Effect of low-dose bromocriptine in treatment of psychosis: the dopamine autoreceptor-stimulation strategy

Effects of brief inhibition of the ventral tegmental area dopamine neurons on the cocaine seeking during abstinence

Preclinical studies strongly suggest that cocaine seeking depends on the neuronal activity of the ventral tegmental area (VTA) and phasic dopaminergic (DA) signaling. Notably, VTA pharmacological inactivation or dopamine receptor blockade in the forebrain may induce behavioral inhibition in general and acute aversive states in particular, thus reducing cocaine seeking indirectly. Such artifacts hinder successful translation of these findings in clinical studies and practice. Here, we aimed to evaluate if dynamic VTA manipulations effectively reduce cocaine seeking. We used male tyrosine hydroxylase (TH) IRES-Cre⁺ rats along with optogenetic tools to inhibit directly and briefly VTA DA neurons during conditioned stimulus (CS)-induced cocaine seeking under extinction conditions. The behavioral effects of optogenetic inhibition were also assessed in the real-time dynamic place aversion, conditioned place aversion, and CS-induced food-seeking tests. We found that brief and nondysphoric/nonsedative pulses of VTA photo-inhibition (1 s every 9 s, ie, for 10% of time) attenuated CS-induced cocaine seeking under extinction conditions in rats expressing archaerhodopsin selectively on the TH⁺ neurons. Furthermore, direct inhibition of the VTA DA activity reduced CS-induced cocaine seeking 24 hours after photo-modulation. Importantly, such effect appears to be selective for cocaine seeking as similar inhibition of the VTA DA activity had no effect on CS-induced food seeking. Thus, briefly inhibiting VTA DA activity during CS-induced cocaine seeking drastically and selectively reduces seeking without behavioral artifacts such as sedation or dysphoria. Our results point to the therapeutic possibilities of coupling nonpharmacologic treatments with extinction training in reducing cocaine addiction.

Catecholamines and cognition after traumatic brain injury

Cognitive problems are one of the main causes of ongoing disability after traumatic brain injury. The heterogeneity of the injuries sustained and the variability of the resulting cognitive deficits makes treating these problems difficult. Identifying the underlying pathology allows a targeted treatment approach aimed at cognitive enhancement. For example, damage to neuromodulatory neurotransmitter systems is common after traumatic brain injury and is an important cause of cognitive impairment. Here, we discuss the evidence implicating disruption of the catecholamines (dopamine and noradrenaline) and review the efficacy of catecholaminergic drugs in treating post-traumatic brain injury cognitive impairments. The response to these therapies is often variable, a likely consequence of the heterogeneous patterns of injury as well as a non-linear relationship between catecholamine levels and cognitive functions. This individual variability means that measuring the structure and function of a person’s catecholaminergic systems is likely to allow more refined therapy. Advanced structural and molecular imaging techniques offer the potential to identify disruption to the catecholaminergic systems and to provide a direct measure of catecholamine levels. In addition, measures of structural and functional connectivity can be used to identify common patterns of injury and to measure the functioning of brain ‘networks’ that are important for normal cognitive functioning. As the catecholamine systems modulate these cognitive networks, these measures could potentially be used to stratify treatment selection and monitor response to treatment in a more sophisticated manner.

Pharmacokinetic-pharmacodynamic study of apomorphine's effect on growth hormone secretion in healthy subjects

