title: Neural activation during processing of aversive faces predicts treatment outcome in alcoholism.
abstract: Neuropsychological studies reported decoding deficits of emotional facial expressions in alcohol-dependent patients, and imaging studies revealed reduced prefrontal and limbic activation during emotional face processing. However, it remains unclear whether this reduced neural activation is mediated by alcohol-associated volume reductions and whether it interacts with treatment outcome. We combined analyses of neural activation during an aversive face-cue-comparison task and local gray matter volumes (GM) using Biological Parametric Mapping in 33 detoxified alcohol-dependent patients and 33 matched healthy controls. Alcoholics displayed reduced activation toward aversive faces-neutral shapes in bilateral fusiform gyrus [FG; Brodmann areas (BA) 18/19], right middle frontal gyrus (BA46/47), right inferior parietal gyrus (BA7) and left cerebellum compared with controls, which were explained by GM differences (except for cerebellum). Enhanced functional activation in patients versus controls was found in left rostral anterior cingulate cortex (ACC) and medial frontal gyrus (BA10/11), even after GM reduction control. Increased ACC activation correlated significantly with less (previous) lifetime alcohol intake [Lifetime Drinking History (LDH)], longer abstinence and less subsequent binge drinking in patients. High LDH appear to impair treatment outcome via its neurotoxicity on ACC integrity. Thus, high activation of the rostral ACC elicited by affective faces appears to be a resilience factor predicting better treatment outcome. Although no group differences were found, increased FG activation correlated with patients' higher LDH. Because high LDH correlated with worse task performance for facial stimuli in patients, elevated activation in the fusiform 'face' area may reflect inefficient compensatory activation. Therapeutic interventions (e.g. emotion evaluation training) may enable patients to cope with social stress and to decrease relapses after detoxification.
authors.affiliation: Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Charlet
authors.forename: Florian
authors.initials: F
authors.lastname: Schlagenhauf
authors.forename: Anne
authors.initials: A
authors.lastname: Richter
authors.forename: Karina
authors.initials: K
authors.lastname: Naundorf
authors.forename: Lina
authors.initials: L
authors.lastname: Dornhof
authors.forename: Christopher E J
authors.initials: CE
authors.lastname: Weinfurtner
authors.forename: Friederike
authors.initials: F
authors.lastname: König
authors.forename: Bernadeta
authors.initials: B
authors.lastname: Walaszek
authors.forename: Florian
authors.initials: F
authors.lastname: Schubert
authors.forename: Christian A
authors.initials: CA
authors.lastname: Müller
authors.forename: Stefan
authors.initials: S
authors.lastname: Gutwinski
authors.forename: Annette
authors.initials: A
authors.lastname: Seissinger
authors.forename: Lioba
authors.initials: L
authors.lastname: Schmitz
authors.forename: Henrik
authors.initials: H
authors.lastname: Walter
authors.forename: Anne
authors.initials: A
authors.lastname: Beck
authors.forename: Jürgen
authors.initials: J
authors.lastname: Gallinat
authors.forename: Falk
authors.initials: F
authors.lastname: Kiefer
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000503:physiopathology* / Q000534:rehabilitation; D001931:Brain Mapping / Q000379:methods; D016022:Case-Control Studies; D002531:Cerebellum / Q000502:physiology*; D002540:Cerebral Cortex / Q000502:physiology*; D003463:Cues; D004644:Emotions / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008606:Mental Processes / Q000502:physiology*; D008875:Middle Aged; D010296:Parietal Lobe / Q000502:physiology; D017397:Prefrontal Cortex / Q000502:physiology; D012008:Recurrence; D013702:Temporal Lobe / Q000502:physiology; D016896:Treatment Outcome
keywords: Anger; anterior cingulate cortex; fear; follow-up; implicit emotional face processing; relapse