线索诱发海洛因依赖者心理渴求及相关因素分析

目的　了解环境线索对海洛因依赖者心理渴求的影响及其相关因素。方法　380名戒断 期海洛因依赖者暴露于海洛因相关环境线索,测量暴露前后血压、心率、瞳孔,Likert分级法记录暴露前 后的渴求程度,完成自编诱发后戒断反应问卷及自编毒品使用情况和一般社会学资料。采用配对t检 验,比较暴露前后渴求程度及心率、血压等生理指标的变化,运用逐步回归分析与线索诱发渴求相关的 指标。结果　暴露后渴求、心率、血压及瞳孔均明显高于暴露前,差别有极显著意义(分别为t= -15.02,-14.23,-8.12,-5.03,-14.65,P<0.01)。诱发渴求与毒品依赖自评分值、诱发后心率及 主观戒断反应呈正相关,与成瘾时间呈成负相关。结论　环境线索可以使戒断期海洛因依赖者心理渴 求明显增加,依赖自评分值、诱发后心率、主观戒断反应及成瘾时间均与诱发渴求程度相关。     

戒断期海洛因依赖者额叶认知功能的功能磁共振成像研究

目的 研究戒断期海洛因依赖者(AHD)的脑认知功能.方法 采用3.0 T磁共振成像系统,对30例AHD(AHD组)和18名健康对照者(对照组)在完成Go/NoGo任务时行全脑功能磁共振成像(fMRI)扫描,记录反应时间(RT).结果 (1)RT:AHD组在完成Go/NoGo任务时的RT[(394±34)ms]长于对照组[(374±26)ms;P<0.05].(2)fMRI:对照组在完成Go/NoGo任务时,诱发激活双侧前额叶内侧回、前扣带回以及双侧额下回等脑区;AHD组全脑活动普遍低,仅有双侧额上回和左侧额中回激活.两组间比较,AHD组激活显著低于对照组的区域主要位于在双侧额内侧回、前扣带回、额下回及双侧颞叶等脑区(P<0.005).结论 戒断期海洛因依赖者反应抑制功能障碍仍然存在,促进其认知功能的恢复可能成为戒毒、抗复吸的有效策略.     

5-羟色胺2A受体基因多态与海洛因成瘾及渴求程度的关联分析

目的探讨5-HT2A-1438A／G基因多态与海洛因成瘾及线索诱发海洛因渴求程度的关系。方法采 用PCR-RFLP技术对380例海洛因依赖者(依赖组)和275名健康人(对照组)的5-HT2A-1438A／G基因多态进行检 测,并对依赖组行线索诱发海洛因渴求实验。比较依赖组和对照组的5-HT2A-1438A／G多态基因型及等位基因频 率,分析依赖组不同基因型与线索诱发海洛因渴求程度和主观戒断反应的关系。结果 (1)依赖组与对照组的5- HT2A-1438A／G的基因型和等位基因频率均无显著性差异(P>0．05)。(2)依赖组中,5-HT2A-1438A／G的3种多态 基因型诱发渴求和主观戒断反应的差异有统计学意义(P<0．05),G／G基因型诱发渴求和主观戒断反应均小于A／ A(P=0．024,P=0．009)和A／G(P=0．018,P=0．011)基因型。结论未发现5-HT2A-1438A／G基因多态与海洛 因成瘾有关,但该基因多态性与线索诱发海洛因的渴求程度有关,A+(A／A和A／G)携带者线索诱发海洛因的渴求 程度和主观戒断反应明显高于A-(G／G)携带者。     

海洛因依赖者环境线索诱发心理生理反应

目的：了解海洛因依赖者对吸毒相关环境线索诱发反应。方法：对来自自愿戒毒机构的36例刚完成生理脱毒（康复早期）的海洛因依赖者和劳教戒毒机构112例康复期满1年的海洛因依赖者观看吸毒相关视频同时给予海洛因模拟物及吸毒用具刺激,于暴露前后自评渴求程度、情绪以及戒断症状反应;用生物反馈仪自动记录暴露前后的生理反应。结果：环境线索暴露后海洛因依赖者心理渴求、害怕／焦虑、抑郁／悲伤、戒断症状、心率、皮肤导电和肌电增高（P〈0．05）,中性／放松／自然降低（P〈0．05）。自愿戒毒机构康复早期海洛因依赖者环境诱发心率增高,比康复期满一年以上者更明显（P〈0．05）,其余与康复期长短无显著关系。结论：海洛因依赖者戒断康复期的延长并不会使渴求和环境诱发心理生理反应减弱或消褪。     

