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with reduced emotion expression recognition ability. However, this work has primarily occurred in adults and has not considered neuro-cognitive risk factors associated with conduct problems that commonly co-occur with, and precede, substance use. Yet, conduct problems are also associated with reduced emotion expression recognition ability. The current study investigated the extent of negative association between AUD and CUD symptom severity and expression recognition ability over and above any association of expression recognition ability with conduct problems [conduct disorder (CD) diagnostic status]. Methods: In this study, 152 youths aged 12.5-18 years (56 female; 60 diagnosed with CD) completed a rapid presentation morphed intensity facial expression task to investigate the association between relative severity of AUD/CUD and expression recognition ability. Results: Cannabis use disorder identification test (CUDIT) scores were negatively associated with recognition accuracy for higher intensity (particularly sad and fearful) expressions while CD diagnostic status was independently negatively associated with recognition of sad expressions. Alcohol use disorder identification test (AUDIT) scores were not significantly associated with expression recognition ability. Conclusions: These data indicate that relative severity of CUD and CD diagnostic status are statistically independently associated with reduced expression recognition ability. On the basis of these data, we speculate that increased cannabis use during adolescence may exacerbate a neuro-cognitive risk factor for the emergence of aggression and antisocial behavior.
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Affiliation(s)
- Robert James R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Avantika Mathur
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Patrick Tyler
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, NE, United States
| | | | - Francesca M. Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
| | - Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, United States
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16
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Ooms M, Roozen HG, Willering JH, Zijlstra WP, de Waart R, Goudriaan AE. Effects of Multiple Detoxifications on Withdrawal Symptoms, Psychiatric Distress and Alcohol-Craving in Patients with an Alcohol Use Disorder. Behav Med 2021; 47:296-310. [PMID: 32396039 DOI: 10.1080/08964289.2020.1760777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous studies have shown an association between the number of withdrawal attempts and increased severity of withdrawal symptoms in patients with an alcohol use disorder (AUD). An underlying allostatic neuroadaptive response may negatively affect the withdrawal pathology after alcohol discontinuation. The objective of the present research is to examine the intensification of psychiatric distress, craving, and post-detoxification drinking outcomes, which may result from these neurobehavioral alternations. Fifty-two AUD inpatients were divided into two groups: <2 previous detoxifications and ≥2 previous detoxifications. Patients completed the Dutch version of the Severity of Withdrawal Scale (SWS), Depression Anxiety Stress Scales (DASS-21), VAS Craving, and Desires for Alcohol Questionnaire (DAQ). Linear mixed effects models were applied, controlling for the number of drinks consumed in the past 30 days and alcohol drinking history (years). Patients who had undergone ≥2 detoxifications reported statistically significantly higher scores on SWS withdrawal and DASS psychiatric symptoms. Also, craving patterns were different between groups, as shown by a statistically significant interaction effect for VAS craving for the time of day factor (morning vs. evening). No statistically significant group differences were found for DAQ scores and post-detoxification drinking outcomes. Due to relatively low 1-month follow-up rates our power was limited to detect such a difference. The present study contributes to the existing body of evidence that multiple detoxifications are associated with aggravated withdrawal/psychiatric pathology, and distinct diurnal patterns of VAS craving. Several clinical implications are discussed and alternative strategies are provided to manage repeated cycles of detoxifications.
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Affiliation(s)
- Martha Ooms
- Centrum voor Transculturele Psychiatrie (CTP) Veldzicht, Balkbrug, ZG, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, The University of New Mexico (UNM), Albuquerque, NM, USA
| | - Juul H Willering
- Altrecht Centrum Psychodiagnostiek, Centrum Psychodiagnostiek, Zeist, WB, The Netherlands
| | - Wobbe P Zijlstra
- CITO, Department of Psychometrics and Research, Arnhem, CM, The Netherlands
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17
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Morley KC, Logge WB, Fraser I, Morris RW, Baillie AJ, Haber PS. High-dose baclofen attenuates insula activation during anticipatory anxiety in treatment-seeking alcohol dependant individuals: Preliminary findings from a pharmaco-fMRI study. Eur Neuropsychopharmacol 2021; 46:28-36. [PMID: 33735709 DOI: 10.1016/j.euroneuro.2021.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/28/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
The GABA B agonist, baclofen, has been shown to reduce alcohol consumption in patients with alcohol use disorder and also those with comorbid anxiety. This study aimed to evaluate the effect of baclofen versus placebo on the BOLD response during an anticipatory anxiety fMRI task in treatment seeking alcohol patients. Participants included 28 alcohol dependant individuals who had received daily baclofen 30 mg (n = 10), 75 mg (n = 8) or placebo (n = 10) for at least 2 week on a randomized controlled trial (Morley, Leung et al. 2013, Morley, Baillie et al. 2018). Using functional magnetic resonance imaging (fMRI), we examined threat cue-elicited neural activation during a threat reactivity task 120 min following administration of BAC (30 mg or 75 mg) or placebo. Whole-brain analyses revealed no significant differences between the combined BAC doses versus PL. However, there were significant decreases in anticipatory threat cue-elicited activation observed in BAC 75 mg/day compared to PL participants in the insula. In response to threat cues, high dose (75 mg/day) baclofen administration attenuates activation in the insula and inferior frontal gyrus, relative to placebo. These preliminary findings suggests that modulating emotional regulation and attentional allocation during high threat stimuli may be mediated by GABA B receptors and may be a potential mechanism of action for baclofen's beneficial treatment effects for alcohol use disorder.
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Affiliation(s)
- Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
| | - Warren B Logge
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Isabel Fraser
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Richard W Morris
- Psychological Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Andrew J Baillie
- Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Paul S Haber
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
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18
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Pang M, Zhong Y, Hao Z, Xu H, Wu Y, Teng C, Li J, Xiao C, Fox PT, Zhang N, Wang C. Resting-state causal connectivity of the bed nucleus of the stria terminalis in panic disorder. Brain Imaging Behav 2021; 15:25-35. [PMID: 31833015 DOI: 10.1007/s11682-019-00229-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Panic disorder (PD) is associated with anticipatory anxiety, a sustained threat response that appears to be related to the bed nucleus of the stria terminalis (BNST). Individuals with panic disorder may demonstrate significant differences in causal connectivity of the BNST in comparison to healthy controls. To test this hypothesis, resting-state functional magnetic resonance imaging (fMRI) was used to identify aberrant causal connectivity of the BNST in PD patients. 19 PD patients and 18 healthy controls (HC) matched for gender, age and education were included. Granger causality analysis (GCA) utilizing the BNST as a seed region was used to investigate changes in directional connectivity. Relative to healthy controls, PD patients displayed abnormal directional connectivity of the BNST including enhanced causal connectivity between the left parahippocampal gyrus and left BNST, the right insula and the right BNST, the left BNST and the right dorsolateral prefrontal cortex (dlPFC) and right BNST to the left and right dlPFC. Furthermore, PD patients displayed weakened causal connectivity between the right dlPFC and the left BNST, the left dlPFC and the right BNST, the left BNST and the left dorsomedial prefrontal cortex (dmPFC), right insula, right fusiform, and right BNST to the right insula. The results suggest that PD strongly correlates with increased causal connectivity between emotional processing regions and the BNST and enhanced causal connectivity between the BNST and cognitive control regions.
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Affiliation(s)
- Manlong Pang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Ziyu Hao
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Huazhen Xu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Wu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changjun Teng
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Li
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Chaoyong Xiao
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peter T Fox
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China. .,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China. .,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China.
