Use of cognitive event-related potentials in the management of psychiatric disorders: Towards an individual follow-up and multi-component clinical approach

Abstract

Relapse prevention remains a major challenge in psychiatry, thus indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. In recent years, several intervention strategies have been devised that are aimed at improving psychiatric treatment by providing a complementary set of add-on tools that can be used by clinicians to improve current patient assessment. Among these, cognitive event-related potentials (ERPs) have been indexed as valuable biomarkers of the pathophysiological mechanisms of various mental illnesses. However, despite decades of research, their clinical utility is still controversial and a matter of debate. In this opinion review, I present the main arguments supporting the use of cognitive ERPs in the management of psychiatric disorders, stressing why it is currently still not the case despite the vast number of ERP studies to date. I also propose a clinically-oriented suitable way in which this technique could — in my opinion — be effectively incorporated into individual patient care by promotion of the use of individual ERP test-retest sessions and the use of a multi-component approach.

Intact Error-Related Negativity at the Start of a Three-Week Detoxification Program Reflects a Short-Term Protective Factor Against Relapse in Alcoholic Patients: Some Preliminary Evidence from a Follow-up Event-Related Potentials Study

“…In the absence of significant behavioral modifications, ERPs have proved to be a useful tool to detect neural vulnerabilities reflecting latent inhibitory restrictions among alcoholic patients that can influence clinical trajectory (abstinence vs. relapse; 9,13,22 ). In the present study, we focused on the ERN as it can indicate a vulnerability factor for, respectively, undercontrolled and risky behaviors (substance abuse).…”

“…Approximately 15 to 20 days later, shortly before being discharged, the patients underwent another testing session, identical to the first, followed by a 1-month follow up to gather information about their drinking behaviors once the detoxification program had ended. Relapse was defined as the re-establishment of a state of alcohol dependence according to the DSM-IV criteria, and it was treated as a binary outcome variable as only days of complete abstinence were considered ( 9,52,10,13 ). Thus, only patients who were "totally alcoholfree" at 1 month were considered to be "Abstinent".…”

“…5 By this way, ERPs may be useful (1) to favor an individualized monitoring of cognitive abilities as a function of any type of treatment (psychotherapy, drug medication…) 7 ; and (2) as biomarkers to predict clinical trajectory of individual patients. [8][9][10][11][12][13] Among psychiatric disorders, alcohol dependence is a huge worldwide problem, and a main challenge for clinicians is to face with the relapse rate. Indeed, despite anti-craving medication, withdrawal and psychotherapy, at least 50% of recently detoxified patients relapse within three months following detoxification, 6,9,10,14 this rate increasing up to 85% when detoxification is not followed by post-withdrawal treatment.…”

“…[17][18][19][20] In this perspective, ERPs have been proposed to be used as biomarkers of clinical post-cure trajectory. 6,13 Several studies found neural markers of cue reactivity (oddball P3; eg, 10,21 ) and inhibitory skills (No-go P3; eg, 9,22 ), that predict future abstinence or relapse in recently detoxified alcoholic patients. More recently, a longitudinal ERP study addressed this challenge by linking the change on these two main ERP components -P3 component assessing attentional processing and NoGo P3 component assessing inhibitory response -during a detoxification program to further assess abstinence versus relapse.…”

“…Although the vast majority of clinical trials have focused on behavioral interventions that reduce alcohol relapse after three months or more, 9,10,13 a large proportion of patients relapse within a couple of weeks following discharge. 23 Therefore, recent clinical trials showed that cognitive training alone 24 or combined with tDCS 25 disclosed a positive impact on abstinence in the critical first weeks following discharge.…”