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Bellini BB, Scholz JR, Abe TO, Arnaut D, Tonstad S, Alberto RL, Gaya PV, de Moraes IRA, Teixeira MJ, Marcolin MA. Does deep TMS really works for smoking cessation? A prospective, double blind, randomized, sham controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110997. [PMID: 38531486 DOI: 10.1016/j.pnpbp.2024.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION A substantial proportion of smokers wishing to quit do not stop smoking when using current therapies to aid cessation. Magnetic pulses to specific brain areas designated as transcranial magnetic stimulation may modulate brain activity and thereby change chemical dependencies. Deep transcranial magnetic stimulation (dTMS) with the H4 coil stimulates neuronal pathways in the lateral prefrontal cortex and insula bilaterally, areas involved in tobacco addiction. OBJECTIVE To evaluate the efficacy and safety of dTMS with T4 coil in smoking cessation. METHODS In a double blind, controlled clinical trial, adult smokers of at least 10 cigarettes/day were randomized to active (n = 50) versus sham dTMS (n = 50). The protocol involved up to 21 sessions administered over up to 12 weeks. Tobacco use was monitored by self-report and confirmed by expired air monoximetry (at each dTMS visit) and blood cotinine (at the screening visit and at the end of sessions). Participants completed abstinence, mood and cognition scales at determined timepoints during follow-up. RESULTS In the intention to-treat-analysis, the cessation rate of the intervention and control groups was 14.0%. The reported side effects were as expected for this procedure. Although there were no serious adverse events, three participants were withdrawn according to safety criteria. CONCLUSION Active treatment with dTMS H4 coil was safe but not effective for smoking cessation.
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Affiliation(s)
- Bianca B Bellini
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil; Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil.
| | - Jaqueline R Scholz
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Tania O Abe
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Debora Arnaut
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Rodrigo L Alberto
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia V Gaya
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Iana R A de Moraes
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco A Marcolin
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
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van Ruitenbeek P, Franzen L, Mason NL, Stiers P, Ramaekers JG. Methylphenidate as a treatment option for substance use disorder: a transdiagnostic perspective. Front Psychiatry 2023; 14:1208120. [PMID: 37599874 PMCID: PMC10435872 DOI: 10.3389/fpsyt.2023.1208120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
A transition in viewing mental disorders from conditions defined as a set of unique characteristics to one of the quantitative variations on a collection of dimensions allows overlap between disorders. The overlap can be utilized to extend to treatment approaches. Here, we consider the overlap between attention-deficit/hyperactivity disorder and substance use disorder to probe the suitability to use methylphenidate as a treatment for substance use disorder. Both disorders are characterized by maladaptive goal-directed behavior, impaired cognitive control, hyperactive phasic dopaminergic neurotransmission in the striatum, prefrontal hypoactivation, and reduced frontal cortex gray matter volume/density. In addition, methylphenidate has been shown to improve cognitive control and normalize associated brain activation in substance use disorder patients and clinical trials have found methylphenidate to improve clinical outcomes. Despite the theoretical basis and promising, but preliminary, outcomes, many questions remain unanswered. Most prominent is whether all patients who are addicted to different substances may equally profit from methylphenidate treatment.
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Affiliation(s)
- Peter van Ruitenbeek
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Conti AA, Baldacchino AM. Early-onset smoking theory of compulsivity development: a neurocognitive model for the development of compulsive tobacco smoking. Front Psychiatry 2023; 14:1209277. [PMID: 37520221 PMCID: PMC10372444 DOI: 10.3389/fpsyt.2023.1209277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
According to the literature, individuals who start tobacco smoking during adolescence are at greater risk of developing severe tobacco addiction and heavier smoking behavior in comparison with individuals who uptake tobacco smoking during subsequent developmental stages. As suggested by animal models, this may be related to the unique neuroadaptive and neurotoxic effects of nicotine on adolescents' fronto-striatal brain regions modulating cognitive control and impulsivity. Previous research has proposed that these neuroadaptive and neurotoxic effects may cause a heightened reward-oriented impulsive behavior that may foster smoking relapses during quit attempts. However, developments in the field of addiction neuroscience have proposed drug addiction to represent a type of compulsive behavior characterized by the persistent use of a particular drug despite evident adverse consequences. One brain region that has received increased attention in recent years and that has been proposed to play a central role in modulating such compulsive drug-seeking and using behavior is the insular cortex. Lesion studies have shown that structural damages in the insular cortex may disrupt smoking behavior, while neuroimaging studies reported lower gray matter volume in the anterior insular cortex of chronic smokers compared with non-smokers, in addition to correlations between gray matter volume in the anterior insular cortex and measures of compulsive cigarette smoking. Based on the findings of our recent study reporting on early-onset smokers (mean age at regular smoking initiation = 13.2 years) displaying lower gray matter and white matter volume in the anterior insular cortex compared to late-onset smokers (mean age at regular smoking initiation = 18.0 years), we propose that the anterior insular cortex may play a central role in mediating the association between smoking uptake during adolescence and smoking heaviness/tobacco addiction during adulthood.
