Czermainski, Fernanda Rasch; Willhelm, Alice Rodrigues; Santos, Álvaro Zaneti; Pachado, Mayra Pacheco; de Almeida, Rosa Maria Martins

doi:10.1590/2237-6089-2016-0043

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Sumário

Review Article • Trends Psychiatry Psychother. 39 (3) • Jul-Sep 2017 • https://doi.org/10.1590/2237-6089-2016-0043 copiar

Avaliação do controle inibitório em usuários de cocaína e/ou crack: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Prejuízos envolvendo o controle inibitório têm sido considerados déficits centrais em usuários de substâncias psicoativas, contudo parece haver disfunções específicas de acordo com a droga de escolha. Este artigo teve por objetivo revisar os achados recentes sobre alterações do controle inibitório em amostras de usuários de cocaína e/ou crack.

Método

A pesquisa foi realizada nas bases de dados PubMed, PsycINFO e Web of Knowledge, em duas etapas, de acordo com os critérios de elegibilidade: inicialmente foi feita uma pesquisa nas bases de dados com análise dos títulos e resumos; após, os artigos foram lidos na íntegra. Os critérios de inclusão foram: artigos empíricos publicados em inglês, português ou espanhol, nos últimos 10 anos e que tenham avaliado o controle inibitório em usuários de cocaína e/ou crack.

Resultados

Do total de 3.796 resultados, 56 títulos foram selecionados, sendo 20 excluídos. Como resultado, 36 artigos foram incluídos na revisão. Em 90% dos estudos revisados, foi relatada a presença de déficits de controle inibitório, verificados através de prejuízos no processamento cognitivo e no monitoramento de respostas, além de níveis elevados de impulsividade, independentemente do padrão de consumo de cocaína e/ou crack (uso recreativo ou crônico). Usuários em abstinência apresentaram níveis elevados de impulsividade, mesmo após longos períodos sem uso da droga.

Conclusão

Usuários de cocaína e/ou crack podem apresentar prejuízos de controle inibitório apesar dos diferentes padrões de consumo. Níveis elevados de impulsividade podem constituir fator de vulnerabilidade para o uso de drogas e para a recaída.

