Internet gaming disorder: Microstructural brain alterations and their relation to functionally assessed correlates of reward processing, inhibitory control and the self-concept

在过去的10年里，越来越多的网络游戏障碍病例使这种疾病越来越成为临床研究的重点。然而，仍然缺乏适当的治疗和预防措施，特别是对青少年而言。鉴于这种情况具有很高的成瘾潜力，本提案重点关注在线角色扮演游戏的有问题的使用。这些游戏提供了多个用户通过他们的图形代理(化身)在虚拟世界中与彼此进行或相互对抗的同时游戏。与物质成瘾和病态赌博的相似之处在于中皮质边缘奖赏处理以及前额叶抑制控制机制的变化。弥散张量成像(DTI)研究表明，边缘奖赏系统的纹状体等皮质下区域相对较早的成熟与额叶前部控制区成熟过程迟缓之间的不平衡是青少年更容易患成瘾障碍的基础。奖赏相关脑区的早期成熟可能会导致对即时奖赏的渴望和冒险行为的增加，但由于发育迟缓，前额叶抑制控制机制无法抵消这一点。鉴于受影响的年轻个体的高流行率，这种解释性模式可能也会成为互联网游戏障碍的关键。对网络游戏成瘾者的奖励处理研究表明，在感知与虚拟形象和虚拟世界相关的图像时，纹状体大脑的激活增加。这些线索的高度突出可能有其基础，即通过增加对自己化身的认同感来弥补经常观察到的自我概念缺陷。自我概念相关的功能磁共振成像(FMRI)研究提示额顶网络参与，例如由内侧前额叶(MPFC)和包括角回(AG)在内的顶叶组成。相应的对青少年的DTI研究显示，与年龄相关的白质在连接额顶脑区的上纵束中成熟。我们自己的研究小组对网络游戏成瘾者进行的一项研究表明，与身体相关的自我概念缺陷与AG活性低下之间存在关联。相反，AG的过度激活与对自己化身的认同感呈正相关。结合前人的研究结果，本研究旨在纵向评估微结构(DTI)和功能(FMRI)测量之间的关系，这些测量考察了男性青少年和青少年网络游戏成瘾者的奖赏加工、抑制控制和自我概念方面。

Accumulating case numbers of internet gaming disorder have moved the condition increasingly into the focus of clinical research within the past 10 years. Yet, adequate therapies and preventive measures, especially for adolescents, are still lacking. Given the high addictive potential of the condition, this proposal focuses on problematic usage of online role-playing games. These offer the simultaneous gaming of multiple users via their graphical agent (avatar) with or against each other in a virtual world. Similarities to substance addictions and pathological gambling point towards alterations in mesocorticolimbic reward processing- as well as prefrontal inhibitory control mechanisms. Diffusion Tensor Imaging (DTI) studies suggest an imbalance between the relatively early maturation of subcortical areas such as the striatum of the limbic reward system and retarded maturation processes in prefrontal control areas to be at the basis of adolescents increased vulnerability for addictive disorders. The early maturation of reward-associated brain regions might entail craving for immediate rewards and increase risk-taking, which cannot be counterbalanced by prefrontal inhibitory control mechanisms due to their delayed development. Seeing the high prevalence of young affected individuals, this explanatory model might also become essential for internet gaming disorder. Reward processing studies on internet gaming addicts showed increased striatal brain activations upon the perception of avatar- and virtual world-related images. The high salience of these cues might have its basis in the compensation of often observed self-concept deficits by an increased identification with the own avatar. Self-concept-related functional Magnetic Resonance Imaging (fMRI) studies suggest the involvement of a fronto-parietal network, e.g. composed of the medial prefrontal cortex (MPFC) as well as the parietal lobe including the Angular Gyrus (AG). Corresponding DTI studies on adolescents showed age-related white matter maturation processes in the superior longitudinal fasciculus, connecting fronto-parietal brain regions. A study of our own research group on online gaming addicts indicated an association of body-related self-concept deficits with AG hypoactivations. In contrast, AG hyperactivations positively correlated with the strength of identification with the own avatar. Connecting to previous research results, the present proposal aims to longitudinally assess the relation between microstructural (DTI) and functional (fMRI) measures investigating reward processing, inhibitory control as well as self-concept aspects in male adolescent and young adult internet gaming addicts.