de Ruiter Michiel B, Veltman Dick J, Goudriaan Anna E, Oosterlaan Jaap, Sjoerds Zsuzsika, van den Brink Wim
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Neuropsychopharmacology. 2009 Mar;34(4):1027-38. doi: 10.1038/npp.2008.175. Epub 2008 Oct 1.
Pathological gambling (PG) is associated with maladaptive perseverative behavior, but the underlying mechanism and neural circuitry is not completely clear. Here, the hypothesis was tested that PG is characterized by response perseveration and abnormalities in reward and/or punishment sensitivity in the ventral frontostriatal circuit. Executive functioning was assessed to verify if these effects are independent of the dorsal frontostriatal circuit. A group of smokers was also included to examine whether impairments in PG generalize to substance use disorders. Response perseveration and reward/punishment sensitivity were measured with a probabilistic reversal-learning task, in which subjects could win and lose money. Executive functioning was measured with a planning task, the Tower of London. Performance and fMRI data were acquired in 19 problem gamblers, 19 smokers, and 19 healthy controls. Problem gamblers showed severe response perseveration, associated with reduced activation of right ventrolateral prefrontal cortex in response to both monetary gain and loss. Results did not fully generalize to smokers. Planning performance and related activation of the dorsal frontostriatal circuit were intact in both problem gamblers and smokers. PG is related to response perseveration and diminished reward and punishment sensitivity as indicated by hypoactivation of the ventrolateral prefrontal cortex when money is gained and lost. Moreover, intact planning abilities and normal dorsal frontostriatal responsiveness indicate that this deficit is not due to impaired executive functioning. Response perseveration and ventral prefrontal hyporesponsiveness to monetary loss may be markers for maladaptive behavior seen in chemical and nonchemical addictions.
病理性赌博（PG）与适应不良的持续性行为相关，但其潜在机制和神经回路尚不完全清楚。在此，我们检验了这样一个假设，即PG的特征在于反应持续性以及腹侧额前脑区回路中奖励和/或惩罚敏感性的异常。对执行功能进行评估，以验证这些影响是否独立于背侧额前脑区回路。还纳入了一组吸烟者，以研究PG中的损害是否会扩展到物质使用障碍。通过概率性反转学习任务来测量反应持续性和奖励/惩罚敏感性，在该任务中受试者可能赢钱或输钱。用伦敦塔计划任务来测量执行功能。对19名问题赌徒、19名吸烟者和19名健康对照者进行了行为表现和功能磁共振成像（fMRI）数据采集。问题赌徒表现出严重的反应持续性，这与右侧腹外侧前额叶皮质在金钱得失时的激活减少有关。结果并未完全适用于吸烟者。问题赌徒和吸烟者的计划能力以及背侧额前脑区回路的相关激活均完好无损。PG与反应持续性以及奖励和惩罚敏感性降低有关，表现为在金钱得失时腹外侧前额叶皮质激活不足。此外，完好的计划能力和正常的背侧额前脑区反应性表明，这种缺陷并非由于执行功能受损所致。反应持续性和腹侧前额叶对金钱损失的低反应性可能是在化学成瘾和非化学成瘾中出现的适应不良行为的标志。
