饮酒障碍患者中，岛叶激活的应激诱导敏感可预测酒渴求及饮酒。

Stress-Induced Sensitization of Insula Activation Predicts Alcohol Craving and Alcohol Use in Alcohol Use Disorder.

机构信息

Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim. Heidelberg University, Heidelberg, Germany; Feuerlein Center on Translational Addiction Medicine, University of Heidelberg, Heidelberg, Germany.

Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim. Heidelberg University, Heidelberg, Germany.

出版信息

Biol Psychiatry. 2024 Feb 1;95(3):245-255. doi: 10.1016/j.biopsych.2023.08.024. Epub 2023 Sep 9.

DOI:10.1016/j.biopsych.2023.08.024

PMID:37678541

Abstract

BACKGROUND

Stress and alcohol cues trigger alcohol consumption and relapse in alcohol use disorder. However, the neurobiological processes underlying their interaction are not well understood. Thus, we conducted a randomized, controlled neuroimaging study to investigate the effects of psychosocial stress on neural cue reactivity and addictive behaviors.

METHODS

Neural alcohol cue reactivity was assessed in 91 individuals with alcohol use disorder using a validated functional magnetic resonance imaging (fMRI) task. Activation patterns were measured twice, at baseline and during a second fMRI session, prior to which participants were assigned to psychosocial stress (experimental condition) or a matched control condition or physical exercise (control conditions). Together with fMRI data, alcohol craving and cortisol levels were assessed, and alcohol use data were collected during a 12-month follow-up. Analyses tested the effects of psychosocial stress on neural cue reactivity and associations with cortisol levels, craving, and alcohol use.

RESULTS

Compared with both control conditions, psychosocial stress elicited higher alcohol cue-induced activation in the left anterior insula (familywise error-corrected p < .05) and a stress- and cue-specific dynamic increase in insula activation over time (F = 2.143, p = .007), which was predicted by higher cortisol levels during the experimental intervention (r = 0.310, false discovery rate-corrected p = .016). Cue-induced insula activation was positively correlated with alcohol craving during fMRI (r = 0.262, false discovery rate-corrected p = .032) and alcohol use during follow-up (r = 0.218, false discovery rate-corrected p = .046).

CONCLUSIONS

Results indicate a stress-induced sensitization of cue-induced activation in the left insula as a neurobiological correlate of the effects of psychosocial stress on alcohol craving and alcohol use in alcohol use disorder, which likely reflects changes in salience attribution and goal-directed behavior.

摘要

背景

压力和酒精线索会引发酒精使用障碍患者的饮酒和复发。然而，其相互作用的神经生物学过程尚不清楚。因此，我们进行了一项随机对照神经影像学研究，以调查心理社会应激对神经线索反应性和成瘾行为的影响。

方法

使用经过验证的功能磁共振成像（fMRI）任务，对 91 名酒精使用障碍患者的神经酒精线索反应性进行评估。在基线和第二次 fMRI 检查之前，两次测量激活模式，在此之前，参与者被分配到心理社会应激（实验组）或匹配的对照条件或体育锻炼（对照条件）。与 fMRI 数据一起，评估了酒精渴求程度和皮质醇水平，并在 12 个月的随访期间收集了酒精使用数据。分析测试了心理社会应激对神经线索反应性的影响，以及与皮质醇水平、渴求程度和酒精使用的关联。

结果

与两种对照条件相比，心理社会应激引起了左侧前岛叶（校正后的错误发现率<.05）更高的酒精线索诱导激活，并且随着时间的推移，岛叶激活呈现出应激和线索特异性的动态增加（F=2.143，p=0.007），这与实验干预期间更高的皮质醇水平有关（r=0.310，校正后的错误发现率<.016）。fMRI 期间，线索诱导的岛叶激活与酒精渴求呈正相关（r=0.262，校正后的错误发现率<.032），与随访期间的酒精使用呈正相关（r=0.218，校正后的错误发现率<.046）。