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19
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A biological framework for emotional dysregulation in alcohol misuse: from gut to brain. Mol Psychiatry 2021; 26:1098-1118. [PMID: 33288871 DOI: 10.1038/s41380-020-00970-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 02/08/2023]
Abstract
Alcohol use disorder (AUD) has been associated with impairments in social and emotional cognition that play a crucial role in the development and maintenance of addiction. Repeated alcohol intoxications trigger inflammatory processes and sensitise the immune system. In addition, emerging data point to perturbations in the gut microbiome as a key regulator of the inflammatory cascade in AUD. Inflammation and social cognition are potent modulators of one another. At the same time, accumulating evidence implicates the gut microbiome in shaping emotional and social cognition, suggesting the possibility of a common underlying loop of crucial importance for addiction. Here we propose an integrative microbiome neuro-immuno-affective framework of how emotional dysregulation and alcohol-related microbiome dysbiosis could accelerate the cycle of addiction. We outline the overlapping effects of chronic alcohol use, inflammation and microbiome alterations on the fronto-limbic circuitry as a convergence hub for emotional dysregulation. We discuss the interdependent relationship of social cognition, immunity and the microbiome in relation to alcohol misuse- from binge drinking to addiction. In addition, we emphasise adolescence as a sensitive period for the confluence of alcohol harmful effects and emotional dysregulation in the developing gut-brain axis.
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20
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Flook EA, Luchsinger JR, Silveri MM, Winder DG, Benningfield MM, Blackford JU. Anxiety during abstinence from alcohol: A systematic review of rodent and human evidence for the anterior insula's role in the abstinence network. Addict Biol 2021; 26:e12861. [PMID: 31991531 DOI: 10.1111/adb.12861] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 12/30/2022]
Abstract
Alcohol Use Disorder (AUD) is a chronic, relapsing disease that impacts almost a third of Americans. Despite effective treatments for attaining sobriety, the majority of patients relapse within a year, making relapse a substantial barrier to long-term treatment success. A major factor contributing to relapse is heightened negative affect that results from the combination of abstinence-related increases in stress-reactivity and decreases in reward sensitivity. Substantial research has contributed to the understanding of reward-related changes in AUD. However, less is known about anxiety during abstinence, a critical component of understanding addiction as anxiety during abstinence can trigger relapse. Most of what we know about abstinence-related negative affect comes from rodent studies which have identified key brain regions responsible for abstinence-related behaviors. This abstinence network is composed of brain regions that make up the extended amygdala: the nucleus accumbens (NAcc), the central nucleus of the amygdala (CeA), and the bed nucleus of the stria terminalis (BNST). More recently, emerging evidence from rodent and human studies suggests a fourth brain region, the anterior insula, might be part of the abstinence network. Here, we review current rodent and human literature on the extended amygdala's role in alcohol abstinence and anxiety, present evidence for the anterior insula's role in the abstinence network, and provide future directions for research to further elucidate the neural underpinnings of abstinence in humans. A better understanding of the abstinence network is critical toward understanding and possibly preventing relapse in AUD.
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Affiliation(s)
- Elizabeth A. Flook
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
| | - Joseph R. Luchsinger
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
| | - Marisa M. Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, Brain Imaging Center, McLean Hospital Belmont MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Danny G. Winder
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
- Department of Molecular Physiology and Biophysics Vanderbilt University School of Medicine Nashville TN USA
| | - Margaret M. Benningfield
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
| | - Jennifer Urbano Blackford
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
- Research Health Scientist, Research and Development, Department of Veterans Affairs Medical Center Nashville TN USA
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21
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Walker LC. A balancing act: the role of pro- and anti-stress peptides within the central amygdala in anxiety and alcohol use disorders. J Neurochem 2021; 157:1615-1643. [PMID: 33450069 DOI: 10.1111/jnc.15301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
The central nucleus of the amygdala (CeA) is widely implicated as a structure that integrates both appetitive and aversive stimuli. While intrinsic CeA microcircuits primarily consist of GABAergic neurons that regulate amygdala output, a notable feature of the CeA is the heterogeneity of neuropeptides and neuropeptide/neuromodulator receptors that it expresses. There is growing interest in the role of the CeA in mediating psychopathologies, including stress and anxiety states and their interactions with alcohol use disorders. Within the CeA, neuropeptides and neuromodulators often exert pro- or anti- stress actions, which can influence anxiety and alcohol associated behaviours. In turn, alcohol use can cause adaptions within the CeA, which may render an individual more vulnerable to stress which is a major trigger of relapse to alcohol seeking. This review examines the neurocircuitry, neurochemical phenotypes and how pro- and anti-stress peptide systems act within the CeA to regulate anxiety and alcohol seeking, focusing on preclinical observations from animal models. Furthermore, literature exploring the targeting of genetically defined populations or neuronal ensembles and the role of the CeA in mediating sex differences in stress x alcohol interactions are explored.
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Affiliation(s)
- Leigh C Walker
- Florey Institute of Neuroscience and Mental Health, Parkville, Vic, Australia.,Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Vic, Australia
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22
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Maurage P, Pabst A, Lannoy S, D'Hondt F, de Timary P, Gaudelus B, Peyroux E. Tackling heterogeneity: Individual variability of emotion decoding deficits in severe alcohol use disorder. J Affect Disord 2021; 279:299-307. [PMID: 33096328 PMCID: PMC7738413 DOI: 10.1016/j.jad.2020.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/02/2020] [Accepted: 10/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Severe alcohol use disorder (SAUD) is associated with social cognition deficits. Patients with SAUD are impaired for the recognition of emotional facial expressions, particularly at early stages of abstinence. These deficits damage interpersonal relations and increase relapse risk. However, uncertainties still abound on their variation across emotions and on the heterogeneity of emotional impairments across patients. We addressed these questions by exploring how the deficit varies according to emotions' type/intensity and patients' heterogeneity. METHODS Sixty-five recently detoxified patients with SAUD and 65 matched healthy controls performed the Facial Emotion Recognition Test, assessing the ability to identify six emotions (anger, contempt, disgust, fear, happiness, sadness) displayed by morphed faces with various intensities. Accuracy scores and detection thresholds were collected for each emotion. Beyond group comparisons, multiple single-case analyses determined the percentage of patients presenting decoding deficits for each emotion. RESULTS When current depression and anxiety symptoms were controlled for, patients did not present a general emotion decoding deficit, but were rather characterized by specific deficits for disgust/contempt in accuracy, and for disgust in detection threshold scores. Single-case analyses showed that only a third of patients presented a clinically significant emotional deficit. CONCLUSIONS Patients with SAUD only present emotional decoding deficits for specific interpersonal emotions (disgust/contempt) when subclinical psychopathological states are controlled for, and show no general emotional impairment. This goes against the proposal of a generalized social cognition deficit in this population. This group effect moreover masks a massive heterogeneity across patients, which has implications at experimental and clinical levels.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium.
| | - Arthur Pabst
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Séverine Lannoy
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France; CHU Lille, Clinique de Psychiatrie, CURE, Lille, France; Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
| | - Philippe de Timary
- Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium; Department of Adult Psychiatry, Saint-Luc Academic Hospital & Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Baptiste Gaudelus
- Centre de Neurosciences Cognitives, UMR 5229, CNRS, Bron, France; Service Universitaire de Réhabilitation, SUR-CL3R, Centre Hospitalier Le Vinatier, Lyon, France
| | - Elodie Peyroux
- Centre de Neurosciences Cognitives, UMR 5229, CNRS, Bron, France; Service Universitaire de Réhabilitation, SUR-CL3R, Centre Hospitalier Le Vinatier, Lyon, France
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23
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Alcohol. Alcohol 2021. [DOI: 10.1016/b978-0-12-816793-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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24
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Blair RJR, Bajaj S, Sherer N, Bashford-Largo J, Zhang R, Aloi J, Hammond C, Lukoff J, Schwartz A, Elowsky J, Tyler P, Filbey FM, Dobbertin M, Blair KS. Alcohol Use Disorder and Cannabis Use Disorder Symptomatology in Adolescents and Aggression: Associations With Recruitment of Neural Regions Implicated in Retaliation. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:536-544. [PMID: 33712378 DOI: 10.1016/j.bpsc.2020.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alcohol and cannabis are commonly used by adolescents in the United States. Both alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with an increased risk of aggression. One form of aggression seen during retaliation is reactive aggression to social provocation. This study investigated the association between AUD and CUD symptom severity and recruitment of neural regions implicated in retaliation. METHODS In this study, 102 youths aged 13-18 years (67 male; 84 in residential care) completed self-report measures of aggression-related constructs and participated in a retaliation task during functional magnetic resonance imaging to investigate the association between relative severity of AUD/CUD and atypical recruitment of regions implicated in retaliation. RESULTS AUD Identification Test scores were positively associated with irritability and reactive aggression scores. CUD Identification Test scores were positively associated with callous-unemotional traits and both proactive and reactive aggression scores. In functional magnetic resonance imaging analyses, only AUD Identification Test (not CUD Identification Test) scores were associated with an exaggerated recruitment of regions implicated in retaliation (dorsomedial frontal, anterior insula cortices, caudate, and, to a lesser extent, periaqueductal gray). CONCLUSIONS These data suggest that relative severity of AUD is associated with a disinhibited, exaggerated retaliation response that relates to an increased risk for reactive aggression. Similar findings were not related to severity of CUD.
