Dysconnection in schizophrenia: from abnormal synaptic plasticity to failures of self-monitoring

Over the last 2 decades, a large number of neurophysiological and neuroimaging studies of patients with schizophrenia have furnished in vivo evidence for dysconnectivity, ie, abnormal functional integration of brain processes. While the evidence for dysconnectivity in schizophrenia is strong, its etiology, pathophysiological mechanisms, and significance for clinical symptoms are unclear. First, dysconnectivity could result from aberrant wiring of connections during development, from aberrant synaptic plasticity, or from both. Second, it is not clear how schizophrenic symptoms can be understood mechanistically as a consequence of dysconnectivity. Third, if dysconnectivity is the primary pathophysiology, and not just an epiphenomenon, then it should provide a mechanistic explanation for known empirical facts about schizophrenia. This article addresses these 3 issues in the framework of the dysconnection hypothesis. This theory postulates that the core pathology in schizophrenia resides in aberrant N-methyl-D-aspartate receptor (NMDAR)–mediated synaptic plasticity due to abnormal regulation of NMDARs by neuromodulatory transmitters like dopamine, serotonin, or acetylcholine. We argue that this neurobiological mechanism can explain failures of self-monitoring, leading to a mechanistic explanation for first-rank symptoms as pathognomonic features of schizophrenia, and may provide a basis for future diagnostic classifications with physiologically defined patient subgroups. Finally, we test the explanatory power of our theory against a list of empirical facts about schizophrenia

Altered brainstem responses to modafinil in schizophrenia: implications for adjunctive treatment of cognition.

Candidate pro-cognitive drugs for schizophrenia targeting several neurochemical systems have consistently failed to demonstrate robust efficacy. It remains untested whether concurrent antipsychotic medications exert pharmacodynamic interactions that mitigate pro-cognitive action in patients. We used functional MRI (fMRI) in a randomized, double-blind, placebo-controlled within-subject crossover test of single-dose modafinil effects in 27 medicated schizophrenia patients, interrogating brainstem regions where catecholamine systems arise to innervate the cortex, to link cellular and systems-level models of cognitive control. Modafinil effects were evaluated both within this patient group and compared to a healthy subject group. Modafinil modulated activity in the locus coeruleus (LC) and ventral tegmental area (VTA) in the patient group. However, compared to the healthy comparison group, these effects were altered as a function of task demands: the control-independent drug effect on deactivation was relatively attenuated (shallower) in the LC and exaggerated (deeper) in the VTA; in contrast, again compared to the comparison group, the control-related drug effects on positive activation were attenuated in LC, VTA and the cortical cognitive control network. These altered effects in the LC and VTA were significantly and specifically associated with the degree of antagonism of alpha-2 adrenergic and dopamine-2 receptors, respectively, by concurrently prescribed antipsychotics. These sources of evidence suggest interacting effects on catecholamine neurons of chronic antipsychotic treatment, which respectively increase and decrease sustained neuronal activity in LC and VTA. This is the first direct evidence in a clinical population to suggest that antipsychotic medications alter catecholamine neuronal activity to mitigate pro-cognitive drug action on cortical circuits

Unraveling monoamine receptors involved in the action of typical and atypical antipsychotics on glutamatergic and serotonergic transmission in prefrontal cortex

