NEUROPSIHOLOGIE CLINICA

NEUROPSIHOLOGIE CLINICA

Tulburare de uz/abuz de
substante

• Diagnosticul are in vedere 4 aspecte: lipsa de control, afectarea vietii

sociale, consumul riscant, toleranta & sevraj. Pentru diagnostic este
necesara indeplinirea a cel putin 2

• Lipsa de control:
1) Utilizarea pentru perioade mai lungi sau folosind cantități mai mari
2) Dorinta de a reduce consumul, dar fără succes
3) Petrecerea timpului excesiv pentru cautarea drogului
4) Pofta atât de intensa, incat este dificil să se gândească la altceva.
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• Afectarea vietii sociale:

5. Persoana poate continua să utilizeze, în ciuda problemelor cu locul de
muncă, școală sau de familie / obligații sociale. Aceasta ar putea include
absentele repetate de lucru, rezultate școlare slabe, neglijarea copiilor, sau
incapacitatea de a-și îndeplini responsabilitățile de uz casnic.

6) Persoana continuă consumul de substante in ciuda problemelor

interpersonale din cauza consumului : certuri cu membrii familiei cu privire la
utilizarea substanței sau pierderea prieteniilor importante

7) Activități sociale și recreative importante și semnificative pot fi pierdute

sau reduse din cauza consumului de substanțe. O persoană poate petrece mai
putin timp cu familia lor, sau cu prietenii lor
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• Consumul riscant:
8. Dependenta poate fi indicată atunci când cineva folosește în mod repetat
substanțe în situații periculoase fizic. De exemplu, folosind alcool sau alte
droguri în timp ce funcționează utilaje sau conduce o masina.

9. Unii oameni continuă să folosească substanțe care dau dependență, chiar

dacă sunt conștienți că este cauza sau agravarea problemelor fizice și psihice.
Un exemplu este persoana care continuă să fumeze țigări în ciuda faptului că
o tulburare respiratorie, cum ar fi astmul.
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• Toleranta & sevraj:

10. Toleranța apare atunci când oamenii au nevoie sa creasca doza de
substanță pentru a obține același efect dorit. "Efectul dorit" ar putea fi
dorinta de a evita simptomele de sevraj. Pe de altă parte, ar putea fi dorinta
de a se droga.

11. Sevrajul este raspunsul organismului la întreruperea bruscă a unui drog,

odată ce organismul a dezvoltat o toleranta la el. Simptomele sunt foarte
neplacute si uneori fatale si sunt specifice pentru fiecare drog.
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• Drogul creează dependenţă fizică, psihică şi tulburări grave ale activităţii mentale,
percepţiei şi comportamentului

• Dependenţa psihica este starea mentala caracterizata prin impulsul

pacientului spre consumul periodic sau continuu al drogului, in scopul
dobandirii unei placeri sau al anularii unei stari de tensiune

• Dependenţa fizica reprezinta starea adaptativa care are drept consecinţe

apariţia unor tulburari fizice intense, cand este stopata administrarea
substanţei sau dupa neutralizarea acţiunii sale de catre un antagonist
specific
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• Stilul decizional „impulsiv” este în mod frecvent implicat în explicarea consumului şi
abuzului de substanţe, precum şi a angajării în diverse comportamente de risc sau
excesive

• Impulsivitatea, ca şi trăsătură de personalitate, este văzută ca tendinţa de a trăi

momentul fără a ţine cont de ce urmează în viitor, a acţiona fără premeditare, fără a
gândi şi reflecta asupra consecinţelor unui act, înainte de angajarea în el (Bechara,
2005)

• Termenul “impulsivitate” doar denumeşte un stil comportamental sau decisional nu

îl şi explică. Explicaţia trebuie căutată în altă parte

• Adicţia este legată de mecanismele creierului răspunzătoare de învăţarea apetitivă

(prin recompensă), deci sursa impulsivităţii ar trebui căutată în aceste mecanisme.
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• Adicţia este legată de mecanismele creierului răspunzătoare de învăţarea apetitivă (prin
recompensă), deci sursa impulsivităţii ar trebui căutată în aceste mecanisme
• Printre componentele impulsivităţii este si o slabă toleranţă pentru incertitudinea primirii unei
recompense şi o reacţie exagerată la non-alocarea unei recompense anticipate/prezente
• Atunci când aşteptăm o recompensă, amânarea ei şi incertitudinea primirii îi scad valoarea,
proces numit „discounting” (reducere a valorii)
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Journal of the International Neuropsychological Society Volume 12 Issue 3, May 2006 , pp. 405 - 415
Executive dysfunction in substance dependent individuals during drug use and abstinence: An
examination of the behavioral, cognitive and emotional correlates of addiction