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Affiliation(s)
- Aldo Alberto Conti
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Alexander Mario Baldacchino
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
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Ely AV, Wetherill RR. Reward and inhibition in obesity and cigarette smoking: Neurobiological overlaps and clinical implications. Physiol Behav 2023; 260:114049. [PMID: 36470508 PMCID: PMC10694810 DOI: 10.1016/j.physbeh.2022.114049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Cigarette smoking and obesity are the leading causes of premature morbidity and mortality and increase the risk of all-cause mortality four-fold when comorbid. Individuals with these conditions demonstrate neurobiological and behavioral differences regarding how they respond to rewarding stimuli or engage in inhibitory control. This narrative review examines the role of reward and inhibition in cigarette smoking and obesity independently, as well as recent research demonstrating an effect of increased body mass index (BMI) on neurocognitive function in individuals who smoke. It is possible that chronic smoking and overeating of highly palatable food, contributing to obesity, dysregulates reward neurocircuitry, subsequently leading to hypofunction of brain networks associated with inhibitory control. These brain changes do not appear to be specific to food or nicotine and, as a result, can potentiate continued cross-use. Changes to reward and inhibitory function due to increased BMI may also make cessation more difficult for those comorbid for obesity and smoking.
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Affiliation(s)
- Alice V Ely
- Cooper University Health Care, Center for Healing, Division of Addiction Medicine, Camden, NJ 08103, USA.
| | - Reagan R Wetherill
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA 19104, USA
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5
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Conti AA, Baldacchino AM. Chronic tobacco smoking, impaired reward-based decision-making, and role of insular cortex: A comparison between early-onset smokers and late-onset smokers. Front Psychiatry 2022; 13:939707. [PMID: 36090372 PMCID: PMC9459116 DOI: 10.3389/fpsyt.2022.939707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The literature suggests that tobacco smoking may have a neurotoxic effect on the developing adolescent brain. Particularly, it may impair the decision-making process of early-onset smokers (<16 years), by rendering them more prone to impulsive and risky choices toward rewards, and therefore more prone to smoking relapses, in comparison to late-onset smokers (≥16 years). However, no study has ever investigated reward-based decision-making and structural brain differences between early-onset smokers and late-onset smokers. METHODS Computerized measures of reward-based decision-making [Cambridge Gambling Task (CGT); 5-trials adjusting delay discounting task (ADT-5)] were administered to 11 early-onset smokers (mean age at regular smoking initiation = 13.2 years), 17 late-onset smokers (mean age at regular smoking initiation = 18.0 years), and 24 non-smoker controls. Voxel-based morphometry (VBM) was utilized to investigate the gray matter (GM) and white matter (WM) volume differences in fronto-cortical and striatal brain regions between early-onset smokers, late-onset smokers, and non-smokers. RESULTS Early-onset smokers displayed a riskier decision-making behavior in comparison to non-smokers as assessed by the CGT (p < 0.01, Cohen's f = 0.48). However, no significant differences (p > 0.05) in reward-based decision-making were detected between early-onset smokers and late-onset smokers. VBM results revealed early-onset smokers to present lower GM volume in the bilateral anterior insular cortex (AI) in comparison to late-onset smokers and lower WM volume in the right AI in comparison to late-onset smokers. CONCLUSION Impairments in reward-based decision-making may not be affected by tobacco smoking initiation during early adolescence. Instead, lower GM and WM volume in the AI of early-onset smokers may underline a vulnerability to develop compulsive tobacco seeking and smoking behavior during adulthood.