Drogas; avaliação; inibição; cognição

Authors	Sample	Clinical and cognitive assessments	Inhibition assessment	Impaired inhibition?
Albein-Urios et al.²⁵25. Albein-Urios N, Martinez-Gonzalez JM, Lozano O, Clark L, Verdejo-Garcia A. Comparison of impulsivity and working memory in cocaine addiction and pathological gambling: implications for cocaine-induced neurotoxicity. Drug Alcohol Depend. 2012;126:1-6.	CG = 20 GCO = 29 PG = 23	Delay-Discounting; N-back; UPPS-P	CWIT	Yes (GDC and PG)
Albein-Urios et al.²⁶26. Albein-Urios N, Martinez-Gonzalez JM, Lozano-Rojas O, Verdejo-Garcia A. Executive functions in cocaine-dependent patients with Cluster B and Cluster C personality disorders. Neuropsychology. 2014;28:84-90.	CG = 34 GCO = 36 GCDCB = 22 GCDCC = 15	Category Test; D2; LNS (WAIS-III); N-back; PBQ	CWIT	Yes (GCDCB, GCDCC and GDC)
Colzato & Hommel¹⁷17. Colzato LS, Hommel B. Recreational use of cocaine eliminates inhibition of return. Neuropsychology. 2009;23:125-9.	CG = 16 GURC = 13	MINI; MPR	IOR	Yes (GURC)
Colzato et al.²⁷27. Colzato LS, van den Wildenberg WP, Hommel B. Impaired inhibitory control in recreational cocaine users. Plos One. 2007;2:e1143.	CG = 13 GURC = 13	MINI; MPR	Stop-signal	Yes (GURC)
Fillmore & Rush²⁸28. Fillmore MT, Rush CR. Polydrug abusers display impaired discrimination-reversal learning in a model of behavioural control. J Psychopharmacol. 2006;20;24-32.	CG = 20 GP = 20	BDI; BPRS; DAST; K-BIT	Cue-dependent Go/No-Go	Yes (GP)
Fillmore et al.²³23. Fillmore MT, Rush CR, Hays L. Cocaine improves inhibitory control in a human model of response conflict. Exp Clin Psychopharmacol. 2005;13:327-35.	GP = 14	DAST; DEQ; MINI	Cue-dependent Go/No go	Improved inhibition after administration of cocaine
Fillmore et al.²⁴24. Fillmore MT, Rush CR, Hays L. Acute effects of cocaine in two models of inhibitory control: implications of non-linear dose effects. Addiction. 2006;101:1323-32.	GP = 12	DAST; DEQ; MINI	Cue-dependent Go/No-Go; Stop signal	Improved inhibition after administration of cocaine
Fernández-Serrano et al.²⁹29. Fernández-Serrano MJ, Pérez-García M, Schmidt Río-Valle J, Verdejo-García A. Neuropsychological consequences of alcohol and drug abuse on different components of executive functions. J Psychopharmacol. 2010;24:1317-32.	CG = 30 GP = 60	FAS; RFFT; IGT; IRAB; OTM; R-SAT; Digits, Cubes, Similarities, and Categorization (WAIS-III)	5DT; Color-Word Stroop	Yes (GP)
Fernández-Serrano et al.³⁰30. Fernández-Serrano MJ, Perales JC, Moreno-López L, Pérez-García M, Verdejo-García A. Neuropsychological profiling of impulsivity and compulsivity in cocaine dependent individuals. Psychopharmacology (Berl). 2012;219:673-83.	CG = 65 GCO = 46	IRAB; Probabilistic reversal learning task; R-SAT; UPPS-P	Color-Word Stroop; Go/No go	Yes (GCO)
Hester et al.³¹31. Hester R, Simões-Franklin C, Garavan H. Post-error behavior in active cocaine users: poor awareness of errors in the presence of intact performance adjustments. Neuropsychopharmacology. 2007;32:1974-84.	CG = 22 GCO = 21	SCID-I	BAT; EAT; Go/No-Go	Yes (GCO)
Sellaro et al.³²32. Sellaro R, Hommel B, Colzato LS. Increased response conflict in recreational cocaine polydrug users. Exp Brain Res. 2014;232:113-9.	CG = 17 GP = 17	MINI; MPR	Simon Task	Yes (GP)
Kjome et al.³³33. Kjome KL, Lane SD, Schmitz JM, Green C, Ma L, Prasla I, et al. Relationship between impulsivity and decision making in cocaine dependence. Psychiatry Res. 2010;178:299-304.	CG = 20 GCO = 66	ASI; BIS-11; IGT; SCID	IMT	Yes (GCO)
Li et al.³⁴34. Li CS, Milivojevic V, Kemp K, Hong K, Sinha R. Performance monitoring and stop signal inhibition in abstinent patients with cocaine dependence. Drug Alcohol Depend. 2006;85:205-12.	CG = 41 GCO = 18	SCID	Stop-Signal	Yes (GCO)
