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Arumugham SS, Reddy JYC. Augmentation strategies in obsessive–compulsive disorder. Expert Rev Neurother 2014; 13:187-202; quiz 203. [DOI: 10.1586/ern.12.160] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
PURPOSE OF REVIEW Evidence-based pharmacological interventions for obsessive compulsive disorder (OCD) are targeted mainly at the serotonergic and dopaminergic pathways, and are not always effective. It is timely to review the growing evidence from animal models and clinical research (e.g., brain imaging, genetics) on the role of the glutamatergic system in OCD. RECENT FINDINGS Emerging evidence from both animal models and clinical research (including brain imaging, neurogenetics) supports the glutamatergic system as a potential target for pharmacotherapy in OCD. Although there have been relatively few randomized controlled trials of glutamatergic agents in pediatric or adult OCD to date, there is some work on riluzole, memantine, ketamine, topiramate, lamotrigine, N-acetylcysteine, and D-cycloserine. SUMMARY Given the need for more efficacious treatments in OCD, and given emergent findings on the role of the glutamatergic system in this disorder, there is a need for additional pharmacotherapy trials on glutamatergic agents in OCD. Possible research designs for such trials might include stand-alone approaches, pharmacotherapy augmentation, or psychotherapy augmentation.
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Pallanti S, Grassi G, Cantisani A. Emerging drugs to treat obsessive-compulsive disorder. Expert Opin Emerg Drugs 2013; 19:67-77. [PMID: 24377420 DOI: 10.1517/14728214.2014.875157] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a chronic and disabling neuropsychiatric disorder with a lifetime prevalence of approximately 1 - 2% and a rate of treatment resistance of 40%. Other disorders have been related to OCD and have been grouped together in a separate DSM-5 chapter, hypothesizing the existence of an 'OC spectrum', showing a paradigm shift in the conceptualization of the disorder. AREAS COVERED A review of the most important and recent neurobiological findings that sustain the hypothesis of a more sophisticated model of the disorder is provided, together with a brief overview of the most relevant pharmacological animal models of OCD and its first-line treatments. Current research goals, new compounds tested and the rationale behind the development of these new pharmacologic agents are then explained and reviewed. EXPERT OPINION In the past years, no effective novel compounds have emerged for the treatment of OCD, even if many efforts has been made in the study of its neurobiological underpinnings. Relevant changes in the conceptualization of the disorder, suggested by interesting new neurobiological evidences, may result helpful in the development of new treatments.
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Affiliation(s)
- Stefano Pallanti
- University of Florence, Department of Psychiatry , via delle Gore 2H, 50141 Florence , Italy
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Pereira VS, Casarotto PC, Hiroaki-Sato VA, Sartim AG, Guimarães FS, Joca SRL. Antidepressant- and anticompulsive-like effects of purinergic receptor blockade: involvement of nitric oxide. Eur Neuropsychopharmacol 2013; 23:1769-78. [PMID: 23434291 DOI: 10.1016/j.euroneuro.2013.01.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/27/2012] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
Activation of purinergic receptors by ATP (P2R) modulates glutamate release and the activation of post-synaptic P2R is speculated to induce nitric oxide (NO) synthesis. Increased glutamatergic and nitrergic signaling have been involved in the neurobiology of stress-related psychiatric disorders such as anxiety and depression. Therefore, the aim of this study was to test the effects of two P2R antagonists (PPADS and iso-PPADS) in animals submitted to models predictive of antidepressant-, anxiolytic- and anticompulsive-like effects. Swiss mice receiving PPADS at 12.5mg/kg showed reduced immobility time in the forced swimming test (FST) similarly to the prototype antidepressant imipramine (30mg/kg). This dose was also able to decrease the number of buried marbles in the marble-burying test (MBT), an anticompulsive-like effect. However, no effect was observed in animals submitted to the elevated plus maze (EPM) and to the open field test. The systemic administration of iso-PPADS, a preferential P2XR antagonist, also reduced the immobility time in FST, which was associated to a decrease in NOx levels in the prefrontal cortex. In addition, P2X7 receptor was found co-immunoprecipitated with neuronal nitric oxide synthase (NOS1) in the prefrontal cortex. These results suggest that P2X7, possibly coupled to NOS1, could modulate behavioral responses associated to stress-related disorders and it could be a new target for the development of more effective treatments for affective disorders.
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Affiliation(s)
- Vitor S Pereira
- Department of Pharmacology, School of Medicine, Campus USP, Ribeirão Preto, SP 14049-900, Brazil
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55
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Riluzole as an adjunctive therapy to risperidone for the treatment of irritability in children with autistic disorder: a double-blind, placebo-controlled, randomized trial. Paediatr Drugs 2013; 15:505-14. [PMID: 23821414 DOI: 10.1007/s40272-013-0036-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A hyperglutamatergic state has been shown to play a possible role in the pathophysiology of autistic disorders. Riluzole is a glutamate-modulating agent with neuroprotective properties, which has been shown to have positive effects in many neuropsychiatric disorders. OBJECTIVE The aim of this study was to assess the efficacy and tolerability of riluzole as an adjunctive to risperidone in the treatment of irritability in autistic children who were not optimally responding to previous medications. STUDY DESIGN This was a 10-week, randomized, double-blind, parallel-group, placebo-controlled trial. PARTICIPANTS The study enrolled male and female outpatients aged 5-12 years with a diagnosis of autistic disorder based on the DSM-IV-TR criteria and a score of ≥12 on the Aberrant Behavior Checklist-Community (ABC-C) irritability subscale who had discontinued other medications because of a lack of efficacy. INTERVENTIONS Subjects received riluzole (titrated to 50 or 100 mg/day based on bodyweight) or placebo in addition to risperidone (titrated up to 2 or 3 mg/day based on bodyweight) for 10 weeks. OUTCOME Patients were assessed at baseline, week 5, and week 10. The primary outcome measure was the difference in the change in the ABC-C irritability subscale score from baseline to week 10 between the two groups. We also compared changes in other ABC-C subscale scores and Clinical Global Impressions-Improvement (CGI-I) scale scores between the two groups. RESULTS Forty-nine patients were enrolled in the study, and forty children completed the trial (dropouts: placebo = 4, riluzole = 5). A significantly greater improvement in the study primary outcome (the ABC-C irritability subscale score) was achieved by the riluzole-treated children compared with the placebo group (P = 0.03). Patients in the riluzole group also showed significantly greater improvement on the lethargy/social withdrawal (P = 0.02), stereotypic behavior (P = 0.03), and hyperactivity/non-compliance subscales (P = 0.005), but not on the inappropriate speech subscale (P = 0.20) than patients in the placebo group. Eleven patients in the riluzole group and five patients in the placebo group were classified as responders based on their CGI-I scores [χ(2)(1) = 3.750, P = 0.05]. Children in the riluzole group experienced significantly more increases in their appetite and bodyweight than children in the placebo group by the end of the study. CONCLUSION Riluzole add-on therapy shows several therapeutic outcomes, particularly for improving irritability, in children with autism. However, its add-on to risperidone also results in significantly increased appetite and weight gain.
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Nandhra HS, Murphy CL, Sule A. Novel pharmacological agents targeting memory and cognition in the treatment of anxiety disorders. Hum Psychopharmacol 2013; 28:538-43. [PMID: 24038630 DOI: 10.1002/hup.2348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/23/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study is to review data for several promising novel pharmacological drugs for anxiety disorders and describe how they exert their effects. METHOD We presented a review of the published literature. Online search plus reference list checking was also used. RESULTS The neurobiology of anxiety is overviewed. N-methyl-D-aspartate and beta adrenaline are involved in memory consolidation. We describe studies using memantine, D-cycloserine, propranolol, and riluzole that modulate these pathways. CONCLUSION There are a number of promising new therapies, but these require further studies before they can enter routine clinical practice.
