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Gueguen MCM, Anlló H, Bonagura D, Kong J, Hafezi S, Palminteri S, Konova AB. Recent Opioid Use Impedes Range Adaptation in Reinforcement Learning in Human Addiction. Biol Psychiatry 2024; 95:974-984. [PMID: 38101503 PMCID: PMC11065633 DOI: 10.1016/j.biopsych.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Drugs like opioids are potent reinforcers thought to co-opt value-based decisions by overshadowing other rewarding outcomes, but how this happens at a neurocomputational level remains elusive. Range adaptation is a canonical process of fine-tuning representations of value based on reward context. Here, we tested whether recent opioid exposure impacts range adaptation in opioid use disorder, potentially explaining why shifting decision making away from drug taking during this vulnerable period is so difficult. METHODS Participants who had recently (<90 days) used opioids (n = 34) or who had abstained from opioid use for ≥ 90 days (n = 20) and comparison control participants (n = 44) completed a reinforcement learning task designed to induce robust contextual modulation of value. Two models were used to assess the latent process that participants engaged while making their decisions: 1) a Range model that dynamically tracks context and 2) a standard Absolute model that assumes stationary, objective encoding of value. RESULTS Control participants and ≥90-days-abstinent participants with opioid use disorder exhibited choice patterns consistent with range-adapted valuation. In contrast, participants with recent opioid use were more prone to learn and encode value on an absolute scale. Computational modeling confirmed the behavior of most control participants and ≥90-days-abstinent participants with opioid use disorder (75%), but a minority in the recent use group (38%), was better fit by the Range model than the Absolute model. Furthermore, the degree to which participants relied on range adaptation correlated with duration of continuous abstinence and subjective craving/withdrawal. CONCLUSIONS Reduced context adaptation to available rewards could explain difficulty deciding about smaller (typically nondrug) rewards in the aftermath of drug exposure.
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Affiliation(s)
- Maëlle C M Gueguen
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey; Intercultural Cognitive Network, Tokyo, Japan
| | - Hernán Anlló
- Intercultural Cognitive Network, Tokyo, Japan; Watanabe Laboratory, School of Fundamental Science and Engineering, Waseda University, Tokyo, Japan; Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale U960, École Normale Supérieure-Université de Recherche Paris Science et Lettres, Paris, France
| | - Darla Bonagura
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey; Intercultural Cognitive Network, Tokyo, Japan
| | - Julia Kong
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey
| | - Sahar Hafezi
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey
| | - Stefano Palminteri
- Intercultural Cognitive Network, Tokyo, Japan; Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale U960, École Normale Supérieure-Université de Recherche Paris Science et Lettres, Paris, France
| | - Anna B Konova
- Department of Psychiatry, Brain Health Institute and University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, New Jersey; Intercultural Cognitive Network, Tokyo, Japan.
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Dejoie JM, Senia N, Konova AB, Smith DV, Fareri DS. Common and Distinct Drug Cue Reactivity Patterns Associated with Cocaine and Heroin: An fMRI Meta-Analysis. medRxiv 2024:2023.10.19.23297268. [PMID: 37905133 PMCID: PMC10615011 DOI: 10.1101/2023.10.19.23297268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Substance use and substance use disorders represent ongoing major public health crises. Specifically, the use of substances such as cocaine and heroin are responsible for over 50,000 drug related deaths combined annually. We used a comparative meta-analysis procedure to contrast activation patterns associated with cocaine and heroin cue reactivity, which may reflect substance use risk for these substances. PubMed and Google Scholar were searched for studies with within-subject whole brain analyses comparing drug to neutral cues for users of cocaine and heroin published between 1995 and 2022. A total of 18 studies were included, 9 in each subgroup. Voxel-based meta-analyses were performed using seed-based d mapping with permuted subject images (SDM-PSI) for subgroup mean analyses and a contrast meta-regression comparing the two substances. Mean analysis results indicated that users of heroin showed more widespread activation in the nucleus accumbens, right inferior and left middle temporal gyrus, the right thalamus, and the right cerebellum while cocaine use was associated with recruitment of dorsolateral prefrontal cortex. Direct comparison of cue reactivity studies in heroin relative to cocaine users revealed greater activation in dopaminergic targets for users of heroin compared to users of cocaine. Differential activation patterns between substances may underlie differences in the clinical characteristics observed across users of cocaine and heroin, including seeking mood numbing effects in users of heroin. More consistent research methodology is needed to provide adequate studies for stringent meta-analyses examining common and distinct neural activation patterns across substances and moderation by clinically relevant factors.
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Affiliation(s)
- Jordan M Dejoie
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
| | - Nicole Senia
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
| | | | - David V Smith
- Department of Psychology and Neuroscience, Temple University
| | - Dominic S Fareri
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
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Schweitzer EM, Urmanche A, Kong J, Hafezi S, Zhao J, Cooperman NA, Konova AB. The role of social connection in opioid use disorder treatment engagement. Psychol Addict Behav 2024; 38:222-230. [PMID: 37384450 PMCID: PMC10755080 DOI: 10.1037/adb0000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Medications for opioid use disorder (OUD or MOUD) treatment combining pharmacotherapy with psychosocial support are effective for managing OUD. However, treatment engagement remains a challenge, with retention rates ∼30%-50%. Although social connection has been identified as important to recovery, it remains unclear whether and how social factors can bolster participation in treatment. METHOD Individuals receiving MOUD at three outpatient treatment programs (N = 82) and healthy community controls (N = 62) completed validated measures assessing social connection including (a) size, diversity, and embeddedness of social networks; (b) perceived social support and criticism within familial relationships; and (c) subjective social status. For those receiving MOUD, we also examined how aspects of social connection related to opioid (re)use and treatment engagement (medication adherence, group, and individual meeting attendance) assessed over ∼8 weeks/person. RESULTS Compared to controls, individuals receiving MOUD had smaller and less diverse and embedded social networks (Cohen's d > 0.4), and despite similar levels of perceived social support (d = 0.02), reported higher levels of social criticism (d = 0.6) and lower subjective social status (d = 0.5). Within the MOUD group, higher social network indices correlated specifically with higher therapeutic group attendance (Rs > 0.30), but not medication adherence, while higher levels of perceived criticism correlated with more frequent opioid use (R = 0.23). Results were mostly robust to control for sociodemographic variables, psychological distress/COVID-19, and treatment duration, but differed by MOUD type/program. CONCLUSIONS These findings highlight the potential importance of assessing an individual's social capital, promoting positive social connection, and continuing to assess the implementation and value of psychosocial support in MOUD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Adelya Urmanche
- University Behavioral Health Care & Brain Health Institute, Rutgers University-New Brunswick
| | - Julia Kong
- Department of Psychiatry, Rutgers University-New Brunswick
| | - Sahar Hafezi
- Department of Psychiatry, Rutgers University-New Brunswick
| | - Joshua Zhao
- Department of Psychiatry, Rutgers University-New Brunswick
| | | | - Anna B Konova
- Graduate Program in Neuroscience, Rutgers University-New Brunswick
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4
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Abstract
Computational models of addiction often rely on a model-free reinforcement learning (RL) formulation, owing to the close associations between model-free RL, habitual behavior and the dopaminergic system. However, such formulations typically do not capture key recurrent features of addiction phenomena such as craving and relapse. Moreover, they cannot account for goal-directed aspects of addiction that necessitate contrasting, model-based formulations. Here we synthesize a growing body of evidence and propose that a latent-cause framework can help unify our understanding of several recurrent phenomena in addiction, by viewing them as the inferred return of previous, persistent "latent causes". We demonstrate that applying this framework to Pavlovian and instrumental settings can help account for defining features of craving and relapse such as outcome-specificity, generalization, and cyclical dynamics. Finally, we argue that this framework can bridge model-free and model-based formulations, and account for individual variability in phenomenology by accommodating the memories, beliefs, and goals of those living with addiction, motivating a centering of the individual, subjective experience of addiction and recovery.
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Affiliation(s)
- Sashank Pisupati
- Limbic Limited, London UK
- Princeton Neuroscience Institute & Department of Psychology, Princeton University, Princeton NJ, USA
| | - Angela Langdon
- National Institute of Mental Health & National Institute on Drug Abuse, National Institutes of Health, Bethesda MD, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care & Brain Health Institute Rutgers University, New Brunswick NJ, USA
| | - Yael Niv
- Princeton Neuroscience Institute & Department of Psychology, Princeton University, Princeton NJ, USA
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Konova AB, Ceceli AO, Horga G, Moeller SJ, Alia-Klein N, Goldstein RZ. Reduced neural encoding of utility prediction errors in cocaine addiction. Neuron 2023; 111:4058-4070.e6. [PMID: 37883973 PMCID: PMC10880133 DOI: 10.1016/j.neuron.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/18/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023]
Abstract
Influential accounts of addiction posit alterations in adaptive behavior driven by deficient dopaminergic prediction errors (PEs), signaling the discrepancy between actual and expected reward. Dopamine neurons encode these error signals in subjective terms, calibrated by individual risk preferences, as "utility" PEs. It remains unclear, however, whether people with drug addiction have PE deficits or their computational source. Here, using an analogous task to prior single-unit studies with known expectancies, we show that fMRI-measured PEs similarly reflect utility PEs. Relative to control participants, people with chronic cocaine addiction demonstrate reduced utility PEs in the dopaminoceptive ventral striatum, with similar trends in orbitofrontal cortex. Dissecting this PE signal into its subcomponent terms attributed these reductions to weaker striatal responses to received reward/utility, whereas suppression of activity with reward expectation was unchanged. These findings support that addiction may fundamentally disrupt PE signaling and reveal an underappreciated role for perceived reward value in this mechanism.
