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Osugo M, Whitehurst T, Shatalina E, Townsend L, O’Brien O, Mak TLA, McCutcheon R, Howes O. Dopamine partial agonists and prodopaminergic drugs for schizophrenia: systematic review and meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2022; 135:104568. [DOI: 10.1016/j.neubiorev.2022.104568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
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Prodopaminergic Drugs for Treating the Negative Symptoms of Schizophrenia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Clin Psychopharmacol 2020; 39:658-664. [PMID: 31688399 DOI: 10.1097/jcp.0000000000001124] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The negative symptoms of schizophrenia pose a heavy burden on patients and relatives and represent an unmet therapeutic need. The observed association of negative symptoms with impaired reward system function has stimulated research on prodopaminergic agents as potential adjunctive treatments. METHODS We conducted a systematic review and meta-analysis of published randomized controlled trials of amphetamine, methylphenidate, modafinil, armodafinil, lisdexamphetamine, L-dopa, levodopa, bromocriptine, cabergoline, quinagolide, lisuride, pergolide, apomorphine, ropinirole, pramipexole, piribedil, and rotigotine augmentation in schizophrenia and schizoaffective disorder.Medline, EMBASE, and several other databases as well as trial registries were searched for placebo-controlled trials. RESULTS Ten randomized controlled trials were included in the meta-analysis, 6 trials on modafinil, 2 on armodafinil, 1 on L-dopa, and 1 on pramipexole. Overall, prodopaminergic agents did not significantly reduce negative symptoms. Restricting the analysis to studies requiring a minimum threshold for negative symptom severity, modafinil/armodafinil showed a significant but small effect on negative symptoms. A subset of studies allowed for calculating specific effects for the negative symptom dimensions diminished expression and amotivation, but no significant effect was found. Prodopaminergic agents did not increase positive symptom scores. CONCLUSIONS The currently available evidence does not allow for formulating recommendations for the use of prodopaminergic agents for the treatment of negative symptoms. Nevertheless, the observed improvement in studies defining a minimum threshold for negative symptom severity in the absence of an increase in positive symptoms clearly supports further research on these agents.
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Zarkowski PA. Relative prevalence of 10 types of pharmacodynamic interactions in psychiatric treatment. Int J Psychiatry Med 2020; 55:82-104. [PMID: 31470752 DOI: 10.1177/0091217419870669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the relative prevalence and factors affecting the prescription of medication combinations with a theoretical efficacy limiting pharmacodynamic interaction, defined as two medications with opposing indications and side effects or antagonistic action at the primary receptor of mechanism of action. METHOD One hundred sixteen combinations were identified for 10 types of pharmacodynamic interactions. PubMed was searched for each combination to assess the quality of evidence either supporting clinical use or verifying reduced efficacy. Micromedex was searched to determine the presence of warnings to prescribers of reduced efficacy. The prevalence in clinical practice was determined by computer review of the Genoa Healthcare database for all prescribers at 10 participating community mental health centers. The expected prevalence was calculated as the product of the probability of each medication prescribed alone and was compared with the actual prevalence of the combination using the test of proportions. RESULTS The frequency of prescription of eight combinations met the Bonferroni corrected level of significance of p < 0.001. Four were combinations of amphetamine and D2 antagonists and each were prescribed less often than chance, p = 0.0001 consistent with epidemiological studies and multiple animal studies verifying an efficacy limiting interaction. Despite epidemiological studies indicating increased risk of accidents, alprazolam and amphetamine were prescribed more often than chance, p = 0.0001. Micromedex generated warnings for efficacy limiting interactions for five other combinations, but with no subsequent change in prescription frequency. CONCLUSIONS Neither presence of medical evidence nor warnings from Micromedex consistently affect the prescription of combinations with pharmacodynamic efficacy limiting interactions.
