Hammond Christopher J, Allick Aliyah, Rahman Naisa, Nanavati Julie
Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Child Adolesc Psychopharmacol. 2019 Aug;29(7):498-507. doi: 10.1089/cap.2019.0007. Epub 2019 Jul 16.
Addictive disorders start during adolescence for most individuals, and developmental differences in brain maturation and response to treatments are present. Recent studies in adults have identified associations between addiction treatment response and regional and circuit specific brain dysfunction, suggesting candidate neural treatment targets. The purpose of this systematic review and meta-analysis was to qualitatively and quantitatively summarize findings from structural and functional neuroimaging studies that examine neural correlates of treatment response in adolescents and young adults with addictive disorders. A systematic review and meta-analysis of peer-reviewed studies was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were selected if they included individuals aged 13-26 with a DSM-IV or DSM-5 () addictive disorder diagnosis, used neuroimaging, administered a treatment/intervention, and reported within- or between-subject contrasts in brain structure or activity across treatment/intervention and a control condition or brain-behavior correlations with treatment-outcome variables. Quantitative meta-analyses used an activation-likelihood estimation (ALE) approach. Out of 3177 citations, 27 studies were included in the qualitative analysis. Qualitative analyses revealed anatomical, connectivity, and functional brain-behavior associations with response to addiction interventions across a broad array of cortical and subcortical brain regions and associated networks. Eighteen functional magnetic resonance imaging studies involving 354 participants and 88 brain foci were included in the ALE meta-analysis. Despite significant heterogeneity in study design and methods, six ALE activation clusters localized to the anterior cingulate cortex, inferior frontal gyrus, supramarginal gyrus, middle temporal gyrus, precuneus, and putamen showed consistent brain-behavior associations with treatment-outcome variables. Cortical and subcortical brain regions involved in cognition, emotion regulation, decision-making, reward, and self-reference are associated with treatment response in addicted youth. These results are consistent with findings in the adult literature and suggest overlapping neural treatment targets across developmental stages.
大多数人的成瘾性障碍始于青春期，大脑成熟和对治疗的反应存在发育差异。最近针对成年人的研究已经确定了成瘾治疗反应与区域及特定脑回路功能障碍之间的关联，这提示了潜在的神经治疗靶点。本系统评价和荟萃分析的目的是定性和定量总结结构和功能神经影像学研究的结果，这些研究考察了患有成瘾性障碍的青少年和青年治疗反应的神经关联。按照PRISMA（系统评价和荟萃分析的首选报告项目）指南，对同行评审的研究进行了系统评价和荟萃分析。如果研究纳入了年龄在13 - 26岁、患有DSM - IV或DSM - 5成瘾性障碍诊断的个体，使用了神经影像学方法，实施了治疗/干预，并报告了治疗/干预与对照条件下脑结构或活动的受试者内或受试者间对比，或者脑与行为与治疗结果变量的相关性，则将其纳入。定量荟萃分析采用激活似然估计（ALE）方法。在3177条文献引用中，27项研究纳入了定性分析。定性分析揭示了在广泛的皮层和皮层下脑区及相关网络中，与成瘾干预反应相关的解剖学、连接性和功能性脑与行为关联。ALE荟萃分析纳入了18项涉及354名参与者和88个脑区的功能磁共振成像研究。尽管研究设计和方法存在显著异质性，但六个ALE激活簇定位于前扣带回皮质、额下回、缘上回、颞中回、楔前叶和壳核，显示出与治疗结果变量一致的脑与行为关联。参与认知、情绪调节、决策、奖赏和自我参照的皮层和皮层下脑区与成瘾青少年的治疗反应相关。这些结果与成人文献中的发现一致，并提示跨发育阶段存在重叠的神经治疗靶点。