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Affiliation(s)
- Aldo Alberto Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alexander Mario Baldacchino
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
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Rohlfing N, Bonnet U, Tendolkar I, Hinney A, Scherbaum N. Subjective reward processing and catechol- O- methyltransferase Val158Met polymorphism as potential research domain criteria in addiction: A pilot study. Front Psychiatry 2022; 13:992657. [PMID: 36311493 PMCID: PMC9613938 DOI: 10.3389/fpsyt.2022.992657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
The Research Domain Criteria (RDoC) approach seeks to understand mental functioning in continuous valid dimensions ranging from functional to pathological. Reward processing is a transdiagnostic functioning domain of the RDoC. Due to prototypical abnormalities, addictions are especially applicable for the investigation of reward processing. Subjective reward processing is challenging to determine and differs between genotypes of the catechol-O-methyltransferase gene (COMT) Val158Met polymorphism for incomparable daily life experiences. Thus, we implemented the monetary incentive delay (MID) task with comparable reward cues and visual analog scales (VAS) to assess subjective reward processing in male abstinent cannabis-dependent individuals (N = 13) and a control group of nicotine smokers (N = 13). COMT Val158Met genotypes were nominally associated with differences in cigarettes smoked per day and motivation in the MID Task (p = 0.028; p = 0.017). For feedback gain, activation of the right insula was increased in controls, and activation correlated with gain expectancy and satisfaction about gain. Subjective value is not detached from reward parameters, but is modulated from expectancy and reward by the insula. The underlying neural mechanisms are a fundamental target point for treatments, interventions, and cognitive behavioral therapy.
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Affiliation(s)
- Nico Rohlfing
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Essen, Germany.,Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Udo Bonnet
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Essen, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behaviour, Centre for Medical Neuroscience, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Essen, Germany.,Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
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Ward HB, Beermann A, Nawaz U, Halko MA, Janes AC, Moran LV, Brady RO. Evidence for Schizophrenia-Specific Pathophysiology of Nicotine Dependence. Front Psychiatry 2022; 13:804055. [PMID: 35153877 PMCID: PMC8829345 DOI: 10.3389/fpsyt.2022.804055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/03/2022] [Indexed: 12/30/2022] Open
Abstract
Tobacco use is the top preventable cause of early mortality in schizophrenia. Over 60% of people with schizophrenia smoke, three times the general prevalence. The biological basis of this increased risk is not understood, and existing interventions do not target schizophrenia-specific pathology. We therefore used a connectome-wide analysis to identify schizophrenia-specific circuits of nicotine addiction. We reanalyzed data from two studies: In Cohort 1, 35 smokers (18 schizophrenia, 17 control) underwent resting-state fMRI and clinical characterization. A multivariate pattern analysis of whole-connectome data was used to identify the strongest links between cigarette use and functional connectivity. In Cohort 2, 12 schizophrenia participants and 12 controls were enrolled in a randomized, controlled crossover study of nicotine patch with resting-state fMRI. We correlated change in network functional connectivity with nicotine dose. In Cohort 1, the strongest (p < 0.001) correlate between connectivity and cigarette use was driven by individual variation in default mode network (DMN) topography. In individuals with greater daily cigarette consumption, we observed a pathological expansion of the DMN territory into the identified parieto-occipital region, while in individuals with lower daily cigarette consumption, this region was external to the DMN. This effect was entirely driven by schizophrenia participants. Given the relationship between DMN topography and nicotine use we observed in Cohort 1, we sought to directly test the impact of nicotine on this network using an independent second cohort. In Cohort 2, nicotine reduced DMN connectivity in a dose-dependent manner (R = -0.50; 95% CI -0.75 to -0.12, p < 0.05). In the placebo condition, schizophrenia subjects had hyperconnectivity compared to controls (p < 0.05). Nicotine administration normalized DMN hyperconnectivity in schizophrenia. We here provide direct evidence that the biological basis of nicotine dependence is different in schizophrenia and in non-schizophrenia populations. Our results suggest the high prevalence of nicotine use in schizophrenia may be an attempt to correct a network deficit known to interfere with cognition.
