A 41-year-old man with severe stimulant and opioid use disor…
A 41-year-old man with severe stimulant and opioid use disorders presents for evaluation after multiple relapses despite prior behavioral treatment. Neuroimaging from a research-based PET study shows markedly reduced D2 receptor availability in the dorsal striatum, along with decreased metabolic activity in the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC). He exhibits a pattern of compulsive drug seeking even after periods of abstinence, intense craving when exposed to paraphernalia, and impaired ability to modify behavior despite adverse consequences. The clinician explains that chronic substance exposure has altered the balance between reward-driven behavior and executive control by reshaping several neuroadaptations across mesocorticolimbic circuitry. Which of the following best describes the integrated neurobiological mechanism underlying this patient’s compulsive drug use and impaired behavioral regulation?
Read DetailsA 39-year-old school teacher presents at the urging of her p…
A 39-year-old school teacher presents at the urging of her peers. The patient says that she was sent here because she “just likes things a little cleaner” than her colleagues do. In the school restaurant, she brings her own utensils because she’s seen the kitchen crew grasp all of the forks with their bare hands. When she gets home, she must wash her hands and dry them using only a clean towel without touching the fingers of her other hand. She repeats this washing process at least 5 times before she can stop. Because of the patient’s belief that the world is dirty, she has stopped going to shows or the movies, which she once enjoyed immensely, according to her friends. What is the next step in management of this patient?
Read DetailsA 52-year-old male with a history of alcohol use disorder, h…
A 52-year-old male with a history of alcohol use disorder, hypertension, and cirrhosis presents to the ER requesting a detox admission. The patient has been drinking 12 beers daily for the past 2 weeks. He has experienced withdrawal seizures when attempting to detox at home from alcohol. His initial lab work demonstrates a GFR >60, an AST of 210, and an ALT of 152. He is admitted for a medically managed detox. Which of the following agents would be the best choice to use for this patient’s alcohol detox?
Read DetailsA 45-year-old man with a 20-year history of alcohol and stim…
A 45-year-old man with a 20-year history of alcohol and stimulant use disorders presents after a relapse triggered by cue exposure. Neuroimaging research performed during a university addiction study demonstrates reduced basal dopamine release in the ventral striatum, upregulated glutamatergic input from the prefrontal cortex to the nucleus accumbens, and elevated expression of ΔFosB in D1 receptor–expressing medium spiny neurons. Clinically, he reports intense craving, automatic “habit-like” drug-seeking behaviors, and difficulty inhibiting responses despite strong motivation to abstain. Based on these findings, which neurobiological process best explains the patient’s persistent vulnerability to relapse, even after periods of abstinence?
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