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Segura IA, McGhee J, Della Sala S, Cowan N, Pompéia S. A reappraisal of acute doses of benzodiazepines as a model of anterograde amnesia. Hum Psychopharmacol 2021; 36:e2774. [PMID: 33368617 DOI: 10.1002/hup.2774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/28/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute administration of benzodiazepines is considered a pharmacological model of general organic anterograde amnesias (OAA). We sought to determine which type of amnesia these drugs best model by comparing the effects of diazepam with those reported in amnesiacs regarding working memory capacity (WMC), susceptibility to retroactive interference (RI), and accelerated forgetting. METHODS In this double-blind, parallel-group design study, 30 undergraduates were randomly allocated to acute oral treatments with 15 mg diazepam or placebo. WMC and story recall were assessed pre- and post-treatment. Story presentation was succeeded by 10 min of RI (spotting differences in pictures) or minimal RI (doing nothing in a darkened room). Delayed story recall was assessed under diazepam and 7 days later in a drug-free session to assess accelerated forgetting. RESULTS Recall of stories encoded under diazepam, whether reactivated or not, was severely impaired (anterograde amnesia). However, diazepam did not impair WMC, increase susceptibility to RI, or accelerate forgetting. CONCLUSIONS Diazepam's amnestic effects mirror those in patients with probable severe medial temporal damage, mostly restricted to initial consolidation and differ from other OAA (Korsakoff syndrome, frontal, transient epileptic, posttraumatic amnesia, and most progressive amnesias) in terms of WMC, susceptibility to RI and accelerated forgetting.
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Affiliation(s)
- Isis Angélica Segura
- Departamento de Psicobiologia, Universidade Federal de São Paulo- Escola Paulista de Medicina, Sao Paulo, Brazil
| | - Jamie McGhee
- Department of Psychology, Human Cognitive Neuroscience, University of Edinburgh, Edinburgh, UK.,Laboratory of Experimental Psychology, Suor Orsola Benincasa University, Naples, Italy
| | - Sergio Della Sala
- Department of Psychology, Human Cognitive Neuroscience, University of Edinburgh, Edinburgh, UK
| | - Nelson Cowan
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Sabine Pompéia
- Departamento de Psicobiologia, Universidade Federal de São Paulo- Escola Paulista de Medicina, Sao Paulo, Brazil
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Abstract
Occupation is central to the concept of occupational therapy. However, the definition and use of the term occupation have been through many stages. This paper considers some of these stages. It then discusses the role of lifestyle and the emergence of what has become known as lifestyle medicine. Lifestyle is an important area for occupational therapy to explore because it influences both the individual's perception and his or her experience of health. The suggestion is made that lifestyle provides both occupational form and occupational performance. Occupational synthesis can be achieved through the use of a therapeutic intervention promoting lifestyle change. Research evidence is presented relating to two specific lifestyle factors, caffeine and general fluid intake, examining their potential effect on mental health. Case studies demonstrate how a lifestyle approach can provide a beneficial early intervention strategy. The discussion resulting from the case studies illustrates how the approach can be used in a number of different ways to influence the outcome of therapeutic interventions positively.
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Rodríguez MLC, Campos J, Forcato C, Leiguarda R, Maldonado H, Molina VA, Pedreira ME. Enhancing a declarative memory in humans: the effect of clonazepam on reconsolidation. Neuropharmacology 2012; 64:432-42. [PMID: 22819624 DOI: 10.1016/j.neuropharm.2012.06.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/23/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
A consolidated memory recalled by a specific reminder can become unstable (labile) and susceptible to facilitation or impairment for a discrete period of time. This labilization phase is followed by a process of stabilization called reconsolidation. The phenomenon has been shown in diverse types of memory, and different pharmacological agents have been used to disclose its presence. Several studies have revealed the relevance of the GABAergic system to this process. Consequently, our hypothesis is that the system is involved in the reconsolidation of declarative memory in humans. Thus, using our verbal learning task, we analyzed the effect of benzodiazepines on the re-stabilization of the declarative memory. On Day 1, volunteers learned an association between five cue- response-syllables. On Day 2, the verbal memory was labilized by a reminder presentation, and then a placebo capsule or 0.25 mg or 0.03 mg of clonazepam was administered to the subjects. The verbal memory was evaluated on Day 3. The volunteers who had received the 0.25 mg clonazepam along with the specific reminder on Day 2, exhibited memory improvement. In contrast, there was no effect when the drug was given without retrieval, when the memory was simply retrieved instead of being reactivated or when short-term memory testing was performed 4 h after reactivation. We discuss the GABAergic role in reconsolidation, which shows a collateral effect on other memories when the treatment is aimed at treating anxiety disorders. Further studies might elucidate the role of GABA in the reconsolidation process associated with dissimilar scenarios. This article is part of a Special Issue entitled 'Cognitive Enhancers'.