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Affiliation(s)
| | | | - Akeem Sule
- South Essex Partnership Trust and Department of Psychiatry; University of Cambridge; UK
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57
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Singer HS. Motor control, habits, complex motor stereotypies, and Tourette syndrome. Ann N Y Acad Sci 2013; 1304:22-31. [DOI: 10.1111/nyas.12281] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Grados MA, Specht MW, Sung HM, Fortune D. Glutamate drugs and pharmacogenetics of OCD: a pathway-based exploratory approach. Expert Opin Drug Discov 2013; 8:1515-27. [PMID: 24147578 DOI: 10.1517/17460441.2013.845553] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Neuropharmacology research in glutamate-modulating drugs supports their development and use in the management of neuropsychiatric disorders, including major depression, Alzheimer's disorder and schizophrenia. Concomitantly, there is a growing use of these agents used in the treatment of obsessive-compulsive disorder (OCD). AREAS COVERED This article provides a review of glutamate-modulating drugs used in the treatment of OCD. Specifically, the authors examine riluzole, N-acetylcysteine, d-cycloserine, glycine, ketamine, memantine and acamprosate as treatments. Furthermore, recent genetic epidemiology research findings are presented with a focus on the positional candidate genes SLC1A1 (a glutamate transporter), ADAR3 (an RNA-editing enzyme), RYR3 (a Ca(2+) channel), PBX1 (a homeobox transcription factor) and a GWAS candidate gene, DLGAP1 (a protein interacting with post-synaptic density). These genetic findings are submitted to a curated bioinformatics database to conform a biological network for discerning potential pharmacological targets. EXPERT OPINION In the genetically informed network, known genes and identified key connecting components, including DLG4 (a developmental gene), PSD-95 (a synaptic scaffolding protein) and PSEN1 (presenilin, a regulator of secretase), conform a group of potential pharmacological targets. These potential targets can be explored, in the future, to deliver new therapeutic approaches to OCD. There is also the need to develop a better understanding of neuroprotective mechanisms as a foundation for future OCD drug discovery.
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Affiliation(s)
- Marco A Grados
- Johns Hopkins University School of Medicine , 1800 Orleans St. - 12th floor, Baltimore, MD 21287 , USA +1 443 287 2291 ; +1 410 955 8691 ;
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59
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Palmer E, Fuller M. Obsessive-compulsive disorder in pediatrics and adolescents: Review of treatment and future directions. Ment Health Clin 2013. [DOI: 10.9740/mhc.n155509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder associated with significant morbidity, and found at a relatively high overall prevalence in the pediatric and adolescent population. This article reviews the treatment of OCD in pediatrics and adolescents.
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Affiliation(s)
- Emma Palmer
- 1 PGY2 Psychiatric Pharmacy Resident, Louis Stokes Cleveland VAMC
| | - Matthew Fuller
- 2 Clinical Pharmacy Specialist- Psychiatry PGY2 Psychiatric Pharmacy Residency Program Director, Louis Stokes Cleveland VAMC
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Abstract
This paper provides a selective overview of the past, present and future of pediatric psychopharmacology. The acceptance of medication use in child psychiatry was based on the results of double-blind, placebo-controlled trials documenting the efficacy of drug treatments for attention-deficit/hyperactivity disorder, enuresis, depression, anxiety disorders, obsessive-compulsive disorder and psychoses. This period of success was followed by a series of challenges, including a growing awareness of the long-term adverse effects of medications and of the inadequacy of long-term drug surveillance. There is great concern today that children are being overtreated with medication, especially in the US. Further advances in pediatric psychopharmacology may come from examination of large medical data sets including both pharmacological and psychiatric information, which could lead to drug repurposing, as well as from preclinical translational studies such as those using human induced pluripotent stem cells.
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Affiliation(s)
- Judith L. Rapoport
- Child Psychiatry Branch, National Institute of Mental Health; Bethesda; MD; USA
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Stewart SE, Mayerfeld C, Arnold PD, Crane JR, O'Dushlaine C, Fagerness JA, Yu D, Scharf JM, Chan E, Kassam F, Moya PR, Wendland JR, Delorme R, Richter MA, Kennedy JL, Veenstra-VanderWeele J, Samuels J, Greenberg BD, McCracken JT, Knowles JA, Fyer AJ, Rauch SL, Riddle MA, Grados MA, Bienvenu OJ, Cullen B, Wang Y, Shugart YY, Piacentini J, Rasmussen S, Nestadt G, Murphy DL, Jenike MA, Cook EH, Pauls DL, Hanna GL, Mathews CA. Meta-analysis of association between obsessive-compulsive disorder and the 3' region of neuronal glutamate transporter gene SLC1A1. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:367-79. [PMID: 23606572 DOI: 10.1002/ajmg.b.32137] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/15/2013] [Indexed: 12/12/2022]
Abstract
The neuronal glutamate transporter gene SLC1A1 is a candidate gene for obsessive-compulsive disorder (OCD) based on linkage studies and convergent evidence implicating glutamate in OCD etiology. The 3' end of SLC1A1 is the only genomic region with consistently demonstrated OCD association, especially when analyzing male-only probands. However, specific allele associations have not been consistently replicated, and recent OCD genome-wide association and meta-analysis studies have not incorporated all previously associated SLC1A1 SNPs. To clarify the nature of association between SLC1A1 and OCD, pooled analysis was performed on all available relevant raw study data, comprising a final sample of 815 trios, 306 cases and 634 controls. This revealed weak association between OCD and one of nine tested SLC1A1 polymorphisms (rs301443; uncorrected P = 0.046; non-significant corrected P). Secondary analyses of male-affecteds only (N = 358 trios and 133 cases) demonstrated modest association between OCD and a different SNP (rs12682807; uncorrected P = 0.012; non-significant corrected P). Findings of this meta-analysis are consistent with the trend of previous candidate gene studies in psychiatry and do not clarify the putative role of SLC1A1 in OCD pathophysiology. Nonetheless, it may be important to further examine the potential associations demonstrated in this amalgamated sample, especially since the SNPs with modest associations were not included in the more highly powered recent GWAS or in a past meta-analysis including five SLC1A1 polymorphisms. This study underscores the need for much larger sample sizes in future genetic association studies and suggests that next-generation sequencing may be beneficial in examining the potential role of rare variants in OCD.
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Affiliation(s)
- S E Stewart
- McLean Hospital, Belmont, Massachusetts, USA.
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Isoforms of the neuronal glutamate transporter gene, SLC1A1/EAAC1, negatively modulate glutamate uptake: relevance to obsessive-compulsive disorder. Transl Psychiatry 2013; 3:e259. [PMID: 23695234 PMCID: PMC3669922 DOI: 10.1038/tp.2013.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The SLC1A1 gene, which encodes the neuronal glutamate transporter, EAAC1, has consistently been implicated in obsessive-compulsive disorder (OCD) in genetic studies. Moreover, neuroimaging, biochemical and clinical studies support a role for glutamatergic dysfunction in OCD. Although SLC1A1 is an excellent candidate gene for OCD, little is known about its regulation at the genomic level. Here, we report the identification and characterization of three alternative SLC1A1/EAAC1 mRNAs: a transcript derived from an internal promoter, termed P2 to distinguish it from the transcript generated by the primary promoter (P1), and two alternatively spliced mRNAs: ex2skip, which is missing exon 2, and ex11skip, which is missing exon 11. All isoforms inhibit glutamate uptake from the full-length EAAC1 transporter. Ex2skip and ex11skip also display partial colocalization and interact with the full-length EAAC1 protein. The three isoforms are evolutionarily conserved between human and mouse, and are expressed in brain, kidney and lymphocytes under nonpathological conditions, suggesting that the isoforms are physiological regulators of EAAC1. Moreover, under specific conditions, all SLC1A1 transcripts were differentially expressed in lymphocytes derived from subjects with OCD compared with controls. These initial results reveal the complexity of SLC1A1 regulation and the potential clinical utility of profiling glutamatergic gene expression in OCD and other psychiatric disorders.
