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Robbins TW, Banca P, Belin D. From compulsivity to compulsion: the neural basis of compulsive disorders. Nat Rev Neurosci 2024; 25:313-333. [PMID: 38594324 DOI: 10.1038/s41583-024-00807-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
Compulsive behaviour, an apparently irrational perseveration in often maladaptive acts, is a potential transdiagnostic symptom of several neuropsychiatric disorders, including obsessive-compulsive disorder and addiction, and may reflect the severe manifestation of a dimensional trait termed compulsivity. In this Review, we examine the psychological basis of compulsions and compulsivity and their underlying neural circuitry using evidence from human neuroimaging and animal models. Several main elements of this circuitry are identified, focused on fronto-striatal systems implicated in goal-directed behaviour and habits. These systems include the orbitofrontal, prefrontal, anterior cingulate and insular cortices and their connections with the basal ganglia as well as sensoriomotor and parietal cortices and cerebellum. We also consider the implications for future classification of impulsive-compulsive disorders and their treatment.
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Affiliation(s)
- Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
| | - Paula Banca
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
| | - David Belin
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
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2
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Zhao K, Fonzo GA, Xie H, Oathes DJ, Keller CJ, Carlisle NB, Etkin A, Garza-Villarreal EA, Zhang Y. Discriminative functional connectivity signature of cocaine use disorder links to rTMS treatment response. NATURE. MENTAL HEALTH 2024; 2:388-400. [PMID: 39279909 PMCID: PMC11394333 DOI: 10.1038/s44220-024-00209-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/23/2024] [Indexed: 09/18/2024]
Abstract
Cocaine use disorder (CUD) is prevalent, and repetitive transcranial magnetic stimulation (rTMS) shows promise in reducing cravings. However, the association between a consistent CUD-specific functional connectivity signature and treatment response remains unclear. Here we identify a validated functional connectivity signature from functional magnetic resonance imaging to discriminate CUD, with successful independent replication. We found increased connectivity within the visual and dorsal attention networks and between the frontoparietal control and ventral attention networks, alongside reduced connectivity between the default mode and limbic networks in patients with CUD. These connections were associated with drug use history and cognitive impairments. Using data from a randomized clinical trial, we also established the prognostic value of these functional connectivities for rTMS treatment outcomes in CUD, especially involving the frontoparietal control and default mode networks. Our findings reveal insights into the neurobiological mechanisms of CUD and link functional connectivity biomarkers with rTMS treatment response, offering potential targets for future therapeutic development.
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Affiliation(s)
- Kanhao Zhao
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
| | - Gregory A Fonzo
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Hua Xie
- Center for Neuroscience Research, Children's National Hospital, Washington DC, USA
- George Washington University School of Medicine, Washington DC, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Corey J Keller
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Alto Neuroscience, Los Altos, CA, USA
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiología, Universidad Nacional Autónoma de México campus Juriquilla, Querétaro, Mexico
| | - Yu Zhang
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA, USA
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3
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Mosca A, Miuli A, Mancusi G, Chiappini S, Stigliano G, De Pasquale A, Di Petta G, Bubbico G, Pasino A, Pettorruso M, Martinotti G. To bridge or not to bridge: Moral Judgement in Cocaine Use Disorders, a case-control study on human morality. Soc Neurosci 2023; 18:271-281. [PMID: 37594151 DOI: 10.1080/17470919.2023.2242096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND In the "Dual-Process theory", morality is characterized by the interaction between an automatic-emotional process, mediated by the Anterior Cingulate Cortex (ACC) and linked to personal-deontological decisions, and a rational-conscious one, mediated by the Dorso-Lateral Prefrontal Cortex (DLPFC) and linked to impersonal-utilitarian decisions. These areas are altered by chronic use of cocaine, with a possible impact on moral decision-making. OBJECTIVE To evaluate the difference between a group of Cocaine Use Disorder (CUD) patients and a control group in moral decision-making. METHODS Subjects with CUD were compared to an equal-sized healthy group regarding their moral decision-making. Trolley and Footbridge Moral Dilemmas were administered to each group. The quality of the answer (yes or no) and the time needed to answer were recorded. RESULTS The recruited group includes 72 subjects, 36 with CUD and 36 healthy subjects (average age of 39.51 ± 9.89). In the Trolley dilemma, almost all the subjects (97.3%) answered "yes", while in the Footbridge dilemma CUD subjects answered "yes" more often (52.7%) than the healthy group (19.4%). CONCLUSION For strong emotional dilemmas (Footbridge), cocaine users answered "yes" with a higher frequency compared to healthy subjects, highlighting a wider utilitarian tendency in decision-making and a poor emotional participation.
