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Heim B, Peball M, Krismer F, Djamshidian A, Seppi K. Pimavanserin: A Truly Effective Treatment for Parkinson's Disease Psychosis? A Review of Interventions. Neuropsychiatr Dis Treat 2023; 19:1303-1312. [PMID: 37274140 PMCID: PMC10239266 DOI: 10.2147/ndt.s371641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
Parkinson's disease (PD) is the second-most common neurodegenerative disorder with a long-term 60% cumulative prevalence of PD psychosis. Medical treatment is limited to few atypical antipsychotic drugs with low affinity to dopamine D2 receptors. In 2016, pimavanserin, a selective 5-HT2A inverse agonist/antagonist, was approved by the US Food and Drug Administration (FDA) as the only treatment for PD psychosis (PDP). This article provides an overview of the epidemiology, pathophysiology, and treatment options for PDP and illuminates the mode of action and therapy options with pimavanserin and the current study data.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Rissardo JP, Durante Í, Sharon I, Fornari Caprara AL. Pimavanserin and Parkinson's Disease Psychosis: A Narrative Review. Brain Sci 2022; 12:1286. [PMID: 36291220 PMCID: PMC9599742 DOI: 10.3390/brainsci12101286] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 10/18/2023] Open
Abstract
Pimavanserin (PMV) is the first approved drug for treating hallucinations and delusions in Parkinson's disease (PD) psychosis. Psychosis is one of the leading causes of nursing home placement in people with PD. Furthermore, hallucinations are a more frequent cause of institutionalization than motor disability or dementia related to PD. The management of PD psychosis involves antipsychotic medications. Most of the drugs in this class directly block dopamine D2 receptors, leading to significantly worsening motor symptoms in patients with PD. The most commonly used medications for managing PD psychosis are quetiapine, clozapine, and PMV. This literature review aims to study pimavanserin's history, mechanism, clinical trials, and post-marketing experience. PMV is a potent 5-HT2A receptor antagonist/inverse agonist. Moreover, this drug can interact with 5-HT2C receptors. We calculated some physicochemical descriptors and pharmacokinetic properties of PMV. Eight clinical trials of PMV and PD psychosis are registered on ClinicalTrials.gov. Only four of them have complete results already published. Meta-analytic results showed that PMV efficacy is inferior to clozapine. However, PMV has a significantly lower number of side-effects for managing psychosis in PD. Medicare database assessment revealed 35% lower mortality with PMV compared to other atypical antipsychotics. Moreover, sensitive statistical analysis demonstrated that PMV is a protective factor for the risk of falls in individuals with PD.
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Affiliation(s)
- Jamir Pitton Rissardo
- Medicine Department, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | - Ícaro Durante
- Department of Medicine, Federal University of Fronteira Sul, Passo Fundo 99010-121, Brazil
| | - Idan Sharon
- NewYork-Presbyterian Brooklyn Methodist Hospital, New York, NY 11215, USA
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Mahmood D, Alenezi SK, Anwar MJ, Azam F, Qureshi KA, Jaremko M. New Paradigms of Old Psychedelics in Schizophrenia. Pharmaceuticals (Basel) 2022; 15:ph15050640. [PMID: 35631466 PMCID: PMC9147282 DOI: 10.3390/ph15050640] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/08/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Psychedelics such as lysergic acid diethylamide (LSD), psilocybin (magic mushrooms), and mescaline exhibit intense effects on the human brain and behaviour. In recent years, there has been a surge in studies investigating these drugs because clinical studies have shown that these once banned drugs are well tolerated and efficacious in medically supervised low doses called microdosing. Psychedelics have demonstrated efficacy in treating neuropsychiatric maladies such as difficult to treat anxiety, depression, mood disorders, obsessive compulsive disorders, suicidal ideation, posttraumatic stress disorder, and also in treating substance use disorders. The primary mode of action of psychedelics is activation of serotonin 5-HT2A receptors affecting cognition and brain connectivity through the modulation of several downstream signalling pathways via complex molecular mechanisms. Some atypical antipsychotic drugs (APDs) primarily exhibit pharmacological actions through 5-HT2A receptors, which are also the target of psychedelic drugs. Psychedelic drugs including the newer second generation along with the glutamatergic APDs are thought to mediate pharmacological actions through a common pathway, i.e., a complex serotonin-glutamate receptor interaction in cortical neurons of pyramidal origin. Furthermore, psychedelic drugs have been reported to act via a complex interplay between 5HT2A, mGlu2/3, and NMDA receptors to mediate neurobehavioral and pharmacological actions. Findings from recent studies have suggested that serotoninergic and glutamatergic neurotransmissions are very closely connected in producing pharmacological responses to psychedelics and antipsychotic medication. Emerging hypotheses suggest that psychedelics work through brain resetting mechanisms. Hence, there is a need to dig deeply into psychedelic neurobiology to uncover how psychedelics could best be used as scientific tools to benefit psychiatric disorders including schizophrenia.
