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Ahmad F, Karan A, Sharma R, Sharma NS, Sundar V, Jayaraj R, Mukherjee S, DeCoster MA. Evolving therapeutic interventions for the management and treatment of Alzheimer's disease. Ageing Res Rev 2024; 95:102229. [PMID: 38364913 DOI: 10.1016/j.arr.2024.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/11/2023] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
Alzheimer's Disease (AD) patients experience diverse symptoms, including memory loss, cognitive impairment, behavioral abnormalities, mood changes, and mental issues. The fundamental objective of this review is to discuss novel therapeutic approaches, with special emphasis on recently approved marketed formulations for the treatment of AD, especially Aducanumab, the first FDA approved moiety that surpasses the blood-brain barrier (BBB) and reduces amyloid plaques in the brain, thereby reducing associated cognitive decline. However, it is still in the phase IV trial and is to be completed by 2030. Other drugs such as lecanemab are also under clinical trial and has recently been approved by the FDA and is also discussed here. In this review, we also focus on active and passive immunotherapy for AD as well as several vaccines, such as amyloid-beta epitope-based vaccines, amyloid-beta DNA vaccines, and stem cell therapy for AD, which are in clinical trials. Furthermore, ongoing pre-clinical trials associated with AD and other novel strategies such as curcumin-loaded nanoparticles, Crispr/ cas9, precision medicine, as well as some emerging therapies like anti-sense therapy are also highlighted. Additionally, we discuss some off-labeled drugs like non-steroidal anti-inflammatory drugs (NSAID), anti-diabetic drugs, and lithium, which can manage symptoms of AD and different non-pharmacological approaches are also covered which can help to manage AD. In summary, we have tried to cover all the therapeutic interventions which are available for the treatment and management of AD under sections approved, clinical phase, pre-clinical phase or futuristic interventions, off-labelled drugs, and non-pharmacological interventions for AD, offering positive findings and well as challenges that remain.
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Affiliation(s)
- Faizan Ahmad
- Department of Medical Elementology and Toxicology, Jamia Hamdard University, Delhi, India
| | - Anik Karan
- Department of Mechanical and Bioengineering, University of Kansas, Lawrence, KS, USA.
| | - Rashi Sharma
- Department of Biotechnology, Delhi Technological University, Bawana, Delhi, India
| | - Navatha Shree Sharma
- Department of Surgery Transplant, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Vaishnavi Sundar
- Department of Internal Medicine, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Richard Jayaraj
- Department of Paediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Sudip Mukherjee
- Biomedical Engineering, Indian Institute of Technology- Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mark A DeCoster
- Cellular Neuroscience Laboratory, Biomedical Engineering, College of Engineering and Science, Louisiana Tech University, Ruston, LA, USA; Cellular Neuroscience Laboratory, Institute for Micromanufacturing, College of Engineering and Science, Louisiana Tech University, Ruston, LA, USA.
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Hersey M, Tanda G. Modafinil, an atypical CNS stimulant? ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2023; 99:287-326. [PMID: 38467484 DOI: 10.1016/bs.apha.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Modafinil is a central nervous system stimulant approved for the treatment of narcolepsy and sleep disorders. Due to its wide range of biochemical actions, modafinil has been explored for other potential therapeutic uses. Indeed, it has shown promise as a therapy for cognitive disfunction resulting from neurologic disorders like ADHD, and as a smart drug in non-medical settings. The mechanism(s) of actions underlying the therapeutic efficacy of this agent remains largely elusive. Modafinil is known to inhibit the dopamine transporter, thus decreasing dopamine reuptake following neuronal release, an effect shared by addictive psychostimulants. However, modafinil is unique in that only a few cases of dependence on this drug have been reported, as compared to other psychostimulants. Moreover, modafinil has been tested, with some success, as a potential therapeutic agent to combat psychostimulant and other substance use disorders. Modafinil has additional, but less understood, actions on other neurotransmitter systems (GABA, glutamate, serotonin, norepinephrine, etc.). These interactions, together with its ability to activate selected brain regions, are likely one of the keys to understand its unique pharmacology and therapeutic activity as a CNS stimulant. In this chapter, we outline the pharmacokinetics and pharmacodynamics of modafinil that suggest it has an "atypical" CNS stimulant profile. We also highlight the current approved and off label uses of modafinil, including its beneficial effects as a treatment for sleep disorders, cognitive functions, and substance use disorders.
