Conditioned emotional responding under diazepam: a psychophysiological study of state dependent learning

Using New Approaches in Neurobiology to Rethink Stress-Induced Amnesia

Purpose of Review

Psychological stress can impact memory systems in several different ways. In individuals with healthy defense and coping systems, stress results in the formation of negatively valenced memories whose ability to induce emotional and somatic distress subsides with time. Vulnerable individuals, however, go on to develop stress-related disorders such as post-traumatic stress disorder (PTSD) and suffer from significant memory abnormalities. Whether expressed as intrusive trauma memories, partial amnesia, or dissociative amnesia, such abnormalities are thought to be the core source of patients' symptoms, which are often debilitating and implicate an entire socio-cognitive-affective spectrum.

Recent Findings

With this in mind, and focusing on stress-responsive hippocampal microcircuits, this article highlights recent advances in the neurobiology of memory that allow us to (1) isolate and visualize memory circuits, (2) change their activity using genetic tools and state-dependent manipulations, and (3) directly examine their impact on socio-affective circuits and global network connectivity. By integrating these approaches, we are now in a position to address important questions that have troubled psychiatry for a long time-questions such as are traumatic memories special, and why are stress effects on memory diverse.

Summary

Furthering our fundamental understanding of memory in the framework of adaptive and maladaptive stress responses has the potential to boost the development of new treatments that can benefit patients suffering from psychological trauma.

Neurobiological correlates of state-dependent context fear

Retrieval of fear memories can be state-dependent, meaning that they are best retrieved if the brain states at encoding and retrieval are similar. Such states can be induced by activating extrasynaptic γ-aminobutyric acid type A receptors (GABA_AR) with the broad α-subunit activator gaboxadol. However, the circuit mechanisms and specific subunits underlying gaboxadol's effects are not well understood. Here we show that gaboxadol induces profound changes of local and network oscillatory activity, indicative of discoordinated hippocampal–cortical activity, that were accompanied by robust and long-lasting state-dependent conditioned fear. Episodic memories typically are hippocampus-dependent for a limited period after learning, but become cortex-dependent with the passage of time. In contrast, state-dependent memories continued to rely on hippocampal GABAergic mechanisms for memory retrieval. Pharmacological approaches with α-subunit-specific agonists targeting the hippocampus implicated the prototypic extrasynaptic subunits (α₄) as the mediator of state-dependent conditioned fear. Together, our findings suggest that continued dependence on hippocampal rather than cortical mechanisms could be an important feature of state-dependent memories that contributes to their conditional retrieval.

Tolerance, sensitization and dependence to diazepam in Balb/c mice exposed to a novel open space anxiety test

Balb/c mice were exposed to an elevated platform that is extended on two opposite sides with lowered steep slopes. They were tested for 12min per session in 6 successive days. They received i.p. administration of either saline or one dose of diazepam (DZP 0.5, 1, 3mg/kg) in sessions 1-3, and saline in sessions 4 and 5. All groups of mice received a single dose of DZP (1mg/kg) in session 6. DZP produced inverted U-shaped dose-responses on the number of entries into different areas of the apparatus, with a peak in mean response at 1mg/kg whereas its effect on the duration of entries was mostly comparable between the 3 doses. It increased the number of crossings on the surface of the platform and facilitated entries onto the slopes. DZP-treated mice crossed frequently onto and spent longer time on the slopes in sessions 1-3 whereas saline-treated mice remained on the platform in sessions 1-6. Withdrawal of DZP in sessions 4-5 increased the latency of first entry and decreased the number and duration of entries onto the slopes which was reversed with the administration of 1mg/kg of DZP in the next session. This ON-OFF the drug may be due to the half-life of DZP which is very short in mice and rats ( approximately 0.88h). It also indicates that DZP-treated mice did not benefit from previous experience of entries onto the slopes which suggests a possible "state-dependent" effect. Administration of DZP after repeated exposures to the test did not facilitate entries onto the slopes but instead increased significantly the number of crossings on the surface of the platform; this increase was much higher than that observed in mice initially treated with DZP and exposed to the test. There is no evidence of habituation in saline-treated mice: the number of crossings on the platform was comparable between the first 5 sessions of the test. These results demonstrate that repeated exposures to the same anxiogenic environment resulted in avoidance responses developing tolerance and approach responses developing sensitization. They suggest that tolerance and sensitization are two opposite sides of the habituation process to the same stimulus and may account for the maintained state of anxiety.

