强迫性特征在药物成瘾行为中的易感性及其前额叶-反奖赏系统神经基础

强迫性是一种与不顾严重后果的固着行为密切相关的神经心理结构, 大脑神经系统对强迫性行为的调控机制崩溃是导致药物成瘾的直接原因。以往研究对于奖赏系统(中脑-皮层-边缘神经环路)在成瘾行为中的作用及机制已经具有丰富的了解, 但针对药物成瘾的强迫性特征本身以及前额叶-反奖赏系统神经环路在成瘾行为中的作用机制了解有限, 尤其是缺乏对药物成瘾强迫性特征的系统考察、缺少遗传学研究以及非兴奋剂类药物的汇聚证据。项目拟结合人类成瘾行为的遗传学视角(海洛因成瘾者与其无药物使用的兄弟姐妹对照), 结合神经认知、脑电生理、神经影像等不同层面的方法和技术, 对药物成瘾强迫性的外在表征、神经生物学基础以及与个体差异有关的遗传易感性进行探索, 期在进一步识别药物成瘾的神经生物标记, 为探寻潜在的药物或非药物干预靶点提供更多证据。     

多巴胺对动物冲动性的影响

冲动性是注意缺陷障碍、物质成瘾以及病理性赌博等常见精神疾病的主要症状, 已经成为人们日益关注的焦点。研究发现, 前额叶–纹状体神经回路多巴胺参与了冲动性的调节, 但是研究结果并不一致, 多巴胺在冲动性中发挥的作用, 可能会受到三个不同因素的影响。首先, 冲动性具有多维度特征, 多巴胺对冲动的多种亚结构的作用存在差异; 其次, 多巴胺可以通过多个脑区以及与其他递质系统的交互作用影响冲动性; 最后, 多巴胺在调节冲动性的过程中可能还受到多种变量的影响, 如个体差异、环境线索等。     

成瘾相关记忆的表观遗传学机制 ——药物成瘾研究的新视角

成瘾相关记忆长期性的脑机制一直是药物成瘾研究领域的难点与热点,该文简要介绍了成瘾记忆长期性分子机制的研究脉络,提示表观遗传学修饰可能是研究药物成瘾的新视角。成瘾药物可以调节染色体不同亚型组蛋白乙酰化水平,不同基因DNA的甲基化程度从而改变染色体的空间结构,进而调节基因的表达导致成瘾,特别是DNA甲基化改变的相对的稳定性可能是成瘾记忆长期存在的分子基础。记忆再巩固过程中学习记忆相关脑区的记忆促进基因与记忆抑制基因的表观遗传学改变可能是未来研究的新趋势     

家庭环境、亲子依恋与青少年网络成瘾

本研究从北京、重庆和石家庄选取三所初中学校1038名初一到初三学生为被试,采用问卷调查的方式,探讨青少年的家庭环境、亲子依恋对其网络成瘾的影响及作用机制,以检验“人-情境交互作用理论”和“过程-个人-情境-时间”模型提出的理论观点。结果表明:(1)家庭环境和亲子依恋均与青少年的网络成瘾成显著负相关;(2)家庭环境中家庭亲密度对青少年网络成瘾有显著预测作用,父子依恋中的父子信任能显著负向预测青少年网络成瘾,母子依恋中的母子疏离能显著正向预测青少年网络成瘾;(3)家庭亲密度不仅直接影响青少年的网络成瘾,而且还通过母子疏离和父子信任间接影响青少年的网络成瘾,但母子疏离和父子信任所起的中介作用差异不显著。研究结果不仅说明了家庭环境对青少年心理行为发展的重要性,同时支持了“人-情境交互作用理论”和“过程-个人-情境-时间”模型提出的相应理论观点。     

青少年问题性社交网络使用

青少年问题性社交网络使用是世界范围内受到普遍关注的问题。问题性社交网络使用常被称作“社交网络成瘾”、“病理性社交网络使用”或“社交网络过度使用”, 概念和界定标准还没有达成一致看法。青少年合理的社交网络使用对促进社交关系的建立、维持和发展有积极意义, 但问题性社交网络使用却对青少年的身心发展产生消极影响。对青少年问题性社交网络使用发生机制的探讨, 将为问题性社交网络的干预引导提供依据。未来的研究应对问题性社交网络使用的概念和界定标准进行澄清, 用多维视角的方法开展问题性社交网络使用发生机制的深入研究, 加强对问题性社交网络使用的理论建构和干预研究。     