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Affiliation(s)
- M L C Rodríguez
- Laboratorio de Neurobiología de la Memoria, Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, IFIBYNE - CONICET, Ciudad Universitaria, Pab II (1428), Buenos Aires, Argentina
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Amato RJ, Moerschbaecher JM, Winsauer PJ. Effects of pregnanolone and flunitrazepam on the retention of response sequences in rats. Pharmacol Biochem Behav 2011; 99:391-8. [PMID: 21640749 PMCID: PMC3298444 DOI: 10.1016/j.pbb.2011.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/05/2011] [Accepted: 05/20/2011] [Indexed: 11/29/2022]
Abstract
Neuroactive steroids produce effects similar to other GABA(A) modulators (e.g., benzodiazepines and barbiturates) and have a large therapeutic potential; however, a greater understanding of the effects of these substances on learning and memory is needed. To specifically assess the effects of a neurosteroid on memory, pregnanolone (1-18 mg/kg) was administered to male Long-Evans rats responding under a repeated acquisition and delayed-performance procedure in which different 4-response sequences were acquired and then retested after varying delays. Responding was maintained under a second-order fixed-ratio (FR) 2 schedule of food reinforcement, and incorrect responses (errors) produced a 5-sec timeout. For comparison purposes, both a high (flunitrazepam) and low efficacy agonist/antagonist (flumazenil) of the GABA(A) receptor complex were also administered both alone and in combination. Retention of each sequence was quantified as percent savings in errors-to-criterion and this dependent measure was shown to be sensitive to increases in delay. When administered 15 min prior to the end of either a 30- or 180-minute delay, pregnanolone produced both dose- and delay-dependent decreases in percent savings, response rate and accuracy; this effect was selective in that decreases in retention occurred at doses lower than those that disrupted response rate or accuracy. Flunitrazepam (0.056-1mg/kg) produced similar disruptions in retention and these disruptions were antagonized by 5.6 mg/kg of flumazenil. Both an ineffective (0.056 mg/kg) and an effective (0.18 mg/kg) dose of flunitrazepam also potentiated the dose- and delay-dependent disruptions in retention produced by pregnanolone. These data indicate that the neurosteroid pregnanolone disrupts retention in a manner similar to the benzodiazepine flunitrazepam, and suggests that the interaction of flunitrazepam and pregnanolone on retention may be mediated by the GABA(A) receptor complex.
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Affiliation(s)
- Russell J Amato
- Department of Pharmacology and Experimental Therapeutics, 1901 Perdido St., New Orleans, LA 70112, USA.
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Izaute M, Bacon E. Specific effects of an amnesic drug: effect of lorazepam on study time allocation and on judgment of learning. Neuropsychopharmacology 2005; 30:196-204. [PMID: 15483562 DOI: 10.1038/sj.npp.1300564] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We investigated the effects of lorazepam, a benzodiazepine, on the allocation of study time, memory, and judgment of learning, in a cognitive task where the repetition of word presentation was manipulated. The aim was to assess whether lorazepam would affect the learning processes and/or whether the participants would be aware of the amnesic difficulty. A total of 30 healthy volunteers participated in the study, 15 of whom received a capsule containing the lorazepam drug (0.038 mg/kg) and 15 a placebo capsule. First, the accuracy of delayed judgments of learning (JOL) was measured in both groups. For the JOL ratings, results showed that all the participants benefited from word repetition. Although the overall performance was lower in the lorazepam than in the placebo group, the accuracy of the JOL ratings was preserved by the drug. Second, all the participants benefited from the repetition of learning, although the performances of the lorazepam-treated subjects remained lower than those of the placebo participants. The repetition of learning had an effect on JOL in both groups. Finally, the time spent learning each (allocation study time) pair of words was measured. For the placebo group, results revealed that study time decreased significantly with the frequency of presentation. For the lorazepam group, no effect of presentation frequency was found. Overall, our findings suggest that the lorazepam drug has a differential effect on the monitoring and the control processes involved in a learning task. The implications of these findings are discussed within the theoretical framework of metacognition.
