Reduced fMRI activity predicts relapse in patients recovering from stimulant dependence

Relapse presents a significant problem for patients recovering from stimulant dependence. Here we examined the hypothesis that patterns of brain function obtained at an early stage of abstinence differentiates patients who later relapse versus those who remain abstinent. Forty‐five recently abstinen...

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Bibliographic Details
Published in:	Human brain mapping Vol. 35; no. 2; pp. 414 - 428
Main Authors:	Clark, Vincent P., Beatty, Gregory K., Anderson, Robert E., Kodituwakku, Piyadassa, Phillips, John P., Lane, Terran D.R., Kiehl, Kent A., Calhoun, Vince D.
Format:	Journal Article
Language:	English
Published:	New York, NY Blackwell Publishing Ltd 01-02-2014 Wiley-Liss John Wiley & Sons, Inc John Wiley and Sons Inc
Subjects:	Adult attention Attention Deficit Disorder with Hyperactivity - diagnosis Attention Deficit Disorder with Hyperactivity - etiology Bayes Theorem Biological and medical sciences Brain - blood supply Brain - physiopathology Brain Mapping cingulated cocaine Cognition Disorders - etiology drug dependence Electrodiagnosis. Electric activity recording Female Humans Image Processing, Computer-Assisted insula Investigative techniques, diagnostic techniques (general aspects) Magnetic Resonance Imaging Male Medical sciences methamphetamine Middle Aged Nervous system Neuropsychological Tests Oxygen - blood Radiodiagnosis. Nmr imagery. Nmr spectrometry Recurrence Substance-Related Disorders - complications Substance-Related Disorders - diagnosis Young Adult Human Nervous system diseases Relapse Radiodiagnosis methamphetamine Attention Dependence Cocaine cingulated insula Nuclear magnetic resonance imaging drug dependence attention cocaine
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Summary:	Relapse presents a significant problem for patients recovering from stimulant dependence. Here we examined the hypothesis that patterns of brain function obtained at an early stage of abstinence differentiates patients who later relapse versus those who remain abstinent. Forty‐five recently abstinent stimulant‐dependent patients were tested using a randomized event‐related functional MRI (ER‐fMRI) design that was developed in order to replicate a previous ERP study of relapse using a selective attention task, and were then monitored until 6 months of verified abstinence or stimulant use occurred. SPM revealed smaller absolute blood oxygen level‐dependent (BOLD) response amplitude in bilateral ventral posterior cingulate and right insular cortex in 23 patients positive for relapse to stimulant use compared with 22 who remained abstinent. ER‐fMRI, psychiatric, neuropsychological, demographic, personal and family history of drug use were compared in order to form predictive models. ER‐fMRI was found to predict abstinence with higher accuracy than any other single measure obtained in this study. Logistic regression using fMRI amplitude in right posterior cingulate and insular cortex predicted abstinence with 77.8% accuracy, which increased to 89.9% accuracy when history of mania was included. Using 10‐fold cross‐validation, Bayesian logistic regression and multilayer perceptron algorithms provided the highest accuracy of 84.4%. These results, combined with previous studies, suggest that the functional organization of paralimbic brain regions including ventral anterior and posterior cingulate and right insula are related to patients' ability to maintain abstinence. Novel therapies designed to target these paralimbic regions identified using ER‐fMRI may improve treatment outcome. Hum Brain Mapp 35:414–428, 2014. © 2012 Wiley Periodicals, Inc.
Bibliography:	National Institute of Drug Abuse and NIH - No. R01DA012852 ark:/67375/WNG-99DM0RV3-K istex:8EEAEC97A7400B0A235FE24ABC78C77312270D1D ArticleID:HBM22184 NCRR - No. 5M01RR000997, subproject 8353 (to V.P.C.) This manuscript is dedicated to Dr. Robert E. Anderson, who played an essential part in acquiring the data described here, and passed away during the preparation of this article.
ISSN:	1065-9471 1097-0193
DOI:	10.1002/hbm.22184