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Affiliation(s)
- Anna B Konova
- Department of Psychiatry, University Behavioral Health Care & the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, NJ 08855, USA.
| | - Ahmet O Ceceli
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, New York, NY 10024, USA
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Nelly Alia-Klein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rita Z Goldstein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Yip SW, Barch DM, Chase HW, Flagel S, Huys QJ, Konova AB, Montague R, Paulus M. From Computation to Clinic. Biol Psychiatry Glob Open Sci 2023; 3:319-328. [PMID: 37519475 PMCID: PMC10382698 DOI: 10.1016/j.bpsgos.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
Theory-driven and data-driven computational approaches to psychiatry have enormous potential for elucidating mechanism of disease and providing translational linkages between basic science findings and the clinic. These approaches have already demonstrated utility in providing clinically relevant understanding, primarily via back translation from clinic to computation, revealing how specific disorders or symptoms map onto specific computational processes. Nonetheless, forward translation, from computation to clinic, remains rare. In addition, consensus regarding specific barriers to forward translation-and on the best strategies to overcome these barriers-is limited. This perspective review brings together expert basic and computationally trained researchers and clinicians to 1) identify challenges specific to preclinical model systems and clinical translation of computational models of cognition and affect, and 2) discuss practical approaches to overcoming these challenges. In doing so, we highlight recent evidence for the ability of computational approaches to predict treatment responses in psychiatric disorders and discuss considerations for maximizing the clinical relevance of such models (e.g., via longitudinal testing) and the likelihood of stakeholder adoption (e.g., via cost-effectiveness analyses).
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Affiliation(s)
- Sarah W. Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Deanna M. Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University, St. Louis, Missouri
| | - Henry W. Chase
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shelly Flagel
- Department of Psychiatry and Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan
| | - Quentin J.M. Huys
- Division of Psychiatry and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Institute of Neurology, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Anna B. Konova
- Department of Psychiatry and Brain Health Institute, Rutgers University, Piscataway, New Jersey
| | - Read Montague
- Fralin Biomedical Research Institute and Department of Physics, Virginia Tech, Blacksburg, Virginia
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
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Konova AB, Schweitzer EM. Decoding Craving: Insights From a Brain-Based Connectome Predictive Model of Subjective Reports. Am J Psychiatry 2023; 180:407-409. [PMID: 37259510 DOI: 10.1176/appi.ajp.20230299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute (Konova, Schweitzer), and Graduate Program in Neuroscience, Robert Wood Johnson Medical School (Schweitzer), Rutgers University-New Brunswick, Piscataway, N.J
| | - Emma M Schweitzer
- Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute (Konova, Schweitzer), and Graduate Program in Neuroscience, Robert Wood Johnson Medical School (Schweitzer), Rutgers University-New Brunswick, Piscataway, N.J
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8
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Yip SW, Konova AB. Emerging Topics in Computational Psychiatric Research: Clarity Through Complexity? Biol Psychiatry 2023; 93:652-654. [PMID: 36948759 DOI: 10.1016/j.biopsych.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Sarah W Yip
- Department of Psychiatry, Department of Child Study, Yale University, New Haven, Connecticut.
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and Brain Health Institute, Rutgers University-New Brunswick, Piscataway, New Jersey.
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9
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Anlló H, Bavard S, Benmarrakchi F, Bonagura D, Cerrotti F, Cicue M, Gueguen M, Guzmán EJ, Kadieva D, Kobayashi M, Lukumon G, Sartorio M, Yang J, Zinchenko O, Bahrami B, Concha JS, Hertz U, Konova AB, Li J, O’Madagain C, Navajas J, Reyes G, Sarabi-Jamab A, Shestakova A, Sukumaran B, Watanabe K, Palminteri S. Outcome context-dependence is not WEIRD: Comparing reinforcement- and description-based economic preferences worldwide. Res Sq 2023:rs.3.rs-2621222. [PMID: 36909645 PMCID: PMC10002789 DOI: 10.21203/rs.3.rs-2621222/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Recent evidence indicates that reward value encoding in humans is highly context-dependent, leading to suboptimal decisions in some cases. But whether this computational constraint on valuation is a shared feature of human cognition remains unknown. To address this question, we studied the behavior of individuals from across 11 countries of markedly different socioeconomic and cultural makeup using an experimental approach that reliably captures context effects in reinforcement learning. Our findings show that all samples presented evidence of similar sensitivity to context. Crucially, suboptimal decisions generated by context manipulation were not explained by risk aversion, as estimated through a separate description-based choice task (i.e., lotteries) consisting of matched decision offers. Conversely, risk aversion significantly differed across countries. Overall, our findings suggest that context-dependent reward value encoding is a hardcoded feature of human cognition, while description-based decision-making is significantly sensitive to cultural factors.
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Affiliation(s)
- Hernán Anlló
- Human Reinforcement Learning Team, Laboratory of Cognitive and Computational Neuroscience, ENS-PSL, Paris, France
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan
- Intercultural Cognitive Network
| | - Sophie Bavard
- Human Reinforcement Learning Team, Laboratory of Cognitive and Computational Neuroscience, ENS-PSL, Paris, France
- Intercultural Cognitive Network
- General Psychology Lab, Hamburg University, Hamburg, Germany
| | - FatimaZzahra Benmarrakchi
- Intercultural Cognitive Network
- School of Collective Intelligence, Universite Mohammed VI Polytechnique, Rabat, Morocco
| | - Darla Bonagura
- Intercultural Cognitive Network
- Department of Psychiatry, University Behavioural Health Care, & the Brain Health Institute, Rutgers University—New Brunswick, Piscataway, USA
| | - Fabien Cerrotti
- Human Reinforcement Learning Team, Laboratory of Cognitive and Computational Neuroscience, ENS-PSL, Paris, France
- Intercultural Cognitive Network
| | - Mirona Cicue
- Department of Cognitive Sciences, University of Haifa, Haifa, Israel
| | - Maelle Gueguen
- Intercultural Cognitive Network
- Department of Psychiatry, University Behavioural Health Care, & the Brain Health Institute, Rutgers University—New Brunswick, Piscataway, USA
| | - Eugenio José Guzmán
- Facultad de Psicología, Universidad del Desarrollo, Santiago de Chile, Chile
| | - Dzerassa Kadieva
- International Laboratory for Social Neurobiology, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
| | - Maiko Kobayashi
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan
| | - Gafari Lukumon
- School of Collective Intelligence, Universite Mohammed VI Polytechnique, Rabat, Morocco
| | - Marco Sartorio
- Laboratorio de Neurociencia, Universidad Torcuato Di Tella, Buenos Aires, Argentina
| | - Jiong Yang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of behaviour and Mental Health, Peking University, Beijing, China
| | - Oksana Zinchenko
- Intercultural Cognitive Network
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
| | - Bahador Bahrami
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Jaime Silva Concha
- Intercultural Cognitive Network
- Facultad de Psicología, Universidad del Desarrollo, Santiago de Chile, Chile
| | - Uri Hertz
- Intercultural Cognitive Network
- Department of Cognitive Sciences, University of Haifa, Haifa, Israel
| | - Anna B. Konova
- Intercultural Cognitive Network
- Department of Psychiatry, University Behavioural Health Care, & the Brain Health Institute, Rutgers University—New Brunswick, Piscataway, USA
| | - Jian Li
- Intercultural Cognitive Network
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of behaviour and Mental Health, Peking University, Beijing, China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Cathal O’Madagain
- Intercultural Cognitive Network
- School of Collective Intelligence, Universite Mohammed VI Polytechnique, Rabat, Morocco
| | - Joaquin Navajas
- Intercultural Cognitive Network
- Laboratorio de Neurociencia, Universidad Torcuato Di Tella, Buenos Aires, Argentina
- Escuela de Negocios, Universidad Torcuato Di Tella, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Cientifícas y Técnicas (CONICET), Argentina
| | - Gabriel Reyes
- Intercultural Cognitive Network
- Facultad de Psicología, Universidad del Desarrollo, Santiago de Chile, Chile
| | - Atiye Sarabi-Jamab
- Intercultural Cognitive Network
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Anna Shestakova
- Intercultural Cognitive Network
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
| | - Bhasi Sukumaran
- Intercultural Cognitive Network
- Department of Clinical Psychology, SRM Medical College Hospital & Research Centre, Chennai, India
| | - Katsumi Watanabe
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan
- Intercultural Cognitive Network
| | - Stefano Palminteri
- Human Reinforcement Learning Team, Laboratory of Cognitive and Computational Neuroscience, ENS-PSL, Paris, France
- Intercultural Cognitive Network
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10
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Konova AB, Zilverstand A. Deriving Generalizable and Interpretable Brain-Behavior Phenotypes of Cannabis Use. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:238-240. [PMID: 36889869 PMCID: PMC10766112 DOI: 10.1016/j.bpsc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, New Jersey.