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63
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Campos AC, Moreira FA, Gomes FV, Del Bel EA, Guimarães FS. Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. Philos Trans R Soc Lond B Biol Sci 2013; 367:3364-78. [PMID: 23108553 DOI: 10.1098/rstb.2011.0389] [Citation(s) in RCA: 276] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cannabidiol (CBD) is a major phytocannabinoid present in the Cannabis sativa plant. It lacks the psychotomimetic and other psychotropic effects that the main plant compound Δ(9)-tetrahydrocannabinol (THC) being able, on the contrary, to antagonize these effects. This property, together with its safety profile, was an initial stimulus for the investigation of CBD pharmacological properties. It is now clear that CBD has therapeutic potential over a wide range of non-psychiatric and psychiatric disorders such as anxiety, depression and psychosis. Although the pharmacological effects of CBD in different biological systems have been extensively investigated by in vitro studies, the mechanisms responsible for its therapeutic potential are still not clear. Here, we review recent in vivo studies indicating that these mechanisms are not unitary but rather depend on the behavioural response being measured. Acute anxiolytic and antidepressant-like effects seem to rely mainly on facilitation of 5-HT1A-mediated neurotransmission in key brain areas related to defensive responses, including the dorsal periaqueductal grey, bed nucleus of the stria terminalis and medial prefrontal cortex. Other effects, such as anti-compulsive, increased extinction and impaired reconsolidation of aversive memories, and facilitation of adult hippocampal neurogenesis could depend on potentiation of anandamide-mediated neurotransmission. Finally, activation of TRPV1 channels may help us to explain the antipsychotic effect and the bell-shaped dose-response curves commonly observed with CBD. Considering its safety profile and wide range of therapeutic potential, however, further studies are needed to investigate the involvement of other possible mechanisms (e.g. inhibition of adenosine uptake, inverse agonism at CB2 receptor, CB1 receptor antagonism, GPR55 antagonism, PPARγ receptors agonism, intracellular (Ca(2+)) increase, etc.), on CBD behavioural effects.
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Affiliation(s)
- Alline Cristina Campos
- Group of Neuroimmunology, Laboratory of Immunopharmacology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Murphy DL, Moya PR, Fox MA, Rubenstein LM, Wendland JR, Timpano KR. Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120435. [PMID: 23440468 DOI: 10.1098/rstb.2012.0435] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Individuals with obsessive-compulsive disorder (OCD) have also been shown to have comorbid lifetime diagnoses of major depressive disorder (MDD; rates greater than 70%), bipolar disorder (rates greater than 10%) and other anxiety disorders (e.g. panic disorder, post-traumatic stress disorder (PTSD)). In addition, overlap exists in some common genetic variants (e.g. the serotonin transporter gene (SLC6A4), the brain-derived neurotrophic factor (BDNF) gene), and rare variants in genes/chromosomal abnormalities (e.g. the 22q11 microdeletion syndrome) found across the affective/anxiety disorder spectrums. OCD has been proposed as a possible independent entity for DSM-5, but by others thought best retained as an anxiety disorder subtype (its current designation in DSM-IV), and yet by others considered best in the affective disorder spectrum. This review focuses on OCD, a well-studied but still puzzling heterogeneous disorder, regarding alterations in serotonergic, dopaminergic and glutamatergic neurotransmission in addition to other systems involved, and how related genes may be involved in the comorbidity of anxiety and affective disorders. OCD resembles disorders such as depression, in which gene × gene interactions, gene × environment interactions and stress elements coalesce to yield OC symptoms and, in some individuals, full-blown OCD with multiple comorbid disorders.
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Affiliation(s)
- Dennis L Murphy
- Laboratory of Clinical Science, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
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Ghaleiha A, Entezari N, Modabbernia A, Najand B, Askari N, Tabrizi M, Ashrafi M, Hajiaghaee R, Akhondzadeh S. Memantine add-on in moderate to severe obsessive-compulsive disorder: randomized double-blind placebo-controlled study. J Psychiatr Res 2013; 47:175-80. [PMID: 23063327 DOI: 10.1016/j.jpsychires.2012.09.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 08/17/2012] [Accepted: 09/20/2012] [Indexed: 12/17/2022]
Abstract
There is a growing body of evidence for the efficacy of memantine augmentation in patients with obsessive-compulsive disorder (OCD). However, to date, no double-blind study has addressed this issue. The objective of the present randomized double-blind placebo-controlled study was to evaluate efficacy and tolerability of memantine add-on treatment in patients with moderate to severe OCD. Forty-two patients with the diagnosis of OCD based on DSM-IV-TR who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of ≥21 were randomly assigned to memantine (10 mg/day for the first week, and 20 mg/day for the rest of the trial) or placebo in addition to fluvoxamine for eight weeks. Patients were assessed using Y-BOCS every two weeks. Thirty-eight patients completed the study. Repeated measure ANOVA showed significant effect for time × treatment interaction in total scale [F (2.096, 75.470) = 5.280, P = 0.006] and obsession [F (2.340, 94.547) = 5.716, P = 0.002] and near significant effect for compulsion subscales [F (2.005, 79.179) = 2.841, P = 0.065]. By week eight, all patients in the memantine group and six (32%) patients in the placebo group [P value of Fisher's exact test <0.001] met the criteria for partial and complete response. At the end of the trial, 17 (89%) patients in the memantine group compared with six (32%) patients in the placebo group achieved remission (χ(2)(1) = 13.328, P < 0.001). Frequency of side-effects was not significantly different between the two groups. In summary, we showed that memantine add-on to fluvoxamine significantly improved short-term outcomes in patients with moderate to severe OCD.
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Affiliation(s)
- Ali Ghaleiha
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
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66
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Fineberg NA, Reghunandanan S, Brown A, Pampaloni I. Pharmacotherapy of obsessive-compulsive disorder: evidence-based treatment and beyond. Aust N Z J Psychiatry 2013; 47:121-41. [PMID: 23125399 DOI: 10.1177/0004867412461958] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder associated with a significant degree of functional disability and poor quality of life. Pharmacotherapy may have a substantial impact on the course and outcome of OCD. METHOD We review the evidence supporting available strategies for the pharmacological treatment of OCD. RESULTS Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice and are associated with improved health-related quality of life. Discontinuation is associated with relapse and loss of quality of life, implying treatment should continue long-term. A substantial minority of patients who fail to respond to SSRI may benefit from dose elevation or adjunctive antipsychotics, though long-term trials validating the effectiveness and tolerability of these strategies are relatively lacking. CONCLUSION The pharmacological evidence-base for the treatment of OCD is becoming increasingly robust. Treatment with SSRIs and clomipramine remains uncontroversial and improvements are sustained over time. Newer compounds targeting serotonin receptor subtypes and other neurotransmitter systems are undergoing evaluation.
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Affiliation(s)
- Naomi A Fineberg
- 1Mental Health Unit, Hertfordshire Partnership Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, UK
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Bloch MH, Wasylink S, Landeros-Weisenberger A, Panza KE, Billingslea E, Leckman JF, Krystal JH, Bhagwagar Z, Sanacora G, Pittenger C. Effects of ketamine in treatment-refractory obsessive-compulsive disorder. Biol Psychiatry 2012; 72:964-70. [PMID: 22784486 PMCID: PMC3667652 DOI: 10.1016/j.biopsych.2012.05.028] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/04/2012] [Accepted: 05/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Treatments for obsessive-compulsive disorder (OCD) usually lead to incomplete symptom relief and take a long-time to reach full effect. Convergent evidence suggests that glutamate abnormalities contribute to the pathogenesis of OCD. Ketamine is a potent noncompetitive antagonist of the N-methyl-D-aspartate glutamate receptor. Trials have reported rapid antidepressant effects after low-dose ketamine infusion. METHODS We conducted an open-label trial of ketamine (.5 mg/kg IV over 40 min) in 10 subjects with treatment-refractory OCD. Response was defined as >35% improvement in OCD symptoms and >50% improvement in depression symptoms from baseline at any time between 1 and 3 days after infusion. RESULTS None of 10 subjects experienced a response in OCD symptoms in the first 3 days after ketamine. Four of seven patients with comorbid depression experienced an antidepressant response to ketamine in the first 3 days after infusion. Both OCD and depression symptoms demonstrated a statistically significant improvement in the first 3 days after infusion compared with baseline, but the OCD response was <12%. The percentage reduction in depressive symptoms in the first 3 days after ketamine infusion was significantly greater than the reduction in OCD symptoms. CONCLUSIONS Ketamine effects on OCD symptoms, in contrast to depressive symptoms, did not seem to persist or progress after the acute effects of ketamine had dissipated.