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Affiliation(s)
- Paul A Zarkowski
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, WA, USA
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Sleep therapeutics and neuropsychiatric illness. Neuropsychopharmacology 2020; 45:166-175. [PMID: 31376815 PMCID: PMC6879486 DOI: 10.1038/s41386-019-0474-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
Alterations in sleep are extremely common in patients with neuropsychiatric illness. In addition, sleep disorders such as insomnia, obstructive sleep apnea, rapid eye movement sleep behavior disorder, and circadian rhythm disorders commonly occur at a rate greater than the general population in neuropsychiatric conditions. Historically, sleep problems have been viewed as symptoms of associated neuropsychiatric disorders. However, there is increasing evidence suggesting a complex inter-relationship with possible bidirectional causality. The inter-relatedness of these conditions represents an opportunity for understanding mechanisms and improving clinical treatment. To the extent that sleep problems affect neuropsychiatric conditions, it may be possible to address sleep problems and have a positive impact on the course of neuropsychiatric illnesses. Further, some treatments for sleep disorders have direct effects on neuropsychiatric illnesses that may be unrelated to their effects on sleep disorders. Similarly, neuropsychiatric conditions and their treatments can affect sleep and sleep disorders. This article reviews available evidence on the effects of therapies for sleep disorders on neuropsychiatric conditions and also secondarily considers the impacts of therapies for neuropsychiatric conditions on sleep. Primary goals of this review are to identify gaps in current research, to determine the extent to which the cross-therapeutic effects of these treatments help to elucidate therapeutic or pathological mechanisms, and to assist clinicians in optimizing therapeutic choice in patients with sleep disorders and neuropsychiatric conditions.
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The past and future of novel, non-dopamine-2 receptor therapeutics for schizophrenia: A critical and comprehensive review. J Psychiatr Res 2019; 108:57-83. [PMID: 30055853 DOI: 10.1016/j.jpsychires.2018.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/13/2018] [Accepted: 07/12/2018] [Indexed: 01/28/2023]
Abstract
Since the discovery of chlorpromazine in the 1950's, antipsychotic drugs have been the cornerstone of treatment of schizophrenia, and all attenuate dopamine transmission at the dopamine-2 receptor. Drug development for schizophrenia since that time has led to improvements in side effects and tolerability, and limited improvements in efficacy, with the exception of clozapine. However, the reasons for clozapine's greater efficacy remain unclear, despite the great efforts and resources invested therewith. We performed a comprehensive review of the literature to determine the fate of previously tested, non-dopamine-2 receptor experimental treatments. Overall we included 250 studies in the review from the period 1970 to 2017 including treatments with glutamatergic, serotonergic, cholinergic, neuropeptidergic, hormone-based, dopaminergic, metabolic, vitamin/naturopathic, histaminergic, infection/inflammation-based, and miscellaneous mechanisms. Despite there being several promising targets, such as allosteric modulation of the NMDA and α7 nicotinic receptors, we cannot confidently state that any of the mechanistically novel experimental treatments covered in this review are definitely effective for the treatment of schizophrenia and ready for clinical use. We discuss potential reasons for the relative lack of progress in developing non-dopamine-2 receptor treatments for schizophrenia and provide recommendations for future efforts pursuing novel drug development for schizophrenia.