冲动性对不同成瘾行为发展的调控及其神经机制

近年来越来越多的研究证据提示, 个体冲动性在成瘾疾患发生发展机制中具有关键作用, 可能成为成瘾行为的潜在易感标记以及早期识别和干预的重要靶点, 但冲动性对不同成瘾行为变化发展的调控机制尚不明确。项目拟综合跨成瘾谱系比较、纵向追踪设计、冲动行为干预等研究途径, 采用人格测量、神经认知、神经影像等技术, 首先比较尼古丁依赖者与网络游戏成瘾者的冲动性结构及其在前额叶–纹状体环路的结构功能改变; 然后采用混合分组设计筛选出具有高低冲动性的非成瘾青少年进行连续追踪研究, 考察冲动性对尼古丁依赖与网络游戏成瘾的预测效力; 并采用认知行为训练, 对吸烟成瘾者与网络游戏成瘾者进行冲动干预, 考察行为干预对冲动性水平及前额叶–纹状体环路功能的改变, 以及对不同成瘾行为发展的抑制后效。旨在探索冲动性作为成瘾的潜在易感标记及干预靶点的效力。     

药物成瘾的易感性生物标记：从神经认知到分子遗传的证据

药物成瘾作为一种慢性复发性的脑疾病,具有从偶然性用药、规律性用药到强迫性用药的渐进式发展特征。研究提示,药物成瘾存在潜在的个体易感性机制,即在成瘾发生过程中不同个体接触药物后的成瘾风险并不相同,探索药物成瘾的神经生物标记是揭示成瘾易感性机制的重要途径。近十多年来,关于成瘾易感性标记的研究不断积聚。文章从神经认知、神经影像及脑电生理、分子遗传等层面梳理与药物成瘾生物标记有关的证据,试图在基因-大脑-心理-行为的理论框架下,对成瘾的发生发展机制进行综合阐释,期望为未来研究在探索药物成瘾的候选神经生物标记、寻找临床干预试验的精准靶点等方面提供更多理论参考。     

无意视盲的认知神经机制

无意视盲现象是指即使某些刺激物出现在视野中, 观察者也并没有觉察到这些刺激物的存在。这种现象在我们的现实生活中普遍存在, 它是许多交通和医疗事故的罪魁祸首。回顾前人的研究结果我们发现, 从认知行为角度出发, 无意视盲主要由两方面原因引起, 即“资源有限”与“注意定势”。一般情况下, “资源有限”与“注意定势”会共同导致无意视盲; 但有时候, “注意定势”也会独立于“资源有限”直接导致无意视盲。另外, 从大脑神经机制的角度来看, “资源有限”与“注意定势”作用于大脑加工的中后期, 即使产生无意视盲, 意识加工脑区对非预期刺激也进行了一定的认知加工, 但是否能进入到意识层面, 一方面取决于刺激呈现后中期枕顶部位的意识输入, 另一方面取决于与刺激驱动相关的颞顶联合区的激活程度以及与记忆负荷相关的顶内沟的抑制程度。     

易感人格的工作记忆特征对药物成瘾的调节机制

药物成瘾是指持续使用成瘾药物, 出现耐受性和戒断症状并严重阻碍正常社会功能的精神疾病。工作记忆在调节药物成瘾行为中扮演了中心角色：在神经易感性和易感人格特质基础上, 低工作记忆容量导致危险决策和去抑制性, 进而影响寻求药物和复吸行为。目前的研究基于已经产生成瘾的个体, 无法区别神经易感性、人格特质以及工作记忆缺陷是药物成瘾的原因还是结果; 而且, 仅从认知角度研究药物成瘾的原因, 会忽视该行为受多个因素影响的事实。     

Gamma神经振荡和信息整合加工

Gamma神经振荡是一种基础神经活动。它的特性使其与“信息整合加工”产生了潜在联系。已有研究显示, 自下而上的跨通道信息整合与感觉皮层的Gamma振荡同步化有关; 单通道自上而下的信息整合与高级皮层的Gamma振荡增强有关。现有的“神经耦合理论”和“匹配利用模型”分别描述了Gamma振荡如何在“自下而上”及“自上而下”的信息整合中发挥作用。Gamma振荡虽与整合加工密切相关, 但作为指标需谨慎。对于Gamma振荡在复杂情景整合加工中的作用仍待探究。     

The genetics of gambling and behavioral addictions

Behavioral addictions are considered as the repetitive occurrence of impulsive behaviors without consideration of their potential negative consequences. These addictions represent an increasing cost to society and are an important new field of research in psychiatric genetics. There has been a growing body of evidence on the familial aggregation and genetic influences on the development of behavioral addictions and mainly on pathological gambling. The aim of this article is to critically review findings of family and molecular genetic studies on behavioral addictions, focusing on pathological gambling and commenting on other disorders where appropriate. This review provides a comprehensive approach to genetic studies on behavioral addiction and points out the necessity of expanding the genetic research in this field. Future directions for genetic studies in this field are also discussed.     