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Affiliation(s)
- Melinda Hersey
- Medication Development Program, NIDA-IRP, NIH, Baltimore, MD, United States
| | - Gianluigi Tanda
- Medication Development Program, NIDA-IRP, NIH, Baltimore, MD, United States.
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Lipschitz JM, Perez-Rodriguez M, Majd M, Larsen E, Locascio J, Pike CK, Shanahan M, Burdick KE. Modafinil's effects on cognition and sleep quality in affectively-stable patients with bipolar disorder: a pilot study. Front Psychiatry 2023; 14:1246149. [PMID: 37732080 PMCID: PMC10507316 DOI: 10.3389/fpsyt.2023.1246149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Despite advances in the treatment of bipolar disorder (BD), most patients do not achieve complete inter-episode recovery and functional disability is common. During periods of relative remission, many patients continue to experience neurocognitive dysfunction, reduced daytime activity levels, and sleep disturbances. This 8-week, randomized, placebo-controlled pilot study evaluated the feasibility, safety and preliminary efficacy of the wake-promoting drug, modafinil (Provigil®), on neurocognitive functioning, daytime sleepiness, and sleep quality in affectively-stable BD patients. Methods Twelve individuals with affectively-stable BD were recruited and randomized to a flexible dose of modafinil (100 to 200 mg/day) or placebo, adjunctive to a therapeutic dose of a mood stabilizer. Weekly in-person visits tracked sleep quality and daytime sleepiness as well as side effects and mood symptoms. Neurocognitive functioning was assessed at baseline, week 4, and week 8. Results No serious adverse events were reported. Newly emergent side effects in the modafinil group included heart palpitations, itching, fatigue, and decreased energy. Two patients discontinued modafinil owing to side effects and one of these patients withdrew from the study. One patient discontinued placebo and was withdrawn from the study. Preliminary evaluations of clinical efficacy showed a marginally significant interaction between treatment group and time in two cognitive domains (speed of processing and verbal learning), indicating greater improvement in the modafinil group versus placebo. Additionally, there was a marginally significant effect of treatment group on daytime sleepiness, suggesting lower daytime sleepiness in the modafinil group versus placebo. Counterintuitively, we found a significant treatment group by time interaction effect on sleep quality, suggesting greater improvement in sleep quality in the placebo group versus the modafinil group. Discussion Results suggest that modafinil is a relatively safe medication for affectively-stable BD patients when given with adjunctive mood stabilizers. Results are suggestive of cognitive benefit and improved daytime sleepiness, but worse sleep quality in those patients prescribed modafinil. A fully powered clinical trial is warranted with specific attention to the characteristics of patients who are most likely to benefit from treatment with modafinil and other methodological lessons learned from this pilot. Clinical trial registration ClinicalTrials.gov, identifier NCT01965925.
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Affiliation(s)
- Jessica M. Lipschitz
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Marzieh Majd
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Emmett Larsen
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Joseph Locascio
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology and Harvard Catalyst Biostatistical Group, Harvard Medical School, Boston, MA, United States
| | - Chelsea K. Pike
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Megan Shanahan
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Katherine E. Burdick
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Becker M, Repantis D, Dresler M, Kühn S. Cognitive enhancement: Effects of methylphenidate, modafinil, and caffeine on latent memory and resting state functional connectivity in healthy adults. Hum Brain Mapp 2022; 43:4225-4238. [PMID: 35670369 PMCID: PMC9435011 DOI: 10.1002/hbm.25949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/02/2022] Open
Abstract
Stimulants like methylphenidate, modafinil, and caffeine have repeatedly shown to enhance cognitive processes such as attention and memory. However, brain-functional mechanisms underlying such cognitive enhancing effects of stimulants are still poorly characterized. Here, we utilized behavioral and resting-state fMRI data from a double-blind randomized placebocontrolled study of methylphenidate, modafinil, and caffeine in 48 healthy male adults. The results show that performance in different memory tasks is enhanced, and functional connectivity (FC) specifically between the frontoparietal network (FPN) and default mode network (DMN) is modulated by the stimulants in comparison to placebo. Decreased negative connectivity between right prefrontal and medial parietal but also between medial temporal lobe and visual brain regions predicted stimulant-induced latent memory enhancement. We discuss dopamine's role in attention and memory as well as its ability to modulate FC between large-scale neural networks (e.g., FPN and DMN) as a potential cognitive enhancement mechanism.
