Neural correlates of adherence to extended-release naltrexone pharmacotherapy in heroin dependence.
Neural correlates of adherence to extended-release naltrexone pharmacotherapy in heroin dependence.
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DOI：
10.1038/tp.2015.20
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发表时间：
2015-03-17
影响因子：
6.8
通讯作者：
Langleben DD
中科院分区：
文献类型：
--
作者：
Wang AL;Elman I;Lowen SB;Blady SJ;Lynch KG;Hyatt JM;O'Brien CP;Langleben DD
可注射延长释放纳洛酮（XRNTX）是阿片类药物成瘾的有效治疗策略，但其效用可能会受到依从性差的阻碍。为了更好地了解这一现象，我们利用血氧水平依赖性功能磁共振成像（fMRI）结合一个有效的线索诱导的渴望程序来检查XRNTX坚持的神经相关性。我们将治疗依从性操作为每月XRNTX注射次数（范围：0-3）给予一组完全脱毒的海洛因依赖受试者（n=32）。其他结果包括尿液毒理学筛查和自我报告的烟草使用。所提出的海洛因相关的视觉线索可靠地引起所有测试对象的海洛因渴望。分别有9名、5名、3名和15名参与者接受了0次、1次、2次和3次XRNTX注射，这是通过内侧前额叶皮层（一个参与抑制性自我控制和情绪评估的大脑区域）中的线索对个体基线fMRI信号变化的反应来预测的。XRNTX治疗期间阿片类药物阳性尿液的发生率较低，在XRNTX结束后仍保持约一半的治疗前发生率。在治疗期间，吸烟行为遵循阿片类药物使用模式，而可卡因消费量随着阿片类药物使用的减少而增加。目前的数据支持这一假设，内侧前额叶皮质功能参与阿片拮抗剂治疗的坚持。在XRNTX药物治疗期间同时服用非阿片类成瘾物质的潜在作用值得进一步研究。我们的研究结果为进一步研究阿片类药物依赖预防复发的机制奠定了基础。
Injectable extended-release naltrexone (XRNTX) presents an effective therapeutic strategy for opioid addiction, however its utility could be hampered by poor adherence. To gain a better insight into this phenomenon, we utilized blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) in conjunction with a validated cue-induced craving procedure to examine neural correlates of XRNTX adherence. We operationalized treatment adherence as the number of monthly XRNTX injections (range: 0–3) administered to a group of fully detoxified heroin-dependent subjects (n=32). Additional outcomes included urine toxicology screening and self-reported tobacco use. The presented heroin-related visual cues reliably elicited heroin craving in all tested subjects. Nine, five, three and 15 of the participants, respectively, received zero, one, two and three XRNTX injections, predicted by the individual baseline fMRI signal change in response to the cues in the medial prefrontal cortex, a brain region involved in inhibitory self-control and emotional appraisal. The incidence of opioid-positive urines during the XRNTX therapy was low and remained about half the pre-treatment rate after the XRNTX ended. During the treatment, cigarette smoking behaviors followed patterns of opioid use, while cocaine consumption was increased with reductions in opioid use. The present data support the hypothesis that medial prefrontal cortex functions are involved in adherence to opioid antagonist therapy. A potential role of concurrent non-opioid addictive substances consumption during the XRNTX pharmacotherapy warrants further investigation. Our findings set the stage for further bio-behavioral investigations of the mechanisms of relapse prevention in opioid dependence.
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影响因子：
120.7
作者：
Chandler, Redonna K.;Fletcher, Bennett W.;Volkow, Nora D.
通讯作者：
Volkow, Nora D.
影响因子：
--
作者：
Hser, YI;Hoffman, V;Anglin, MD
通讯作者：
Anglin, MD
DOI：
10.1523/jneurosci.0005-12.2012
发表时间：
2012-04-04
期刊：
The Journal of neuroscience : the official journal of the Society for Neuroscience
影响因子：
--
作者：
Bossert JM;Stern AL;Theberge FR;Marchant NJ;Wang HL;Morales M;Shaham Y
通讯作者：
Shaham Y
影响因子：
6.7
作者：
Elman I;Borsook D;Volkow ND
通讯作者：
Volkow ND
影响因子：
4.4
作者：
Ghitza, Udi E.;Epstein, David H.;Preston, Kenzie L.
通讯作者：
Preston, Kenzie L.