| | - Anna Zilverstand
- Department of Psychiatry and Behavioral Sciences, Medical Discovery Team on Addiction, University of Minnesota, Minneapolis, Minnesota
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11
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Yip SW, Konova AB. Densely sampled neuroimaging for maximizing clinical insight in psychiatric and addiction disorders. Neuropsychopharmacology 2022; 47:395-396. [PMID: 34354248 PMCID: PMC8617277 DOI: 10.1038/s41386-021-01124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/20/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Sarah W. Yip
- grid.47100.320000000419368710Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
| | - Anna B. Konova
- grid.430387.b0000 0004 1936 8796Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute, Rutgers University—New Brunswick, Piscataway, NJ USA
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12
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Alvarez EE, Hafezi S, Bonagura D, Kleiman EM, Konova AB. A Proof-of-Concept Ecological Momentary Assessment Study of Day-Level Dynamics in Value-Based Decision-Making in Opioid Addiction. Front Psychiatry 2022; 13:817979. [PMID: 35664484 PMCID: PMC9156899 DOI: 10.3389/fpsyt.2022.817979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Drug addiction is thought to be characterized by risky and impulsive behavior despite harmful consequences. Whether these aspects of value-based decision-making in people with addiction are stable and trait-like, and the degree to which they vary within-person and are sensitive to changes in psychological state, remains unknown. In this pilot study, we examined the feasibility of distinguishing these state- vs. trait-like components by probing day-level dynamics of risk and time preferences in patients with opioid use disorder (OUD) as they engaged with their natural environment. METHODS Twenty-three individuals with OUD receiving outpatient treatment (40% female; M = 45.67 [SD = 13.16] years of age) and twenty-one matched healthy community controls (47% female; M = 49.67 [SD = 14.38] years of age) participated in a 28-day smartphone-based ecological momentary assessment study (1085 person days; M = 24.66, SD = 5.84). Random prompts administered daily assessed subjects' psychological state (e.g., mood) and economic preferences for real delayed and risky monetary rewards. RESULTS Subjects demonstrated dynamic decision-making preferences, with 40-53% of the variation in known risk and ambiguity tolerance, and 67% in discounting, attributable to between-person vs. within-person (day-to-day) differences. We found that changes in psychological state were related to changes in risk preferences, with patients preferring riskier offers on days they reported being in a better mood but no differences between groups in aggregate level behavior. By contrast, temporal discounting was increased overall in patients compared to controls and was unrelated to global mood. The study was well-tolerated, but compliance rates were moderate and lower in patients. CONCLUSION Our data support the idea that decision-making preferences in drug addiction exhibit substantial within-person variability and that this variability can be well-captured using remote data collection methods. Preliminary findings suggested that aspects of decision-making related to consideration of risk may be more sensitive to within-person change in global psychological state while those related to consideration of delay to reward, despite also being somewhat variable, stably differ from healthy levels. Identifying the cognitive factors that contribute to opioid use risk in a "real-world" setting may be important for identifying unique, time-sensitive targets for intervention.
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Affiliation(s)
- Emmanuel E Alvarez
- Department of Neuroscience, Robert Wood Johnson Medical School, Rutgers University-New Brunswick, Piscataway, NJ, United States.,Department of Psychiatry, Brain Health Institute, University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, NJ, United States
| | - Sahar Hafezi
- Department of Psychiatry, Brain Health Institute, University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, NJ, United States
| | - Darla Bonagura
- Department of Psychiatry, Brain Health Institute, University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, NJ, United States.,Department of Psychology, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Evan M Kleiman
- Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, United States
| | - Anna B Konova
- Department of Psychiatry, Brain Health Institute, University Behavioral Health Care, Rutgers University-New Brunswick, Piscataway, NJ, United States
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Cassidy CM, Konova AB, Abi-Dargham A, Martinez D, Horga G. Ubiquitous Dopamine Deficit Hypotheses in Cocaine Use Disorder Lack Support: Response to Leyton. Am J Psychiatry 2021; 178:469-470. [PMID: 33979543 DOI: 10.1176/appi.ajp.2020.20111581r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Clifford M Cassidy
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Anna B Konova
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Anissa Abi-Dargham
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Diana Martinez
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
| | - Guillermo Horga
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa (Cassidy); Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York (Cassidy, Abi-Dargham, Martinez, Horga); Department of Psychiatry, Rutgers University, Piscataway, N.J. (Konova); Department of Psychiatry, Stony Brook University, Stony Brook, N.Y. (Abi-Dargham)
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14
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Bjork JM, Reisweber J, Burchett JR, Plonski PE, Konova AB, Lopez-Guzman S, Dismuke-Greer CE. Impulsivity and Medical Care Utilization in Veterans Treated for Substance Use Disorder. Subst Use Misuse 2021; 56:1741-1751. [PMID: 34328052 DOI: 10.1080/10826084.2021.1949603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Impulsivity has been defined by acting rashly during positive mood states (positive urgency; PU) or negative mood states (negative urgency; NU) and by excessive de-valuation of deferred rewards. These behaviors reflect a "live in the now" mentality that is not only characteristic of many individuals with severe substance use disorder (SUD) but also impedes medical treatment compliance and could result in repeated hospitalizations or other poor health outcomes. Purpose/objectives: We sought preliminary evidence that impulsivity may relate to adverse health outcomes in the veteran population. Impulsivity measured in 90 veterans receiving inpatient or outpatient SUD care at a Veterans Affairs Medical Center was related to histories of inpatient/residential care costs, based on VA Health Economics Resource Center data. Results: We found that positive urgency, lack of persistence and lack of premeditation, but not sensation-seeking or preference for immediate or risky rewards, were significantly higher in veterans with a history of one or more admissions for VA-based inpatient or residential health care that either included (n = 30) or did not include (n = 29) an admission for SUD care. Among veterans with a history of inpatient/residential care for SUD, NU and PU, but not decision-making behavior, correlated with SUD care-related costs. Conclusions/Importance: In veterans receiving SUD care, questionnaire-assessed trait impulsivity (but not decision-making) related to greater care utilization within the VA system. This suggests that veterans with high impulsivity are at greater risk for adverse health outcomes, such that expansion of cognitive interventions to reduce impulsivity may improve their health.
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Affiliation(s)
- James M Bjork
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Jarrod Reisweber
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Jason R Burchett
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Paul E Plonski
- Hunter Holmes McGuire Veterans Affairs Medical Center, McGuire Research Institute, Richmond, Virginia, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, NJ, USA
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15
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Gueguen MCM, Schweitzer EM, Konova AB. Computational theory-driven studies of reinforcement learning and decision-making in addiction: What have we learned? Curr Opin Behav Sci 2020; 38:40-48. [PMID: 34423103 DOI: 10.1016/j.cobeha.2020.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Computational psychiatry provides a powerful new approach for linking the behavioral manifestations of addiction to their precise cognitive and neurobiological substrates. However, this emerging area of research is still limited in important ways. While research has identified features of reinforcement learning and decision-making in substance users that differ from health, less emphasis has been placed on capturing addiction cycles/states dynamically, within-person. In addition, the focus on few behavioral variables at a time has precluded more detailed consideration of related processes and heterogeneous clinical profiles. We propose that a longitudinal and multidimensional examination of value-based processes, a type of dynamic "computational fingerprint", will provide a more complete understanding of addiction as well as aid in developing better tailored and timed interventions.
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Affiliation(s)
- Maëlle C M Gueguen
- Department of Psychiatry, University Behavioral Health Care, & the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, USA
| | - Emma M Schweitzer
- Department of Psychiatry, University Behavioral Health Care, & the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, USA.,Graduate Program in Cell Biology & Neuroscience, Rutgers University-New Brunswick, Piscataway, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, & the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, USA
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16
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Cassidy CM, Carpenter KM, Konova AB, Cheung V, Grassetti A, Zecca L, Abi-Dargham A, Martinez D, Horga G. Evidence for Dopamine Abnormalities in the Substantia Nigra in Cocaine Addiction Revealed by Neuromelanin-Sensitive MRI. Am J Psychiatry 2020; 177:1038-1047. [PMID: 32854531 PMCID: PMC9108998 DOI: 10.1176/appi.ajp.2020.20010090] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent evidence supports the use of neuromelanin-sensitive MRI (NM-MRI) as a novel tool to investigate dopamine function in the human brain. The authors investigated the NM-MRI signal in individuals with cocaine use disorder, compared with age- and sex-matched control subjects, based on previous imaging studies showing that this disorder is associated with blunted presynaptic striatal dopamine. METHODS NM-MRI and T1-weighted images were acquired from 20 participants with cocaine use disorder and 35 control subjects. Diagnostic group effects in NM-MRI signal were determined using a voxelwise analysis within the substantia nigra. A subset of 20 cocaine users and 17 control subjects also underwent functional MRI imaging using the monetary incentive delay task, in order to investigate whether NM-MRI signal was associated with alterations in reward processing. RESULTS Compared with control subjects, cocaine users showed significantly increased NM-MRI signal in ventrolateral regions of the substantia nigra (area under the receiver operating characteristic curve=0.83). Exploratory analyses did not find a significant correlation of NM-MRI signal to activation of the ventral striatum during anticipation of monetary reward. CONCLUSIONS Given that previous imaging studies show decreased dopamine signaling in the striatum, the finding of increased NM-MRI signal in the substantia nigra provides additional insight into the pathophysiology of cocaine use disorder. One interpretation is that cocaine use disorder is associated with a redistribution of dopamine between cytosolic and vesicular pools, leading to increased accumulation of neuromelanin. The study findings thus suggest that NM-MRI can serve as a practical imaging tool for interrogating the dopamine system in addiction.
