Environmental stress-induced functional modification of the central benzodiazepine binding site

The central benzodiazepine binding site mediates the therapeutically relevant pharmacologic actions of benzodiazepine agonists, including reducing anxiety, sedation, muscle relaxation, and antagonism of seizure production. Benzodiazepines potentiate the ability of gamma-aminobutyric acid (GABA) to promote membrane chloride ion conductance by binding reversibly to a distinct site on the GABAA receptor complex. Although the role of this central benzodiazepine binding site in mediating the pharmacologic actions of benzodiazepine agonists has been shown conclusively, its participation in an animal's response to stress is less certain. Data are reviewed consistent with an environmental stress-induced modification of the structure and function of the central benzodiazepine binding site. Modifications show brain anatomic regional selectivity. The mechanisms of these modifications include rapid enzyme-mediated phosphorylations of the GABAA receptor complex and the selective transcription of individual polypeptide subunits. The potential relevance of the data on environmental stress-induced functional modifications of the central benzodiazepine binding site to the development of newer medications and improved understanding of the pathophysiology of stress-related neuropsychiatric disorders is discussed.

Allosteric effects of a GABA receptor-active steroid are altered by stress

Recently, ring A reduced metabolites of naturally occurring steroids have been shown to act as allosteric modulators of GABA-gated chloride ion conductance. Specifically, 5 alpha-pregnane-3 alpha,21-diol-20-one (allotetrahydrodeoxycorticosterone; 5 alpha-THDOC) was shown to be a positive allosteric effector. For example, 5 alpha-THDOC enhances the specific binding of [3H]flunitrazepam, a benzodiazepine receptor agonist, among other pharmacological actions. Swim stress has been shown to reduce the ability of flurazepam, a prototypic benzodiazepine agonist, to antagonize the electrical precipitation of tonic hindlimb extension in mice. This stress-induced reduction in flurazepam's antiseizure efficacy persists for up to 72 h and is associated with alterations in the specific binding of ligands to the GABAA receptor complex. In the current study, the potentiation of [3H]flunitrazepam binding by 5 alpha-THDOC was greater in cerebral cortical membranes prepared from stressed mice compared with unstressed controls. Moreover, nanomolar concentrations of 5 alpha-THDOC that were ineffective in potentiating the specific binding of [35S]TBPS in cerebral cortical membranes prepared from unstressed control mice were capable of potentiating this binding in membranes prepared from stressed animals. Specifically, 50 nM 5 alpha-THDOC caused a 23% increase in the specific binding of [35S]TBPS in membranes from stressed mice, whereas it was without any significant effect in unstressed controls. This apparent ability of 5 alpha-THDOC to distinguish between the binding of [35S]TBPS to crude membranes prepared from stressed and unstressed control mice was eliminated in the presence of a 5 microM concentration of GABA.(ABSTRACT TRUNCATED AT 250 WORDS)

Saccadic distractibility in cocaine dependent patients: a preliminary laboratory exploration of the cocaine-OCD hypothesis

Epidemiologic Cachment Area Survey (ECAS) results suggest that cocaine abusing patients are at increased risk for the later development of Obsessive Compulsive Disorder (OCD), and a need for attention in laboratory and clinical research to the 'cocaine-OCD hypothesis' has been described. Analysis of the ECAS data, however, could not rule out the possibility of a 'distinctive OCD-like syndrome' related to cocaine use. Such an OCD-like syndrome in cocaine dependent individuals has been recently described, where some cocaine dependent patients compulsively forage for cocaine, especially after a cocaine binge. To further explore a possible relationship between cocaine dependence and OCD, the performance on an antisaccade task of 32 cocaine dependent individuals was compared to a group of 15 individuals without neuropsychiatric or substance abusing histories. OCD patients have been described as having a greater frequency of reflexive glances (i.e., increased saccadic distractibility) during the antisaccade task than normals. No statistically significant differences in antisaccade performance were observed between the cocaine dependent patients and a normal comparison group. However, when the cocaine using group was divided into those endorsing and those not endorsing significant cocaine-induced compulsive foraging, statistically significant differences emerged. Cocaine-induced compulsive foragers had the poorest antisaccade performance. While the small sample sizes and the lack of an OCD control group limit the conclusions that can be drawn from the present study, the results seem to suggest that a cocaine-OCD link might be particularly relevant for those cocaine addicts endorsing compulsive foraging.

