Advantages and limitations of Internet‐based interventions for common mental disorders

Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face‐to‐face psychotherapy and that they are cost‐effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care.     

中国替代方法研究评价中心共识平台的建立

在社会需要和科技进步的双重推动下,＂3R＂原则和动物试验替代方法正在从道德理念向实验技术转变。站在全球科技发展的高度,结合我国实验动物替代领域的现状和未来趋势,利用MSSQLServer2000构建中国替代方法研究评价中心共识平台,管理信息数据库,用WEB技术将数据库与internet WWW（WorldWideWeb）页面连接,构成动态的咨询平台和信息数据网络查询系统。该共识平台的建立为国内从事实验动物及替代方法研究应用的用户提供了便利,起到了国内外替代技术交流的桥梁作用。     

Long‐term nicotine treatment down‐regulates α6β2* nicotinic receptor expression and function in nucleus accumbens

Long‐term nicotine exposure induces alterations in dopamine transmission in nucleus accumbens that sustain the reinforcing effects of smoking. One approach to understand the adaptive changes that arise involves measurement of endogenous dopamine release using voltammetry. We therefore treated rats for 2–3 months with nicotine and examined alterations in nAChR subtype expression and electrically evoked dopamine release in rat nucleus accumbens shell, a region key in addiction. Long‐term nicotine treatment selectively decreased stimulated α6β2* nAChR‐mediated dopamine release compared with vehicle‐treated rats. It also reduced α6β2* nAChRs, suggesting the receptor decline may contribute to the functional loss. This decreased response in release after chronic nicotine treatment was still partially sensitive to the agonist nicotine. Studies with an acetylcholinesterase inhibitor demonstrated that the response was also sensitive to increased endogenous acetylcholine. However, unlike the agonists, nAChR antagonists decreased dopamine release only in vehicle‐ but not nicotine‐treated rats. As antagonists function by blocking the action of acetylcholine, their ineffectiveness suggests that reduced acetylcholine levels partly underlie the dampened α6β2* nAChR‐mediated function in nicotine‐treated rats. As long‐term nicotine modifies dopamine release by decreasing α6β2* nAChRs and their function, these data suggest that interventions that target this subtype may be useful for treating nicotine dependence.

     

Dim Light Melatonin Onset in Alcohol-Dependent Men and Women Compared with Healthy Controls

Sleep disturbances in alcohol-dependent (AD) individuals may persist despite abstinence from alcohol and can influence the course of the disorder. Although the mechanisms of sleep disturbances of AD are not well understood and some evidence suggests dysregulation of circadian rhythms, dim light melatonin onset (DLMO) has not previously been assessed in AD versus healthy control (HC) individuals in a sample that varied by sex and race. The authors assessed 52 AD participants (mean?±?SD age: 36.0?±?11.0 yrs of age, 10 women) who were 3–12 wks since their last drink (abstinence: 57.9?±?19.3 d) and 19 age- and sex-matched HCs (34.4?±?10.6 yrs, 5 women). Following a 23:00–06:00?h at-home sleep schedule for at least 5 d and screening/baseline nights in the sleep laboratory, participants underwent a 3-h extension of wakefulness (02:00?h bedtime) during which salivary melatonin samples were collected every 30?min beginning at 19:30?h. The time of DLMO was the primary measure of circadian physiology and was assessed with two commonly used methodologies. There was a slower rate of rise and lower maximal amplitude of the melatonin rhythm in the AD group. DLMO varied by the method used to derive it. Using 3 pg/mL as threshold, no significant differences were found between the AD and HC groups. Using 2 standard deviations above the mean of the first three samples, the DLMO in AD occurred significantly later, 21:02?±?00:41?h, than in HC, 20:44?±?00:21?h (t?=??2.4, p?=?.02). Although melatonin in the AD group appears to have a slower rate of rise, using well-established criteria to assess the salivary DLMO did not reveal differences between AD and HC participants. Only when capturing melatonin when it is already rising was DLMO found to be significantly delayed by a mean 18?min in AD participants. Future circadian analyses on alcoholics should account for these methodological caveats. (Author correspondence: daconroy@med.umich.edu)     

