Frontal systems deficits in stimulant-dependent patients: Evidence of pre-illness dysfunction and relationship to treatment response

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• 作者：Theresa M. Winhusen^a ; ^{winhusen@carc.uc.edu} ; Eugene C. Somoza^a ; ^b ; Daniel F. Lewis^a ; Frankie B. Kropp^a ; Viviana Elizabeth Horigian^c ; Bryon Adinoff^d ; ^e
• 关键词：Cocaine ; Methamphetamine ; Stimulant ; Prefrontal cortex dysfunction ; FrSBe
• 刊名：Drug and Alcohol Dependence
• 出版年：2013
• 出版时间：1 January, 2013
• 年：2013
• 卷：127
• 期：1-3
• 页码：94-100
• 全文大小：302 K

文摘

Background

Frontal systems dysfunction is present in stimulant-dependent patients. However, it is unclear whether this dysfunction is a pre-morbid risk factor or stimulant-induced, is severe enough to be clinically relevant, and if it is relevant to treatment response. These questions were addressed using the Frontal Systems Behavior Scale (FrSBe), a reliable and valid self-report assessment of three neurobehavioral domains associated with frontal systems functioning (Apathy, Disinhibition, and Executive Dysfunction, summed for a Total), that assesses both pre- and post-morbid functioning, and has a specific cutoff for defining clinically significant abnormalities.

Method

Six sites evaluating 12-step facilitation for stimulant abusers obtained the FrSBe from 180 methamphetamine- and/or cocaine-dependent participants. Dichotomous treatment response measures included self-reported stimulant use, stimulant urine drug screens, and treatment completion.

Results

A substantial percentage of participants retrospectively reported clinically significant neurobehavioral abnormalities prior to lifetime stimulant abuse initiation (e.g., 67.5 % on FrSBe-Total) with a significant increase in the proportion reporting such abnormalities for current functioning (86 % on FrSBe-Total; p < 0.0001). Treatment response was significantly worse for participants with, relative to those without, clinically significant Disinhibition as measured by treatment non-completion (31.6 % vs. 15.6 % , OR = 2.51) and self-reported stimulant use during treatment (40.5 % vs. 16.7 % , OR = 3.40).

Conclusion

These findings suggest that frontal systems dysfunction is present prior to stimulant-abuse onset and worsens with stimulant use. Disinhibition may be a prime target for intervention in stimulant-dependent individuals.