Wilbertz Gregor, Delgado Mauricio R, Tebartz Van Elst Ludger, Maier Simon, Philipsen Alexandra, Blechert Jens
a Department of Psychology , University of Freiburg , Freiburg , Germany.
b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.
World J Biol Psychiatry. 2017 Jun;18(4):268-278. doi: 10.3109/15622975.2015.1112032. Epub 2015 Dec 22.
Risky behaviour seriously impacts the life of adult patients with attention deficit hyperactivity disorder (ADHD). Such behaviours have often been attributed to their exaggerated reward seeking, but dysfunctional anticipation of negative outcomes might also play a role.
The present study compared adult patients with ADHD (n = 28) with matched healthy controls (n = 28) during anticipation of monetary losses versus gains while undergoing functional magnetic resonance imaging (fMRI) and skin conductance recording.
Skin conductance was higher during anticipation of losses compared to gains in both groups. Affective ratings of predictive cues did not differ between groups. ADHD patients showed increased activity in bilateral amygdalae, left anterior insula (region of interest analysis) and left temporal pole (whole brain analysis) compared to healthy controls during loss versus gain anticipation. In the ADHD group higher insula and temporal pole activations went along with more negative affective ratings.
Neural correlates of loss anticipation are not blunted but rather increased in ADHD, possibly due to a life history of repeated failures and the respective environmental sanctions. Behavioural adaptations to such losses, however, might differentiate them from controls: future research should study whether negative affect might drive more risk seeking than risk avoidance.
危险行为严重影响成年注意缺陷多动障碍（ADHD）患者的生活。此类行为通常被归因于他们过度追求奖励，但对负面结果的功能失调预期可能也起了作用。
本研究在成年ADHD患者（n = 28）和匹配的健康对照者（n = 28）预期金钱损失与收益的过程中，对他们进行功能磁共振成像（fMRI）和皮肤电记录。
两组在预期损失时的皮肤电均高于预期收益时。两组对预测线索的情感评分无差异。与健康对照者相比，ADHD患者在预期损失与收益时，双侧杏仁核、左侧前脑岛（感兴趣区分析）和左侧颞极（全脑分析）的活动增加。在ADHD组中，脑岛和颞极的激活程度越高，情感评分越负面。
ADHD患者对损失预期的神经相关性未减弱反而增强，这可能归因于其反复失败的生活经历及相应的环境约束。然而，他们对此类损失的行为适应可能使其有别于对照组：未来研究应探讨消极情绪是否比避免风险更能促使他们寻求风险。