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Affiliation(s)
- Maxi Becker
- Department of PsychologyHumboldt‐University BerlinBerlinGermany
- Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Dimitris Repantis
- Department of Psychiatry and PsychotherapyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu BerlinBerlinGermany
| | - Martin Dresler
- Donders Institute for Brain, Cognition and BehaviourRadboud University Medical Center NijmegenNijmegenThe Netherlands
| | - Simone Kühn
- Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Lise Meitner Group for Environmental NeuroscienceMax Planck Institute for Human DevelopmentBerlinGermany
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Oyesanya M, Al-Juffali N. Is modafinil an effective adjunct to standard care in the treatment of schizophrenia-spectrum disorders? BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYAntipsychotics are the cornerstone of schizophrenia management but they are not adequate in treating the negative and cognitive symptoms of the illness. The Cochrane review discussed in this commentary examines the safety and effectiveness of the wakefulness-promoting agent, modafinil, as an adjunct to standard care in the mitigation of negative and cognitive symptoms of schizophrenia. Add-on modafinil, compared to add-on placebo and standard treatment, did not result in a clear benefit. Due to the heterogenous body of evidence, the quality of which ranged from very low to moderate, the review's conclusions are equivocal.
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A Novel and Selective Dopamine Transporter Inhibitor, (S)-MK-26, Promotes Hippocampal Synaptic Plasticity and Restores Effort-Related Motivational Dysfunctions. Biomolecules 2022; 12:biom12070881. [PMID: 35883437 PMCID: PMC9312958 DOI: 10.3390/biom12070881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Abstract
Dopamine (DA), the most abundant human brain catecholaminergic neurotransmitter, modulates key behavioral and neurological processes in young and senescent brains, including motricity, sleep, attention, emotion, learning and memory, and social and reward-seeking behaviors. The DA transporter (DAT) regulates transsynaptic DA levels, influencing all these processes. Compounds targeting DAT (e.g., cocaine and amphetamines) were historically used to shape mood and cognition, but these substances typically lead to severe negative side effects (tolerance, abuse, addiction, and dependence). DA/DAT signaling dysfunctions are associated with neuropsychiatric and progressive brain disorders, including Parkinson’s and Alzheimer diseases, drug addiction and dementia, resulting in devastating personal and familial concerns and high socioeconomic costs worldwide. The development of low-side-effect, new/selective medicaments with reduced abuse-liability and which ameliorate DA/DAT-related dysfunctions is therefore crucial in the fields of medicine and healthcare. Using the rat as experimental animal model, the present work describes the synthesis and pharmacological profile of (S)-MK-26, a new modafinil analogue with markedly improved potency and selectivity for DAT over parent drug. Ex vivo electrophysiology revealed significantly augmented hippocampal long-term synaptic potentiation upon acute, intraperitoneally delivered (S)-MK-26 treatment, whereas in vivo experiments in the hole-board test showed only lesser effects on reference memory performance in aged rats. However, in effort-related FR5/chow and PROG/chow feeding choice experiments, (S)-MK-26 treatment reversed the depression-like behavior induced by the dopamine-depleting drug tetrabenazine (TBZ) and increased the selection of high-effort alternatives. Moreover, in in vivo microdialysis experiments, (S)-MK-26 significantly increased extracellular DA levels in the prefrontal cortex and in nucleus accumbens core and shell. These studies highlight (S)-MK-26 as a potent enhancer of transsynaptic DA and promoter of synaptic plasticity, with predominant beneficial effects on effort-related behaviors, thus proposing therapeutic potentials for (S)-MK-26 in the treatment of low-effort exertion and motivational dysfunctions characteristic of depression and aging-related disorders.
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Abstract
Substantial evidence, composed of drug mechanisms of action, in vivo testing, and epidemiological data, exists to support clinical testing of FDA-approved drugs for repurposing to the treatment of Alzheimer’s disease (AD). Licensed compound investigation can often proceed at a faster and more cost-effective manner than un-approved compounds moving through the drug pipeline. As the prevalence of AD increases with life expectancy, the current rise in life expectancy amalgamated with the lack of an effective drug for the treatment of AD unnecessarily burdens our medical system and is an urgent public health concern. The unfounded reluctance to examine repurposing existing drugs for possible AD therapy further impedes the possibility of improving the quality of patient lives with a terminal disease. This review summarizes some evidence which exists to suggest certain already-approved drugs may be considered for the treatment of AD and will perhaps encourage physicians to off-label prescribe these safe therapeutics.
