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，有许多痛苦 共病的情绪障碍。尽管接受了“黄金标准”丁丙诺啡治疗以减少戒断， 肥胖的母亲仍然患有饥渴、抑郁、人际交往障碍和适应不良 可能导致虐待儿童和寄养成本高昂的养育行为。 我们知道，育儿干预改善了父母的情绪和敏感的照看行为 高危非OUD人群。我们开发了“妈妈力量”(MP)，这是一种基于证据的13次会议 心理社会母婴干预。我们已经证实，MP能增强情绪敏感度 照顾，同时减少父母的压力和非肥胖母亲的抑郁。我们还有 有物质使用障碍的MP的初步可行性数据。然而，我们不知道养育子女的方式 针对患有OUD的母亲的干预--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管理育儿的。我们团队最近的工作证明， 对非OUD母亲的育儿干预与更大的唤起潜力增强相关 情绪面孔相对于中性面孔的反应(ERPs)，以及情绪面孔对 情绪化的面孔与观察到的母性敏感有关。使用磁共振成像(MRI) 在大脑中，我们还建立了母性行为神经回路(MBN)，调节灵活的 产后早期的面部刺激。我们已经建立了与核磁共振孕妇大脑变化相关的 非母体母体中的MP，以及母体母体的大脑效应。然而，我们不知道 父母的大脑机制，通过这些机制，育儿干预可能对患有先天性巨结肠的母亲起作用- 它们是否会影响ERP对婴儿刺激的反应或影响MBN。 中心假设：与匹配的对照组相比，接受虚拟MP(VMP)治疗的母亲将 通过预先指定的MBN大脑区域的变化，显示出改善的药物渴求、情绪和压力症状。 在高危R61阶段，我们将确定是否可以实施OUD的VMP(n=25)并改善情绪， 与对照组(n=25)相比，减少药物使用并影响对婴儿照片的脑电反应。如果假设 在R61得到确认后，我们将用R33期(n=160，80个/组)确认和扩大这一突破， 增加了更丰富的母体结局指标和MBN MRI。这项研究将阐明父母教养方式的影响 干预MP对肥胖母亲的药物使用和脑功能的影响-具有生物标志物和 治疗的发展。

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.