The role of dopamine and endocannabinoid systems in prefrontal cortex development: Adolescence as a critical period

The prefrontal cortex plays a central role in the control of complex cognitive processes including action control and decision making. It also shows a specific pattern of delayed maturation related to unique behavioral changes during adolescence and allows the development of adult cognitive processes. The adolescent brain is extremely plastic and critically vulnerable to external insults. Related to this vulnerability, adolescence is also associated with the emergence of numerous neuropsychiatric disorders involving alterations of prefrontal functions. Within prefrontal microcircuits, the dopamine and the endocannabinoid systems have widespread effects on adolescent-specific ontogenetic processes. In this review, we highlight recent advances in our understanding of the maturation of the dopamine system and the endocannabinoid system in the prefrontal cortex during adolescence. We discuss how they interact with GABA and glutamate neurons to modulate prefrontal circuits and how they can be altered by different environmental events leading to long-term neurobiological and behavioral changes at adulthood. Finally, we aim to identify several future research directions to help highlight gaps in our current knowledge on the maturation of these microcircuits.

Cannabis exposure during adolescence: A uniquely sensitive period for neurobiological effects

Adolescence is a crucial developmental period where neural circuits are refined and the brain is especially vulnerable to external insults. The endocannabinoid (eCB) system undergoes changes during adolescence which affect the way in which it modulates the development of other systems, in particular dopamine circuits, which show protracted development into adolescence. Given the rise of cannabis use by adolescents and young people, as well as variants containing increasingly higher concentrations of THC, it is now crucial to understand the unique effects of adolescent exposure to cannabis on the developing brain and it might shape future adult vulnerabilities to conditions such as psychosis, schizophrenia, addiction and more. Here we discuss the development of the eCB system across the lifespan, how CB1 receptors modulate dopamine release and potential neurobiological and behavioral effects of adolescent THC exposure on the developing brain such as alterations in excitatory/inhibitory balance during this developmental period.

Protein Appetite Drives Macronutrient-Related Differences in Ventral Tegmental Area Neural Activity

Control of protein intake is essential for numerous biological processes as several amino acids cannot be synthesized de novo, however, its neurobiological substrates are still poorly understood. In the present study, we combined in vivo fiber photometry with nutrient-conditioned flavor in a rat model of protein appetite to record neuronal activity in the VTA, a central brain region for the control of food-related processes. In adult male rats, protein restriction increased preference for casein (protein) over maltodextrin (carbohydrate). Moreover, protein consumption was associated with a greater VTA response, relative to carbohydrate. After initial nutrient preference, a switch from a normal balanced diet to protein restriction induced rapid development of protein preference but required extensive exposure to macronutrient solutions to induce elevated VTA responses to casein. Furthermore, prior protein restriction induced long-lasting food preference and VTA responses. This study reveals that VTA circuits are involved in protein appetite in times of need, a crucial process for animals to acquire an adequate amount of protein in their diet.SIGNIFICANCE STATEMENT Acquiring insufficient protein in one's diet has severe consequences for health and ultimately will lead to death. In addition, a low level of dietary protein has been proposed as a driver of obesity as it can leverage up intake of fat and carbohydrate. However, much remains unknown about the role of the brain in ensuring adequate intake of protein. Here, we show that in a state of protein restriction a key node in brain reward circuitry, the VTA, is activated more strongly during consumption of protein than carbohydrate. Moreover, although rats' behavior changed to reflect new protein status, patterns of neural activity were more persistent and only loosely linked to protein status.

Discharges from an early intervention in psychosis service: The effect of patient characteristics on discharge destination

AIM

The present study aimed to determine the influence of demographic and clinical features on the likelihood of patients being discharge to primary vs secondary care. The overarching aim of this service evaluation is to assess factors affecting discharge and determine important modulators of discharge destination to inform care planning in services.

METHOD

Clinical and demographic data were extracted from patient notes of those discharged from the Psychosis Intervention and Early Recovery (PIER) service in Leicestershire between January 2005 and December 2013. A total of 508 records were analysed and logistic regression was used to assess the impact of diagnostic, demographic and other clinical factors on the discharge destination of patients.

RESULTS

Of the 508 patients, 241 (47.44%) had been discharged to primary care and 267 (52.55%) to secondary psychiatric services. The factors which increased the likelihood of patients being discharged to secondary care were diagnoses of enduring psychoses, being referred from inpatient services and longer time spent with the PIER team.

CONCLUSIONS

Diagnosis and duration of treatment were significant predictors of discharge destination. Patients with diagnoses of enduring psychotic illness, were more likely to be discharged to a secondary psychiatric service irrespective of gender, ethnicity and geographical location. These data may suggest the possibility to predict the discharge destination when patients are taken on to the caseload of an early intervention in psychosis (EIP) team and have important implications for psychoeducation, preparing the patient for future after EIP and distribution of resources.