Postpartum Intervention for Mothers with Opioid Use Disorders - Brain-Behavior Mechanisms

项目摘要 阿片类药物使用障碍母亲的产后干预-脑行为机制 阿片类药物使用障碍（OUD）在美国是一种快速增长和毁灭性的流行病， 共病情绪障碍尽管接受“金标准”丁丙诺啡治疗以减少戒断， OUD母亲仍然遭受渴望，抑郁，人际交往受损和适应不良 可能导致虐待儿童和昂贵的寄养服务的父母行为。 我们知道，父母干预可以改善父母的情绪和敏感的养育行为， 非高危人群。我们开发了“妈妈力量”（MP），一个基于证据的13个会议 心理社会母子干预。我们已经确定MP可以增强情感敏感性 护理，同时减轻非OUD母亲的父母压力和抑郁症。我们也有 药物使用障碍MP的初步可行性数据。然而，我们不知道如何养育子女 针对OUD母亲的干预措施-特别是虚拟MP（vMP）将如何减少药物使用或 改善情绪。 我们也知道大脑是如何调节育儿的。我们团队最近的工作表明， 对非OUD母亲的养育干预与诱发电位的更大增强相关 情绪面孔相对于中性面孔的ERP反应（ERP），以及ERP反应的幅度， 情绪化的面孔与观察到的母亲敏感性有关。使用磁共振成像（MRI） 我们还建立了一个母亲行为神经回路（MBN）， 对自己婴儿的要求的反应--例如对独特的、在行为学上突出的自己婴儿的哭声， 在产后早期面对刺激。我们已经建立了MRI母体脑变化与 与非OUD母亲的MP，以及OUD对母亲的大脑影响。然而，我们不知道 父母的大脑机制，通过这些机制，父母的干预可能对患有OUD的母亲起作用- 它们是否会影响对婴儿刺激的ERP反应或影响MBN。 中心假设：与匹配的对照组相比，接受虚拟MP（vMP）的OUD母亲将 通过改变预先指定的MBN大脑区域，显示出改善的药物渴望，情绪和应激症状。 在高风险R61阶段，我们将确定是否可以实施针对OUD的vMP（n=25）并改善情绪， 与对照组相比，减少药物使用并影响婴儿图片的ERP脑反应（n=25）。如果假设 在R61中，我们将用R33阶段（n=160，80/组）确认并扩大这一突破， 增加了更丰富的母亲结局指标和MBN MRI。这项研究将阐明养育子女的影响 OUD母亲药物使用和脑功能干预MP-生物标志物和 治疗发展。

Project Summary Postpartum Intervention for Mothers with Opioid Use Disorders - Brain-Behavior Mechanisms Opioid use disorder (OUD) is a fast-growing and devastating epidemic in the US with many suffering comorbid mood disorders. Despite receiving “gold standard” buprenorphine treatment to reduce withdrawal, OUD mothers still suffer have cravings, depression, impaired interpersonal interactions and maladaptive parenting behaviors that may lead to child maltreatment and costly utilization of foster care. We know that parenting interventions improve parent mood and sensitive caregiving behaviors for high-risk non-OUD populations. We developed “Mom Power” (MP), an evidence-based 13-session psychosocial mother-child intervention. We have established that MP enhances emotionally sensitive caregiving, while concurrently reducing parental stress and depression for non-OUD mothers. We also have preliminary feasibility data for MP with substance use disorders. However, we do not know about parenting interventions for mothers with OUD – specifically how virtual MP (vMP) will work to reduce drug use or improve mood. We also know about how the brain regulates parenting. Recent work from our team has established that a parenting intervention for non-OUD mothers was associated with a larger enhancement of evoke potential responses (ERPs) for emotional faces relative to neutral faces and that the magnitude of ERP responses to emotional faces was associated with observed maternal sensitivity. Using magnetic resonance imaging (MRI) of the brain, we have also established a Maternal Behavior Neurocircuit (MBN) that regulates flexible responses to the demands of their own infant – such as to the unique, ethologically salient own-baby cry and face stimuli during the early postpartum period. We have established MRI maternal brain changes associated with MP in non-OUD mothers, and brain effects of OUD on mothers. However, we do not know about parental brain mechanisms through which parenting interventions may work for mothers with OUD – whether they will affect ERP responses to baby stimuli or affect the MBN. Central hypotheses: Mothers with OUD who receive virtual MP (vMP), compared to matched controls, will show improved drug craving, mood, and stress symptoms, via changes in pre-specified MBN brain regions. In the high-risk R61 phase, we will establish if vMP (n=25) for OUD can be implemented and improve mood, reduce drug use and affect ERP brain responses to baby pictures compared with control (n=25). If hypotheses in the R61 are confirmed, we will confirm and expand this breakthrough with the R33 Phase (n=160, 80/group), adding richer maternal outcome measures and MBN MRI. This research will elucidate the effects of parenting intervention MP on drug use and brain function for OUD mothers - with translational potential for biomarker and treatment development.