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Affiliation(s)
- Heather Burrell Ward
- Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Adam Beermann
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Uzma Nawaz
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Mark A Halko
- Harvard Medical School, Boston, MA, United States.,McLean Hospital, Belmont, MA, United States
| | - Amy C Janes
- Harvard Medical School, Boston, MA, United States.,McLean Hospital, Belmont, MA, United States
| | - Lauren V Moran
- Harvard Medical School, Boston, MA, United States.,McLean Hospital, Belmont, MA, United States
| | - Roscoe O Brady
- Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,McLean Hospital, Belmont, MA, United States
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Zangen A, Moshe H, Martinez D, Barnea‐Ygael N, Vapnik T, Bystritsky A, Duffy W, Toder D, Casuto L, Grosz ML, Nunes EV, Ward H, Tendler A, Feifel D, Morales O, Roth Y, Iosifescu D, Winston J, Wirecki T, Stein A, Deutsch F, Li X, George MS. Repetitive transcranial magnetic stimulation for smoking cessation: a pivotal multicenter double-blind randomized controlled trial. World Psychiatry 2021; 20:397-404. [PMID: 34505368 PMCID: PMC8429333 DOI: 10.1002/wps.20905] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation method increasingly used to treat psychiatric disorders, primarily depression. Initial studies suggest that rTMS may help to treat addictions, but evaluation in multicenter randomized controlled trials (RCTs) is needed. We conducted a multicenter double-blind RCT in 262 chronic smokers meeting DSM-5 criteria for tobacco use disorder, who had made at least one prior failed attempt to quit, with 68% having made at least three failed attempts. They received three weeks of daily bilat-eral active or sham rTMS to the lateral prefrontal and insular cortices, followed by once weekly rTMS for three weeks. Each rTMS session was administered following a cue-induced craving procedure, and participants were monitored for a total of six weeks. Those in abstinence were monitored for additional 12 weeks. The primary outcome measure was the four-week continuous quit rate (CQR) until Week 18 in the intent-to-treat efficacy set, as determined by daily smoking diaries and verified by urine cotinine measures. The trial was registered at ClinicalTrials.gov (NCT02126124). In the intent-to-treat analysis set (N=234), the CQR until Week 18 was 19.4% following active and 8.7% following sham rTMS (X2 =5.655, p=0.017). Among completers (N=169), the CQR until Week 18 was 28.0% and 11.7%, respectively (X2 =7.219, p=0.007). The reduction in cigarette consumption and craving was significantly greater in the active than the sham group as early as two weeks into treatment. This study establishes a safe treatment protocol that promotes smoking cessation by stimulating relevant brain circuits. It represents the first large multicenter RCT of brain stimulation in addiction medicine, and has led to the first clearance by the US Food and Drug Administration for rTMS as an aid in smok-ing cessation for adults.
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Affiliation(s)
- Abraham Zangen
- Department of Life Sciences and Zlotowski Centre for NeuroscienceBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Hagar Moshe
- Department of Life Sciences and Zlotowski Centre for NeuroscienceBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Diana Martinez
- Department of PsychiatryColumbia University Irving Medical CenterNew YorkNYUSA
| | - Noam Barnea‐Ygael
- Department of Life Sciences and Zlotowski Centre for NeuroscienceBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Tanya Vapnik
- Pacific Institute of Medical ResearchLos AngelesCAUSA
| | | | | | - Doron Toder
- Department of Life Sciences and Zlotowski Centre for NeuroscienceBen‐Gurion University of the NegevBeer‐ShevaIsrael,Beer‐Sheva Mental Health Center, Ministry of HealthBeer‐ShevaIsrael
| | - Leah Casuto
- Lindner Center of HOPE, and University of Cincinnati Department of Psychiatry and Behavioral MedicineCincinnatiOHUSA
| | - Moran Lipkinsky Grosz
- Tel Aviv University Medical School, Tel Aviv and Be’er Yaacov Mental Health CenterBe'er YaacovIsrael
| | - Edward V. Nunes
- Department of PsychiatryColumbia University Irving Medical CenterNew YorkNYUSA
| | - Herbert Ward
- Department of PsychiatryUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Aron Tendler
- Advanced Mental Health Care Inc.Royal Palm BeachFLUSA
| | | | | | - Yiftach Roth
- Department of Life Sciences and Zlotowski Centre for NeuroscienceBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Dan V. Iosifescu
- New York University School of Medicine and Nathan Kline InstituteNew YorkNYUSA
| | | | | | - Ahava Stein
- A. Stein ‐ Regulatory Affairs Consulting Ltd.Kfar SabaIsrael
