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Amarasekera R, Wood E. Worsening stimulant use disorder outcomes coinciding with off-label antipsychotic prescribing: a commonly unrecognised side effect? BMJ Case Rep 2023; 16:e255129. [PMID: 37907321 PMCID: PMC10618975 DOI: 10.1136/bcr-2023-255129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/02/2023] Open
Abstract
Antipsychotic medications exert their effects via dopamine antagonism and are widely used off-label among persons with substance use disorders (SUD). While dopamine antagonists are recognised to stimulate food craving and weight gain, outside of possibly increasing nicotine craving and use, their impact on other SUD outcomes is poorly recognised. In this context, research has demonstrated that antipsychotic therapy can produce 'supersensitivity' to dopamine, enhancing the motivational effects of addictive drugs. Worsened drug craving and higher rates of substance use have also been observed in double-blind placebo-controlled trials. Nevertheless, widespread off-label antipsychotic prescribing among persons with SUD implies that the risks of worsening SUD outcomes are overall poorly recognised in both primary care and among specialists. We present a typical case of worsening stimulant use disorder in a patient prescribed antipsychotic medication for low mood and insomnia, highlighting that this is likely a widely under-recognised adverse effect of off-label antipsychotic therapy.
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Affiliation(s)
- Ruvini Amarasekera
- BC Centre on Substance Use, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Evan Wood
- BC Centre on Substance Use, The University of British Columbia, Vancouver, British Columbia, Canada
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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2
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Servonnet A, Rompré PP, Samaha AN. Optogenetic activation of basolateral amygdala-to-nucleus accumbens core neurons promotes Pavlovian approach responses but not instrumental pursuit of reward cues. Behav Brain Res 2023; 440:114254. [PMID: 36516942 DOI: 10.1016/j.bbr.2022.114254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Reward-associated conditioned stimuli (CSs) can acquire predictive value, evoking conditioned approach behaviours that prepare animals to engage with forthcoming rewards. Such CSs can also acquire conditioned reinforcing value, becoming attractive and pursued. Through their conditioned effects, CSs can promote adaptive (e.g., locating food) but also maladaptive behaviours (e.g., drug use). Basolateral amygdala neurons projecting to the nucleus accumbens core (BLA→NAc core neurons) mediate the response to appetitive CSs, but the extent to which this involves effects on the predictive and/or conditioned reinforcing properties of CSs is unclear. Thus, we examined the effects of optogenetic stimulation of BLA→NAc core neurons on i) CS-triggered approach to the site of reward delivery, a Pavlovian conditioned approach response and ii) the instrumental pursuit of a CS, a measure of conditioned reinforcement. Water-restricted, adult male rats learned that a light-tone compound cue (the CS) predicts water delivery into a receptacle. Pairing optogenetic stimulation of BLA→NAc core neurons with CS presentation potentiated CS-triggered water receptacle visits. This suggests that activity in BLA→NAc core neurons promotes Pavlovian goal-approach behaviour. Next, rats could lever press for CS presentations, without water delivery. Optogenetic stimulation of BLA→NAc core neurons either during instrumental test sessions or during prior CS-water conditioning did not influence lever responding for the CS. This suggests that activity in BLA→NAc core neurons does not influence the instrumental pursuit of a water-paired CS. We conclude that activation of BLA→NAc core neurons promotes cue-induced control over behaviour by increasing conditioned goal-approach responses, without affecting the operant pursuit of reward cues.
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Affiliation(s)
| | | | - Anne-Noël Samaha
- Department of Pharmacology and Physiology (Faculty of Medicine), Canada; Groupe de recherche sur le système nerveux central, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit Boulevard, Montreal H3T 1J4, Quebec, Canada.
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3
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Servonnet A, Allain F, Gravel-Chouinard A, Hernandez G, Bourdeau Caporuscio C, Legrix M, Lévesque D, Rompré PP, Samaha AN. Dopaminergic mechanisms underlying the expression of antipsychotic-induced dopamine supersensitivity in rats. Neuropharmacology 2021; 197:108747. [PMID: 34364897 DOI: 10.1016/j.neuropharm.2021.108747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Antipsychotic treatment can produce a dopamine-supersensitive state, potentiating the response to dopamine receptor stimulation. In both schizophrenia patients and rats, this is linked to tolerance to ongoing antipsychotic treatment. In rodents, dopamine supersensitivity is often confirmed by an exaggerated psychomotor response to d-amphetamine after discontinuation of antipsychotic exposure. Here we examined in rats the dopaminergic mechanisms mediating this enhanced behavioural response, as this could uncover pathophysiological processes underlying the expression of antipsychotic-evoked dopamine supersensitivity. Rats received 0.5 mg/kg/day haloperidol via osmotic minipump for 2 weeks, before treatment was discontinued. After cessation of antipsychotic treatment, rats showed a supersensitive psychomotor response to the D2 agonist quinpirole, but not to the D1 partial agonist SKF38393 or the dopamine reuptake blocker GBR12783. Furthermore, acute D1 receptor blockade (using SCH39166) decreased the exaggerated psychomotor response to d-amphetamine in haloperidol-pretreated rats, whereas acute D2 receptor blockade (using sulpiride) enhanced it. Thus, after discontinuation of antipsychotic treatment, D1- and D2-mediated transmission differentially modulate the expression of a supersensitive response to d-amphetamine. This supersensitive behavioural response was accompanied by enhanced GSK3β activity and suppressed ERK1/2 activity in the nucleus accumbens (but not caudate-putamen), suggesting increased mesolimbic D2 transmission. Finally, after discontinuing haloperidol treatment, neither increasing ventral midbrain dopamine impulse flow nor infusing d-amphetamine into the cerebral ventricles triggered the expression of already established dopamine supersensitivity, suggesting that peripheral effects are required. Thus, while dopamine receptor-mediated signalling regulates the expression of antipsychotic-evoked dopamine supersensitivity, a simple increase in central dopamine neurotransmission is insufficient to trigger this supersensitivity.
