双相障碍青年在情绪处理过程中的应对性饮酒动机、神经功能耦合与饮酒。
Coping drinking motives, neural functional coupling during emotion processing, and alcohol use in young adults with bipolar disorder.
机构信息
Department of Psychiatry and Behavioral Sciences, University of Texas, Austin, Texas, USA.
Department of Psychology, University of Texas, Austin, Texas, USA.
出版信息
Alcohol Clin Exp Res. 2022 Aug;46(8):1482-1496. doi: 10.1111/acer.14885. Epub 2022 Jul 22.
BACKGROUND
Rates of alcohol use disorders in individuals with bipolar disorder are 3 to 5 times greater than in the general population and exceed rates of alcohol use disorders reported in other affective and anxiety disorders. Despite this high rate of comorbidity, our understanding of the psychosocial and neural mechanisms that underlie the initiation of alcohol misuse in young adults with bipolar disorder remains limited. Prior work suggests that individuals with bipolar disorder may misuse alcohol as a coping mechanism, yet the neural correlates of coping drinking motives and associated alcohol use have not been previously investigated in this population.
METHODS
Forty-eight young adults (22 bipolar disorder type I, 26 typically developing; 71% women; average age ± standard deviation = 22 ± 2 years) completed the Drinking Motives and Daily Drinking Questionnaires, and a Continuous Performance Functional magnetic resonance imaging (fMRI) Task with Emotional and Neutral Distracters. We calculated the relative difference in anterior cingulate cortex (ACC) functional coupling with the anterior insula and amygdala in response to emotional distracters compared with neutral stimuli and investigated the relations with coping drinking motives and alcohol use.
RESULTS
Across all participants, coping drinking motives were associated with greater quantity of recent alcohol use. In individuals with bipolar disorder, greater ACC-anterior insula functional coupling was associated with greater coping drinking motives, and greater quantity and frequency of recent alcohol use. The relative difference in ACC-anterior insula functional coupling was not associated with coping drinking motives or alcohol use in the typically developing group. Greater ACC-anterior insula functional coupling in individuals with bipolar disorder was also associated with greater anxiety symptoms and recent perceived psychological stress. Exploratory analyses suggest that the relations between ACC-anterior insula functional coupling and coping drinking motives may be confounded by anticonvulsant use.
CONCLUSION
Results suggest that a difference in ACC-anterior insula functional coupling during emotion processing may underlie alcohol use as a maladaptive coping mechanism in young adults with bipolar disorder.
背景
双相情感障碍患者的酒精使用障碍发生率是普通人群的 3 至 5 倍，超过了其他情感和焦虑障碍报告的酒精使用障碍发生率。尽管这种共病率很高，但我们对导致双相情感障碍青年开始滥用酒精的心理社会和神经机制的理解仍然有限。先前的研究表明，双相情感障碍患者可能会将酒精滥用作应对机制，但该人群中尚未研究过与应对性饮酒动机相关的饮酒行为的神经相关性。
方法
48 名年轻人（22 名双相情感障碍 I 型，26 名典型发展；71%为女性；平均年龄±标准差=22±2 岁）完成了饮酒动机和每日饮酒问卷，以及一个包含情绪和中性分心物的连续表现功能磁共振成像（fMRI）任务。我们计算了在对情绪分心物的反应中与对中性刺激的反应相比，前扣带回皮层（ACC）与前岛叶和杏仁核的功能耦合的相对差异，并研究了与应对性饮酒动机和酒精使用的关系。
结果
在所有参与者中，应对性饮酒动机与近期饮酒量有关。在双相情感障碍患者中，更大的 ACC-前岛叶功能耦合与更大的应对性饮酒动机以及更多和更频繁的近期饮酒量有关。在典型发展组中，ACC-前岛叶功能耦合的相对差异与应对性饮酒动机或酒精使用无关。双相情感障碍患者的 ACC-前岛叶功能耦合也与焦虑症状和近期感知的心理压力有关。探索性分析表明，ACC-前岛叶功能耦合与应对性饮酒动机之间的关系可能受到抗惊厥药物使用的混淆。
结论
结果表明，在情绪处理过程中，ACC-前岛叶功能耦合的差异可能是双相情感障碍青年将酒精滥用作适应不良的应对机制的基础。
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