Neural Correlates of the Affect Regulation Model in Schizophrenia Patients With Substance Use History: A Functional Magnetic Resonance Imaging Study
J Clin Psychiatry 2006;67(3):342-350
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Background: The lifetime prevalence of
substance use disorders among schizophrenia patients is close to 50%. The negative
consequences of substance abuse in schizophrenia are
well documented, but the etiology of this comorbid condition remains unknown. According to
the affect regulation model, schizophrenia
patients abuse drugs in order to cope with their
negative affects. Supporting the model, clinical
studies have shown that dual-diagnosis patients have
less blunting of affect and that they experience
more negative affect. We hypothesized that
patients with a history of substance use would have
increased cerebral activations in response to aversive stimuli when compared to abstinent patients.
Method: Schizophrenia patients were
divided into 2 groups: patients with (SCZ-SU
group; N = 12) and without (SCZ group; N = 11) a
current or past substance use disorder (alcohol,
cannabis, and/or LSD). Diagnoses were made according
to DSM-IV criteria. Using functional magnetic resonance imaging (fMRI), patients were
scanned during passive viewing of emotionally
negative pictures (International Affective Picture
System). Data were gathered from September 2001 to
Results: Subjectively, the emotional
experience induced by viewing the negative
pictures was rated significantly higher in the
SCZ-SU group than in the SCZ group (p = .008). Neurally, in the SCZ-SU group, significant loci of
activation were identified in the right medial
prefrontal cortex (Brodmann's area [BA] 10), left
medial prefrontal cortex (BA 10), right orbitofrontal
cortex (BA 47), and left amygdala. No significant loci of activation were observed in the
Conclusions: These results suggest that
the functioning of the medial prefrontal cortex, thought to be impaired in patients with
prominent negative symptoms, is more preserved in
dual-diagnosis schizophrenia. This relative
preservation could be primary or secondary to