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Affiliation(s)
- Alice Servonnet
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada.
| | - Florence Allain
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Alice Gravel-Chouinard
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Giovanni Hernandez
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Casey Bourdeau Caporuscio
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Mathilde Legrix
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Daniel Lévesque
- Faculty of Pharmacy, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Pierre-Paul Rompré
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada
| | - Anne-Noël Samaha
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montreal, H3T 1J4, Quebec, Canada; Groupe de recherche sur le système nerveux central, Faculty of Medicine, Université de Montréal, 2900 Edouard-Montpetit boulevard, Montrea, H3T 1J4, Quebec, Canada.
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4
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Effects of dopamine receptor antagonism and amphetamine-induced psychomotor sensitization on sign- and goal-tracking after extended training. Behav Brain Res 2021; 407:113238. [PMID: 33744334 DOI: 10.1016/j.bbr.2021.113238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/20/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
The dopamine system is important for incentive salience attribution, where motivational value is assigned to conditioned cues that predict appetitive reinforcers. However, the role of dopamine in this process may change with extended training. We tested the effects of dopamine D1-like and D2-like receptor antagonism on the expression of sign-tracking and goal-tracking conditioned responses following extended Pavlovian conditioned approach (PCA) training. We also tested if amphetamine-induced psychomotor sensitization accelerates the enhanced acquisition of sign-tracking that is observed with extended training. In experiment 1, 24 male Long-Evans rats received 20 PCA sessions in which one lever (CS+, 10 s) predicted 0.2 ml sucrose (10 %, w/v) delivery and the other lever (CS-) did not. SCH-23390 (D1-like antagonist) or eticlopride (D2-like antagonist) were administered before non-reinforced behavioural tests at doses of 0, 0.01, and 0.1 mg/kg (s.c.). In experiment 2, rats received vehicle or 2 mg/kg amphetamine (i.p.) for 7 days (n = 12/group). Ten days later, they received 16 PCA training sessions. Both doses of SCH-23390 reduced sign- and goal-tracking, but also reduced locomotor behaviour. A low dose of eticlopride (0.01 mg/kg) selectively reduced goal-tracking, without affecting sign-tracking or locomotor behaviour. Amphetamine produced psychomotor sensitization, and this did not affect the acquisition of sign- or goal-tracking. Following extended PCA training, dopamine D2-like receptor activity is required for the expression of goal-tracking but not sign-tracking. Psychomotor sensitization to amphetamine did not impact incentive salience attribution; however, more selective manipulations of the dopamine system may be needed.
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5
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Servonnet A, Uchida H, Samaha AN. Continuous versus extended antipsychotic dosing in schizophrenia: Less is more. Behav Brain Res 2020; 401:113076. [PMID: 33345826 DOI: 10.1016/j.bbr.2020.113076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022]
Abstract
Antipsychotic drugs temper psychotic symptoms by interacting with dopamine D2 receptors to reduce dopamine neurotransmission. Currently, the standard of care involves antipsychotic treatment protocols that achieve steady-state levels of medication. Maintaining patients on continuous treatment is thought to be necessary to keep them stabilised. However, continuous antipsychotic exposure increases the risk of adverse effects over time. These effects include metabolic and cardiovascular disorders, extrapyramidal complications, and dopamine receptor supersensitivity, the latter of which could potentially promote both treatment tolerance and psychosis relapse. In the present review, we describe evidence showing that continuous exposure to antipsychotic drugs can not only worsen long-term outcome, but-past acute phase treatment-it is also unnecessary to effectively manage schizophrenia symptoms. We also describe evidence that regular but extended dosing, allowing predictable periods of lower antipsychotic levels/D2 occupancy, is both safe and effective in patients, and it greatly reduces drug exposure overall. Studies in laboratory animals show that compared to continuous antipsychotic exposure, regular but extended dosing actually has superior antipsychotic-like efficacy, and it also substantially reduces the likelihood of both motor side effects and dopamine receptor supersensitivity. We propose that regular, but extended dosing should be considered in the long-term treatment of people with schizophrenia, because the available evidence suggests it can be just as effective as continuous treatment, while decreasing overall drug exposure and potentially reducing harmful side effects.
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Affiliation(s)
- Alice Servonnet
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Anne-Noël Samaha
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Groupe de recherche sur le système nerveux central, Faculty of Medicine, Université de Montréal, Montreal, Canada.
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6
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Bardgett ME, Downnen T, Crane C, Baltes Thompson EC, Muncie B, Steffen SA, Yates JR, Pauly JR. Chronic risperidone administration leads to greater amphetamine-induced conditioned place preference. Neuropharmacology 2020; 179:108276. [PMID: 32814089 DOI: 10.1016/j.neuropharm.2020.108276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022]
Abstract
Risperidone is an atypical antipsychotic drug used increasingly in children to manage symptoms of ADHD and conduct disorder. In rats, developmental risperidone administration is accompanied by increased locomotor activity during adulthood, as well as heightened sensitivity to the locomotor stimulating effects of amphetamine. This study compared sensitivity to the rewarding effects of amphetamine, as measured by conditioned place preference (CPP), between groups of rats administered chronic risperidone (3.0 mg/kg, s.c.) during development (postnatal days 14-42) or adulthood (postnatal days 77-105). Locomotor activity in a novel test cage and amphetamine-induced CPP were measured beginning three and four weeks, respectively, after the final risperidone injection. Female rats administered risperidone early in life were more active than any other group tested. Previous risperidone administration enhanced amphetamine CPP regardless of sex, and this effect appeared more prominent in the developmentally treated group. The density of forebrain dopamine transporters, a primary target of amphetamine, was also quantified in rats administered risperidone early in life and found to be reduced in the medial anterior, posterior, and ventral caudate nucleus. These results suggest that chronic risperidone treatment modifies later locomotor activity and sensitivity to the reinforcing effects of amphetamine, perhaps via a mechanism related to decreased forebrain dopamine transporter density.