| | | | - Xingbao Li
- Brain Stimulation DivisionPsychiatry, Medical University of South CarolinaCharlestonSCUSA
| | - Mark S. George
- Brain Stimulation DivisionPsychiatry, Medical University of South CarolinaCharlestonSCUSA,Ralph H. Johnson VA Medical CenterCharlestonSCUSA
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Jo S, Kim HC, Lustig N, Chen G, Lee JH. Mixed-effects multilevel analysis followed by canonical correlation analysis is an effective fMRI tool for the investigation of idiosyncrasies. Hum Brain Mapp 2021; 42:5374-5396. [PMID: 34415651 PMCID: PMC8519860 DOI: 10.1002/hbm.25627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We report that regions-of-interest (ROIs) associated with idiosyncratic individual behavior can be identified from functional magnetic resonance imaging (fMRI) data using statistical approaches that explicitly model individual variability in neuronal activations, such as mixed-effects multilevel analysis (MEMA). We also show that the relationship between neuronal activation in fMRI and behavioral data can be modeled using canonical correlation analysis (CCA). A real-world dataset for the neuronal response to nicotine use was acquired using a custom-made MRI-compatible apparatus for the smoking of electronic cigarettes (e-cigarettes). Nineteen participants smoked e-cigarettes in an MRI scanner using the apparatus with two experimental conditions: e-cigarettes with nicotine (ECIG) and sham e-cigarettes without nicotine (SCIG) and subjective ratings were collected. The right insula was identified in the ECIG condition from the χ2 -test of the MEMA but not from the t-test, and the corresponding activations were significantly associated with the similarity scores (r = -.52, p = .041, confidence interval [CI] = [-0.78, -0.17]) and the urge-to-smoke scores (r = .73, p <.001, CI = [0.52, 0.88]). From the contrast between the two conditions (i.e., ECIG > SCIG), the right orbitofrontal cortex was identified from the χ2 -tests, and the corresponding neuronal activations showed a statistically meaningful association with similarity (r = -.58, p = .01, CI = [-0.84, -0.17]) and the urge to smoke (r = .34, p = .15, CI = [0.09, 0.56]). The validity of our analysis pipeline (i.e., MEMA followed by CCA) was further evaluated using the fMRI and behavioral data acquired from the working memory and gambling tasks available from the Human Connectome Project.
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Affiliation(s)
- Sungman Jo
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Hyun-Chul Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niv Lustig
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Gang Chen
- Scientific and Statistical Computing Core, NIMH/NIH/DHHS, Bethesda, Maryland
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
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Subtypes of inhibitory and reward activation associated with substance use variation in adolescence: A latent profile analysis of brain imaging data. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2021; 21:1101-1114. [PMID: 33973159 DOI: 10.3758/s13415-021-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
The present study identified subgroups based on inhibitory and reward activation, two key neural functions involved in risk-taking behavior, and then tested the extent to which subgroup differences varied by age, sex, behavioral and familial risk, and substance use. Participants were 145 young adults (18-21 years old; 40.0% female) from the Michigan Longitudinal Study. Latent profile analysis (LPA) was used to establish subgroups using task-based brain activations. Demographic and substance use differences between subgroups were then examined in logistic regression analyses. Whole-brain task activations during a functional magnetic resonance imaging go/no-go task and monetary incentive delay task were used to identify beta weights as input for LPA modeling. A four-class model showed the best fit with the data. Subgroups were categorized as: (1) low inhibitory activation/moderate reward activation (39.7%), (2) moderate inhibitory activation/low reward activation (22.7%), (3) moderate inhibitory activation/high reward activation (25.2%), and (4) high inhibitory activation/high reward activation (12.4%). Compared with the other subgroups, Class 2 was older, less likely to have parental alcohol use disorder, and had less alcohol use. Class 4 was the youngest and had greater marijuana use. Classes 1 and 3 did not differ significantly from the other subgroups. These findings demonstrate that LPA applied to brain activations can be used to identify distinct neural profiles that may explain heterogeneity in substance use outcomes and may inform more targeted substance use prevention and intervention efforts.