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Affiliation(s)
- R James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska.
| | - Sahil Bajaj
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Noah Sherer
- Department of Biological Sciences, Fordham University, New York City, New York
| | - Johannah Bashford-Largo
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Ru Zhang
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Joseph Aloi
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chris Hammond
- Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Amanda Schwartz
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Jaimie Elowsky
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Patrick Tyler
- Child and Family Translational Research Center, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
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25
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Carlson HN, Weiner JL. The neural, behavioral, and epidemiological underpinnings of comorbid alcohol use disorder and post-traumatic stress disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 157:69-142. [PMID: 33648676 DOI: 10.1016/bs.irn.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alcohol use disorder (AUD) and (PTSD) frequently co-occur and individuals suffering from this dual diagnosis often exhibit increased symptom severity and poorer treatment outcomes than those with only one of these diseases. Although there have been significant advances in our understanding of the neurobiological mechanisms underlying each of these disorders, the neural underpinnings of the comorbid condition remain poorly understood. This chapter summarizes recent epidemiological findings on comorbid AUD and PTSD, with a focus on vulnerable populations, the temporal relationship between these disorders, and the clinical consequences associated with the dual diagnosis. We then review animal models of the comorbid condition and emerging human and non-human animal research that is beginning to identify maladaptive neural changes common to both disorders, primarily involving functional changes in brain reward and stress networks. We end by proposing a neural framework, based on the emerging field of affective valence encoding, that may better explain the epidemiological and neural findings on AUD and PTSD.
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Affiliation(s)
- Hannah N Carlson
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jeff L Weiner
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
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26
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Blaine SK, Wemm S, Fogelman N, Lacadie C, Seo D, Scheinost D, Sinha R. Association of Prefrontal-Striatal Functional Pathology With Alcohol Abstinence Days at Treatment Initiation and Heavy Drinking After Treatment Initiation. Am J Psychiatry 2020; 177:1048-1059. [PMID: 32854534 PMCID: PMC7606814 DOI: 10.1176/appi.ajp.2020.19070703] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Alcohol use disorder (AUD) is associated with neuroadaptations in brain stress and reward circuits. It is not known whether such neuroadaptations are affected by number of days of alcohol abstinence and whether they influence heavy drinking during the early treatment phase. The authors used a novel functional MRI (fMRI) approach to assess brain responses during sustained exposure to standardized visual stimuli of stressful, alcohol cue, and neutral control images combined with prospective assessment of drinking outcomes during early outpatient treatment, in two related studies. METHODS In study 1, 44 treatment-entering patients with AUD and 43 demographically matched healthy control subjects participated in the fMRI experiment to identify dysfunctional responses associated with chronic alcohol abuse. In study 2, 69 treatment-entering patients with AUD were assessed for whether fMRI responses at treatment initiation were influenced by alcohol abstinence and were prospectively predictive of early heavy drinking outcomes. RESULTS Relative to control subjects, patients with AUD showed significant hyperreactivity in the ventromedial prefrontal cortex (vmPFC) in response to neutral images, but significant hypoactivation in the vmPFC and ventral striatum in response to stress images and to alcohol cues relative to response to neutral images. In study 2, this specific prefrontal-ventral striatal dysfunction was associated with fewer days of alcohol abstinence and also predicted greater number heavy drinking days during the subsequent 2 weeks of treatment engagement. CONCLUSIONS Number of days of alcohol abstinence at treatment initiation significantly affected functional disruption of the prefrontal-striatal responses to stress images and to alcohol cues in patients with AUD, and the severity of this disruption in turn predicted greater heavy drinking during early treatment. Treatments that target this functional prefrontal-striatal pathology could improve early treatment outcomes in AUD.
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Affiliation(s)
- Sara K Blaine
- Auburn University, Department of Psychology, Auburn, AL
| | - Stephanie Wemm
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT
| | - Nia Fogelman
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT
| | - Cheryl Lacadie
- Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT
| | - Dongju Seo
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT
| | - Dustin Scheinost
- Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT
| | - Rajita Sinha
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT,Address correspondence to: Rajita Sinha, Ph.D., Yale University School of Medicine, Department of Psychiatry, Yale Stress Center, 2 Church Street South, Suite 209, New Haven, CT 06519.
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27
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Ghetti C, Chen XJ, Brenner AK, Hakvoort LG, Lien L, Fachner J, Gold C. Music therapy for people with substance use disorders. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd012576.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Claire Ghetti
- GAMUT - The Grieg Academy Music Therapy Research Centre, Grieg Academy; University of Bergen; Bergen Norway
| | - Xi-Jing Chen
- CAS Key Laboratory of Mental Health; Institute of Psychology, Chinese Academy of Science; Beijing China
| | - Annette K Brenner
- GAMUT - The Grieg Academy Music Therapy Research Centre; NORCE Norwegian Research Centre AS; Bergen Norway
| | | | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders; Hospital Innlandet Trust; Brumunddal Norway
| | - Jorg Fachner
- Music and Perfoming Arts; Anglia Ruskin University; Cambridge UK
| | - Christian Gold
- GAMUT - The Grieg Academy Music Therapy Research Centre; NORCE Norwegian Research Centre AS; Bergen Norway
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28
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Laniepce A, Cabé N, André C, Bertran F, Boudehent C, Lahbairi N, Maillard A, Mary A, Segobin S, Vabret F, Rauchs G, Pitel AL. The effect of alcohol withdrawal syndrome severity on sleep, brain and cognition. Brain Commun 2020; 2:fcaa123. [PMID: 33543128 PMCID: PMC7846181 DOI: 10.1093/braincomms/fcaa123] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
In alcohol use disorder, drinking cessation is frequently associated with an alcohol withdrawal syndrome. Early in abstinence (within the first 2 months after drinking cessation), when patients do not exhibit physical signs of alcohol withdrawal syndrome anymore (such as nausea, tremor or anxiety), studies report various brain, sleep and cognitive alterations, highly heterogeneous from one patient to another. While the acute neurotoxicity of alcohol withdrawal syndrome is well-known, its contribution to structural brain alterations, sleep disturbances and neuropsychological deficits observed early in abstinence has never been investigated and is addressed in this study. We included 54 alcohol use disorder patients early in abstinence (from 4 to 21 days of sobriety) and 50 healthy controls. When acute physical signs of alcohol withdrawal syndrome were no longer present, patients performed a detailed neuropsychological assessment, a T1-weighted MRI and a polysomnography for a subgroup of patients. According to the severity of the clinical symptoms collected during the acute withdrawal period, patients were subsequently classified as mild alcohol withdrawal syndrome (mild-AWS) patients (Cushman score ≤ 4, no benzodiazepine prescription, N = 17) or moderate alcohol withdrawal syndrome (moderate-AWS) patients (Cushman score > 4, benzodiazepine prescription, N = 37). Patients with severe withdrawal complications (delirium tremens or seizures) were not included. Mild-AWS patients presented similar grey matter volume and sleep quality as healthy controls, but lower processing speed and episodic memory performance. Compared to healthy controls, moderate-AWS patients presented non-rapid eye movement sleep alterations, widespread grey matter shrinkage and lower performance for all the cognitive domains assessed (processing speed, short-term memory, executive functions and episodic memory). Moderate-AWS patients presented a lower percentage of slow-wave sleep, grey matter atrophy in fronto-insular and thalamus/hypothalamus regions, and lower short-term memory and executive performance than mild-AWS patients. Mediation analyses revealed both direct and indirect (via fronto-insular and thalamus/hypothalamus atrophy) relationships between poor sleep quality and cognitive performance. Alcohol withdrawal syndrome severity, which reflects neurotoxic hyperglutamatergic activity, should be considered as a critical factor for the development of non-rapid eye movement sleep alterations, fronto-insular atrophy and executive impairments in recently detoxified alcohol use disorder patients. The glutamatergic activity is involved in sleep-wake circuits and may thus contribute to molecular mechanisms underlying alcohol-related brain damage, resulting in cognitive deficits. Alcohol withdrawal syndrome severity and sleep quality deserve special attention for a better understanding and treatment of brain and cognitive alterations observed early in abstinence, and ultimately for more efficient relapse prevention strategies.