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Weng JJ, Wang LH, Zhu H, Xu WR, Wei YM, Wang ZY, Yu WJ, Li HF. Efficacy of low-dose D 2/D 3 partial agonist pramipexole on neuroleptic-induced extrapyramidal symptoms and symptoms of schizophrenia: a stage-1 open-label pilot study. Neuropsychiatr Dis Treat 2019; 15:2195-2203. [PMID: 31496702 PMCID: PMC6689661 DOI: 10.2147/ndt.s205933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Some lines of evidence show that D2/D3 receptor partial agonist pramipexole may be effective in the treatment of extrapyramidal symptoms (EPS) and psychiatric symptoms of schizophrenia. Therefore, we analyzed whether a low dose of pramipexole (0.375-0.75 mg/day) has efficacy on EPS and symptoms of schizophrenia while maintaining tolerability. METHODS Ten subjects with EPS [including drug-induced parkinsonism (DIP) and akathisia] were recruited in a stage-1, open-label pilot study. All the subjects were treated with a low dose of pramipexole. The evaluations were performed at baseline, day 3, week 1, week 2, week 4, week 6, and week 8. The ratings of SAS, BARS, PANSS, CDSS, and CGI-S and adverse effects (AE) were recorded in every visit. RESULTS SAS total scores decreased significantly during the study in patients with DIP (P<0.001), and mild AEs were detected. Treatments with pramipexole did not show an anti-akathisia effect during the study, while 2 subjects experienced deterioration of akathisia and mood symptoms. The psychiatric symptoms of schizophrenia showed a trend of improvement during the study, but there was no improvement in depressive mood. CONCLUSION A low dose of pramipexole can significantly relieve antipsychotic-induced parkinsonism, but not akathisia. Improvements in psychiatric symptoms of schizophrenia were found, but the results of this study need to be validated in a larger sample. No improvement of mood disorder was detected.
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Affiliation(s)
- Jia Jun Weng
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Li Hua Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Hao Zhu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Wen Rong Xu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Yu Mei Wei
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Zhi Yang Wang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Wen Juan Yu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China
| | - Hua Fang Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University of Medicine, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Psychotic Disorders , Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Leroy A, Petyt G, Pignon B, Vaiva G, Jardri R, Amad A. Research Letter: Auto-activation deficit in schizophrenia: a case report. Psychol Med 2018; 48:525-527. [PMID: 28835308 DOI: 10.1017/s0033291717002252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Leroy
- Univ. Lille, CNRS, UMR 9193-PsyCHIC-SCALab & CHU Lille,Department of Psychiatry,Lille,France
| | - G Petyt
- Nuclear Medicine Department,CHU Lille, PET Center R. Salengro,Lille Cedex,France
| | - B Pignon
- AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie,Créteil,France
| | - G Vaiva
- Univ. Lille, CNRS, UMR 9193-PsyCHIC-SCALab & CHU Lille,Department of Psychiatry,Lille,France
| | - R Jardri
- Univ. Lille, CNRS, UMR 9193-PsyCHIC-SCALab & CHU Lille,Department of Psychiatry,Lille,France
| | - A Amad
- Univ. Lille, CNRS, UMR 9193-PsyCHIC-SCALab & CHU Lille,Department of Psychiatry,Lille,France
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Hsu WY, Lane HY, Lin CH. Medications Used for Cognitive Enhancement in Patients With Schizophrenia, Bipolar Disorder, Alzheimer's Disease, and Parkinson's Disease. Front Psychiatry 2018; 9:91. [PMID: 29670547 PMCID: PMC5893641 DOI: 10.3389/fpsyt.2018.00091] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/06/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Cognitive impairment, which frequently occurs in patients with schizophrenia, bipolar disorder, Alzheimer's disease, and Parkinson's disease, has a significant impact on the daily lives of both patients and their family. Furthermore, since the medications used for cognitive enhancement have limited efficacy, the issue of cognitive enhancement still remains a clinically unsolved challenge. SAMPLING AND METHODS We reviewed the clinical studies (published between 2007 and 2017) that focused on the efficacy of medications used for enhancing cognition in patients with schizophrenia, bipolar disorder, Alzheimer's disease, and Parkinson's disease. RESULTS Acetylcholinesterase inhibitors and memantine are the standard treatments for Alzheimer's disease and Parkinson's disease. Some studies have reported selective cognitive improvement in patients with schizophrenia following galantamine treatment. Newer antipsychotics, including paliperidone, lurasidone, aripiprazole, ziprasidone, and BL-1020, have also been reported to exert cognitive benefits in patients with schizophrenia. Dopaminergic medications were found to improve language function in patients with Parkinson's disease. However, no beneficial effects on cognitive function were observed with dopamine agonists in patients with schizophrenia. The efficacies of nicotine and its receptor modulators in cognitive improvement remain controversial, with the majority of studies showing that varenicline significantly improved the cognitive function in schizophrenic patients. Several studies have reported that N-methyl-d-aspartate glutamate receptor (NMDAR) enhancers improved the cognitive function in patients with chronic schizophrenia. NMDAR enhancers might also have cognitive benefits in patients with Alzheimer's disease or Parkinson's disease. Raloxifene, a selective estrogen receptor modulator, has also been demonstrated to have beneficial effects on attention, processing speed, and memory in female patients with schizophrenia. CONCLUSION Clinical trials with larger sample sizes evaluating comprehensive cognitive domains are warranted to examine the efficacy of medications in cognitive enhancement in patients with schizophrenia, bipolar disorder, Alzheimer's disease, and Parkinson's disease.
