Search

Background: Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD., Objective: To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence., Methods: A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year)., Results: Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT., Conclusions: AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes., Trial Registration: ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054., Competing Interests: Declaration of competing interest This study is part of Macha Dubuson Ph.D thesis. Dr Kornreich reported receiving grants from the King Baudouin Foundation and the CHU Brugmann Foundation during the study. Dubuson reported receiving salary support through grants of the King Baudouin Foundation and the Brugmann Foundation during the study. There are no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Finding new tools for conventional management of alcohol disorders is a challenge for psychiatrists. Brain indications related to cognitive functioning could represent such an add-on tool., Methods: Forty alcohol-dependent inpatients undertook two cognitive event-related potential (ERP) tasks at the beginning and at the end of a 4-week detoxification program. These comprised a visual oddball task investigating cue reactivity and a Go/No-go task tagging inhibition using oddball P3d and No-go P3d ERP components. Three months after discharge, the patient group (N = 40) was split into two subgroups: patients who remained abstinent during this post-treatment period (90 days; n = 15), and patients who relapsed (mean time: 28.5 ± 26.2 days; n = 25). Pattern changes of both ERP markers (oddball P3d and No-go P3d) during the detoxification were compared to differentiate these populations., Results: Abstinent patients exhibited similar P3d responses devoted to alcohol cues in Sessions 1 and 2, but an increased No-go P3d devoted to No-go trials in alcohol-related contexts in Session 2 compared to Session 1., Conclusions: Specific cue-reactivity and inhibitory neurophysiological markers subtend a further three-months of complete abstinence., Significance: Monitoring these ERP changes during detoxification may provide important clues regarding patients' future abstinence vs. relapse., (Copyright © 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Objective: Cognitive impairment is a major component in addiction. However, research has been inconclusive as to whether this is also the case for smokers. The present study aims at providing electrophysiological clue for altered inhibitory control in smokers and at investigating whether reduced inhibition was more pronounced during exposure to a smoking cue., Methods: ERPs were recorded during a visual Go-NoGo task performed by 18 smokers and 23 controls, in which either a frequent Go signal (letter "M") or a rare No-Go signal ("letter W") were superimposed on three different long-lasting background contexts: black-neutral, smoking-related and non smoking-related., Results: (1) Smokers performed worse and had an earlier NoGo-N2 latency as compared to controls and independently of context, suggesting a general inhibition impairment; (2) with smoking-related backgrounds specifically, smokers made fewer mistakes than they did in other contexts and displayed a larger NoGo P3 amplitude., Conclusion: These data might suggest that background cues related to addiction may help smokers to be more accurate in an inhibition task., Significance: Our results show the classical inhibitory impairment in smokers as compared to non-smokers. However, our data also suggest that a smoking-related background may bolster the inhibitory ability of smokers specifically., (Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Objective: We found previously that use of a bimodal oddball design with synchronized pairs of audio-visual stimuli increased the sensitivity of the P300 wave to detect subclinical anxiety-depression in otherwise healthy subjects. Here, we wished to determine whether these P300 modulations would also be encountered when a clinical population comprised of patients with an adjustment disorder (AJD) was compared to healthy controls., Method: Two groups, each comprised of twenty-five participants (AJD patients, and controls; N=50) had to detect deviant stimuli among frequent stimuli in an oddball task by clicking on a button. Separate blocks involving audio (A), visual (V) or bimodal congruent (AV) stimuli were used and compared., Results: P300 amplitudes of the control group were higher than those displayed by AJD patients, but only in the bimodal AV oddball task, while unimodal (visual or auditory) oddball tasks did not reveal any significant differences., Conclusions: The increased sensitivity of the bimodal P300 that we observed previously in subclinical anxiety-depression was also observed in AJD patients., Significance: The impaired "bimodal congruence effect" in AJD suggests that these patients have altered integrative processes, which has potential implications for cognitive therapy., (Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Currently, relapse prevention remains the main challenge in addiction medicine, indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. Therefore, there is a push to develop alternatives to psychotherapy- and medication-based approaches to addiction treatment. Two major cognitive factors have been identified that trigger relapse in addicted patients: attentional biases directed toward drug-related cues, which increase the urge to consume, and impaired response inhibition toward these cues, which makes it more difficult for addicted people to resist temptation. Recent studies on newly detoxified alcoholic patients have shown that by using the appropriate tasks to index these cognitive functions with event-related potentials (ERPs), it is possible to discriminate between future relapsers and nonrelapsers. These preliminary data suggest that the ERP technique has great clinical potential for preventing relapse in alcohol-dependent patients, as well as for addictive states in general. Indeed, ERPs may help to identify patients highly vulnerable to relapse and allow the development of individually adapted cognitive rehabilitation programs. The implementation of this combined approach requires an intense collaboration between psychiatry departments, clinical neurophysiology laboratories, and neuropsychological rehabilitation centers. The potential pitfalls and limitations of this approach are also discussed., (© 2016 Elsevier B.V. All rights reserved.)