El pdf del artículo es la versión post-print.The systemic administration of noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonists has been considered as a pharmacological model of schizophrenia. In the present work, we used in vivo microdialysis to examine: first, the effects of MK-801, on the efflux of glutamate and serotonin (5-HT) in the medial prefrontal cortex (mPFC) of the rat; second, whether the MK-801-induced changes in the cortical efflux of both transmitters could be blocked by atypical (clozapine and olanzapine) and classical (haloperidol and chlorpromazine) antipsychotic drugs given intra-mPFC; and third, the role of local blockade of dopamine D2/D3/D4, serotonin 5-HT2A and α1-adrenergic receptors as well as agonism at dopamine D1/D5 and 5-HT1A receptors in the mPFC on the increased efflux of glutamate and 5-HT elicited by MK-801. The four antipsychotic drugs blocked the MK-801-induced increase in glutamate, whereas only clozapine and olanzapine were able to block the increased efflux of 5-HT. Furthermore, M100907 (5-HT2A antagonist), BAY x 3702 (5-HT1A agonist) and prazosin (α1-adrenergic antagonist) blocked the MK-801-induced increase of 5-HT and glutamate in the mPFC. In contrast, raclopride (D2/D3 antagonist) and L-745,870 (D4 antagonist) were able to prevent the increased efflux of glutamate (but not that of 5-HT) elicited by MK-801. SKF-38393 (dopamine D1/D5 agonist) also prevented the MK-801-induced increase of glutamate in the mPFC, but the same effect on cortical 5-HT was reached only at the highest concentration tested. We suggest that the blockade of an exacerbated 5-HT release in the mPFC induced by NMDA antagonists can be a characteristic of atypical antipsychotic drugs. Moreover, we propose that D 2/D3/D4 receptor antagonists would act predominantly on a subpopulation of GABAergic interneurons of the mPFC, thus enhancing cortical inhibition, which would prevent an excessive glutamatergic transmission. Dopamine D1/D5 agonists would further stimulate GABA release from other subpopulation of interneurons controlling cortical output to the dorsal raphe nucleus. Atypical antipsychotic drugs might further act upon 5-HT2A, 5-HT1A and α1- adrenoceptors present in pyramidal cells (including those projecting to the dorsal raphe nucleus), which would directly inhibit an excessive excitability of these cells. © 2010 Bentham Science Publishers Ltd.This work was supported by the Spanish Ministry of Health (FIS Grant PI070111 to A. A.), the Spanish Ministry of Education and Science (Grant SAF 2007-62378 to F.A.), and the Generalitat de Catalunya (SGR2005/00758). X.L.- G. is the recipient of a predoctoral fellowship from the Consejo Superior de Investigaciones Cientificas (CSIC).Peer Reviewe

Could dopamine agonists aid in drug development for anorexia nervosa?

Anorexia nervosa is a severe psychiatric disorder most commonly starting during the teenage-years and associated with food refusal and low body weight. Typically there is a loss of menses, intense fear of gaining weight, and an often delusional quality of altered body perception. Anorexia nervosa is also associated with a pattern of high cognitive rigidity, which may contribute to treatment resistance and relapse. The complex interplay of state and trait biological, psychological, and social factors has complicated identifying neurobiological mechanisms that contribute to the illness. The dopamine D1 and D2 neurotransmitter receptors are involved in motivational aspects of food approach, fear extinction, and cognitive flexibility. They could therefore be important targets to improve core and associated behaviors in anorexia nervosa. Treatment with dopamine antagonists has shown little benefit, and it is possible that antagonists over time increase an already hypersensitive dopamine pathway activity in anorexia nervosa. On the contrary, application of dopamine receptor agonists could reduce circuit responsiveness, facilitate fear extinction, and improve cognitive flexibility in anorexia nervosa, as they may be particularly effective during underweight and low gonadal hormone states. This article provides evidence that the dopamine receptor system could be a key factor in the pathophysiology of anorexia nervosa and dopamine agonists could be helpful in reducing core symptoms of the disorder. This review is a theoretical approach that primarily focuses on dopamine receptor function as this system has been mechanistically better described than other neurotransmitters that are altered in anorexia nervosa. However, those proposed dopamine mechanisms in anorexia nervosa also warrant further study with respect to their interaction with other neurotransmitter systems, such as serotonin pathways

Dopamine neurotransmission and atypical antipsychotics in prefrontal cortex: a critical review