The neurobiology of substance and behavioral addictions

Behavioral addictions, such as pathological gambling, kleptomania, pyromania, compulsive buying, and compulsive sexual behavior, represent significant public health concerns and are associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of these behaviors is still in the early stages, recent advances in the understanding of motivation, reward, and addiction have provided insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.     

Glücksspielsucht in der Rechtsprechung des Bundesgerichtshofs

Among the non-substance-related addictions, pathological gambling is the only one that has gained noteworthy forensic relevance. There are numerous parallels to substance-related addictions and not only in the symptomatology. A high proportion of pathological gamblers commit criminal offences to enable them to continue gambling or to pay gambling debts. According to the jurisdiction of the Federal Court of Justice (BGH) pathological gambling in itself cannot be considered as a pathological mental disorder or other serious mental abnormality that substantially diminishes the responsibility of the offender (German Penal Code § 21 StGB); however, the BGH recognizes that in serious cases of pathological gambling mental changes and personality defects can evolve that show similar structure and severity to substance-related addictions and severe withdrawal symptoms might also develop. As with substance-related addictions a substantial diminution of the offender’s responsibility can be assumed, therefore, also with pathological gambling if it has led to most severe personality changes or if the offender suffered from severe withdrawal symptoms while committing an addiction-related crime. According to these criteria a substantial diminution of the offender’s responsibility can be stated only in very rare cases. A custodial addiction treatment order (§ 64 StGB), which is also possible for fully responsible delinquents, is not applicable to cases of mere pathological gambling because the order requires an addiction to alcohol or other drugs. A mental hospital commitment order (§ 63 StGB) can be issued by the court under the same strict conditions that are applied to cases of substance-related addictions. Based on these principles this can only be issued if the defendant is addicted to gambling due to a mental defect that can be distinguished from the addiction itself or if the dependence has already been manifested in very severe personality changes. Pathological gambling can cause a propensity to commit serious offences and therefore, under the further conditions of §§ 66, 66a StGB justify detention for the purpose of incapacitation or a deferred incapacitation order. Even during imprisonment, detainees must be offered a suitable therapy (§ 66c para 2 StGB); however, penitentiaries do not offer the best environment for the treatment of pathological gamblers. The treatment in an addiction therapeutic setting appears to be more promising. Criminal political demands to make custodial addiction treatment orders also applicable to pathological gamblers have, however, very little chance of success.     

Internet addiction: a review of current assessment techniques and potential assessment questions.

The concept of Internet addiction has been proposed as an explanation for uncontrollable and damaging use of the Internet. Symptoms of excessive Internet use have been compared to the criteria used to diagnose other addictions such as pathological gambling. Although criteria to diagnose this problem have been proposed, methods of assessing excessive Internet use are limited. A structured interview based on the criteria proposed by Beard and Wolf is proposed to aid in the assessment of "Internet addiction." This, in turn, could aid in the diagnosis and intervention of a client who enters treatment reporting difficulties with excessive Internet use.     

Attachment and behavioral addictions in adolescents: The mediating and moderating role of coping strategies

Gambling, video gaming, and Internet use are typically included as everyday activities that could potentially become behavioral addictions. There is growing evidence that views non‐substance related addictions as coping mechanisms, and considers that attachment styles are likely to play a pivotal role on the development of such addictions, especially on young people. Therefore, the present study aimed to: (1) explore the association between attachment, coping, and behavioral addictions (i.e., gambling disorder, video game addiction, and problematic Internet use); and (2) to analyze the mediating/moderating effect that coping has in the relationship of attachment and these behavioral addictions. A sample consisting of 472 students from secondary education (Mean age = 15.6; SD = 1.33; 51.6% females) was recruited. The findings showed a negative association between attachment and behavioral addictions. Most coping strategies were found to be associated with attachment styles, except for self‐critique and emotional avoidance. In particular, problem avoidance was significantly correlated to all behavioral addictions. In addition, self‐blame and problem solving were significantly correlated to video game addiction and problematic Internet use. Finally, coping was found to act as a mediator and moderator between attachment and video game addiction and problematic Internet use.     

