Research reportBrain fMRI study of crave induced by cue pictures in online game addicts (male adolescents)
Highlights
► fMRI data were collected with 3.0 T equipment. ► Our study showed that World of Warcraft game pictures have induced crave in adolescent addicts, causing an increased brain activity in specific regions bilateral dorso lateral frontal cortex, cingulated cortex, and right inferior parietal lobule regions, and cerebellum. ► There are significant positive correlations between the regions of interest (ROI) and craving scores, these relative regions being in left inferior frontal gyrus, right inferior frontal gyrus and cingulate gyrus.
Introduction
We have reviewed relative articles in the Pubmed database. There are 135 published studies about crave in relation with fMRI, of which 41 papers study alcohol addiction. The main results have suggested that craving has been linked to abnormal activity in the orbit of the frontal cortex, dorsal anterior cingulate cortex (dACC) and amygdala. Cue induced craving activated the ACC-vmPFC and PCC on fMRI, as well as the nucleus accumbens area, and lateral frontoparietal areas [1], [2]. The other 5 papers are about heroin cue-induced fMRI studies. Upon heroin-visual stimulation, the markedly activated brain areas of fMRI were found to be the bilateral middle frontal gyrus, left cingulate gyrus, bilateral insular gyrus, occipital cortex, left cuneus, cerebellum, bilateral thalamus, right hippocampus and right amygdala which are closely related to the human's psychological craving activities [3], [4], [5]. 32 papers study chronic cocaine use associated with enhanced cue reactivity to drug stimuli. Cocaine addicts showed increased activation compared to the control group in the left dorsolateral prefrontal and bilateral occipital cortex in response to cocaine cues but not to appetitive control stimuli [6], [7]. 3 papers included studies about drug craving and their implicated craving related to dorsolateral and orbital frontal cortex [7]. There are 6 papers that suggested that brain activation patterns are associated with cue reactivity and craving in abstinent problematic gamblers. Subjective craving in PRG correlated positively with brain activation in the left ventrolateral prefrontal cortex and left insular regions [8], [9]. There are 43 papers that concerned studies on smoking crave, and implied the smoking cues versus neutral cues contrast. During the crave condition, activation was seen on the left anterior cingulate cortex (LACC), medial prefrontal cortex, left middle frontal gyrus, cingulate gyrus, bilateral posterior cingulate gyrus and bilateral precuneus; the areas associated with attention, decision-making and episodic memory [10], [11].
Functional magnetic resonance imaging (fMRI) is the most widely used neural imaging technology. Use of the “cue-induced craving” paradigm for the study of cerebral regions is based on several methodologies and was applied in the study of craving in substance addicts. The findings revealed that the craving set in related brain areas are: anterior cingulate cortex, dorsolateral prefrontal cortex, the nucleus accumbens, amygdala, striatum of body and orbital back. Crockford [12(a)] found that when patients with pathological gambling habits were shown gambling videos, the right dorsal lateral prefrontal (right inferior frontal gyrus and the middle frontal gyrus), the left temporal lobe (parahippocampal gyrus), fusiform gyrus showed sharp increased activity. A study (Potenza) on craving state shows pathological gambling related brain areas activity, such as in: frontal lobes, orbital region and the basal ganglia, thalamus and cingulated cortex, before activating the reduction phase, and bilateral right occipital lobe activation signal increasing the wedge-leaf in turn [12(b)]. Presently, there are no online game addicts fMRI studies to describe online game craving related to brain activity areas. This research aims to use fMRI technology, “cue-induced craving paradigm”, and addiction game screenshots as cue stimuli, to observe and record brain activity areas, activity strength, and other brain activated areas, allowing the examinee to watch the game's cue pictures. Assuming that activated brain areas and activity strength exist and show significant differences between the game addicts and the normal control group, we can hence reveal the psychological craving mechanism for online game addicts. We can therefore assume that the game cue picture activates brain regions which include: cingulate cortex, dorsolateral prefrontal cortex, amygdala, caudate nucleus, nucleus accumbens, and other brain regions.
Section snippets
Subjects
Subjects were recruited via the internet in Dalian city. They included two groups: one group being “War of Warcraft” online game players, and the other being non-game addicts. They all received self-made general statement questionnaires, and Chen's Chinese Internet Addiction Scale (CIAS) [48], [49], [50]. Criteria for players falling in the addicts’ group were: CIAS score volume higher than 64, weekly gaming time of 30 h and above. Criteria for the control group were: those not playing the game.
General statement of subjects
10 WoW internet online game addicts and 10 control group members were run into the final analysis. There were no significant differences between the two groups in age and education. There were significant differences between the CIAS group and control group in the CIAS score, craving scores and game experience recall. There were higher scores in CIAS group than the control group (Table 2).
Comparison of brain region activity between the game addicts group and the non-gaming group
Comparison of differences of brain regions activated between the game addicts group and the non-gaming
Discussion
The results have suggested that WoW game pictures have induced crave for adolescent addicts, which looks like substance abuse, all being crave induced behavior by cues. We will consider that playing WoW online games for a longer time has successfully led to an addictive behavior by adolescents. We also found addicts’ craving behavior may mainly be related with bilateral dorsolateral frontal cortex, cingulate cortex, right inferior parietal lobule regions. We consider that playing WoW game for
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