Associations between insomnia and reward learning in clinical depression
Associations between insomnia and reward learning in clinical depression
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临床抑郁症患者失眠与奖励学习之间的关系
DOI：
10.1017/s003329172100026x
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发表时间：
2021-02-26
影响因子：
6.9
通讯作者：
Pizzagalli, Diego A.
中科院分区：
文献类型：
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作者：
Liverant, Gabrielle, I;Hall, Kimberly A. Arditte;Pizzagalli, Diego A.
抑郁症和失眠通常同时发生。然而，人们对失眠影响抑郁的机制知之甚少。最近的研究和理论强调奖励系统功能障碍是失眠和抑郁之间关系的潜在中介。这项研究首次研究了失眠对临床抑郁症患者奖励学习的影响，奖励学习是奖励系统功能的关键组成部分。方法对72例有睡眠障碍症状的单相抑郁症退伍军人进行调查。参与者完成了DSM-IV的结构化临床访谈，失眠、抑郁和奖励处理的自我报告测量，以及先前验证的信号检测任务（Pizzagalli et al., 2005，生物精神病学，57(4),319-327）。使用线性混合模型分析来研究奖励学习的变化，对200个任务试验中每个试验的反应偏差（RB）估计进行了检验。结果发现，在整个任务中，失眠组的奖励学习率和幅度相对于嗜睡/混合症状组有所降低。在失眠组中，失眠更严重的参与者表现出最低的奖励学习率，在整个任务中，RB增加，失眠严重程度降低。结论：在抑郁症患者中，失眠与学习中性刺激和奖励结果之间联系的能力下降和/或对不同的奖励接收改变行为的能力下降有关。这种奖励学习的减弱可能导致临床意义上的动机下降和这种合并症组戒断行为的增加。研究结果扩展了现有的理论，突出了奖励学习的障碍，特别是作为失眠和抑郁之间关联的潜在中介。
Background Depression and insomnia commonly co-occur. Yet, little is known about the mechanisms through which insomnia influences depression. Recent research and theory highlight reward system dysfunction as a potential mediator of the relationship between insomnia and depression. This study is the first to examine the impact of insomnia on reward learning, a key component of reward system functioning, in clinical depression. Methods The sample consisted of 72 veterans with unipolar depression who endorsed sleep disturbance symptoms. Participants completed the Structured Clinical Interview for DSM-IV, self-report measures of insomnia, depression, and reward processing, and a previously validated signal detection task (Pizzagalli et al., 2005, Biological Psychiatry, 57(4), 319-327). Trial-by-trial response bias (RB) estimates calculated for each of the 200 task trials were examined using linear mixed-model analyses to investigate change in reward learning. Results Findings demonstrated diminished rate and magnitude of reward learning in the Insomnia group relative to the Hypersomnia/Mixed Symptom group across the task. Within the Insomnia group, participants with more severe insomnia evidenced the lowest rates of reward learning, with increased RB across the task with decreasing insomnia severity. Conclusions Among individuals with depression, insomnia is associated with decreased ability to learn associations between neutral stimuli and rewarding outcomes and/or modify behavior in response to differential receipt of reward. This attenuated reward learning may contribute to clinically meaningful decreases in motivation and increased withdrawal in this comorbid group. Results extend existing theory by highlighting impairments in reward learning specifically as a potential mediator of the association between insomnia and depression.