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Callejas GH, Figueira RL, Gonçalves FLL, Volpe FAP, Zuardi AW, Crippa JA, Hallak JE, Sbragia L. Maternal administration of cannabidiol promotes an anti-inflammatory effect on the intestinal wall in a gastroschisis rat model. ACTA ACUST UNITED AC 2018; 51:e7132. [PMID: 29561958 PMCID: PMC5875904 DOI: 10.1590/1414-431x20177132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023]
Abstract
Gastroschisis (GS) is an abdominal wall defect that results in histological and morphological changes leading to intestinal motility perturbation and impaired absorption of nutrients. Due to its anti-inflammatory, antioxidant, and neuroprotective effects, cannabidiol (CBD) has been used as a therapeutic agent in many diseases. Our aim was to test the effect of maternal CBD in the intestine of an experimental model of GS. Pregnant rats were treated over 3 days with CBD (30 mg/kg) after the surgical induction of GS (day 18.5 of gestation) and compared to controls. Fetuses were divided into 4 groups: 1) control (C); 2) C+CBD (CCBD); 3) gastroschisis (G), and 4) G+CBD (GCBD). On day 21.5 of gestation, the fetuses were harvested and evaluated for: a) body weight (BW), intestinal weight (IW), and IW/BW ratio; b) histometric analysis of the intestinal wall; c) immunohistochemically analysis of inflammation (iNOS) and nitrite/nitrate level. BW: GCBD was lower than CCBD (P<0.005), IW and IW/BW ratio: GCBD was smaller than G (P<0.005), GCBD presented lower thickness in all parameters compared to G (P<0.005), iNOS and nitrite/nitrate were lower concentration in GCBD than to G (P<0.005). Maternal use of CBD had a beneficial effect on the intestinal loops of GS with decreased nitrite/nitrate and iNOS expression.
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Affiliation(s)
- G H Callejas
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R L Figueira
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L L Gonçalves
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F A P Volpe
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A W Zuardi
- Departmento de Neurociências e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J A Crippa
- Departmento de Neurociências e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J E Hallak
- Departmento de Neurociências e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Binelli C, Muñiz A, Sanches S, Ortiz A, Navines R, Egmond E, Udina M, Batalla A, López-Sola C, Crippa JA, Subirà S, Martín-Santos R. New evidence of heterogeneity in social anxiety disorder: defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors. Eur Psychiatry 2014; 30:160-5. [PMID: 25499444 DOI: 10.1016/j.eurpsy.2014.09.418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 08/22/2014] [Accepted: 09/21/2014] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions. METHOD One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR). RESULTS Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with "high-HA/low-NS", and a smaller (39%) atypical impulsive subgroup with high-moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005). CONCLUSIONS Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.
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Affiliation(s)
- C Binelli
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - A Muñiz
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - S Sanches
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - A Ortiz
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - R Navines
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Human Pharmacology and Clinical Neurosciences Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - E Egmond
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - M Udina
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A Batalla
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - C López-Sola
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - J A Crippa
- Department of Neuroscience and Cognitive Behavior, Hospital das Clinicas, Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil
| | - S Subirà
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Spain
| | - R Martín-Santos
- Service of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
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Bhattacharyya S, Iyegbe C, Atakan Z, Martin-Santos R, Crippa JA, Xu X, Williams S, Brammer M, Rubia K, Prata D, Collier DA, McGuire PK. Protein kinase B (AKT1) genotype mediates sensitivity to cannabis-induced impairments in psychomotor control. Psychol Med 2014; 44:3315-3328. [PMID: 25065544 DOI: 10.1017/s0033291714000920] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND What determines inter-individual variability to impairments in behavioural control that may underlie road-traffic accidents, and impulsive and violent behaviours occurring under the influence of cannabis, the most widely used illicit drug worldwide? METHOD Employing a double-blind, repeated-measures design, we investigated the genetic and neural basis of variable sensitivity to cannabis-induced behavioural dyscontrol in healthy occasional cannabis users. Acute oral challenge with placebo or Δ9-tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, was combined with functional magnetic resonance imaging, while participants performed a response inhibition task that involved inhibiting a pre-potent motor response. They were genotyped for rs1130233 single nucleotide polymorphisms (SNPs) of the protein kinase B (AKT1) gene. RESULTS Errors of inhibition were significantly (p = 0.008) increased following administration of THC in carriers of the A allele, but not in G allele homozygotes of the AKT1 rs1130233 SNP. The A allele carriers also displayed attenuation of left inferior frontal response with THC evident in the sample as a whole, while there was a modest enhancement of inferior frontal activation in the G homozygotes. There was a direct relationship (r = -0.327, p = 0.045) between the behavioural effect of THC and its physiological effect in the inferior frontal gyrus, where AKT1 genotype modulated the effect of THC. CONCLUSIONS These results require independent replication and show that differing vulnerability to acute psychomotor impairments induced by cannabis depends on variation in a gene that influences dopamine function, and is mediated through modulation of the effect of cannabis on the inferior frontal cortex, that is rich in dopaminergic innervation and critical for psychomotor control.