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Affiliation(s)
- Michael H. Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Suzanne Wasylink
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | | | - Kaitlyn E. Panza
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT
| | - Eileen Billingslea
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - James F. Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT,Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Psychology, Yale University School of Medicine, New Haven, CT
| | - John H. Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,VA Connecticut Health Care System, West Haven, CT,Psychiatry Services, Yale-New Haven Hospital
| | - Zubin Bhagwagar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Bristol Myers-Squibb, Inc., Wallingford, CT
| | - Gerard Sanacora
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Christopher Pittenger
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT,Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Integrated Neuroscience Program, Yale University School of Medicine, New Haven, CT
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Abstract
Pharmacological strategies for the treatment of obsessive-compulsive disorder (OCD) continue to develop apace but deficiencies remain. We present an updated literature review of the evidence supporting available strategies. We aim to answer key questions including: (1) What are the first-line treatments? (2) Does pharmacotherapy improve health-related quality of life? (3) How do we evaluate clinical response and relapse? (4) How long should treatment continue? (5) Can we predict treatment outcomes? (6) What is the management of treatment-refractory OCD? Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice for most patients and are associated with improved health-related quality of life. However, discontinuation is associated with relapse and loss of quality of life, implying treatment should continue long term. A substantial minority of patients fail to respond to SSRI. Such patients may respond to strategies such as dose elevation or adjunctive antipsychotic, although long-term trials validating the effectiveness and tolerability of these strategies are relatively lacking. Newer compounds targeting other neurotransmitter systems, such as glutamate, are undergoing evaluation.
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69
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Real E, Gratacòs M, Labad J, Alonso P, Escaramís G, Segalàs C, Subirà M, López-Solà C, Estivill X, Menchón JM. Interaction of SLC1A1 gene variants and life stress on pharmacological resistance in obsessive-compulsive disorder. THE PHARMACOGENOMICS JOURNAL 2012; 13:470-5. [PMID: 22776887 DOI: 10.1038/tpj.2012.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/07/2012] [Accepted: 05/23/2012] [Indexed: 11/09/2022]
Abstract
Genetic and environmental factors seem to interact and influence both the onset and the course of obsessive-compulsive disorder (OCD), but the role of glutamate transporter variants (SLC1A1) in pharmacological resistance is not known. We aimed to assess whether genetic variants in SLC1A1 and life stress at onset of the disorder interact and modulate pharmacological resistance in OCD. A single-marker association study of several single-nucleotide polymorphisms in the SLC1A1 genomic region was performed in a sample of 238 OCD patients. For the most strongly associated SNP (rs3087879), one copy of the risk allele increased the probability of higher treatment resistance (odds ratio=2.42; 95% confidence interval=1.39-4.21; P=0.0018), but only in OCD patients without life stress at onset of the disorder. These results suggest a gene-by-environment interaction effect on treatment resistance in OCD and strengthen the existing evidence of the role of the glutamatergic system in the phenomenology of OCD.
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Affiliation(s)
- E Real
- 1] Neuroscience Group-IDIBELL (Institut d'Investigació Biomèdica de Bellvitge), CIBERSAM (Centro de Investigación en Red de Salud Mental-Instituto de Salud Carlos III), L'Hospitalet de Llobregat, Barcelona, Spain [2] OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain
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70
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Albelda N, Joel D. Current animal models of obsessive compulsive disorder: an update. Neuroscience 2012; 211:83-106. [PMID: 21925243 DOI: 10.1016/j.neuroscience.2011.08.070] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/29/2011] [Accepted: 08/31/2011] [Indexed: 12/30/2022]
Affiliation(s)
- N Albelda
- Department of Psychology, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel
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71
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Wu PL, Lane HY, Tang HS, Tsai GE. Glutamate theory in developing novel pharmacotherapies for obsessive compulsive disorder: Focusing on N-methyl-D-aspartate signaling. Biomedicine (Taipei) 2012. [DOI: 10.1016/j.biomed.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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72
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Wetterneck CT, Little TE, Rinehart KL, Cervantes ME, Hyde E, Williams M. Latinos with obsessive-compulsive disorder: Mental healthcare utilization and inclusion in clinical trials. J Obsessive Compuls Relat Disord 2012; 1:85-97. [PMID: 29057210 PMCID: PMC5647138 DOI: 10.1016/j.jocrd.2011.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Previous research has documented that ethnic minorities, particularly Latinos, obtain fewer mental health services than Caucasians (Kearney, Draper, & Baron 2005; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). Conceivably, this may be due to a wide array of cultural issues (e.g., negative stigma attached to mental health, and language, socio-economic, and acculturation barriers), symptom disparities across Caucasian and Latino groups, or lack of effective outreach methods by clinicians and researchers. However, research is limited. As a result, Latinos may be insufficiently represented in clinical studies for OCD, making it unclear whether evidence-based treatments demonstrate the same efficacy and effectiveness for Latinos as has been demonstrated for Caucasians. The current study takes an in-depth analysis of 98 efficacy and effectiveness studies for OCD from across the Western hemisphere and reports the rates of Latino inclusion from each sample. Ninety clinical studies in the US and Canada, as well as eight clinical studies in Mexico and Central America were reviewed. Findings showed that only 11 (24%) US and Canadian studies included Latino participants, illustrating an overwhelming underrepresentation of Latinos in clinical studies for OCD. Further explanation of the results and their implications are discussed, along with suggestions for effectively improving access to mental health research and appropriate treatments.
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Affiliation(s)
- Chad T Wetterneck
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Tannah E Little
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Kimberly L Rinehart
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Maritza E Cervantes
- University of Houston-Clear Lake, 2700 Bay Area Blvd., Houston, TX 77058, United States
| | - Emma Hyde
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Monnica Williams
- University of Louisville, Center for Mental Health Disparities, Department of Psychological & Brain Sciences, 2301 South Third St., Louisville, KY 40292, United States
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73
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Evaluation of oral zinc sulfate effect on obsessive-compulsive disorder: a randomized placebo-controlled clinical trial. Nutrition 2012; 28:892-5. [PMID: 22465904 DOI: 10.1016/j.nut.2011.11.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/12/2011] [Accepted: 11/26/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder is a common neuropsychiatric condition. Although various pharmaceutical agents are available for the treatment of obsessive-compulsive disorder, psychiatrists often find that many patients cannot tolerate the side effects of these medications, the patients do not respond properly to the treatment, or the medications lose their effectiveness after a period of treatment. The augmentation with safe supplementation of medication, such as with trace elements, may be a solution to some of these problems. METHODS This study was a prospective, double-blinded, 8-wk trial. Twelve patients were given fluoxetine (20 mg/d) plus zinc (440 mg/d) and 11 patients were given fluoxetine plus placebo for 8 wk. RESULTS Both groups showed a decrease in the mean Yale-Brown Obsessive-Compulsive Scale score. Based on t tests, in weeks 2 and 8, patients treated with fluoxetine plus zinc had significantly lower scores than those treated with fluoxetine plus placebo. CONCLUSION The results show that zinc, as adjuvant agent for obsessive-compulsive disorder, produces improved outcomes.