环境线索对戒断期海洛因依赖者神经电生理的影响

目的 了解戒断期海洛因依赖者暴露在吸毒相关环境线索下神经电生理指标的变化特点.方法 采用自身配对设计,指导382例戒断康复期的海洛因依赖者进行放松训练后,观看吸毒相关视频及展示的海洛因模拟物及吸毒用具,同时采用多导联生物反馈仪记录环境线索暴露前后神经电生理指标,评估暴露前后的心理渴求程度,分析心理渴求程度及神经电生理各指标的变化特点.结果 (1)海洛因相关环境线索暴露后,心理渴求程度较暴露前增加[暴露前:(18±22)mm;暴露后:(29±29)mm],肌电[暴露前:(12±7)μV;暴露后:(14±10)μV]及皮肤导电性[暴露前:(6.8±4.3)μS;暴露后:(7.4±4.3)μS]均增加(P<0.01).(2)线索暴露中的脑电各项指标[δ波、θ波、α波、感觉运动节律(SMR)、低β波和高β波的百分率]均低于诱发前(P<0.01～0.05).(3)心理渴求变化与脑电θ波、α波和SMR呈负相关(相关系数为-0.13、-0.12和-0.12);除肌电、δ波外,上述各电生理指标与皮肤导电性之间呈负相关(Pearson相关系数为-0.18～-0.22);余各项指标间呈正相关.结论 海洛因依赖者暴露在吸毒相关环境时,诱发心理渴求反应增强,并引起多项神经电生理指标的变化.     

多巴胺D2受体TaqI A多态性与海洛因渴求程度的关联分析

目的探讨多巴胺D2受体TaqI A多态性与线索诱发海洛因渴求程度的关系.方法 380名海洛因依赖者接受环境诱发渴求实验,用PCR-RFLP技术检测DRD2受体TaqI A多态性,比较不同基因型与线索暴露前后渴求程度的关系. 结果强制戒毒被试者基因型与暴露前后渴求程度未见显示差异(P＞0.05).自愿戒断被试者基因型与诱发后渴求分值、暴露前后渴求分差值的差异有显著性(F=4.523,P=0.012;F=3.936,P=0.021),A1/A1基因型被试者暴露后渴求程度高于A2/A2(P=0.027,P=0.019)和A1/A2(P=0.032,P=0.035)被试者.三者基因型在成瘾、加量和海洛因使用时间差异上有显著性(P=0.014,P=0.001,P=0.004).A1/A1基因型个体成瘾时间和加量时间小于A2/A2(P=0.007,P=0.001)和A1/A2(P=0.023,P=0.001)基因型个体,但吸毒时间大于A1/A2(P=0.003)和A2/A2(P=0.002)基因型个体. 结论 DRD2受体基因TaqI A多态性可能与环境诱发海洛因渴求程度易感性和成瘾、加量及毒品使用时间有关,A2+(A2/A2,A1/A2)基因型可能在海洛因依赖中起保护作用,而A2-(A1/A1)基因型则可能具有促进作用.     

海洛因依赖者环境线索诱发渴求的影响因素分析

目的 研究康复期海洛因依赖者环境诱发渴求的影响因素.方法 从环境生物心理角度收集407例海洛因依赖者的人口学资料、社会支持、药物滥用与治疗情况、心理健康水平、气质性格特点以及自尊与自我效能感等,并进行海洛因相关环境线索诱发试验,评估诱发前后的渴求程度,采用非条件Logistic回归分析环境线索诱发渴求增高的影响因素.结果 回归分析显示,"诱发前渴求程度"、"亲密朋友同学有无吸毒"和"新异刺激寻求"3个因素是环境诱发渴求的影响因素(OR分别为1.36、1.71、1.62,P均小于0.05),其标准回归系数分别为0.31、0.54和0.48.基线渴求越高、亲密朋友同学中有吸毒行为以及明显的新异刺激寻求人格特性,则环境诱发渴求增高的机率越大.结论 环境线索诱发渴求程度的增高受生物环境心理多因素的影响,需采取综合干预模式降低渴求继而降低复吸率.     