Apomorphine (APO) stimulates growth hormone (GH) release via dopamine D2 receptors (DRD2). There is no specific study assessing the relationship between APO pharmacokinetic (PK) and the pharmacodynamic (PD) response e.g. GH release. The objective of the study is the PK-PD modelling of APO in healthy subjects. This is a randomized crossover study with s.c. administration of 5, 10, and 20 micro g/kg of APO in 18 healthy subjects. APO concentrations were modelled according to both a bi-compartmental model with zero-order absorption and a bi-compartmental model with first-order absorption. PK-PD relationship was modelled in accordance with the Emax Hill equation using plasma concentrations of APO calculated according to the bi-compartmental model with zero-order absorption. Modelled parameters were very similar to the experimental parameters. PK of APO was linear and there was no significant difference between the tested doses for AUC0--> infinity and Cmax (normalised to the dose 1 micro g/kg), t1/2alpha and t1/2beta. These parameters expressed as mean (CV%: SD/mean) were: 17.2 (26.9) ng/mL.min, 0.26 (33.3) ng/mL, 17.1 (54.2) and 45.2 (20.6) min, respectively (n = 53). An anticlockwise hysteresis loop (effect function of APO plasma concentration) appeared for each dose and each subject. The predicted and measured GH concentrations for all subjects and times were similar whatever the dose (P > 0.27). Emax values were 246 (121), 180 (107), 205 (139) ng/mL, respectively, and EC50 were 0.98 (48.1), 1.70 (62.3), 3.67 (65.2) ng/mL, respectively at dose 5, 10, and 20 micro g/kg (P < 10-4). APO and GH concentrations were predicted with good accuracy using bi-compartmental with zero-order absorption PK model and sigmoid Emax PD model, respectively.

Aryl 1-but-3-ynyl-4-phenyl-1,2,3,6-tetrahydropyridines as potential antipsychotic agents: synthesis and structure-activity relationships

A novel series of aryl 1-but-3-ynyl-4-phenyl-1,2,3,6-tetrahydropyridines with dopaminergic activity is described. The structure-activity relationships of this series were studied by synthesis of analogs and evaluation of their affinities for the dopamine (DA) D2 receptor and inhibition of locomotor activity (LMA) in rodents. The basic amine, alkyne chain length, and aryl groups were varied. Compounds having a 4-phenyl-1,2,3,6-tetrahydropyridine and an aryl group with hydrogen-bonding substituents separated by a butynyl chain were found to have the most potent dopaminergic activity. Several compounds that were found to have exceptional in vivo activity in LMA inhibition in rodents were evaluated for additional pharmacological activity including binding affinities for other DA receptor subtypes as well as effects on brain DA synthesis, DA neuronal firing, and conditioned avoidance responding in squirrel monkeys.

The neurochemical effects on striatal dopamine turnover rate of N-stearyl dopamine after acute administration in rats

1. Considerable efforts have been made in order to develop autoreceptor selective agonists for the treatment of schizophrenia and hyperkinetic disorders. 2. Recent behavioural studies showed that the newly synthesized dopamine lipoamide, N-stearyl dopamine induced a strong hypomotility (-80%) in rats and mice. It is worth noting that this behavioural response was partially antagonized by dopaminergic antagonists, such as haloperidol and sulpiride, administered at doses that block DA autoreceptors. 3. In the present study the authors investigated the neurochemical changes induced by S-DA, in the striatum of the rat brain, in order to estimate a possible correlation between the above mentioned behavioural response and DA metabolism. 4. S-DA (10 or 100 mg/kg, i.p.) induced a significant decrease in DA turnover rate while it did not affect 5-HT metabolism in the striatum. 5. Considering that 5-DA induces a strong hypomotility, which can be partially antagonized by haloperidol or sulpiride administered at low doses, while also decreases the striatal DA turnover rate, it could be suggested that together these findings indicate that this DA lipoamide may be display the characteristics of an antipsychotic agent, acting on the "DA selective" autoreceptors.

Effects of the dopamine-related drug bromocriptine on event-related potentials and its relation to the law of initial value

Effects of the dopamine-related drug bromocriptine (BCT) on event-related potentials (ERP) were investigated in 18 healthy volunteers. Bromocriptine 2.5 mg or an inactive placebo was administered according to a completely randomized double-blind, cross-over design. The ERP were recorded 3 h after medication was given. Although BCT prolonged the P300 latency, it had no effect on the amplitudes of the ERP components as a whole. Bromocriptine increased the latencies of N100, P200 and P300 in the respective short-latency subject group, and decreased the latency of N200 in the long-latency subject group. It increased the amplitude of N200 in the low-amplitude subject group. It was concluded that the prolongation of P300 latency as a whole and the different responses that take place are dependent on the initial values and were recognized in the effect of a single administration of BCT 2.5 mg. The results of this study are discussed in relation to the law of initial value.