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Affiliation(s)
- S Bhattacharyya
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - C Iyegbe
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - Z Atakan
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - R Martin-Santos
- Pharmacology Research Unit, IMIM-Hospital del Mar and Psychiatric Department,ICN,Hospital Clinico, Barcelona,Spain
| | - J A Crippa
- Department of Neurology, Psychiatry and Medical Psychology, Faculty of Medicine of Ribeirão Preto,University of São Paulo,Brazil
| | - X Xu
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - S Williams
- Department of Neuroimaging, Centre for Neuroimaging Sciences,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - M Brammer
- Department of Neuroimaging, Centre for Neuroimaging Sciences,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - K Rubia
- Department of Child and Adolescent Psychiatry,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - D Prata
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - D A Collier
- Social, Genetic and Developmental Psychiatry Centre,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
| | - P K McGuire
- Department of Psychosis Studies,King's College London,Institute of Psychiatry, De Crespigny Park, London,UK
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Ribeiro A, Almeida VI, Costola-de-Souza C, Ferraz-de-Paula V, Pinheiro ML, Vitoretti LB, Gimenes-Junior JA, Akamine AT, Crippa JA, Tavares-de-Lima W, Palermo-Neto J. Cannabidiol improves lung function and inflammation in mice submitted to LPS-induced acute lung injury. Immunopharmacol Immunotoxicol 2014; 37:35-41. [DOI: 10.3109/08923973.2014.976794] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Atakan Z, Bhattacharyya S, Allen P, Martín-Santos R, Crippa JA, Borgwardt SJ, Fusar-Poli P, Seal M, Sallis H, Stahl D, Zuardi AW, Rubia K, McGuire P. Cannabis affects people differently: inter-subject variation in the psychotogenic effects of Δ9-tetrahydrocannabinol: a functional magnetic resonance imaging study with healthy volunteers. Psychol Med 2013; 43:1255-1267. [PMID: 23020923 DOI: 10.1017/s0033291712001924] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cannabis can induce transient psychotic symptoms, but not all users experience these adverse effects. We compared the neural response to Δ9-tetrahydrocannabinol (THC) in healthy volunteers in whom the drug did or did not induce acute psychotic symptoms. Method In a double-blind, placebo-controlled, pseudorandomized design, 21 healthy men with minimal experience of cannabis were given either 10 mg THC or placebo, orally. Behavioural and functional magnetic resonance imaging measures were then recorded whilst they performed a go/no-go task. RESULTS The sample was subdivided on the basis of the Positive and Negative Syndrome Scale positive score following administration of THC into transiently psychotic (TP; n = 11) and non-psychotic (NP; n = 10) groups. During the THC condition, TP subjects made more frequent inhibition errors than the NP group and showed differential activation relative to the NP group in the left parahippocampal gyrus, the left and right middle temporal gyri and in the right cerebellum. In these regions, THC had opposite effects on activation relative to placebo in the two groups. The TP group also showed less activation than the NP group in the right middle temporal gyrus and cerebellum, independent of the effects of THC. CONCLUSIONS In this first demonstration of inter-subject variability in sensitivity to the psychotogenic effects of THC, we found that the presence of acute psychotic symptoms was associated with a differential effect of THC on activation in the ventral and medial temporal cortex and cerebellum, suggesting that these regions mediate the effects of the drug on psychotic symptoms.