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Affiliation(s)
- Alice Laniepce
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Nicolas Cabé
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Claire André
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Françoise Bertran
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Céline Boudehent
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Najlaa Lahbairi
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Angéline Maillard
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Alison Mary
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - François Vabret
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Géraldine Rauchs
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
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29
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Distress tolerance in methamphetamine and opium abusers with non-drug abuser (A comparative analysis). CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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30
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Huang L, Peng Z, Lu C, Chen Y, Lv JW, Qin M, Liao DF, Liu XM, Shi Z. Ginsenoside Rg1 alleviates repeated alcohol exposure-induced psychomotor and cognitive deficits. Chin Med 2020; 15:44. [PMID: 32411290 PMCID: PMC7206760 DOI: 10.1186/s13020-020-00325-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background Chronic alcohol consumption disrupts psychomotor and cognitive functions, most of which are subserved by the dysfunction of hippocampus. Dysregulated excitatory glutamatergic transmission is implicated in repeated alcohol induced psychomotor and cognitive impairment. Ginsenoside Rg1, one of the main active ingredient of the traditional tonic medicine Panax ginseng C.A. Meyer (Araliaceae), has been used to treat cognitive deficits. Particularly, Rg1 has been demonstrated to improve hippocampus-dependent learning in mice and attenuate glutamate-induced excitotoxicity in vitro. Thus, in the present research, we sought to investigate the therapeutic effects of Ginsenoside Rg1 on repeated alcohol induced psychomotor and cognitive deficits in hippocampal-dependent behavioral tasks and unravel the underpinnings of its neuroprotection. Methods Male ICR (CD-1) mice were consecutively intragastrically treated with 20% (w/v) alcohol for 21 days. Then, behavior tests were conducted to evaluate repeated alcohol induced psychomotor and cognitive deficits. Histopathological changes, and biochemical and molecular alterations were assessed to determine the potential neuroprotective mechanism of Rg1. Results The results suggested that Rg1, at the optimal dose of 6 mg/kg, has the potential to ameliorate repeated alcohol induced cognitive deficits by regulating activities of NR2B containing NMDARs and excitotoxic signaling. Conclusion Our findings further provided a new strategy to treat chronic alcohol exposure induced adverse consequences.
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Affiliation(s)
- Lu Huang
- 1Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha, 410208 Hunan China.,2Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, 510632 China
| | - Zhuang Peng
- 1Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha, 410208 Hunan China.,5College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, 100029 China
| | - Cong Lu
- 3Research Center for Pharmacology and Toxicology, Institute of Medicinal Plant Development (IMPLAD), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100193 China
| | - Ying Chen
- 4Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700 China
| | - Jing-Wei Lv
- 3Research Center for Pharmacology and Toxicology, Institute of Medicinal Plant Development (IMPLAD), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100193 China
| | - Meng Qin
- 5College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, 100029 China
| | - Duan-Fang Liao
- 1Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha, 410208 Hunan China
| | - Xin-Min Liu
- 1Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha, 410208 Hunan China.,3Research Center for Pharmacology and Toxicology, Institute of Medicinal Plant Development (IMPLAD), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100193 China
| | - Zhe Shi
- 1Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha, 410208 Hunan China
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Voon V, Grodin E, Mandali A, Morris L, Doñamayor N, Weidacker K, Kwako L, Goldman D, Koob GF, Momenan R. Addictions NeuroImaging Assessment (ANIA): Towards an integrative framework for alcohol use disorder. Neurosci Biobehav Rev 2020; 113:492-506. [PMID: 32298710 DOI: 10.1016/j.neubiorev.2020.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/30/2020] [Accepted: 04/05/2020] [Indexed: 02/08/2023]
Abstract
Alcohol misuse and addiction are major international public health issues. Addiction can be characterized as a disorder of aberrant neurocircuitry interacting with environmental, genetic and social factors. Neuroimaging in alcohol misuse can thus provide a critical window into underlying neural mechanisms, highlighting possible treatment targets and acting as clinical biomarkers for predicting risk and treatment outcomes. This neuroimaging review on alcohol misuse in humans follows the Addictions Neuroclinical Assessment (ANA) that proposes incorporating three functional neuroscience domains integral to the neurocircuitry of addiction: incentive salience and habits, negative emotional states, and executive function within the context of the addiction cycle. Here we review and integrate multiple imaging modalities focusing on underlying cognitive processes such as reward anticipation, negative emotionality, cue reactivity, impulsivity, compulsivity and executive function. We highlight limitations in the literature and propose a model forward in the use of neuroimaging as a tool to understanding underlying mechanisms and potential clinical applicability for phenotyping of heterogeneity and predicting risk and treatment outcomes.
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Affiliation(s)
- Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Behavioural and Clinical Neurosciences Institute, Cambridge, UK; Cambridgeshire and Peterborough NHS Trust, Cambridge, UK.
| | - Erica Grodin
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, UK
| | - Alekhya Mandali
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Laurel Morris
- Behavioural and Clinical Neurosciences Institute, Cambridge, UK; Department of Psychology, University of Cambridge, Cambridge, UK
| | - Nuria Doñamayor
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Laura Kwako
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, UK
| | - David Goldman
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, UK
| | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, UK
| | - Reza Momenan
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, UK
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Wilcox CE, Adinoff B, Clifford J, Ling J, Witkiewitz K, Mayer AR, Boggs KM, Eck M, Bogenschutz M. Brain activation and subjective anxiety during an anticipatory anxiety task is related to clinical outcome during prazosin treatment for alcohol use disorder. NEUROIMAGE-CLINICAL 2020; 26:102162. [PMID: 32037283 PMCID: PMC7229347 DOI: 10.1016/j.nicl.2020.102162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/15/2019] [Accepted: 01/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Higher levels of anxiety, negative affect, and impaired emotion regulation are associated with alcohol use disorder (AUD) and contribute to relapse and worse treatment outcomes. Prazosin, while typically used to treat post-traumatic stress disorder (PTSD) and other anxiety disorders, has shown promise for treating AUD. In order to better understand these underlying neural processes in individuals with AUD, our aims in this study were to measure brain activation during an anticipatory anxiety task before treatment to determine whether observed patterns supported previous work. We then aimed to measure the effects of prazosin on patients with AUD and explore whether greater baseline anticipatory anxiety (as measured by subjective and neural measures) predicts better treatment outcomes. METHODS Thirty-four individuals seeking treatment for AUD participated in a six-week placebo-controlled study of prazosin and underwent an anticipatory anxiety task during fMRI scans at baseline and three weeks. Alcohol use over six weeks was measured. RESULTS Greater levels of subjective anxiety and deactivation in posterior cingulate cortex (PCC) and ventromedial prefrontal cortex (vmPFC) were observed during high-threat stimuli compared to low-threat stimuli. Compared to placebo, prazosin reduced subjective anxiety to high-threat stimuli but there were no observed significant effects of prazosin on brain activation during the task. However, AUD patients with greater vmPFC deactivation during high threat relative to low threat and patients with low baseline anticipatory anxiety during the task had worse clinical outcomes on prazosin. CONCLUSIONS Deactivation in PCC and vmPFC to high-threat stimuli replicated previous work and shows promise for further study as a marker for AUD. Although prazosin did not affect brain activation in the regions of interest during the anticipatory anxiety task, subjective levels of anxiety and brain activation in vmPFC predicted treatment outcomes in individuals with AUD undergoing treatment with prazosin, highlighting individuals more likely to benefit from prazosin than others.
