Prefrontal cortex response to drug cues, craving, and current depressive symptoms are associated with treatment outcomes in methadone-maintained patients
Prefrontal cortex response to drug cues, craving, and current depressive symptoms are associated with treatment outcomes in methadone-maintained patients
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DOI：
10.1038/s41386-018-0252-0
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发表时间：
2019-03-01
影响因子：
7.6
通讯作者：
Dunn, Kelly E.
中科院分区：
文献类型：
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作者：
Huhn, Andrew S.;Sweeney, Mary M.;Dunn, Kelly E.
美沙酮维持是阿片类药物使用障碍的有效治疗方法，但许多美沙酮维持患者（MMP）继续与慢性复发作斗争。目前的研究评估了功能性近红外光谱（fNIRS）是否可以识别MMPs中持续使用阿片类药物的前额叶皮层（PFC）标记物，以及抑郁症的临床测量和自我报告的渴望测量是否也与阿片类药物使用相关。MMPs（n = 29）在PFC反应性的fNIRS测量期间经历药物线索反应性范例。在药物线索反应之前和之后收集自我报告的阿片样物质渴求（通过视觉模拟量表测量; 0-100），并通过17项汉密尔顿抑郁评定量表（HAM-D）评估抑郁症状。使用分层回归和偏相关来评估90天随访期内每周尿液药物筛查与fNIRS、渴望和HAM-D评估之间的关联。在控制年龄、性别和治疗天数的情况下，左侧PFC对药物提示的神经反应与随访期间阿片类药物阴性尿液筛查的百分比显著相关（Δ F-1，F- 24 = 13.19，p = 0.001，Δ R-2 = 0.30），并将86%的MMP正确分类为使用阿片类药物，或戒断阿片类药物（χ 2（4）= 16.28，p = 0.003）。基线渴望（p < 0.001）和HAM-D评估（p < 0.01）也与阿片类药物阴性尿液筛查百分比相关。结合fNIRS结果、基线渴望评分和HAM-D评分创建了稳健的预测模型（Δ F-3，F- 22 = 16.75，p < 0.001，Δ R-2 = 0.59）。这些数据提供了初步证据，表明fNIRS技术可能具有作为美沙酮门诊治疗结果客观指标的价值。抑郁症状和药物渴求也与MMPs中阿片类药物的使用相关。
Methadone maintenance is an effective treatment for opioid use disorder, yet many methadone-maintained patients (MMPs) continue to struggle with chronic relapse. The current study evaluated whether functional near-infrared spectroscopy (fNIRS) could identify prefrontal cortex (PFC) markers of ongoing opioid use in MMPs, and whether clinical measures of depression and self-report measures of craving would also be associated with opioid use. MMPs (n = 29) underwent a drug cue reactivity paradigm during fNIRS measurements of PFC reactivity. Self-reported opioid craving (measured by a visual analog scale; 0-100) was collected before and after drug cue reactivity, and depressive symptoms were assessed via the 17-item Hamilton Depression Rating Scale (HAM-D). Hierarchical regression and partial correlations were used to evaluate associations between weekly urine drug screens over a 90-day follow-up period and fNIRS, craving, and HAM-D assessments. Neural response to drug cues in the left lateral PFC, controlling for age, sex, and days in treatment was significantly associated with percent opioid-negative urine screens during follow-up (Delta F-1,F- 24 = 13.19, p = 0.001, Delta R-2 = 0.30), and correctly classified 86% of MMPs as either using opioids, or abstaining from opioids (chi(2)(4) = 16.28, p = 0.003). Baseline craving (p < 0.001) and HAM-D assessment (p < 0.01) were also associated with percent opioid-negative urine screens. Combining fNIRS results, baseline craving scores, and HAM-D scores created a robust predictive model (Delta F-3,F- 22 = 16.75, p < 0.001, Delta R-2 = 0.59). These data provide preliminary evidence that the fNIRS technology may have value as an objective measure of treatment outcomes within outpatient methadone clinics. Depressive symptoms and drug craving were also correlated with opioid use in MMPs.