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Affiliation(s)
- Clifford M Cassidy
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, ON,Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY,Corresponding author: Clifford Cassidy, 1145 Carling Ave, Ottawa ON, K1Z 7K4, Canada.
| | - Kenneth M Carpenter
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Anna B Konova
- Department of Psychiatry, Rutgers University, Newark, NJ
| | - Victoria Cheung
- University of Ottawa Institute of Mental Health Research, affiliated with The Royal, Ottawa, ON
| | - Alexander Grassetti
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Luigi Zecca
- Institute of Biomedical Technologies, National Research Council of Italy, Milan, Italy
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | - Diana Martinez
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Guillermo Horga
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
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17
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Raio CM, Konova AB, Otto AR. Trait impulsivity and acute stress interact to influence choice and decision speed during multi-stage decision-making. Sci Rep 2020; 10:7754. [PMID: 32385327 PMCID: PMC7210896 DOI: 10.1038/s41598-020-64540-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/02/2020] [Indexed: 11/17/2022] Open
Abstract
Impulsivity and stress exposure are two factors that are associated with changes in reward-related behavior in ways that are relevant to both healthy and maladaptive decision-making. Nonetheless, little empirical work has examined the possible independent and joint effects of these factors upon reward learning. Here, we sought to examine how trait impulsivity and acute stress exposure affect participants' choice behavior and decision speed in a two-stage sequential reinforcement-learning task. We found that more impulsive participants were more likely to repeat second-stage choices after previous reward, irrespective of stress condition. Exposure to stress, on the other hand, was associated with an increased tendency to repeat second-stage choices independent of whether these choices previously led to a reward, and this tendency was exacerbated in more impulsive individuals. Such interaction effects between stress and impulsivity were also found on decision speed. Stress and impulsivity levels interacted to drive faster choices overall (again irrespective of reward) at both task stages, while reward received on the previous trial slowed subsequent first-stage choices, particularly among impulsive individuals under stress. Collectively, our results reveal novel, largely interactive effects of trait impulsivity and stress exposure and suggest that stress may reveal individual differences in decision-making tied to impulsivity that are not readily apparent in the absence of stress.
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Affiliation(s)
- Candace M Raio
- Neuroscience Institute, New York University Grossman School of Medicine, New York, USA.
| | - Anna B Konova
- Department of Psychiatry, Rutgers University - New Brunswick, Piscataway, USA
| | - A Ross Otto
- Department of Psychology, McGill University, Montreal, Canada
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18
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Konova AB, Lopez-Guzman S, Urmanche A, Ross S, Louie K, Rotrosen J, Glimcher PW. Computational Markers of Risky Decision-making for Identification of Temporal Windows of Vulnerability to Opioid Use in a Real-world Clinical Setting. JAMA Psychiatry 2020; 77:368-377. [PMID: 31812982 PMCID: PMC6902203 DOI: 10.1001/jamapsychiatry.2019.4013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Opioid addiction is a major public health problem. Despite availability of evidence-based treatments, relapse and dropout are common outcomes. Efforts aimed at identifying reuse risk and gaining more precise understanding of the mechanisms conferring reuse vulnerability are needed. OBJECTIVE To use tools from computational psychiatry and decision neuroscience to identify changes in decision-making processes preceding opioid reuse. DESIGN, SETTING, AND PARTICIPANTS A cohort of individuals with opioid use disorder were studied longitudinally at a community-based treatment setting for up to 7 months (1-15 sessions per person). At each session, patients completed a risky decision-making task amenable to computational modeling and standard clinical assessments. Time-lagged mixed-effects logistic regression analyses were used to assess the likelihood of opioid use between sessions (t to t + 1; within the subsequent 1-4 weeks) from data acquired at the current session (t). A cohort of control participants completed similar procedures (1-5 sessions per person), serving both as a baseline comparison group and an independent sample in which to assess measurement test-retest reliability. Data were analyzed between January 1, 2018, and September 5, 2019. MAIN OUTCOMES AND MEASURES Two individual model-based behavioral markers were derived from the task completed at each session, capturing a participant's current tolerance of known risks and ambiguity (partially unknown risks). Current anxiety, craving, withdrawal, and nonadherence were assessed via interview and clinic records. Opioid use was ascertained from random urine toxicology tests and self-reports. RESULTS Seventy patients (mean [SE] age, 44.7 [1.3] years; 12 women and 58 men [82.9% male]) and 55 control participants (mean [SE] age, 42.4 [1.5] years; 13 women and 42 men [76.4% male]) were included. Of the 552 sessions completed with patients (mean [SE], 7.89 [0.59] sessions per person), 252 (45.7%) directly preceded opioid use events (mean [SE], 3.60 [0.44] sessions per person). From the task parameters, only ambiguity tolerance was significantly associated with increased odds of prospective opioid use (adjusted odds ratio, 1.37 [95% CI, 1.07-1.76]), indicating patients were more tolerant specifically of ambiguous risks prior to these use events. The association of ambiguity tolerance with prospective use was independent of established clinical factors (adjusted odds ratio, 1.29 [95% CI, 1.01-1.65]; P = .04), such that a model combining these factors explained more variance in reuse risk. No significant differences in ambiguity tolerance were observed between patients and control participants, who completed 197 sessions (mean [SE], 3.58 [0.21] sessions per person); however, patients were more tolerant of known risks (B = 0.56 [95% CI, 0.05-1.07]). CONCLUSIONS AND RELEVANCE Computational approaches can provide mechanistic insights about the cognitive factors underlying opioid reuse vulnerability and may hold promise for clinical use.
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Affiliation(s)
- Anna B. Konova
- Brain Health Institute, Department of Psychiatry, University Behavioral Health Care, Rutgers University–New Brunswick, Piscataway, New Jersey,Neuroscience Institute, New York University School of Medicine, New York
| | - Silvia Lopez-Guzman
- Neuroscience Institute, New York University School of Medicine, New York,,Grupo de Investigación en Neurociencias, Neuros Group, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Adelya Urmanche
- Department of Psychiatry, New York University School of Medicine, New York
| | - Stephen Ross
- Department of Psychiatry, New York University School of Medicine, New York
| | - Kenway Louie
- Neuroscience Institute, New York University School of Medicine, New York,,Center for Neural Science, New York University, New York
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine, New York
| | - Paul W. Glimcher
- Neuroscience Institute, New York University School of Medicine, New York,,Department of Psychiatry, New York University School of Medicine, New York
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19
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Baker SC, Konova AB, Daw ND, Horga G. A distinct inferential mechanism for delusions in schizophrenia. Brain 2019; 142:1797-1812. [PMID: 30895299 PMCID: PMC6644849 DOI: 10.1093/brain/awz051] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/27/2018] [Accepted: 01/16/2019] [Indexed: 12/14/2022] Open
Abstract
Delusions, a core symptom of psychosis, are false beliefs that are rigidly held with strong conviction despite contradictory evidence. Alterations in inferential processes have long been proposed to underlie delusional pathology, but previous attempts to show this have failed to yield compelling evidence for a specific relationship between inferential abnormalities and delusional severity in schizophrenia. Using a novel, incentivized information-sampling task (a modified version of the beads task), alongside well-characterized decision-making tasks, we sought a mechanistic understanding of delusions in a sample of medicated and unmedicated patients with schizophrenia who exhibited a wide range of delusion severity. In this novel task, participants chose whether to draw beads from one of two hidden jars or to guess the identity of the hidden jar, in order to minimize financial loss from a monetary endowment, and concurrently reported their probability estimates for the hidden jar. We found that patients with higher delusion severity exhibited increased information seeking (i.e. increased draws-to-decision behaviour). This increase was highly specific to delusion severity as compared to the severity of other psychotic symptoms, working-memory capacity, and other clinical and socio-demographic characteristics. Delusion-related increases in information seeking were present in unmedicated patients, indicating that they were unlikely due to antipsychotic medication. In addition, after adjusting for delusion severity, patients as a whole exhibited decreased information seeking relative to healthy individuals, a decrease that correlated with lower socioeconomic status. Computational analyses of reported probability estimates further showed that more delusional patients exhibited abnormal belief updating characterized by stronger reliance on prior beliefs formed early in the inferential process, a feature that correlated with increased information seeking in patients. Other decision-making parameters that could have theoretically explained the delusion effects, such as those related to subjective valuation, were uncorrelated with both delusional severity and information seeking among the patients. In turn, we found some preliminary evidence that subjective valuation (rather than belief updating) may explain group differences in information seeking unrelated to delusions. Together, these results suggest that abnormalities in belief updating, characterized by stronger reliance on prior beliefs formed by incorporating information presented earlier in the inferential process, may be a core computational mechanism of delusional ideation in psychosis. Our results thus provide direct empirical support for an inferential mechanism that naturally captures the characteristic rigidity associated with delusional beliefs.
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Affiliation(s)
- Seth C Baker
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, USA
| | - Anna B Konova
- Department of Psychiatry, University Behavioral Health Care, and Brain Health Institute, Rutgers University – New Brunswick, 671 Hoes Lane West, Piscataway, NJ, USA
| | - Nathaniel D Daw
- Department of Psychology and Princeton Neuroscience Institute, Princeton University, South Drive, Princeton, NJ, USA
| | - Guillermo Horga
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, USA
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20
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Lopez-Guzman S, Konova AB, Glimcher PW. Computational psychiatry of impulsivity and risk: how risk and time preferences interact in health and disease. Philos Trans R Soc Lond B Biol Sci 2019; 374:20180135. [PMID: 30966919 PMCID: PMC6335456 DOI: 10.1098/rstb.2018.0135] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2018] [Indexed: 12/11/2022] Open
Abstract
Choice impulsivity is an important subcomponent of the broader construct of impulsivity and is a key feature of many psychiatric disorders. Choice impulsivity is typically quantified as temporal discounting, a well-documented phenomenon in which a reward's subjective value diminishes as the delay to its delivery is increased. However, an individual's proclivity to-or more commonly aversion to- risk can influence nearly all of the standard experimental tools available for measuring temporal discounting. Despite this interaction, risk preference is a behaviourally and neurobiologically distinct construct that relates to the economic notion of utility or subjective value. In this opinion piece, we discuss the mathematical relationship between risk preferences and time preferences, their neural implementation, and propose ways that research in psychiatry could, and perhaps should, aim to account for this relationship experimentally to better understand choice impulsivity and its clinical implications. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.