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Cruces-Solis H, Nissen W, Ferger B, Arban R. Whole-brain signatures of functional connectivity after bidirectional modulation of the dopaminergic system in mice. Neuropharmacology 2020; 178:108246. [PMID: 32771528 DOI: 10.1016/j.neuropharm.2020.108246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
While neuropsychiatric drugs influence neural activity across multiple brain regions, the current understanding of their mechanism of action derives from studies that investigate an influence of a given drug onto a pre-selected and small number of brain regions. To understand how neuropsychiatric drugs affect coordinated activity across brain regions and to detect the brain regions most relevant to pharmacological action in an unbiased way, studies that assess brain-wide neuronal activity are paramount. Here, we used whole-brain immunostaining of the neuronal activity marker cFOS, and graph theory to generate brain-wide maps of neuronal activity upon pharmacological challenges. We generated brain-wide maps 2.5 h after treatment of the atypical dopamine transporter inhibitor modafinil (10, 30, and 100 mg/kg) or the vesicular monoamine transporter 2 inhibitor tetrabenazine (0.25, 0.5 and 1 mg/kg). Modafinil increased the number of cFOS positive neurons in a dose-dependent manner. Moreover, modafinil significantly reduced functional connectivity across the entire brain. Graph theory analysis revealed that modafinil decreased the node degree of cortical and subcortical regions at the three doses tested, followed by a reduction in global efficiency. Simultaneously, we identified highly interconnected hub regions that emerge exclusively upon modafinil treatment. These regions were the mediodorsal thalamus, periaqueductal gray, subiculum, and rhomboid nucleus. On the other hand, while tetrabenazine had mild effects on cFOS counts, it reduced functional connectivity across the entire brain, cortical node degree, and global efficiency. As hub regions, we identified the substantia innominata and ventral pallidum. Our results uncovered novel mechanisms of action at a brain-wide scale for modafinil and tetrabenazine. Our analytical approach offers a tool to characterize signatures of whole-brain functional connectivity for drug candidates and to identify potential undesired effects at a mesoscopic scale. Additionally, it offers a guide towards targeted experiments on newly identified hub regions.
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Affiliation(s)
- Hugo Cruces-Solis
- Central Nervous System Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach Riß, Germany.
| | - Wiebke Nissen
- Central Nervous System Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach Riß, Germany
| | - Boris Ferger
- Central Nervous System Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach Riß, Germany
| | - Roberto Arban
- Central Nervous System Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach Riß, Germany.
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9
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Perez DM. α 1-Adrenergic Receptors in Neurotransmission, Synaptic Plasticity, and Cognition. Front Pharmacol 2020; 11:581098. [PMID: 33117176 PMCID: PMC7553051 DOI: 10.3389/fphar.2020.581098] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022] Open
Abstract
α1-adrenergic receptors are G-Protein Coupled Receptors that are involved in neurotransmission and regulate the sympathetic nervous system through binding and activating the neurotransmitter, norepinephrine, and the neurohormone, epinephrine. There are three α1-adrenergic receptor subtypes (α1A, α1B, α1D) that are known to play various roles in neurotransmission and cognition. They are related to two other adrenergic receptor families that also bind norepinephrine and epinephrine, the β- and α2-, each with three subtypes (β1, β2, β3, α2A, α2B, α2C). Previous studies assessing the roles of α1-adrenergic receptors in neurotransmission and cognition have been inconsistent. This was due to the use of poorly-selective ligands and many of these studies were published before the characterization of the cloned receptor subtypes and the subsequent development of animal models. With the availability of more-selective ligands and the development of animal models, a clearer picture of their role in cognition and neurotransmission can be assessed. In this review, we highlight the significant role that the α1-adrenergic receptor plays in regulating synaptic efficacy, both short and long-term synaptic plasticity, and its regulation of different types of memory. We will also present evidence that the α1-adrenergic receptors, and particularly the α1A-adrenergic receptor subtype, are a potentially good target to treat a wide variety of neurological conditions with diminished cognition.