A glycinergic intervention potentiates the antiseizure efficacies of MK-801, flurazepam, and carbamazepine

Twenty four hours after mice were forced to swim for up to 10 minutes in cold water, there was a reduction in the ability of MK-801 to antagonize the electrical precipitation of tonic hindlimb extension. Milacemide, a lipophilic prodrug of glycine, restored the antiseizure efficacy of MK-801 to the same level observed in unstressed animals treated with milacemide and MK-801. Stimulation of the glycine-gated chloride ionophore subsequent to the liberation of free glycine could explain milacemide's pharmacologic action as an adjuvant to MK-801. Consistent with this interpretation, milacemide was able to potentiate the antiseizure effects of flurazepam, a benzodiazepine agonist, in stressed and unstressed mice and carbamazepine in unstressed animals. D-cycloserine, a partial glycine agonist with greater specificity for the strychnine-insensitive modulatory site on the NMDA receptor complex, was examined for its effect on MK-801's antiseizure efficacy. At a high dose (320 mg/kg), D-cycloserine alone had an anticonvulsant effect. Moreover, this dose of D-cycloserine administered with MK-801 showed a significantly greater anticonvulsant efficacy than MK-801 alone. The data support the development of glycinergic interventions as adjunctive agents in the pharmacotherapy of seizure disorders.

L-tyrosine pharmacotherapy of schizophrenia: preliminary data

The utility of L-tyrosine (10 g/day in four divided doses) as an adjuvant to molindone (150 mg/day) in the treatment of schizophrenia was investigated using a placebo-controlled, double-blind crossover design (3 weeks on L-tyrosine, 3 weeks on placebo). The objective of this inpatient study was to increase dopaminergic neural transmission along mesocortical projections in patients by increasing the precursor availability of L-tyrosine for dopamine biosynthesis. Theoretically, this approach might lessen both negative and positive symptoms of schizophrenia and improve frontal lobe-mediated neuropsychological performance. There was no evidence of statistically significant improvement conferred by L-tyrosine as measured by weekly Brief Psychiatric Rating Scale (BPRS), Schedule for the Assessment of Negative Symptoms (SANS), or Clinical Global Impressions (CGI) scales. The 12-h trough plasma level of L-tyrosine was significantly higher in all patients during the L-tyrosine phase of the study (t = -3.9, df = 20, p = 0.0009). At the end of each 3-week study period, no significant differences could be found in Wisconsin Card Sorting Test (WCST) or memory test performance. Smooth-pursuit eye movement (SPEM) performance had significantly more saccadic intrusions during the L-tyrosine supplementation phase compared to the placebo period. This increase in saccades during SPEM suggests that the tyrosine supplementation might have had some central effect.

Molecular, functional and biochemical characteristics of the dopamine transporter: regional differences and clinical relevance

The carrier molecule that transports dopamine (DA) across the synaptic membrane is known as the dopamine transporter (DAT). Depending on the ionic conditions, DAT may function as a mediator of both the inward directed DA transport known as the "reuptake" and the outward directed DA transport known as the "release." The functional significance of DAT is in the regulation of DA neurotransmission by terminating the action of DA in the synapse via reuptake. With use of DAT binding as a presynaptic marker to measure altered DA innervation, abnormalities of the DAT binding have been demonstrated in idiopathic Parkinson's disease, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) neurotoxicity, and progressive supranuclear palsy. Moreover, the identification of DAT as the neuronal element that mediates the addictive properties of cocaine highlights its significance in cocaine addiction. Cocaine binding in the brain is heterogeneous, and there is an uneven distribution of the high- and low-affinity binding sites across the anatomical regions. Regional differences in ligand binding are observed by using both [3H]cocaine and the diphenyl-substituted piperazine derivatives known as the "GBR series" of ligands. The identification of compounds that inhibit the binding of medications for cocaine abuse. Furthermore, clarification of the various binding domains that may be relevant to transporter function in human neuropsychiatric disorders may lead to the development of new medications for schizophrenia, Tourette's disease, and drug addiction.

