Possible Evidence for Re-regulation of HPA Axis and Brain Reward Systems Over Time in Treatment in Prescription Opioid-Dependent Patients
Possible Evidence for Re-regulation of HPA Axis and Brain Reward Systems Over Time in Treatment in Prescription Opioid-Dependent Patients
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DOI：
10.1097/adm.0000000000000087
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发表时间：
2015-01-01
影响因子：
5.5
通讯作者：
Meyer, Roger E.
中科院分区：
文献类型：
--
作者：
Bunce, Scott C.;Harris, Jonathan D.;Meyer, Roger E.
目标：越来越多的证据表明，神经适应性模型导致阿片类药物依赖容易复发。本研究的目的是评估与健康对照参与者相比，在停药后 2 个时间点反映依赖处方阿片类药物的患者的变态调节失调因素的临床措施。方法：使用药物提示反应性、情感调节惊吓反应任务、将最近退出的处方阿片类药物依赖患者 (n = 7) 与接受 2 至 3 个月监督住院护理的患者 (延长护理；n = 7) 和健康对照 (n = 7) 进行比较。唾液皮质醇和 8 天的睡眠体动记录仪。在线索反应任务期间，用功能性近红外光谱仪监测前额皮质。结果：惊吓反应结果表明，与长期护理患者相比，最近戒断阿片类药物的患者对自然奖励的享乐反应降低。与长期护理患者相比，最近退出的患者的右背外侧前额叶皮层对药物刺激的激活有所增加。相对于健康对照组，最近退出的患者和长期护理患者的皮质醇水平升高。体动记录仪显示最近退出的患者和长期护理患者之间的睡眠受到干扰；长期护理患者与对照组相似。背外侧前额皮质对药物和自然奖励线索的激活、对自然奖励线索的惊吓反应、白天皮质醇水平、卧床时间和总睡眠时间都与自上次使用药物以来的天数（即监督住院治疗的时间）相关。结论：这些结果表明，在住院治疗的无药物期间，处方阿片类药物依赖患者的下丘脑-垂体-肾上腺轴和大脑奖励系统失调可能会重新调节。
Objectives: There is growing evidence for a neuroadaptive model underlying vulnerability to relapse in opioid dependence. The purpose of this study was to evaluate clinical measures hypothesized to mirror elements of allostatic dysregulation in patients dependent on prescription opioids at 2 time points after withdrawal, compared with healthy control participants.Methods: Recently withdrawn (n = 7) prescription opioid-dependent patients were compared with the patients in supervised residential care for 2 to 3 months (extended care; n = 7) and healthy controls (n = 7) using drug cue reactivity, affect-modulated startle response tasks, salivary cortisol, and 8 days of sleep actigraphy. Prefrontal cortex was monitored with functional near-infrared spectroscopy during the cue reactivity task.Results: Startle response results indicated reduced hedonic response to natural rewards among patients recently withdrawn from opioids relative to extended care patients. The recently withdrawn patients showed increased activation to pill stimuli in right dorsolateral prefrontal cortex relative to extended care patients. Cortisol levels were elevated among recently withdrawn patients and intermediate for extended care relative to healthy controls. Actigraphy indicated disturbed sleep between recently withdrawn patients and extended care patients; extended care patients were similar to controls. Dorsolateral prefrontal cortex activation to drug and natural reward cues, startle responses to natural reward cues, day-time cortisol levels, time in bed, and total time spent sleeping were all correlated with the number of days since last drug use (ie, time in supervised residential treatment).Conclusions: These results suggest possible re-regulation of dysregulated hypothalamic-pituitary-adrenal axis and brain reward systems in prescription opioid-dependent patients over the drug-free period in residential treatment.