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Abstract
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A Review by Jaymin Upadhyay and colleagues was published in The Lancet Psychiatry on Nov 11, 2021. We have several concerns about this paper, in which the authors mapped opioid use disorder (OUD) and post-traumatic stress disorder (PTSD) comorbidity onto research domain criteria (RDoC). Some of the factual errors have been corrected as of April 22, 2022. Nonetheless, there are remaining concerns pertaining to scientific rigor, attribution of previously published ideas, and depiction of a theoretical assessment framework as a developed approach.
Upadhyay and colleagues put forward the following hypotheses: negative affect arising in the context of opioid withdrawal (hyperkatifeia) might have a role in OUD-PTSD comorbidity; hyperkatifeia is derived from the dysregulation of dopaminergic and opioidergic systems (other key systems, such as glutamatergic and noradrenergic systems, are not mentioned); loss of the top-down executive control forms the link between OUD and PTSD; proinflammatory markers confer OUD and PTSD susceptibility; dysfunctional top-down circuitry is involved in impaired impulse control associated with OUD and PTSD; imbalance between "bottom-up and top-down CNS mechanisms" is important for OUD and PTSD; OUD-PTSD comorbidity is associated with "aberrant function of brainstem nuclei" leading to "an antireward or stress-surfeit state"; the proposed addictions and PTSD neuroclinical assessments will contribute to better understanding of OUD, PTSD, and comorbid OUD-PTSD neurobiology; pain stimuli might be used to probe the antistress CNS systems and aversive processing in general (the antistress term is not defined or discussed); dual μ receptor agonist and κ antagonist in combination with an α2 agonist might counteract reward and executive dysfunction along with excessive stress in patients with OUD-PTSD comorbidity; and patients with OUD-PTSD comorbidity might present neuroimmune dysregulation.
Although some of the aforementioned hypotheses are by and large established facts, at best they are only touched upon rather than being systematically developed or analysed. Additionally, other than constructing a lengthy list of brain regions, stress-related and reward-related activation of which could be altered in OUD and PTSD, the authors present no model with respect to the type of OUD-PTSD interactions or specific mechanisms leading to the comorbid state...
Language: en |