经颅直流电刺激前额皮质联合认知训练降低了女性甲基苯丙胺使用障碍者的线索诱导渴求:一项随机对照试验。
The transcranial direct current stimulation over prefrontal cortex combined with the cognitive training reduced the cue-induced craving in female individuals with methamphetamine use disorder: A randomized controlled trial.
机构信息
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, China.
Shanghai Female Drug Rehabilitation Center, 7501 Wai Qing Song Road, Shanghai, 201701, China.
出版信息
J Psychiatr Res. 2021 Feb;134:102-110. doi: 10.1016/j.jpsychires.2020.12.056. Epub 2020 Dec 22.
BACKGROUND
Craving and cognitive deficits are potential treatment targets for methamphetamine use disorder (MUD). Previous studies implied that transcranial direct current stimulation (tDCS) and cognitive training respectively improve these symptoms, but the combined effect is unknown. In this study, we investigated the combined effects of tDCS over dorsolateral prefrontal cortex (DLPFC) and computerized cognitive addiction therapy (CCAT) on cue-induced craving and cognitive functions among female individuals with MUD.
METHODS
Seventy-five patients with MUD were randomly assigned to three groups: CCAT + tDCS group, CCAT + sham tDCS group and the control group. The former two groups received 20 sessions of cognitive training combined 1.5 mA active/sham tDCS over DLPFC (20min/session, 5times/week), while the control group received usual care which includes routine medical care, health education, physical exercises and psychological support related to relapse prevention. The cue-induced craving and cognitive functions were tested at the baseline, the end of 2nd week and 4th week.
RESULTS
The CCAT + tDCS group showed a significant reduction in cue-induced craving after 4-week intervention. Moreover, the craving score of the real CCAT + tDCS group was significantly lower than that of the CCAT + sham tDCS group and that of the control group at the end of 4th week. A significant improvement in accuracy of TWOB task was only observed in the CCAT + tDCS group at the end of 4th week when compared to baseline. Unexpectedly, participants who received CCAT plus active or sham tDCS did not change their discounting, whereas those in the control group performed more impulsively over time.
CONCLUSIONS
The study found that the intervention of tDCS over DLPFC combined with CCAT may have potential benefit in improving treatment outcome in patients with MUD. More research is needed to explore the underlying mechanism.
背景
渴望和认知缺陷是治疗甲基苯丙胺使用障碍(MUD)的潜在目标。先前的研究表明,经颅直流电刺激(tDCS)和认知训练分别改善这些症状,但联合效果尚不清楚。在这项研究中,我们调查了背外侧前额叶皮层(DLPFC)的 tDCS 和计算机化认知成瘾治疗(CCAT)联合对女性 MUD 患者线索诱导的渴望和认知功能的联合作用。
方法
75 名 MUD 患者被随机分为三组:CCAT+tDCS 组、CCAT+假 tDCS 组和对照组。前两组接受 20 次认知训练,同时联合 1.5mA 主动/假 tDCS 刺激 DLPFC(20min/次,每周 5 次),而对照组接受常规护理,包括常规医疗、健康教育、体育锻炼和预防复发相关的心理支持。在基线、第 2 周和第 4 周时测试线索诱导的渴望和认知功能。
结果
CCAT+tDCS 组在 4 周干预后,线索诱导的渴望明显减少。此外,在第 4 周结束时,真实 CCAT+tDCS 组的渴望评分明显低于 CCAT+假 tDCS 组和对照组。与基线相比,只有 CCAT+tDCS 组在第 4 周结束时 TWOB 任务的准确性显著提高。出乎意料的是,接受 CCAT 联合活性或假 tDCS 的参与者并没有改变他们的折扣率,而对照组的参与者随着时间的推移表现出更冲动的行为。
结论
该研究发现,DLPFC 上的 tDCS 联合 CCAT 干预可能对改善 MUD 患者的治疗效果有潜在益处。需要进一步研究探索其潜在机制。