الفهرس 
Introduction
Substance use disorderOnly 14 pages are availabe for public view
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Abstract
Drug addiction resembles one of the most important health hazards and is one of the most expanding field of research in psychiatry. Drug addiction is usually associated with multiple morbid personality traits including impulsivity and risky style of decision-making process. Multiple brain structures are involved in processes underlying these traits including orbitofrontal cortex, ventrolateral and dorsolateral prefrontal cortex, amygdala and others. Hypothesis and aim of the study: We hypothesized that drug addicts may show more impulsivity and risky decision-making style than healthy people, also these patients may have smaller size of frontal cortex than normal population. The aim of the study was to detect the pattern of decision-making styles and impulsivity among people with different psychoactive substance addiction. We also aimed at measuring the volume of different regions of frontal cortex and studying the possible correlations between the reduction in frontal lobe volume and the presence of pathological traits. Subjects and methods: The study is a cross- sectional descriptive one. Two groups of participants were recruited in the study: group (A): 50 participants with drug addiction diagnosed by DSM-5 criteria recruited from addiction outpatient clinic at Hospital of neurology and Psychiatry science at Assiut University. group (B): 23 healthy individuals as a cross matching control group. Inclusion Criteria: Male patients aged above 18 years diagnosed as substance use disorder according to DSM-5 criteria and clearly consenting to participate in the study. Exclusion criteria: Patients in intoxication or withdrawal state. Those with other psychiatric disorders or with history or current neurological or medical disease. Tools: Each participant was subjected to: Structured clinical interview SCID-I: used to exclude other psychiatric comorbidities. Urine drug screen: to detect the substance of addiction in the patients’ group and exclude substance use in control group. Iowa gambling task: to evaluate the pattern of decision making. UPPS impulsivity behavior scale: to measure the four traits of impulsivity. MRI brain examination and voxel based morphometry: to measure the volume of each region of frontal lobe.. Results: The present study show: The volume of grey matter and cortical thickness is significantly lower among addicts group than in control group. The patient group show higher impulsivity than control group evidenced by significantly higher scores of UPPS subscales. The patients group show more risky style of decision making in comparison to the control group evidenced by significantly higher scores of IGT-A and IGT-B. The patients group show significantly lower volume of all regions of frontal lobe in comparison to control group. There was no significant difference in frontal lobe regions volume in different substances. The deficit in frontal lobe regions’ volumes composing prefrontal cortex is associated with higher scores of IGT-A,B which is associated with high risk pattern, also associated with higher scores in lack of perseverance and sensation seeking subscales of UPPS. The duration of dependence shows significant correlation to impulsivity and the riskier decision style. Drug addiction cause significant reduction in total brain volume, mainly the grey matter volume and cortical thickness. It causes significant loss in the volume of different regions of frontal lobe in comparison to healthy individuals regardless of the substance of addiction. This disorder is associated with marked impulsivity and risky pattern of decision making Research recommendations: We recommend further studies to evaluate the effect of drug addiction on the function of frontal lobe using advanced functional imaging techniques. Future studies are also recommended to evaluate the volume loss of other regions of the brain than the frontal lobe. We also recommend future research to study the effect of short term and long-term abstinence on the volume loss of the frontal lobe region and the personality traits. Clinical recommendations: As shown in the current work; drug dependence is associated with high impulsivity and risky decision-making style which should be a focus of interest during tailoring the patient’s management plan. Also, the reduction in frontal lobe volume should get the clinician attention to possible further cognitive impairment.