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Affiliation(s)
- Mark E Bardgett
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA.
| | - Tyler Downnen
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA
| | - Casey Crane
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA
| | - Emily C Baltes Thompson
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA
| | - Brittany Muncie
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA
| | - Sara A Steffen
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA
| | - Justin R Yates
- Department of Psychological Science, Northern Kentucky University, Highland Heights, 41076, KY, USA
| | - James R Pauly
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, 40508, USA
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7
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Minogianis EA, Samaha AN. Taking Rapid and Intermittent Cocaine Infusions Enhances Both Incentive Motivation for the Drug and Cocaine-induced Gene Regulation in Corticostriatal Regions. Neuroscience 2020; 442:314-328. [PMID: 32682656 DOI: 10.1016/j.neuroscience.2020.05.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022]
Abstract
A goal in addiction research is to distinguish forms of neuroplasticity that are involved in the transition to addiction from those involved in mere drug taking. Animal models of drug self-administration are essential in this context. Here, we compared in male rats two cocaine self-administration procedures that differ in the extent to which they evoke addiction-like behaviours. We measured both incentive motivation for cocaine using progressive ratio procedures, and cocaine-induced c-fos mRNA expression, a marker of neuronal activity. Rats self-administered intravenous cocaine (0.25 mg/kg/infusion) for seven daily 6-hour sessions. One group had intermittent access (IntA; 6 minutes ON, 26 min OFF × 12) to rapid infusions (delivered over 5 s). This models the temporal kinetics of human cocaine use and produces robust addiction-like behaviour. The other group had Long access (LgA) to slower infusions (90 s). This produces high levels of intake without promoting robust addiction-like behaviour. LgA-90 s rats took twice as much cocaine as IntA-5 s rats did, but IntA-5 s rats showed greater incentive motivation for the drug. Following a final self-administration session, we quantified c-fos mRNA expression in corticostriatal regions. Compared to LgA-90 s rats, IntA-5 s rats had more cocaine-induced c-fos mRNA in the orbitofrontal and prelimbic cortices and the caudate-putamen. Thus, a cocaine self-administration procedure (intermittent intake of rapid infusions) that promotes increased incentive motivation for the drug also enhances cocaine-induced gene regulation in corticostriatal regions. This suggests that increased drug-induced recruitment of these regions could contribute to the neural and behavioural plasticity underlying the transition to addiction.
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Affiliation(s)
- Ellie-Anna Minogianis
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Canada
| | - Anne-Noël Samaha
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Canada; Groupe de recherche sur le système nerveux central (GRSNC), Faculty of Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec H3T 1J4, Canada.
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8
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Neurotensin in reward processes. Neuropharmacology 2020; 167:108005. [PMID: 32057800 DOI: 10.1016/j.neuropharm.2020.108005] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
Neurotensin (NTS) is a neuropeptide neurotransmitter expressed in the central and peripheral nervous systems. Many studies over the years have revealed a number of roles for this neuropeptide in body temperature regulation, feeding, analgesia, ethanol sensitivity, psychosis, substance use, and pain. This review provides a general survey of the role of neurotensin with a focus on modalities that we believe to be particularly relevant to the study of reward. We focus on NTS signaling in the ventral tegmental area, nucleus accumbens, lateral hypothalamus, bed nucleus of the stria terminalis, and central amygdala. Studies on the role of NTS outside of the ventral tegmental area are still in their relative infancy, yet they reveal a complex role for neurotensinergic signaling in reward-related behaviors that merits further study. This article is part of the special issue on 'Neuropeptides'.
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9
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Antipsychotic-evoked dopamine supersensitivity. Neuropharmacology 2020; 163:107630. [DOI: 10.1016/j.neuropharm.2019.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
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10
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Amato D, Kruyer A, Samaha AN, Heinz A. Hypofunctional Dopamine Uptake and Antipsychotic Treatment-Resistant Schizophrenia. Front Psychiatry 2019; 10:314. [PMID: 31214054 PMCID: PMC6557273 DOI: 10.3389/fpsyt.2019.00314] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/23/2019] [Indexed: 01/07/2023] Open
Abstract
Antipsychotic treatment resistance in schizophrenia remains a major issue in psychiatry. Nearly 30% of patients with schizophrenia do not respond to antipsychotic treatment, yet the underlying neurobiological causes are unknown. All effective antipsychotic medications are thought to achieve their efficacy by targeting the dopaminergic system. Here we review early literature describing the fundamental mechanisms of antipsychotic drug efficacy, highlighting mechanistic concepts that have persisted over time. We then reconsider the original framework for understanding antipsychotic efficacy in light of recent advances in our scientific understanding of the dopaminergic effects of antipsychotics. Based on these new insights, we describe a role for the dopamine transporter in the genesis of both antipsychotic therapeutic response and primary resistance. We believe that this discussion will help delineate the dopaminergic nature of antipsychotic treatment-resistant schizophrenia.
