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PET images used to map areas of opiate craving in humans. (Craving vs. Response).

Heroin dependence appears to involve two distinct regions of the brain, said Dr. Mark R.C. Daglish of the University of Bristol (England) and his associates.

Twelve patients with a history of opiate dependence who had been abstinent for 10 days to 3 years underwent PET brain scanning while listening to 2-minute self-recorded descriptions of intense drug craving from their past or a neutral experience unrelated to drugs. Afterward, they completed six visual analog scales measuring cravings for heroin; their urge to use it; happiness; sadness; anxiety; and vividness of the script.

When patients listened to the recorded description, PET images showed an increase in cerebral blood flow to areas overlying the left medial prefrontal region and adjacent to the left anterior cingulated cortex. At the same time, PET showed decreases in regional cerebral blood flow in the primary visual cortex and the right extrastriate cortex. The increase in cerebral blood flow in the left anterior cingulated/medial prefrontal region was consistent in all patients, even those reporting no opiate craving. The longer they abstained, the greater the response in the anterior cingulate (Am. J. Psychiatry 158[10]:680-86, 2001).

One region in the left orbitofrontal cortex was the only area showing activation that correlated positively with subjective measures of craving and urge scores, but it did not show significant activation with opiate-related cues. The left anterior cingulated/medial prefrontal region, activated by opiate-related cues, did not show activation that correlated with the urge/craving scores.

The central role of the orbitofrontal cortex in subjective cravings is consistent with findings from nonimaging studies, the investigators noted.
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Author:Kubetin, Sally Koch
Publication:Clinical Psychiatry News
Geographic Code:4EUUK
Date:Mar 1, 2002
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