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Affiliation(s)
- Wen-Yu Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Psychiatry, China Medical University and Hospital, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Harvey PD, Sand M. Pharmacological Augmentation of Psychosocial and Remediation Training Efforts in Schizophrenia. Front Psychiatry 2017; 8:177. [PMID: 28993740 PMCID: PMC5622160 DOI: 10.3389/fpsyt.2017.00177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022] Open
Abstract
Pharmacological approaches to cognitive enhancement have received considerable attention but have not had considerable success in improving their cognitive and functional targets. Other intervention strategies, such as cognitive remediation therapy (CRT), have been shown to enhance cognitive performance but have not been found to improve functional outcomes without additional psychosocial interventions. Recently, several studies have attempted to enhance the effects of CRT by adding pharmacological interventions to the CRT treatments. In addition, as CRT has been shown to synergistically improve the effects of psychosocial interventions, the combination of pharmacological therapies aimed at cognition and psychosocial interventions may itself provide a promising strategy for improving functional outcomes. This review and commentary examines the current state of interventions combining CRT and psychosocial treatments with pharmacological augmentation. Our focus is on the specific level of effect of the pharmacological intervention, which could be enhancing motivation, training efficiency, or the consolidation of therapeutic gains. Different pharmacological strategies (e.g., stimulants, plasticity-inducing agents, or attentional or alertness enhancers) may have the potential to lead to different types of gains when combined with CRT or psychosocial interventions. The relative potential of these different mechanisms for immediate and durable effects is considered.
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael Sand
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States
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Koola MM, Fawcett J. Dextroamphetamine and Pramipexole Combination for Treatment-Resistant Unipolar Depression. Psychiatr Ann 2016; 46:429-431. [PMID: 27667864 DOI: 10.3928/00485713-20160624-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Maju Mathew Koola
- Attending Psychiatrist, Sheppard Pratt Health System; and an Associate Professor, Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences
| | - Jan Fawcett
- Professor, Department of Psychiatry, University of New Mexico School of Medicine
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11
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McCormick PN, Fletcher PJ, Wilson VS, Remington GJ. The adrenergic α2 antagonist atipamezole alters the behavioural effects of pramipexole and increases pramipexole concentration in blood plasma. Life Sci 2016; 151:300-304. [PMID: 26976325 DOI: 10.1016/j.lfs.2016.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 01/11/2023]
Abstract
Pramipexole is a dopaminergic agonist used in Parkinson's disease treatment. It is thought to exert its therapeutic and side effects through actions on dopamine D3 receptors. In a recent study, we found that at doses occupying D3 but not D2 receptors pramipexole reduced locomotion and operant responding for primary and conditioned reinforcement. These effects, however, were not blocked by a D3 receptor antagonist and were present in D3 knockout mice, suggesting non-D3 receptor mechanisms. Among the next highest affinity binding sites of pramipexole are adrenergic α2 receptors. Here we explored α2 receptor involvement in the behavioural effects of pramipexole. We found that the α2 antagonist atipamezole, which was itself behaviourally silent, counteracted pramipexole's reduction of locomotion, but not operant responding for water or a conditioned reinforcer. The resulting behavioural profile was similar to that of a higher dose of pramipexole, leading to the hypothesize that atipamezole mediates its behavioural effects by increasing pramipexole effective dose. In support of this hypothesis, we found that atipamezole increased pramipexole concentration in blood plasma. This is not likely due to an effect on drug metabolism since pramipexole is not known to undergo metabolic transformation. Future work should examine two alternative hypotheses; that pramipexole plasma concentration is elevated as the result of 1) competition with atipamezole for renal excretion, or 2) atipamezole blockade of peripheral α2 binding sites, thereby preventing pramipexole distribution to α2-rich tissues. The suggestion of adrenergic effects of pramipexole is important in light of recent interest in adrenergic pathophysiology in Parkinson's disease.
