Effects of lorazepam on perceptual integration of visual forms in healthy volunteers

Supplementation of gamma-aminobutyric acid (GABA) affects temporal, but not spatial visual attention

In a randomized, double-blind, and placebo-controlled experiment, the acute effects of gamma-aminobutyric acid (GABA) supplementation on temporal and spatial attention in young healthy adults were investigated. A hybrid two-target rapid serial visual presentation task was used to measure temporal attention and integration. Additionally, a visual search task was used to measure the speed and accuracy of spatial attention. While temporal attention depends primarily on the distribution of limited attentional resources across time, spatial attention represents the engagement and disengagement by relevant and irrelevant stimuli across the visual field. Although spatial attention was unaffected by GABA supplementation altogether, we found evidence supporting improved performance in the temporal attention task. The attentional blink was numerically, albeit not significantly, attenuated at Lag 3, and significantly fewer order errors were committed at Lag 1, compared to the placebo condition. No effect was found on temporal integration rates. Although there is controversy about whether oral GABA can cross the blood-brain barrier, our results offer preliminary evidence that GABA intake might help to distribute limited attentional resources more efficiently, and can specifically improve the identification and ordering of visual events that occur in close temporal succession.

Fluoxetine Does Not Enhance Visual Perceptual Learning and Triazolam Specifically Impairs Learning Transfer

The selective serotonin reuptake inhibitor fluoxetine significantly enhances adult visual cortex plasticity within the rat. This effect is related to decreased gamma-aminobutyric acid (GABA) mediated inhibition and identifies fluoxetine as a potential agent for enhancing plasticity in the adult human brain. We tested the hypothesis that fluoxetine would enhance visual perceptual learning of a motion direction discrimination (MDD) task in humans. We also investigated (1) the effect of fluoxetine on visual and motor cortex excitability and (2) the impact of increased GABA mediated inhibition following a single dose of triazolam on post-training MDD task performance. Within a double blind, placebo controlled design, 20 healthy adult participants completed a 19-day course of fluoxetine (n = 10, 20 mg per day) or placebo (n = 10). Participants were trained on the MDD task over the final 5 days of fluoxetine administration. Accuracy for the trained MDD stimulus and an untrained MDD stimulus configuration was assessed before and after training, after triazolam and 1 week after triazolam. Motor and visual cortex excitability were measured using transcranial magnetic stimulation. Fluoxetine did not enhance the magnitude or rate of perceptual learning and full transfer of learning to the untrained stimulus was observed for both groups. After training was complete, trazolam had no effect on trained task performance but significantly impaired untrained task performance. No consistent effects of fluoxetine on cortical excitability were observed. The results do not support the hypothesis that fluoxetine can enhance learning in humans. However, the specific effect of triazolam on MDD task performance for the untrained stimulus suggests that learning and learning transfer rely on dissociable neural mechanisms.

Dissecting perception and memory-driven imagery by boosting GABA-ergic neurotransmission

Flanking lateral masks enhance or weaken the detection of a low-contrast visual target. This effect depends on the target-to-mask distance. An improvement of stimulus detection can also be observed when participants imagine (i.e., retrieve from memory) the previously presented masks. In this double-blind, placebo-controlled study, we show that the gamma-aminobutyric acid-A (GABAA) receptor agonist alprazolam disrupts perceptual but not imagery enhancement of contrast detection in individuals with generalized anxiety and adjustment disorder. The weakened target detection at short target-to-mask distances became more pronounced after the administration of the GABA-agonist in both perception and imagery conditions. Healthy control participants did not differ from individuals with generalized anxiety and adjustment disorder receiving placebo. These results indicate that perception and imagery can be dissociated by boosting GABA-ergic neurotransmission. Further studies are warranted to investigate this effect in healthy individuals.

Effects of lorazepam on visual perceptual abilities

OBJECTIVE

To evaluate the effects of an acute dose of the benzodiazepine (BZ) lorazepam in young healthy volunteers on five distinguishable visual perception abilities determined by previous factor-analytic studies.

METHODS

This was a double-blind, cross-over design study of acute oral doses of lorazepam (2 mg) and placebo in young healthy volunteers. We focused on a set of paper-and-pencil tests of visual perceptual abilities that load on five correlated but distinguishable factors (Spatial Visualization, Spatial Relations, Perceptual Speed, Closure Speed, and Closure Flexibility). Some other tests (DSST, immediate and delayed recall of prose; measures of subjective mood alterations) were used to control for the classic BZ-induced effects.