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74
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Sugiyama A, Saitoh A, Iwai T, Takahashi K, Yamada M, Sasaki-Hamada S, Oka JI, Inagaki M, Yamada M. Riluzole produces distinct anxiolytic-like effects in rats without the adverse effects associated with benzodiazepines. Neuropharmacology 2012; 62:2489-98. [PMID: 22377384 DOI: 10.1016/j.neuropharm.2012.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/09/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
In this study, we investigated the anxiolytic-like effect of riluzole using three different innate anxiety models in rats. In the elevated plus-maze test, riluzole significantly increased the time spent in, and entries into, the open arm after 60 min administration. This finding was supported by results obtained from light/dark and open-field tests. The magnitude of the anxiolytic-like effects of riluzole in each of the behavioral models was similar to those produced by a benzodiazepine, diazepam, suggesting that riluzole has a robust anxiolytic-like activity in rats. To clarify the involvement of sodium channels in this anxiolytic activity, we examined the effect of a co-administered sodium channel activator, veratrine. The anxiolytic-like action of riluzole was diminished by veratrine in the elevated plus-maze, light/dark and open-field tests. Based on these results, it is suggested that the anxiolytic mechanism of riluzole is clearly distinct from that of diazepam. In addition, to examine whether riluzole directly and non-selectively affected the GABA(A)-benzodiazepine receptor complex, we performed three behavioral tests (footprint analysis, Y-maze test and the ethanol-induced sleeping time test) that are closely related to the GABA(A)-benzodiazepine pathways. In contrast to diazepam, riluzole produced no significant effects in these tests. Here, we provide the first report demonstrating that riluzole produces distinct anxiolytic-like effects in rats without the adverse effects associated with benzodiazepines.
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Affiliation(s)
- Azusa Sugiyama
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashimachi, Kodaira, Tokyo 187-8553, Japan
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75
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Vloet TD, Simons M, Herpertz-Dahlmann B. Psychotherapeutische und medikamentöse Behandlung der kindlichen Zwangsstörung. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:29-39; quiz 39-40. [DOI: 10.1024/1422-4917/a000147] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Zur Behandlung der kindlichen Zwangsstörung werden kognitiv-verhaltenstherapeutische (KVT) und medikamentöse Interventionen eingesetzt. Insbesondere kombiniert sind diese Behandlungen gut wirksam, dennoch zeigen sich ca. 40 % der Behandelten auch nach der Therapie noch symptomatisch. Die am besten evaluierte Methode der KVT ist die Exposition mit Reaktionsverhinderung, die auf dem Prinzip der Habituation beruht. Neuere kognitive und metakognitive Techniken fokussieren auf die Modifikation von Erwartungen und haben vielleicht das Potential, die Wirksamkeit der Behandlung zu verbessern. Selektive Serotonin-Wiederaufnahme-Hemmer (selective serotonin reuptake inhibitors, SSRIs) stellen die Medikamente der ersten Wahl zur Behandlung der kindlichen Zwangsstörung dar. Wenn die Patienten bei ausreichend langer Gabe nicht auf die Medikation ansprechen, sollte ein Therapieversuch mit einem alternativen SSRI oder mit Clomipramin durchgeführt werden. Bei einem erneuten Scheitern der Behandlung kann eine Augmentation mit einer Kombination zweier SSRIs bzw. einem SSRI und Clomipramin oder einem SSRI und einem (atypischen) Neuroleptikum erfolgen. Nach einer erfolgreichen Behandlung sollte das Ausschleichen der Medikation sehr langsam erfolgen. Erste Studien zum Einsatz neuer Substanzen wie dem Glutamatantagonisten Riluzol liegen für das Kindes- und Jugendalter vor.
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Affiliation(s)
- Timo D. Vloet
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
- Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters an der Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
| | - Michael Simons
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
| | - Beate Herpertz-Dahlmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
- JARA Translational Brain Medicine, Jülich/Aachen
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76
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Wu K, Hanna GL, Rosenberg DR, Arnold PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol Biochem Behav 2011; 100:726-35. [PMID: 22024159 DOI: 10.1016/j.pbb.2011.10.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 09/23/2011] [Accepted: 10/03/2011] [Indexed: 01/16/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a common and often debilitating neuropsychiatric condition characterized by persistent intrusive thoughts (obsessions), repetitive ritualistic behaviors (compulsions) and excessive anxiety. While the neurobiology and etiology of OCD has not been fully elucidated, there is growing evidence that disrupted neurotransmission of glutamate within corticalstriatal-thalamocortical (CSTC) circuitry plays a role in OCD pathogenesis. This review summarizes the findings from neuroimaging, animal model, candidate gene and treatment studies in the context of glutamate signaling dysfunction in OCD. First, studies using magnetic resonance spectroscopy are reviewed demonstrating altered glutamate concentrations in the caudate and anterior cingulate cortex of patients with OCD. Second, knockout mouse models, particularly the DLGAP3 and Sltrk5 knockout mouse models, display remarkably similar phenotypes of compulsive grooming behavior associated with glutamate signaling dysfunction. Third, candidate gene studies have identified associations between variants in glutamate system genes and OCD, particularly for SLC1A1 which has been shown to be associated with OCD in five independent studies. This converging evidence for a role of glutamate in OCD has led to the development of novel treatment strategies involving glutamatergic compounds, particularly riluzole and memantine. We conclude the review by outlining a glutamate hypothesis for OCD, which we hope will inform further research into etiology and treatment for this severe neuropsychiatric condition.
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Affiliation(s)
- Ke Wu
- Program in Genetics and Genomic Biology, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8
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77
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Glutamate abnormalities in obsessive compulsive disorder: neurobiology, pathophysiology, and treatment. Pharmacol Ther 2011; 132:314-32. [PMID: 21963369 DOI: 10.1016/j.pharmthera.2011.09.006] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022]
Abstract
Obsessive compulsive disorder is prevalent, disabling, incompletely understood, and often resistant to current therapies. Established treatments consist of specialized cognitive-behavioral psychotherapy and pharmacotherapy with medications targeting serotonergic and dopaminergic neurotransmission. However, remission is rare, and more than a quarter of OCD sufferers receive little or no benefit from these approaches, even when they are optimally delivered. New insights into the disorder, and new treatment strategies, are urgently needed. Recent evidence suggests that the ubiquitous excitatory neurotransmitter glutamate is dysregulated in OCD, and that this dysregulation may contribute to the pathophysiology of the disorder. Here we review the current state of this evidence, including neuroimaging studies, genetics, neurochemical investigations, and insights from animal models. Finally, we review recent findings from small clinical trials of glutamate-modulating medications in treatment-refractory OCD. The precise role of glutamate dysregulation in OCD remains unclear, and we lack blinded, well-controlled studies demonstrating therapeutic benefit from glutamate-modulating agents. Nevertheless, the evidence supporting some important perturbation of glutamate in the disorder is increasingly strong. This new perspective on the pathophysiology of OCD, which complements the older focus on monoaminergic neurotransmission, constitutes an important focus of current research and a promising area for the ongoing development of new therapeutics.
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78
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Walsh KH, McDougle CJ. Psychotherapy and medication management strategies for obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2011; 7:485-94. [PMID: 21931490 PMCID: PMC3173031 DOI: 10.2147/ndt.s13205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT) and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response. The role of streptococcal infections in pediatric OCD has become an area of intense scrutiny and controversy. In this article, current treatment methods for OCD will be reviewed, with special attention to strategies for treating OCD in children and in patients with comorbid tic disorders. Alternative psychotherapy strategies for patients who are highly anxious about starting CBT, such as cognitive therapy or augmentation with D-cycloserine, will be reviewed. Newer issues regarding use of antibiotics, neuroleptics, and glutamate modulators in OCD treatment will also be explored.