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Affiliation(s)
- Davide Amato
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Anna Kruyer
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Anne-Noël Samaha
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Andreas Heinz
- Department of Psychiatry, Charité University Medicine Berlin, Campus Charité Mitte, Berlin, Germany
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Li BT, Moukaddam N, Parks KDL, Shah AA. When Treatment Turns to Addiction: Emerging Issues in Over-the-Counter and Prescription Drug Abuse. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180719-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Chouinard G, Samaha AN, Chouinard VA, Peretti CS, Kanahara N, Takase M, Iyo M. Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018. [PMID: 28647739 DOI: 10.1159/000477313] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The first-line treatment for psychotic disorders remains antipsychotic drugs with receptor antagonist properties at D2-like dopamine receptors. However, long-term administration of antipsychotics can upregulate D2 receptors and produce receptor supersensitivity manifested by behavioral supersensitivity to dopamine stimulation in animals, and movement disorders and supersensitivity psychosis (SP) in patients. Antipsychotic-induced SP was first described as the emergence of psychotic symptoms with tardive dyskinesia (TD) and a fall in prolactin levels following drug discontinuation. In the era of first-generation antipsychotics, 4 clinical features characterized drug-induced SP: rapid relapse after drug discontinuation/dose reduction/switch of antipsychotics, tolerance to previously observed therapeutic effects, co-occurring TD, and psychotic exacerbation by life stressors. We review 3 recent studies on the prevalence rates of SP, and the link to treatment resistance and psychotic relapse in the era of second-generation antipsychotics (risperidone, paliperidone, perospirone, and long-acting injectable risperidone, olanzapine, quetiapine, and aripiprazole). These studies show that the prevalence rates of SP remain high in schizophrenia (30%) and higher (70%) in treatment-resistant schizophrenia. We then present neurobehavioral findings on antipsychotic-induced supersensitivity to dopamine from animal studies. Next, we propose criteria for SP, which describe psychotic symptoms and co-occurring movement disorders more precisely. Detection of mild/borderline drug-induced movement disorders permits early recognition of overblockade of D2 receptors, responsible for SP and TD. Finally, we describe 3 antipsychotic withdrawal syndromes, similar to those seen with other CNS drugs, and we propose approaches to treat, potentially prevent, or temporarily manage SP.
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Affiliation(s)
- Guy Chouinard
- Clinical Pharmacology and Toxicology Program, McGill University Montreal, Montreal, QC, Canada
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13
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Guma E, Rocchetti J, Devenyi GA, Tanti A, Mathieu A, Lerch JP, Elgbeili G, Courcot B, Mechawar N, Chakravarty MM, Giros B. Regional brain volume changes following chronic antipsychotic administration are mediated by the dopamine D2 receptor. Neuroimage 2018; 176:226-238. [PMID: 29704613 DOI: 10.1016/j.neuroimage.2018.04.054] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuroanatomical alterations are well established in patients suffering from schizophrenia, however the extent to which these changes are attributable to illness, antipsychotic drugs (APDs), or their interaction is unclear. APDs have been extremely effective for treatment of positive symptoms in major psychotic disorders. Their therapeutic effects are mediated, in part, through blockade of D2-like dopamine (DA) receptors, i.e. the D2, D3 and D4 dopamine receptors. Furthermore, the dependency of neuroanatomical change on DA system function and D2-like receptors has yet to be explored. METHODS We undertook a preclinical longitudinal study to examine the effects of typical (haloperidol (HAL)) and atypical (clozapine (CLZ)) APDs in wild type (WT) and dopamine D2 knockout (D2KO) mice over 9-weeks using structural magnetic resonance imaging (MRI). RESULTS Chronic typical APD administration in WT mice was associated with reductions in total brain (p = 0.009) and prelimbic area (PL) (p = 0.02) volumes following 9-weeks, and an increase in striatal volume (p = 0.04) after six weeks. These APD-induced changes were not present in D2KOs, where, at baseline, we observed significantly smaller overall brain volume (p < 0.01), thinner cortices (q < 0.05), and enlarged striata (q < 0.05). Stereological assessment revealed increased glial density in PL area of HAL treated wild types. Interestingly, in WT and D2KO mice, chronic CLZ administration caused more limited changes in brain structure. CONCLUSIONS Our results present evidence for the role of D2 DA receptors in structural alterations induced by the administration of the typical APD HAL and that chronic administration of CLZ has a limited influence on brain structure.
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Affiliation(s)
- Elisa Guma
- Department of Psychiatry & Integrated Program in Neuroscience, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4 Canada; Cerebral Imaging Center, Douglas Mental Health University Institute, Verdun, Quebec, H4H 1R3, Canada
| | - Jill Rocchetti
- Department of Psychiatry & Integrated Program in Neuroscience, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4 Canada
| | - Gabriel A Devenyi
- Cerebral Imaging Center, Douglas Mental Health University Institute, Verdun, Quebec, H4H 1R3, Canada
| | - Arnaud Tanti
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Axel Mathieu
- Cerebral Imaging Center, Douglas Mental Health University Institute, Verdun, Quebec, H4H 1R3, Canada
| | - Jason P Lerch
- Mouse Imaging Center - Hospital for Sick Children, Department of Medical Biophysics -University of Toronto, Toronto, Ontario, M5T 3H7, Canada
| | - Guillaume Elgbeili
- Department of Psychiatry & Integrated Program in Neuroscience, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4 Canada
| | - Blandine Courcot
- Cerebral Imaging Center, Douglas Mental Health University Institute, Verdun, Quebec, H4H 1R3, Canada
| | - Naguib Mechawar
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - M Mallar Chakravarty
- Department of Psychiatry & Integrated Program in Neuroscience, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4 Canada; Cerebral Imaging Center, Douglas Mental Health University Institute, Verdun, Quebec, H4H 1R3, Canada; Department of Biological and Biomedical Engineering, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4, Canada
| | - Bruno Giros
- Department of Psychiatry & Integrated Program in Neuroscience, McGill University, 845 Sherbrooke St W, Montreal, QC, H3A 0G4 Canada; Sorbonne University, Neuroscience Paris Seine, CNRS UMR 8246, INSERM U 1130, UPMC Univ Paris 06, UM119, 75005, Paris, France.
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Abstract
Early-life administration of risperidone, the most widely used antipsychotic drug in children, leads to persistently elevated locomotor activity in adult rats. This study determined whether and when elevated locomotor activity emerges during developmental risperidone administration. Developing and adult rats were administered daily injections of risperidone (1.0 and 3.0 mg/kg) or vehicle for 4 weeks beginning at postnatal days 14 and 74, respectively. Starting with the first injection and every 7 days thereafter, locomotor activity was measured immediately after the injection and 20 min before the next day's injection. Activity was also recorded 1 week after the final injection. Risperidone markedly decreased locomotor activity in developing and adult rats immediately after injection. Within 24 h after their first injection, adult rats administered risperidone showed greater activity levels. In contrast, developing rats did not show compensatory hyperactivity until the beginning of the fourth week of risperidone administration. One week after the final risperidone injection, there was no evidence of hyperactivity in the adult rats maintained on risperidone, but developing rats administered risperidone, especially females, showed greater activity levels relative to vehicle-administered controls. In comparison with adult rats, the emergence of compensatory hyperactivity during long-term antipsychotic drug administration is delayed in developing rats, but persists after treatment cessation.
