Department of Psychiatry, Yale University School of Medicine and Veteran Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
Biol Psychiatry. 2011 Sep 15;70(6):553-60. doi: 10.1016/j.biopsych.2011.05.008. Epub 2011 Jun 24.
Although cocaine dependence (CD) involves abnormalities in drug-related, reward-based decision making, it is not well understood whether these abnormalities generalize to nondrug-related cues and rewards and how neural functions underlying reward processing in cocaine abusers relate to treatment outcome.
Twenty CD patients before treatment and 20 matched healthy control (HC) subjects participated in functional magnetic resonance imaging while performing a monetary incentive delay task. Outcomes through 8 weeks were assessed via percent cocaine-negative urine toxicology, self-reported cocaine abstinence, and treatment retention.
Among the whole sample, anticipation of working for monetary reward (i.e., reward anticipation) was associated with activation in the ventral striatum (VS), medial frontal gyrus, thalamus, right subcallosal gyrus, right insula, and left amygdala. Cocaine dependence compared with HC participants exhibited greater activation during notification of rewarding outcome (i.e., reward receipt) in left and right VS, right caudate, and right insula. In CD participants during reward anticipation, activation in left and right thalamus and right caudate correlated negatively with percent cocaine-negative urine toxicology, activation in thalamus bilaterally correlated negatively with self-reported abstinence measures, and activation in left amygdala and parahippocampal gyrus correlated negatively with treatment retention. During reward notification, activation in right thalamus, right VS, and left culmen correlated negatively with abstinence and with urine toxicology.
These findings suggest that in treatment-seeking CD participants, corticolimbic reward circuitry is relatively overactivated during monetary incentive delay task performance and specific regional activations related to reward processing may predict aspects of treatment outcome and represent important targets for treatment development in CD.
尽管可卡因依赖（CD）涉及与药物相关的奖励决策异常，但尚不清楚这些异常是否会泛化到非药物相关的线索和奖励，以及可卡因滥用者的奖励处理的神经功能与治疗结果有何关系。
20 名 CD 患者在治疗前和 20 名匹配的健康对照（HC）受试者在执行货币奖励延迟任务时进行了功能磁共振成像。通过 8 周的可卡因阴性尿液毒理学、自我报告的可卡因戒断和治疗保留来评估结果。
在整个样本中，对获得货币奖励的期待（即奖励预期）与腹侧纹状体（VS）、内侧前额叶、丘脑、右侧胼胝体下回、右侧岛叶和左侧杏仁核的激活有关。与 HC 参与者相比，CD 参与者在通知奖励结果（即奖励获得）时，左侧和右侧 VS、右侧尾状核和右侧岛叶的激活增加。在 CD 参与者的奖励预期期间，左侧和右侧丘脑以及右侧尾状核的激活与可卡因阴性尿液毒理学呈负相关，双侧丘脑的激活与自我报告的禁欲措施呈负相关，左侧杏仁核和海马旁回的激活与治疗保留呈负相关。在奖励通知期间，右侧丘脑、右侧 VS 和左侧喙部的激活与禁欲和尿液毒理学呈负相关。
这些发现表明，在寻求治疗的 CD 参与者中，在进行货币奖励延迟任务时，皮质边缘奖励回路相对过度激活，与奖励处理相关的特定区域激活可能预测治疗结果的某些方面，并代表 CD 治疗发展的重要目标。