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Affiliation(s)
- A Mosca
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - A Miuli
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - G Mancusi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - S Chiappini
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life, and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - G Stigliano
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - A De Pasquale
- Dipartimento di Salute Mentale E Delle Dipendenze, Sede Regionale, Sede di Isernia, Isernia, Italy
| | - G Di Petta
- SPDC, Mental Health Department, Santa Maria Delle Grazie Hospital, Naples, Italy
| | - G Bubbico
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - A Pasino
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - M Pettorruso
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
- Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life, and Medical Sciences, University of Hertfordshire, Hatfield, UK
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4
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Amerio A, Baccino C, Breda GS, Cortesi D, Spiezio V, Magnani L, De Berardis D, Conio B, Costanza A, De Paola G, Rocca G, Arduino G, Aguglia A, Amore M, Serafini G. Effects of transcranial magnetic stimulation on cocaine addiction: A systematic review of randomized controlled trials. Psychiatry Res 2023; 329:115491. [PMID: 37783092 DOI: 10.1016/j.psychres.2023.115491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE While pharmacological strategies appear to be ineffective in treating long-term addiction, repetitive transcranial magnetic stimulation (rTMS) is emerging as a promising new tool for the attenuation of craving among multiple substance dependent populations. METHOD A systematic review of randomized controlled trials (RCTs) was conducted on the efficacy and tolerability of rTMS in treating cocaine use disorder (CUD). Relevant papers published in English through November 30th 2022 were identified, searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS Eight studies matched inclusion criteria. The best findings were reported by the RCTs conducted at high-frequency (≥5 Hz) multiple sessions of rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC): a significant decrease in self-reported cue-induced cocaine craving and lower cocaine craving scores and a considerable amelioration in the tendency to act rashly under extreme negative emotions (impulsivity) were found in the active group compared to controls. CONCLUSION Although still scant and heterogeneous, the strongest evidence so far on the use of rTMS on individuals with CUD support the high frequency stimulation over the left DLPFC as a well tolerated treatment of cocaine craving and impulsivity.
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Affiliation(s)
- A Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - C Baccino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G S Breda
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - D Cortesi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - V Spiezio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - L Magnani
- Department of Psychiatry, San Maurizio Hospital, Bolzano, Italy
| | - D De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | - B Conio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Costanza
- Department of Psychiatry, Faculty of Medicine, Geneva University (UNIGE), Geneva, Switzerland; Department of Psychiatry, Adult Psychiatry Service (SPA), University Hospitals of Geneva (HUG), Geneva, Switzerland; Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Lugano, Switzerland.
