Zhao Wei, Duan Fan, Li Xiangyu, Li Junda, Xia Lingling, Ren Zixuan, Li Yegang, Song Li, Song Peipei, Mu Linlin, Wang Lijin, Zhang Jing, Song Xun, Wang Ze, Chen Jinxuan, Zhang Xiaochu, Jiao Dongliang
School of Mental Health, Bengbu Medical University, Bengbu, Anhui, 233030, China.
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, China.
BMC Psychiatry. 2025 Jan 28;25(1):78. doi: 10.1186/s12888-025-06523-x.
Although impaired cognitive control is common during the acute detoxification phase of substance use disorders (SUD) and is considered a major cause of relapse, it remains unclear after prolonged methadone maintenance treatment (MMT). The aim of the present study was to elucidate cognitive control in individuals with heroin use disorder (HUD) after prolonged MMT and its association with previous relapse.
A total of 63 HUD subjects (41 subjects with previous relapse and 22 non-relapse subjects, mean MMT duration: 12.24 ± 2.92 years) and 31 healthy controls were enrolled in this study. Eye tracking tasks, prospective memory tasks, the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and the Prospective and Retrospective Memory Questionnaire (PRMQ) were used to assess cognitive control.
HUD individuals exhibited worse saccade error rate and executive dysfunction but showed no significant impairment in prospective memory. Additionally, the relapsers performed worse in terms of antisaccade amplitude and velocity at higher difficulty gradients (11° or 16°). Antisaccade performance in terms of amplitude and velocity was negatively correlated with executive function scores. Deficits in inhibition, cognitive flexibility, and self-monitoring were found to mediate the relationship between previous relapse and impaired antisaccade performance.
Even after prolonged MMT, HUD individuals still show partial impairments in cognitive control and antisaccade performance. Previous relapse exacerbates cognitive control deficits through executive dysfunction in inhibition, cognitive flexibility and self-monitoring, which can be screened by higher difficulty of antisaccade amplitude and velocity. More importantly, saccade error rate can reflect impaired inhibitory control in HUD individuals, whereas antisaccade amplitude and velocity appear to have potential diagnostic value for relapse.
尽管认知控制受损在物质使用障碍（SUD）的急性脱毒期很常见，且被认为是复发的主要原因，但在长期美沙酮维持治疗（MMT）后情况仍不清楚。本研究的目的是阐明长期MMT后海洛因使用障碍（HUD）个体的认知控制及其与既往复发的关联。
本研究共纳入63名HUD受试者（41名有既往复发史的受试者和22名无复发史的受试者，平均MMT时长：12.24±2.92年）和31名健康对照者。使用眼动追踪任务、前瞻性记忆任务、成人版执行功能行为评定量表（BRIEF - A）和前瞻性与回顾性记忆问卷（PRMQ）来评估认知控制。
HUD个体表现出更差的扫视错误率和执行功能障碍，但在前瞻性记忆方面未显示出显著损害。此外，在较高难度梯度（11°或16°）下，复发者在反扫视幅度和速度方面表现更差。反扫视幅度和速度方面的表现与执行功能得分呈负相关。发现抑制、认知灵活性和自我监控方面的缺陷介导了既往复发与反扫视表现受损之间的关系。
即使经过长期MMT，HUD个体在认知控制和反扫视表现方面仍存在部分损害。既往复发通过抑制、认知灵活性和自我监控方面的执行功能障碍加剧了认知控制缺陷，可以通过更高难度的反扫视幅度和速度来筛查。更重要的是，扫视错误率可以反映HUD个体的抑制控制受损，而反扫视幅度和速度似乎对复发具有潜在的诊断价值。