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Affiliation(s)
- Silvia Lopez-Guzman
- Center for Neural Science, New York University, New York, NY 10003, USA
- Grupo de Investigación en Neurociencias (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia
| | - Anna B. Konova
- Center for Neural Science, New York University, New York, NY 10003, USA
- Department of Psychiatry, University Behavioral Health Care (UBHC), and the Brain Health Institute, Rutgers University-New Brunswick, Piscataway, NJ 08854, USA
| | - Paul W. Glimcher
- Center for Neural Science, New York University, New York, NY 10003, USA
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21
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Konova AB, Parvaz MA, Bernstein V, Zilverstand A, Moeller SJ, Delgado MR, Alia-Klein N, Goldstein RZ. Neural mechanisms of extinguishing drug and pleasant cue associations in human addiction: role of the VMPFC. Addict Biol 2019; 24:88-99. [PMID: 28872745 PMCID: PMC5837898 DOI: 10.1111/adb.12545] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/30/2017] [Accepted: 07/15/2017] [Indexed: 01/23/2023]
Abstract
The neurobiological mechanisms that underlie the resistance of drug cue associations to extinction in addiction remain unknown. Fear extinction critically depends on the ventromedial prefrontal cortex (VMPFC). Here, we tested if this same region plays a role in extinction of non-fear, drug and pleasant cue associations. Eighteen chronic cocaine users and 15 matched controls completed three functional MRI scans. Participants first learned to associate an abstract cue (the conditioned stimulus, CS) with a drug-related (CSD+ ) or pleasant (CSP+ ) image. Extinction immediately followed where each CS was repeatedly presented without the corresponding image. Participants underwent a second identical session 24 hours later to assess retention of extinction learning. Results showed that like fear extinction, non-fear-based extinction relies on the VMPFC. However, extinction-related changes in the VMPFC differed by cue valence and diagnosis. In controls, VMPFC activation to the CSD+ (which was unpleasant for participants) gradually increased as in fear extinction, while it decreased to the CSP+ , consistent with a more general role of the VMPFC in flexible value updating. Supporting a specific role in extinction retention, we further observed a cross-day association between VMPFC activation and skin conductance, a classic index of conditioned responses. Finally, cocaine users showed VMPFC abnormalities for both CSs, which, in the case of the CSD+ , correlated with craving. These data suggest a global deficit in extinction learning in this group that may hinder extinction-based treatment efforts. More broadly, these data show that the VMPFC, when functionally intact, supports extinction learning in diverse contexts in humans.
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Affiliation(s)
- Anna B. Konova
- Center for Neural Science; New York University; New York NY USA
| | - Muhammad A. Parvaz
- Departments of Psychiatry and Neuroscience; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Vladimir Bernstein
- Departments of Psychiatry and Neuroscience; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Anna Zilverstand
- Departments of Psychiatry and Neuroscience; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Scott J. Moeller
- Department of Psychiatry; Stony Brook University School of Medicine; Stony Brook NY USA
| | | | - Nelly Alia-Klein
- Departments of Psychiatry and Neuroscience; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Rita Z. Goldstein
- Departments of Psychiatry and Neuroscience; Icahn School of Medicine at Mount Sinai; New York NY USA
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22
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Abstract
Fear extinction has been extensively studied in both humans and non-human animals, and this work has contributed greatly to our understanding and treatment of anxiety disorders. Yet other psychopathologies like addiction might be associated with impairments selectively in extinction of non-fear based, appetitive and drug cue associations, and these processes have been underexplored in clinical translational neuroscience. Important questions regarding similarities and differences in the neurobiological mechanisms underlying aversive and appetitive extinction remain unanswered, particularly those pertaining to cross-species evidence for the role of the ventromedial prefrontal cortex and, to some extent, the striatum. Here, we aim to draw attention to the paucity of studies investigating non-fear based extinction in humans, summarize emerging findings from the available literature, and highlight important directions for future research. We argue that closing these gaps in our understanding could help inform the development of more targeted, and perhaps more durable, forms of extinction-based treatments for addiction and related psychopathologies characterized by abnormally persistent appetitive and drug cue associations.
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Affiliation(s)
- Anna B Konova
- Department of Psychiatry and University Behavioral Health Care (UBHC), Rutgers University-New Brunswick, 671 Hoes Lane West, Piscataway, NJ, 08854, USA.
| | - Rita Z Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, The Leon and Norma Hess Center for Science and Medicine, 1470 Madison Ave., New York, NY, 10029, USA.
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23
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Lopez-Guzman S, Konova AB, Louie K, Glimcher PW. Risk preferences impose a hidden distortion on measures of choice impulsivity. PLoS One 2018; 13:e0191357. [PMID: 29373590 PMCID: PMC5786295 DOI: 10.1371/journal.pone.0191357] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/03/2018] [Indexed: 12/31/2022] Open
Abstract
Measuring temporal discounting through the use of intertemporal choice tasks is now the gold standard method for quantifying human choice impulsivity (impatience) in neuroscience, psychology, behavioral economics, public health and computational psychiatry. A recent area of growing interest is individual differences in discounting levels, as these may predispose to (or protect from) mental health disorders, addictive behaviors, and other diseases. At the same time, more and more studies have been dedicated to the quantification of individual attitudes towards risk, which have been measured in many clinical and non-clinical populations using closely related techniques. Economists have pointed to interactions between measurements of time preferences and risk preferences that may distort estimations of the discount rate. However, although becoming standard practice in economics, discount rates and risk preferences are rarely measured simultaneously in the same subjects in other fields, and the magnitude of the imposed distortion is unknown in the assessment of individual differences. Here, we show that standard models of temporal discounting —such as a hyperbolic discounting model widely present in the literature which fails to account for risk attitudes in the estimation of discount rates— result in a large and systematic pattern of bias in estimated discounting parameters. This can lead to the spurious attribution of differences in impulsivity between individuals when in fact differences in risk attitudes account for observed behavioral differences. We advance a model which, when applied to standard choice tasks typically used in psychology and neuroscience, provides both a better fit to the data and successfully de-correlates risk and impulsivity parameters. This results in measures that are more accurate and thus of greater utility to the many fields interested in individual differences in impulsivity.
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Affiliation(s)
- Silvia Lopez-Guzman
- Center for Neural Science, New York University, New York, United States of America
- * E-mail:
| | - Anna B. Konova
- Center for Neural Science, New York University, New York, United States of America
| | - Kenway Louie
- Center for Neural Science, New York University, New York, United States of America
| | - Paul W. Glimcher
- Center for Neural Science, New York University, New York, United States of America
- Institute for the Study of Decision Making, New York University, New York, United States of America
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Moeller SJ, Konova AB, Tomasi D, Parvaz MA, Goldstein RZ. Abnormal response to methylphenidate across multiple fMRI procedures in cocaine use disorder: feasibility study. Psychopharmacology (Berl) 2016; 233:2559-69. [PMID: 27150080 PMCID: PMC4916842 DOI: 10.1007/s00213-016-4307-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/18/2016] [Indexed: 12/14/2022]
Abstract
RATIONALE The indirect dopamine agonist methylphenidate remediates cognitive deficits in psychopathology, but the individual characteristics that determine its effects on the brain are not known. OBJECTIVES We aimed to determine whether targeted dopaminergically modulated traits and individual differences could predict neural response to methylphenidate across multiple functional magnetic resonance imaging (fMRI) procedures. METHODS We combined neural measures from three separate procedures (two inhibitory control tasks differing in their degree of emotional salience and resting-state functional connectivity) during methylphenidate (20 mg oral, versus randomized and counterbalanced placebo) and correlated these aggregated responses with cocaine use disorder diagnosis (22 cocaine abusers, 21 controls), symptoms of attention deficit hyperactivity disorder, and working memory capacity. RESULTS Cocaine abusers, relative to controls, had a lower response in the dorsolateral prefrontal cortex to methylphenidate across all three procedures, driven by responses to the two inhibitory control tasks; reduced methylphenidate fMRI response in this region further correlated with more frequent cocaine use. CONCLUSIONS Cocaine abuse (and its frequency), associated with lower tonic dopamine levels, correlated with a reduction in activation to methylphenidate (versus placebo). These initial results provide feasibility to the idea that multimodal fMRI tasks can be meaningfully aggregated, and that these aggregated procedures show a common disruption in addiction in a highly anticipated region relevant to cognitive control. Results also suggest that drug use frequency may represent an important modulatory variable in interpreting the efficacy of pharmacologically enhanced cognitive interventions in addiction.
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Affiliation(s)
- Scott J. Moeller
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Correspondence may be addressed to: Scott J. Moeller, 1470 Madison Ave (Room 9-115), New York, NY 10029; Tel: 212-824-8973; Fax: 212-803-6743; . Or to: Rita Z. Goldstein, One Gustave L. Levy Place, Box 1230, New York, NY 10029; tel. (212) 824-9312; fax (212) 996-8931;
| | - Anna B. Konova
- Center for Neural Science, New York University, NY 10003
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892
| | - Muhammad A. Parvaz
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Rita Z. Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Correspondence may be addressed to: Scott J. Moeller, 1470 Madison Ave (Room 9-115), New York, NY 10029; Tel: 212-824-8973; Fax: 212-803-6743; . Or to: Rita Z. Goldstein, One Gustave L. Levy Place, Box 1230, New York, NY 10029; tel. (212) 824-9312; fax (212) 996-8931;
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Konova AB, Moeller SJ, Parvaz MA, Froböse MI, Alia-Klein N, Goldstein RZ. Converging effects of cocaine addiction and sex on neural responses to monetary rewards. Psychiatry Res 2016; 248:110-118. [PMID: 26809268 PMCID: PMC4752897 DOI: 10.1016/j.pscychresns.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/09/2015] [Accepted: 01/03/2016] [Indexed: 12/11/2022]
Abstract
There is some evidence that cocaine addiction manifests as more severe in women than men. Here, we examined whether these sex-specific differences in the clinical setting parallel differential neurobehavioral sensitivity to rewards in the laboratory setting. Twenty-eight (14 females/14 males) cocaine-dependent and 25 (11 females/14 males) healthy individuals completed a monetary reward task during fMRI. Results showed that the effects of cocaine dependence and sex overlapped in regions traditionally considered part of the mesocorticolimbic brain circuits including the hippocampus and posterior cingulate cortex (PCC), as well as those outside of this circuit (e.g., the middle temporal gyrus). The nature of this 'overlap' was such that both illness and female sex were associated with lower activations in these regions in response to money. Diagnosis-by-sex interactions instead emerged in the frontal cortex, such that cocaine-dependent females exhibited lower precentral gyrus and greater inferior frontal gyrus (IFG) activations relative to cocaine-dependent males and healthy females. Within these regions modulated both by diagnosis and sex, lower activation in the hippocampus and PCC, and higher IFG activations, correlated with increased subjective craving during the task. Results suggest sex-specific differences in addiction extend to monetary rewards and may contribute to core symptoms linked to relapse.