| | - G De Paola
- Ospedale Maria Luigia, Monticelli Terme, Italy
| | - G Rocca
- R&R Neuromodulation Lab, Piacenza, Italy
| | - G Arduino
- Department of Mental Health and Pathological Addictions, Piacenza Local Health Authority, Piacenza, Italy
| | - A Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - M Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - G Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Zhao K, Fonzo GA, Xie H, Oathes DJ, Keller CJ, Carlisle N, Etkin A, Garza-Villarreal EA, Zhang Y. A generalizable functional connectivity signature characterizes brain dysfunction and links to rTMS treatment response in cocaine use disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.21.23288948. [PMID: 37162878 PMCID: PMC10168499 DOI: 10.1101/2023.04.21.23288948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Cocaine use disorder (CUD) is a prevalent substance abuse disorder, and repetitive transcranial magnetic stimulation (rTMS) has shown potential in reducing cocaine cravings. However, a robust and replicable biomarker for CUD phenotyping is lacking, and the association between CUD brain phenotypes and treatment response remains unclear. Our study successfully established a cross-validated functional connectivity signature for accurate CUD phenotyping, using resting-state functional magnetic resonance imaging from a discovery cohort, and demonstrated its generalizability in an independent replication cohort. We identified phenotyping FCs involving increased connectivity between the visual network and dorsal attention network, and between the frontoparietal control network and ventral attention network, as well as decreased connectivity between the default mode network and limbic network in CUD patients compared to healthy controls. These abnormal connections correlated significantly with other drug use history and cognitive dysfunctions, e.g., non-planning impulsivity. We further confirmed the prognostic potential of the identified discriminative FCs for rTMS treatment response in CUD patients and found that the treatment-predictive FCs mainly involved the frontoparietal control and default mode networks. Our findings provide new insights into the neurobiological mechanisms of CUD and the association between CUD phenotypes and rTMS treatment response, offering promising targets for future therapeutic development.
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Affiliation(s)
- Kanhao Zhao
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
| | - Gregory A. Fonzo
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, TX, USA
| | - Hua Xie
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Desmond J. Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Corey J. Keller
- Wu Tsai Neuroscience Institute, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Nancy Carlisle
- Department of Psychology, Lehigh University, Bethlehem, PA, USA
| | - Amit Etkin
- Alto Neuroscience, Inc., Los Altos, CA, USA
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiología, Universidad Nacional Autónoma de México campus Juriquilla, Querétaro, Mexico
| | - Yu Zhang
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA, USA
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Morgan C, Sáez-Briones P, Barra R, Reyes A, Zepeda-Morales K, Constandil L, Ríos M, Ramírez P, Burgos H, Hernández A. Prefrontal Cortical Control of Activity in Nucleus Accumbens Core Is Weakened by High-Fat Diet and Prevented by Co-Treatment with N-Acetylcysteine: Implications for the Development of Obesity. Int J Mol Sci 2022; 23:10089. [PMID: 36077493 PMCID: PMC9456091 DOI: 10.3390/ijms231710089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022] Open
Abstract
A loss of neuroplastic control on nucleus accumbens (NAc) neuronal activity exerted by the medial prefrontal cortex (mPFC) through long-term depression (LTD) is involved in triggering drug-seeking behavior and relapse on several substances of abuse due to impaired glutamate homeostasis in tripartite synapses of the nucleus accumbens (NAc) core. To test whether this maladaptive neuroplastic mechanism underlies the addiction-like behavior induced in young mice by a high-fat diet (HFD), we utilized 28-days-old male mice fed HFD ad-libitum over 2 weeks, followed by 5 days of HFD abstinence. Control groups were fed a regular diet. HFD fed mice showed increased ΔFosB levels in the NAc core region, whereas LTD triggered from the mPFC became suppressed. Interestingly, LTD suppression was prevented by an i.p. injection of 100 mg/kg N-acetylcysteine 2.5 h before inducing LTD from the mPFC. In addition, excessive weight gain due to HFD feeding was diminished by adding 2mg/mL N-acetylcysteine in drinking water. Those results show a loss of neuroplastic mPFC control over NAc core activity induced by HFD consumption in young subjects. In conclusion, ad libitum consumption of HFD can lead to neuroplastic changes an addiction-like behavior that can be prevented by N-acetylcysteine, helping to decrease the rate of excessive weight gain.
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Affiliation(s)
- Carlos Morgan
- Laboratorio de Neurofarmacología y Comportamiento, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Patricio Sáez-Briones
- Laboratorio de Neurofarmacología y Comportamiento, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Rafael Barra
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Andrea Reyes
- Laboratorio de Neurobiología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Katherine Zepeda-Morales
- Laboratorio de Neurobiología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Luis Constandil
- Laboratorio de Neurobiología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Miguel Ríos
- Laboratorio de Neurobiología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Paulina Ramírez
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY 10010, USA
| | - Héctor Burgos
- Escuela de Psicología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago 7570008, Chile
| | - Alejandro Hernández
- Laboratorio de Neurobiología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170022, Chile
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