School of Psychology, University of Southampton, Southampton, United Kingdom; Centre for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom; Institute for Life Sciences, University of Southampton, Southampton, United Kingdom; Institute of Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; Solent NHS Trust, Southampton, United Kingdom.
School of Psychology, University of Southampton, Southampton, United Kingdom; Centre for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom; Institute for Life Sciences, University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; School of Psychology, University of Nottingham, Semenyih, Malaysia.
Neurosci Biobehav Rev. 2024 Sep;164:105841. doi: 10.1016/j.neubiorev.2024.105841. Epub 2024 Aug 2.
Stimulants represent the first line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) and are among the most prescribed psychopharmacological treatments. Their mechanism of action at synaptic level has been extensively studied. However, it is less clear how their mechanism of action determines clinically observed benefits. To help bridge this gap, we provide a comprehensive review of stimulant effects, with an emphasis on nuclear medicine and magnetic resonance imaging (MRI) findings. There is evidence that stimulant-induced modulation of dopamine and norepinephrine neurotransmission optimizes engagement of task-related brain networks, increases perceived saliency, and reduces interference from the default mode network. An acute administration of stimulants may reduce brain alterations observed in untreated individuals in fronto-striato-parieto-cerebellar networks during tasks or at rest. Potential effects of prolonged treatment remain controversial. Overall, neuroimaging has fostered understanding on stimulant mechanism of action. However, studies are often limited by small samples, short or no follow-up, and methodological heterogeneity. Future studies should address age-related and longer-term effects, potential differences among stimulants, and predictors of treatment response.
兴奋剂是治疗注意力缺陷多动障碍（ADHD）的一线药物，也是最常被开的精神药理学治疗方法之一。它们在突触水平的作用机制已被广泛研究。然而，它们的作用机制如何决定临床观察到的益处还不太清楚。为了帮助弥合这一差距，我们全面回顾了兴奋剂的作用，重点介绍了核医学和磁共振成像（MRI）的发现。有证据表明，兴奋剂诱导的多巴胺和去甲肾上腺素神经传递的调节优化了与任务相关的大脑网络的参与，增加了感知的显着性，并减少了来自默认模式网络的干扰。急性给予兴奋剂可能会减少未接受治疗的个体在执行任务或休息时在前额纹状体顶叶小脑网络中观察到的大脑改变。长期治疗的潜在影响仍存在争议。总的来说，神经影像学促进了对兴奋剂作用机制的理解。然而，这些研究往往受到样本量小、随访时间短或没有随访以及方法学异质性的限制。未来的研究应解决与年龄相关的和长期的影响、不同兴奋剂之间的潜在差异以及治疗反应的预测因素。