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Affiliation(s)
- Anna B Konova
- Center for Neural Science, New York University, New York, NY 10003, United States
| | - Scott J Moeller
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Muhammad A Parvaz
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Monja I Froböse
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Nelly Alia-Klein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Rita Z Goldstein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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Belilovsky E, Gkirtzou K, Misyrlis M, Konova AB, Honorio J, Alia-Klein N, Goldstein RZ, Samaras D, Blaschko MB. Predictive sparse modeling of fMRI data for improved classification, regression, and visualization using the k -support norm. Comput Med Imaging Graph 2015; 46 Pt 1:40-46. [DOI: 10.1016/j.compmedimag.2015.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 11/29/2022]
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Moeller SJ, Beebe-Wang N, Schneider KE, Konova AB, Parvaz MA, Alia-Klein N, Hurd YL, Goldstein RZ. Effects of an opioid (proenkephalin) polymorphism on neural response to errors in health and cocaine use disorder. Behav Brain Res 2015; 293:18-26. [PMID: 26164485 DOI: 10.1016/j.bbr.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/16/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
Chronic exposure to drugs of abuse perturbs the endogenous opioid system, which plays a critical role in the development and maintenance of addictive disorders. Opioid genetics may therefore play an important modulatory role in the expression of substance use disorders, but these genes have not been extensively characterized, especially in humans. In the current imaging genetics study, we investigated a single nucleotide polymorphism (SNP) of the protein-coding proenkephalin gene (PENK: rs2609997, recently shown to be associated with cannabis dependence) in 55 individuals with cocaine use disorder and 37 healthy controls. Analyses tested for PENK associations with fMRI response to error (during a classical color-word Stroop task) and gray matter volume (voxel-based morphometry) as a function of Diagnosis (cocaine, control). Results revealed whole-brain Diagnosis×PENK interactions on the neural response to errors (fMRI error>correct contrast) in the right putamen, left rostral anterior cingulate cortex/medial orbitofrontal cortex, and right inferior frontal gyrus; there was also a significant Diagnosis×PENK interaction on right inferior frontal gyrus gray matter volume. These interactions were driven by differences between individuals with cocaine use disorders and controls that were accentuated in individuals carrying the higher-risk PENK C-allele. Taken together, the PENK polymorphism-and potentially opioid neurotransmission more generally-modulates functioning and structural integrity of brain regions previously implicated in error-related processing. PENK could potentially render a subgroup of individuals with cocaine use disorder (i.e., C-allele carriers) more sensitive to mistakes or other related challenges; in future studies, these results could contribute to the development of individualized genetics-informed treatments.
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Affiliation(s)
- Scott J Moeller
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | | | - Kristin E Schneider
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Anna B Konova
- Center for Neural Science, New York University, New York, NY 10003, USA
| | - Muhammad A Parvaz
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nelly Alia-Klein
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yasmin L Hurd
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Pharmacology & Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rita Z Goldstein
- Departments of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Konova AB, Moeller SJ, Tomasi D, Goldstein RZ. Effects of chronic and acute stimulants on brain functional connectivity hubs. Brain Res 2015; 1628:147-56. [PMID: 25721787 DOI: 10.1016/j.brainres.2015.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 12/16/2022]
Abstract
The spatial distribution and strength of information processing 'hubs' are essential features of the brain׳s network topology, and may thus be particularly susceptible to neuropsychiatric disease. Despite growing evidence that drug addiction alters functioning and connectivity of discrete brain regions, little is known about whether chronic drug use is associated with abnormalities in this network-level organization, and if such abnormalities could be targeted for intervention. We used functional connectivity density (FCD) mapping to evaluate how chronic and acute stimulants affect brain hubs (i.e., regions with many short-range or long-range functional connections). Nineteen individuals with cocaine use disorders (CUD) and 15 healthy controls completed resting-state fMRI scans following a randomly assigned dose of methylphenidate (MPH; 20mg) or placebo. Short-range and long-range FCD maps were computed for each participant and medication condition. CUD participants had increased short-range and long-range FCD in the ventromedial prefrontal cortex, posterior cingulate/precuneus, and putamen/amygdala, which in areas of the default mode network correlated with years of use. Across participants, MPH decreased short-range FCD in the thalamus/putamen, and decreased long-range FCD in the supplementary motor area and postcentral gyrus. Increased density of short-range and long-range functional connections to default mode hubs in CUD suggests an overrepresentation of these resource-expensive hubs. While the effects of MPH on FCD were only partly overlapping with those of CUD, MPH-induced reduction in the density of short-range connections to the putamen/thalamus, a network of core relevance to habit formation and addiction, suggests that some FCD abnormalities could be targeted for intervention.
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Affiliation(s)
- Anna B Konova
- Center for Neural Science, New York University, New York, NY 10003, United States
| | - Scott J Moeller
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, United States
| | - Rita Z Goldstein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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Affiliation(s)
- Scott J. Moeller
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at
Mount Sinai, New York, NY 10029
| | - Anna B. Konova
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at
Mount Sinai, New York, NY 10029
| | - Rita Z. Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at
Mount Sinai, New York, NY 10029 ,Correspondence may be addressed to: Rita Z. Goldstein, One
Gustave L. Levy Place, Box 1230, New York, NY 10029-6574; tel. (212) 824-9312; fax (212)
996-8931;
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Moeller SJ, Froböse MI, Konova AB, Misyrlis M, Parvaz MA, Goldstein RZ, Alia-Klein N. Common and distinct neural correlates of inhibitory dysregulation: stroop fMRI study of cocaine addiction and intermittent explosive disorder. J Psychiatr Res 2014; 58:55-62. [PMID: 25106072 PMCID: PMC4163519 DOI: 10.1016/j.jpsychires.2014.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/20/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
Despite the high prevalence and consequences associated with externalizing psychopathologies, little is known about their underlying neurobiological mechanisms. Studying multiple externalizing disorders, each characterized by compromised inhibition, could reveal both common and distinct mechanisms of impairment. The present study therefore compared individuals with intermittent explosive disorder (IED) (N = 11), individuals with cocaine use disorder (CUD) (N = 21), and healthy controls (N = 17) on task performance and functional magnetic resonance imaging (fMRI) activity during an event-related color-word Stroop task; self-reported trait anger expression was also collected in all participants. Results revealed higher error-related activity in the two externalizing psychopathologies as compared with controls in two subregions of the dorsolateral prefrontal cortex (DLPFC) (a region known to be involved in exerting cognitive control during this task), suggesting a neural signature of inhibitory-related error processing common to these psychopathologies. Interestingly, in one DLPFC subregion, error-related activity was especially high in IED, possibly indicating a specific neural correlate of clinically high anger expression. Supporting this interpretation, error-related DLPFC activity in this same subregion positively correlated with trait anger expression across all participants. These collective results help to illuminate common and distinct neural signatures of impaired self-control, and could suggest novel therapeutic targets for increasing self-control in clinical aggression specifically and/or in various externalizing psychopathologies more generally.
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Affiliation(s)
- Scott J. Moeller
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Monja I. Froböse
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, 6500 HB Nijmegen, the Netherlands
| | - Anna B. Konova
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Psychology, Stony Brook University, Stony Brook, NY 11794
| | - Michail Misyrlis
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Computer Science, Stony Brook University, Stony Brook, NY 11794
| | - Muhammad A. Parvaz
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Rita Z. Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Nelly Alia-Klein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Moeller SJ, Parvaz MA, Shumay E, Wu S, Beebe-Wang N, Konova AB, Misyrlis M, Alia-Klein N, Goldstein RZ. Monoamine polygenic liability in health and cocaine dependence: imaging genetics study of aversive processing and associations with depression symptomatology. Drug Alcohol Depend 2014; 140:17-24. [PMID: 24837582 PMCID: PMC4053494 DOI: 10.1016/j.drugalcdep.2014.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/10/2014] [Accepted: 04/14/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Gene polymorphisms that affect serotonin signaling modulate reactivity to salient stimuli and risk for emotional disturbances. Here, we hypothesized that these serotonin genes, which have been primarily explored in depressive disorders, could also have important implications for drug addiction, with the potential to reveal important insights into drug symptomatology, severity, and/or possible sequelae such as dysphoria. METHODS Using an imaging genetics approach, the current study tested in 62 cocaine abusers and 57 healthy controls the separate and combined effects of variations in the serotonin transporter (5-HTTLPR) and monoamine oxidase A (MAOA) genes on processing of aversive information. Reactivity to standardized unpleasant images was indexed by a psychophysiological marker of stimulus salience (i.e., the late positive potential (LPP) component of the event-related potential) during passive picture viewing. Depressive symptomatology was assessed with the Beck Depression Inventory (BDI). RESULTS Results showed that, independent of diagnosis, the highest unpleasant LPPs emerged in individuals with MAOA-Low and at least one 'Short' allele of 5-HTTLPR. Uniquely in the cocaine participants with these two risk variants, higher unpleasant LPPs correlated with higher BDI scores. CONCLUSIONS Taken together, these results suggest that a multilocus genetic composite of monoamine signaling relates to depression symptomatology through brain function associated with the experience of negative emotions. This research lays the groundwork for future studies that can investigate clinical outcomes and/or pharmacogenetic therapies in drug addiction and potentially other psychopathologies of emotion dysregulation.
