标题: | 成瘾性疾病的神经生物基础: 神经造影研究的统合分析 Neurobiological basis of addictive disorders: A meta-analysis of task-related neuroimaging studies |
作者: | 庄家臻 黄植懋 Chuang, Chia-Chen Huang, Chih-Mao 生物科技学系 |
关键字: | 统合分析;成瘾性疾病;赌博成瘾;精神疾病诊断手册;addictive disorder;meta-analysis;DSM-5;gambling disorder |
公开日期: | 2017 |
摘要: | 成瘾行为是神经生物系统有关的心智疾患,包括藉由吸入尼古丁、酒精、古柯硷等所造成的药物成瘾现象,以及社会文化环境所导致的赌博成瘾、网路成瘾、购物成瘾等。这些成瘾疾病的来源虽然歧异,但其成瘾的外显行为表现却相当类似,包含无法抑制获取成瘾物的渴望,因此,精神疾病诊断与统计手册(DSM-5)将药物成瘾与赌博成瘾疾病共同归类到成瘾性疾病下,提供诊断、评估与治疗成瘾行为的临床参考。然而,众多成瘾行为是否具有相似的成瘾神经机制,仍然未知。本实验运用了医学影像的统合分析方法(meta-analysis),分析生物医学资料库中运用功能性磁振造影(functional MRI)探讨成瘾行为的神经科学文献,使用活化可能性估计法 (Activation Likelihood Estimation)计算文献报告中与成瘾行为高度相关的大脑活动区域,在1036篇与神经造影有关的论文中,先将不符合活化可能性估计法需求的文献排除,最后将150篇文献归类成三类:药物成瘾、赌博成瘾、网路与性爱成瘾。统合分析的结果发现:(1) 当受试者观看药物相关的影片或图片时,他们的尾状核、前扣带回、脑岛会有较高的活化现象;尾状核的功能主要是负责评估事件价值,并决定是否将要执行,前扣带回目前已知的功能则是有错误侦测的能力与发现事件矛盾或冲突区域;(2) 当受试者观看赌博相关的影片或图片,大脑活化状况与观看药物图片的状况类似,显示大脑的生物回馈系统无论成瘾来源为赌博或是药物,均引发相同的神经回路;(3)成瘾患者的杏仁核有较正常人有高的活化状态,可能显示成瘾患者的情绪调控能力较正常人为低;(4) 无论在任何具成瘾的提示刺激之下,丘脑下核与黑质皆会有活化的现象,大脑神经核均涉及了神经回馈系统,显示成瘾疾病是与大脑回馈系统功能异常有高度相关。本篇论文的结果提供了精神疾病诊断与统计手册在诊断、评估与治疗成瘾行为的证据,并支持精神疾病诊断与统计手册在行为成瘾疾病和药物成瘾疾病分类的神经生物基础。 Addiction is a neurobiological disease characterized by compulsive engagement in rewarding stimuli despite negative bio-psychosocial consequences, and can be classified as the loss of voluntary control over mood-alerting addicting substances (e.g., alcohol) or behaviors (e.g., gambling). However, with the new edition of the Diagnostic and Statistical Manual for Mental Disorder (DSM-5), both Substance-Related Disorder and Gambling Disorder are re-conceptualized into the revised category of “Addiction and Related Disorder” which suggests a variety of commonalities in clinical expression and treatment between two types of addictions. Here, we investigate whether brain activities are affected the same way in behavioral addictions as they are by substance addiction which has been identified by chronic exposure to drugs that causes significant biochemistry changes in brain circuits. A meta-analysis approach using Activation Likelihood Estimation (ALE) was conducted to compute statistically significant concordance with published coordinates across independent task-related functional neuroimaging studies. One hundred and fifty studies were categorized into three visual stimuli that induce specific nature of addictive behaviors: substance cue, gambling cue, and Internet & sex cues. Meta-analytic neuroimaging results demonstrated that participants showed greater brain activation in caudate, anterior cingulate cortex (ACC), and insula when viewing substance cues. Caudate has been identified to be responsible for estimating values and commanding action, and ACC has been suggested to error monitoring and conflict resolution. Similarly, the patterns of brain activation were also observed when viewing gambling cues, suggesting a common reward system regardless of different types of stimulants. Moreover, participants with substance-related disorder showed greater activation in right amygdala compared to healthy controls, indicating a dysfunction of neural circuitry to regulate the affective responses. Finally, the common brain regions in subthalamic nucleus (STN) and substania nigra (SN) were found across a variety of visual stimulus presented, including substance-related cue and CNS stimulant cue. These results provide a quantitative meta-analytic evidence of neurobiological basis of addictive disorder, and provide empirical evidence of similarities in reward neural pathways of the addictive human brain between substance addictions and behavioral addictions. Finally, our results support the classification of DSM-5 that neural network of gambling disorder could be resemble to other substance-related and addictive disorders. |
URI: | http://etd.lib.nctu.edu.tw/cdrfb3/record/nctu/#GT070457035 http://hdl.handle.net/11536/141178 |
显示于类别: | Thesis |