Famotidine adjunctive pharmacotherapy for schizophrenia: preliminary data

The usefulness of the histamine-2 (H2) antagonist famotidine as an adjunct to conventional antipsychotic treatments of idiopathic psychotic disorders (i.e., schizophrenia and schizoaffective disorder) was investigated in an open-label study. After stabilization for at least 1 week with their conventional antipsychotic medication regimen, 10 patients completed a 3-week study period in which famotidine (20 mg twice a day) was added as an adjunctive medication. The 10 patients were all somewhat treatment refractory and had spent a mean of 230 days of the previous 2 years in the hospital. Total Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression scores were significantly lower during the 3 weeks with famotidine compared with the week before and after its administration. Nevertheless, review of the scores revealed that the magnitude of the changes were small. Negative symptoms as measured by the Schedule for the Assessment of Negative Symptoms (SANS) were not significantly different during famotidine treatment, although there was the tendency for total SANS scores to be lower during famotidine treatment. When BPRS items were divided into specific versus nonspecific symptom subscales, only the specific-item subscales had significantly improved during famotidine treatment. The results of this study suggest that famotidine might prove a useful adjunctive agent in certain patients with schizophrenia. Future studies using a double-blind placebo-controlled design and higher doses are needed. Additionally, other H2 receptor antagonists with better penetration across the blood-brain barrier should be pursued.

Discriminative stimulus properties of midazolam are shared by a GABA-receptor positive steroid

3-Alpha-5-alpha-tetrahydrodeoxycorticosterone (alloTHDOC) is a 3-alpha ring A-reduced metabolite of deoxycorticosterone that has been shown to act via nongenomic mechanisms to modulate the GABAA receptor complex allosterically in vitro. Moreover, there are behavioral data consistent with the anxiolytic actions of GABA-receptor positive steroids. The drug discrimination paradigm was used in rats to demonstrate that effects of alloTHDOC are mediated by the GABAA receptor complex in the intact animal. In rats trained to discriminate 1.8 mg/kg of midazolam from saline, alloTHDOC substituted for the training stimulus.

Positive and negative symptoms of schizophrenia as predictors of length of military service: a retrospective study

Forty-three chronic schizophrenic veterans had negative symptom, positive symptom, and smooth pursuit eye movement evaluations to determine if the severity of impairment in these dimensions could retrospectively predict their length of military service. For the entire patient group, there was a strong trend for severity of negative symptoms to predict the length of military service (p = 0.055). However, different associations for these variables emerged when the patients were divided into groups with more or less than 2 years of service. The length of military service might serve as a type of "filter" that meaningfully separates out different subtypes of schizophrenic veterans.

Swim stress selectively alters the specific binding of a benzodiazepine antagonist in mice

The ability of flurazepam to antagonize the electrical precipitation of tonic hindlimb extension is reduced 24 h after mice are forced to swim for 10 min in cold water (6 degrees C). Presumably, this reduction in flurazepam's antiseizure efficacy reflects an environmental stress-induced modification of the GABAA receptor complex. The current study employed a variety of complementary in vitro approaches to characterize the delayed effects of cold-water swim stress on binding parameters of the GABAA receptor complex that may be associated with flurazepam's reduced antiseizure efficacy. The specific binding of [3H]flunitrazepam and the potentiation of this binding by chloride ions did not change after stress in the cerebral cortex, hippocampus, and cerebellum. Moreover, swim stress did not alter the ability of GABA to inhibit the binding of [35S]t-butylbicyclophosphorothionate (TBPS), a ligand that is a specific biochemical marker of the GABA-associated chloride ionophore, to crude membranes prepared from the cerebral cortex and cerebellum. Swim stress was associated with alterations of the specific binding of [3H]Ro 15-1788, a benzodiazepine receptor antagonist, to crude hippocampal and cerebellar membranes. The results are considered in the context of new insights derived from molecular cloning studies of the GABAA receptor complex.