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Servonnet A, Minogianis EA, Bouchard C, Bédard AM, Lévesque D, Rompré PP, Samaha AN. Neurotensin in the nucleus accumbens reverses dopamine supersensitivity evoked by antipsychotic treatment. Neuropharmacology 2017; 123:10-21. [DOI: 10.1016/j.neuropharm.2017.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/09/2017] [Accepted: 05/13/2017] [Indexed: 12/20/2022]
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16
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Liu S, Wang Z, Li Y, Sun X, Ge F, Yang M, Wang X, Wang N, Wang J, Cui C. CRFR1 in the ventromedial caudate putamen modulates acute stress-enhanced expression of cocaine locomotor sensitization. Neuropharmacology 2017; 121:60-68. [DOI: 10.1016/j.neuropharm.2017.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 12/30/2022]
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17
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El Hage C, Bédard AM, Samaha AN. Antipsychotic treatment leading to dopamine supersensitivity persistently alters nucleus accumbens function. Neuropharmacology 2015; 99:715-25. [DOI: 10.1016/j.neuropharm.2015.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
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Charron A, Hage CE, Servonnet A, Samaha AN. 5-HT2 receptors modulate the expression of antipsychotic-induced dopamine supersensitivity. Eur Neuropsychopharmacol 2015; 25:2381-93. [PMID: 26508706 DOI: 10.1016/j.euroneuro.2015.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/20/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Antipsychotic treatment can produce supersensitivity to dopamine receptor stimulation. This compromises the efficacy of ongoing treatment and increases the risk of relapse to psychosis upon treatment cessation. Serotonin 5-HT2 receptors modulate dopamine function and thereby influence dopamine-dependent responses. Here we evaluated the hypothesis that 5-HT2 receptors modulate the behavioural expression of antipsychotic-induced dopamine supersensitivity. To this end, we first treated rats with the antipsychotic haloperidol using a clinically relevant treatment regimen. We then assessed the effects of a 5-HT2 receptor antagonist (ritanserin; 0.01 and 0.1mg/kg) and of a 5-HT2A receptor antagonist (MDL100,907; 0.025-0.1mg/kg) on amphetamine-induced psychomotor activity. Antipsychotic-treated rats showed increased amphetamine-induced locomotion relative to antipsychotic-naïve rats, indicating a dopamine supersensitive state. At the highest dose tested (0.1mg/kg for both antagonists), both ritanserin and MDL100,907 suppressed amphetamine-induced locomotion in antipsychotic-treated rats, while having no effect on this behaviour in control rats. In parallel, antipsychotic treatment decreased 5-HT2A receptor density in the prelimbic cortex and nucleus accumbens core and increased 5-HT2A receptor density in the caudate-putamen. Thus, activation of either 5-HT2 receptors or of 5-HT2A receptors selectively is required for the full expression of antipsychotic-induced dopamine supersensitivity. In addition, antipsychotic-induced dopamine supersensitivity enhances the ability of 5-HT2/5-HT2A receptors to modulate dopamine-dependent behaviours. These effects are potentially linked to changes in 5-HT2A receptor density in the prefrontal cortex and the striatum. These observations raise the possibility that blockade of 5-HT2A receptors might overcome some of the behavioural manifestations of antipsychotic-induced dopamine supersensitivity.
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Affiliation(s)
- Alexandra Charron
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Canada
| | - Cynthia El Hage
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Canada
| | - Alice Servonnet
- Department of Neuroscience, Faculty of Medicine, Université de Montréal, Canada
| | - Anne-Noël Samaha
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Canada; CNS Research Group, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Fervaha G, Takeuchi H, Lee J, Foussias G, Fletcher PJ, Agid O, Remington G. Antipsychotics and amotivation. Neuropsychopharmacology 2015; 40:1539-48. [PMID: 25567425 PMCID: PMC4397414 DOI: 10.1038/npp.2015.3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/24/2014] [Accepted: 12/11/2014] [Indexed: 02/05/2023]
Abstract
Antipsychotic drugs are thought to produce secondary negative symptoms, which can also exacerbate primary negative symptoms. In the present study, we examined whether motivational deficits in particular were related to antipsychotic treatment in patients with schizophrenia in a dose-dependent manner. Five hundred and twenty individuals with schizophrenia who were receiving antipsychotic monotherapy for at least 6 months and followed prospectively were included in the present study. Participants were receiving one of five antipsychotic medications (olanzapine, perphenazine, quetiapine, risperidone, or ziprasidone), and analyses were conducted for patients receiving each drug separately. Analysis of covariance models were constructed to examine the effect of antipsychotic dose on level of motivational impairment, controlling for selected demographic and clinical variables (eg, positive symptoms). Level of motivation, or deficits therein, were evaluated using a derived measure from the Quality of Life Scale, and in addition with scores derived from the Positive and Negative Syndrome Scale. Antipsychotic dose was not related to the level of amotivation for any of the medications examined. Moreover, severity of sedation was not significantly related to the degree of amotivation. One hundred and twenty-one individuals were identified as antipsychotic-free at baseline, and after 6 months of antipsychotic treatment, no change in motivation was found. Chronic treatment with antipsychotics does not necessarily impede or enhance goal-directed motivation in patients with schizophrenia. It is possible that the negative impact of antipsychotics in this regard is overstated; conversely, the present results also indicate that we must look beyond antipsychotics in our efforts to improve motivation.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Canada,Schizophrenia Division, Centre for Addiction and Mental Health, 250 College Street, Room 320, Toronto, Ontario M5T 1R8, Canada, Tel: +416 535 8501 (ext 34818), Fax: +416 979 4292, E-mail:
| | - Hiroyoshi Takeuchi
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jimmy Lee
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul J Fletcher
- Department of Psychiatry, University of Toronto, Toronto, Canada,Biopsychology Section, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada
