以認知模擬檢視男性美沙酮替代療法患者之抑制缺損

Investigating the Inhibition Deficits in Male Patients Undergoing Methadone-maintained Treatment with Cognitive Modeling

過去研究顯示，以Go/No-Go測驗來檢視美沙酮替代療法的患者（patients undergoing methadone-maintained treatment）之認知缺損時，忽略了此測驗中學習行為抑制與行為趨近的條件是不對等的。為此，本研究設計一個修改版的Go/No-Go測驗，不論是go反應還是nogo反應，當反應為正確時皆得到酬賞，反應錯誤時皆得到處罰。在此反應與價性正交化（orthogonalized）的情況下，檢視美沙酮替代療法患者的抑制缺損情況。本研究於台北市立聯合醫院招募50位正在接受美沙酮替代療法的男性海洛因成癮患者，以及30位從網路招募的男性對照組。參與者會接受瑞文氏標準圖形推理測驗、貝克憂鬱量表、貝克焦慮量表，以及修改版Go/No-Go測驗。為了檢視於修改版Go/No-Go測驗中的認知運作歷程，本研究使用認知模擬來分析行為資料。本研究結果顯示，美沙酮替代療法患者於nogo-to-win嘗試次中的錯誤率顯著高於go-to-win嘗試次之錯誤率；對照組中則沒有這樣的顯著差異。美沙酮替代療法患者於nogo-to-win嘗試次中的學習速率，不僅顯著低於對照組，也顯著低於美沙酮替代療法患者自身於goto-win嘗試次中的學習速率。本研究的結果意涵著美沙酮替代療法患者具有抑制缺損，這可能是因為其學習行為抑制上的學習速率較差所帶來的影響。

Previous literature assessing inhibition deficits in patients undergoing methadone maintenance treatment (MMT) using the Go/No-Go task has overlooked the unbalanced design in which participants learn behavioral inhibition and behavioral approach. This study aims to examine the extent of behavioral deficits in patients undergoing MMT when response (go/nogo response) and valence (reward for correct response/punishment for incorrect response) are orthogonalized in the modified Go/No-Go task. Fifty former heroin misusers were recruited from a city hospital, along with 30 male controls, and were assessed using Raven’s Standard Progressive Matrices, Beck Depression Inventory-II, Beck Anxiety Inventory, and the modified Go/No-Go task. Cognitive modeling was conducted to investigate the underlying processes. The results showed that patients undergoing MMT had significantly higher error rates in the nogo-to-win trials than in the go-to-win trials, while there was no significant difference in the control group. The learning rate in nogo-to-win trials of patients undergoing MMT was not only slower than that in controls but also slower than patients’undergoing MMT own learning rate in go-to-win trials. The findings suggest that the patients undergoing MMT showed an inhibition deficit, which might be relevant to a poorer learning rate for behavioral inhibition.