Schizophrenia has been historically characterized by the presence of positive symptomatology, however, decades of research highlight the importance of cognitive deficits in this disorder. At present, cognitive impairments remain one of the most important unmet therapeutic needs in schizophrenia. The prefrontal cortex (PFC) controls a large number of higher brain functions altered in a variety of psychiatric disorders, including schizophrenia. Histological studies indicate the presence of a large proportion of PFC neurons expressing monoaminergic receptors sensitive to the action of current atypical antipsychotics. Functional studies also show that these medications act at PFC level to increase dopamine neurotransmission in the mesocortical pathway. Here we focus on monoaminergic molecular targets that are actively being explored as potential therapeutic agents in the basic and clinical cognitive neuroscience research, to support the development of co-treatments used in conjunction with antipsychotic medications. These targets include dopamine and serotonin receptors in the prefrontal cortex, as well as elements of the noradrenergic system

Dopamine receptor signaling molecules are altered in elderly schizophrenic cortex

Alterations of molecules that mediate dopaminergic signal transduction have been found in schizophrenia, supporting the hypothesis of altered dopaminergic neurotransmission in this illness. To further explore this hypothesis, the authors measured transcript expression of three proteins involved in dopamine (DA) signaling in postmortem dorsolateral prefrontal and anterior cingulate cortex of elderly schizophrenic subjects and a comparison group. The transcript encoding calcyon, a protein that potentiates crosstalk between D1 DA receptors and G q/11 -linked receptors, was increased in schizophrenic prefrontal and cingulate cortex by 25%. Transcript levels of spinophilin, a protein enriched in dendritic spines that modulates excitatory neurotransmission, were increased 22% in dorsolateral prefrontal cortex but were unchanged in anterior cingulate cortex in schizophrenia. Levels of DARPP-32 mRNA, a downstream effector of dopaminergic neurotransmission, were similar in both groups for both cortical groups. These alterations in spinophilin and calcyon mRNA levels in schizophrenic prefrontal and cingulate cortex provide further evidence of altered dopaminergic neurotransmission in this illness. Synapse 60:271–279, 2006. © 2006 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55792/1/20292_ftp.pd

Positron emission tomography studies of the D₁ dopamine receptor in schizophrenia

This thesis is based on investigations of central D1-dopamine receptor (D1R) binding in vivo using positron emission tomography (PET). The aims were i) to examine the antipsychotic effect of a D1R antagonist in schizophrenia and ii) to test the dopamine hypothesis of schizophrenia by comparing D1R binding between patients and healthy subjects. SCH39166, is the first selective D1R antagonist that was developed both as a PET radioligand for D1R and as an antipsychotic drug. The D1-receptor occupancy of SCH39166 was determined with PET and [11C]SCH39166 in a dose-response fashion after single oral doses in healthy volunteers. The D1R occupancy in the putamen was about 70 % after 100 mg. The conclusion was that this dose would be adequate to investigate potential antipsychotic effect of a D1R antagonist in schizophrenia. SCH39166 was then given orally in escalating doses to 17 acutely ill drug free schizophrenic patients (DSM-IIIR) in an open 4-week study. The drug had to be withdrawn prematurely in ten patients due to deterioration or refusal to take SCH39166. In the nine patients participating for more than 2 weeks, the drug did not have an apparent antipsychotic effect. After withdrawal of SCH39166, the patients improved when treated with classical neuroleptics or clozapine. The result of the study does not support the prediction that selective D1R antagonism have antipsychotic effect in schizophrenia. To better inform statistical evaluation of any cross sectional evaluation of D1R binding a testretest PET study of the D1R selective radioligand [11C]SCH23390 was performed in fifteen healthy subjects to compare different methodologies of image analysis. The binding potential (BPND ) values were compared following manual and automated delineation of regions of interest (ROI’s) as well as with and without frame-by-frame realignment. No significant differences were observed for repeatability using automated and manual delineation methods whereas frame-by-frame realignment generated higher BPND values and improved repeatability. The results suggest that the choice of ROI delineation method is not an important condition for reliability, whereas thorough movement correction is of importance. A cohort of 18 first-episode neuroleptic-naïve patients with schizophrenia or schizophreniform psychosis and 17 healthy control subjects were examined with PET and [11C]SCH23390. The patients had a statistically significant lower D1R BPND in frontal cortex with a moderate effect size. This suggests a reduction of prefrontal D1R density in the pathophysiology of schizophrenia. Study II and IV provides indirect support for the hypothesis of frontal hypodopaminergia. The observation of a low D1R-binding in schizophrenia may explain why a D1R-antagonist (which further reduces the availability of D1R) has no obvious antipsychotic effect. The findings provide support for current developments of D1R-agonists for the treatment of schizophrenia