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Dose and dosing frequency of long-acting injectable antipsychotics: a systematic review of PET and SPECT data and clinical implications. J Clin Psychopharmacol 2014; 34:728-35. [PMID: 24781442 DOI: 10.1097/jcp.0000000000000065] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brain imaging data of antipsychotics have mainly been derived from oral antipsychotic drugs, which hampers our understanding of the requirement of dose/dosing frequency of long-acting injectable (LAI) antipsychotics for the maintenance treatment of schizophrenia. A systematic literature search was performed to identify positron emission tomography (PET) and single-photon emission computed tomography (SPECT) studies that assessed dopamine D2 receptor occupancy levels with LAI antipsychotic drugs in humans, using PubMed, EMBASE, and PsycINFO (last search, February 2013). Twenty studies (15 PET and 5 SPECT studies) were identified. The most investigated drug in these PET and SPECT studies was haloperidol decanoate (44 subjects; 11 studies), followed by risperidone LAI (24 subjects; 3 studies), olanzapine pamoate (14 subject; 1 study), and fluphenazine decanoate (12 subjects; 3 studies). The data have demonstrated high and continuous D2 receptor blockade with LAIs; the effects of LAI first-generation antipsychotics on the central nervous system may persist for several months. The prospective and cross-sectional studies showed that continuous dopamine D2 receptor blockade above 65% (ie, the lower end of the established therapeutic window for the acute phase treatment) was not always necessary for maintenance treatment for at least some of the patients. In conclusion, because of the limited brain imaging data on LAI antipsychotics, we still do not know the best way to dose them. Still, the currently available brain imaging data raises a possibility that the dosing interval of LAI antipsychotics may be extended beyond the currently indicated range in some patients.
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Bouayad-Gervais K, Minogianis EA, Lévesque D, Samaha AN. The self-administration of rapidly delivered cocaine promotes increased motivation to take the drug: contributions of prior levels of operant responding and cocaine intake. Psychopharmacology (Berl) 2014; 231:4241-52. [PMID: 24752656 DOI: 10.1007/s00213-014-3576-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/02/2014] [Indexed: 01/19/2023]
Abstract
RATIONALE Rapid drug delivery to the brain might increase the risk for developing addiction. In rats, increasing the speed of intravenous cocaine delivery (5 vs. 90 s) increases drug intake and the subsequent motivation to self-administer cocaine. Increased motivation for cocaine could result not only from more extensive prior drug intake and operant responding for drug, but also from neuroplasticity evoked by rapid drug uptake. OBJECTIVE We determined the contributions of prior drug intake and operant responding to the increased motivation for cocaine evoked by rapid delivery. We also investigated the effects of cocaine delivery speed on corticostriatal expression of brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) mRNA. METHODS Rats self-administered cocaine (0.25 mg/kg/infusion) delivered over 5 or 90 s during short-access (1 h/session; ShA) or long-access (6 h; LgA) sessions. Motivation for cocaine was then assessed by measuring responding under a progressive ratio schedule of reinforcement. Next, BDNF and TrkB mRNA levels were measured in 5- and 90-s rats. RESULTS Five-second ShA and 5-s-LgA rats were more motivated for cocaine than their 90-s counterparts. This effect was dissociable from previous levels of drug intake or of operant responding for cocaine. In parallel, only rats self-administering rapid cocaine injections had altered BDNF and TrkB mRNA levels in corticostriatal regions. CONCLUSIONS Rapid drug delivery augments the motivation for cocaine independently of effects on the levels of drug intake or operant responding for drug. We suggest that rapid delivery might increase the motivation for drug by promoting neuroplasticity within reward pathways. This neuroplasticity could involve increased regulation of BDNF/TrkB.
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Affiliation(s)
- Karim Bouayad-Gervais
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada
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22
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Samaha AN. Can antipsychotic treatment contribute to drug addiction in schizophrenia? Prog Neuropsychopharmacol Biol Psychiatry 2014; 52:9-16. [PMID: 23793001 DOI: 10.1016/j.pnpbp.2013.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/02/2013] [Accepted: 06/11/2013] [Indexed: 12/27/2022]
Abstract
Individuals with schizophrenia are at very high risk for drug abuse and addiction. Patients with a coexisting drug problem fare worse than patients who do not use drugs, and are also more difficult to treat. Current hypotheses cannot adequately account for why patients with schizophrenia so often have a co-morbid drug problem. I present here a complementary hypothesis based on evidence showing that chronic exposure to antipsychotic medications can induce supersensitivity within the brain's dopamine systems, and that this in turn can enhance the rewarding and incentive motivational effects of drugs and reward cues. At the neurobiological level, these effects of antipsychotics are potentially linked to antipsychotic-induced increases in the striatal levels of dopamine D2 receptors and D2 receptors in a high-affinity state for dopamine, particularly at postsynaptic sites. Antipsychotic-induced dopamine supersensitivity and enhanced reward function are not inevitable consequences of prolonged antipsychotic treatment. At least two parameters appear to promote these effects; the use of antipsychotics of the typical class, and continuous rather than intermittent antipsychotic exposure, such that silencing of dopaminergic neurotransmission via D2/3 receptors is unremitting. Thus, by inducing forms of neural plasticity that facilitate the ability of drugs and reward cues to gain control over behaviour, some currently used treatment strategies with typical antipsychotics might contribute to compulsive drug seeking and drug taking behaviours in vulnerable schizophrenia patients.
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Affiliation(s)
- Anne-Noël Samaha
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada, H3C 3J7; CNS Research Group, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada, H3C 3J7.