RESULTS

Lorazepam impaired performance in the DSST and delayed recall of prose, increased subjective sedation and impaired tasks of all abilities except Spatial Visualization and Closure Speed. Only impairment in Perceptual Speed (Identical Pictures task) and delayed recall of prose were not explained by sedation.

CONCLUSION

Acute administration of lorazepam, in a dose that impaired episodic memory, selectively affected different visual perceptual abilities before and after controlling for sedation. Central executive demands and sedation did not account for results, so impairment in the Identical Pictures task may be attributed to lorazepam's visual processing alterations.

Lorazepam induces multiple disturbances in selective attention: attentional overload, decrement in target processing efficiency, and shifts in perceptual discrimination and response bias

There is a general consensus that benzodiazepines affect attentional processes, yet only few studies have tried to investigate these impairments in detail. The purpose of the present study was to investigate the effects of a single dose of Lorazepam on performance in a target cancellation task with important time constraints. We measured correct target detections and correct distractor rejections, misses and false positives. The results show that Lorazepam produces multiple kinds of shifts in performance, which suggests that it impairs multipLe processes: (a) the evolution of performance over time was not the same between the placebo and the Lorazepam groups, with the Lorazepam affecting performance quite early after the beginning of the test. This is suggestive of a depletion of attentional resources during sequential attentional processing; (b) Lorazepam affected differently target and distractor processing, with target detection being the most impaired; (c) misses were more frequent under Lorazepam than under placebo, but no such difference was observed as far as false positives were concerned. Signal detection analyses showed that Lorazepam (d) decreased perceptual discrimination, and (e) reliably increased response bias. Our results bring new insights on the multiple effects of Lorazepam on selective attention which, when combined, may have deleterious effects on human performance.

Diazepam impairs temporal dynamics of visual attention

The effect of benzodiazepines on attention has been the object of few investigations. Studies using the spatial cueing paradigm (Posner's paradigm) have reported inconsistent results, which are likely due to methodological and/or dose differences but suggest impaired disengagement of attention from the cue to the target. The authors investigated the effect of a benzodiazepine (diazepam) on attentional shifting in the temporal domain. The attentional blink effect refers to difficulties in detecting a target if it follows the identification of a previous target occurring within a temporal window of 200-400 ms. The authors assessed whether the duration of the attentional blink was affected by diazepam. Streams of 15 real-world scenes displaying a road were presented for 50 ms each. A city name (target) appeared at Serial Positions 2, 3, or 4 of each stream. A vehicle (probe) appeared at different intervals following the city name. In a dual-task condition, participants were asked to report the city name and whether a vehicle was present. In a control condition, participants had to report only the presence of a vehicle and ignore the city name. Thirty-six healthy volunteers were assigned to 3 groups (placebo, diazepam 0.1 mg/kg, or 0.3 mg/kg). Diazepam increased both the magnitude and duration of the attentional blink effect. Participants treated with a high dose of diazepam needed more than 600 ms to detect a vehicle following identification of the name. Results suggest that diazepam at a therapeutic dosage affects attentional shifting in the temporal domain and impairs dual-task performance.

Some facilitatory effects of lorazepam on dynamic visual binding

RATIONALE

The benzodiazepine lorazepam enhances the potential for inhibitory gamma-aminobutyric acid (GABAA) synapses in the cortex to stabilize postsynaptic, excitatory activity by synchronizing discharge rates at frequencies of around 40 Hz. Treatment with lorazepam also affects contour integration processes, suggesting that GABAA-mediated synchronization plays a role in visuospatial organization. This conclusion is supported by other physiological studies that link visual feature integration with neuronal synchronization.

OBJECTIVES

One experiment was conducted to assess variations in dynamic figural priming as a result of lorazepam administration.

METHODS

Observers were presented a modified version of a figural priming paradigm designed to investigate the effects of dynamic synchronization on visual feature integration. The priming paradigm consisted of premask crosses presented in a square arrangement within the same phase of a multiphase premask matrix oscillating at 40 Hz. Observers responded to a subsequently presented target square. The modification consisted of line elements presented at various distances relative to the unspecified extension of the lines making up the premask crosses. It was expected that priming effects would be enhanced for lines terminating close to the unspecified extension but only following administration of lorazepam.