多巴胺D4受体基因多态性与海洛因依赖及渴求程度的关系

目的 探讨DRD4 exon Ⅲ 48bp可变串连重复序列（VNTR）与海洛因成瘾及线索诱发海洛因渴求程度的关系。方法 采用美国ABI公司3100基因分析仪对380名海洛因依赖者（依赖组）和275名健康对照者（对照组）的DRD4 exon Ⅲ 48bpVNTR基因多态进行检测,并给予依赖组实施线索诱发海洛因渴求实验。比较依赖组和对照组的DRD4 exon Ⅲ 48bpVNTR多态的基因型及等位基因频率是否有差异,分析不同基因型与线索诱发海洛因渴求程度的关系。结果 （1）依赖组与对照组相比．DRD4exon Ⅲ 48bpVNTR多态的基因型和等位基因频率差异均无显著性（P〉0．05）。（2）依赖组中,DRD4 exon Ⅲ 48bpVNTR长重复基因型诱发的渴求高于短重复基因型（P〈0．05）。结论 未发现DRD4 exon Ⅲ 48bpVNTR基因多态与海洛因成瘾有关,但该基因多态与线索诱发海洛因的渴求程度有关,长重复基因型线索诱发的海洛因渴求程度明显高于短重复基因型。     

强制和自愿戒毒者线索诱发海洛因渴求反应的差异

目的 比较环境线索诱发强制和自愿戒毒者海洛因渴求反应的差异。方法 208名强制戒毒被试者和172名自愿戒毒被试者暴露于海洛因相关环境线索,根据被试者的自我报告,采用Likert分级法评价线索诱发的渴求程度,填写主观戒断反应问卷、毒品使用情况和一般社会学资料,并测量暴露前后血压、心率及瞳孔。采用独立样本t检验,比较线索暴露诱发强制和自愿戒毒被试者渴求及生理指标的差异。结果 暴露后,自愿戒毒被试者的渴求分值明显高于强制戒毒被试者（P〈0．01）,强制戒毒被试者暴露前的收缩压和舒张压均明显高于自愿戒毒被试者（P〈0．01）,但暴露后两组血压未见显著性差异（P〉0．05）。结论 环境线索诱发强制和自愿戒毒被试者渴求反应存在差异,可能与实验地点、调查者和测量方法的不同有关。     

性别对海洛因相关环境线索诱发心理生理反应的影响

目的 了解康复期海洛因依赖者对吸毒相关环境线索的心理生理反应的性别差异.方法 采用自身配对设计,173例男性和235例女性康复期海洛因依赖者观看吸毒相关视频的同时给予海洛因模拟物及吸毒用具刺激,用生物反馈仪记录诱发前、中、后的心理生理反应.结果 环境线索诱发使男女海洛因依赖者的皮温随时间变化而不同,其中诱发中与诱发后阶段比较差异有统计学意义(P＜0.05);环境线索诱发导致女性诱发中阶段的呼吸频率和诱发后阶段的皮温均低于男性(P＜0.01).结论 环境线索诱发对男女性的呼吸频率和皮温指标反应具有不同影响,且性别对皮温的影响随时间阶段的变化而不同.     

基于独立成分分析方法的海洛因成瘾者功能磁共振成像研究

目的 使用独立成分分析(ICA)法分析功能磁共振(fMRI)数据研究线索诱导因素导致海洛因成瘾者复吸的神经网络. 方法 安徽医科大学附属省立医院神经外科自2010年2月至2010年12月对海洛因成瘾组(n=15,来自安徽省戒毒康复中心)和正常对照组(n=15,来自招募的志愿者)在接受吸毒相关场景视频刺激的同时进行fMRI扫描,然后使用ICA方法对数据进行分析和比较2组受试者脑区的激活情况. 结果 与正常对照组相比,海洛因成瘾组患者双侧前额叶、左前扣带回、双侧后扣带回、左侧顶叶、左侧颞下回的激活降低;双侧伏核、右侧海马以及部分枕叶的激活增强,差异有统计学意义(P＜0.05). 结论 ICA方法是一种有效的任务相关fMRI数据分析方法,海洛因成瘾者学习记忆和奖赏系统相关脑区功能改变是线索诱发复吸的重要原因,主要涉及左前额叶、左顶叶、前后扣带回、海马、伏核等脑区.     

