title: Reduced fMRI activity predicts relapse in patients recovering from stimulant dependence.
abstract: 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.
authors.affiliation: Mind Research Network, Albuquerque, New Mexico; Department of Psychology, University of New Mexico, Albuquerque, New Mexico; Department of Neuroscience, University of New Mexico, Albuquerque, New Mexico; Clinical Neuroscience Center in Psychology, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Clark
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Beatty
authors.forename: Robert E
authors.initials: RE
authors.lastname: Anderson
authors.forename: Piyadassa
authors.initials: P
authors.lastname: Kodituwakku
authors.forename: John P
authors.initials: JP
authors.lastname: Phillips
authors.forename: Terran D R
authors.initials: TD
authors.lastname: Lane
authors.forename: Kent A
authors.initials: KA
authors.lastname: Kiehl
authors.forename: Vince D
authors.initials: VD
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000209:etiology; D001499:Bayes Theorem; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D001931:Brain Mapping; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010100:Oxygen / Q000097:blood; D012008:Recurrence; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D010100:Oxygen