内感受对成瘾行为的诱导及其岛叶的调控机制

内感受是机体对自身生理状态的感觉.近年来,越来越多的研究证据表明,内感受可以调控成瘾行为,岛叶是其发挥作用的重要神经基础之一.目前,对岛叶作用机制的研究正受到高度重视.本文从岛叶的基本结构和功能出发,结合近几年来岛叶调控成瘾行为、行为抑制以及情感决策的重要发现,讨论岛叶在成瘾发生及发展过程中的可能作用及其机制,并根据已有的实验证据,试图提出较为合理的研究展望,以推动相关神经环路和神经化学机制研究的深入.     

电针对氯胺酮成瘾大鼠内侧前额叶皮质酪氨酸羟化酶表达的影响

目的观察不同时辰电针“足三里”和“三阴交”穴对氯胺酮成瘾大鼠内侧前额叶皮质（mPFC）酪氨酸羟化酶（TH）表达的影响,探讨电针治疗氯胺酮滥用成瘾的作用机制。方法将56只SD大鼠随机分为正常对照组、生理盐水对照组、模型组、电针治疗组,电针治疗组再分为子时（23：00）、卯时（05：00）、午时（11：00）、酉时（17：00）4个电针组,每组8只。每天1次经腹腔注射氯胺酮复制氯胺酮成瘾模型,不同时辰电针组在给药7d后分别选取一侧“足三里”和“三阴交”穴给予低频（2Hz）电针治疗,每次30min,连续治疗7d。采用免疫组织化学染色方法检测mPFC内TH的表达。结果与正常对照组和生理盐水对照组相比较,模型组mPFC内TH免疫反应阳性神经元的数量明显增多（P〈0．01）,细胞平均灰度值降低（P〈0．01）,与模型组相比较,午时、酉时电针组TH免疫反应阳性神经元的数量明显减少（P〈0．01）,细胞平均灰度值升高（P〈0．01）;子时、卯时电针组则无明显变化（P〉0．05）。结论氯胺酮成瘾使mPFC内TH的表达明显增加;午时、酉时电针“足三里”和“三阴交”穴可明显下调mPFC内TH的表达,改善氯胺酮成瘾症状。     

Electrophysiological effects of orexin-B and dopamine on rat nucleus accumbens shell neurons in vitro

Orexin (ORX) plays a critical role in reward-seeking behavior for natural rewards and drugs of abuse. The mesolimbic dopamine (DA) pathway that projects into the nucleus accumbens (NAc) from the ventral tegmental area is deeply involved in the neural mechanisms underlying reward, drug abuse and motivation. A recent study demonstrated that ORX-immunopositive fibers densely project into the shell of the NAc (NAcSh), suggesting that the NAcSh might be a site of the interaction between the ORXergic and DAergic systems for reward-seeking behavior. Therefore, the electrophysiological effects of ORX-B and DA on NAcSh neurons were examined extracellularly in rat brain slice preparations. ORX-B excited approximately 78% of neurons tested and inhibited 4%, whereas DA excited 50% and inhibited 22% of NAcSh neurons. These excitations and inhibitions persisted during synaptic blockade in a low-Ca²⁺/high-Mg²⁺ solution. DA-induced excitation was attenuated by SCH23390 or sulpiride, whereas DA-induced inhibition was suppressed by sulpiride. Of the neurons that were excited by ORX-B, 71% and 18% were excited and inhibited by DA, respectively. In 63% of neurons that were excited by ORX-B, the simultaneous application of ORX-B and DA increased the firing rate to two times greater than ORX-B alone, whereas, the simultaneous application significantly decreased the neuronal firing rate by 73% in the remaining 37% compared to ORX-B. These results suggest that an interaction between the ORXergic and DAergic systems occurs in the NAcSh and that the NAcSh is involved in the neural mechanisms in which ORX participates in the regulation of reward-seeking behavior.