Acupuncture inhibits cue-induced heroin craving and brain activation

Previous research using functional MRI has shown that specific brain regions associated with drug dependence and cue-elicited heroin craving are activated by environmental cues. Craving is an important trigger of heroin relapse, and acupuncture may inhibit craving. In this study, we performed functional MRI in heroin addicts and control subjects. We compared differences in brain activation between the two groups during heroin cue exposure, heroin cue exposure plus acupuncture at the Zusanli point (ST36) without twirling of the needle, and heroin cue exposure plus acupuncture at the Zusanli point with twirling of the needle. Heroin cue exposure elicited significant activation in craving-related brain regions mainly in the frontal lobes and callosal gyri. Acupuncture without twirling did not significantly affect the range of brain activation induced by heroin cue exposure, but significantly changed the extent of the activation in the heroin addicts group. Acupuncture at the Zusanli point with twirling of the needle significantly decreased both the range and extent of activation induced by heroin cue exposure compared with heroin cue exposure plus acupuncture without twirling of the needle. These experimental findings indicate that presentation of heroin cues can induce activation in craving-related brain regions, which are involved in reward, learning and memory, cognition and emotion. Acupuncture at the Zusanli point can rapidly suppress the activation of specific brain regions related to craving, supporting its potential as an intervention for drug craving.     

Effects of Acute Nicotine Abstinence on Cue-elicited Ventral Striatum/Nucleus Accumbens Activation in Female Cigarette Smokers: A Functional Magnetic Resonance Imaging Study

To achieve greater understanding of the brain mechanisms underlying nicotine craving in female smokers, we examined the influence of nicotine non-abstinence vs. acute nicotine abstinence on cue-elicited activation of the ventral striatum. Eight female smokers underwent an event-related functional magnetic resonance imaging (fMRI) paradigm presenting randomized sequences of smoking-related and non-smoking related pictures. Participants were asked to indicate by a key press the gender of individuals in smoking-related and non-smoking related pictures (gender discrimination task), to maintain and evaluate attention to the pictures. There was a significant effect of smoking condition on reaction times (RT) for a gender discrimination task intended to assess and maintain attention to the photographs-suggesting a deprivation effect of acute nicotine abstinence and a statistical trend indicating greater RTs for smoking cues than neutral cues. BOLD contrast (smoking vs. non-smoking cues) was greater in the non-abstinent vs. acutely abstinent conditions in the ventral striatum including the nucleus accumbens (VS/NAc). Moreover, a significant positive correlation was observed between baseline cigarette craving prior to scanning and VS/NAc activation (r=0.84, p=0.009), but only in the non-abstinent condition. These results may either be explained by ceiling effects of nicotine withdrawal in the abstinent condition or, may indicate reduced relative activation (smoking vs. neutral contrast) in the VS/NAc in the abstinent vs. non-abstinent conditions in this group of female smokers.     

An analysis of cue reactivity among persons with and without schizophrenia who are addicted to cocaine

OBJECTIVE: Persons with schizophrenia who are addicted to cocaine experience more psychiatric and substance abuse relapses and worse long-term outcomes than persons with only one of these conditions. This study examined whether individuals with cocaine dependence and schizophrenia experience more cue-elicited craving than those without schizophrenia. METHODS: Ninety-one cocaine-dependent participants who had been abstinent from cocaine for at least 72 hours were recruited from substance abuse treatment programs in the Veterans Affairs New Jersey Health Care System. The study used a cue-exposure paradigm to stimulate cocaine craving. A self-report instrument was used to measure changes from baseline in four areas: craving intensity, happy or depressed mood, increased or decreased energy, and physical health or sickness. RESULTS: The participants with schizophrenia (N=35) reported significantly more cocaine craving than those without schizophrenia (N=56). When data for participants who were cue reactive were analyzed without regard to diagnosis, 97 percent of the cocaine-dependent participants with schizophrenia were cue reactive, compared with 43 percent of those without schizophrenia. CONCLUSIONS: Future research on cocaine dependence should focus on craving, particularly among patients with coexisting psychiatric disorders.     