The Long-term Effects of Chronic Antipsychotic Drug Treatment in Juvenile Rats on Adult Behavioural Attributes, Dopamine and Serotonin Neurotransmitter Systems

The prescription and use of antipsychotic drugs (APDs) to treat various mental illnesses and behavioural disorders in children and adolescents has exponentially increased in recent years on a global scale. This significant increase in rates of use across both male and female sexes is despite a limited knowledge of what the long-term effects of early APD treatment are. With critical neurodevelopmental phases well-known to extend through this juvenile time period, there is the potential that exposure to the potent actions of APDs on numerous multifunctional neurotransmitter (NT) systems may alter brain topography on a long-term and/or permanent basis. Furthermore, alterations to NT systems including dopamine (DA) and serotonin (5-HT) have previously been heavily implicated in both the pathogenesis of mental illness, and known to play significant roles in behavioural attributes such as activity levels and anxiety. With the second generation APDs aripiprazole, olanzapine and risperidone three of the most commonly prescribed to the juvenile population, and the therapeutic effects of APDs predominantly based on a partial agonist and/or antagonist mechanism of action on DA and 5-HT receptors and hence modulation of NT signal, this thesis investigated the long-term effects of juvenile APD treatment during this critical neurodevelopmental time period on adult behavioural attributes, and subsequently uncovered potential longterm alterations to the DA and 5-HT NT system in the adult brain across both male and female cohorts

5-HT2A Receptors Modulate Dopamine D2-mediated Maternal Effects

Serotonin 5-HT2A receptors are expressed throughout the mesolimbic and mesocortical dopamine pathways, and manipulation of this receptor system has a profound impact on dopamine functions and dopamine-mediated behaviors. It is highly likely that 5-HT2A receptors may also modulate the D2-mediated maternal effects. The present study investigated this issue and also explored the possible behavioral mechanisms. We tested the effects of two D2 drugs (an agonist quinpirole: 0.5, 1.0 mg/kg, and a potent D2 antagonist haloperidol: 0.05, 0.10 mg/kg, sc) and their combinations with two 5-HT2A drugs (a selective 5-HT2A agonist TCB-2: 2.5 mg/kg, and 5-HT2A antagonist MDL100907, 1.0 mg/kg, sc) on maternal behavior in Sprague-Dawley postpartum females. Individually, TCB-2 (2.5 mg/kg, sc) and quinpirole (0.5 and 1.0 mg/kg, sc) reduced pup preference and disrupted home-cage maternal behavior. In contrast, haloperidol (0.10 mg/kg, sc) only disrupted home-cage maternal behavior, but did not suppress pup preference. MDL100907 (1.0 mg/kg, sc) by itself had no effect on either pup preference or maternal behavior. When administered in combination, pretreatment of TCB-2 did not alter quinpirole’s disruption of pup preference and home-cage maternal behavior (possibly due to the floor effect), however, it did enhance haloperidol’s disruption of pup retrieval in the home cage. MDL100907 had no effect both quinpirole’s and haloperidol’s disruption of pup preference and home-cage maternal behavior. Interestingly, haloperidol attenuated TCB-2’s disruptive effect on pup preference. These findings suggest that activation of 5-HT2A receptors tends to enhance D2-mediated maternal disruption, whereas blockade of 5-HT2A receptors is less effective. They also suggest that 5-HT2A receptors may have a direct effect on maternal behavior independent of their interaction with D2 receptors. The possible behavioral and neural mechanisms by which 5-HT2A-and D2-mediated maternal effects and their interaction are discussed