Heinz Andreas, Wrase Jana, Kahnt Thorsten, Beck Anne, Bromand Zohra, Grüsser Sabine M, Kienast Thorsten, Smolka Michael N, Flor Herta, Mann Karl
Department of Psychiatry, Charité-University Medical Center Berlin, CCM, Berlin, Germany.
Alcohol Clin Exp Res. 2007 Jul;31(7):1138-47. doi: 10.1111/j.1530-0277.2007.00406.x. Epub 2007 May 4.
Stimuli that are regularly associated with alcohol intake (AI) may acquire incentive salience, while other reinforcers can be devalued. We assessed whether brain activation elicited by (1) alcohol associated, (2) affectively positive, and (3) negative versus neutral stimuli is associated with the subsequent risk of relapse.
Twelve detoxified alcoholic subjects (6 women and 6 men) and 12 age-matched and gender-matched healthy control subjects were assessed with functional magnetic resonance imaging (fMRI) and a fast single-event paradigm using standardized affective and alcohol-associated pictures. Patients were followed for 6 months and AI was recorded.
In alcoholic subjects, compared with healthy control subjects, (1) alcohol-related versus neutral visual stimuli elicited increased activation in the prefrontal (PFC; BA 6 and 10) and cingulate cortex (BA 23 and 24), precuneus and adjacent parietal cortex; (2) positive versus neutral stimuli elicited increased activation in the anterior cingulate cortex (ACC; BA 24), PFC (BA 10), ventral striatum and thalamus; and (3) negative versus neutral stimuli elicited increased activation in the PFC (BA 10). Seven alcoholic subjects relapsed. Within the follow-up period of 6 months, the number of subsequent drinking days (DD) and the amount of AI were inversely correlated with brain activation elicited by positive versus neutral stimuli in the thalamus (DD: r=-0.63, p=0.03; AI: r=-0.63, p=0.03) and in the ventral striatum (DD: r=-0.60, p=0.04; AI: r=-0.48, p=0.11).
In this study, brain activation elicited by briefly presented alcohol-associated stimuli was not associated with the prospective risk of relapse. Unexpectedly, alcoholic subjects displayed increased limbic brain activation during the presentation of affectively positive but not negative stimuli, which may reflect a protective factor in detoxified alcoholic subjects.
经常与酒精摄入（AI）相关联的刺激可能会获得激励显著性，而其他强化物则可能被贬值。我们评估了由（1）与酒精相关的、（2）情感上积极的、以及（3）消极与中性刺激所引发的大脑激活是否与随后的复发风险相关。
使用标准化的情感和与酒精相关的图片，通过功能磁共振成像（fMRI）和快速单事件范式对12名已戒酒的酒精成瘾者（6名女性和6名男性）以及12名年龄和性别匹配的健康对照者进行评估。对患者进行6个月的随访并记录酒精摄入量。
在酒精成瘾者中，与健康对照者相比，（1）与酒精相关的视觉刺激相对于中性视觉刺激在前额叶（PFC；BA 6和10）、扣带回皮质（BA 23和24）、楔前叶和相邻顶叶皮质引发了更强的激活；（2）积极刺激相对于中性刺激在前扣带回皮质（ACC；BA 24）、PFC（BA 10）、腹侧纹状体和丘脑引发了更强的激活；（3）消极刺激相对于中性刺激在PFC（BA 10）引发了更强的激活。7名酒精成瘾者复发。在6个月的随访期内，随后的饮酒天数（DD）和酒精摄入量与丘脑（DD：r = -0.63，p = 0.03；AI：r = -0.63，p = 0.03）和腹侧纹状体（DD：r = -0.60，p = 0.04；AI：r = -0.48，p = 0.11）中积极刺激相对于中性刺激所引发的大脑激活呈负相关。
在本研究中，短暂呈现的与酒精相关的刺激所引发的大脑激活与复发的前瞻性风险无关。出乎意料的是，酒精成瘾者在呈现情感上积极而非消极的刺激时，边缘脑区的激活增加，这可能反映了已戒酒的酒精成瘾者中的一种保护因素。