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Affiliation(s)
- Z Atakan
- Section of Neuroimaging, Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
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Martin-Santos R, Crippa JA, Batalla A, Bhattacharyya S, Atakan Z, Borgwardt S, Allen P, Seal M, Langohr K, Farré M, Zuardi AW, McGuire PK. Acute effects of a single, oral dose of d9-tetrahydrocannabinol (THC) and cannabidiol (CBD) administration in healthy volunteers. Curr Pharm Des 2013; 18:4966-79. [PMID: 22716148 DOI: 10.2174/138161212802884780] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/10/2012] [Indexed: 11/22/2022]
Abstract
RATIONALE Animal and humans studies suggest that the two main constituents of cannabis sativa, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have quite different acute effects. However, to date the two compounds have largely been studied separately. OBJECTIVE To evaluate and compare the acute pharmacological effects of both THC and CBD in the same human volunteers. METHODS A randomised, double-blind, cross-over, placebo controlled trial was conducted in 16 healthy male subjects. Oral THC 10 mg or CBD 600 mg or placebo was administered in three consecutive sessions, at one-month interval. Physiological measures and symptom ratings were assessed before, and at 1, 2 and 3 hours post drug administration. The area under the curve (AUC) between baseline and 3 hours, and the maximum absolute change from baseline at 2 hours were analysed by one-way repeated measures analysis of variance, with drug condition (THC or CBD or placebo) as the factor. RESULTS Relative to both placebo and CBD, administration of THC was associated with anxiety, dysphoria, positive psychotic symptoms, physical and mental sedation, subjective intoxication (AUC and effect at 2 hours: p < 0.01), an increase in heart rate (p < 0.05). There were no differences between CBD and placebo on any symptomatic, physiological variable. CONCLUSIONS In healthy volunteers, THC has marked acute behavioural and physiological effects, whereas CBD has proven to be safe and well tolerated.
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Affiliation(s)
- R Martin-Santos
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, UK.
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Bhattacharyya S, Atakan Z, Martin-Santos R, Crippa JA, Kambeitz J, Prata D, Williams S, Brammer M, Collier DA, McGuire PK. Preliminary report of biological basis of sensitivity to the effects of cannabis on psychosis: AKT1 and DAT1 genotype modulates the effects of δ-9-tetrahydrocannabinol on midbrain and striatal function. Mol Psychiatry 2012; 17:1152-5. [PMID: 22290123 DOI: 10.1038/mp.2011.187] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Macêdo DS, Araújo DP, Sampaio LRL, Vasconcelos SMM, Sales PMG, Sousa FCF, Hallak JE, Crippa JA, Carvalho AF. Animal models of prenatal immune challenge and their contribution to the study of schizophrenia: a systematic review. Braz J Med Biol Res 2012; 45:179-86. [PMID: 22392187 PMCID: PMC3854194 DOI: 10.1590/s0100-879x2012007500031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 02/10/2012] [Indexed: 11/21/2022] Open
Abstract
Prenatal immune challenge (PIC) in pregnant rodents produces offspring with abnormalities in behavior, histology, and gene expression that are reminiscent of schizophrenia and autism. Based on this, the goal of this article was to review the main contributions of PIC models, especially the one using the viral-mimetic particle polyriboinosinic-polyribocytidylic acid (poly-I:C), to the understanding of the etiology, biological basis and treatment of schizophrenia. This systematic review consisted of a search of available web databases (PubMed, SciELO, LILACS, PsycINFO, and ISI Web of Knowledge) for original studies published in the last 10 years (May 2001 to October 2011) concerning animal models of PIC, focusing on those using poly-I:C. The results showed that the PIC model with poly-I:C is able to mimic the prodrome and both the positive and negative/cognitive dimensions of schizophrenia, depending on the specific gestation time window of the immune challenge. The model resembles the neurobiology and etiology of schizophrenia and has good predictive value. In conclusion, this model is a robust tool for the identification of novel molecular targets during prenatal life, adolescence and adulthood that might contribute to the development of preventive and/or treatment strategies (targeting specific symptoms, i.e., positive or negative/cognitive) for this devastating mental disorder, also presenting biosafety as compared to viral infection models. One limitation of this model is the incapacity to model the full spectrum of immune responses normally induced by viral exposure.