RESULTS

As anticipated, priming was enhanced substantially when the premask crosses flickered around static lines that terminated adjacent to the unspecified extension between the premask crosses. This effect was maximal following treatment with lorazepam.

CONCLUSIONS

This finding supports the idea that GABAA-enhanced inhibitory synchronization mediates continuity coding during early visual processing.

Influence of benzodiazepines on auditory perception

The aim of this study was to test for an influence of benzodiazepine (BZD) on various perceptual and/or cognitive auditory processes. Loudness, auditory selective attention, and the ability of subjects to form perceptual streams out of alternating tone sequences were tested. Nine subjects were tested before, 1, 3, 7, and 24 h after a single-dose oxazepam vs placebo administration in a crossover design. A sample of blood allows us to measure plasma oxazepam concentration. The results revealed a significant reduction in stream segregation expressed as d' scores 1 h after oxazepam intake in the test subjects. No significant change occurred across time in the same subjects when they were administrated a placebo in another session. Furthermore, oxazepam had no substantial and systematic influence either on auditory selective attention or on loudness perception. Altogether, these results suggest that the perceptual organization of sound sequences involves inhibitory neural mechanisms, which can be affected by BZDs. This outcome is consistent with existing models of auditory stream segregation and may be paralleled with earlier findings on the effect of BZDs on perceptual binding in the visual modality.

Lorazepam induces an atypical dissociation of visual and auditory event-related potentials

Lorazepam has been reported to atypically disrupt visual processing compared to other benzodiazepines (BZs), but it is not known to what extent this effect extends to impairment in other modalities. Our objective was to compare the effects of lorazepam with those of flunitrazepam, a BZ with standard effects, on visual and auditory event-related potentials (ERPs) using the same paradigm. The study followed a placebo-controlled, double-blind, parallel group-design and involved single oral doses of lorazepam (2.0 mg), flunitrazepam (1.2 mg) and placebo. Thirty-six young, healthy subjects completed a test battery before and after treatment including classic behavioural tests, visual and auditory ERPs. Both drugs led to comparable alterations on behavioural tests and double-dissociations were found, indicating that the doses used were equipotent: lorazepam was more deleterious than flunitrazepam and placebo in fragmented shape identification, while simple reaction times were prolonged for flunitrazepam in comparison to lorazepam and placebo. Effects on P3 latencies were also distinct: alterations in both modalities for flunitrazepam were equivalent and greater than placebo's. In contrast, lorazepam at the frontal and central electrode sites led to greater changes in visual than in auditory latency, and also to longer visual latencies than flunitrazepam and placebo, but lorazepam's auditory latency effects were only different to placebo's at the parietal electrode site. Peripheral visual changes were not responsible for these effects. Differences in the impairment profile between equipotent doses of lorazepam and flunitrazepam suggests that lorazepam induces atypical central visual processing changes.

Pharmacological modulation of behavioral and neuronal correlates of repetition priming

In this experiment we address the pharmacological modulation of repetition priming, a basic form of learning, using event-related functional magnetic resonance imaging. We measured brain activity in a word-stem completion paradigm in which, before study, volunteers were given either placebo, lorazepam (2 mg orally), or scopolamine (0.4 mg, i.v.). Relative to placebo, both drugs attenuated the behavioral expression of priming. Repetition was associated with a decreased neuronal response in left extrastriate, left middle frontal, and left inferior frontal cortices in the placebo group. Both drugs abolished these "repetition suppression" effects. By showing a concurrence of behavioral and neuronal modulations, the results suggest that GABAergic and cholinergic systems influence the neuronal plasticity necessary for repetition priming.

Effects of a benzodiazepine, lorazepam, on motion integration and segmentation: an effect on the processing of line-ends?