Objective: We previously found that using a bimodal oddball design with synchronized pairs of audio-visual stimuli increased the sensitivity of the P300 wave to subclinical differences in depression. We wondered: (1) whether these P300 modulations were due to facilitated discrimination of deviant vs. frequent stimuli and (2) whether congruency of the stimuli was necessary to produce this effect., Method: Two groups of participants (students displaying anxious-depressive tendencies as the subclinical group and healthy students as the control group) had to detect deviant stimuli among frequent stimuli in oddball tasks. Experiment 1 involved either single faces (Single condition) or two similar faces presented side-by-side (Double condition). Experiment 2 involved audio (A), visual (V), bimodal congruent (AVC), and bimodal incongruent (AVI) oddball tasks., Results: While the easiest Double condition produced the fastest reaction times and shortest P300 latencies, there were no significant differences in P300 modulation between the groups in Experiment 1. In Experiment 2, P300 amplitudes of the control group were higher in response to AVC tasks than in response to unimodal (A or V) or AVI tasks., Conclusions: The increased sensitivity of the P300 wave to subclinical differences that we observed here is not related to an enhanced discrimination effect. However, during bimodal tasks, stimulus congruency is necessary for the appearance of the increased P300 sensitivity., Significance: The impaired "bimodal congruence effect" in patients with subclinical depression/anxiety suggests these patients have altered integrative processes, which has potential implications for cognitive therapy., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: Addiction has been shown to be associated with the endorsement of utilitarian moral judgments. Ventro-medial prefrontal cortex (VMPFC) dysfunction may explain these findings., Methods: 100 subjects were recruited: 25 polysubstance dependent patients, 25 alcohol dependent patients, 25 patients with major depressive disorders, and 25 normal controls. Subjects were assessed with a battery of 24 moral dilemmas: 8 impersonal dilemmas (no physical contact involved); 8 personal pareto (direct action that does not make the harmed individual worse off) and 8 personal non-pareto (direct action that does make the harmed individual worse off). The Iowa Gambling Task was used to document a possible connection between VMPFC dysfunction and responses to the moral dilemmas., Results: Polysubstance dependent patients endorsed more utilitarian choices than controls on all types of dilemmas and more than depressed patients on impersonal and personal pareto dilemmas. Alcohol dependent patients had intermediate results between polysubstance dependent patients and controls but these differences were not significant. All patients showed significantly poorer performance compared to controls on the Iowa Gambling Task, but there was no significant association between Iowa Gambling Tasks scores and moral dilemma choices., Conclusion: Polysubstance dependent patients made more utilitarian choices when responding to moral dilemmas than depressed patients and normal controls, while alcoholic patients showed intermediate results. The absence of correlation between performance on the Iowa Gambling Task and the number of more utilitarian choices indicates that moral dilemma and decision making under uncertainty tap into separate mechanisms., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Impulsivity is a hallmark of addictive behaviors. Addicts' weakened inhibition of irrelevant prepotent responses is commonly thought to explain this association. However, inhibition is not a unitary mechanism. This study investigated the efficiency of overcoming competition due to irrelevant responses (i.e., inhibition of a prepotent response) and overcoming competition in memory (i.e., resistance to proactive interference) in sober and recently detoxified alcohol-dependent individuals., Methods: Three cognitive tasks assessing the inhibition of a prepotent response (Hayling task, anti-saccade task and Stroop task) and two tasks tapping into the capacity to resist proactive interference (cued recall, Brown-Peterson variant) were administered to 30 non-amnesic recently detoxified alcohol-dependent individuals and 30 matched healthy participants without alcohol dependency. In addition, possible confounds such as verbal updating in working memory was assessed., Results: Alcohol-dependent subjects performed worse than healthy participants on the three cognitive tasks assessing the inhibition of irrelevant prepotent responses but group performance was similar in the tasks assessing overcoming proactive interference in memory, updating of working memory and abstract reasoning., Conclusions: These findings suggest that alcohol-dependence is mainly associated with impaired capacity to intentionally suppress irrelevant prepotent response information. Control of proactive interference from memory is preserved. Theoretical and clinical implications are discussed., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: Episodic excessive alcohol consumption (i.e., binge drinking) is now considered to be a major concern in our society. Previous studies have shown that alcohol cues can capture attentional resources in chronic alcoholic populations and that the phenomenon is associated with the development and maintenance of alcoholism. Using event-related potentials (ERPs), we investigated the responses of binge drinkers to alcohol-related pictures., Methods: Two groups of college students (n=18 in each group) were recruited for the study. One group was composed of binge drinkers and the other of controls. Each student completed a simple visual oddball paradigm in which alcohol-related and non-alcohol-related pictures (positive, neutral or negative) were presented. ERPs were recorded to explore the electrophysiological activity associated with the processing of each cue during the different cognitive steps., Results: Although there were no behavioural differences between the two groups after detection of alcohol- and non-alcohol-related cues, the ERP data indicated that processing of alcohol-related stimuli was modulated by binge drinking: in the binge drinkers, the P100 amplitudes elicited