Drugs, sweat, and fears: a comparison of the effects of diazepam and methylphenidate on fear conditioning

RATIONALE

Classical conditioning of a fear response involves the formation of an association between a stimulus and an emotional response and can be seen as a basic form of emotional memory. While both benzodiazepines and stimulant drugs may influence the formation of episodic memories for emotional events, their effects on fear conditioning are less clear.

OBJECTIVES

This study compared the effects of diazepam with methylphenidate on fear conditioning.

MATERIALS AND METHODS

In a single-session between groups design with three conditions [placebo, diazepam (10 mg), and methylphenidate (40 mg)], classical conditioning of a skin conductance response to a visual stimulus previously paired with a 100-db white noise was tested in 45 healthy volunteers.

RESULTS

Diazepam blocked fear conditioning, despite responses to the unconditioned aversive stimulus and neutral control stimulus being unimpaired. Conditioning remained intact after methylphenidate. Conditioned responses were not extinguished completely by the end of the experiment, and it was not possible to draw conclusions about the effects of the drugs on extinction.

CONCLUSIONS

Although diazepam has well-documented amnesic effects, it has not been found to affect implicit forms of memory like perceptual and conceptual priming. As the present study found impaired fear conditioning after diazepam, it adds weight to recent findings that emotional memories are disproportionately impaired by the benzodiazepines.

Pharmacological manipulations of the extinction process of fear-induced ultrasonic vocalization in rats

The effects of pharmacological manipulation on the extinction process of fear-induced ultrasonic vocalizations (USVs), which are considered distress calls related to anxiety, were investigated. Male Wistar rats were conditioned to emit USVs by being given repeated electrical foot-shocks while in a chamber. After 10 sessions of conditioning, the animals started to emit USVs upon mere exposure to the shock chamber without being shocked. Using these animals, the extinction process of the USVs was examined. With repeated exposure to the chamber without shocks, the USVs first increased and then gradually decreased. i.e., the extinction burst was observed. Daily intraperitoneal injections of a benzodiazepine-GABA receptor agonist diazepam (DZP; 1.0 mg/kg) or a tricyclic antidepressant clomipramine (CLM; 20 mg/kg) inhibited this extinction burst. Moreover, CLM, but not DZP, shortened the period required for extinction as compared with the vehicle-treated animals. Following the extinction phase, the emission of USVs was enhanced by the cessation of both drug treatments. These results suggest that CLM would be useful for reducing anxiety-related behaviors in the extinction process, as long as withdrawal symptoms after long-term drug treatments are taken into consideration.

Comparison of buspirone with diazepam and fluvoxamine on aversive classical conditioning in humans

The effects of buspirone, fluvoxamine and diazepam were investigated, using healthy volunteers, in an aversive conditioning paradigm, a putative model for conditioned anxiety. The main prediction was that buspirone, an anxiolytic agent which reduces activity in serotonin (5-hydroxytryptophan, 5-HT) neurones, would attenuate aversively conditioned skin conductance responses. Skin conductance responses were recorded to 10 neutral tones (habituation phase). Tone 11 was immediately followed by a 1-s 90-dB aversive white noise (unconditioned stimulus). The conditioning trial reinstated responding to a second presentation of the tones (extinction phase). Skin conductance response amplitude, inter-response level and spontaneous fluctuations were recorded. There were five treatment groups comprising five men and five women. One control group took placebo, another control group received nothing; there was no effect of placebo on any measure. Diazepam (2 mg, p.o.), a positive comparator, markedly reduced the amplitude of skin conductance responses at all phases of the experiment, but only in women. Buspirone (5 mg, p.o.) had the predicted effect of accelerating extinction but also of unexpectedly accelerated habituation of skin conductance responses. There was a trend to reduce spontaneous fluctuations and no effect on skin conductance level. The effects of buspirone were thus specific to responses to stimuli. Fluvoxamine (25 mg, p.o.) had similar effects to buspirone and diazepam in women. An action common to buspirone, fluvoxamine and diazepam, which may account for their shared effect on conditioned autonomic responses, is the suppression of neural activity in the dorsal raphe nucleus. It is argued that enhanced habituation must involve a different mechanism, such as enhanced 5-HT1A function in the terminal fields of the median raphe nucleus.