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Affiliation(s)
- Danish Mahmood
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia; (S.K.A.); (M.J.A.)
- Correspondence: or
| | - Sattam K. Alenezi
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia; (S.K.A.); (M.J.A.)
| | - Md. Jamir Anwar
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia; (S.K.A.); (M.J.A.)
| | - Faizul Azam
- Department of Pharmaceutical Chemistry & Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia;
| | - Kamal A. Qureshi
- Department of Pharmaceutics, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia;
| | - Mariusz Jaremko
- Smart-Health Initiative (SHI) and Red Sea Research Center (RSRC), Division of Biological and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955, Saudi Arabia;
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The Therapeutic Potential of Psilocybin. Molecules 2021; 26:molecules26102948. [PMID: 34063505 PMCID: PMC8156539 DOI: 10.3390/molecules26102948] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022] Open
Abstract
The psychedelic effects of some plants and fungi have been known and deliberately exploited by humans for thousands of years. Fungi, particularly mushrooms, are the principal source of naturally occurring psychedelics. The mushroom extract, psilocybin has historically been used as a psychedelic agent for religious and spiritual ceremonies, as well as a therapeutic option for neuropsychiatric conditions. Psychedelic use was largely associated with the "hippie" counterculture movement, which, in turn, resulted in a growing, and still lingering, negative stigmatization for psychedelics. As a result, in 1970, the U.S. government rescheduled psychedelics as Schedule 1 drugs, ultimately ending scientific research on psychedelics. This prohibition on psychedelic drug research significantly delayed advances in medical knowledge on the therapeutic uses of agents such as psilocybin. A 2004 pilot study from the University of California, Los Angeles, exploring the potential of psilocybin treatment in patients with advanced-stage cancer managed to reignite interest and significantly renewed efforts in psilocybin research, heralding a new age in exploration for psychedelic therapy. Since then, significant advances have been made in characterizing the chemical properties of psilocybin as well as its therapeutic uses. This review will explore the potential of psilocybin in the treatment of neuropsychiatry-related conditions, examining recent advances as well as current research. This is not a systematic review.
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Bravermanová A, Viktorinová M, Tylš F, Novák T, Androvičová R, Korčák J, Horáček J, Balíková M, Griškova-Bulanova I, Danielová D, Vlček P, Mohr P, Brunovský M, Koudelka V, Páleníček T. Psilocybin disrupts sensory and higher order cognitive processing but not pre-attentive cognitive processing-study on P300 and mismatch negativity in healthy volunteers. Psychopharmacology (Berl) 2018; 235:491-503. [PMID: 29302713 DOI: 10.1007/s00213-017-4807-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023]
Abstract
RATIONALE Disruption of auditory event-related evoked potentials (ERPs) P300 and mismatch negativity (MMN), electrophysiological markers of attentive and pre-attentive cognitive processing, is repeatedly described in psychosis and schizophrenia. Similar findings were observed in a glutamatergic model of psychosis, but the role of serotonergic 5-HT2A receptors in information processing is less clear. OBJECTIVES We studied ERPs in a serotonergic model of psychosis, induced by psilocybin, a psychedelic with 5-HT2A/C agonistic properties, in healthy volunteers. METHODS Twenty subjects (10M/10F) were given 0.26 mg/kg of psilocybin orally in a placebo-controlled, double-blind, cross-over design. ERPs (P300, MMN) were registered during the peak of intoxication. Correlations between measured electrophysiological variables and psilocin serum levels and neuropsychological effects were also analyzed. RESULTS Psilocybin induced robust psychedelic effects and psychotic-like symptoms, decreased P300 amplitude (p = 0.009) but did not affect the MMN. Psilocybin's disruptive effect on P300 correlated with the intensity of the psychedelic state, which was dependent on the psilocin serum levels. We also observed a decrease in N100 amplitude (p = 0.039) in the P300 paradigm and a negative correlation between P300 and MMN amplitude (p = 0.014). CONCLUSIONS Even though pre-attentive cognition (MMN) was not affected, processing at the early perceptual level (N100) and in higher-order cognition (P300) was significantly disrupted by psilocybin. Our results have implications for the role of 5-HT2A receptors in altered information processing in psychosis and schizophrenia.