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Wang KS, Zegel M, Molokotos E, Moran LV, Olson DP, Pizzagalli DA, Janes AC. The acute effects of nicotine on corticostriatal responses to distinct phases of reward processing. Neuropsychopharmacology 2020; 45:1207-1214. [PMID: 31931509 PMCID: PMC7235267 DOI: 10.1038/s41386-020-0611-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/09/2022]
Abstract
Nicotine enhances the reinforcement of non-drug rewards by increasing nucleus accumbens (NAcc) reactivity to anticipatory cues. This anticipatory effect is selective as no clear evidence has emerged showing that nicotine acutely changes reward receipt reactivity. However, repeated rewarding experiences shift peak brain reactivity from hedonic reward outcome to the motivational anticipatory cue yielding more habitual cue-induced behavior. Given nicotine's influence on NAcc reactivity and connectivity, it is plausible that nicotine acutely induces this shift and alters NAcc functional connectivity during reward processing. To evaluate this currently untested hypothesis, a randomized crossover design was used in which healthy non-smokers were administered placebo and nicotine (2-mg lozenge). Brain activation to monetary reward anticipation and outcome was evaluated with functional magnetic resonance imaging. Relative to placebo, nicotine induced more NAcc reactivity to reward anticipation. Greater NAcc activation during anticipation was significantly associated with lower NAcc activation to outcome. During outcome, nicotine reduced NAcc functional connectivity with cortical regions including the anterior cingulate cortex, orbitofrontal cortex, and insula. These regions showed the same negative relationship between reward anticipation and outcome as noted in the NAcc. The current findings significantly improve our understanding of how nicotine changes corticostriatal circuit function and communication during distinct phases of reward processing and critically show that these alterations happen acutely following a single dose. The implications of this work explain nicotinic modulation of general reward function, which offer insights into the initial drive to smoke and the subsequent difficulty in cessation.
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Affiliation(s)
- Kainan S. Wang
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Maya Zegel
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA
| | - Elena Molokotos
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,0000 0001 0684 8852grid.264352.4Department of Psychology, Suffolk University, Boston, MA USA
| | - Lauren V. Moran
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - David P. Olson
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Diego A. Pizzagalli
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Amy C. Janes
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
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12
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Licheri V, Eckernäs D, Bergquist F, Ericson M, Adermark L. Nicotine-induced neuroplasticity in striatum is subregion-specific and reversed by motor training on the rotarod. Addict Biol 2020; 25:e12757. [PMID: 30969011 PMCID: PMC7187335 DOI: 10.1111/adb.12757] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
Nicotine is recognized as one of the most addictive drugs, which in part could be attributed to progressive neuroadaptations and rewiring of dorsal striatal circuits. Since motor‐skill learning produces neuroplasticity in the same circuits, we postulate that rotarod training could be sufficient to block nicotine‐induced rewiring and thereby prevent long‐lasting impairments of neuronal functioning. To test this hypothesis, Wistar rats were subjected to 15 days of treatment with either nicotine (0.36 mg/kg) or vehicle. After treatment, a subset of animals was trained on the rotarod. Ex vivo electrophysiology was performed 1 week after the nicotine treatment period and after up to 3 months of withdrawal to define neurophysiological transformations in circuits of the striatum and amygdala. Our data demonstrate that nicotine alters striatal neurotransmission in a distinct temporal and spatial sequence, where acute transformations are initiated in dorsomedial striatum (DMS) and nucleus accumbens (nAc) core. Following 3 months of withdrawal, synaptic plasticity in the form of endocannabinoid‐mediated long‐term depression (eCB‐LTD) is impaired in the dorsolateral striatum (DLS), and neurotransmission is altered in DLS, nAc shell, and the central nucleus of the amygdala (CeA). Training on the rotarod, performed after nicotine treatment, blocks neurophysiological transformations in striatal subregions, and prevents nicotine‐induced impairment of eCB‐LTD. These datasets suggest that nicotine‐induced rewiring of striatal circuits can be extinguished by other behaviors that induce neuroplasticity. It remains to be determined if motor‐skill training could be used to prevent escalating patterns of drug use in experienced users or facilitate the recovery from addiction.