Liu et al.³⁵35. Liu S, Lane SD, Schmitz JM, Green CE, Cunningham KA, Moeller FG. Increased intra-individual reaction time variability in cocaine-dependent subjects: role of cocaine-related cues. Addict Behav. 2012;37:193-7.	CG = 50 GCO = 123	SCID	Cocaine Stroop	Yes (GCO)
Madoz-Gurpide et al.³⁶36. Madoz-Gurpide A, Blasco-Fontecilla H, Baca-Garcia E, Ochoa-Mangado E. Executive dysfunction in chronic cocaine users: an exploratory study. Drug Alcohol Depend. 2011;117:55-8.	CG = 27 GCO = 24	BADS; EHI; MINI; Digits (WAIS-III); TMT; WCST	Rule Shift Cards (BADS)	Yes (GCO)
Pike et al.³⁷37. Pike E, Marks KR, Stoops WW, Rush CR. Cocaine-related stimuli impair inhibitory control in cocaine users following short stimulus onset asynchronies. Addiction. 2015;110:1281-6.	GCOCGo = 45 GCONGo = 45	Not stated.	ABBA (cued Go/No-Go)	Yes (GCOCGo)
Ruiz et al.³⁸38. Ruiz MJ, Paolieri D, Colzato LS, Bajo MT. Chronic and recreational use of cocaine is associated with a vulnerability to semantic interference. Psychopharmacology (Berl). 2015;232:1717-26.	Experiment 1: CG = 20 GRCOU = 20 Experiment 2: CG = 16 GCCOU = 16	Boston Naming Test; MPR; MINI; MST; SCID; Verbal Fluency Test	Semantic blocking task	Yes (GRCOU and GCCOU)
Soar et al.³⁹39. Soar K, Dawkins L, Page F, Wooldridge J. Recreational cocaine use is associated with attenuated latent inhibition. Addict Behav. 2015;50:34-9.	CG = 18 GP = 17 GRCOU = 21	BSI; NART-R; SPQ-B	Latent inhibition task	Yes (GRCOU)
van der Plas et al.⁴⁰40. van der Plas EA, Crone EA, van den Wildenberg WP, Tranel D, Bechara A. Executive control deficits in substance-dependent individuals: a comparison of alcohol, cocaine, and methamphetamine and of men and women. J Clin Exp Neuropsychol. 2009;31:706-19.	CG = 36 GCO = 27 GA = 33 GMET = 38	IGT; SCID; Tic Tac Toe; WCST	Cued Go/No-Go; Stop-signal	No Differences in executive functioning, by sex and by type of drug, were observed
Verdejo-Garcia et al.⁴¹41. Verdejo-Garcia AJ, Lopez-Torrecillas F, Aguilar de Arcos F, Perez-Garcia M. Differential effects of MDMA, cocaine, and cannabis use severity on distinctive components of the executive functions in polysubstance users: a multiple regression analysis. Addict Behav. 2005;30:89-101.	GP = 38	Changes: Test of Cognitive Flexibility; IRAB; LNS, Arithmetic, Similarities and Digits (WAIS-III)	Color-Word Stroop	Yes (GP)
Verdejo-Garcia & Perez-Garcia²⁰20. Verdejo-Garcia A, Perez-Garcia M. Profile of executive deficits in cocaine and heroin polysubstance users: common and differential effects on separate executive components. Psychopharmacology (Berl). 2007;190:517-30.	CG = 37 GCO = 45 GH = 28	Category test; CBT; FAS; IGT; LNS, Arithmetic, Digits, and Similarities (WAIS-III); RFFT; Spatial span (WMS-III); WAT; WCST	5DT; Color-Word Stroop; Go/No-Go	Yes (GCO)
Verdejo-Garcia et al.⁴²42. Verdejo-Garcia AJ, Perales JC, Perez-Garcia M. Cognitive impulsivity in cocaine and heroin polysubstance abusers. Addict Behav. 2007;32:950-66.	CG = 30 GCO = 39 GH = 25	IGT; IRAB; WAT	5DT; Color-Word Stroop; Go/No-Go	Yes (GCO and GH)
Vonmoos et al.⁴³43. Vonmoos M, Hulka LM, Preller KH, Jenni D, Schulz C, Baumgartner MR, et al. Differences in self-reported and behavioral measures of impulsivity in recreational and dependent cocaine users. Drug Alcohol Depend. 2013;133:61-70.	CG = 68 GCCOU = 30 GRCOU = 68	ADHD-SR; BDI; CCQ; MWT-B; SCID-I	BIS-11; RVIPT; Stop-Signal; TCINS	No
Winhusen et al.⁴⁴44. Winhusen T, Lewis D, Adinoff B, Brigham G, Kropp F, Donovan DM, et al. Impulsivity is associated with treatment non-completion in cocaine- and methamphetamine-dependent patients but differs in nature as a function of stimulant-dependence diagnosis. J Subst Abuse Treat. 2013;44:541-7.	GCO = 125 GMET = 47	PHQ; WURS	Bis-11; Color-Word Stroop (Comalli–Kaplan version)	Yes (GCO)