Dopamine agonists in schizophrenia: a review

Although it is unlikely that the different types of course and severity of schizophrenia are caused by one neurochemical abnormality alone, indirect pharmacological evidence still suggests a relative excess of dopaminergic activity being implicated in the pathogenesis of most of the schizophrenic symptoms, e.g. positive symptomatology. Synthesis and release of dopamine as well as firing rates of dopaminergic neurons are controlled by stimulation of autoreceptors via a negative feedback regulation. Investigations on therapeutic effects of autoreceptor-nonselective dopamine agonists in schizophrenia have yielded inconsistent results. Dopamine autoreceptor agonists like pramipexole, roxindole, talipexole and OPC-4392 as well as partial agonists like terguride and SDZ HDC 912 have been tested in positive schizophrenic symptomatology in order to reduce the postulated excess of central dopaminergic activity. However, administration of autoreceptor-'selective' agonists did not result in a significant improvement of positive symptoms. In predominantly negative schizophrenic symptomatology, a dopamine deficit rather than an excess has been hypothesized. Consequently, a nonselective dopamine agonistic action could be effective in some negative symptoms. Current evidence from several open and one placebo-controlled clinical trial suggests that some dopamine autoreceptor agonists like pramipexole, roxindole and talipexole may produce a mild improvement of symptoms like affective flattening, depressed mood, alogia and avolition. Nevertheless, these findings do not yet allow a reliable judgement and remain to be clarified by further double-blind placebo-controlled studies over a sufficient treatment duration.

Dopamine autoreceptor agonists in the treatment of schizophrenic disorders

1. Synthesis and release of dopamine as well as firing rates of dopaminergic neurons are controlled by stimulation of autoreceptors via a negative feedback regulation. Investigations on therapeutic effects of autoreceptor-nonselective dopamine agonists in schizophrenia have yielded inconsistent results. 2. With respect to the dopamine hypothesis of schizophrenia, dopamine autoreceptor agonists have been tested in positive schizophrenic symptomatology in order to reduce the postulated excess of central dopaminergic activity. However, administration of selective dopamine autoreceptor agonists like talipexole or roxindole did not result in a significant improvement of psychopathological symptoms. 3. In negative schizophrenic symptomatology, a dopamine deficit rather than an excess has been hypothesized. Current evidence from open clinical trials suggests that dopamine autoreceptor agonists may produce a minor to moderate improvement of symptoms like affective flattening, depressed mood, alogia and avolition.

Beginning-of-dose motor deterioration following the acute administration of levodopa and apomorphine in Parkinson's disease

Six Parkinsonian patients on long term levodopa therapy complained of short-lived deterioration of Parkinsonian symptoms immediately after levodopa intake. After withdrawal of the drug overnight, and following an oral challenge with levodopa/carbidopa (250/25) in all six cases, and with subcutaneous apomorphine (3 mg) in two, deterioration below base line levels of disability were observed which would not be explained by loss of sleep benefit. This occurred 10-20 minutes after levodopa challenge and lasted for 10-20 minutes. The latency and duration of this phenomenon were shorter with apomorphine but the characteristics were similar. This phenomenon may be due to an inhibitory effect of levodopa acting via presynaptic dopamine receptors.

Amisulpride versus bromocriptine in infantile autism: A controlled crossover comparative study of two drugs with opposite effects on dopaminergic function

An alteration of dopaminergic (DA) function much more complex than simple hyperactivity has been evoked in infantile autism. We therefore compared the clinical efficacy of a DA antagonist (amisulpride) and a DA agonist (bromocriptine) in a randomized, double-blind, crossover trial in 9 children with autism, likely severely mentally retarded. Amisulpride acts preferentially on specific autistic symptoms whereas bromocriptine acts more on motor hyperactivity and attention symptoms. These findings raise the specificity of these two drugs which appear to act preferentially on some target symptoms and are consistent with some clinical and pharmacological observations showing a sedative effect with low doses of DA agonists and a stimulant effect with low doses of DA antagonists such as the benzamides.

