مقایسه‌‌ی کارکردهای اجرایی در مصرف کنندگان شیشه، هروئین و افراد هنجار

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، مرکز تحقیقات روان تنی و مرکز تحقیقات علوم رفتاری، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 کارشناس ارشد، مرکز تحقیقات روان تنی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 پژوهشگر، مرکز تحقیقات روان تنی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 کارشناس ارشد، گروه روانشناسی، دانشگاه گیلان، رشت، ایران

5 کارشناس ارشد، گروه روانسنجی، دانشگاه علامه طباطبایی تهران، تهران، ایران

چکیده

مقدمه: سوء مصرف مواد؛ به عنوان مشکلی جهانی و یک بیماری مغزی شناخته شده است. هدف از این پژوهش، مقایسه‌ی کارکردهای اجرایی در مصرف کنندگان هروئین و شیشه و گروه شاهد بود.روش‌ها: پژوهش حاضر مطالعه‌ای از نوع پس رویدادی است. روش نمونه‌گیری دو گروه شیشه و هروئین به صورت هدفمند بود و گروه شاهد به صورت تصادفی انتخاب شدند. جامعه‌ی آماری این پژوهش شامل مصرف کنندگان شیشه و هروئین در شهر اصفهان در سال 1391 بود که به مراکز درمانی، نگهداری (کمپ) و کلینیک‌های روانپزشکی و ترک اعتیاد شهر اصفهان مراجعه می‌نمودند. در نهایت، 75 نفر در سه گروه شیشه (25 نفر)، هروئین (25 نفر) و گروه شاهد (25 نفر) با توجه به معیارهای وابستگی به مواد DSM-IV-TR (Diagnostic and statistical manual of mental disorders- text revision) انتخاب شدند و بر اساس آزمون‌های عصب روانشناختی برج لندن (Tower of London) و استروپ (Stroop) مورد ارزیابی قرار گرفتند.یافته‌ها: افراد شاهد در دو آزمون برج لندن و استروپ، عمکرد بهتری داشتند (05/0 > P). گروه هروئین در آزمون برج لندن نسبت به گروه شیشه عملکرد بهتری داشتند (05/0 > P)؛ اما در آزمون استروپ، عملکرد دو گروه مصرف کننده‌ی شیشه و هروئین تفاوت معنی‌داری نداشت.نتیجه‌گیری: مصرف شیشه و هروئین در سیستم‌های فرونتا استریاتال، به خصوص قشر پره فرونتال و کارکردهای عصب روانشناختی (عملکردهای اجرایی)، نقایص بیشتر و دراز مدت نشان می‌دهد. با الهام از این یافته‌ها، می‌توان برنامه‌های توانبخشی شناختی تخصصی برای آماده‌سازی این افراد جهت ورود دوباره به زندگی فردی، شغلی و اجتماعی طراحی نمود. 

کلیدواژه‌ها


عنوان مقاله [English]

Executive Functions in Methamphetamine and Heroin Users versus Non-Users

نویسندگان [English]

  • Mehrdad Salehi 1
  • Hamid Afshar 1
  • Kamal Moghtadaei 2
  • Mahshid Taslimi 3
  • Mansoureh Salamat 4
  • Asieh Ebrahimi 5
1 Associate Professor, Psychosomatic Research Center AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Researcher, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Psychology, University of Guilan, Rasht, Iran
5 Department of Psychometric, Allameh Tabatabai University, Tehran, Iran
چکیده [English]

Background: Substance abuse is an important worldwide health problem and also a brain disorder. The main aim of this research was the comparison of executive functions in methamphetamine and heroin users versus non-users.Methods: The research method of current study was Ex-post facto. The method of sampling in both methamphetamine and heroin group was purposeful; but non-users group has been selected randomly. Statistical population in this study was heroin and methamphetamine dependents or abusers in the Isfahan city, Iran, which were referred to medical rehabilitation centers and psychiatric clinics in this city in 2012. Finally, 75 patients were selected in the three equal (n = 25) groups, methamphetamine, heroin and non-users groups, according to criteria of drug abuse or dependence in DSM-IV-TR; they were evaluated based on the Tower of London and Stroop Neuropsychological Tests.Findings: The non-users group had better performance in the Tower of London and Stroop tests than substance dependents groups (P < 0.05). Heroin group show better performance than methamphetamine group in the Tower of London test (P < 0.05). However, these two groups did not show significant differences in the Stroop test.Conclusion: Methamphetamine and heroin use causes prefrontal cortex and executive dysfunctions and neurological disturbances in fronto-striatal systems function. According to our findings, we can design professional cognitive rehabilitation programs to rehabilitate them to be ready to comeback to personal, occupational and social life. 

