eprintid: 30692
rev_number: 15
eprint_status: archive
userid: 6177
dir: disk0/00/03/06/92
datestamp: 2021-11-15 12:57:10
lastmod: 2021-12-21 08:30:36
status_changed: 2021-11-15 12:57:10
type: doctoralThesis
metadata_visibility: show
creators_name: Reinhard, Iris
title: Investigations on the influence of cue reactivity on relapse behavior in alcohol use disorder using innovative methods of 
statistical survival analysis
subjects: ddc-310
subjects: ddc-610
divisions: i-60001
divisions: i-851200
adv_faculty: af-06
abstract: The overall objective of this thesis was to clarify the extent to which functional neurobiological (functional magnetic resonance imaging (fMRI)) and psychophysiological (startle reflex) measures of cue reactivity are suitable predictors of severe relapse in individuals with alcohol use disorder (AUD). This could be achieved by complex modern methods of survival analysis. It could be shown that fMRI cue reactivity in the ventral striatum (VS) is suitable as a prognostic factor for relapse in patients suffering from AUD by calculating different fMRI-based aggregation measures which are not yet implemented in standard whole-brain fMRI software. For the VS a measure combining the spatial extent of cue-induced brain activation with the intensity of this activation was found to be most appropriate as a biomarker for relapse prediction. 
Furthermore the startle response as a psychophysiological measure showed a moderator effect when evaluating differential medication effects of naltrexone and acamprosate. The results suggest that AUD patients benefit more from naltrexone than from acamprosate treatment, the more appetitive their startle response appears. In contrast the findings point to lower relapse risk for patients with an aversive startle response pattern when treated with acamprosate compared to naltrexone. The findings support the idea of an individualized treatment based on differential pharmacological treatment due to different underlying biological mechanisms which can be identified by the affective modulation of the startle response. 
The presented methods offer a potential for future analyses of high clinical relevance, also in areas besides addiction (i.e. psychiatry, oncology).
date: 2021
id_scheme: DOI
id_number: 10.11588/heidok.00030692
ppn_swb: 1780898517
own_urn: urn:nbn:de:bsz:16-heidok-306921
date_accepted: 2021-09-15
advisor: HASH(0x55bdeab58f00)
language: eng
bibsort: REINHARDIRINVESTIGAT2021
full_text_status: public
place_of_pub: Heidelberg
citation:   Reinhard, Iris  (2021) Investigations on the influence of cue reactivity on relapse behavior in alcohol use disorder using innovative methods of statistical survival analysis.  [Dissertation]     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/30692/1/Diss140421_heidoc.pdf