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23
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Sabioni P, Ramos AC, Galduróz JCF. The effectiveness of treatments for cocaine dependence in schizophrenic patients: a systematic review. Curr Neuropharmacol 2014; 11:484-90. [PMID: 24403872 PMCID: PMC3763756 DOI: 10.2174/1570159x11311050003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/21/2012] [Accepted: 01/04/2013] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate and compare the effectiveness of available treatments for cocaine dependence in schizophrenic patients. Method: We searched articles published between May 2002 and June 2012 in the following databases: Scopus, Pubmed and Web of Knowledge. The key words utilised were “schizophrenia”, "dementia praecox", "schizophrenic disorder", "cocaine related disorder", "cocaine abuse", "cocaine addiction", "cocaine dependence", “treatment”, “therapeutic”, and "drug therapy”. Selection of studies and data extraction: Original articles in English, Portuguese and Spanish were selected. Controlled, double-blind and open-label studies involving only human subjects were included in this review. Data Synthesis: We found studies on typical and atypical antipsychotics and one monoamine transporter antagonist. There were few indications of the effectiveness of atypical antipsychotic medications for the treatment of cocaine dependence in patients with schizophrenia. Conclusions: We suggest that further studies be conducted with atypical antipsychotic medicationsand greater methodological strictness, including using a placebo group in the studies, so that health professionals can determine the real effectiveness of this class of medication for the treatment of cocaine dependence in schizophrenic patients.
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Affiliation(s)
- Pamela Sabioni
- Department of Psychobiology (Departamento de Psicobiologia), Universidade Federal de São Paulo, Brazil
| | - Anna Carolina Ramos
- Department of Psychobiology (Departamento de Psicobiologia), Universidade Federal de São Paulo, Brazil
| | - Jose Carlos F Galduróz
- Department of Psychobiology (Departamento de Psicobiologia), Universidade Federal de São Paulo, Brazil
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24
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Estimated dopamine D₂ receptor occupancy and remission in schizophrenia: analysis of the CATIE data. J Clin Psychopharmacol 2013; 33:682-5. [PMID: 23899638 DOI: 10.1097/jcp.0b013e3182979a0a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In treating schizophrenia, 65% to 80% occupancy of dopamine D₂ receptors optimizes therapeutic efficacy while minimizing risks of extrapyramidal symptoms and cognitive impairments. However, it is unclear as to whether it is necessary to keep D₂ receptor occupancy within this therapeutic window to maintain clinical response. The data set from phase 1 of the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) trial was reappraised. Thirty patients receiving risperidone (12 patients), olanzapine (12 patients), or ziprasidone (6 patients) fulfilled the following definition of remission and were included: a score of 3 or less on the 8 specific items in the Positive and Negative Syndrome Scale (ie, P1, P2, P3, N1, N4, N6, G5, and G9; adopted from Andreasen et al, 2005) at the initial assessment and months 1, 2, and 6. Peak and trough D₂ receptor occupancy levels at month 6 were estimated from plasma antipsychotic concentrations using population pharmacokinetic analysis and our D₂ prediction model. Estimated mean ± SD peak and trough D₂ receptor occupancy levels at month 6 were 70.3% ± 9.8% and 60.5% ± 20.2%, respectively; among these individuals, 46.7% (14 patients) did not achieve continuous blockade of 65% or greater (ie, trough D₂ occupancy of <65%). In conclusion, approximately half of patients with remission did not achieve continuous blockade of estimated D₂ receptor occupancy 5% or greater. These results extend our previous findings and suggest that sustained D₂ receptor occupancy greater than 65% may not always be necessary for the maintenance treatment of schizophrenia.
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25
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Olanzapine treatment of adolescent rats alters adult reward behaviour and nucleus accumbens function. Int J Neuropsychopharmacol 2013; 16:1599-609. [PMID: 23351612 PMCID: PMC5819604 DOI: 10.1017/s1461145712001642] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Antipsychotic drugs are increasingly used in children and adolescents to treat a variety of psychiatric disorders. However, little is known about the long-term effects of early life antipsychotic drug (APD) treatment. Most APDs are potent antagonists or partial agonists of dopamine (DA) D₂ receptors; atypical APDs also have multiple serotonergic activities. DA and serotonin regulate many neurodevelopmental processes. Thus, early life APD treatment can, potentially, perturb these processes, causing long-term behavioural and neurobiological sequelae. We treated adolescent, male rats with olanzapine (Ola) on post-natal days 28-49, under dosing conditions that approximate those employed therapeutically in humans. As adults, they exhibited enhanced conditioned place preference for amphetamine, as compared to vehicle-treated rats. In the nucleus accumbens core, DA D₁ receptor binding was reduced, D₂ binding was increased and DA release evoked by electrical stimulation of the ventral tegmental area was reduced. Thus, adolescent Ola treatment enduringly alters a key behavioural response to rewarding stimuli and modifies DAergic neurotransmission in the nucleus accumbens. The persistence of these changes suggests that even limited periods of early life Ola treatment may induce enduring changes in other reward-related behaviours and in behavioural and neurobiological responses to therapeutic and illicit psychotropic drugs. These results underscore the importance of improved understanding of the enduring sequelae of paediatric APD treatment as a basis for weighing the benefits and risks of adolescent APD therapy, especially prophylactic treatment in high-risk, asymptomatic patients.