by the alcohol-related pictures were significantly larger than those elicited by the non-alcohol pictures., Conclusions: The present study provides evidence for an early processing enhancement, indexed by increased P100 amplitude, in binge drinkers when confronted with alcohol cues., Significance: These findings suggest that higher reactivity to alcohol cues is not a phenomenon limited to adult alcoholics, but that young binge drinkers exhibit signs of prioritizing processing related to alcohol. Prevention intervention for alcohol misuse in young people should consider approaches that address this automatic cue reactivity., (Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: Studies that explore neurophysiological correlates of psychiatric disorders have commonly used event-related potentials during a visual or an auditory oddball task with the main results being changes in the P300 component. In the present study, a bimodal oddball design with synchronized pairs of audio-visual stimuli was used to further improve the clinical sensitivity of the P300., Methods: Two groups of healthy participants, one consisting of students displaying anxious-depressive tendencies and the other of control students, completed visual, auditory and two kinds of audio-visual oddball task (one using emotional stimuli and the other using geometrical figures and simple sounds), in which they had to detect deviant rare stimuli among more frequently presented standard stimuli as quickly as possible. Behavioral performance and P300 data were analyzed., Results: The subjects with anxious and depressive tendencies had lower P300 amplitudes than controls, but only in the bimodal tasks., Conclusions: Although the two groups differed in their levels of anxiety and depression, only the bimodal tasks were able to identify these differences., Significances: These results suggest that a bimodal oddball design should be used in future studies to increase the sensitivity of P300 differences for differentiating between healthy participants and those with clinical symptoms., (Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: Studies exploring neurophysiological correlates of main psychiatric disorders have commonly used event-related potentials (ERP) during a visual or an auditory oddball task. The main results concern modulations of the P3b amplitude and/or latency. The present study aims to increase the clinical sensitivity of these P3b modulations by using a more ecological oddball design, using synchronized pairs of audio-visual emotional stimuli., Method: Two groups of healthy participants, one composed of controls and the other of students displaying anxious and depressive tendencies completed visual, auditory and audio-visual (cross-modal) oddball tasks, in which they had to detect deviant happy and sad stimuli among neutral ones as quickly as possible. Behavioral performance and P3b ERP data were analyzed., Results: Subjects displaying anxious and depressive tendencies exhibited lower P3b amplitude than the controls, but only in the cross-modal oddball task., Conclusions: Although the two groups of subjects differed in their levels of co-morbid anxiety and depression, unimodal visual and auditory oddball tasks did not allow us to detect this difference by P3b amplitude modulations, but the cross-modal task did., Significance: These results suggest that a cross-modal oddball design should be used in future studies to increase the sensitivity of the P300 amplitude differences between healthy participants and those with clinical symptoms., (Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: Recent studies have shown that alcoholism is characterized by a deficit in the processing of emotional facial expressions (EFE), and that this deficit could be "emotion specific". The present study explored the hypothesis that there is a specific deficit for the EFE of anger compared to another negative emotion (disgust). Moreover, on the basis of event-related potentials (ERPs), this study aimed at determining the locus of this deficit in the information-processing stream., Methods: Fifteen patients suffering from alcoholism and fifteen matched healthy controls took part in the study, which used a "modified emotional" oddball paradigm. ERPs were recorded in response to repetitions of a particular facial expression (i.e. anger) and in response to two deviant (rare) stimuli obtained by a morphing procedure, one depicting the same emotion as the frequent stimulus, the other depicting a different emotion (i.e. disgust). The participants' task was to press a key as soon as they spotted the deviant stimulus., Results: Behavioural data showed an absence of categorical perception effect for anger (but not for disgust) stimuli among alcoholic patients. Moreover, electrophysiological data revealed that alcoholism is associated with an impaired processing of anger at the attentional level (N2b/P3a complex), extending to the decisional level (P3b)., Conclusion: This study demonstrated disturbed processing of anger in alcoholism, at behavioural and electrophysiological levels. These preliminary results strengthen the proposition of a specific deficit for anger, and localize its possible origin to the attentional level (N2b/P3a complex) of the information processing stream. The clinical implications of these results are discussed.

In opiate-dependent rats previous studies showed that anaesthetic agents, such as chloral hydrate, midazolam and ketamine interfere with naloxone-precipitated opiate withdrawal. Each anaesthetic induces a specific pattern of interference, indicating that the interference is agent-dependent. In order to further investigate these effects and highlight a potential pharmacological basis of opiate withdrawal interference through anaesthetic agents, we hypothesized that anaesthetic-mediated interference of opiate withdrawal is also dose-dependent. Three groups of rats were compared in an experimental procedure of rapid withdrawal induction by an antagonist under anaesthesia using sub-anaesthetic dosage of midazolam, ketamine or saline. We observed that sub-anaesthetic dosage of ketamine, or midazolam, interferes significantly with opiate withdrawal expression. This brings arguments in favour of a pharmacological basis underlying rapid antagonists induction in opiate dependent rats.