Salience and hedonic experience as predictors of central stimulant treatment response in ADHD - A resting state fMRI study

Julia Rode; Rebecka Runnamo; Per Thunberg; Mussie Msghina

doi:10.1016/j.jpsychires.2023.05.073

Salience and hedonic experience as predictors of central stimulant treatment response in ADHD - A resting state fMRI study

J Psychiatr Res. 2023 Jul:163:378-385. doi: 10.1016/j.jpsychires.2023.05.073. Epub 2023 May 26.

Authors

Julia Rode¹, Rebecka Runnamo², Per Thunberg³, Mussie Msghina⁴

Affiliations

¹ Center for Experimental and Biomedical Imaging in Örebro (CEBIO), Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden; Nutrition-Gut-Brain Interactions Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden.
² Department of Psychiatry, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden.
³ Center for Experimental and Biomedical Imaging in Örebro (CEBIO), Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden; Department for Radiology and Medical Physics, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden.
⁴ Department of Psychiatry, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institute, 17177, Stockholm, Sweden. Electronic address: mussie.msghina@oru.se.

PMID: 37269772
DOI: 10.1016/j.jpsychires.2023.05.073

Abstract

Background: Roughly 20-30% of patients with Attention-deficit/hyperactivity disorder (ADHD) fail to respond to central stimulant (CS) medication. Genetic, neuroimaging, biochemical and behavioral biomarkers for CS response have been investigated, but currently there are no biomarkers available for clinical use that help identify CS responders and non-responders.

Methods: In the present paper, we studied if incentive salience and hedonic experience evaluated after a single-dose CS medication could predict response and non-response to CS medication. We used a bipolar visual analogue 'wanting' and 'liking' scale to gauge incentive salience and hedonic experience in 25 healthy controls (HC) and 29 ADHD patients. HC received 30 mg methylphenidate (MPH) and ADHD patients received either MPH or lisdexamphetamine (LDX) as selected by their clinician, with dosage individually determined for optimal effect. Clinician-evaluated global impression - severity (CGI-S) and improvement (CGI-I) and patient-evaluated improvement (PGI-I) were used to assess response to CS medication. Resting state functional magnetic resonance imaging (fMRI) was conducted before and after single-dose CS to correlate wanting and liking scores to changes in functional connectivity.

Results: Roughly 20% of the ADHD patients were CS non-responders (5 of 29). CS responders had significantly higher incentive salience and hedonic experience scores compared to healthy controls and CS non-responders. Resting state fMRI showed that wanting scores were significantly associated to changes in functional connectivity in ventral striatum including nucleus accumbens.

Conclusion: Incentive salience and hedonic experience evaluated after a single-dose CS medication segregate CS responders and non-responders, with corresponding neuroimaging biomarkers in the brain reward system.

Keywords: Attention-deficit/hyperactivity disorder; Central stimulant treatment; Incentive salience; Pharmacological challenge; Resting state; Treatment prediction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attention Deficit Disorder with Hyperactivity* / diagnostic imaging
Attention Deficit Disorder with Hyperactivity* / drug therapy
Brain / diagnostic imaging
Central Nervous System Stimulants* / therapeutic use
Humans
Magnetic Resonance Imaging
Methylphenidate* / pharmacology
Methylphenidate* / therapeutic use
Motivation

Substances

Central Nervous System Stimulants
Methylphenidate