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Affiliation(s)
- Claire E Wilcox
- Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA.
| | - Bryon Adinoff
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA; VA North Texas Health Care System, 4500 S Lancaster Rd, Dallas, TX 75216, USA; Department of Psychiatry, School of Medicine, University of Colorado, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Joshua Clifford
- Department of Psychiatry, University of New Mexico, 2400 Tucker NE, Albuquerque, NM 87131, USA
| | - Josef Ling
- Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse & Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, USA
| | - Andrew R Mayer
- Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA
| | - Kylar M Boggs
- Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA
| | - Matthew Eck
- Mind Research Network, 1101 Yale Blvd. NE, Albuquerque, NM 87106, USA; University of Southern California, USA
| | - Michael Bogenschutz
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA
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Blair RJ. Modeling the Comorbidity of Cannabis Abuse and Conduct Disorder/Conduct Problems from a Cognitive Neuroscience Perspective. J Dual Diagn 2020; 16:3-21. [PMID: 31608811 DOI: 10.1080/15504263.2019.1668099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: A cognitive neuroscience perspective seeks to understand behavior, in this case the comorbidity of cannabis abuse and conduct disorder/conduct problems, in terms of dysfunction in cognitive processes underpinned by neural processes. The goal of this review is to articulate a cognitive neuroscience account of this comorbidity. Methods: Literature on the following issues will be reviewed: (i) the longitudinal relationship between cannabis abuse and conduct disorder/conduct problems (CD/CP); (ii) the extent to which there are genetic and environmental (specifically maltreatment) factors that underpin this relationship; (iii) forms of neurocognitive function that are reported dysfunctional in CD/CP and also, when dysfunctional, appear to be risk factors for future cannabis abuse; and (iv) the extent to which cannabis abuse may further compromise these systems leading to increased future abuse and greater conduct problems. Results: CD/CP typically predate cannabis abuse. There appear to be shared genetic factors that contribute to the relationship between CD/CP and cannabis abuse. Moreover, trauma exposure increases risk for both cannabis abuse and CP/CD. One form of neurocognitive dysfunction, response disinhibition, that likely exacerbates the symptomatology of many individuals with CD also appears to increase the risk for cannabis abuse. The literature with respect to other forms of neurocognitive dysfunction remains inconclusive. Conclusions: Based on the literature, a causal model of the comorbidity of cannabis abuse and CD/CP is developed.
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Affiliation(s)
- R James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
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Suzuki S, Mell MM, O'Malley SS, Krystal JH, Anticevic A, Kober H. Regulation of Craving and Negative Emotion in Alcohol Use Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:239-250. [PMID: 31892465 DOI: 10.1016/j.bpsc.2019.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a chronic, relapsing condition with poor treatment outcomes. Both alcohol craving and negative affect increase alcohol drinking, and-in healthy adults-can be attenuated using cognitive strategies, which rely on the prefrontal cortex (PFC). However, AUD is associated with cognitive impairments and PFC disruptions. Thus, we tested whether individuals with AUD can successfully recruit the PFC to effectively regulate craving and negative emotions, whether neural mechanisms are shared between the two types of regulation, and whether individual differences influence regulation success. METHODS During functional magnetic resonance imaging, participants with AUD completed the regulation of craving task (n = 17) that compares a cue-induced craving condition with an instructed regulation condition. They also completed the emotion regulation task (n = 15) that compares a negative affect condition with an instructed regulation condition. Regulation strategies were drawn from cognitive behavioral therapy treatments for AUD. Self-reported craving and negative affect were collected on each trial. RESULTS Individuals with AUD effectively regulated their craving and negative affect when instructed to do so using cognitive behavioral therapy-based strategies. Regulation was associated with recruitment of both common and distinct PFC regions across tasks, as well as with reduced activity in regions associated with craving and negative affect (e.g., ventral striatum, amygdala). Effective regulation of craving was associated with negative alcohol expectancies. CONCLUSIONS Both common and distinct regulatory systems underlie regulation of craving and negative emotions in AUD, with notable individual differences. This has important implications for AUD treatment.
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Affiliation(s)
- Shosuke Suzuki
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Maggie Mae Mell
- Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
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Leiker EK, Meffert H, Thornton LC, Taylor BK, Aloi J, Abdel-Rahim H, Shah N, Tyler PM, White SF, Blair KS, Filbey F, Pope K, Dobbertin M, Blair RJR. Alcohol use disorder and cannabis use disorder symptomatology in adolescents are differentially related to dysfunction in brain regions supporting face processing. Psychiatry Res Neuroimaging 2019; 292:62-71. [PMID: 31541926 PMCID: PMC6992382 DOI: 10.1016/j.pscychresns.2019.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 01/20/2023]
Abstract
Despite extensive behavioral evidence of impairments in face processing and expression recognition in adults with alcohol or cannabis use disorders (AUD/CUD), neuroimaging findings have been inconsistent. Moreover, relatively little work has examined the relationship of AUD or CUD symptoms with face or expression processing within adolescents. Given the high prevalence of alcohol and cannabis use during adolescence, understanding how these usage behaviors interact with neural mechanisms supporting face and expression processing could have important implications for youth social and emotional functioning. In this study, adolescents (N = 104) responded to morphed fearful and happy expressions during fMRI and their level of AUD and/or CUD symptoms were related to the BOLD response data. We found that AUD and CUD symptom severity were both negatively related to responses to faces generally. However, whereas this relationship was shown for AUD within ventromedial prefrontal cortex and lingual gyrus, it was shown for CUD within rostromedial prefrontal cortex including anterior cingulate cortex. Additionally, AUD symptom levels were associated with differential responses within medial temporal pole and inferior parietal lobule as a function of expression. These results have potential implications for understanding the social and emotional functioning of adolescents with AUD and CUD symptoms.
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Affiliation(s)
- Emily K Leiker
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Harma Meffert
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Laura C Thornton
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Brittany K Taylor
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Joseph Aloi
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA; Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heba Abdel-Rahim
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Niraj Shah
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Patrick M Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Stuart F White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - Francesca Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Kayla Pope
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA; Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, USA; Department of Psychiatry, Creighton University, Omaha, NE, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA
| | - R James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, 14100 Crawford St, Boys Town, NE 68010, USA.
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Creupelandt C, D'Hondt F, Maurage P. Towards a Dynamic Exploration of Vision, Cognition and Emotion in Alcohol-Use Disorders. Curr Neuropharmacol 2019; 17:492-506. [PMID: 30152285 PMCID: PMC6712295 DOI: 10.2174/1570159x16666180828100441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/30/2018] [Accepted: 08/17/2018] [Indexed: 11/23/2022] Open
Abstract
Abstract: Visuoperceptive impairments are among the most frequently reported deficits in alcohol-use disorders, but only very few studies have investigated their origin and interactions with other categories of dysfunctions. Besides, these deficits have generally been interpreted in a linear bottom-up perspective, which appears very restrictive with respect to the new models of vision developed in healthy populations. Indeed, new theories highlight the predictive nature of the visual system and demonstrate that it interacts with higher-level cognitive functions to generate top-down predictions. These models nota-bly posit that a fast but coarse visual analysis involving magnocellular pathways helps to compute heuristic guesses regard-ing the identity and affective value of inputs, which are used to facilitate conscious visual recognition. Building on these new proposals, the present review stresses the need to reconsider visual deficits in alcohol-use disorders as they might have cru-cial significance for core features of the pathology, such as attentional bias, loss of inhibitory control and emotion decoding impairments. Centrally, we suggest that individuals with severe alcohol-use disorders could present with magnocellular dam-age and we defend a dynamic explanation of the deficits. Rather than being restricted to high-level processes, deficits could start at early visual stages and then extend and potentially intensify during following steps due to reduced cerebral connec-tivity and dysfunctional cognitive/emotional regions. A new research agenda is specifically provided to test these hypotheses.