ANTONIO VERDEJO-GARCÍA ,ANTOINE BECHARA ,EMILY C. RECKNOR and MIGUEL PÉREZ-GARCÍA

Increasing evidence indicates that substance-dependent individuals (SDI) are impaired in executive
control tasks relying on different systems within the prefrontal cortex (PFC). Three different
functional systems have been described: the dorsolateral prefrontal cortex (DLPC), orbitofrontal
cortex (OFC), and anterior cingulate cortex (ACC) circuits. Dysfunction within each PFC system is
associated with different behavioral, cognitive, and emotional abnormalities. Few studies have
conducted an exhaustive examination of all these different factors in SDI. In this study, SDI (including
alcohol, cocaine, and methamphetamine polysubstance users, n = 35) were compared with healthy
controls (n = 36) on a series of behavioral (Frontal Systems Behaviour Scale, FrSBe), cognitive (N-
back, Go-No Go, and Wisconsin Card Sorting Tasks), and emotional (International Affective Picture
System, IAPS) tasks, each of which was thought to tax a different component of these PFC functional
systems. SDI showed greater behavioral problems in the apathy, disinhibition, and executive
dysfunction subscales of the FrSBe. Behavioral deficits were significantly associated with several real-
life domains in which SDI typically have problems. SDI also showed poorer performance on cognitive
tests of working memory, response inhibition and mental flexibility, and abnormal processing of
affective images from the IAPS. Cognitive, behavioral, and emotional measures were moderately
correlated
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Efectele drogurilor asupra

creierului
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Impactul produs asupra
creierului de vederea
drogului

• vederea pachetului
activeaza centrii placerii
(cercul albastru)
• pachetul de tigari
activeaza la fumatori si
centrii adictiei (cercul
rosu)
• designul pachetului
suplimenteaza
activarea in zonele
placerii
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PNAS June 30, 2020 117 (26) 15253-15261
Brain networks underlying vulnerability and resilience to drug addiction

Karen D. Ersche, Chun Meng, Hisham Ziauddeen, Jan Stochl, Guy B. Williams, Edward T. Bullmore, and Trevor
W. Robbins

Regular drug use can lead to addiction, but not everyone who takes drugs makes this transition.
How exactly drugs of abuse interact with individual vulnerability is not fully understood, nor is it
clear how individuals defy the risks associated with drugs or addiction vulnerability. We used
resting-state functional MRI (fMRI) in 162 participants to characterize risk- and resilience-related
changes in corticostriatal functional circuits in individuals exposed to stimulant drugs both with
and without clinically diagnosed drug addiction, siblings of addicted individuals, and control
volunteers. The likelihood of developing addiction, whether due to familial vulnerability or drug
use, was associated with significant hypoconnectivity in orbitofrontal and ventromedial prefrontal
cortical-striatal circuits—pathways critically implicated in goal-directed decision-making. By
contrast, resilience against a diagnosis of substance use disorder was associated with
hyperconnectivity in two networks involving 1) the lateral prefrontal cortex and medial caudate
nucleus and 2) the supplementary motor area, superior medial frontal cortex, and putamen—brain
circuits respectively implicated in top-down inhibitory control and the regulation of habits. These
findings point toward a predisposing vulnerability in the causation of addiction, related to impaired
goal-directed actions, as well as countervailing resilience systems implicated in behavioral
regulation, and may inform novel strategies for therapeutic and preventative interventions
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Neurosci Lett. 2012 Jun 19;518(2):167-71. doi: 10.1016/j.neulet.2012.05.003. Epub 2012 May 8.

Inhibition of CaMKII activity in the nucleus accumbens shell blocks the

reinstatement of morphine-seeking behavior in rats
Liu Z, Zhang JJ, Liu XD, Yu LC.

The Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) may be a core component in

the common molecular pathways for drug addiction. Moreover, studies using animal models
of drug addiction have demonstrated that changing CaMKII activity or expression influences
animals' responses to the drugs of abuse. Here, we explored the roles of CaMKII in the
nucleus accumbens (NAc) shell in the extinction and reinstatement of morphine-seeking
behavior. Rats were trained to obtain intravenous morphine infusions through poking hole
on a fixed-ratio one schedule. Selective CaMKII inhibitor myristoylated autocamtide-2-
inhibitory peptide (myr-AIP) was injected into the NAc shell of rats after the acquisition of
morphine self-administration (SA) or before the reinstatement test. The results demonstrated
that injection of myr-AIP after acquisition of morphine SA did not influence morphine-
seeking in the following extinction days and the number of days spent for reaching
extinction criterion. However, pretreatment with myr-AIP before the reinstatement test
blocked the reinstatement of morphine-seeking behavior induced by morphine-priming. Our
results strongly indicate that CaMKII activity in the NAc shell is essential to the relapse to
morphine-seeking.
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Published online 2018 Apr 12. doi: 10.1155/2018/6238989

Clocking In Time to Gate Memory Processes: The Circadian Clock Is Part of the Ins and Outs of
Memory

Oliver Rawashdeh, Rex Parsons, and Erik Maronde

Learning, memory consolidation, and retrieval are processes known to be modulated by the
circadian (circa: about; dies: day) system. The circadian regulation of memory performance is
evolutionarily conserved, independent of the type and complexity of the learning paradigm
tested, and not specific to crepuscular, nocturnal, or diurnal organisms. In mammals, long-term
memory (LTM) formation is tightly coupled to de novo gene expression of plasticity-related
proteins and posttranslational modifications and relies on intact cAMP/protein kinase A
(PKA)/protein kinase C (PKC)/mitogen-activated protein kinase (MAPK)/cyclic adenosine
monophosphate response element-binding protein (CREB) signaling. These memory-essential
signaling components cycle rhythmically in the hippocampus across the day and night and are
clearly molded by an intricate interplay between the circadian system and memory. Important
components of the circadian timing mechanism and its plasticity are members of the Period clock
gene family (Per1, Per2). Interestingly, Per1 is rhythmically expressed in mouse hippocampus.
Observations suggest important and largely unexplored roles of the clock gene protein PER1 in
synaptic plasticity and in the daytime-dependent modulation of learning and memory. Here, we
review the latest findings on the role of the clock gene Period 1 (Per1) as a candidate molecular
and mechanistic blueprint for gating the daytime dependency of memory processing.
Neuron, 2019. DOI: https://doi.org/10.1016/
NEUROPSIHOLOGIE CLINICA
CaMKII Measures the Passage of Time to Coordinate Behavior and Motivational
State
Thornquist, S.C. et al.

The mating behavior of fruit flies is not haphazard. Instead, motivation and behavior are under the control of
neurons that track time. What we learned is that CaMKII, also found in the neurons of humans and other
mammals, gets activated in four specific neurons when mating begins and remains active for six minutes.
CaMKII might be the most well-studied enzyme in neuroscience, it is mostly thought of as a memory molecule,
but we think what it really does is hold information over long timescales, either for memory or for timing other
brain processes. Also like a clock, the CaMKII enzyme is made up of 12 subunits that form a circle. Once
activated, each subunit activates its neighbors to maintain activity even after the triggering signal has faded
away.. Most behaviors take millions of times longer than the time it takes for neurons to fire. But this is the first
clear example that a behavior is organized using time itself, as opposed to just one thing happening after
another. Since the structure of CaMKII is almost identical in humans, flies, and even the most simple animals,
we believe it might be helpful for understanding lots of human behaviors.
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• Research revealed that 35 percent of service members in Vietnam had tried

heroin and as many as 20 percent were addicted

• when soldiers who had been heroin users returned home, only 5 percent of
them became re-addicted within a year, and just 12 percent relapsed
within three years

• In other words, approximately nine out of ten soldiers who used heroin in
Vietnam eliminated their addiction nearly overnight (James Clear,
Atomic Habits, Chapter 7, 2018)
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• To Change Your Behavior, Change Your Environment

• The Secret to Self Control

• One of the most practical ways to eliminate a bad habit is to

reduce exposure to the cue that causes it (James Clear,
Atomic Habits, Chapter 7, 2018)