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Affiliation(s)
- P N McCormick
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - P J Fletcher
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - V S Wilson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - G J Remington
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Newton TF, Haile CN, Mahoney JJ, Shah R, Verrico CD, De La Garza R, Kosten TR. Dopamine D3 receptor-preferring agonist enhances the subjective effects of cocaine in humans. Psychiatry Res 2015; 230:44-9. [PMID: 26239766 PMCID: PMC4584195 DOI: 10.1016/j.psychres.2015.07.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/21/2015] [Accepted: 07/26/2015] [Indexed: 01/24/2023]
Abstract
Pramipexole is a D3 dopamine receptor-preferring agonist indicated for the treatment of Parkinson disease. Studies associate pramipexole with pathological gambling and impulse control disorders suggesting a role for D3 receptors in reinforcement processes. Clinical studies showed pramipexole decreased cocaine craving and reversed central deficits in individuals with cocaine use disorder. Preclinical studies have shown acute administration of pramipexole increases cocaine's reinforcing effects whereas other reports suggest chronic pramipexole produces tolerance to cocaine. In a randomized, double-blind, placebo-controlled study we examined the impact of pramipexole treatment on the subjective effects produced by cocaine in volunteers with cocaine use disorder. Volunteers received pramipexole titrated up to 3.0mg/d or placebo over 15 days. Participants then received intravenous cocaine (0, 20 and 40mg) on day 15. Cardiovascular and subjective effects were obtained with visual analog scales at time points across the session. Pramipexole alone increased peak heart rate following saline and diastolic blood pressure following cocaine. Pramipexole produced upwards of two-fold increases in positive subjective effects ratings following cocaine. These results indicate that chronic D3 receptor activation increases the subjective effects of cocaine in humans. Caution should be used when prescribing pramipexole to patients that may also use cocaine.
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Affiliation(s)
- Thomas F. Newton
- Correspondence to: Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Menninger Department of Psychiatry, 2002 Holcombe Blvd, Houston, TX 77030, USA. Fax: +1 713 794 7833. (T.F. Newton)
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Koola MM, Fawcett JA. A Case of Electroconvulsive Therapy-Resistant Depression Responding to Multiple Dopaminergic Medications. Prim Care Companion CNS Disord 2015; 17:14l01745. [PMID: 26445685 DOI: 10.4088/pcc.14l01745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Maju Mathew Koola
- Department of Psychiatry, Clinical Research Program, Sheppard Pratt Health System and University of Maryland School of Medicine, Baltimore, Maryland (Dr Koola); and Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Dr Fawcett)
| | - Jan A Fawcett
- Department of Psychiatry, Clinical Research Program, Sheppard Pratt Health System and University of Maryland School of Medicine, Baltimore, Maryland (Dr Koola); and Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Dr Fawcett)
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McCormick PN, Fletcher PJ, Wilson VS, Browne JDC, Nobrega JN, Remington GJ. Low dose pramipexole causes D3 receptor-independent reduction of locomotion and responding for a conditioned reinforcer. Neuropharmacology 2014; 89:225-31. [PMID: 25283483 DOI: 10.1016/j.neuropharm.2014.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 01/11/2023]
Abstract
Pramipexole is a clinically important dopamine receptor agonist with reported selectivity for dopamine D3 receptors over other dopaminergic and non-dopaminergic sites. Many of its behavioural effects are therefore attributed to D3 receptor activity. Here we relate pramipexole's ex vivo D2 and D3 receptor binding (measured using [(3)H]-(+)-PHNO binding experiments) to its effects on locomotion and operant responding for primary and conditioned reinforcers. We show that pramipexole has inhibitory behavioural effects on all three behaviours at doses that occupy D3 but not D2 receptor. However, these effects are 1) not inhibited by a D3 selective dose of the antagonist SB-277011-A, and 2) present in D3 receptor knockout mice. These results suggest that a pharmacological mechanism other than D3 receptor activity must be responsible for these behavioural effects. Finally, our receptor binding results also suggest that these behavioural effects are independent of D2 receptor activity. However, firmer conclusions regarding D2 involvement would be aided by further pharmacological or receptor knock-out experiments. The implications of our findings for the understanding of pramipexole's behavioural and clinical effects are discussed.