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Affiliation(s)
- Coralie Creupelandt
- Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,SCALab-Sciences Cognitives et Sciences Affectives, CNRS, UMR 9193, Université de Lille, Lille, France
| | - Fabien D'Hondt
- SCALab-Sciences Cognitives et Sciences Affectives, CNRS, UMR 9193, Université de Lille, Lille, France.,CHU Lille, Clinique de Psychiatrie, CURE, Lille, France
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
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Abstract
OBJECTIVE To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research. METHOD First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed. RESULTS Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition). CONCLUSIONS The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Lannoy S, Benzerouk F, Maurage P, Barrière S, Billieux J, Naassila M, Kaladjian A, Gierski F. Disrupted Fear and Sadness Recognition in Binge Drinking: A Combined Group and Individual Analysis. Alcohol Clin Exp Res 2019; 43:1978-1985. [PMID: 31329296 DOI: 10.1111/acer.14151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Binge drinking is a harmful pattern of alcohol consumption, associated with cognitive and cerebral impairments. Indeed, various cognitive processes have been identified as disrupted in binge drinking, ranging from perceptive to executive functions, but emotional processes have conversely been little investigated. Particularly, it is unclear to what extent binge drinkers (BD) present difficulties to recognize and categorize the emotions expressed by other individuals. Such an exploration would, however, offer a more comprehensive view of the deficits associated with alcohol-related disorders and potentially involved in the maintenance of this harmful habit. METHODS Fifty-two BD and 42 control participants performed an emotional task assessing the ability to recognize 6 basic emotions (i.e., anger, contempt, disgust, fear, happiness, and sadness). Accuracy score and detection threshold were collected for each emotion. To explore the extent of emotion recognition difficulties, 2 analyses were conducted: (i) classical repeated measures analyses of variance, to compare groups' performance, and (ii) multiple single-case analyses (i.e., Crawford's t-tests), to determine the percentage of BD presenting genuine emotion recognition deficits. Correlations were also performed between alcohol consumption characteristics and emotional recognition scores. RESULTS BD presented reduced performance for the recognition of fear and sadness. Multiple single cases highlighted that these deficits respectively concerned 21.15 and 15.38% of the binge drinking sample, and the relation between binge drinking and reduced sadness detection was supported by correlational analyses. CONCLUSIONS These findings show that binge drinking is associated with a disrupted processing of emotional stimuli. By identifying heterogeneity in the impairments presented by BD, the present results also underline the usefulness of a combined group and individual Analysis.
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Affiliation(s)
- Séverine Lannoy
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, Reims, France.,Laboratory for Experimental Psychopathology (LEP), Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Farid Benzerouk
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, Reims, France.,EPSM Marne, CHU de Reims, Pôle Universitaire de Psychiatrie, Reims, France
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology (LEP), Psychological Science Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sarah Barrière
- EPSM Marne, CHU de Reims, Pôle Universitaire de Psychiatrie, Reims, France
| | - Joël Billieux
- Addictive and Compulsive Behaviour Lab (ACB-Lab), Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Mickaël Naassila
- INSERM U1247 GRAP, Research Group on Alcohol and Pharmacodependences, Université de Picardie Jules Verne, Amiens, France
| | - Arthur Kaladjian
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, Reims, France.,EPSM Marne, CHU de Reims, Pôle Universitaire de Psychiatrie, Reims, France
| | - Fabien Gierski
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, Reims, France.,EPSM Marne, CHU de Reims, Pôle Universitaire de Psychiatrie, Reims, France.,INSERM U1247 GRAP, Research Group on Alcohol and Pharmacodependences, Université de Picardie Jules Verne, Amiens, France
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Blair RJR, White SF, Tyler PM, Johnson K, Lukoff J, Thornton LC, Leiker EK, Filbey F, Dobbertin M, Blair KS. Threat Responsiveness as a Function of Cannabis and Alcohol Use Disorder Severity. J Child Adolesc Psychopharmacol 2019; 29:526-534. [PMID: 31170004 DOI: 10.1089/cap.2019.0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: Two of the most commonly abused substances by adolescents in the United States are alcohol and cannabis, both of which are associated with adverse medical and psychiatric outcomes throughout the lifespan. Both are assumed to impact the development of emotional processing although findings on the direction of this impact have been mixed. Preclinical animal work and some functional magnetic resonance imaging (fMRI) work with humans have suggested cannabis use disorder (CUD) and alcohol use disorder (AUD) are associated with increased threat responsiveness. However, other fMRI work has indicated CUD/AUD are associated with diminished threat responsiveness. In this study, we report on a study examining the relationship of severity of CUD/AUD and threat responsiveness in an adolescent population. Methods: The study involved 87 (43 male) adolescents with varying levels of CUD/AUD symptomatology (N = 45 above clinical cutoffs for CUD or AUD). They were scanned with fMRI during a looming threat task that involved images of threatening and neutral human faces or animals that appeared to be either looming or receding. Results: Increasing levels of CUD symptomatology were associated with decreased responding to looming stimuli within regions, including rostral frontal and fusiform gyrus as well as the amygdala. There were no relationships with AUD symptomatology. Conclusions: These data indicate that CUD in particular is associated with a decrease in responsiveness to the looming threat cue possibly relating to the putative neurotoxic impact of cannabis abuse.
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Affiliation(s)
- Robert James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Stuart F White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Patrick M Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Kimberly Johnson
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Laura C Thornton
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Emily K Leiker
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Francesca Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas
| | - Matt Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Repeated diazepam administration reversed working memory impairments and glucocorticoid alterations in the prefrontal cortex after short but not long alcohol-withdrawal periods. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2019; 18:665-679. [PMID: 29713956 DOI: 10.3758/s13415-018-0595-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study was designed to assess whether repeated administration of diazepam (Valium®, Roche)-a benzodiazepine exerting an agonist action on GABAA receptors-may alleviate both the short (1 week, 1W) and long-term (6 weeks, 6W) deleterious effects of alcohol withdrawal occurring after chronic alcohol consumption (6 months; 12% v/v) in C57/BL6 male mice. More pointedly, we first evidenced that 1W and 6W alcohol-withdrawn mice exhibited working memory deficits in a sequential alternation task, associated with sustained exaggerated corticosterone rise and decreased pCREB levels in the prefrontal cortex (PFC). In a subsequent experiment, diazepam was administered i.p. for 9 consecutive days (1 injection/day) during the alcohol withdrawal period at decreasing doses ranging from 1.0 mg/kg to 0.25 mg/kg. Diazepam was not detected in the blood of withdrawn mice at the time of memory testing, occurring 24 hours after the last diazepam injection. Repeated diazepam administration significantly improved alternation rates and normalized levels of glucocorticoids and pCREB activity in the PFC in 1W but not in 6W withdrawn mice. Thus, repeated diazepam administration during the alcohol-withdrawal period only transitorily canceled out the working memory impairments and glucocorticoid alterations in the PFC of alcohol-withdrawn animals.
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O'Connor E, Zeffiro T. Is treated HIV infection still toxic to the brain? PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:259-284. [PMID: 31481166 DOI: 10.1016/bs.pmbts.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinically apparent HIV infection, accompanied by CNS opportunistic infections and HIV encephalopathy, was often associated with profound structural and functional brain effects prior to the introduction of anti-retroviral therapy (ART). With treatment, HIV structural and functional brain effects are smaller and have not been as easily detected. With near complete elimination of CNS opportunistic infections, the HIV neuroimaging research community now grapples with the problem of detecting subtler structural and functional changes against a background of persisting confounds, such as comorbidities and clinical features common in the HIV infected population. This situation also raises the question of whether imaging measure changes that are reported as HIV brain effects are purely related to viral infection, rather than originating from confounding effects that might include age, substance use, hepatitis C coinfection, cerebrovascular risk factors, ART, premorbid cognitive skills and illness duration. In addition to cohort characteristics, variation in image acquisition and analysis techniques may also contribute to study outcome heterogeneity. We review the potential effects of these confounds on detection of HIV infection effects and discuss strategies to avoid or mitigate the effects of these confounds. We then present a systematic approach to measurement, design and analysis in HIV neuroimaging studies, combining both experimental and statistical control techniques to determine if HIV infection effects persist, fluctuate or worsen in groups achieving viral suppression from ART.
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Affiliation(s)
- Erin O'Connor
- University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Thomas Zeffiro
- University of Maryland School of Medicine, Baltimore, MD, United States.
