Cognitive Impairments & Comorbidity
Contents
Types of Impairments
Attention
Smoking associated with loss of brain volume
Cortical activity of never-smokers was larger, reflecting greater processing attention
Memory
MDMA produces neurotoxic damage in both animals (Wang et al. 2004) and humans (Cowan et al.)
(Brown et al. 2010) - investigated memory deficits in human ecstasy users
- Verb Paired Associates (VPA) - i.e frog-table
- Stem Cued Recall Task - finish a word from a list of previously seen
Ecstasy users showed selective memory impairment in the VPA task but not in cued stem completion
Reversal Learning
Probes the ability to change behaviour in the face of changed outcomes that occur as a result of that behaviour
- Acquisition: Reinforcement learning to do the 'right' thing
- Reversal Stage: The options are switched
The number of errors before switching to the new stage indexes the inability to learn the new response strategy
Cocaine and methamphetamines render subjects less able to learn to switch strategies
Habits / Response Inhibition
Two types of instrumental behaviour
- Goal-directed instrumental response - idea of the reward + response that should produce that reward
- Habitual instrumental response - occurs after training | context elicit the response
There needs to be a balance between these two types of response.
Even after the devaluation procedure, amphetamine-injected rats still decided to press the lever. This indicates that they were less able to act in a goal-direct instrumental response.
Impulsivity
The tendency to do things without thinking about the consequences
Drug users have a higher impulsivity
Comorbidity
the simultaneous presence of two or more diseases or medical conditions in a patient.
43.6M with mental illness
20.2M substance use disorder
7.9 dual diagnosis
High metric of depression and substance use disorder
(Hart et al. 2012) - Impairments in addicts often fall within the normal range of the population as a whole,.
Addiction is determined by a multitude of factors.
- Need to try to enjoy the drug
- Risks of drugs only multiply the possibility