Paraskevopoulou Maria, van Rooij Daan, Batalla Albert, Chauvin Roselyne, Luijten Maartje, Schene Aart H, Buitelaar Jan K, Schellekens Arnt F A
Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.
Neuropsychopharmacology. 2021 Feb;46(3):622-631. doi: 10.1038/s41386-020-00896-1. Epub 2020 Nov 12.
Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorder (SUD) often co-occur and are associated with treatment resistance. Both disorders are characterized by similar reward-processing deficits with decreased striatal responses to reward anticipation, though literature is inconsistent. It is unclear whether substance misuse exaggerates reward-processing deficits observed in ADHD. The aim of this study was to examine substance misuse effects on reward-processing in ADHD. Functional MRI data in a Monetary Incentive Delay (MID) task from a multi-site study were compared across ADHD groups with and without substance misuse (ADHD + SM and ADHD-only, respectively) and healthy controls (n = 40/group, 74 males and 46 females, aged 13.7-25.9 years). Substance misuse was defined as misuse of alcohol, nicotine, or drugs. Groups were matched with presence/absence of parental SUD to avoid interference with SUD trait effects. Compared to ADHD-only and controls, ADHD + SM showed hyperactivation in putamen during reward anticipation. Compared to controls, the ADHD groups showed hypoactivation in motor/sensory cortices and hyperactivation in frontal pole and OFC during reward outcome. ADHD + SM also showed hyperactivation in frontal pole during neutral outcome. Moreover, ADHD + SM patients showed higher callous-unemotional (CU) traits that were positively correlated with putamen responses to reward anticipation. Our results show distinct condition-independent neural activation profile for ADHD + SM compared to ADHD-only and controls. Effects of comorbid substance misuse and variability of its prevalence across ADHD studies might have contributed to inconsistencies in ADHD literature. Contrasted with findings for reward-processing in SUD literature, results potentially suggest distinct underlying mechanisms for SUD subgroups with different characteristics, like antisocial/psychopathic traits.
注意缺陷多动障碍（ADHD）与物质使用障碍（SUD）常常同时出现，且与治疗抵抗相关。这两种障碍都具有类似的奖赏处理缺陷，纹状体对奖赏预期的反应减弱，不过相关文献的说法并不一致。目前尚不清楚物质滥用是否会加剧ADHD中观察到的奖赏处理缺陷。本研究的目的是检验物质滥用对ADHD奖赏处理的影响。对一项多中心研究中金钱激励延迟（MID）任务的功能磁共振成像数据，在有物质滥用和无物质滥用的ADHD组（分别为ADHD + SM组和单纯ADHD组）以及健康对照组（每组n = 40，74名男性和46名女性，年龄13.7 - 25.9岁）之间进行了比较。物质滥用被定义为酒精、尼古丁或药物的滥用。根据父母是否患有SUD对各组进行匹配，以避免SUD特质效应的干扰。与单纯ADHD组和对照组相比，ADHD + SM组在奖赏预期期间壳核表现为激活增强。与对照组相比，ADHD组在奖赏结果期间运动/感觉皮层表现为激活减弱，额极和眶额皮质表现为激活增强。ADHD + SM组在中性结果期间额极也表现为激活增强。此外，ADHD + SM患者表现出更高的冷酷无情（CU）特质，且这些特质与壳核对奖赏预期的反应呈正相关。我们的结果表明，与单纯ADHD组和对照组相比，ADHD + SM组具有独特的、与条件无关的神经激活模式。共病物质滥用的影响及其在ADHD研究中的患病率差异可能导致了ADHD相关文献的不一致。与SUD文献中关于奖赏处理的研究结果相比，这些结果可能表明具有不同特征（如反社会/精神病态特质）的SUD亚组存在不同的潜在机制。