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Affiliation(s)
- D S Macêdo
- Departamento de Fisiologia e Farmacologia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
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Levitan MN, Crippa JA, Bruno LM, Pastore DL, Freire RC, Arrais KC, Hallak JE, Nardi AE. Postural balance in patients with social anxiety disorder. Braz J Med Biol Res 2011; 45:38-42. [PMID: 22086467 PMCID: PMC3854136 DOI: 10.1590/s0100-879x2011007500155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 10/31/2011] [Indexed: 11/22/2022] Open
Abstract
Body stability is controlled by the postural system and can be affected by fear and anxiety. Few studies have addressed freezing posture in psychiatric disorders. The purpose of the present study was to assess posturographic behavior in 30 patients with social anxiety disorder (SAD) and 35 without SAD during presentation of blocks of pictures with different valences. Neutral images consisted of objects taken from a catalog of pictures, negative images were mutilation pictures and anxiogenic images were related to situations regarding SAD fears. While participants were standing on a force platform, similar to a balance, displacement of the center of pressure in the mediolateral and anteroposterior directions was measured. We found that the SAD group exhibited a lower sway area and a lower velocity of sway throughout the experiment independent of the visual stimuli, in which the phobic pictures, a stimulus associated with a defense response, were unable to evoke a significantly more rigid posture than the others. We hypothesize that patients with SAD when entering in a situation of exposure, from the moment the pictures are presented, tend to move less than controls, remaining this way until the experiment ends. This discrete body manifestation can provide additional data to the characterization of SAD and its differentiation from other anxiety disorders, especially in situations regarding facing fear.
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Affiliation(s)
- M N Levitan
- Laboratório do Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Nardi AE, Valença AM, Freire RC, Mochcovitch MD, Amrein R, Sardinha A, Levitan MN, Nascimento I, de-Melo-Neto VL, King AL, de O E Silva AC, Veras AB, Dias GP, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine. Braz J Med Biol Res 2011. [PMID: 21344132 DOI: 10.1590/s0100‐879x2011007500020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
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Affiliation(s)
- A E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
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Nardi AE, Valença AM, Freire RC, Mochcovitch MD, Amrein R, Sardinha A, Levitan MN, Nascimento I, de-Melo-Neto VL, King AL, de O E Silva AC, Veras AB, Dias GP, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine. Braz J Med Biol Res 2011; 44:366-73. [PMID: 21344132 DOI: 10.1590/s0100-879x2011007500020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 02/03/2011] [Indexed: 11/22/2022]
Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
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Affiliation(s)
- A E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
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Martín-Santos R, Fagundo AB, Crippa JA, Atakan Z, Bhattacharyya S, Allen P, Fusar-Poli P, Borgwardt S, Seal M, Busatto GF, McGuire P. Neuroimaging in cannabis use: a systematic review of the literature. Psychol Med 2010; 40:383-398. [PMID: 19627647 DOI: 10.1017/s0033291709990729] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We conducted a systematic review to assess the evidence for specific effects of cannabis on brain structure and function. The review focuses on the cognitive changes associated with acute and chronic use of the drug. METHOD We reviewed literature reporting neuroimaging studies of chronic or acute cannabis use published up until January 2009. The search was conducted using Medline, EMBASE, LILACS and PsycLIT indexing services using the following key words: cannabis, marijuana, delta-9-tetrahydrocannabinol, THC, cannabidiol, CBD, neuroimaging, brain imaging, computerized tomography, CT, magnetic resonance, MRI, single photon emission tomography, SPECT, functional magnetic resonance, fMRI, positron emission tomography, PET, diffusion tensor MRI, DTI-MRI, MRS and spectroscopy. RESULTS Sixty-six studies were identified, of which 41 met the inclusion criteria. Thirty-three were functional (SPECT/PET/fMRI) and eight structural (volumetric/DTI) imaging studies. The high degree of heterogeneity across studies precluded a meta-analysis. The functional studies suggest that resting global and prefrontal blood flow are lower in cannabis users than in controls. The results from the activation studies using a cognitive task are inconsistent because of the heterogeneity of the methods used. Studies of acute administration of THC or marijuana report increased resting activity and activation of the frontal and anterior cingulate cortex during cognitive tasks. Only three of the structural imaging studies found differences between users and controls. CONCLUSIONS Functional neuroimaging studies suggest a modulation of global and prefrontal metabolism both during the resting state and after the administration of THC/marijuana cigarettes. Minimal evidence of major effects of cannabis on brain structure has been reported.