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Affiliation(s)
- Kelda H Walsh
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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79
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Wink LK, Erickson CA, Stigler KA, McDougle CJ. Riluzole in autistic disorder. J Child Adolesc Psychopharmacol 2011; 21:375-9. [PMID: 21823915 DOI: 10.1089/cap.2010.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Logan K. Wink
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - Craig A. Erickson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - Kimberly A. Stigler
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. McDougle
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
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80
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Sampaio AS, Fagerness J, Crane J, Leboyer M, Delorme R, Pauls DL, Stewart SE. Association between polymorphisms in GRIK2 gene and obsessive-compulsive disorder: a family-based study. CNS Neurosci Ther 2011; 17:141-7. [PMID: 20370803 PMCID: PMC6493828 DOI: 10.1111/j.1755-5949.2009.00130.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Several studies support a genetic influence on obsessive-compulsive disorder (OCD) etiology. The role of glutamate as an important neurotransmitter affecting OCD pathophysiology has been supported by neuroimaging, animal model, medication, and initial candidate gene studies. Genes involved in glutamatergic pathways, such as the glutamate receptor, ionotropic, kainate 2 (GRIK2), have been associated with OCD in previous studies. This study examines GRIK2 as a candidate gene for OCD susceptibility in a family-based approach. Probands had full DSM-IV diagnostic criteria for OCD. Forty-seven OCD probands and their parents were recruited from tertiary care OCD specialty clinics from France and USA. Genotypes of single nucleotide polymorphism (SNP) markers and related haplotypes were analyzed using Haploview and FBAT software. The polymorphism at rs1556995 (P= 0.0027; permuted P-value = 0.03) was significantly associated with the presence of OCD. Also, the two marker haplotype rs1556995/rs1417182, was significantly associated with OCD (P= 0.0019, permuted P-value = 0.01). This study supports previously reported findings of association between proximal GRIK2 SNPs and OCD in a comprehensive evaluation of the gene. Further study with independent samples and larger sample sizes is required.
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Affiliation(s)
- Aline S. Sampaio
- Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Jesen Fagerness
- Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Massachusetts General Hospital, Harvard University
| | - Jacquelyn Crane
- Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Massachusetts General Hospital, Harvard University
| | - Marion Leboyer
- INSERM U 513, Faculté de Médecine, 8 rue du Général Sarrail, 94010 Créteil, France
- Service de Psychiatrie, Hôpitaux Henri Mondor et Albert Chenevier, Assistance Publique‐Hôpitaux de Paris, Créteil, France
| | - Richard Delorme
- INSERM U 513, Faculté de Médecine, 8 rue du Général Sarrail, 94010 Créteil, France
- Service de Psychopathologie de l‘Enfant et de l‘Adolescent, Hôpital Robert Debré, Assistance Publique‐Hôpitaux de Paris, Paris, France
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Massachusetts General Hospital, Harvard University
| | - S. Evelyn Stewart
- Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Massachusetts General Hospital, Harvard University
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81
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Abstract
BACKGROUND Several lines of evidence implicate glutamatergic neurotransmission in the pathophysiology of obsessive compulsive disorder (OCD). Sarcosine is an endogenous antagonist of glycine transporter-1. By blocking glycine uptake, sarcosine may increase the availability of synaptic glycine and enhance N-methyl-d-aspartate (NMDA) subtype glutamatergic neurotransmission. In this 10-week open-label trial, we examined the potential benefit of sarcosine treatment in OCD patients. METHOD Twenty-six outpatients with OCD and baseline Yale-Brown Obsessive Compulsive Scale (YBOCS) scores higher than 16 were enrolled. Drug-naive subjects (group 1, n = 8) and those who had discontinued serotonin reuptake inhibitors for at least 8 weeks at study entry (group 2, n = 6) received sarcosine monotherapy. The other subjects (group 3, n = 12) received sarcosine as adjunctive treatment. A flexible dosage schedule of sarcosine 500 to 2000 mg/d was applied. The primary outcome measures were Y-BOCS and Hamilton Anxiety Inventory, rated at weeks 0, 2, 4, 6, 8, and 10. Results were analyzed by repeated-measures analysis of variance. RESULTS Data of 25 subjects were eligible for analysis. The mean ± SD Y-BOCS scores decreased from 27.6 ± 5.8 to 22.7 ± 8.7, indicating a mean decrease of 19.8% ± 21.7% (P = 0.0035). Eight (32%) subjects were regarded as responders with greater than 35% reduction of Y-BOCS scores. Five of the responders achieved the good response early by week 4. Although not statistically significant, drug-naive (group 1) subjects had more profound and sustained improvement and more responders than the subjects who had received treatment before (groups 2 and 3). Sarcosine was tolerated well; only one subject withdrew owing to transient headache. CONCLUSION Sarcosine treatment can achieve a fast therapeutic effect in some OCD patients, particularly those who are treatment naive. The study supports the glycine transporter-1 as a novel target for developing new OCD treatment. Large-series placebo-controlled, double-blind studies are recommended.
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82
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Abbara C, Estournet B, Lacomblez L, Lelièvre B, Ouslimani A, Lehmann B, Viollet L, Barois A, Diquet B. Riluzole pharmacokinetics in young patients with spinal muscular atrophy. Br J Clin Pharmacol 2011; 71:403-10. [PMID: 21284699 DOI: 10.1111/j.1365-2125.2010.03843.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS The objective of the present study was to assess the pharmacokinetics of riluzole in patients with spinal muscular atrophy (SMA). METHODS Fourteen patients were enrolled in an open-label, nonrandomized and repeat-dose pharmacokinetic study. All participants were assigned to receive 50mg riluzole orally for 5 days. Riluzole plasma concentrations were determined from samples obtained at day 5. RESULTS The pharmacokinetic analysis demonstrated that a dose of 50mg once a day was sufficient to obtain a daily total exposure [AUC(0,24h)=2257ng ml(-1) h] which was comparable with results obtained in adult healthy volunteers or ALS patients in whom a dose of 50mg twice a day is recommended. The pharmacokinetic simulation demonstrated that the administration of 50mg twice a day could result in higher concentrations, hence reduced safety margin. CONCLUSION The dose of 50mg once a day was chosen for the clinical trial evaluating the efficacy of riluzole in SMA patients.
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Affiliation(s)
- Chadi Abbara
- Université d'Angers, UFR médecine, Angers cedex, F-49045 CHU d'Angers, Service Pharmacologie-Toxicologie, Angers cedex 09, France
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83
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Riaza Bermudo-Soriano C, Perez-Rodriguez MM, Vaquero-Lorenzo C, Baca-Garcia E. New perspectives in glutamate and anxiety. Pharmacol Biochem Behav 2011; 100:752-74. [PMID: 21569789 DOI: 10.1016/j.pbb.2011.04.010] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/05/2011] [Accepted: 04/15/2011] [Indexed: 02/07/2023]
Abstract
Anxiety and stress-related disorders, namely posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (ODC), social and specific phobias, and panic disorder, are a major public health issue. A growing body of evidence suggests that glutamatergic neurotransmission may be involved in the biological mechanisms underlying stress response and anxiety-related disorders. The glutamatergic system mediates the acquisition and extinction of fear-conditioning. Thus, new drugs targeting glutamatergic neurotransmission may be promising candidates for new pharmacological treatments. In particular, N-methyl-d-aspartate receptors (NMDAR) antagonists (AP5, AP7, CGP37849, CGP39551, LY235959, NPC17742, and MK-801), NMDAR partial agonists (DCS, ACPC), α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs) antagonists (topiramate), and several allosteric modulators targeting metabotropic glutamate receptors (mGluRs) mGluR1, mGluR2/3, and mGluR5, have shown anxiolytic-like effects in several animal and human studies. Several studies have suggested that polyamines (agmatine, putrescine, spermidine, and spermine) may be involved in the neurobiological mechanisms underlying stress-response and anxiety-related disorders. This could mainly be attributed to their ability to modulate ionotropic glutamate receptors, especially NR2B subunits. The aim of this review is to establish that glutamate neurotransmission and polyaminergic system play a fundamental role in the onset of anxiety-related disorders. This may open the way for new drugs that may help to treat these conditions.
