NEUROBIOLOGY OF COGNITIVE GAINS WITH OPIATE MAINTENANCE

描述：（申请人摘要） 我们提出了一个纵向研究，以监测前额叶皮层功能 56例海洛因依赖患者在阿片类药物维持治疗期间。 使用新开发的Go/No Go任务变体和功能磁 核磁共振成像（fMRI），我们将评估是否前额叶皮层 活动随着临床改善而增加，无论是在背外侧区域 与延迟依赖性处理相关， 抑制性加工 我们还将使用组合 fMRI/微透析系统在大鼠模型中测量神经化学 在临床中确定的那些相关脑区的变化 调查 海洛因依赖仍然是美国的一个主要公共卫生问题。 States. 阿片维持是最有效的治疗方式， 估计有115，000人目前正在接受美沙酮维持治疗（IOM 报告，1995年）。 尽管它具有明显的有效性和广泛的使用， 对慢性美沙酮的认知影响知之甚少。 我们 知道阿片类药物维持治疗可以让阿片类药物成瘾者停止他们的 对非法鸦片剂的不懈搜查， 在一些领域实现稳定，包括减少犯罪活动， 提高生产力，增加就业和教育追求。 临床上，由于成瘾者不稳定的生活方式的特点是 冲动（根据诊断定义），很明显，临床 改善必须伴随着这种认知的改善， 特色 反对阿片类药物的维持一直是由 认为维持鸦片制剂只是用一种滥用的麻醉品交换另一种。 从临床和社会政治的角度来看， 确定阿片类药物维持治疗由以下因素引起的认知缺陷 之前非法吸食鸦片 我们没有发现任何研究表明， 以及阿片类药物的维持如何影响冲动。

DESCRIPTION: (Applicant's Abstract) We propose a longitudinal study to monitor prefrontal cortical functioning in 56 heroin-dependent patients during the course of opiate maintenance. Using a newly developed variant of the Go/No Go task and functional magnetic resonance imaging (fMRI), we will assess whether prefrontal cortical activity increases with clinical improvement, both in dorsolateral regions associated with delay-dependent processing and in ventral areas associated with inhibitory processing. We will additionally use a combined fMRI/microdialysis system in a rat model to measure the neurochemical changes in those relevant brain areas identified in the clinical investigation. Heroin dependence remains a major public health problem in the United States. Opiate maintenance is the most effective treatment modality with an estimated 115,000 individuals currently receiving methadone maintenance (IOM Report, 1995). Despite its demonstrable effectiveness and widespread use, very little is known about the cognitive effects of chronic methadone. We know that opiate maintenance treatment allows opiate addicts to cease their relentless search for illicit opiates, accompanied by psychosocial stabilization in a number of domains including decreased criminal activity, increased productivity, increased employment and educational pursuits. Clinically, as the destabilized lifestyle of the addict is marked by impulsivity (by diagnostic definition), it appears apparent that clinical improvement must be accompanied by improvements in this cognitive characteristic. Opposition to opiate maintenance has always arisen from the view that opiate maintenance merely swaps one abused narcotic for another. From both a clinical and sociopolitical standpoint it is obviously relevant to establish that opiate maintenance treats a cognitive deficit induced by previous illicit opiate abuse. We have found no study addressing whether and how opiate maintenance affects impulsivity.