Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York2Department of Psychology, Stony Brook University, Stony Brook, New York.
JAMA Psychiatry. 2014 Jan;71(1):61-70. doi: 10.1001/jamapsychiatry.2013.2833.
Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions mediating insight and self-awareness.
To investigate the neural correlates of impaired insight in addiction using a combined functional magnetic resonance imaging and voxel-based morphometry approach.
DESIGN, SETTING, AND PARTICIPANTS: This multimodal imaging study was performed at the Clinical Research Center at Brookhaven National Laboratory. The study included 33 CUD cases and 20 healthy controls.
Functional magnetic resonance imaging, voxel-based morphometry, Levels of Emotional Awareness Scale, and drug use variables.
Compared with the other 2 study groups, the impaired insight CUD group had lower error-induced rostral anterior cingulate cortex (rACC) activity as associated with more frequent cocaine use, less gray matter within the rACC, and lower Levels of Emotional Awareness Scale scores.
These results point to rACC functional and structural abnormalities and diminished emotional awareness in a subpopulation of CUD cases characterized by impaired insight. Because the rACC has been implicated in appraising the affective and motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments that target this CUD subgroup could focus on enhancing the salience of errors (eg, lapses).
可卡因使用障碍 (CUD) 个体在监测正在进行的行为方面存在困难，这可能源于介导洞察力和自我意识的大脑区域的功能障碍。
使用功能磁共振成像和基于体素的形态测量学相结合的方法研究成瘾中洞察力受损的神经相关性。
设计、地点和参与者：这项多模态成像研究在布鲁克海文国家实验室的临床研究中心进行。该研究包括 33 例可卡因使用障碍病例和 20 例健康对照者。
功能磁共振成像、基于体素的形态测量学、情绪意识水平量表和药物使用变量。
与其他 2 个研究组相比，洞察力受损的 CUD 组在错误诱发的前扣带皮质 (rACC) 活性较低，与更频繁地使用可卡因、rACC 内的灰质较少以及情绪意识水平量表评分较低相关。
这些结果表明，rACC 的功能和结构异常以及情绪意识降低，存在于洞察力受损的 CUD 病例亚群中。因为 rACC 参与评估错误和其他类型自我参照处理的情感和动机意义，该区域的功能和结构异常可能导致对潜在导致药物使用增加的行为结果的关注减少（通常归因于最小化和否认）。针对该 CUD 亚组的治疗方法可以集中在增强错误的显著性（例如，失误）上。