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84
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Albelda N, Joel D. Animal models of obsessive-compulsive disorder: exploring pharmacology and neural substrates. Neurosci Biobehav Rev 2011; 36:47-63. [PMID: 21527287 DOI: 10.1016/j.neubiorev.2011.04.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/05/2011] [Accepted: 04/08/2011] [Indexed: 01/07/2023]
Abstract
During the last 30 years there have been many attempts to develop animal models of obsessive-compulsive disorder (OCD). Most models have not been studied further following the original publication, and in the past few years, most papers present studies employing a few established animal models, exploring the neural basis of compulsive behavior and developing new treatment strategies. Here we summarize findings from the five most studied animal models of OCD: 8-OHDPAT (8-hydroxy-2-(di-n-propylamino)-tetralin hydrobromide) induced decreased alternation, quinpirole-induced compulsive checking, marble burying, signal attenuation and spontaneous stereotypy in deer mice. We evaluate each model's face validity, derived from similarity between the behavior in the model and the specific symptoms of the human condition, predictive validity, derived from similarity in response to treatment (pharmacological or other), and construct validity, derived from similarity in the mechanism (physiological or psychological) that induces behavioral symptoms and in the neural systems involved. We present ideas regarding future clinical research based on each model's findings, and on this basis, also emphasize possible new approaches for the treatment of OCD.
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Affiliation(s)
- Noa Albelda
- Department of Psychology, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel
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85
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Gomes FV, Casarotto PC, Resstel LBM, Guimarães FS. Facilitation of CB1 receptor-mediated neurotransmission decreases marble burying behavior in mice. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:434-8. [PMID: 21111767 DOI: 10.1016/j.pnpbp.2010.11.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 11/02/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common psychiatric disorder characterized by the occurrence of obsessions and compulsions. Glutamatergic abnormalities have been related to the pathophysiology of OCD. Cannabinoids inhibit glutamate release in the central nervous system, but the involvement of drugs targeting the endocannabinoid system has not yet been tested in animal models of repetitive behavior. Thus, the aim of the present study was to verify the effects of the CB1 receptor agonist WIN55,212-2, the inhibitor of anandamide uptake AM404 and the anandamide hydrolysis inhibitor URB597, on compulsive-associate behavior in male C57BL/6J mice submitted to the marble burying test (MBT), an animal model used for anti-compulsive drug screening. WIN55,212-2 (1 and 3 mg/kg), AM404 (1 and 3 mg/kg) and URB597 (0.1, 0.3 and 1 mg/kg) induced a significant decrease in the number of buried marbles compared to controls. Pretreatment with the CB1 receptor antagonist, AM251, prevented both WIN55,212-2 and URB597 effects. These results suggest a potential role for drugs acting on the cannabinoid system in modulating compulsive behavior.
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Affiliation(s)
- Felipe V Gomes
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue 3900, Ribeirão Preto, SP, 14049-900, Brazil
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De Nadai AS, Storch EA, McGuire JF, Lewin AB, Murphy TK. Evidence-based pharmacotherapy for pediatric obsessive-compulsive disorder and chronic tic disorders. J Cent Nerv Syst Dis 2011; 3:125-42. [PMID: 23861643 PMCID: PMC3663618 DOI: 10.4137/jcnsd.s6616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In recent years, much progress has been made in pharmacotherapy for pediatric obsessive-compulsive disorder (OCD) and chronic tic disorders (CTDs). What were previously considered relatively intractable conditions now have an array of efficacious medicinal (and psychosocial) interventions available at clinicians’ disposal, including selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha-2 agonists. The purpose of this review is to discuss the evidence base for pharmacotherapy with pediatric OCD and CTDs with regard to efficacy, tolerability, and safety, and to put this evidence in the context of clinical management in integrated behavioral healthcare. While there is no single panacea for these disorders, there are a variety of medications that provide considerable relief for children with these disabling conditions.
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87
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Rynn M, Puliafico A, Heleniak C, Rikhi P, Ghalib K, Vidair H. Advances in pharmacotherapy for pediatric anxiety disorders. Depress Anxiety 2011; 28:76-87. [PMID: 21225851 DOI: 10.1002/da.20769] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pediatric anxiety disorders are prevalent, chronic, and often lead to significant impaired functioning that impacts both short- and long-term outcomes for children and adolescents. Treatment options include pharmacotherapy and psychosocial interventions. This presentation will review treatment advances specifically for pharmacotherapy. Current research supports serotonin reuptake inhibitors as the medication class to be the first-line treatment option for pediatric anxiety disorders. Available evidence for the efficacy of other classes of medications will be reviewed, along with the available approaches to manage partial responders and nonresponders. The risks and benefits of pharmacotherapy will also be reviewed. In addition, recent research has shown the potential promise of novel agents that act upon other neural systems implicated in the development of pediatric anxiety disorders. Novel compounds that affect the glutamate system will be discussed.
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Affiliation(s)
- Moira Rynn
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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88
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Erickson CA, Weng N, Weiler IJ, Greenough WT, Stigler KA, Wink LK, McDougle CJ. Open-label riluzole in fragile X syndrome. Brain Res 2010; 1380:264-70. [PMID: 21059347 DOI: 10.1016/j.brainres.2010.10.108] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/27/2010] [Accepted: 10/31/2010] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Glutamatergic dysregulation is implicated in the pathophysiology of fragile X syndrome (FXS). Riluzole is hypothesized to have an inhibitory effect on glutamate release, block excitotoxic effects of glutamate, and potentiate postsynaptic GABA(A) receptor function. Extracellular signal-related kinase (ERK) activation is known to be delayed in humans with FXS and knockout animal models of FXS. Correction of delayed ERK activation is a potential biomarker of treatment response in FXS. We conducted a six-week open-label prospective pilot study of riluzole (100 mg/day) in six adults with FXS. METHODS Riluzole was started at 50mg every evening and then increased to 50mg twice daily at week 2. The dose was kept constant for the final 4 weeks of the trial. Clinical response was determined by a score of 1 "very much improved" or 2 "much improved" on the Clinical Global Impressions Improvement (CGI-I) scale and a≥25% improvement on the Children's Yale-Brown Obsessive Compulsive Scale modified for Pervasive Developmental Disorders. The primary target of treatment in this study was repetitive, compulsive behavior that commonly occurs in persons with FXS. The study incorporated an ERK activation biomarker assay. Potential adverse effects were assessed in a systematic manner at all clinic visits and by phone between visits. RESULTS Riluzole treatment was associated with clinical response in 1 of 6 subjects (17%). Among a number of secondary outcome measures employed, significant improvement was only noted on the ADHD Rating Scale-IV (became non-significant when corrected for multiple comparisons). Riluzole use was associated with significant correction in ERK activation time in all subjects (mean change from 3.82±0.27 (baseline) to 2.99±0.26 (endpoint) minutes; p=0.007). Riluzole was well tolerated; mean increases in liver function tests occurred but drug discontinuation was not required. CONCLUSION Overall, riluzole use was not associated with significant clinical improvement despite uniform correction of peripheral ERK activation. Future directions of study include testing of riluzole in animal models of FXS and assessment of psychotropic monotherapy on ERK activation.
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Affiliation(s)
- Craig A Erickson
- Department of Psychiatry, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, IN 46202, USA.