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Affiliation(s)
- Valentina Licheri
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Daniel Eckernäs
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Filip Bergquist
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Mia Ericson
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Louise Adermark
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
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13
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Molokotos E, Peechatka AL, Wang KS, Pizzagalli DA, Janes AC. Caudate reactivity to smoking cues is associated with increased responding to monetary reward in nicotine-dependent individuals. Drug Alcohol Depend 2020; 209:107951. [PMID: 32145666 PMCID: PMC7127934 DOI: 10.1016/j.drugalcdep.2020.107951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/20/2023]
Abstract
Quitting smoking is challenging in part because environmental smoking cues can trigger the desire to smoke. Neurobiological responses to smoking cues are often observed in reward-related brain regions such as the caudate and nucleus accumbens (NAc). While reward plays a well-established role in the formation of cue reactivity, whether general reward responsiveness contributes to individual differences in cue-reactivity among chronic smokers is unclear; establishing such link could provide insight into the mechanisms maintaining cue reactivity. The current study explored this relationship by assessing smoking cue reactivity during functional magnetic imaging followed by an out-of-scanner probabilistic reward task (PRT) in 24 nicotine-dependent smokers (14 women). In addition, owing to sex differences in cue reactivity and reward function, this same relationship was examined as a function of sex. Following recent smoking, greater reward responsiveness on the PRT was associated with enhanced left caudate reactivity to smoking cues. No relationship was found in any other striatal subregion. The positive relationship between reward responsiveness and caudate smoking cue reactivity was significant only in male smokers, fitting with the idea that males and females respond to the reinforcing elements of smoking cues differently. These findings are clinically relevant as they show that, following recent smoking, nicotine-dependent individuals who are more cue reactive are also more likely to be responsive to non-drug rewards, which may be useful for making individualized treatment decisions that involve behavioral reward contingencies.
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Affiliation(s)
- Elena Molokotos
- McLean Hospital, Belmont, MA, USA; Department of Psychology, Suffolk University, Boston, MA, USA.
| | | | - Kainan S. Wang
- McLean Hospital, Belmont, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Amy C. Janes
- McLean Hospital, Belmont, MA, USA,Harvard Medical School, Boston, MA, USA
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14
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Whitton AE, Green AI, Pizzagalli DA, Roth RM, Williams JM, Brunette MF. Potent Dopamine D2 Antagonists Block the Reward-Enhancing Effects of Nicotine in Smokers With Schizophrenia. Schizophr Bull 2019; 45:1300-1308. [PMID: 30690638 PMCID: PMC6811816 DOI: 10.1093/schbul/sby185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antipsychotics that are potent dopamine (DA) D2 receptor antagonists have been linked to elevated levels of nicotine dependence in smokers with schizophrenia. Because activation of D2 receptors mediates motivation for nicotine, we examined whether potent D2 antagonists would diminish nicotine's ability to stimulate reward processing-a mechanism that may drive compensatory increases in smoking. Smokers with schizophrenia (n = 184) were recruited and stratified into medication groups based on D2 receptor antagonist potency. The effects of smoking on reward function were assessed using a probabilistic reward task (PRT), administered pre- and post-smoking. The PRT used an asymmetrical reinforcement schedule to produce a behavioral response bias, previously found to increase under conditions (including smoking) that enhance mesolimbic DA signaling. Among the 98 participants with valid PRT data and pharmacotherapy that could be stratified into D2 receptor antagonism potency, a medication × smoking × block interaction emerged (P = .005). Post-hoc tests revealed a smoking × block interaction only for those not taking potent D2 antagonists (P = .007). This group exhibited smoking-related increases in response bias (P < .001) that were absent in those taking potent D2 antagonists (P > .05). Our findings suggest that potent D2 antagonists diminish the reward-enhancing effects of nicotine in smokers with schizophrenia. This may be a mechanism implicated in the increased rate of smoking often observed in patients prescribed these medications. These findings have important clinical implications for the treatment of nicotine dependence in schizophrenia.
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Affiliation(s)
- Alexis E Whitton
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH,Dartmouth Clinical and Translational Science Institute, Hanover, NH
| | - Diego A Pizzagalli
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Robert M Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jill M Williams
- Department of Psychiatry, Rutgers University, New Brunswick, NJ
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH,To whom correspondence should be addressed; Department of Psychiatry, Dartmouth-Hitchcock, 2 Pillsbury Street, Suite 40, Concord, NH 03301, US; tel: 603-229-5419, fax: 603-271-5262, e-mail:
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15
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Ibrahim C, Rubin-Kahana DS, Pushparaj A, Musiol M, Blumberger DM, Daskalakis ZJ, Zangen A, Le Foll B. The Insula: A Brain Stimulation Target for the Treatment of Addiction. Front Pharmacol 2019; 10:720. [PMID: 31312138 PMCID: PMC6614510 DOI: 10.3389/fphar.2019.00720] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.
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Affiliation(s)
- Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Dafna S Rubin-Kahana
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abhiram Pushparaj
- Qunuba Sciences, Toronto, ON, Canada.,Ironstone Product Development, Toronto, ON, Canada
| | | | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abraham Zangen
- Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Addictions Division, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Alcohol Research and Treatment Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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