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Affiliation(s)
- Marie Izaute
- Laboratoire de Psychologie Sociale de la Cognition (LAPSCO-UMR 6024 CNRS), Universite Blaise Pascal, Clermont-Ferrand Cedex, France
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Pompéia S, Bueno OFA, Galduróz JCF, Tufik S. Stem-completion tasks (indirect, direct inclusion and exclusion) are differently affected by equipotent doses of lorazepam and flunitrazepam. Hum Psychopharmacol 2003; 18:541-9. [PMID: 14533136 DOI: 10.1002/hup.515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study was designed to explore the effects on performance in stem-completion tasks of two benzodiazepines (BZ) in equipotent doses: lorazepam, a drug that atypically disrupts perceptual priming, and flunitrazepam, a compound with standard BZ effects. The study followed a placebo-controlled, double-blind, parallel-group design. Thirty-six young and healthy subjects carried out three completion tasks at theoretical peak-plasma concentrations of drugs: (a) indirect tasks, in which the subjects were instructed to complete stems with the first word that came to mind; (b) direct inclusion tasks/cued recall, in which the participants had to try to use words seen at study as completions; and (c) direct exclusion tasks, in which words seen at study were to be avoided. The PDP was applied to the results in the inclusion and exclusion tasks, to obtain indices of explicit/controlled (C) and implicit/automatic (A) memory. The C index was lowered by both BZs and A was equivalent in all treatments, confirming the general amnestic action of BZs. However, lorazepam led to decreases in completions in the indirect and inclusion tasks, while flunitrazepam impaired performance in the exclusion task. The qualitative differences between the drugs in their effects on performance suggest that these BZs may lead to differences in response bias.
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Affiliation(s)
- S Pompéia
- Departamento de Psicobiologia--UNIFESP, Brazil
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Lucchesi LM, Pompéia S, Manzano GM, Kohn AF, Galduroz JCF, Bueno OFA, Tufik S. Flunitrazepam-induced changes in neurophysiological, behavioural, and subjective measures used to assess sedation. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:525-33. [PMID: 12691789 DOI: 10.1016/s0278-5846(03)00044-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Certain features of event-related potentials (ERPs), electroencephalographic (EEG), and behavioural measures vary with differing states of alertness and/or sedation. PURPOSE This study was conducted to investigate changes in several measures usually viewed as reflecting states of sedation/sleepiness associated with the use of a range of doses of the hypnotic benzodiazepine (BZD) flunitrazepam (FNZ). METHODS This was a double blind, independent group design study of the effects of acute oral doses of FNZ in young healthy volunteers. Forty-eight subjects were randomly allocated to one of four groups-FNZ (0.6, 0.8, and 1.0 mg) and placebo (PLAC)-and tested prior to treatment and then in a posttreatment session close to the theoretical peak plasma concentration. ERP latencies and amplitudes were measured at midfrontal (Fz), midcentral (Cz), and midparietal (Pz) using a standard auditory oddball paradigm. EEG changes were assessed at Pz. Behavioural measures included the digit-symbol substitution test (DSST), a cancellation task (CT), and subjective ratings of alertness and attentiveness by the subjects (SUB) and the experimenter (EXP). RESULTS FNZ led to psychomotor impairments and decreased alertness and attention; these effects were consistent with previous findings. A progressive, dose-related increase in P3 latency occurred in Fz, Cz, and Pz, and there was an increase in N1 (Fz, Cz) and N2 (Fz). N2-P3 amplitude decreased in Fz. EEG power bands beta 1 increased for the two highest doses, but no significant differences were noted in theta, delta, and alpha bands. P3 latencies, experimenter-rated levels of alertness, and DSST scores differentiated all three doses of FNZ from PLAC. CONCLUSION The most sensitive measures used were P3 latencies of the ERPs (which varied with FNZ dose), DSST, and the experimenter-rated levels of alertness. However, we found no evidence for the assumption that one single phenomenon was reflected in all measures and different mechanisms were probably involved. Further experiments will be needed for more in-depth probing of the finer mechanisms underlying sedation/sleepiness and how they affect behavioural and eletrophysiological measures of the central nervous system (CNS) function.