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Affiliation(s)
- Scott J Moeller
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Muhammad A Parvaz
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Elena Shumay
- Department of Biosciences, Brookhaven National Laboratory, Upton, NY 11973, United States of America
| | - Salina Wu
- Department of Biosciences, Brookhaven National Laboratory, Upton, NY 11973, United States of America
| | - Nicasia Beebe-Wang
- Department of Biosciences, Brookhaven National Laboratory, Upton, NY 11973, United States of America
| | - Anna B Konova
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Department of Psychology, Stony Brook University, Stony Brook, NY 11794, United States of America
| | - Michail Misyrlis
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Department of Computer Science, Stony Brook University, Stony Brook, NY 11794, United States of America
| | - Nelly Alia-Klein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Rita Z Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
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Parvaz MA, Maloney T, Moeller SJ, Malaker P, Konova AB, Alia-Klein N, Goldstein RZ. Multimodal evidence of regional midcingulate gray matter volume underlying conflict monitoring. Neuroimage Clin 2014; 5:10-8. [PMID: 24918068 PMCID: PMC4050316 DOI: 10.1016/j.nicl.2014.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/23/2014] [Accepted: 05/23/2014] [Indexed: 12/29/2022]
Abstract
Functional neuroimaging studies have long implicated the mid-cingulate cortex (MCC) in conflict monitoring, but it is not clear whether its structural integrity (i.e., the gray matter volume) influences its conflict monitoring function. In this multimodal study, we used T1-weighted MRI scans as well as event-related potentials (ERPs) to test whether the MCC gray matter volume is associated with the electrocortical marker (i.e., No-go N200 ERP component) of conflict monitoring in healthy individuals. The specificity of such a relationship in health was determined in two ways: by (A) acquiring the same data from individuals with cocaine use disorder (CUD), known to have deficits in executive function including behavioral monitoring; and (B) acquiring the P300 ERP component that is linked with attention allocation and not specifically with conflict monitoring. Twenty-five (39.1 ± 8.4 years; 8 females) healthy individuals and 25 (42.7 ± 5.9 years; 6 females) individuals with CUD underwent a rewarded Go/No-go task during which the ERP data was collected, and they also underwent a structural MRI scan. The whole brain regression analysis showed a significant correlation between MCC structural integrity and the well-known ERP measure of conflict monitoring (N200, but not the P300) in healthy individuals, which was absent in CUD who were characterized by reduced MCC gray matter volume, N200 abnormalities as well as reduced task accuracy. In individuals with CUD instead, the N200 amplitude was associated with drug addiction symptomatology. These results show that the integrity of MCC volume is directly associated with the electrocortical correlates of conflict monitoring in healthy individuals, and such an association breaks down in psychopathologies that impact these brain processes. Taken together, this MCC–N200 association may serve as a biomarker of improved behavioral monitoring processes in diseased populations. No-go N200 amplitude is correlated with gray matter volume of the midcingulate cortex in controls. Such N200-midcingulate association is absent in individuals with cocaine use disorder (CUD). In the CUD group, No-go N200 amplitude is correlated with withdrawal symptoms. N200-midcingulate association can serve as a biomarker of intact conflict monitoring.
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Affiliation(s)
- Muhammad A Parvaz
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Thomas Maloney
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Scott J Moeller
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pias Malaker
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Anna B Konova
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA ; Department of Psychology, Stony Brook University, Stony Brook, NY 11790, USA
| | - Nelly Alia-Klein
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rita Z Goldstein
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Abstract
IMPORTANCE Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions mediating insight and self-awareness. OBJECTIVE To investigate the neural correlates of impaired insight in addiction using a combined functional magnetic resonance imaging and voxel-based morphometry approach. DESIGN, SETTING, AND PARTICIPANTS This multimodal imaging study was performed at the Clinical Research Center at Brookhaven National Laboratory. The study included 33 CUD cases and 20 healthy controls. MAIN OUTCOMES AND MEASURES Functional magnetic resonance imaging, voxel-based morphometry, Levels of Emotional Awareness Scale, and drug use variables. RESULTS Compared with the other 2 study groups, the impaired insight CUD group had lower error-induced rostral anterior cingulate cortex (rACC) activity as associated with more frequent cocaine use, less gray matter within the rACC, and lower Levels of Emotional Awareness Scale scores. CONCLUSIONS AND RELEVANCE These results point to rACC functional and structural abnormalities and diminished emotional awareness in a subpopulation of CUD cases characterized by impaired insight. Because the rACC has been implicated in appraising the affective and motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments that target this CUD subgroup could focus on enhancing the salience of errors (eg, lapses).
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Affiliation(s)
- Scott J. Moeller
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Anna B. Konova
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Department of Psychology, Stony Brook University, Stony Brook, NY 11794
| | - Muhammad A. Parvaz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Dardo Tomasi
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892
| | - Richard D. Lane
- Department of Psychiatry, University of Arizona, Tuscon, AZ 85724
| | - Carolyn Fort
- Department of Psychiatry, University of Arizona, Tuscon, AZ 85724
| | - Rita Z. Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029,Correspondence and requests for materials should be addressed to: Rita Z. Goldstein, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574; tel. (212) 659-8838; fax (212) 996-8931;
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Konova AB, Moeller SJ, Goldstein RZ. Common and distinct neural targets of treatment: changing brain function in substance addiction. Neurosci Biobehav Rev 2013; 37:2806-17. [PMID: 24140399 DOI: 10.1016/j.neubiorev.2013.10.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/17/2013] [Accepted: 10/08/2013] [Indexed: 01/28/2023]
Abstract
Neuroimaging offers an opportunity to examine the neurobiological effects of therapeutic interventions for human drug addiction. Using activation likelihood estimation, the aim of the current meta-analysis was to quantitatively summarize functional neuroimaging studies of pharmacological and cognitive-based interventions for drug addiction, with an emphasis on their common and distinct neural targets. More exploratory analyses also contrasted subgroups of studies based on specific study and sample characteristics. The ventral striatum, a region implicated in reward, motivation, and craving, and the inferior frontal gyrus and orbitofrontal cortex, regions involved in inhibitory control and goal-directed behavior, were identified as common targets of pharmacological and cognitive-based interventions; these regions were observed when the analysis was limited to only studies that used established or efficacious interventions, and across imaging paradigms and types of addictions. Consistent with theoretical models, cognitive-based interventions were additionally more likely to activate the anterior cingulate cortex, middle frontal gyrus, and precuneus, implicated in self-referential processing, cognitive control, and attention. These results suggest that therapeutic interventions for addiction may target the brain structures that are altered across addictions and identify potential neurobiological mechanisms by which the tandem use of pharmacological and cognitive-based interventions may yield synergistic or complementary effects. These findings could inform the selection of novel functional targets in future treatment development for this difficult-to-treat disorder.
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Affiliation(s)
- Anna B Konova
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Psychology, Stony Brook University, Stony Brook, NY 11794, United States
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Konova AB, Moeller SJ, Tomasi D, Volkow ND, Goldstein RZ. Effects of methylphenidate on resting-state functional connectivity of the mesocorticolimbic dopamine pathways in cocaine addiction. JAMA Psychiatry 2013; 70:857-68. [PMID: 23803700 PMCID: PMC4358734 DOI: 10.1001/jamapsychiatry.2013.1129] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Cocaine addiction is associated with altered resting-state functional connectivity among regions of the mesocorticolimbic dopamine pathways. Methylphenidate hydrochloride, an indirect dopamine agonist, normalizes task-related regional brain activity and associated behavior in cocaine users; however, the neural systems-level effects of methylphenidate in this population have not yet been described. OBJECTIVE To use resting-state functional magnetic resonance imaging to examine changes in mesocorticolimbic connectivity with methylphenidate and how connectivity of affected pathways relates to severity of cocaine addiction. DESIGN Randomized, placebo-controlled, before-after, crossover study. SETTING Clinical research center. PARTICIPANTS Eighteen nonabstaining individuals with cocaine use disorders. INTERVENTIONS Single doses of oral methylphenidate (20 mg) or placebo were administered at each of 2 study sessions. At each session, resting scans were acquired twice: immediately after drug administration (before the onset of effects [baseline]) and 120 minutes later (within the window of peak effects). MAIN OUTCOMES AND MEASURES Functional connectivity strength was evaluated using a seed voxel correlation approach. Changes in this measure were examined to characterize the neural systems-level effects of methylphenidate; severity of cocaine addiction was assessed by interview and questionnaire. RESULTS Short-term methylphenidate administration reduced an abnormally strong connectivity of the ventral striatum with the dorsal striatum (putamen/globus pallidus), and lower connectivity between these regions during placebo administration uniquely correlated with less severe addiction. In contrast, methylphenidate strengthened several corticolimbic and corticocortical connections. CONCLUSIONS AND RELEVANCE These findings help elucidate the neural systems-level effects of methylphenidate and suggest that short-term methylphenidate can, at least transiently, remodel abnormal circuitry relevant to the pathophysiologic characteristics of cocaine addiction. In particular, the effects of methylphenidate within striatal and cortical pathways constitute a potentially viable mechanism by which methylphenidate could facilitate control of behavior in cocaine addiction.