Do autoreceptors mediate dopamine agonist--induced yawning and suppression of exploration? A critical review

The hypothesis that stimulation of dopamine autoreceptors is the mechanism by which dopamine agonists induce yawning and suppression of exploration is critically examined. It is shown that the relation between reduced extracellular dopamine levels, assessed by microdialysis, and behavioural effects of dopamine agonists, a dopamine synthesis inhibitor and a granule storage blocker is highly inconsistent. The time-course and duration of the behavioural effects of dopamine agonists differ from the reduction of extracellular dopamine. Amphetamine cotreatment is shown to increase dopamine levels, while yawning and suppression of exploration can still be induced. The data strongly indicate that autoreceptors are not the mediators of these behavioural effects. It is proposed that postsynaptic receptors mediate dopamine agonist induced yawning and suppression of exploration. Evidence is also presented showing that yawning and suppression of exploration are not functionally equivalent.

Substance abuse and schizophrenia: impediments to optimal care

With lifetime prevalence estimates of substance abuse among schizophrenics as high as 47.01%, there is an increasing awareness of the importance of this dual diagnosis and the global deficiencies in our knowledge about this comorbid condition. Patients with substance abuse disorders and schizophrenia are problematic from a clinical, economic, and health care systems perspective. The lack of systematic research into phenomenology, etiology, and treatment approaches (both psychotherapeutic and psychopharmacologic) has hindered the development of an adequate strategy to care for the needs of these patients. Thus, these patients place a significant burden on the mental health delivery system through chronic disability, social dysfunction, frequent rehospitalizations, and poor overall treatment compliance. The authors critically review the contemporary literature relevant to concurrent substance abuse and schizophrenia, highlight major deficiencies in our knowledge, and call for research to reduce the individual, economic, and social costs of this condition.

Acute and subchronic effects of low-dose bromocriptine in haloperidol-treated schizophrenics

The effects of the acute (within 24 hr) and subchronic (21 days) addition of low-dose bromocriptine (2.5 mg/day) were compared to placebo in schizophrenic patients treated concomitantly with haloperidol. After 24 hr patients on bromocriptine (n = 15) showed a mean improvement of 29% in the total score of the Brief Psychiatric Rating Scale (BPRS) as compared to 14% in the placebo group (n = 15) (p less than 0.10). The acute improvement correlated negatively with bromocriptine plasma levels; patients with the highest reduction in BPRS score had the lowest plasma levels (between 50 and 150 pg/ml) at 60, 90, and 120 min after intake. The improvement in the bromocriptine group continued until the 10th day of the trial, when a nonsignificant increase in the total BPRS score took place. Analysis of Variance of the overall BPRS improvement during the 21 days revealed no significant difference between both patient groups. Our results give modest support to the idea of an acute antipsychotic response to low-dose dopamine agonists in neuroleptic-treated patients, but fail to support their clinical usefulness in the subchronic treatment of schizophrenia.

On the selectivity and specificity of the antagonism of apomorphine-induced suppression of exploration by sulpiride

Ten behavioural variables were recorded by means of an automatic holeboard apparatus. The behaviour of rats placed for the first time in the apparatus was recorded for 10 min. The suppression of this exploratory behaviour by the dopamine agonist apomorphine (0.01-0.1 mg/kg) was shown to be reversible in a surmountable fashion by the dopamine antagonist sulpiride (2 and 4 mg/kg). Suppression of exploration induced by clonidine (0.05-0.2 mg/kg) or diazepam (2 mg/kg) was not antagonised by sulpiride (10 and 50 mg/kg, respectively). The partial dopamine D1-agonist SKF 38393 (2-20 mg/kg) also suppressed exploration but neither sulpiride (20 mg/kg) nor the D1-antagonist SCH 23390 (0.02 mg/kg) could antagonise this effect. The data show that dopamine agonist induced suppression of exploration display pharmacological characteristics of a receptor-mediated response and the data support our previous suggestion that these receptors may be pharmacologically distinct from other dopamine D2-receptors.