Differentiation between MK-801- and apomorphine-induced stereotyped behaviors in mice

The ability of phencyclidine (PCP) to model schizophreniform psychosis is believed to be related to its ability to produce both hypoglutamatergia and hyperdopaminergia. As such, identification of PCP-stimulated behaviors may be important for the development of animal models of schizophrenia. In this study, MK-801 [(+)-5-methyl-10,11-dihydro-5H- dibenzo[a,d]cycloheptane-5,10-imine maleate], a high-affinity PCP analogue, was administered to mice in order to stimulate "PCP behaviors." These PCP behaviors were compared with behaviors stimulated by apomorphine, a dopamine agonist. Stereotyped behavior was assessed by both visual observations and automated measurements. Visual observations showed highly intense gnawing and sniffing in apomorphine-treated mice and the absence of gnawing in MK-801-treated mice. Automated stereotypic measures showed that, compared with vehicle-treated controls, there were frequent dissociations between MK-801 and apomorphine. Conceivably, a compound that attenuates PCP-stimulated behaviors while sparing apomorphine-stimulated behaviors would possess both antipsychotic efficacy and be devoid of undesirable side effects associated with dopamine blockade.

Measurement of an explosive behavior in the mouse, induced by MK-801, a PCP analogue

MK-801, a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor complex that binds with high-affinity to the phencyclidine (PCP) binding site, stimulated an outbred strain of NIH Swiss mice to display discrete episodes of explosive jumping behavior, designated as "popping." The episodes of this behavior were characterized with respect to their dose dependency, latency, and duration. The number of mice displaying this behavior increased with increasing doses of MK-801. The intensity of the popping behavior was sensitive to dose-dependent inhibition by haloperidol, a conventional antipsychotic medication, and clozapine, an atypical antipsychotic medication. In view of PCP's ability to precipitate a schizophreniform psychosis in humans, the behavior may serve as a useful preclinical paradigm for the screening of potentially novel antipsychotic medications.

Correlation between antisaccade and Wisconsin Card Sorting Test performance in schizophrenia

In 27 patients with chronic schizophrenia, there was a significant correlation between performance on an antisaccade eye movement task and on the Wisconsin Card Sorting Test. A significant correlation was not obtained between antisaccade task performance and scores on the modified Mini-Mental State examination or the Schedule for the Assessment of Negative Symptoms in Schizophrenia. In addition, patients' antisaccade task performance was impaired compared with that of 12 normal subjects.

Transient compulsive foraging behavior associated with crack cocaine use

Compulsive foraging behavior associated with use of crack cocaine involves compulsively searching the environment for possibly misplaced pieces of crack. Of 41 crack cocaine addicts evaluated, 33 (80.5%) reported at least some compulsive foraging associated with use of crack; 21 (51.2%) reported such behavior as always associated with crack use. The mean length of time spent in compulsive foraging was 90 minutes. Cocaine-induced foraging may represent a drug-induced model of a type of compulsive behavior.

Limits of the processing view in accounting for dissociations among memory measures in a clinical population

In three experiments, we examined the performance of patients with schizophrenia on implicit and explicit memory tests that have been shown to involve predominantly data-driven or predominantly conceptually driven processes. In Experiment 1, we compared the implicit tests of category production (conceptually driven) and word identification (data driven) and found that schizophrenic patients' performance on these tests did not differ from that of normal subjects. In Experiment 2, a comparison of the category-production and explicit cued-recall tests, both of which involve conceptual processes, showed that schizophrenic patients were impaired on the cued-recall test but not on the category-production test. In Experiment 3, a comparison of the word-identification and explicit graphemic cued-recall tests, both of which involve data-driven processes, showed that patients were impaired on the cued-recall test but not on the word-identification test. The results of both Experiments 2 and 3 revealed a dissociation between implicit and explicit test performance under conditions in which the two tests involve similar types of processes. These results support theoretical views that distinguish implicit from explicit modes of retrieval.