کلیدواژه‌ها [English]

  • Executive functions
  • Methamphetamine
  • Heroin
  1. Abou-Saleh MT. Substance use disorders: Recent advances in treatment and models of care. J Psychosom Res 2006; 61(3): 305-10.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder. 4th ed. Washington, DC: American Psychiatric Pub; 2000.
  3. Ghorbani M, Kazemi Zahrani H, Ghorbani T. Comparing irrational beliefs in patients with crystal abuse disorder and ordinary people. Knowledge and Research in Applied Psychology 2011; 12(45): 31-7. [In Persian].
  4. Ekhtiari H, Alammehrjerdi Z, Hassani Abharian P, Nouri M, Farnam R, Mokri A. Examination and evaluation of craving-inductive verbal cues among Persian-speaking methamphetamine abusers. Advances in Cognitive Science 2010; 12(2): 69-82. [In Persian].
  5. Chang L, Ernst T, Speck O, Patel H, DeSilva M, Leonido-Yee M, et al. Perfusion MRI and computerized cognitive test abnormalities in abstinent methamphetamine users. Psychiatry Res 2002; 114(2): 65-79.
  6. Dolan SL, Martin RA, Rohsenow DJ. Self-efficacy for cocaine abstinence: pretreatment correlates and relationship to outcomes. Addict Behav 2008; 33(5): 675-88.
  7. Izawa J, Yamanashi K, Asakura T, Misu Y, Goshima Y. Differential effects of methamphetamine and cocaine on behavior and extracellular levels of dopamine and 3,4-dihydroxyphenylalanine in the nucleus accumbens of conscious rats. Eur J Pharmacol 2006; 549(1-3): 84-90.
  8. Ernst T, Chang L, Leonido-Yee M, Speck O. Evidence for long-term neurotoxicity associated with methamphetamine abuse: A 1H MRS study. Neurology 2000; 54(6): 1344-9.
  9. Langston JW, Langston EB. Neurological consequences of drug abuse. In: Asbury AK, MacKhann GM, McDonald WI, Editors. Diseases of the Nervous System: Clinical Neurobiology. Philadelphia, PA: Ardmore Medical Books; 1986. p. 1333-40.
  10. Laplane D, Levasseur M, Pillon B, Dubois B, Baulac M, Mazoyer B, et al. Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. A neuropsychological, magnetic resonance imaging and positron tomography study. Brain 1989; 112(Pt 3): 699-725.
  11. Dubois B, Defontaines B, Deweer B, Malapani C, Pillon B. Cognitive and behavioral changes in patients with focal lesions of the basal ganglia. Adv Neurol 1995; 65: 29-41.
  12. Scoville WB, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry 1957; 20(1): 11-21.
  13. Fishbein DH, Krupitsky E, Flannery BA, Langevin DJ, Bobashev G, Verbitskaya E, et al. Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use. Drug Alcohol Depend 2007; 90(1): 25-38.
  14. Mintzer MZ, Stitzer ML. Cognitive impairment in methadone maintenance patients. Drug Alcohol Depend 2002; 67(1): 41-51.
  15. Weinstein CS, Shaffer HJ. Neurocognitive aspects of substance abuse treatment: A psychotherapist's primer. Psychotherapy Theory Research & Practice 1993; 30(2): 317-33.
  16. Dawkins L, Powell JH, West R, Powell J, Pickering A. A double-blind placebo controlled experimental study of nicotine: I--effects on incentive motivation. Psychopharmacology (Berl) 2006; 189(3): 355-67.
  17. Lyvers M, Yakimoff M. Neuropsychological correlates of opioid dependence and withdrawal. Addict Behav 2003; 28(3): 605-11.
  18. Lundqvist T. Cognitive consequences of cannabis use: comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions. Pharmacol Biochem Behav 2005; 81(2): 319-30.
  19. Sarmad Z, Bazargan A, Hejazi E. Research Methods in Behavioral Sciences. Tehran, Iran: Ahah Publications; 2012. [In Persian].
  20. Phillips LH, Wynn V, Gilhooly KJ, Della SS, Logie RH. The role of memory in the Tower of London task. Memory 1999; 7(2): 209-31.
  21. Morris RG, Rushe T, Woodruffe PW, Murray RM. Problem solving in schizophrenia: a specific deficit in planning ability. Schizophr Res 1995; 14(3): 235-46.
