海洛因成瘾与赌博成瘾的认知神经机制比较研究：奖赏加工和认知控制在成瘾中的作用及其机制

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	海洛因成瘾与赌博成瘾的认知神经机制比较研究：奖赏加工和认知控制在成瘾中的作用及其机制
其他题名	A comparison of cognitive and neural mechanisms between heroin dependence and pathological gambling: Reward processing and cognitive control in addiction
	严万森
	2013-05
摘要	研究药物成瘾的形成和发展机制对成瘾疾病的预防和治疗具有重要的意义。已有的研究提示，药物成瘾的形成可能受到个体易感素质和药物作用的双重影响，这种混合效应是困扰成瘾机制研究的重要问题之一。病理性赌博在许多方面与药物成瘾极为相似，已被DSM-V 正式界定为一种非物质成瘾。赌博成瘾排除了药物的干扰作用，为研究成瘾的原始机制提供了理想的模型。药物成瘾和赌博成瘾的比较有助于将药物的效应分离，揭示成瘾的一般途径和共同基础。近年来成瘾的理论越来越关注奖赏/情绪加工系统（腹内侧前额叶/眶额叶、岛叶、纹状体、杏仁核等）和认知控制系统（背外侧前额叶、前扣带回等）异常在成瘾中的作用，但这两个系统在药物成瘾和赌博成瘾中的变化机制尚不明确。本研究结合神经认知、神经生理两个层面，探讨了药物成瘾和赌博成瘾的奖赏加工和认知控制系统的变化机制。实验一、实验二采用经典的神经心理测试，包括奖赏决策任务、冒险任务和奖惩敏感性任务，以及工作记忆任务和反转学习任务，分别考察了海洛因成瘾者与赌博成瘾者的腹内侧前额叶-纹状体、背外侧前额叶-前扣带回的功能；实验三、实验四采用功能性磁共振成像技术（fMRI），考察了海洛因成瘾者和赌博成瘾者在奖赏决策、反应抑制时腹内侧前额叶/眶额叶-岛叶-纹状体、背外侧前额叶-前扣带回的功能变化。研究发现：（1）海洛因成瘾者和赌博成瘾者表现出类似的奖赏决策障碍，都倾向于注重眼前的获益而忽视长远的风险；海洛因使用年限对奖赏决策功能有显著影响，但赌博年限与奖赏决策功能不相关；（2）海洛因成瘾者工作记忆和反转学习能力明显损伤，且药物使用年限越长工作记忆损伤越严重，但赌博成瘾者的工作记忆和反转学习能力正常；（3）在奖赏体验和评估时海洛因成瘾者的内侧前额叶和前扣带回的功能减退；在损失体验和评估时赌博成瘾者和海洛因成瘾者的岛叶和眶额叶的功能均减退；（4）在反应抑制时海洛因成瘾者的背外侧前额叶的调控功能下降，但赌博成瘾者无明显异常。这些结果提示，奖赏/情绪加工和认知控制的双重失调是海洛因成瘾的重要特征，而与负性结果体验和评估相关的系统功能异常是海洛因成瘾和赌博成瘾的潜在共同机制。
其他摘要	Research on the underlying mechanisms of drug addiction is crucial to its prevention and treatment. Previous studies have implied that both individual susceptibility and neurotoxicity of drugs may be involved in the development of drug addiction and the confusion effect of these factors has been an obstacle to studying the mechanisms of drug addiction. As a non-substance induced behavioral addiction formally included in the DSM-V, pathological gambling (PG) shares many similarities with drug addiction. However, PG does not involve the neurotoxicity associated with drug use, thus it offers an opportunity to study the mechanisms of addiction without drug-related effects. It is believed that a comparison of PG and drug addiction may help dissociate the specific effects of chronic drug use from the vulnerabilities that predispose addiction. Recently the dual-system theories of addiction have paid much attention on the reward/affective system (e.g. vmPFC, OFC, insula, amygdala, striatum) and the cognitive control/reflective system (e.g. dlPFC, ACC, IFG), which functioning may be disrupted in addiction. However, whether these two systems are disrupted in both PG and drug addiction is unclear. In the present study, neurocognitive aspects of pathological gamblers (PGs), heroin addicts (HAs) and a group of age-, sex-, and education-matched healthy controls were assessed by well-constructed neuropsychological tasks. In Study 1, affective decision-making was measured by the Iowa Gambling Task (IGT), risk-taking behavior was assessed by the Balloon Analogue Risk Task (BART), and reward/punishment sensitivity was assessed using the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SRSPQ). In Study 2, working memory was assessed using the Self-ordered Pointing Test (SOPT), and reversal learning was measured by the Reversal Learning Task (RLT). Moreover, functional magnetic resonance imaging (fMRI) was used to investigate the neural circuitry associated with impaired reward-based/ affective decision-making in the IGT (Study 3) and response inhibition in the Go/No Go task (Study 4) among PGs and HAs compared with controls. The results showed that: (1) both PGs and HAs showed significant deficits in affective decision-making, guided by immediate prospects, oblivious to future consequences, and years of heroin use were correlated negatively with decision-making performance in heroin addicts; (2) deficits in working memory and reversal learning were also detected in HAs, with longer duration of heroin use associated with more severe working memory deficits, while PGs showed non-impaired performance on working memory and reversal learning; (3) Has showed hyporesponsiveness of the medial prefrontal cortex and the anterior cingulate gyrus compared to healthy controls during experiencing reward outcome (win money), and both PGs and HAs showed hyporesponsiveness of the orbital frontal cortex and the insular cortex during experiencing punishment outcome (lose money) in the IGT; (4) HAs showed hyporesponsiveness of the dorsolateral prefrontal cortex during response inhibition in the Go/No Go task, while PGs did not show hyporesponsiveness of the dorsolateral prefrontal cortex during response inhibition compared to controls. Our findings indicate that heroin dependence is characterized by deficits of the reward/affective system and the cognitive control/reflective system, implying a dual-disordered neurophysiological model of addiction, by contrast, PG is associated with impairments in the reward/affective system, especially the circuitry connected to negative affects such as loss. Deficits of the affective system may thus serve as one common neural mechanism of HA and PG.
学科领域	医学心理学
关键词	海洛因成瘾病理性赌博奖赏决策抑制控制功能性磁共振成像
学位类型	博士
语种	中文
学位专业	心理学
学位授予单位	中国科学院研究生院
学位授予地点	北京
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/19741
专题	认知与发展心理学研究室
作者单位	中国科学院心理研究所
推荐引用方式 GB/T 7714	严万森. 海洛因成瘾与赌博成瘾的认知神经机制比较研究：奖赏加工和认知控制在成瘾中的作用及其机制[D]. 北京. 中国科学院研究生院,2013.

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