Brain activities associated with gaming urge of online gaming addiction

The aim of this study was to identify the neural substrates of online gaming addiction through evaluation of the brain areas associated with the cue-induced gaming urge. Ten participants with online gaming addiction and 10 control subjects without online gaming addiction were tested. They were presented with gaming pictures and the paired mosaic pictures while undergoing functional magnetic resonance imaging (fMRI) scanning. The contrast in blood-oxygen-level dependent (BOLD) signals when viewing gaming pictures and when viewing mosaic pictures was calculated with the SPM2 software to evaluate the brain activations. Right orbitofrontal cortex, right nucleus accumbens, bilateral anterior cingulate and medial frontal cortex, right dorsolateral prefrontal cortex, and right caudate nucleus were activated in the addicted group in contrast to the control group. The activation of the region-of-interest (ROI) defined by the above brain areas was positively correlated with self-reported gaming urge and recalling of gaming experience provoked by the WOW pictures. The results demonstrate that the neural substrate of cue-induced gaming urge/craving in online gaming addiction is similar to that of the cue-induced craving in substance dependence. The above-mentioned brain regions have been reported to contribute to the craving in substance dependence, and here we show that the same areas were involved in online gaming urge/craving. Thus, the results suggest that the gaming urge/craving in online gaming addiction and craving in substance dependence might share the same neurobiological mechanism.     

Abnormal resting‐state functional connectivity of the nucleus accumbens in multi‐year abstinent heroin addicts

Functional neuroimaging studies suggest that abnormal brain functional connectivity may be the neural underpinning of addiction to illicit drugs and of relapse after successful cessation therapy. Aberrant brain networks have been demonstrated in addicted patients and in newly abstinent addicts. However, it is not known whether abnormal brain connectivity patterns persist after prolonged abstinence. In this cross‐sectional study, whole‐brain resting‐state functional magnetic resonance images (8 min) were collected from 30 heroin‐addicted individuals after a long period of abstinence (more than 3 years) and from 30 healthy controls. We first examined the group differences in the resting‐state functional connectivity of the nucleus accumbens (NAc), a brain region implicated in relapse‐related processes, including craving and reactivity to stress following acute and protracted withdrawal from heroin. We then examined the relation between the duration of abstinence and the altered NAc functional connectivity in the heroin group. We found that, compared with controls, heroin‐dependent participants exhibited significantly greater functional connectivity between the right ventromedial prefrontal cortex and the NAc and weaker functional connectivity between the NAc and the left putamen, left precuneus, and supplementary motor area. However, with longer abstinence time, the strength of NAc functional connectivity with the left putamen increased. These results indicate that dysfunction of the NAc functional network is still present in long‐term‐abstinent heroin‐dependent individuals. © 2015 Wiley Periodicals, Inc.     

EEG spectral power and mean frequencies in early heroin abstinence

The purpose of the present study was to investigate cumulative heroin effects on brain functioning by studying relationships among electroencephalography (EEG) spectral power and mean frequencies and heroin abuse history. Eyes-closed resting EEG data were collected from the 19 monopolar electrode sites in 33 heroin abusers and 13 age-matched healthy volunteers. The mean age of the patients was 23.1+/-4.5 years, the duration of daily heroin abuse (DDHA) ranged from 4 to 44 months, the intravenous doses of heroin ranged from 0.04 to 1.00 g/day, the abstinence length ranged from 6 days to 4.5 months. General linear model (GLM) repeated measures procedure revealed a significant group effect on the distribution of the mean power spectrum between bands and mean frequencies in almost all analyzed derivations. Further analysis demonstrated that these intergroup differences were diversely related to at least three aspects of heroin-taking history. Frequency shifts in alpha2 range, most prominent in frontal and central derivations, were related to duration of daily heroin consumption. Slowing of alpha1 mean frequency, most prominent in central, temporal, and occipital derivations, was registered mainly in heroin addicts who abused high doses of the drug. Spectral power characteristics of brain electrical activities in our patient population were strongly predicted by abstinence length. The present results give grounds to suppose that chronic heroin-taking induces neuronal oscillation frequency changes, which may contribute to the development of antisocial trends and some semantic processes disturbances in these patients. Supplementary neurophysiological deficit is characteristic for heroin addicts who takes high doses of the drug, however, its relation to heroin abuse remains unclear. Pronounced desynchronization is observed in acute heroin withdrawal, and spectral power characteristics tend to normalize almost completely during several weeks of abstinence.