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Lima DR, Gonçalves PD, Ometto M, Malbergier A, Amaral RA, Dos Santos B, Cavallet M, Chaim-Avancini T, Serpa MH, Ferreira LRK, Duran FLDS, Zanetti MV, Nicastri S, Busatto GF, Andrade AG, Cunha PJ. The role of neurocognitive functioning, substance use variables and the DSM-5 severity scale in cocaine relapse: A prospective study. Drug Alcohol Depend 2019; 197:255-261. [PMID: 30875646 DOI: 10.1016/j.drugalcdep.2019.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD). METHODS 128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge. RESULTS Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse. CONCLUSIONS Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.
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Affiliation(s)
- Danielle Ruiz Lima
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil.
| | - Priscila Dib Gonçalves
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Mariella Ometto
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Andre Malbergier
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Ricardo Abrantes Amaral
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Bernardo Dos Santos
- Escola de Enfermagem, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cerqueira César, 05403-000, Sao Paulo, SP, Brazil
| | - Mikael Cavallet
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Tiffany Chaim-Avancini
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Mauricio Henriques Serpa
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Luiz Roberto Kobuti Ferreira
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Fabio Luis de Souza Duran
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Marcus Vinicius Zanetti
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Sergio Nicastri
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Geraldo Filho Busatto
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Arthur Guerra Andrade
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Departmento de Neurociencias, Escola de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, 09060-870, Santo Andre, SP, Brazil
| | - Paulo Jannuzzi Cunha
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
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Stern ER, Shahab R, Grimaldi SJ, Leibu E, Murrough JW, Fleysher L, Parides MK, Coffey BJ, Burdick KE, Goodman WK. High-dose ondansetron reduces activation of interoceptive and sensorimotor brain regions. Neuropsychopharmacology 2019; 44:390-398. [PMID: 30116006 PMCID: PMC6300545 DOI: 10.1038/s41386-018-0174-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/22/2018] [Accepted: 07/29/2018] [Indexed: 01/16/2023]
Abstract
Several psychiatric disorders involve abnormalities of interoception and associated neural circuitry centered on the insula. The development of interventions modulating interoceptive circuits could lead to novel treatment approaches for these disorders. The 5-HT3 receptor antagonist ondansetron is a good candidate for the modulation of interoceptive circuits, as 5-HT3 receptors are located abundantly on sensory pathways and ondansetron has shown some clinical utility in disorders characterized by sensory and interoceptive abnormalities. The present study tested the ability of three different doses of ondansetron to engage neural regions involved in interoception to determine the drug's utility as a therapeutic agent to target circuit abnormalities in patients. Fifty-three healthy subjects were randomized to receive a single 8-mg (n = 18), 16-mg (n = 17), or 24-mg (n = 18) dose of ondansetron and placebo before MRI scanning on separate days. Subjects performed an fMRI task previously shown to engage interoceptive circuitry in which they viewed videos depicting body movements/sensation and control videos. The results revealed a highly significant relationship between dosage and activation in bilateral insula, somatosensory and premotor regions, cingulate cortex, and temporal cortex for control but not body-focused videos. These effects were driven by a robust reduction in activation for ondansetron compared to placebo for the 24-mg group, with weaker effects for the 16-mg and 8-mg groups. In conclusion, high-dose ondansetron reduces activation of several areas important for interoception, including insula and sensorimotor cortical regions. This study reveals the potential utility of this drug in modulating hyperactivity in these regions in patients.
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Affiliation(s)
- Emily R Stern
- Department of Psychiatry, The New York University School of Medicine, New York, NY, USA.
- The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
| | - Rebbia Shahab
- Department of Psychiatry, The New York University School of Medicine, New York, NY, USA
- The Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | | | - Evan Leibu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael K Parides
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Medical School, Miami, FL, USA
| | | | - Wayne K Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
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Mete M, Sakoglu U, Spence JS, Devous MD, Harris TS, Adinoff B. Successful classification of cocaine dependence using brain imaging: a generalizable machine learning approach. BMC Bioinformatics 2016; 17:357. [PMID: 27766943 PMCID: PMC5073995 DOI: 10.1186/s12859-016-1218-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Neuroimaging studies have yielded significant advances in the understanding of neural processes relevant to the development and persistence of addiction. However, these advances have not explored extensively for diagnostic accuracy in human subjects. The aim of this study was to develop a statistical approach, using a machine learning framework, to correctly classify brain images of cocaine-dependent participants and healthy controls. In this study, a framework suitable for educing potential brain regions that differed between the two groups was developed and implemented. Single Photon Emission Computerized Tomography (SPECT) images obtained during rest or a saline infusion in three cohorts of 2–4 week abstinent cocaine-dependent participants (n = 93) and healthy controls (n = 69) were used to develop a classification model. An information theoretic-based feature selection algorithm was first conducted to reduce the number of voxels. A density-based clustering algorithm was then used to form spatially connected voxel clouds in three-dimensional space. A statistical classifier, Support Vectors Machine (SVM), was then used for participant classification. Statistically insignificant voxels of spatially connected brain regions were removed iteratively and classification accuracy was reported through the iterations. Results The voxel-based analysis identified 1,500 spatially connected voxels in 30 distinct clusters after a grid search in SVM parameters. Participants were successfully classified with 0.88 and 0.89 F-measure accuracies in 10-fold cross validation (10xCV) and leave-one-out (LOO) approaches, respectively. Sensitivity and specificity were 0.90 and 0.89 for LOO; 0.83 and 0.83 for 10xCV. Many of the 30 selected clusters are highly relevant to the addictive process, including regions relevant to cognitive control, default mode network related self-referential thought, behavioral inhibition, and contextual memories. Relative hyperactivity and hypoactivity of regional cerebral blood flow in brain regions in cocaine-dependent participants are presented with corresponding level of significance. Conclusions The SVM-based approach successfully classified cocaine-dependent and healthy control participants using voxels selected with information theoretic-based and statistical methods from participants’ SPECT data. The regions found in this study align with brain regions reported in the literature. These findings support the future use of brain imaging and SVM-based classifier in the diagnosis of substance use disorders and furthering an understanding of their underlying pathology. Electronic supplementary material The online version of this article (doi:10.1186/s12859-016-1218-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mutlu Mete
- Department of Computer Science and Information Systems, Texas A&M University-Commerce, Commerce, TX, USA.
| | - Unal Sakoglu
- Computer Engineering, University of Houston - Clear Lake, Houston, TX, USA
| | - Jeffrey S Spence
- Center for Brain Health, University of Texas at Dallas, Richardson, TX, USA
| | - Michael D Devous
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA.,Avid Radiopharmaceuticals, Philadelphia, PA, USA
| | | | - Bryon Adinoff
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
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