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Affiliation(s)
- Dianne M Perez
- The Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH, United States
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Robbins TW. Pharmacological treatment of cognitive deficits in nondementing mental health disorders
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 21:301-308. [PMID: 31749654 PMCID: PMC6829171 DOI: 10.31887/dcns.2019.21.3/trobbins] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Evidence for pharmacological remediation of cognitive deficits in three major
psychiatric disorders—attention deficit- hyperactivity disorder (ADHD), schizophrenia,
and depression—is reviewed. ADHD is effectively treated with the stimulant medications
methylphenidate and d-amphetamine, as well as nonstimulants such as atomoxetine,
implicating cognitive enhancing effects mediated by noradrenaline and dopamine. However,
the precise mechanisms underlying these effects remains unclear. Cognitive deficits in
schizophrenia are less effectively treated, but attempts via a variety of
neurotransmitter strategies are surveyed. The possibility of treating cognitive deficits
in depression via antidepressant medication (eg, selective serotonin reuptake
inhibitors) and by adjunctive drug treatment has only recently received attention
because of confounding, or possibly interactive, effects on mood. Prospects for future
advances in this important area may need to take into account transdiagnostic
perspectives on cognition (including neurodegenerative diseases) as well as improvements
in neuropsychological, neurobiological, and clinical trial design approaches to
cognitive enhancement.
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Affiliation(s)
- Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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11
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Sagheddu C, Pintori N, Kalaba P, Dragačević V, Piras G, Lubec J, Simola N, De Luca MA, Lubec G, Pistis M. Neurophysiological and Neurochemical Effects of the Putative Cognitive Enhancer ( S)-CE-123 on Mesocorticolimbic Dopamine System. Biomolecules 2020; 10:biom10050779. [PMID: 32443397 PMCID: PMC7277835 DOI: 10.3390/biom10050779] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/14/2022] Open
Abstract
Treatments for cognitive impairments associated with neuropsychiatric disorders, such as attention deficit hyperactivity disorder or narcolepsy, aim at modulating extracellular dopamine levels in the brain. CE-123 (5-((benzhydrylsulfinyl)methyl) thiazole) is a novel modafinil analog with improved specificity and efficacy for dopamine transporter inhibition that improves cognitive and motivational processes in experimental animals. We studied the neuropharmacological and behavioral effects of the S-enantiomer of CE-123 ((S)-CE-123) and R-modafinil in cognitive- and reward-related brain areas of adult male rats. In vivo single unit recordings in anesthetized animals showed that (S)-CE-123, but not R-modafinil, dose-dependently (1.25 to 10 mg/kg i.v.) reduced firing of pyramidal neurons in the infralimbic/prelimbic (IL/PrL) cortex. Neither compound the affected firing activity of ventral tegmental area dopamine cells. In freely moving animals, (S)-CE-123 (10 mg/kg i.p.) increased extracellular dopamine levels in the IL/PrL, with different patterns when compared to R-modafinil (10 mg/kg i.p.); in the nucleus accumbens shell, a low and transitory increase of dopamine was observed only after (S)-CE-123. Neither (S)-CE-123 nor R-modafinil initiated the emission of 50-kHz ultrasonic vocalizations, a behavioral marker of positive affect and drug-mediated reward. Our data support previous reports of the procognitive effects of (S)-CE-123, and show a minor impact on reward-related dopaminergic areas.
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Affiliation(s)
- Claudia Sagheddu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (C.S.); (N.P.); (G.P.); (N.S.); (M.A.D.L.)
| | - Nicholas Pintori
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (C.S.); (N.P.); (G.P.); (N.S.); (M.A.D.L.)
| | - Predrag Kalaba
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, 1010 Vienna, Austria; (P.K.); (V.D.)
| | - Vladimir Dragačević
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, 1010 Vienna, Austria; (P.K.); (V.D.)
| | - Gessica Piras
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (C.S.); (N.P.); (G.P.); (N.S.); (M.A.D.L.)
| | - Jana Lubec
- Department of Neuroproteomics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Nicola Simola
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (C.S.); (N.P.); (G.P.); (N.S.); (M.A.D.L.)
| | - Maria Antonietta De Luca
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (C.S.); (N.P.); (G.P.); (N.S.); (M.A.D.L.)
| | - Gert Lubec
- Department of Neuroproteomics, Paracelsus Medical University, 5020 Salzburg, Austria;
- Correspondence: (G.L.); (M.P.); Tel.: +43-(0)-6622420-0 (G.L.); +39-070-675-4324 (M.P.)
| | - Marco Pistis
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (C.S.); (N.P.); (G.P.); (N.S.); (M.A.D.L.)
