Neuroimagen y drogodependencias
DOI:
https://doi.org/10.20882/adicciones.641Palabras clave:
Técnicas de neuroimagen, drogodependencias, técnicas de activación, efectos reforzadores, “craving”, abstinencia.Resumen
Las técnicas de neuroimagen, que fueron introducidas en los años 70 como instrumentos de exploración neurológica, han aportado en los últimos años un progreso decisivo para las neurociencias, contribuyendo a desvelar las claves del funcionamiento alterado, tanto neuro-químico, como de las estructuras o circuítos que participan en las funciones cerebrales implicadas en las drogodependencias. Han ayudado también a definir el trasfondo neurobiológico de fenómenos característicos de las conductas adictivas, como son tolerancia, reforzamiento, “craving” y los cambios funcionales que se producen tras la administración de fármacos o drogas, así como también, tras la retirada de determinada sustancia psicotrópica. En el futuro, la neuroimagen funcional, asociada a mediciones conductuales o de activación, ayudarán a delimitar los circuítos neuroanatómicos y los cambios neuroquímicos asociados al refuerzo o al “craving” inducido por drogas, así como también las disfunciones cognitivas, emocionales, motivacionales y conductuales, relacionadas con una mayor vulnerabilidad hacia el desarrollo de una drogodependencia o hacia la recaída precoz de los pacientes en programas de recuperación. Todo ello podría contribuir al diseño de nuevas intervenciones preventivas o terapéuticas, que optimicen el rendimiento de los programas de atención a las drogogodependencias.Citas
Behar KL; Rothman DL; Petersen KF; Hooten M; Delaney R; Petroff O; Shulman GI; Navarro V; Petrakis IL; Charney DS; Krystal JH: Preliminary evidence of low cortical GABA levels in localized 1H-MR spectra of alcoholdependent and hepatic encephalopathy patients. Am. J. Psychiatry 1999; 156:925-954.
Blum K, Noble EP, Sheridan PJ, Montgomery A, Ritchie t, Jadeeswaran P, Nogami H, Briggs AH, Cohn JB: Allelic association of human dopamine D2 receptor gene in alcoholism. J.Am. Med. Assoc., 1990; 263:2055-2059.
Blum K, Sheridan PJ, Wood RC, Braverman ER, Chen TJH, Cull JG, Comings DE: The D2 dopamine receptor gene as a determinant of reward deficiency syndrome. J. Royal Soc. Med., 1996; 89:96-100.
Catafau AM; Etcheberrigaray A; Perez de los Cobos J; Estorch M; Guardia J; Flotats A; Bernà L; Marí C; Casas M; Carrió I: Regional cerebral blood flow changes in chronic alcoholic patients induced by naltrexonae challenge during detoxification. J. Nucl. Med. 1999; 40:19- 24.
Childress AR; Mozley PD; McElgin W; Fitzgerald J; Reivich M; O’Brien CP: Limbic activation during cue-induced cocaine craving. Am. J. Psychiatry 1999; 256:11-18.
Ciraulo DA, Barnhill JG, Ciraulo AM, Greenblatt DJ, Shader RI: Parental alcoholism as a risk factor in benzodiazepine abuse: a pilot study. Am. J. Psychiatry, 1989, 146:1333-1335.
Ciraulo DA, Sarid-Segal O, Knapp C, Ciraulo AM, Greenblatt DJ, Shader R: Liability to alprazolam abuse in daughters of alcoholics. Am. J. Psychiatry 1996, 153:956-958.
Cowley DS, Roy-Byrne P, Greenblat DJ, Kramer GL, Petty F: Effect of diazepam on plasma gamma-aminobutyric acid in sons of alcoholic fathers. Alcohol. Clin. Exp. Res. 1996; 20:343-347.
Fowler JS; Volkow ND; Malison R; Gatley SJ: Neuroimaging studies of substance abuse disorders. In: Charney DS; Nestler EJ; Bunney BS (Eds.) Neurobiology of mental illness. New York. Oxford University Press, 1999 (p. 616-626).
Guardia, J.: Estudio de un grupo de alcohólicos de larga evolución, con signos menores de encefalopatía. Rev. Dep. Psiquiatría Fac. Med. Barcelona. 1985; 12:331- 347.
Guardia Serecigni J; Prat Vigué G: Psicobiología del alcoholismo. Medicina del Trabajo 1997; 6:287-305.
Guardia J; Catafau AM; Batlle F; Martían JC; Segura L; Gonzalvo B; Prat G; Carrió I; Casas M: Striatal dopaminergic D2 receptor density measured by [123I] Iodobenzamide SPECT in the prediction of treatment outcome of alcohol-dependent patients. Am. J. Psychiatry 2000; 157:127-129.
Heinz A; Highley JD; Gorey JG; Saunders RC; Jones DW; Hommer D; Zajiecek K; Suomi SJ; Lesch KP; Weinberger DR; Linnoila M: In vivo association between alcohol intoxication, agression and serotonin trasnporter abailability in nonhuman primates. Am. J. Psychiatry, 1998a; 155:1023-1028.