Interaction between benzodiazepine and GABA-A receptors in state-dependent learning

State-dependent learning (SDL) induced by benzodiazepine (BDZ) and GABA-A agonists was investigated in the step-through passive avoidance task in rats. Pre-training injection of diazepam or muscimol dose-dependently reduced step-through latency in the test session conducted 24 hr after the training. Injection of either drug before both the training and test sessions, however, failed to reduce the latency. The results show that passive avoidance failures induced by pre-training injections of diazepam and muscimol are due to SDL. In contrast to diazepam and muscimol, baclofen induced no SDL. Diazepam and muscimol were found to substitute for each other in producing SDL. The failure of learning performance in SDL (dissociation in SDL) induced by diazepam was blocked by flumazenil and picrotoxin but not by bicuculline injected before the training session, whereas dissociation in SDL induced by muscimol was blocked by flumazenil, bicuculline and picrotoxin. On the other hand, the success of learning performance in SDL (non-dissociation in SDL) induced by diazepam was blocked by flumazenil, bicuculline and picrotoxin injected before the test session, whereas non-dissociation in SDL induced by muscimol was blocked by bicuculline and picrotoxin but not by flumazenil. These results demonstrate that 1) BDZ and GABA-A agonists produce a common drug state, but, 2) roles of each receptor in SDL might be different, i.e., BDZ receptors for dissociation in SDL and GABA-A receptors for non-dissociation in SDL, and 3) chloride ion channels are essential for the induction of SDL by BDZ and GABA-A agonists.

Treatment related psychological distress during adjuvant chemotherapy as a conditioned response

Patients receiving cycles of cytotoxic chemotherapy for cancer often experience noxious side effects following treatments and may develop classically conditioned side effects, such as anticipatory nausea and vomiting (ANV) during the course of repeated infusions. The present study explored the possibility that classical conditioning processes may also contribute to treatment related psychological distress. Sixty-six patients, scheduled for adjuvant chemotherapy for breast cancer (stages I, II, IIIa), agreed to participate. Patients were assessed in the clinic on the first day of every chemotherapy cycle and in their homes three to five days before their final cycle. Patients experienced considerable psychological distress during the course of chemotherapy, and particularly before the first infusion. Prior to the last cycle of chemotherapy, psychological distress was significantly higher in the clinic environment than in patients' homes. Consistent with classical conditioning, psychological distress did not escalate over the days before treatment, but rather increased abruptly when patients returned to the clinic. The results of the present study indicate that several factors are involved in patients' anticipatory psychological distress and highlight the potential contribution that conditioning processes may make to patients' emotional distress in the clinic environment.

Effects of ritanserin on aversive classical conditioning in humans

According to one formulation of the behavioural functions of 5HT, aversive conditioned stimuli mediate their behavioural and emotional effects through activation of 5HT projections from dorsal raphe nucleus to receptors of the 5HT2 family in amygdala and elsewhere. To test this theory in humans, groups of ten normal volunteers received placebo, the 5HT2 lc antagonist ritanserin (10 mg PO) and no pill. Ritanserin had no effect on skin conductance level, variability (spontaneous fluctuations) or habituation to a sequence of ten neutral tones. After a conditioning trial in which tone 11 was followed by an aversive white noise, skin conductance responses to a further ten tones were enhanced. This effect was abolished by ritanserin. The results indicate a selective involvement of 5HT2/lc receptors in modulating aversively conditioned skin conductance responses.