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Affiliation(s)
- Lígia M Lucchesi
- Department of Psychobiology, Universidade Federal de São Paulo, R. Napoleão de Barros, 925 V. Clementino, CEP: 04024-002, São Paulo, SP, Brazil.
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de Carvalho SC, Marcourakis T, Artes R, Gorenstein C. Memory performance in panic disorder patients after chronic use of clomipramine. J Psychopharmacol 2002; 16:220-6. [PMID: 12236628 DOI: 10.1177/026988110201600305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated the chronic use (6.3 +/- 0.5 years; mean +/- SEM) of therapeutic doses of clomipramine (57.0 +/- 8.0 mg/day) by outpatients with panic disorder/agoraphobia who were currently in remission to assess impairment of memory and psychomotor functions. In addition, the association between test performance and serum levels of clomipramine (CMI) and its active metabolite desmethylclomipramine (DCMI) was also assessed. Patients and healthy volunteers matched for sex, age and educational level were submitted to rating scales and to memory and psychomotor tests. There was no significant difference between groups regarding any variable, except for metamemory. Significant associations were found between (i) longer-term clomipramine treatment and poorer performance in the implicit test and (ii) higher serum levels of clomipramine or desmethylclomipramine, or both (CMI + DCMI) and lower performance in central executive tests and metamemory. The results showed that low doses of CMI chronically administered to panic patients are associated with diminished metamemory and impaired priming and working memory. Further investigations are needed to confirm these results and to determine whether the chronic use of higher therapeutic doses of tricyclic antidepressants is associated with more intense deleterious effects on memory and psychomotor functions.
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Affiliation(s)
- Stefania Caldeira de Carvalho
- Departamento de Farmacologia, Instituto de Ciências Biomédicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
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Hoffman WE, Balyasnikova IV, Mahay H, Danilov SM, Baughman VL. GABA alpha6 receptors mediate midazolam-induced anxiolysis. J Clin Anesth 2002; 14:206-9. [PMID: 12031754 DOI: 10.1016/s0952-8180(02)00343-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To compare the ability of midazolam to produce sedation and anxiolysis and attenuate memory in 100 patients aged 20 to 70 years. The effect of a point mutation (Pro385Ser) for the gamma amino-butyric acid (GABA) alpha6 receptor on the sedative, anxiolytic, and memory effects of midazolam was determined. SETTING University hospital. DESIGN Prospective, randomized, double-blind study. PATIENTS 100 ASA physical status I and II patients scheduled for surgery. INTERVENTIONS Two midazolam dose groups, 20 microg/kg and 40 microg/kg, with 40 patients per group and 20 control patients receiving saline as a sham control. Treatments were randomly assigned. Blood was collected at the beginning of each study. MEASUREMENTS Patient sedation and anxiolysis were measured using a visual analog scale and explicit and implicit memory of a word task determined before and six minutes after midazolam or saline. A 365-base pair fragment of the GABA alpha6 receptor gene was amplified by polymerase chain reaction (PCR) from patient blood DNA and digested with the restrictase Fok I. Restriction fragments were visualized by ethidium bromide staining after electrophoresis to evaluate the GABA alpha6 receptor subunit mutation. MAIN RESULTS Midazolam produced dose-related sedation and anxiolysis. Explicit (recall) memory was attenuated with high-dose midazolam but implicit (recognition) memory remained intact. The GABA alpha6 receptor mutation did not affect baseline sedation, anxiety, or memory but significantly attenuated the anxiolytic effect of low-dose midazolam. Sedation and explicit memory were not affected by the mutation. CONCLUSIONS A Pro385Ser mutation of the GABA alpha6 receptor subunit decreased the anxiolytic effect of low-dose midazolam.
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Affiliation(s)
- William E Hoffman
- Department of Anesthesiology, University of Illinois at Chicago, 60612, USA.