Previous studies have shown that the perceptual integration of component motions distributed across space is inhibited whenever segmentation cues, such as line-ends, are salient. Herein, we investigate to what extent enhanced inhibition induced by lorazepam, a benzodiazepine facilitating the fixation of GABA on GABAA receptors, modifies the balance between motion integration and motion segmentation at the behavioural level. Motion integration was tested in 16 healthy volunteers taking a single and oral dose of either placebo or lorazepam (0.038 mg kg-1). The stimulus consisted of an outlined diamond presented behind four, otherwise invisible, apertures and translating along a circular trajectory (Lorenceau & Shiffrar (1992). Vision Research, 32, 263-273). Under these conditions, recovering the global diamond direction requires the integration of the component motions available within each aperture. The observers were asked to discriminate the global, clockwise or counter-clockwise, diamond direction under difficult--at high luminance contrasts--or easy--at low luminance contrasts--conditions. Overall, reaction times and error rates increased in the lorazepam group as compared to the placebo group, suggesting strong non-specific effects. However, the changes in performance in the lorazepam group are not homogeneous across conditions, suggesting that lorazepam also induces specific effects that modulate the integration/segmentation balance. Additional experiments performed with visible apertures or visible diamond vertices indicate that the effects of lorazepam are unlikely to reflect a deficit of motion processing or motion integration mechanisms since performance is only slightly impaired in the lorazepam as compared to the placebo group under these conditions. These results suggest that lorazepam might specifically modulate the saliency of line-ends, presumably because processing these features involves inhibitory mechanisms using GABA as a neuromediator, and in turn modify the balance between motion integration and segmentation.

Effects of lorazepam and diazepam on conscious and automatic memory processes

Recent studies exploring benzodiazepine memory effects have used the distinction between explicit and implicit tasks. There is now increasing evidence that implicit tasks can be "contaminated" by conscious uses of memory and that unconscious (automatic) use of memory can contaminate explicit tasks, leading to mistaken estimates of their respective influences on memory performance. The aim of the present double-blind, double-placebo study was to assess the memory effects of diazepam and lorazepam using a process-dissociation procedure in a stem-completion task, this procedure providing uncontaminated estimates of conscious and automatic memory processes. The memory task was administrated to 60 healthy volunteers randomly assigned to one of three parallel groups (placebo, diazepam 0.3 mg/kg, lorazepam 0.038 mg/kg). Lorazepam markedly reduced conscious as well as automatic influences of memory. Diazepam also reduced conscious uses of memory, albeit to a lesser extent than lorazepam, but did not decrease the influence of automatic memory. Secondary analyses showed that when the deleterious effect on conscious uses of memory was equated between a diazepam subgroup and the lorazepam group, only lorazepam impaired the automatic use of memory. This study strongly suggests a qualitative difference in the memory effects of the two benzodiazepines. It has some implications regarding the relationships between states of consciousness and memory processes.

Is cognitive psychopathology plausible? Illustrations from memory research

OBJECTIVE

To examine the strengths and weaknesses of cognitive psychopathology through the specific examples of the memory impairments associated with the administration of benzodiazepines, with schizophrenia, and with depression.

METHOD

These examples are analyzed with reference to a model of memory based on the principle of division between specialized and central processing structures. A basic contention is that it is useful to consider 2 broad classes of processes-automatic, associative, or sensory/perceptual processes on the one hand and intentional, strategic, or reflective processes on the other hand-as being separate.

RESULTS

The functional mechanisms of the memory impairments associated with these conditions are beginning to be identified, and there is preliminary evidence that a deficit in an elementary computation may have dramatic consequences on highest cognitive functions. There is also evidence that certain memory impairments are linked to specific dysfunctional outcomes in everyday life. By showing that specific rate-limiting factors of cognitive performance can be identified and are amenable to cognitive interventions, existing data open the door for theoretically and empirically based cognitive remediation of mental disorders.

CONCLUSION

The bulk of available evidence (albeit limited) makes the enterprise of cognitive psychopathology quite plausible and convincing.

Lorazepam impairs perceptual integration of visual forms: a central effect

Previous studies have shown a lorazepam effect on visual perception. We tested whether this impairment resulted from a peripheral effect induced by benzodiazepines. A first experiment showed that a single dose of lorazepam induces an oculomotor imbalance without impairing visual acuity or accommodation. In a second experiment, we tested whether the impairment induced by lorazepam on visual perception still occurred in monocular vision. Subjects matched incomplete forms controlled on the spacing and alignment of their local contour elements. A reference object was first displayed and followed by two laterally displayed objects, a target and a distractor. The distractor was the mirror-reversed version of the target. Performance was impaired in the lorazepam group when the reference was an incomplete form with a spacing of 10.8' or 22.2' of arc. These results were not correlated with sedation. They confirm that lorazepam has a central deleterious effect on visual perception. A post-hoc analysis also suggested that lorazepam-treated subjects used asymmetry in the stimuli as a compensatory strategy. This result is discussed in relation to previous hypotheses about the physiological mechanisms that determine the effects of lorazepam on visual perception.