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Affiliation(s)
- Anna Bravermanová
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,First Faculty of Medicine, Charles University Prague, Kateřinská 32, 121 08, Prague 2, Czech Republic
| | - Michaela Viktorinová
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Filip Tylš
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Tomáš Novák
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Renáta Androvičová
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Jakub Korčák
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Jiří Horáček
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Marie Balíková
- First Faculty of Medicine, Charles University Prague, Kateřinská 32, 121 08, Prague 2, Czech Republic
| | - Inga Griškova-Bulanova
- Institute of Biosciences, Vilnius University, Sauletekio ave 7, 102 57, Vilnius, Lithuania
| | - Dominika Danielová
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Přemysl Vlček
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Pavel Mohr
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Martin Brunovský
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic
| | - Vlastimil Koudelka
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Tomáš Páleníček
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Praha 10, Czech Republic.
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Sellers EM, Romach MK, Leiderman DB. Studies with psychedelic drugs in human volunteers. Neuropharmacology 2017; 142:116-134. [PMID: 29162429 DOI: 10.1016/j.neuropharm.2017.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/31/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022]
Abstract
Scientific curiosity and fascination have played a key role in human research with psychedelics along with the hope that perceptual alterations and heightened insight could benefit well-being and play a role in the treatment of various neuropsychiatric disorders. These motivations need to be tempered by a realistic assessment of the hurdles to be cleared for therapeutic use. Development of a psychedelic drug for treatment of a serious psychiatric disorder presents substantial although not insurmountable challenges. While the varied psychedelic agents described in this chapter share some properties, they have a range of pharmacologic effects that are reflected in the gradation in intensity of hallucinogenic effects from the classical agents to DMT, MDMA, ketamine, dextromethorphan and new drugs with activity in the serotonergic system. The common link seems to be serotonergic effects modulated by NMDA and other neurotransmitter effects. The range of hallucinogens suggest that they are distinct pharmacologic agents and will not be equally safe or effective in therapeutic targets. Newly synthesized specific and selective agents modeled on the legacy agents may be worth considering. Defining therapeutic targets that represent unmet medical need, addressing market and commercial issues, and finding treatment settings to safely test and use such drugs make the human testing of psychedelics not only interesting but also very challenging. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.
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Affiliation(s)
- Edward M Sellers
- Departments of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Medicine, University of Toronto, Toronto, ON, Canada; Psychiatry, University of Toronto, Toronto, ON, Canada; Surgery, University of Toronto, Toronto, ON, Canada; DL Global Partners Inc, Toronto, ON, Canada.
| | - Myroslava K Romach
- Psychiatry, University of Toronto, Toronto, ON, Canada; Surgery, University of Toronto, Toronto, ON, Canada; DL Global Partners Inc, Toronto, ON, Canada
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Rickli A, Moning OD, Hoener MC, Liechti ME. Receptor interaction profiles of novel psychoactive tryptamines compared with classic hallucinogens. Eur Neuropsychopharmacol 2016; 26:1327-37. [PMID: 27216487 DOI: 10.1016/j.euroneuro.2016.05.001] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/25/2016] [Accepted: 05/08/2016] [Indexed: 11/25/2022]
Abstract
The present study investigated interactions between the novel psychoactive tryptamines DiPT, 4-OH-DiPT, 4-OH-MET, 5-MeO-AMT, and 5-MeO-MiPT at monoamine receptors and transporters compared with the classic hallucinogens lysergic acid diethylamide (LSD), psilocin, N,N-dimethyltryptamine (DMT), and mescaline. We investigated binding affinities at human monoamine receptors and determined functional serotonin (5-hydroxytryptamine [5-HT]) 5-HT2A and 5-HT2B receptor activation. Binding at and the inhibition of human monoamine uptake transporters and transporter-mediated monoamine release were also determined. All of the novel tryptamines interacted with 5-HT2A receptors and were partial or full 5-HT2A agonists. Binding affinity to the 5-HT2A receptor was lower for all of the tryptamines, including psilocin and DMT, compared with LSD and correlated with the reported psychoactive doses in humans. Several tryptamines, including psilocin, DMT, DiPT, 4-OH-DiPT, and 4-OH-MET, interacted with the serotonin transporter and partially the norepinephrine transporter, similar to 3,4-methylenedioxymethamphetamine but in contrast to LSD and mescaline. LSD but not the tryptamines interacted with adrenergic and dopaminergic receptors. In conclusion, the receptor interaction profiles of the tryptamines predict hallucinogenic effects that are similar to classic serotonergic hallucinogens but also MDMA-like psychoactive properties.
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Affiliation(s)
- Anna Rickli
- Psychopharmacology Research, Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Olivier D Moning
- Psychopharmacology Research, Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Marius C Hoener
- Neuroscience Research, pRED, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Matthias E Liechti
- Psychopharmacology Research, Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.
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