Spielsucht – Alkoholabhängigkeit: „Zwei Süchte,eine Behandlung?“

While alcoholism has been undisputedly classified for decades as an addiction in diagnostic manuals like ICD -10 and DSM -IV, the classification of pathological gambling has not been definitively resolved, although alcohol dependence and pathological gambling have many addiction criteria in common. The course of gambling addiction is typically characterized by an initial phase, a critical habituation phase, and a phase of despair. While a gambling addiction may rapidly progress to chronic dependence within a year, the development of chronic alcohol dependence requires many years of misuse. For gambling addicts, external influence plays a considerable role (trigger situation) on the entry into gambling. For the majority of players, the initial contact comes from third parties, while for problem gamblers the social character of an invitation as a maintaining factor has less influence than for alcoholics. There are differences especially in the expression of comorbidities and the consequences of the addiction. For problem gamblers, these are more psychological than social, while secondary disorders are significant for alcoholics.     

Recognition and Treatment of Late-Life Addictions in Medical Settings

Addictive disorders among the elderly have emerged as a growing public health concern. As the proportion of the elderly population increases, more and more older adults will either develop addictions as a dysfunctional means of coping with the psychosocial consequences of aging, or will carry their long-standing addictive behaviors with them into later life. Among the most common of these addictions are smoking, excess consumption of alcohol, and gambling. This article briefly reviews these three addictive disorders and examines assessment and treatment options. The current cohort of older adults tends not to seek help for addiction problems in specialty mental health or substance abuse treatment. To improve rates of cessation and abstinence, assessment and intervention should be delivered in general medical settings such as primary care. With the addition of a behavioral health specialist, primary care has the potential to offer improved interventions in a cost-effective and time-efficient manner.     

Pathologisches Glücksspielen: Persönlichkeitsmerkmale und forensische Aspekte

Causes and psychological characteristics of pathological gambling are reviewed. Neither the addiction model nor the conception of a “disorder of impulse control” is fitting to comprehend the peculiarity of these hardened conduct disorders. Pathological gambling is a learned pattern of behaviour with a variety of etiological backgrounds. There is no uniform type of “the” pathological gambler. Some kinds of gambling like roulette or horse betting are used to experience arousal and thrill; other forms like german slot machines on the contrary are used to relax and to find relief from depression and boredom. There is a broad spectrum of comorbid disorders, e.g. mood disorders and personality disorders. The paper delineates the overlap with antisocial patterns and the juridical consequences.     

反馈相关负波与成瘾

反馈相关负波(feedback-related negativity, FRN)是反馈加工诱发的脑电成分, 体现了个体对奖赏的敏感性。成瘾分为物质成瘾和行为成瘾, 两类个体的反馈加工都呈现病理性模式。相对于普通反馈物(如金钱), 物质成瘾个体在加工成瘾物质时诱发的FRN波幅显著增大; 在与非成瘾被试的对照研究中, 物质成瘾者加工金钱反馈时的FRN也表现出与成瘾相关的异常模式; 在行为成瘾个体中亦观察到与物质成瘾个体类似的FRN失调现象。但以往多数研究中对成瘾类型的区分还不够详细, 未来研究应进一步考虑成瘾不同亚型的特点; 且成瘾个体往往伴随其他精神障碍(如抑郁、焦虑), 将来的研究要区分共病因素的影响, 揭示成瘾独特的奖赏加工机制问题。     

The contribution of imaging genetics to the development of predictive markers for addictions

A key challenge for intervention and prevention of addictions is the identification of genetic, neurobiological and cognitive risk profiles that can predict which adolescents are at risk for addiction. Abnormalities in reinforcement behaviour have been linked to addiction vulnerability and imaging genetic studies have begun to elucidate the mechanisms by which genetic and environmental factors influence brain function underlying individual variability in reinforcement behaviour. Most studies have examined associations between a few well-characterised candidate polymorphisms and task-related brain activation differences in individual regions of interest. Here we propose that integrating the imaging genetic strategy with biological network approaches and longitudinal adolescent designs in large multi-centre samples may offer promising opportunities to identify risk markers for early diagnosis, progression and prediction of addictions.