Dopamine agonists at repeated "autoreceptor-selective" doses: effects upon the sensitivity of A10 dopamine autoreceptors

Previous reports have established the ability of dopamine (DA) agonists to stimulate inhibitory DA autoreceptors at doses which minimally stimulate postsynaptic DA receptors, suggesting that hyperactive DA transmission may be controlled clinically by treatment with DA agonists. Little is known, however, about the possible loss of autoreceptor sensitivity that may occur after repeated treatment with low doses of DA agonists. Extracellular single cell recording and microiontophoretic techniques were used to measure the sensitivity of impulse-regulating DA autoreceptors on A10 DA cells in the ventral tegmental area (VTA) of chloral hydrate-anesthetized rats pretreated for seven days with repeated subcutaneous (s.c.) doses of the DA agonist apomorphine (APO). The ability of intravenous (i.v.) administration of the potent D2 DA agonist quinpirole (QUIN) to inhibit the firing of A10 cells was not attenuated in rats pretreated with repeated low doses (2 x 50 micrograms/kg/day, s.c.) of APO for 7 days, although higher doses (2 x 250 or 500 micrograms/kg/day) did cause subsensitive responses to QUIN. In rats pretreated with repeated low doses of APO, microiontophoretic application of DA on A10 cells revealed somewhat subsensitive responses. However, ibotenic acid lesions of postsynaptic cells in the nucleus accumbens (NAc) prior to initiation of APO treatment (2 x 50 micrograms/kg/day) did not alter the response of A10 cells to systemic QUIN, contradicting the possibility that the feedback projection from the NAc to the VTA was compensating for autoreceptor down-regulation during systemic challenge with QUIN. In contrast, administration of the irreversible DA antagonist EEDQ (2 mg/kg, i.p.) to control and APO-treated rats (2 x 50 micrograms/kg/day) 24 hr prior to recording did reveal a difference in A10 cell sensitivity to systemic QUIN and to microiontophoretic DA between the two groups, suggesting that "spare" DA autoreceptors may have concealed the down-regulation of autoreceptors induced by repeated low doses of APO. Challenge of A10 DA cells with the partial DA autoreceptor agonist (-)-3-(3-hydroxyphenyl)-N-n-propylpiperidine [(-)3-PPP], for which an autoreceptor reserve should not exist, produced slightly attenuated responses in APO-treated rats (2 x 50 micrograms/kg/day). These findings provide evidence for the existence of spare somatodendritic DA autoreceptors on A10 DA cells with respect to potent DA agonists, suggesting that repeated administration of "autoreceptor-selective" doses of DA agonists may not result in a diminished inhibition of DA neuronal activity.

Yawning and suppression of exploration in amphetamine-treated rats, incompatibility with the autoreceptor hypothesis

The hypothesis that yawning and suppression of exploration, induced by low doses of dopamine agonists, are mediated by stimulation of dopamine autoreceptors was tested by studying the influence of amphetamine on these behavioural models and on extracellular levels of dopamine sampled by microdialysis. Behaviour was measured in a holeboard apparatus. A low dose of amphetamine (0.2 mg/kg) caused slight activation of habituated rats. The same dose of amphetamine completely counteracted the decrease in extracellular dopamine levels caused by pergolide (0.02 mg/kg) and, instead, elevated the dopamine levels to 300% above baseline. The same or higher doses of amphetamine (0.5-1.0 mg/kg) did not completely antagonise suppression of exploration or yawning induced by apomorphine (0.05 mg/kg) or pergolide (0.02 mg/kg). The results suggest that both yawning and suppression of exploration induced by low doses of dopamine agonists are not mediated by dopamine autoreceptors, since these behaviours could be elicited when the extracellular levels of dopamine were elevated above baseline. The alternative hypothesis that these behaviours are mediated by sensitive post-synaptic receptors is suggested. It was also found that combined treatment with SCH 23390 (0.05 mg/kg) and amphetamine (2 mg/kg) induced yawning, which further supports the new hypothesis.