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Affiliation(s)
- Anna B Konova
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
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Moeller SJ, Beebe-Wang N, Woicik PA, Konova AB, Maloney T, Goldstein RZ. Choice to view cocaine images predicts concurrent and prospective drug use in cocaine addiction. Drug Alcohol Depend 2013; 130:178-85. [PMID: 23218913 PMCID: PMC3609942 DOI: 10.1016/j.drugalcdep.2012.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/01/2012] [Accepted: 11/01/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Identifying variables that predict drug use in treatment-seeking drug addicted individuals is a crucial research and therapeutic goal. This study tested the hypothesis that choice to view cocaine images is associated with concurrent and prospective drug use in cocaine addiction. METHODS To establish choice-concurrent drug use associations, 71 cocaine addicted subjects (43 current users and 28 treatment seekers) provided data on (A) choice to view cocaine images and affectively pleasant, unpleasant, and neutral images [collected under explicit contingencies (when choice was made between two fully visible side-by-side images) and under more probabilistic contingencies (when choice was made between pictures hidden under flipped-over cards)]; and (B) past-month cocaine and other drug use. To establish choice-prospective drug use associations, 20 of these treatment-seeking subjects were followed over the next 6 months. RESULTS Baseline cocaine-related picture choice as measured by both tasks positively correlated with subjects' concurrent cocaine and other drug use as driven by the actively-using subjects. In a subsequent multiple regression analysis, choice to view cocaine images as compared with affectively pleasant images (under probabilistic contingencies) was the only predictor that continued to be significantly associated with drug use. Importantly, this same baseline cocaine>pleasant probabilistic choice also predicted the number of days drugs were used (cocaine, alcohol, and marijuana) over the next 6 months. CONCLUSIONS Simulated cocaine choice - especially when probabilistic and when compared with other positive reinforcers - may provide a valid laboratory marker of current and future drug use in cocaine addiction.
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Affiliation(s)
| | | | | | - Anna B. Konova
- Brookhaven National Laboratory, Upton, NY 11973,Stony Brook University, Stony Brook, New York 11794
| | | | - Rita Z. Goldstein
- Brookhaven National Laboratory, Upton, NY 11973,Correspondence and requests for materials should be addressed to: Rita Z. Goldstein, Medical Research, Brookhaven National Laboratory, 30 Bell Ave., Bldg. 490, Upton, NY, 11973-5000; tel. (631) 344-2657; fax (631) 344-5260;
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Konova AB, Moeller SJ, Tomasi D, Parvaz MA, Alia-Klein N, Volkow ND, Goldstein RZ. Structural and behavioral correlates of abnormal encoding of money value in the sensorimotor striatum in cocaine addiction. Eur J Neurosci 2012; 36:2979-88. [PMID: 22775285 DOI: 10.1111/j.1460-9568.2012.08211.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abnormalities in frontostriatal systems are thought to be central to the pathophysiology of addiction, and may underlie the maladaptive processing of the highly generalizable reinforcer, money. Although abnormal frontostriatal structure and function have been observed in individuals addicted to cocaine, it is less clear how individual variability in brain structure is associated with brain function to influence behavior. Our objective was to examine frontostriatal structure and neural processing of money value in chronic cocaine users and closely matched healthy controls. A reward task that manipulated different levels of money was used to isolate neural activity associated with money value. Gray matter volume measures were used to assess frontostriatal structure. Our results indicated that cocaine users had an abnormal money value signal in the sensorimotor striatum (right putamen/globus pallidus) that was negatively associated with accuracy adjustments to money and was more pronounced in individuals with more severe use. In parallel, group differences were also observed in both the function and gray matter volume of the ventromedial prefrontal cortex; in the cocaine users, the former was directly associated with response to money in the striatum. These results provide strong evidence for abnormalities in the neural mechanisms of valuation in addiction and link these functional abnormalities with deficits in brain structure. In addition, as value signals represent acquired associations, their abnormal processing in the sensorimotor striatum, a region centrally implicated in habit formation, could signal disadvantageous associative learning in cocaine addiction.
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Affiliation(s)
- Anna B Konova
- Medical Research, Brookhaven National Laboratory, Upton, NY, USA
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Parvaz MA, Konova AB, Tomasi D, Volkow ND, Goldstein RZ. Structural integrity of the prefrontal cortex modulates electrocortical sensitivity to reward. J Cogn Neurosci 2011; 24:1560-70. [PMID: 22098260 DOI: 10.1162/jocn_a_00166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The P300 is a known ERP component assessing stimulus value, including the value of a monetary reward. In parallel, the incentive value of reinforcers relies on the PFC, a major cortical projection region of the mesocortical reward pathway. Here we show a significant positive correlation between P300 response to money (vs. no money) with PFC gray matter volume in the OFC, ACC, and dorsolateral and ventrolateral PFC in healthy control participants. In contrast, individuals with cocaine use disorders showed compromises in both P300 sensitivity to money and PFC gray matter volume in the ventrolateral PFC and OFC and their interdependence. These results document for the first time the importance of gray matter structural integrity of subregions of PFC to the reward-modulated P300 response.
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Horga G, Parellada E, Lomeña F, Fernández-Egea E, Mané A, Font M, Falcón C, Konova AB, Pavia J, Ros D, Bernardo M. Differential brain glucose metabolic patterns in antipsychotic-naïve first-episode schizophrenia with and without auditory verbal hallucinations. J Psychiatry Neurosci 2011; 36:312-21. [PMID: 21266125 PMCID: PMC3163647 DOI: 10.1503/jpn.100085] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) are a core symptom of schizophrenia. Previous reports on neural activity patterns associated with AVHs are inconsistent, arguably owing to the lack of an adequate control group (i.e., patients with similar characteristics but without AVHs) and neglect of the potential confounding effects of medication. METHODS The current study was conducted in a homogeneous group of patients with schizophrenia to assess whether the presence or absence of AVHs was associated with differential regional cerebral glucose metabolic patterns. We investigated differences between patients with commenting AVHs and patients without AVHs among a group of dextral antipsychotic-naive inpatients with acute first-episode schizophrenia examined with [(18)F]fluoro-deoxyglucose positron emission tomography (FDG-PET) at rest. Univariate and multivariate approaches were used to establish between-group differences. RESULTS We included 9 patients with AVHs and 7 patients without AVHs in this study. Patients experiencing AVHs during FDG uptake had significantly higher metabolic rates in the left superior and middle temporal cortices, bilateral superior medial frontal cortex and left caudate nucleus (cluster level p < 0.005, family wise error-corrected, and bootstrap ratio > 3.3, respectively). Additionally, the multivariate method identified hippocampal-parahippocampal, cerebellar and parietal relative hypoactivity during AVHs in both hemispheres (bootstrap ratio < -3.3). LIMITATIONS The FDG-PET imaging technique does not provide information regarding the temporal course of neural activity. The limited sample size may have increased the risk of false-negative findings. CONCLUSION Our results indicate that AVHs in patients with schizophrenia may be mediated by an alteration of neural pathways responsible for normal language function. Our findings also point to the potential role of the dominant caudate nucleus and the parahippocampal gyri in the pathophysiology of AVHs. We discuss the relevance of phenomenology-based grouping in the study of AVHs.
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Affiliation(s)
- Guillermo Horga
- Clinic Schizophrenia Program, Psychiatry Department, Hospital Clinic of Barcelona, Barcelona, Spain.
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Alia-Klein N, Parvaz MA, Woicik PA, Konova AB, Maloney T, Shumay E, Wang R, Telang F, Biegon A, Wang GJ, Fowler JS, Tomasi D, Volkow ND, Goldstein RZ. Gene x disease interaction on orbitofrontal gray matter in cocaine addiction. ACTA ACUST UNITED AC 2011; 68:283-94. [PMID: 21383264 DOI: 10.1001/archgenpsychiatry.2011.10] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Long-term cocaine use has been associated with structural deficits in brain regions having dopamine-receptive neurons. However, the concomitant use of other drugs and common genetic variability in monoamine regulation present additional structural variability. OBJECTIVE To examine variations in gray matter volume (GMV) as a function of lifetime drug use and the genotype of the monoamine oxidase A gene, MAOA, in men with cocaine use disorders (CUD) and healthy male controls. DESIGN Cross-sectional comparison. SETTING Clinical Research Center at Brookhaven National Laboratory. PATIENTS Forty individuals with CUD and 42 controls who underwent magnetic resonance imaging to assess GMV and were genotyped for the MAOA polymorphism (categorized as high- and low-repeat alleles). MAIN OUTCOME MEASURES The impact of cocaine addiction on GMV, tested by (1) comparing the CUD group with controls, (2) testing diagnosis × MAOA interactions, and (3) correlating GMV with lifetime cocaine, alcohol, and cigarette smoking, and testing their unique contribution to GMV beyond other factors. RESULTS (1) Individuals with CUD had reductions in GMV in the orbitofrontal, dorsolateral prefrontal, and temporal cortex and the hippocampus compared with controls. (2) The orbitofrontal cortex reductions were uniquely driven by CUD with low- MAOA genotype and by lifetime cocaine use. (3) The GMV in the dorsolateral prefrontal cortex and hippocampus was driven by lifetime alcohol use beyond the genotype and other pertinent variables. CONCLUSIONS Long-term cocaine users with the low-repeat MAOA allele have enhanced sensitivity to gray matter loss, specifically in the orbitofrontal cortex, indicating that this genotype may exacerbate the deleterious effects of cocaine in the brain. In addition, long-term alcohol use is a major contributor to gray matter loss in the dorsolateral prefrontal cortex and hippocampus, and is likely to further impair executive function and learning in cocaine addiction.
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Affiliation(s)
- Nelly Alia-Klein
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973-5000, USA.
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