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Affiliation(s)
- R Martín-Santos
- Section of Neuroimaging, PO67 Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK.
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Bhattacharyya S, Crippa JA, Martin-Santos R, Winton-Brown T, Fusar-Poli P. Imaging the neural effects of cannabinoids: current status and future opportunities for psychopharmacology. Curr Pharm Des 2009; 15:2603-14. [PMID: 19689331 DOI: 10.2174/138161209788957465] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although recreational and medicinal use of cannabis has been known for many centuries, it is only in recent decades that it has again attracted considerable systematic attention because of its adverse psychological and potential beneficial effects. This has also been prompted by better understanding of the molecular targets of cannabinoids in the living organism. While cannabis has attracted the attention of mental health professionals because of accumulating evidence linking regular frequent use of cannabis to psychotic disorders like schizophrenia, neuroscientists and pharmacologists have focused their attention on the potential beneficial effects of cannabinoids in neuropsychiatric diseases. However, evidence regarding the neurobiological basis of these adverse psychological or potential beneficial effects has been mainly derived from pre-clinical research. Developments in neuroimaging modalities now offer the unique opportunity to examine in vivo how the different cannabinoids may act on the human brain to mediate their effects. In this review, we focus on research investigating the effects of cannabinoids in the human brain using neuroimaging techniques and explore how this adds to the current understanding about the pathophysiological correlates of psychotic disorders and points towards newer therapeutic candidates for psychotic and anxiety disorders. Further, we also discuss how combining neuroimaging and pharmacological challenge with cannabinoids may open up newer avenues for target identification and validation in psychopharmacology.
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Affiliation(s)
- S Bhattacharyya
- Section of Neuroimaging, Box PO67, Division of Psychological Medicine & Psychiatry, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.
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Abstract
OBJECTIVE The purpose of this article is to review some of the basic aspects of the dopaminergic system and its role in reward and pleasure behaviour. We also discuss the association between dopamine and unpleasant symptoms that are commonly found in neuropsychiatric disorders and may also be side-effects of neuroleptic drugs. METHOD A computer-based search of the literature, augmented by extensive bibliography-guided article reviews, were used to find basic information on the dopamine and the reward systems, and symptoms such as dysphoria, anhedonia and depression. RESULTS Central dopaminergic neurotransmission is complex, having multiple actions at each level of the mesocorticolimbic reward pathway. The role of dopamine in the reward process was classically associated with the ability to experience pleasure; recent data suggest a more motivational role. Dysfunction of the dopamine transmission in the reward circuit is associated with symptoms such as anhedonia, apathy and dysphoria found in several neuropsychiatric disorders, including Parkinson's disease, depression, drug addiction, and neuroleptic-induced dysphoria. CONCLUSION Viewing the dysfunctions of the reward pathways within a broader spectrum and exploring its complex relations with the dopaminergic transmission may help understand the pathophysiology of these neuropsychiatric disorders and lead to a rational development of novel treatments.
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Affiliation(s)
- R A Bressan
- Interdisciplinary Lab of Neuroimaging and Cognition (LiNC), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil.