On the mode of action of six putative dopamine receptor agonists on suppression of exploratory behaviour in rats

The effects of six putative dopamine receptor agonists on exploratory behaviour in rats were assessed: pergolide, (+)- and (-)-3-PPP, bromocriptine, mesulergine and CQ 32-084. Behaviour was automatically recorded in a holeboard apparatus and the data were analysed by the novel multivariate statistical method of partial least squares. All six substances suppressed exploratory behaviour at low doses. Pergolide and (+)-3-PPP-induced stereo-typed behaviour at higher doses. The suppression of exploration induced by pergolide was completely antagonised by sulpiride, partly antagonised by metoclopramide and weakly affected by haloperidol pretreatment. The effects of a low dose of (+)-3-PPP, bromocriptine or CQ 32-084, but not (-)-3-PPP or mesulergine, were antagonised by sulpiride. These findings support the hypotheses that pergolide, (+)-3-PPP, bromocriptine and CQ 32-084 inhibit exploration via stimulation of dopamine receptors. The present data do not substantiate the hypothesis that the suppression of exploration induced by (-)-3-PPP is mediated by stimulation of dopamine autoreceptors. A detailed analysis of the dose curves for pergolide and (+)-3-PPP indicates that the latter compound may have effects in addition to those of a dopamine receptor agonist.

Effects of intravenous and subcutaneous administration of apomorphine on the clinical symptoms of chronic schizophrenics

The effects of apomorphine, a stimulant of dopamine autoreceptors, were studied in 12 chronic schizophrenics on neuroleptic treatment; both subcutaneous and intravenous administration were used. Apomorphine has been reported to have therapeutic effects in previous studies but, we were not able to confirm any significant and specific differences in psychotic symptoms or tardive dyskinesia scores with apomorphine administration, compared with placebo. These results do not support the importance of dopamine autoreceptors in the regulation of schizophrenic and dyskinetic symptoms in chronic neuroleptic-treated patients.

A comparison of dopamine agonist action to inhibit locomotor activity and to induce stereotyped behaviour in the mouse

51 purported dopamine agonists from the phenylethylamine, tetralin, octahydrobenzo(f)- and (g)quinoline, benzocycloheptene, aporphine and ergoline series were tested in the mouse for ability to cause motor inhibition at low doses and stereotyped responding (motor facilitation) at higher doses. Motor inhibition was characterised either by a freezing akinesia (spiroperidol sensitive) or by sedation (resistant to spiroperidol). Agents potent to induce the freezing response could, if the dose was raised sufficiently (at least 10 fold), cause stereotypy. Within all series tested N-n-propyl substitution generally conferred greatest selectivity of motor inhibitory action. Radioligand binding assays using [3H]ADTN as ligand and rat striatal tissue showed correlations between abilities to associate with the dopamine receptor and to cause motor inhibition or facilitation, but discrepancies were apparent, particularly within the tetralin series. It is concluded that whilst there exists clear potency differences to inhibit locomotor activity and to induce stereotyped behaviour, it is difficult to demonstrate unequivocally an absolute selectivity of dopamine agonist action for the motor inhibitory dopamine system.

Low dose bromocriptine: a study of acute effects in chronic mediated schizophrenics

An acute low oral dose (2 mg) of bromocriptine was administered in a randomized double blind fashion to 11 chronic symptomatic mediated schizophrenic patients. There was an overall improvement for the group on the Brief Psychiatric Rating Scale (BPRS) following bromocriptine. Plasma homovanillic acid, 3-methoxy-4-hydroxyphenylglycol, and vanilloyl-mandelic acid concentrations were unchanged after bromocriptine. Bromocriptine concentrations in the plasma showed a large inter-individual variation. There was a significant inverse correlation between plasma bromocriptine concentration and total BPRS score at 60 minutes post-bromocriptine administration. These results suggest a need for further replication in a larger study population and a need for controlled studies with chronic administration of low dose bromocriptine in chronic medicated schizophrenic patients.