Heinz A; Ragan P; Jones DW; Hommer D; Williams W; Knable MB; Gorey JG; Doty L; Geyer C; Lee KS; Coppola R; Weinberger DR; Linnoila M: (1998b) Reduced central serotonin transporters in alcoholism. Am. J. Psychiatry, 1998b;155:1544-1549.
Iwata N; Cowley DS; Radel M; Roy-Byrne PP; Goldman D: Relation between a GABAA a6 Pro385Ser substitution and benzodiazepine sensitivity. Am. J. Psychiatry 1999; 156:1447-1449.
Lingford-Hughes AR; Acton PD; Gacinovic S; Suckling J; Busatto GF; Boddington SJA; Bullmore E; Woodruff PW; Costa DC; Pillowsky LS; Ell PJ; Marshall EJ; Kerwin RW: Reduced levels of GABA-benzodiazepine receptor in alcohol dependence in the absence of grey matter atrophy. Br. J. Psychiatry, 1998; 173:116-122.
Modell JG; Moutz JM: Focal cerebral blood flow change during craving for alcohol measured by SPECT. Journal of Neuropsychiatry and Clinical Neurosciences, 1995; 7:15-22.
Neiman J: Alcohol as a risk factor for brain damage: neurologic aspects. Alcohol. Clin. Exp. Res. 1998; 22: 346S-351S.
Rosenbloom MJ, Pfefferbaum A, Sullivan EV: Structural brain alterations associated with alcoholism. Alcohol Health & Research World. 1995; 19: 266-272.
Smith SS, O’Hara BF, Persico AM, Gorelick DA, Newlin DB, Vlahov D, Solomon L, Pickens R, Uhl GR: Genetic vulnerability to drug abuse- the D2 dopamine receptor TaqI B1 restriction fragment length polymorphism appears more frequently in polysubstance abusers. Arch. Gen. Psychiatry, 1992; 49:723-727.
Stein EA; Pankiewicz J; Harsch HH; Cho JK; Fuller SA; Hoffmann RG; Hawkins M; Rao SM; Bandettini PA; Bloom AS.: Nicotine-induced limbic cortical activation in the human brain: a functinal MRI study. Am. J. Psychiatry. 1998; 155:1009-1015.
Tiihonen J, Huikka J, Bergström K, Hakola P, Karhu J, Ryynänen OP, Föhr J: Altered striatal dopamine re-uptake site densities in habitually violent and non-violent alcoholics. Nature Medicine. 1995; 1:654-657.
Volkow ND, Wang GJ, Hitzemann R, Fowler JS, Overall JE, Burr G, Wolf AP: Recovery of brain glucose metabolism in detoxified alcoholics. Am. J. Psychiatry 1994; 151:178-183.
Volkow ND; Ding YS; Fowler JS; Wang GJ; Logan J; Gatley JS; Dewey S; Ashby C; Liebermann J; Hitzemann R; Wolf AP: Is Methylphenidate like cocaine? Arch. Gen. Psychiatry 1995a; 52: 456-463.
Volkow N; Wang GJ, Doria JJ.: Monitoring the brain’s response to alcohol with positron emission tommography. Alcohol Health & Research World. 1995b; 19:296-299.
Volkow ND, Wang GJ, Begleiter H, Hitzemann R, Pappas N, Burr G, Pascani K, Wong Ch, Fowler JS, Wolf AP: Regional brain metabolic response to lorazepam in subjects at risk for alcoholism. Alcohol. Clin. Exp. Res. 1995c; 19: 510-516
Volkow ND, Wang GJ, Fowler JS, Logan J, Hitzemann R, Ding YS, Pappas N, Shea C, Piscani K: Decreases in dopamine receptors but not in dopamine transporters in alcoholics. Alcoholism: Clinical & Experimental Research; 1996a; 20:1594-1598
Volkow ND; Wang GJ; Fowler JS; Gatley SJ; Logan J; Dewey SL; Hitzemann R; Lieberman J: Relationship between psychostimulant-induced “high” and dopamine transporter occupancy. Proc. Nat. Acad. Sci. USA 1996b; 93: 10388-10392.
Volkow ND, Wang GJ, Fowler JS, Logan J; Gatley SJ; Gifford A; Hitzemann R; Ding YS; Pappas N: Prediction of reinforcing responses to psychostimulants in humans by brain dopamine D2 receptors levels. Am. J. Psychiatry. 1999a;156:1440-1443.
Volkow ND, Wang GJ, Fowler JS, Hitzemann R, Angrist B; Gatley SJ; Logan J; Ding YS; Pappas N: Association of methylphenidate-induced craving with changes in right striato-orbitofrontal metabolism in cocine abusers: implications in addiction. Am. J. Psychiatry 1999b; 156:19-26.