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Bressan RA, Crippa JA. The role of dopamine in reward and pleasure behaviour--review of data from preclinical research. Acta Psychiatr Scand Suppl 2005. [PMID: 15877719 DOI: 10.1111/j.l600-0447.2005.00540.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The purpose of this article is to review some of the basic aspects of the dopaminergic system and its role in reward and pleasure behaviour. We also discuss the association between dopamine and unpleasant symptoms that are commonly found in neuropsychiatric disorders and may also be side-effects of neuroleptic drugs. METHOD A computer-based search of the literature, augmented by extensive bibliography-guided article reviews, were used to find basic information on the dopamine and the reward systems, and symptoms such as dysphoria, anhedonia and depression. RESULTS Central dopaminergic neurotransmission is complex, having multiple actions at each level of the mesocorticolimbic reward pathway. The role of dopamine in the reward process was classically associated with the ability to experience pleasure; recent data suggest a more motivational role. Dysfunction of the dopamine transmission in the reward circuit is associated with symptoms such as anhedonia, apathy and dysphoria found in several neuropsychiatric disorders, including Parkinson's disease, depression, drug addiction, and neuroleptic-induced dysphoria. CONCLUSION Viewing the dysfunctions of the reward pathways within a broader spectrum and exploring its complex relations with the dopaminergic transmission may help understand the pathophysiology of these neuropsychiatric disorders and lead to a rational development of novel treatments.
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Affiliation(s)
- R A Bressan
- Interdisciplinary Lab of Neuroimaging and Cognition (LiNC), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil.
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Uchida RR, Del-Ben CM, Santos AC, Araújo D, Crippa JA, Guimarães FS, Graeff FG. Decreased left temporal lobe volume of panic patients measured by magnetic resonance imaging. Braz J Med Biol Res 2003; 36:925-9. [PMID: 12845380 DOI: 10.1590/s0100-879x2003000700014] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Reported neuroimaging studies have shown functional and morphological changes of temporal lobe structures in panic patients, but only one used a volumetric method. The aim of the present study was to determine the volume of temporal lobe structures in patients with panic disorder, measured by magnetic resonance imaging. Eleven panic patients and eleven controls matched for age, sex, handedness, socioeconomic status and years of education participated in the study. The mean volume of the left temporal lobe of panic patients was 9% smaller than that of controls (t21 = 2.37, P = 0.028). In addition, there was a trend (P values between 0.05 and 0.10) to smaller volumes of the right temporal lobe (7%, t21 = 1.99, P = 0.06), right amygdala (8%, t21 = 1.83, P = 0.08), left amygdala (5%, t21 = 1.78, P = 0.09) and left hippocampus (9%, t21 = 1.93, P = 0.07) in panic patients compared to controls. There was a positive correlation between left hippocampal volume and duration of panic disorder (r = 0.67, P = 0.025), with recent cases showing more reduction than older cases. The present results show that panic patients have a decreased volume of the left temporal lobe and indicate the presence of volumetric abnormalities of temporal lobe structures.
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Affiliation(s)
- R R Uchida
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Crippa JA, Sanches RF, Hallak JE, Loureiro SR, Zuardi AW. A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience. Acta Psychiatr Scand 2001; 103:465-70. [PMID: 11401662 DOI: 10.1034/j.1600-0447.2001.00185.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the beneficial impact of a structured interview on the reliability of BPRS ratings in raters with low clinical experience. METHOD Each patient was rated once a week in two separate interviews, conducted on the same day. The first interview was conducted by a rater with low clinical experience (recruited from a group of five residents in psychiatry and one clinical psychologist in training). All second interviews were conducted by the same highly experienced psychiatrist. RESULTS The number of items with full agreement between observers increased with the use of SIG. The value of intraclass correlation coefficients for individual items and the total score also increased, approaching reported studies with experienced raters. CONCLUSION These results suggest that the use of SIG reduces variability of information gathering in reliability testing of BPRS with less experienced raters.
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Affiliation(s)
- J A Crippa
- Department of Neuropsychiatry and Medical Psychology, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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