Study	Sample	Clinical/cognitive measures	Imaging studies	Measures of inhibitory control	Inhibitory control deficits?
Albein-Urios et al.⁴⁵45. Albein-Urios N, Martinez-Gonzalez JM, Lozano O, Moreno-Lopez L, Soriano-Mas C, Verdejo-Garcia A. Negative urgency, disinhibition and reduced temporal pole gray matter characterize the comorbidity of cocaine dependence and personality disorders. Drug Alcohol Depend. 2013;132:231-7.	CG = 34 GCO = 44 GCOCB = 32	Cancellation Test; Category Test; D2; LNS (WAIS-III); N-back; PBQ; UPPS-P	fMRI	Color-Word Stroop	Yes (GCO and GCOCB)
Barros-Loscertales et al.⁴⁶46. Barros-Loscertales A, Bustamante JC, Ventura-Campos N, Llopis JJ, Parcet MA, Avila C. Lower activation in the right frontoparietal network during a counting Stroop task in a cocaine-dependent group. Psychiatry Res. 2011;194:111-8.	CG = 16 GCO = 16	Color-Word Stroop; Matrix Reasoning test (WAIS-III)	fMRI	Counting Stroop	Yes (GCO)
Bell et al.⁴⁷47. Bell RP, Foxe JJ, Ross LA, Garavan H. Intact inhibitory control processes in abstinent drug abusers (I): a functional neuroimaging study in former cocaine addicts. Neuropharmacology. 2014;82:143-50.	CG = 45 GACO = 27	SCID	fMRI	Go/No-Go	No
Bell et al.⁴⁸48. Bell RP, Garavan H, Foxe JJ. Neural correlates of craving and impulsivity in abstinent former cocaine users: towards biomarkers of relapse risk. Neuropharmacology. 2014;85:461-70.	CG =19 GACO = 20	BIS-11; CCQ	fMRI	Cocaine cue task; Go/No-Go	No
Castelluccio et al.⁴⁹49. Castelluccio BC, Meda SA, Muska CE, Stevens MC, Pearlson GD. Error processing in current and former cocaine users. Brain Imaging Behav. 2014;8:87-96.	CG = 35 GCO = 30 GECO = 29	BART; BIS-11; BIS/BAS; EDT; Padua Inventory; SPSRQ; SSS Form V	fMRI	Go/No-Go	No
Connolly et al.⁵⁰50. Connolly CG, Foxe JJ, Nierenberg J, Shpaner M, Garavan H. The neurobiology of cognitive control in successful cocaine abstinence. Drug Alcohol Depend. 2012;121:45-53.	CG = 9 GCOST = 9 GCOLT = 9	BIS-11; BPAQ; KMSK	fMRI	Go/No-Go	No
Elton et al.⁵¹51. Elton A, Young J, Smitherman S, Gross RE, Mletzko T, Kilts CD. Neural network activation during a stop-signal task discriminates cocaine-dependent from non-drug-abusing men. Addict Biol. 2014;19:427-38.	CG = 27 GCO = 38	BDI; SCID-I	fMRI	BIS-11; Stop-signal	No
Hester et al.⁵²52. Hester R, Bell RP, Foxe JJ, Garavan H. The influence of monetary punishment on cognitive control in abstinent cocaine-users. Drug Alcohol Depend. 2013;133:86-93.	GACO = 15 CG = 15	SCID-I; WRAT	fMRI	Go/No-Go with monetary punishment	Yes (GACO)
Morie et al.⁵³53. Morie KP, De Sanctis P, Garavan H, Foxe JJ. Executive dysfunction and reward dysregulation: a high-density electrical mapping study in cocaine abusers. Neuropharmacology. 2014;85:397-407.	CG = 27 GCO = 23	BIS-11; BPAQ; KMSK; LHA; SCID	EEG	Go/No-Go	Yes (GCO)
Morie et al.⁵⁴54. Morie KP, Garavan H, Bell RP, De Sanctis P, Krakowski MI, Foxe JJ. Intact inhibitory control processes in abstinent drug abusers (II): a high-density electrical mapping study in former cocaine and heroin addicts. Neuropharmacology. 2014;82:151-60.	CG = 21 GAP = 21	ASI; CPCSS; CSSA; SCID; SHPS	EEG	Go/No-Go; Go/No-Go with emotional bias	No
Morein-Zamir et al.⁵⁵55. Morein-Zamir S, Simon Jones P, Bullmore ET, Robbins TW, Ersche KD. Prefrontal hypoactivity associated with impaired inhibition in stimulant-dependent individuals but evidence for hyperactivation in their unaffected siblings. Neuropsychopharmacology. 2013;38:1945-53.	CG = 41 GHSD = 32 GHSD = 39	AUDIT; DAST-20; NART; OCDUS; SCID	fMRI	Stop-signal	Yes (GHSD)
Smith et al.⁵⁶56. Smith DG, Jones PS, Bullmore ET, Robbins TW, Ersche KD. Cognitive control dysfunction and abnormal frontal cortex activation in stimulant drug users and their biological siblings. Transl Psychiatry. 2013;3:e257.	CG = 47 GHSD = 42 GHSD = 49	AUDIT; BDI-II; DAST-20; OCDUS; SCID	fMRI	Color-Word Stroop	Yes (GHSD)

Instrument	Frequency
Attentional-Bias-Behavioral Activation Task (ABBA)	1
Behavioural Adaptation Task (BAT)	1
Cocaine Cue Task	1
Cocaine Stroop	1
Color-Word Interference Test (CWIT)	2
Color-Word Stroop	9
Counting Stroop	1
Cue-dependent Go/No-Go	5
Error Awareness Task (EAT)	1
5-Digit Test	3
Go/No-Go	10
Go/No-Go with monetary punishment	1
Go/No-Go with emotional bias	1
Immediate Memory Task (IMT)	1
Inhibition of Return Task (IOR)	1
Latent Inhibition Task	1
Rule Shift Cards	1
Semantic Blocking Task	1
Simon Task	1
Stop-Signal	6

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[1] Correspondence: Fernanda Rasch Czermainski. Instituto de Psicologia, Universidade Federal do Rio Grande do Sul. Rua Ramiro Barcelos, 2600, Bairro Santa Cecília. 90035-003 - Porto Alegre, RS - Brazil. Tel.: +55 (51) 3308.5066 / +55 (51) 99835.3909. E-mail: ferrasch@gmail.com