Verdejo-García A, Pérez-García M, Bechara A
Departamento de Personalidad, Evaluación y Tratamiento Psicológico. Universidad de Granada. Campus de Cartuja S/N, 18071, Granada, Spain.
Curr Neuropharmacol. 2006 Jan;4(1):17-31. doi: 10.2174/157015906775203057.
Similar to patients with orbitofrontal cortex lesions, substance dependent individuals (SDI) show signs of impairments in decision-making, characterised by a tendency to choose the immediate reward at the expense of severe negative future consequences. The somatic-marker hypothesis proposes that decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion and feeling. According to this model, there should be a link between abnormalities in experiencing emotions in SDI, and their severe impairments in decision-making in real-life. Growing evidence from neuroscientific studies suggests that core aspects of substance addiction may be explained in terms of abnormal emotional guidance of decision-making. Behavioural studies have revealed emotional processing and decision-making deficits in SDI. Combined neuropsychological and physiological assessment has demonstrated that the poorer decision-making of SDI is associated with altered reactions to reward and punishing events. Imaging studies have shown that impaired decision-making in addiction is associated with abnormal functioning of a distributed neural network critical for the processing of emotional information, including the ventromedial cortex, the amygdala, the striatum, the anterior cingulate cortex, and the insular/somato-sensory cortices, as well as non-specific neurotransmitter systems that modulate activities of neural processes involved in decision-making. The aim of this paper is to review this growing evidence, and to examine the extent of which these studies support a somatic-marker model of addiction.
与眶额皮质受损的患者相似，物质依赖个体（SDI）表现出决策受损的迹象，其特征是倾向于选择即时奖励，而不顾未来的严重负面后果。躯体标记假说提出，决策在许多重要方面依赖于调节体内平衡、情绪和感觉的神经基质。根据该模型，SDI在情绪体验方面的异常与他们在现实生活中决策的严重受损之间应该存在联系。神经科学研究的越来越多的证据表明，物质成瘾的核心方面可以用决策的异常情绪引导来解释。行为研究揭示了SDI在情绪处理和决策方面的缺陷。综合神经心理学和生理学评估表明，SDI较差的决策与对奖励和惩罚事件的反应改变有关。影像学研究表明，成瘾中受损的决策与对处理情绪信息至关重要的分布式神经网络的异常功能有关，该网络包括腹内侧皮质、杏仁核、纹状体、前扣带回皮质和岛叶/躯体感觉皮质，以及调节参与决策的神经过程活动的非特异性神经递质系统。本文的目的是回顾这一越来越多的证据，并研究这些研究在多大程度上支持成瘾的躯体标记模型。
