Louis A. Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Electrical Engineering and Computer Science, University of Maryland Baltimore County, Baltimore, MD, USA.
Brain Stimul. 2024 Mar-Apr;17(2):324-332. doi: 10.1016/j.brs.2024.02.020. Epub 2024 Mar 5.
The smoking rate is high in patients with schizophrenia. Brain stimulation targeting conventional brain circuits associated with nicotine addiction has also yielded mixed results. We aimed to identify alternative circuitries associated with nicotine addiction in both the general population and schizophrenia, and then test whether modulation of such circuitries may alter nicotine addiction behaviors in schizophrenia. In Study I of 40 schizophrenia smokers and 51 non-psychiatric smokers, cross-sectional neuroimaging analysis identified resting state functional connectivity (rsFC) between the dorsomedial prefrontal cortex (dmPFC) and multiple extended amygdala regions to be most robustly associated with nicotine addiction severity in healthy controls and schizophrenia patients (p = 0.006 to 0.07). In Study II with another 30 patient smokers, a proof-of-concept, patient- and rater-blind, randomized, sham-controlled rTMS design was used to test whether targeting the newly identified dmPFC location may causally enhance the rsFC and reduce nicotine addiction in schizophrenia. Although significant interactions were not observed, exploratory analyses showed that this dmPFC-extended amygdala rsFC was enhanced by 4-week active 10Hz rTMS (p = 0.05) compared to baseline; the severity of nicotine addiction showed trends of reduction after 3 and 4 weeks (p ≤ 0.05) of active rTMS compared to sham; Increased rsFC by active rTMS predicted reduction of cigarettes/day (R = -0.56, p = 0.025 uncorrected) and morning smoking severity (R = -0.59, p = 0.016 uncorrected). These results suggest that the dmPFC-extended amygdala circuit may be linked to nicotine addiction in schizophrenia and healthy individuals, and future efforts targeting its underlying pathophysiological mechanisms may yield more effective treatment for nicotine addiction.
精神分裂症患者的吸烟率较高。针对与尼古丁成瘾相关的传统大脑回路的脑刺激也产生了混合结果。我们旨在确定普通人群和精神分裂症患者中与尼古丁成瘾相关的替代回路,然后测试调节这些回路是否可以改变精神分裂症患者的尼古丁成瘾行为。在第一项针对 40 名精神分裂症吸烟者和 51 名非精神科吸烟者的研究中,横断面神经影像学分析确定背内侧前额皮质(dmPFC)与多个扩展杏仁核区域之间的静息状态功能连接(rsFC)与健康对照者和精神分裂症患者的尼古丁成瘾严重程度最密切相关(p=0.006 至 0.07)。在第二项针对另外 30 名患者吸烟者的研究中,采用了一种概念验证、患者和评估者盲、随机、假对照 rTMS 设计,以测试针对新确定的 dmPFC 位置是否可以通过因果关系增强 rsFC 并减少精神分裂症中的尼古丁成瘾。尽管没有观察到显著的相互作用,但探索性分析表明,与基线相比,4 周的 10Hz 活跃 rTMS 可增强 dmPFC-扩展杏仁核 rsFC(p=0.05);与假对照相比,活跃 rTMS 治疗 3 周和 4 周后尼古丁成瘾的严重程度呈下降趋势(p≤0.05);活跃 rTMS 引起的 rsFC 增加预测了每日吸烟量(R=-0.56,p=0.025 未校正)和早晨吸烟严重程度(R=-0.59,p=0.016 未校正)的降低。这些结果表明,dmPFC-扩展杏仁核回路可能与精神分裂症和健康个体中的尼古丁成瘾有关,针对其潜在病理生理机制的未来努力可能会为尼古丁成瘾提供更有效的治疗方法。
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