Neurobiologie stoffgebundener Abhängigkeitserkrankungen - Befunde bildgebender Verfahren[1, ] [2]

Zusammenfassung

Der Einsatz bildgebender Verfahren ermöglicht ein Verständnis grundlegender Mechanismen der Abhängigkeitserkrankungen. Zu den Symptomen einer Abhängigkeitserkrankung gehören die Toleranzentwicklung gegenüber den Substanzwirkungen, Entzugssymptomatik, ein starkes Verlangen nach der Substanz, eine verminderte Kontrolle über den Substanzkonsums und die schädlichen Folgen des Konsums. Bildgebende Studien unterstützen die Hypothese, dass die Ausbildung von Toleranz als homöostatischer Anpassungsprozess an die Wirkung der Droge verstanden werden kann. Beim plötzlichen Entzug der Droge kommt es dann zu einem Verlust der Homöostase, der sich als Entzugssymptomatik zeigt. Die Sensitivierung ist ein der Toleranzentwicklung entgegengesetzter Prozess und beschreibt eine Zunahme der Wirksamkeit einer Substanz bei gleicher Dosierung. Befunde bildgebender Untersuchungen verweisen hier wie bei der Ausbildung des Drogenverlangens auf neuroadaptive Vorgänge im hirneigenen Belohnungssystem. Zu den schädlichen Folgen des Drogenkonsums zählen die neurotoxischen Wirkungen im ZNS. Neben den bildgebenden Befunden zu diesen Kardinalsymptomen der Abhängigkeitserkrankungen diskutieren wir auch bildgebende Studien zu Vulnerabilitätsfaktoren, die zur Entwicklung einer Abhängigkeitserkrankung disponieren.

Abstract

Neuroimaging provides insight into the main biological mechanisms underlying drug and alcohol dependence. Cardinal symptoms of drug dependence are the development of tolerance against drug effects, withdrawal symptoms, drug craving, reduced control over drug intake and harmful consequences of drug consumption. Brain imaging studies support the hypothesis that tolerance development can be understood as a neuroadaptive mechanism to ensure homeostasis during chronic drug intake. When drug consumption is suddenly interrupted during detoxification, the loss of homeostasis can manifest as a withdrawal syndrome. While tolerance development reduces the effects of chronic drug intake, sensitization is a neuroadaptive process that increases the effects of a drug dose. Brain imaging studies indicate that sensitisation and drug craving are associated with neuroadaptive processes in the brain reward system. Harmful consequences of drug intake include neurotoxic effects on the central nervous system. Besides discussing brain imaging studies on the neurobiological correlates of drug dependence, this review also presents studies on vulnerability factors that predispose individuals to excessive drug intake.

Abhängigkeitserkrankung - Neurobiologie - Funktionelle Bildgebung

addiction - neurobiology - neuroimaging

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1 Mit Unterstürzung der DFG (He 2597/4-2 & 7-2)

2 Erstveröffentlichung im 31. Band „Fortschritt und Fortbildung in der Medizin” 2007/2008 der Bundesärztekammer (ISSN 0170-3331).