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Airagnes G, Ducoutumany G, Laffy-Beaufils B, Le Faou AL, Limosin F. Alcohol withdrawal syndrome management: Is there anything new? Rev Med Interne 2019; 40:373-379. [PMID: 30853380 DOI: 10.1016/j.revmed.2019.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/20/2019] [Accepted: 02/06/2019] [Indexed: 01/19/2023]
Abstract
Patients with alcohol use disorder experience frequently alcohol withdrawal syndrome (AWS), which is a potentially life-threatening condition mainly caused by glutamate overactivity. The aim of therapeutic alcohol withdrawal is the entry into a process of complete and lasting abstinence. Therefore preparing withdrawal is crucial to optimize compliance and efficacy of aftercare. Indeed, performing repeated withdrawal per se without any project of subsequent abstinence may be deleterious, at least because of repeated exposure to glutamate neurotoxicity. Managing AWS mainly consists in anticipating severe withdrawal, decreasing the risk of complications, making this experience as comfortable as possible, preventing from long-term benzodiazepine use, and enhancing motivation to aftercare and long-term abstinence. In particular, there are specific guidelines to choose which benzodiazepine administration approach to adopt (i.e. symptom-triggered, fixed schedule or loading dosage) and which other drugs to deliver (e.g. thiamine, folate, magnesium). Specific precautions should be taken in the elderly.
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Affiliation(s)
- G Airagnes
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; UMS 011, Population-based Epidemiological Cohorts, Inserm, 94800 Villejuif, France.
| | - G Ducoutumany
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - B Laffy-Beaufils
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - A-L Le Faou
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; UMR-S 1123, Épidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables (ECEVE), Inserm, 75010 Paris, France
| | - F Limosin
- Hôpitaux universitaires Paris Ouest, Department of Psychiatry and Addictology, AP-HP, 75015 Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; U 894, Centre Psychiatrie et Neurosciences, Inserm, 75014 Paris, France
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Bohnsack JP, Teppen T, Kyzar EJ, Dzitoyeva S, Pandey SC. The lncRNA BDNF-AS is an epigenetic regulator in the human amygdala in early onset alcohol use disorders. Transl Psychiatry 2019; 9:34. [PMID: 30728347 PMCID: PMC6365546 DOI: 10.1038/s41398-019-0367-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022] Open
Abstract
Adolescent alcohol drinking is known to contribute to the development and severity of alcohol use disorders (AUDs) later in adulthood. Recent studies have shown that long non-coding RNAs (lncRNAs) are critical for brain development and synaptic plasticity. One such lncRNA is natural occurring brain-derived neurotrophic factor antisense (BDNF-AS) that has been shown to regulate BDNF expression. The role of BDNF-AS lncRNA in the molecular mechanisms of AUD is unknown. Here, we evaluated the expression and functional role of BDNF-AS in postmortem amygdala of either early onset or late onset alcoholics (individuals who began drinking before or after 21 years of age, respectively) and age-matched control subjects. BDNF-AS expression is increased in early onset but not in late onset AUD amygdala and appears to be regulated epitranscriptomically via decreased N6-methyladenosine on BDNF-AS. Upregulation of BDNF-AS is associated with a significant decrease in BDNF expression and increased recruitment of EZH2, which deposits repressive H3K27 trimethylation (H3K27me3) at regulatory regions in the BDNF gene in the early onset AUD group. Drinking during adolescence also contributed to significant decreases in activity-regulated cytoskeleton-associated protein (ARC) expression which also appeared to be mediated by increased EZH2 deposition of repressive H3K27me3 at the ARC synaptic activity response element. These results suggest an important role for BDNF-AS in the regulation of synaptic plasticity via epigenetic reprogramming in the amygdala of AUD subjects who began drinking during adolescence.
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Affiliation(s)
- John Peyton Bohnsack
- 0000 0001 2175 0319grid.185648.6Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Tara Teppen
- 0000 0001 2175 0319grid.185648.6Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612 USA ,grid.280892.9Jesse Brown VA Medical Center, Chicago, IL 60612 USA
| | - Evan J. Kyzar
- 0000 0001 2175 0319grid.185648.6Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612 USA ,grid.280892.9Jesse Brown VA Medical Center, Chicago, IL 60612 USA
| | - Svetlana Dzitoyeva
- 0000 0001 2175 0319grid.185648.6Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612 USA
| | - Subhash C. Pandey
- 0000 0001 2175 0319grid.185648.6Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612 USA ,grid.280892.9Jesse Brown VA Medical Center, Chicago, IL 60612 USA ,0000 0001 2175 0319grid.185648.6Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL 60612 USA
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Flanagan JC, Yonce S, Calhoun CD, Back SE, Brady KT, Joseph JE. Preliminary development of a neuroimaging paradigm to examine neural correlates of relationship conflict. Psychiatry Res Neuroimaging 2019; 283:125-134. [PMID: 30581042 PMCID: PMC6379119 DOI: 10.1016/j.pscychresns.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/02/2018] [Accepted: 12/11/2018] [Indexed: 01/01/2023]
Abstract
Social stress in the form of conflict between romantic partners is a salient correlate of substance use disorders (SUD), and also plays an integral role in SUD treatment outcomes. Neuroimaging has advanced the study of social stress on SUD etiology, course, and treatment. However, no neuroimaging paradigms have yet been developed to examine neural responses to conflict among romantic couples. In order to fill this gap in the literature, the goal of this exploratory study was to examine the preliminary feasibility of a novel relationship conflict fMRI paradigm. We compared the effects of an auditory relationship conflict versus a neutral cue on functional connectivity in corticolimbic brain regions, and the associations between neural activities and self-report ratings of relationship adjustment, substance use problems, and intimate partner violence. We also explored sex differences in neural correlates of relationship conflict versus neutral cues. Participants demonstrated increased functional connectivity between the amygdala and the prefrontal cortex during the relationship conflict cue compared to the neutral cue. Intimate partner violence was associated with functional connectivity. Sex differences emerged in neural responses to the relationship conflict cue compared to the neutral cue. Collectively, the findings demonstrate preliminary validity of this novel neuroimaging paradigm for couples.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA.
| | - Shayla Yonce
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Casey D Calhoun
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., MSC 861, Charleston, SC 29425, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
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Betka S, Harris L, Rae C, Palfi B, Pfeifer G, Sequeira H, Duka T, Critchley H. Signatures of alcohol use in the structure and neurochemistry of insular cortex: a correlational study. Psychopharmacology (Berl) 2019; 236:2579-2591. [PMID: 31011757 PMCID: PMC6695346 DOI: 10.1007/s00213-019-05228-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/18/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE Insular cortex supports the representation of motivational feelings through the integration of interoceptive information concerning bodily physiology. Compromised insular integrity is implicated in alcohol and drug use disorders. Alcohol-associated insular dysfunction may arise through aberrant glutamatergic neurotransmission associated with selective neuronal death and atrophy. OBJECTIVE In a sample of alcohol users, we combined magnetic resonance spectroscopy (MRS) with voxel and surface-based morphometry (VBM, SBM) to test the hypothesis that the neurochemical and structural properties of the insula relate to alcohol use. METHODS Twenty-three healthy individuals were characterized by measures of alcohol use and subjective craving. Right mid-insula glutamate/glutamine (Glx) and total N-acetylaspartate/N-acetyl-aspartylglutamate (TNAA) concentrations were measured using MRS. Right insular structure was quantified using VBM and SBM parameters. We tested for predictive associations between these neuroimaging and behavioral/psychometric measures using Bayesian statistics. RESULTS Reduced insular Glx concentration was associated with increased alcohol compulsions and, to a lesser extent, with greater alcohol use severity. Anecdotal evidence for a negative relationship between alcohol use severity and levels of insular gyrification was also observed. CONCLUSIONS This study is, to date, the first characterization of the neurochemical and morphological integrity of insular cortex in alcohol users. Our data seem to reveal a negative relationship between alcohol use and the neurochemical and structural integrity of the insula, a critical substrate for motivational behavior. These neurobiological characteristics might contribute to loss of control toward compulsive drinking with prolonged and excessive alcohol use.
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Affiliation(s)
- Sophie Betka
- Trafford Centre, Brighton and Sussex Medical School, Clinical Imaging Science Centre, Brighton, BN1 9RY, UK.
