TY - JOUR
T1 - Neurocircuitry basis of the opioid use disorder-post-traumatic stress disorder comorbid state
T2 - conceptual analyses using a dimensional framework
AU - Upadhyay, Jaymin
AU - Verrico, Christopher D.
AU - Cay, Mariesa
AU - Kodele, Sanda
AU - Yammine, Luba
AU - Koob, George F.
AU - Schreiber, Rudy
N1 - Copyright © 2021 Elsevier Ltd. All rights reserved.
PY - 2022/1
Y1 - 2022/1
N2 - Understanding the interface between opioid use disorder (OUD) and post-traumatic stress disorder (PTSD) is challenging. By use of a dimensional framework, such as research domain criteria, convergent and targetable neurobiological processes in OUD-PTSD comorbidity can be identified. We hypothesise that, in OUD-PTSD, circuitry that is implicated in two research domain criteria systems (ie, negative valence and cognitive control) underpins dysregulation of incentive salience, negative emotionality, and executive function. We also propose that the OUD-PTSD state might be systematically investigated with approaches outlined within a neuroclinical assessment framework for addictions and PTSD. Our dimensional analysis of the OUD-PTSD state shows how first-line therapeutic approaches (ie, partial μ-type opioid receptor [MOR1] agonism) modulate overlapping neurobiological and clinical features and also provides mechanistic rationale for evaluating polytherapeutic strategies (ie, partial MOR1 agonism, κ-type opioid receptor [KOR1] antagonism, and α-2A adrenergic receptor [ADRA2A] agonism). A combination of these therapeutic mechanisms is projected to facilitate recovery in patients with OUD-PTSD by mitigating negative valence states and enhancing executive control.
AB - Understanding the interface between opioid use disorder (OUD) and post-traumatic stress disorder (PTSD) is challenging. By use of a dimensional framework, such as research domain criteria, convergent and targetable neurobiological processes in OUD-PTSD comorbidity can be identified. We hypothesise that, in OUD-PTSD, circuitry that is implicated in two research domain criteria systems (ie, negative valence and cognitive control) underpins dysregulation of incentive salience, negative emotionality, and executive function. We also propose that the OUD-PTSD state might be systematically investigated with approaches outlined within a neuroclinical assessment framework for addictions and PTSD. Our dimensional analysis of the OUD-PTSD state shows how first-line therapeutic approaches (ie, partial μ-type opioid receptor [MOR1] agonism) modulate overlapping neurobiological and clinical features and also provides mechanistic rationale for evaluating polytherapeutic strategies (ie, partial MOR1 agonism, κ-type opioid receptor [KOR1] antagonism, and α-2A adrenergic receptor [ADRA2A] agonism). A combination of these therapeutic mechanisms is projected to facilitate recovery in patients with OUD-PTSD by mitigating negative valence states and enhancing executive control.
KW - AMYGDALA
KW - BRAIN
KW - BUPRENORPHINE TREATMENT
KW - EMOTION DYSREGULATION
KW - FUNCTIONAL CONNECTIVITY
KW - LATERAL HABENULA
KW - NUCLEUS-ACCUMBENS
KW - PREFRONTAL CORTEX
KW - SEX-DIFFERENCES
KW - VENTRAL TEGMENTAL AREA
U2 - 10.1016/s2215-0366(21)00008-0
DO - 10.1016/s2215-0366(21)00008-0
M3 - (Systematic) Review article
C2 - 34774203
SN - 2215-0374
VL - 9
SP - 84
EP - 96
JO - Lancet Psychiatry
JF - Lancet Psychiatry
IS - 1
ER -