GABA-active steroids: endogenous modulators of GABA-gated chloride ion conductance

Naturally occurring 3-alpha-hydroxy ring A-reduced metabolites of progesterone and deoxycorticosterone and their synthetic analogues bind to specific sites within the hydrophobic channel domain of the GABAA receptor complex. Acting at these sites, these ligands function as positive allosteric effectors of the complex; they potentiate GABA-stimulated membrane chloride ion conductance, enhance the binding of [3H]muscimol and [3H]flunitrazepam, and displace the binding of [35S]t-butylbicyclophosphorothionate ([35S]TBPS), a channel ligand that is a specific marker of the GABA-associated chloride ionophore. Moreover, steroid metabolites (namely pregnenolone sulfate and dehydroepiandrosterone sulfate) have been identified that display properties of GABA-negative allosteric effectors. The identification of this membrane-associated steroid binding should stimulate development of new classes of anxiolytic, sedative-hypnotic, anticonvulsant, anesthetic, and muscle-relaxant medications that may be devoid of many of the side effects associated with benzodiazepines and barbiturates. Also, elucidation of the physiologic role of this binding site should contribute both to our understanding of endogenous mechanisms for modulating inhibitory neurotransmission, and the pathophysiologic role of the GABAA receptor complex in a variety of neuropsychiatric disorders.

Glycinergic interventions potentiate the ability of MK 801 to raise the threshold voltage for tonic hindlimb extension in mice

Milacemide, an acylated prodrug of glycine, was able to increase the efficacy with which [+]-5-methyl-10,11-dihydro-5h-dibenzo[a,d]cyclohepten-5,10-imine meleate (MK 801) antagonized the electrical precipitation of seizures in mice. The mechanism of milacemide's potentiation of MK 801's antiseizure efficacy in intact mice is unclear; however, a glycine agonist selective for the strychnine-insensitive site on the NMDA receptor complex was also able to potentiate MK 801. The exciting possibility exists that an exogenous glycinergic intervention can potentiate NMDA-mediated neural transmission in intact animals.

Reduction of flurazepam's antiseizure efficacy persists after stress

Twenty-four hours after mice were forced to swim for up to 10 min in cold (6 degrees C) water, the ability of flurazepam to antagonize the electrical precipitation of seizures was reduced. This stress-induced reduction in flurazepam's antiseizure efficacy persisted for at least 72 h; but was absent 1 week after the single session of swim stress. The data may be relevant to stress-related psychiatric disorders and suggest that the therapeutic efficacy of benzodiazepines may be altered after a severe stress.

Paradoxical effect of flurazepam

Cold water swim stress has been shown to decrease the ability of flurazepam, a prototypic GABA-positive benzodiazepine, to antagonize the electrical precipitation of seizures in mice. This stress-induced reduction in the antiseizure efficacy of flurazepam is not due to a reduction in the threshold voltage for seizure production. In this study, we examined the effect of treating mice with flurazepam 20 min prior to cold water swim stress on its ability to antagonize electrically precipitated seizures 24 h later. Contrary to our expectation, pretreatment with flurazepam potentiated the stress-induced reduction of its antiseizure efficacy.

Effect of a Low-Tryptophan Diet as an Adjuvant to Conventional Neuroleptic Therapy in Schizophrenia

Eleven patients with DSM-III-R schizophrenia were entered into a 4-day tryptophan (TRP)-deficient diet. The diet lowered total plasma TRP levels in all patients; during the diet phase, there was a greater than 50% reduction in mean total plasma TRP levels from the pre-diet phase. The low-TRP diet improved performance on the Stroop Color and Word Test. These data are especially intriguing in view of the suggestion that a deficit in color-word naming is related to frontal lobe dysfunction and the possible occurrence of frontal lobe abnormalities in patients with schizophrenia. Interestingly, depressive symptomatology did not emerge on the TRP-deficient diet, despite the lowering of total plasma TRP levels. There were statistically significant improvements noted on objective ratings of the severity of psychotic symptomatology; however, these statistical improvements were without obvious clinical significance, as the magnitude of the changes on the behavioral ratings were minimal. The results of this study suggest that there might be some adjuvant potential for a low-TRP diet in the treatment of schizophrenia, and that schizophrenia or antipsychotic medications might offer some protection against the depressive effects of a TRP-deficient diet.

The effects of milacemide on item and source memory

Prior research has shown that memory for facts and items (item memory) and memory for where one has learned these items (source memory) can be dissociated under certain conditions. In this study, we examined the effects of milacemide, a derivative of glycine, on memory for item and source information in healthy young and older adults. These results pointed to a dissociation between source memory and item memory: Milacemide administration seemed to facilitate memory for source information but did not affect recognition memory.