  22. Jensen AR. Scoring the Stroop test. In: Golden CJ, Editor. Diagnosis and Rehabilitation in Clinical Neuropsychology. Springfield, IL: Charles C Thomas Publisher; 1965. p. 398-408.
  23. Lezak MD. Neuropsychological Assessment. Oxford, UK: Oxford University Press; 1983.
  24. Barras P. Fonctionnement executif chez les enfants d'âge prescolaire: etude exploratoire d'une batterie de tests executifs. University of Geneva 2010. [In French].
  25. Chan RC, Chen EY, Law CW. Specific executive dysfunction in patients with first-episode medication-naive schizophrenia. Schizophr Res 2006; 82(1): 51-64.
  26. Kravariti E, Dixon T, Frith C, Murray R, McGuire P. Association of symptoms and executive function in schizophrenia and bipolar disorder. Schizophr Res 2005; 74(2-3): 221-31.
  27. Verdejo-Garcia AJ, Lopez-Torrecillas F, Aguilar de AF, Perez-Garcia M. Differential effects of MDMA, cocaine, and cannabis use severity on distinctive components of the executive functions in polysubstance users: a multiple regression analysis. Addict Behav 2005; 30(1): 89-101.
  28. Verdejo-Garcia A, Lopez-Torrecillas F, Gimenez CO, Perez-Garcia M. Clinical implications and methodological challenges in the study of the neuropsychological correlates of cannabis, stimulant, and opioid abuse. Neuropsychol Rev 2004; 14(1): 1-41.
  29. Lewis MD. Dopamine and the Neural "Now": Essay and Review of Addiction: A Disorder of Choice. Perspectives on Psychological Science 2011; 6(2): 150-5.
  30. Heyman GM. Received Wisdom Regarding the Roles of Craving and Dopamine in Addiction A Response to Lewis's Critique of Addiction: A Disorder of Choice. Perspectives on Psychological Science 2011; 6(2): 156-60.
  31. Verdejo-Garcia A, Perez-Garcia M. Ecological assessment of executive functions in substance dependent individuals. Drug Alcohol Depend 2007; 90(1): 48-55.
  32. van Holst RJ, Schilt T. Drug-related decrease in neuropsychological functions of abstinent drug users. Curr Drug Abuse Rev 2011; 4(1): 42-56.
  33. Fishbein DH, Todd AC, Ricketts EP, Semba RD. Relationship between lead exposure, cognitive function, and drug addiction: pilot study and research agenda. Environ Res 2008; 108(3): 315-9.
  34. Alfonso JP, Caracuel A, Delgado-Pastor LC, Verdejo-Garcia A. Combined Goal Management Training and Mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abusers. Drug Alcohol Depend 2011; 117(1): 78-81.
  35. Mokri A, Ekhtiari H, Edalati H, Ganjgahi H, Naderi P. Relationship between craving intensity and risky behaviors and impulsivity factors in different groups of opiate addicts. Iran J Psychiatry Clin Psychol 2008; 14(3): 258-68. [In Persian].
  36. Pau CW, Lee TM, Chan SF. The impact of heroin on frontal executive functions. Arch Clin Neuropsychol 2002; 17(7): 663-70.
  37. Passetti F, Clark L, Mehta MA, Joyce E, King M. Neuropsychological predictors of clinical outcome in opiate addiction. Drug Alcohol Depend 2008; 94(1-3): 82-91.
  38. Blume AW, Marlatt GA. The role of executive cognitive functions in changing substance use: what we know and what we need to know. Ann Behav Med 2009; 37(2): 117-25.
  39. Volkow ND, Chang L, Wang GJ, Fowler JS, Ding YS, Sedler M, et al. Low level of brain dopamine D2 receptors in methamphetamine abusers: association with metabolism in the orbitofrontal cortex. Am J Psychiatry 2001; 158(12): 2015-21.
  40. Nuechterlein KH, Barch DM, Gold JM, Goldberg TE, Green MF, Heaton RK. Identification of separable cognitive factors in schizophrenia. Schizophr Res 2004; 72(1): 29-39.
  41. Paulus MP, Hozack NE, Zauscher BE, Frank L, Brown GG, Braff DL, et al. Behavioral and functional neuroimaging evidence for prefrontal dysfunction in methamphetamine-dependent subjects. Neuropsychopharmacology 2002; 26(1): 53-63.
  42. Ricaurte G, Bryan G, Strauss L, Seiden L, Schuster C. Hallucinogenic amphetamine selectively destroys brain serotonin nerve terminals. Science 1985; 229(4717): 986-8.