Goudriaan Anna E, Yücel Murat, van Holst Ruth J
Department of Psychiatry and Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands.
Monash Clinical and Imaging Neuroscience (MCIN) Laboratory, Monash Biomedical Imaging and School of Psychological Sciences, Monash University Monash, VIC, Australia.
Front Behav Neurosci. 2014 May 20;8:141. doi: 10.3389/fnbeh.2014.00141. eCollection 2014.
In problem gamblers, diminished cognitive control and increased impulsivity is present compared to healthy controls. Moreover, impulsivity has been found to be a vulnerability marker for the development of pathological gambling (PG) and problem gambling (PrG) and to be a predictor of relapse. In this review, the most recent findings on functioning of the brain circuitry relating to impulsivity and cognitive control in PG and PrG are discussed. Diminished functioning of several prefrontal areas and of the anterior cingulate cortex (ACC) indicate that cognitive-control related brain circuitry functions are diminished in PG and PrG compared to healthy controls. From the available cue reactivity studies on PG and PrG, increased responsiveness towards gambling stimuli in fronto-striatal reward circuitry and brain areas related to attentional processing is present compared to healthy controls. At this point it is unresolved whether PG is associated with hyper- or hypo-activity in the reward circuitry in response to monetary cues. More research is needed to elucidate the complex interactions for reward responsivity in different stages of gambling and across different types of reward. Conflicting findings from basic neuroscience studies are integrated in the context of recent neurobiological addiction models. Neuroscience studies on the interface between cognitive control and motivational processing are discussed in light of current addiction theories.
We suggest that innovation in PG therapy should focus on improvement of dysfunctional cognitive control and/or motivational functions. The implementation of novel treatment methods like neuromodulation, cognitive training and pharmacological interventions as add-on therapies to standard treatment in PG and PrG, in combination with the study of their effects on brain-behavior mechanisms could prove an important clinical step forward towards personalizing and improving treatment results in PG.
与健康对照相比，问题赌徒存在认知控制减弱和冲动性增加的情况。此外，冲动性已被发现是病理性赌博（PG）和问题赌博（PrG）发展的易感性标志物，也是复发的预测指标。在本综述中，讨论了关于PG和PrG中与冲动性和认知控制相关的脑回路功能的最新研究结果。几个前额叶区域和前扣带回皮质（ACC）功能减弱表明，与健康对照相比，PG和PrG中与认知控制相关的脑回路功能减弱。从现有的关于PG和PrG的线索反应性研究来看，与健康对照相比，额纹状体奖赏回路和与注意力处理相关的脑区对赌博刺激的反应性增加。目前尚不清楚PG是否与奖赏回路对金钱线索的反应过度或不足有关。需要更多研究来阐明赌博不同阶段和不同类型奖赏中奖赏反应性的复杂相互作用。基础神经科学研究的相互矛盾的结果在近期神经生物学成瘾模型的背景下进行了整合。根据当前的成瘾理论，讨论了关于认知控制与动机处理之间界面的神经科学研究。
我们建议，PG治疗的创新应侧重于改善功能失调的认知控制和/或动机功能。将神经调节、认知训练和药物干预等新的治疗方法作为PG和PrG标准治疗的附加疗法加以应用，并结合研究它们对脑-行为机制的影响，可能是朝着个性化和改善PG治疗效果迈出的重要临床一步。