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Massin-Krauss M, Bacon E, Danion JM. Effects of the benzodiazepine lorazepam on monitoring and control processes in semantic memory. Conscious Cogn 2002; 11:123-37. [PMID: 11883992 DOI: 10.1006/ccog.2001.0538] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lorazepam has been repeatedly shown to induce memory impairments. The effects of this benzodiazepine on the processes involved in the strategic regulation of memory accuracy have not as yet been explored. An experimental procedure that delineates the role of monitoring and control processes was used. Fifteen lorazepam and 15 placebo subjects were examined using a semantic memory task that combined both a forced- and a free-report option and a no-incentive and an incentive condition. Memory accuracy was lower in the lorazepam than in the placebo group. Lorazepam impaired control sensitivity (the extent to which volunteering of answers is affected by the confidence judgments). While the absolute aspect of monitoring was impaired (calibration scores), both the discriminative aspect (the ability to distinguish between correct and incorrect answers) and the response criterion setting (the confidence threshold set for volunteering a report) were spared. The pharmacological dissociation between monitoring effectiveness and control sensitivity indicates that these two components involve distinct processes.
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Affiliation(s)
- Marilyne Massin-Krauss
- Départment de Psychiatrie, INSERM Unité 405, Hôpitaux Universitaires, 1 place de l'Hôpital, Strasbourg, Cedex, F-67091, France
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Pompéia S, Bueno OF, Lucchesi LM, Manzano GM, Galduróz JC, Tufik S. A double-dissociation of behavioural and event-related potential effects of two benzodiazepines with similar potencies. J Psychopharmacol 2001; 14:288-98. [PMID: 11106311 DOI: 10.1177/026988110001400318] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to explore the role of benzodiazepine affinity to benzodiazepine binding site on acute psychomotor, subjective and memory effects, as well as auditory Event Related Potential (ERP) latencies, in healthy volunteers. Two benzodiazepines with similar affinity to benzodiazepine binding sites, or potency, were compared: the atypical compound lorazepam (2.0 mg), which has been reported to impair priming, and a standard benzodiazepine, flunitrazepam (0.6 mg, 0.8 mg, 1.0 mg). The study followed a placebo-controlled, double-blind, parallel-group design. Sixty subjects completed a test battery before treatment and at theoretical peak plasma concentration of drugs. Lorazepam and 1.0 mg of flunitrazepam led to comparable alterations on psychomotor, subjective and auditory episodic memory measures. A double-dissociation was found for lorazepam and the equipotent dose of flunitrazepam (1.0 mg): lorazepam was more deleterious than flunitrazepam in time taken to identify fragmented shapes. Lorazepam also impaired direct and indirect stem-completion in comparison to placebo, but this effect was abolished when time to identify shapes was used as a covariate. By contrast, 1.0 mg of flunitrazepam prolonged auditory ERP latencies to a greater extent than lorazepam. High affinity to the benzodiazepine binding sites does not seem to explain the consistent lorazepam-induced impairment of indirect stem-completion. Differences in impairment profile between the benzodiazepines employed may relate to the modality (visual or not) of the tasks used.
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Affiliation(s)
- S Pompéia
- Departamento de Psicobiologia, UNIFESP, São Paulo, Brazil
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Abstract
The performance, observer-rated, and participant-rated effects of orally administered placebo, and two benzodiazepines, flunitrazepam (2, 4 and 8 mg/70 kg) and triazolam (0.25, 0.5 and 1 mg/70 kg), were compared in 14 sedative drug abusers using a double-blind crossover design. Both flunitrazepam and triazolam produced dose-related decrements in memory and psychomotor/cognitive performance, and increases in many participant- and observer-rated measures. Effects of flunitrazepam had an earlier onset and a longer duration than those of triazolam. Although there was evidence that the flunitrazepam doses selected for study were somewhat higher overall relative to the selected triazolam doses, analysis of the participant-rated measures collected 24 h after drug administration (next-day) suggests that flunitrazepam may have a greater abuse liability than triazolam when abuse liability is assessed 24 h after drug administration. The highest flunitrazepam dose produced effects that were significantly greater than those of the highest triazolam dose on next-day ratings of good effects, take again, and worth; all tested flunitrazepam doses produced effects greater than any triazolam dose on next-day ratings of liking and take again. The highest flunitrazepam dose, but no triazolam dose, significantly increased the maximum dollar value at which participants chose drug over money in a Drug versus Money Choice Procedure.
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Affiliation(s)
- M Z Mintzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Biology Research Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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