Fielenbach Sandra, Donkers Franc Cl, Spreen Marinus, Bogaerts Stefan
Research Department, Forensic Psychiatric Centre Dr S van Mesdag, Groningen, Netherlands.
Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.
JMIR Ment Health. 2018 Dec 11;5(4):e10845. doi: 10.2196/10845.
Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination of psychiatric disorders and SUD increases the risk of future violence. Chronic substance abuse can lead to a structural state of disinhibition, resulting in more drug taking and eventually loss of control over drug intake. When treating SUD, it is crucial to address high levels of impulsivity and lack of inhibitory control.
This study set out to investigate the effects of a theta/sensorimotor rhythm (SMR) neurofeedback training protocol on levels of impulsivity, levels of drug craving, and actual drug intake in a population of forensic psychiatric patients with a diagnosis of SUD.
A total of 21 participants received 20 sessions of theta/SMR neurofeedback training in combination with treatment-as-usual (TAU). Results of the intervention were compared with results from 21 participants who received TAU only.
SMR magnitude showed a significant (P=.02) increase post training for patients in the neurofeedback training group, whereas theta magnitude did not change (P=.71). Levels of drug craving as well as scores on the motor subscale of the Barratt Impulsivity Scale-11 decreased equally for patients in the neurofeedback training group and the TAU group. Other measures of impulsivity as well as drug intake did not change posttreatment (P>.05). Therefore, neurofeedback+TAU was not more effective than TAU only.
This study demonstrated evidence that forensic psychiatric patients are able to increase SMR magnitude over the course of neurofeedback training. However, at the group level, the increase in SMR activity was not related to any of the included impulsivity or drug craving measures. Further research should focus on which patients will be able to benefit from neurofeedback training at an early stage of the employed training sessions.
Dutch National Trial Register: NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl).
法医精神病患者常被诊断患有以高冲动性为特征的精神障碍以及共病物质使用障碍（SUD）。精神障碍与SUD并存会增加未来暴力行为的风险。长期药物滥用可导致一种去抑制的结构状态，导致更多药物使用，最终失去对药物摄入的控制。在治疗SUD时，解决高冲动性和抑制控制不足的问题至关重要。
本研究旨在调查theta/感觉运动节律（SMR）神经反馈训练方案对诊断为SUD的法医精神病患者群体的冲动性水平、药物渴望程度和实际药物摄入量的影响。
共有21名参与者接受了20次theta/SMR神经反馈训练并结合常规治疗（TAU）。将干预结果与仅接受TAU的21名参与者的结果进行比较。
神经反馈训练组患者训练后SMR幅度显著增加（P = 0.02），而theta幅度未改变（P = 0.71）。神经反馈训练组和TAU组患者的药物渴望程度以及Barratt冲动性量表 - 11运动子量表得分均同等下降。其他冲动性指标以及药物摄入量治疗后未改变（P>0.05）。因此，神经反馈 + TAU并不比单纯TAU更有效。
本研究表明，法医精神病患者能够在神经反馈训练过程中提高SMR幅度。然而，在组水平上，SMR活动的增加与所纳入的任何冲动性或药物渴望指标均无关。进一步的研究应聚焦于哪些患者能够在所用训练课程的早期阶段从神经反馈训练中获益。
荷兰国家试验注册库：NTR5386；http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386（由WebCite存档于http://www.webcitation.org/6nXLQuoLl）