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Affiliation(s)
- P N McCormick
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - P J Fletcher
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - V S Wilson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - J D C Browne
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - J N Nobrega
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - G J Remington
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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15
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Neural substrates underlying effort computation in schizophrenia. Neurosci Biobehav Rev 2013; 37:2649-65. [PMID: 24035741 DOI: 10.1016/j.neubiorev.2013.09.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/16/2013] [Accepted: 09/03/2013] [Indexed: 11/23/2022]
Abstract
The lack of initiative, drive or effort in patients with schizophrenia is linked to marked functional impairments. However, our assessment of effort and motivation is crude, relying on clinical rating scales based largely on patient recall. In order to better understand the neurobiology of effort in schizophrenia, we need more rigorous measurements of this construct. In the behavioural neuroscience literature, decades of work has been carried out developing various paradigms to examine the neural underpinnings of an animal's willingness to expend effort for a reward. Here, we shall review this literature on the nature of paradigms used in rodents to assess effort, as well as those used in humans. Next, the neurobiology of these effort-based decisions will be discussed. We shall then review what is known about effort in schizophrenia, and what might be inferred from experiments done in other human populations. Lastly, we shall discuss future directions of research that may assist in shedding light on the neurobiology of effort cost computations in schizophrenia.
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Bet PM, Franken LGW, Klumpers UMH. Could pramipexole induce acute mania? A case report. Bipolar Disord 2013; 15:446-8. [PMID: 23581392 DOI: 10.1111/bdi.12067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/04/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVE In patients with bipolar disorder, olanzapine is commonly used to prevent episodes of acute mania. The drug pramipexole can, in theory, undermine the protective effect of olanzapine. Olanzapine is a dopamine D2 receptor antagonist and pramipexole is a mixed dopamine D2 /D3 receptor agonist. These drugs may therefore theoretically counteract their pharmacological effects. To date, there are no known cases in the literature where this interaction has been described. METHODS We report on a case where a patient with bipolar disorder developed mania after taking pramipexole in combination with olanzapine, and describe the pharmacological background of this interaction. RESULTS A patient with bipolar I disorder was hospitalized with a manic episode characterized by agitation and insomnia after taking pramipexole for restless leg syndrome (RLS) in combination with olanzapine. Co-medication, i.e., lithium and mirtazapine, and other circumstances are not likely to have contributed to this effect. CONCLUSION There is a probable interaction between pramipexole and olanzapine, where pramipexole undermines the protective effect of olanzapine, provoking an episode of acute mania and hospitalization. This interaction is of clinical importance since pramipexole is the treatment of choice for RLS, a condition often seen in end-stage renal disease, and has also been investigated as an antidepressant therapy in patients with bipolar disorder.
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Affiliation(s)
- Pierre M Bet
- Departments of Clinical Pharmacology and Pharmacy, Amsterdam, The Netherlands
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