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, Brighton, BN1 9QH, UK.
- University of Lille, SCALab, CNRS UMR 9193, 59045, Lille, France.
| | - Lisa Harris
- Radiological Science, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Charlotte Rae
- Trafford Centre, Brighton and Sussex Medical School, Clinical Imaging Science Centre, Brighton, BN1 9RY, UK
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - Bence Palfi
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Gaby Pfeifer
- Trafford Centre, Brighton and Sussex Medical School, Clinical Imaging Science Centre, Brighton, BN1 9RY, UK
| | | | - Theodora Duka
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, Brighton, BN1 9QH, UK
- Sussex Addiction Research and Intervention Centre (SARIC), University of Sussex, Brighton, UK
| | - Hugo Critchley
- Trafford Centre, Brighton and Sussex Medical School, Clinical Imaging Science Centre, Brighton, BN1 9RY, UK
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
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Kouimtsidis C, Duka T, Palmer E, Lingford-Hughes A. Prehabilitation in Alcohol Dependence as a Treatment Model for Sustainable Outcomes. A Narrative Review of Literature on the Risks Associated With Detoxification, From Animal Models to Human Translational Research. Front Psychiatry 2019; 10:339. [PMID: 31156483 PMCID: PMC6531862 DOI: 10.3389/fpsyt.2019.00339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
In this review paper, we discuss how the overarching concept of prehabilitation is applicable to alcohol dependence. Central to prehabilitation are the concepts of expected harm, risks, and proactive planning to eliminate the harm or cope with the risks. We review the evidence from animal models, psychological experimental studies, as well as pharmacological studies, on the potential risks and harms associated with medically assisted alcohol detoxification and the current treatment paradigm for alcohol dependence. Animal models provide an approximation mostly of the physical aspect of alcohol withdrawal and detoxification process and make predictions about the development of the phenomena in humans. Despite their limitations, these models provide good evidence that withdrawal from chronic ethanol use induces cognitive impairment, which is worsened by repeated bouts of withdrawal and that these impairments are dependent on the duration of alcohol withdrawal. Initial clinical observations with alcohol-dependent patients confirmed increased incidence of seizures. In recent years, accumulating evidence suggests that patients who have had repeated episodes of withdrawal also show changes in their affect, increased craving, as well as significant deterioration of cognitive abilities, when compared to patients with fewer withdrawals. Alcohol dependence is associated with tolerance and withdrawal, with neuroadaptations in γ-Aminobutyric Acid-A Receptor (GABA-A) and glutamatergic N-methyl-D-aspartate (NMDA) receptors playing key roles. It is suggested that dysregulation of the NMDA receptor system underpins alcohol-related memory impairments. Finally, we discuss the Structured Preparation for Alcohol Detoxification (SPADe) as an example of how prehabilitation has been applied in clinical practice. We discuss the importance of partial control over drinking as an interim step toward abstinence and early introduction of lifestyle changes for both the patient and the immediate environment prior to detoxification and while the patient is still drinking.
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Affiliation(s)
| | - Theodora Duka
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Emily Palmer
- Centre for Psychiatry, Imperial College London, London, United Kingdom
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48
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Béracochéa D, Mons N, David V. Targeting the Glucocorticoid Receptors During Alcohol Withdrawal to Reduce Protracted Neurocognitive Disorders. Front Psychiatry 2019; 10:580. [PMID: 31620025 PMCID: PMC6759466 DOI: 10.3389/fpsyt.2019.00580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
Persistent regional glucocorticoid (GC) dysregulation in alcohol-withdrawn subjects emerges as a key factor responsible for protracted molecular and neural alterations associated with long-term cognitive dysfunction. Regional brain concentrations of corticosterone vary independently from plasma concentrations in alcohol-withdrawn subjects, which may account for the treatment of alcohol withdrawal-induced persistent pathology. Thus, from a pharmacological point of view, a main issue remains to determine the relative efficacy of compounds targeting the GC receptors to attenuate or suppress the long-lasting persistence of brain regional GC dysfunctions in abstinent alcoholics, as well as persistent changes of neural plasticity. Data from animal research show that acting directly on GC receptors during the withdrawal period, via selective antagonists, can significantly counteract the development and persistence of cognitive and neural plasticity disorders during protracted abstinence. A critical remaining issue is to better assess the relative long-term efficacy of GC antagonists and other compounds targeting the corticotropic axis activity such as gamma-aminobutyric acid A (GABAA) and GABAB agonists. Indeed, benzodiazepines (acting indirectly on GABAA receptors) and baclofen (agonist of the GABAB receptor) are the compounds most widely used to reduce alcohol dependence. Clinical and preclinical data suggest that baclofen exerts an effective and more powerful counteracting action on such persistent cognitive and endocrine dysfunctions as compared to diazepam, even though its potential negative effects on memory processes, particularly at high doses, should be better taken into account.
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Affiliation(s)
- Daniel Béracochéa
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
| | - Nicole Mons
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
| | - Vincent David
- Université de Bordeaux, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France.,CNRS UMR 5287, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, Pessac, France
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Ch'ng S, Fu J, Brown RM, McDougall SJ, Lawrence AJ. The intersection of stress and reward: BNST modulation of aversive and appetitive states. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:108-125. [PMID: 29330137 DOI: 10.1016/j.pnpbp.2018.01.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 12/13/2022]
Abstract
The bed nucleus of the stria terminalis (BNST) is widely acknowledged as a brain structure that regulates stress and anxiety states, as well as aversive and appetitive behaviours. The diverse roles of the BNST are afforded by its highly modular organisation, neurochemical heterogeneity, and complex intrinsic and extrinsic circuitry. There has been growing interest in the BNST in relation to psychopathologies such as anxiety and addiction. Although research on the human BNST is still in its infancy, there have been extensive preclinical studies examining the molecular signature and hodology of the BNST and their involvement in stress and reward seeking behaviour. This review examines the neurochemical phenotype and connectivity of the BNST, as well as electrophysiological correlates of plasticity in the BNST mediated by stress and/or drugs of abuse.
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Affiliation(s)
- Sarah Ch'ng
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Jingjing Fu
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Robyn M Brown
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Stuart J McDougall
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria 3052, Australia.
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50
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Exogenous ghrelin administration increases alcohol self-administration and modulates brain functional activity in heavy-drinking alcohol-dependent individuals. Mol Psychiatry 2018; 23:2029-2038. [PMID: 29133954 DOI: 10.1038/mp.2017.226] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/17/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
Preclinical evidence suggests that ghrelin, a peptide synthesized by endocrine cells of the stomach and a key component of the gut-brain axis, is involved in alcohol seeking as it modulates both central reward and stress pathways. However, whether and how ghrelin administration may impact alcohol intake in humans is not clear. For, we believe, the first time, this was investigated in the present randomized, crossover, double-blind, placebo-controlled, human laboratory study. Participants were non-treatment-seeking alcohol-dependent heavy-drinking individuals. A 10-min loading dose of intravenous ghrelin/placebo (3 mcg kg-1) followed by a continuous ghrelin/placebo infusion (16.9 ng/kg/min) was administered. During a progressive-ratio alcohol self-administration experiment, participants could press a button to receive intravenous alcohol using the Computerized Alcohol Infusion System. In another experiment, brain functional magnetic resonance imaging was conducted while participants performed a task to gain points for alcohol, food or no reward. Results showed that intravenous ghrelin, compared to placebo, significantly increased the number of alcohol infusions self-administered (percent change: 24.97±10.65, P=0.04, Cohen's d=0.74). Participants were also significantly faster to initiate alcohol self-administration when they received ghrelin, compared to placebo (P=0.03). The relationships between breath alcohol concentration and subjective effects of alcohol were also moderated by ghrelin administration. Neuroimaging data showed that ghrelin increased the alcohol-related signal in the amygdala (P=0.01) and modulated the food-related signal in the medial orbitofrontal cortex (P=0.01) and nucleus accumbens (P=0.08). These data indicate that ghrelin signaling affects alcohol seeking in humans and should be further investigated as a promising target for developing novel medications for alcohol use disorder.
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