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26
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Bédard AM, Maheux J, Lévesque D, Samaha AN. Prior haloperidol, but not olanzapine, exposure augments the pursuit of reward cues: implications for substance abuse in schizophrenia. Schizophr Bull 2013; 39:692-702. [PMID: 22927669 PMCID: PMC3627770 DOI: 10.1093/schbul/sbs077] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Drug abuse and addiction are excessively common in schizophrenia. Chronic antipsychotic treatment might contribute to this comorbidity by inducing supersensitivity within the brain's dopamine system. Dopamine supersensitivity can enhance the incentive motivational properties of reward cues, and reward cues contribute to the maintenance and severity of drug addiction. We have shown previously that rats withdrawn from continuous haloperidol (HAL) treatment (via subcutaneous minipump) develop dopamine supersensitivity and pursue reward cues more vigorously than HAL-naive rats following an amphetamine (AMPH) challenge. Atypical antipsychotic drugs are thought to be less likely than typicals to produce dopamine supersensitivity. Thus, we compared the effects of HAL and the atypical antipsychotic olanzapine (OLZ) on the pursuit of reward cues. Rats were trained to associate a light-tone cue with water then treated with HAL or OLZ. Following antipsychotic withdrawal, we assessed AMPH-induced enhancement of lever pressing for the cue. Withdrawal from HAL, but not from OLZ, enhanced this effect. HAL, but not OLZ, also enhanced AMPH-induced psychomotor activation and c-fos mRNA expression in the caudate-putamen. Thus, prior HAL, but not OLZ, enhanced conditioned reward following an AMPH challenge, and this was potentially linked to enhanced behavioral sensitivity to AMPH and AMPH-induced engagement of the caudate-putamen. These findings suggest that HAL, but not an atypical like OLZ, modifies reward circuitry in ways that increase responsiveness to reward cues. Because enhanced responsiveness to reward cues can promote drug-seeking behavior, it should be investigated whether atypical antipsychotics might be a preferential option in schizophrenic patients at risk for drug abuse or addiction.
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Affiliation(s)
- Anne-Marie Bédard
- Department of Pharmacology, Faculty of Medicine, Université de MontréalMontreal, QC, Canada
| | - Jérôme Maheux
- Faculty of Pharmacy, Université de MontréalMontreal, QC, Canada
| | - Daniel Lévesque
- Faculty of Pharmacy, Université de MontréalMontreal, QC, Canada
| | - Anne-Noël Samaha
- Department of Pharmacology, Faculty of Medicine, Université de MontréalMontreal, QC, Canada; ,CNS Research Group, Faculty of Medicine, Université de MontréalMontreal, QC, Canada,To whom correspondence should be addressed; C.P. 6128, Succursale Centre-ville, Montreal, Quebec H3C 3J7, Canada; tel: 514-343-6111, ext. 32788, fax: 514-343-2291, e-mail:
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Gómez Gaviro MV, Sánchez Fernández PL, Lovell Badge R, Fernández Avilés F. Looking for the niche: substance delivery into the lateral ventricle of the brain: the osmotic minipump system. Methods Mol Biol 2013; 1035:135-40. [PMID: 23959987 DOI: 10.1007/978-1-62703-508-8_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The infusion of different substances into the left ventricle of the brain allows substances to reach the subventricular zone, one of the neural stem cell niches in the adult brain. Implantation of an osmotic minipump delivers proteins, virus and drugs directly into the lateral ventricle to act locally. Here we describe this method consisting on a cannula implanted into the lateral ventricle and linked to an osmotic minipump via catheter. The cannula is fixed over the brain and the minipump is placed subcutaneously. This system can be maintained from days up to several weeks and ensures constant and regular delivery of the desired biological product.
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Dopamine D2 receptor occupancy with risperidone or olanzapine during maintenance treatment of schizophrenia: a cross-sectional study. Prog Neuropsychopharmacol Biol Psychiatry 2012; 37:182-7. [PMID: 22230651 DOI: 10.1016/j.pnpbp.2011.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 12/18/2011] [Accepted: 12/24/2011] [Indexed: 11/24/2022]
Abstract
In treating schizophrenia, it has been established that 65-80% occupancy of dopamine D2 receptors optimizes therapeutic efficacy while minimizing risks of extrapyramidal symptoms. However, it is unclear as to whether it is necessary to keep D2 receptor occupancy within this therapeutic window to maintain response. In this study, daily peak and trough D2 receptor occupancy levels were estimated in clinically stable patients with schizophrenia (DSM-IV) who were receiving risperidone or olanzapine. Using two collected plasma samples, plasma antipsychotic concentrations at peak and trough were estimated with population pharmacokinetic techniques. Corresponding dopamine D2 receptor occupancy levels were then estimated, using a recently developed model. 35 subjects with stable schizophrenia completed the study (mean±SD age, 48.8±13.8years; male [N=14]; Asians [N=23], Caucasians [N=12]; risperidone [N=20] at 3.2±2.3mg/day, and olanzapine [N=15] at 9.2±4.9mg/day) between September and December 2010. 48.6% (N=17) did not achieve a continuous blockade of ≥65%. Moreover, 11.4% (N=4) did not achieve the 65% threshold at estimated peak concentrations. In conclusion, approximately half the subjects with stable schizophrenia did not achieve estimated continuous blockade of D2 receptor occupancy of ≥65%. The results suggest that sustained D2 receptor occupancy levels of ≥65% may not always be necessary for the maintenance treatment of schizophrenia.
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Blanchet PJ, Parent MT, Rompré PH, Lévesque D. Relevance of animal models to human tardive dyskinesia. Behav Brain Funct 2012; 8:12. [PMID: 22404856 PMCID: PMC3338072 DOI: 10.1186/1744-9081-8-12] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/09/2012] [Indexed: 11/15/2022] Open
Abstract
Tardive dyskinesia remains an elusive and significant clinical entity that can possibly be understood via experimentation with animal models. We conducted a literature review on tardive dyskinesia modeling. Subchronic antipsychotic drug exposure is a standard approach to model tardive dyskinesia in rodents. Vacuous chewing movements constitute the most common pattern of expression of purposeless oral movements and represent an impermanent response, with individual and strain susceptibility differences. Transgenic mice are also used to address the contribution of adaptive and maladaptive signals induced during antipsychotic drug exposure. An emphasis on non-human primate modeling is proposed, and past experimental observations reviewed in various monkey species. Rodent and primate models are complementary, but the non-human primate model appears more convincingly similar to the human condition and better suited to address therapeutic issues against tardive dyskinesia.
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Affiliation(s)
- Pierre J Blanchet
- Faculty of Dental Medicine, University of Montreal, PO Box 6128, Succ, Centre-ville, Montreal, QC H3C 3J7, Canada.
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