Impaired insight in cocaine addiction: laboratory evidence and effects on cocaine-seeking behaviour
Impaired insight in cocaine addiction: laboratory evidence and effects on cocaine-seeking behaviour
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DOI：
10.1093/brain/awq066
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发表时间：
2010-05-01
期刊：
影响因子：
14.5
通讯作者：
Goldstein, Rita Z.
中科院分区：
文献类型：
--
作者：
Moeller, Scott J.;Maloney, Thomas;Goldstein, Rita Z.
神经精神障碍的特征通常是对行为的洞察力受损。这种洞察力的缺陷曾被暗示过，但从未在毒瘾方面进行过直接测试。在这里，我们第一次测试了这种在药物成瘾中损害洞察力的假说，并检查了它与寻求药物行为的潜在联系。我们还测试了可卡因尿液状态对这些影响的潜在调节作用，这种个体差异已知会影响潜在的认知功能和预后。16名尿液可卡因检测呈阳性的可卡因成瘾者、26名尿液可卡因检测为阴性的可卡因成瘾者和23名健康对照组完成了一项概率选择任务，该任务评估了人们对观看四种类型的图片(愉快、不愉快、中性和可卡因)的客观偏好。这项选择任务要求受试者报告他们最喜欢的图片类型；受试者的自我报告与他们的客观选择行为之间的对应关系提供了我们的行为洞察力指数。结果显示，与健康对照组相比，尿液阳性可卡因受试者对自己的选择行为缺乏洞察力；同一研究组还选择了最多的可卡因图片(以及最少令人愉快的图片)进行观看。然而，重要的是，尿液阴性可卡因受试者的行为最受洞察力的影响，因此这一亚组中自知力受损的人只与任务中与可卡因相关的较高选择和更严重的实际可卡因使用有关。这些发现表明，提高洞察力的干预措施可能会减少寻求药物的行为，特别是在尿液中呈阴性的可卡因受试者，这可能会改善他们的长期临床结果。
Neuropsychiatric disorders are often characterized by impaired insight into behaviour. Such an insight deficit has been suggested, but never directly tested, in drug addiction. Here we tested for the first time this impaired insight hypothesis in drug addiction, and examined its potential association with drug-seeking behaviour. We also tested potential modulation of these effects by cocaine urine status, an individual difference known to impact underlying cognitive functions and prognosis. Sixteen cocaine addicted individuals testing positive for cocaine in urine, 26 cocaine addicted individuals testing negative for cocaine in urine, and 23 healthy controls completed a probabilistic choice task that assessed objective preference for viewing four types of pictures (pleasant, unpleasant, neutral and cocaine). This choice task concluded by asking subjects to report their most selected picture type; correspondence between subjects' self-reports with their objective choice behaviour provided our index of behavioural insight. Results showed that the urine positive cocaine subjects exhibited impaired insight into their own choice behaviour compared with healthy controls; this same study group also selected the most cocaine pictures (and fewest pleasant pictures) for viewing. Importantly, however, it was the urine negative cocaine subjects whose behaviour was most influenced by insight, such that impaired insight in this subgroup only was associated with higher cocaine-related choice on the task and more severe actual cocaine use. These findings suggest that interventions to enhance insight may decrease drug-seeking behaviour, especially in urine negative cocaine subjects, potentially to improve their longer-term clinical outcomes.