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Wink LK, Plawecki MH, Erickson CA, Stigler KA, McDougle CJ. Emerging drugs for the treatment of symptoms associated with autism spectrum disorders. Expert Opin Emerg Drugs 2010; 15:481-94. [PMID: 20470188 PMCID: PMC2923687 DOI: 10.1517/14728214.2010.487860] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Autism spectrum disorders, or pervasive developmental disorders (PDDs), are neurodevelopmental disorders defined by qualitative impairment in social interaction, impaired communication and stereotyped patterns of behavior. The most common forms of PDD are autistic disorder (autism), Asperger's disorder and PDD not otherwise specified. Recent surveillance studies reveal an increase in the prevalence of autism and related PDDs. The use of pharmacologic agents in the treatment of these disorders can reduce the impact of interfering symptoms, providing relief for affected individuals and their families. AREAS COVERED IN THIS REVIEW This review examines results from neurobiologic research in an attempt to both elucidate the pathophysiology of autism and guide the development of pharmacologic agents for the treatment of associated symptoms. The safety and efficacy data of drugs currently in clinical use for the treatment of these symptoms, as well as pharmaceuticals currently under development, are discussed. WHAT THE READER WILL GAIN This comprehensive review will deepen the reader's current understanding of the research guiding the pharmacologic treatment of symptoms associated with autism and related PDDs. Areas of focus for future research are also discussed. The need for large-scale investigation of some commonly used pharmacologic agents, in addition to the development of drugs with improved efficacy and safety profiles, is made evident. TAKE HOME MESSAGE Despite progress in the development of pharmacologic treatments for a number of interfering symptom domains associated with autism and other PDDs, a great deal of work remains.
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Affiliation(s)
- Logan K Wink
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, USA
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Grant P, Song JY, Swedo SE. Review of the use of the glutamate antagonist riluzole in psychiatric disorders and a description of recent use in childhood obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 2010; 20:309-15. [PMID: 20807069 PMCID: PMC2958461 DOI: 10.1089/cap.2010.0009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The antiglutamatergic drug riluzole (Rilutek) is presently being used off label in the treatment of psychiatric conditions in adult patients and, increasingly, in children. This article briefly reviews the pharmacology of this drug and its current investigative and clinical uses and adverse effects. It also reports on our experience to date in the study of the drug in children, with emphasis on adverse effects noted so far in these younger patients.
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Affiliation(s)
- Paul Grant
- Pediatrics and Developmental Neuroscience (PDN) Branch, National Institute of Mental Health, Bethesda, Maryland 20892, USA.
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Pine DS, Ernst M, Leibenluft E. Imaging-genetics applications in child psychiatry. J Am Acad Child Adolesc Psychiatry 2010; 49:772-82. [PMID: 20643311 PMCID: PMC2997350 DOI: 10.1016/j.jaac.2009.12.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 12/16/2009] [Accepted: 12/18/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To place imaging-genetics research in the context of child psychiatry. METHOD A conceptual overview is provided, followed by discussion of specific research examples. RESULTS Imaging-genetics research is described linking brain function to two specific genes, for the serotonin-reuptake-transporter protein and a monoamine oxidase enzyme. Work is then described on phenotype selection in imaging genetics. CONCLUSIONS Child psychiatry applications of imaging genetics are only beginning to emerge. The approach holds promise for advancing understandings of pathophysiology and therapeutics.
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Affiliation(s)
- Daniel S Pine
- National Institute of Mental Health Intramural Research Program, Mood and Anxiety Disorders Program, Bethesda, MD 20892-2670, USA.
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92
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MacMaster FP. Translational neuroimaging research in pediatric obsessive-compulsive disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20623921 PMCID: PMC3181954 DOI: 10.31887/dcns.2010.12.2/fmacmaster] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a significant public health problem. Selective serotonin reuptake inhibitors (SSRIs) are the only FDA-approved medications for OCD. However, SSRIs are of limited efficacy in clinical practice. Given the persistence of symptoms and levels of treatment response, it is clear that the serotonin paradigm of OCD does not fully account for the neurobiology of the disorder, and that further translational research is needed. In this review, the glutamate hypothesis of pediatric OCD is explored, the neuroimaging evidence reviewed, and the translational impact highlighted. The traditional strategy of going from pharmacology to pathophysiology has failed to show real progress in our understanding of the neurobiology of psychiatric illness and, while still in the early stages, this work demonstrates the clear benefit of approaching psychiatric illness from the opposite direction.
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Affiliation(s)
- Frank P MacMaster
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA.
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93
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Cannabidiol inhibitory effect on marble-burying behaviour: involvement of CB1 receptors. Behav Pharmacol 2010; 21:353-8. [DOI: 10.1097/fbp.0b013e32833b33c5] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bestha DP, Jeevarakshagan S, Madaan V. Management of tics and Tourette's disorder: an update. Expert Opin Pharmacother 2010; 11:1813-22. [DOI: 10.1517/14656566.2010.486402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The role of NMDA receptors in the signal attenuation rat model of obsessive-compulsive disorder. Psychopharmacology (Berl) 2010; 210:13-24. [PMID: 20238210 DOI: 10.1007/s00213-010-1808-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 02/18/2010] [Indexed: 01/12/2023]
Abstract
RATIONALE In recent years, an increasing body of evidence points to the involvement of the glutamatergic system and specifically the glutamatergic ionotropic N-methyl-D-aspartate (NMDA) receptor in the pathophysiology of obsessive-compulsive disorder (OCD). OBJECTIVES To test the role of NMDA receptors in compulsive behavior using the signal attenuation rat model of OCD. In this model, 'compulsive' behavior is induced by attenuating a signal indicating that a lever-press response was effective in producing food. METHODS The NMDA antagonist, MK 801 (0.025-0.100 mg/kg) and the partial NMDA agonist, D-cycloserine (3-100 mg/kg) were administered to rats just before assessing their lever-press responding following signal attenuation (Experiments 1 and 2, respectively). Because the effects of signal attenuation are assessed under extinction conditions, drug doses that were effective in Experiments 1 and 2 were also tested in an extinction session of lever-press responding that was not preceded by signal attenuation (Experiment 3). RESULTS Systemic administration of D: -cycloserine (15 mg/kg) selectively decreased compulsive lever pressing, whereas systemic administration of MK 801 did not affect compulsive lever-pressing but dramatically increased resistance to extinction. CONCLUSIONS Activation of NMDA receptors may have an anti-compulsive effect in OCD patients.
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Veenstra-VanderWeele J. Increase in valproic acid levels during riluzole treatment in an adolescent with autism. J Child Adolesc Psychopharmacol 2010; 20:163-5. [PMID: 20415615 DOI: 10.1089/cap.2009.0087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeremy Veenstra-VanderWeele
- Center for Molecular Neuroscience, Kennedy Center for Research on Human Development, Vanderbilt University, Nashville, Tennessee
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Effects of agents targeting glutamatergic systems on marble-burying behavior. Neurosci Lett 2010; 471:63-5. [DOI: 10.1016/j.neulet.2009.12.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 12/07/2009] [Accepted: 12/20/2009] [Indexed: 11/24/2022]
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Rotge JY, Aouizerate B, Tignol J, Bioulac B, Burbaud P, Guehl D. The glutamate-based genetic immune hypothesis in obsessive-compulsive disorder. An integrative approach from genes to symptoms. Neuroscience 2010; 165:408-17. [PMID: 19861150 DOI: 10.1016/j.neuroscience.2009.10.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/21/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
Abstract
Recent advances in multiple areas of research have contributed to the identification of several pathophysiological factors underlying obsessive-compulsive disorder (OCD). In particular, the glutamate transporter gene SLC1A1 has been associated with the diagnosis of OCD. Immunological and infectious studies have reported alterations of the immune system and the presence of immune complexes directed against the Borna disease virus in OCD patients. In addition, neuroimaging of OCD patients has demonstrated abnormalities in the anterior cingulate cortex, orbitofrontal cortex, thalamus, and the basal ganglia. Neuropsychological assessments have found several cognitive disruptions that have been identified in OCD, especially impairments in cognitive flexibility. Here, we attempt to bridge the gap between these remarkable findings through several previously unpredicted pathophysiological mechanisms. We propose an integrative hypothesis that indicates how genetic and environmental factors may contribute to the structural and functional alterations of cortico-subcortical circuits, leading to the characteristic cognitive disruptions underlying OCD symptoms.
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Affiliation(s)
- J Y Rotge
- Laboratoire Mouvement Adaptation Cognition, CNRS UMR 5227, Université Bordeaux 2, Bordeaux, France.
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