- Neuroscience Institute, National Research Council of Italy (CNR), Section of Cagliari, 09100 Cagliari, Italy
- Correspondence: (G.L.); (M.P.); Tel.: +43-(0)-6622420-0 (G.L.); +39-070-675-4324 (M.P.)
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12
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Li J, Yang X, Zhou F, Liu C, Wei Z, Xin F, Daumann B, Daumann J, Kendrick KM, Becker B. Modafinil enhances cognitive, but not emotional conflict processing via enhanced inferior frontal gyrus activation and its communication with the dorsomedial prefrontal cortex. Neuropsychopharmacology 2020; 45:1026-1033. [PMID: 31995813 PMCID: PMC7162953 DOI: 10.1038/s41386-020-0625-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 02/05/2023]
Abstract
Cognitive control regulates cognitive and emotional systems to facilitate goal-directed behavior in the context of task-irrelevant distractors. Cognitive control deficits contribute to residual functional impairments across psychiatric disorders and represent a promising novel treatment target. Translational evidence suggests that modafinil may enhance performance in executive functions; however, differential effects on regulatory control in cognitive and emotional domains have not been examined. The present pre-registered randomized-controlled pharmacological fMRI trial examined differential effects of modafinil (single-dose, 200 mg) on cognitive and emotional conflict processing. To further separate objective cognitive enhancing effects from subjective performance perception, a metacognitive paradigm was employed. Results indicated that modafinil specifically enhanced cognitive conflict performance and concomitantly increased activation in the inferior frontal gyrus and its functional communication with the dorsomedial prefrontal cortex. Exploratory analysis further revealed modafinil-enhanced basolateral amygdala reactivity to cognitive conflict, with stronger reactivity being associated with higher cognitive conflict performance. Whereas modafinil enhanced cognitive performance in the metacognitive paradigm, confidence indices remained unaffected. Overall, the present results suggest that modafinil has the potential to enhance cognitive conflict processing while leaving emotional conflict processing unaffected. On the neural level modafinil enhanced the recruitment of a network engaged in general conflict and regulatory control processes, whereas effects on the amygdala may reflect improved arousal-mediated attention processes for conflicting information. The pattern of cognitive enhancing effects in the absence of effects on affective processing suggests a promising potential to enhance cognitive control in clinical populations.
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Affiliation(s)
- Jialin Li
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Yang
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Zhou
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Congcong Liu
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenyu Wei
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Fei Xin
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | | | - Jörg Daumann
- 0000 0000 8580 3777grid.6190.eDepartment of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Keith M. Kendrick
- 0000 0004 0369 4060grid.54549.39The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Benjamin Becker
- The Clinical Hospital of the Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.
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Effects of 5-HT 2C, 5-HT 1A receptor challenges and modafinil on the initiation and persistence of gambling behaviours. Psychopharmacology (Berl) 2020; 237:1745-1756. [PMID: 32123974 PMCID: PMC7239826 DOI: 10.1007/s00213-020-05496-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 11/07/2022]
Abstract
RATIONALE Problematic patterns of gambling are characterised by loss of control and persistent gambling often to recover losses. However, little is known about the mechanisms that mediate initial choices to begin gambling and then continue to gamble in the face of losing outcomes. OBJECTIVES These experiments first assessed gambling and loss-chasing performance under different win/lose probabilities in C57Bl/6 mice, and then investigated the effects of antagonism of 5-HT2CR with SB242084, 5-HT1AR agonism with 8-OH-DPAT and modafinil, a putative cognitive enhancer. RESULTS As seen in humans and other species, mice demonstrated the expected patterns of behaviour as the odds for winning were altered increasing gambling and loss-chasing when winning was more likely. SB242084 decreased the likelihood to initially gamble, but had no effects on subsequent gambling choices in the face of repeated losses. In contrast, 8-OH-DPAT had no effects on choosing to gamble in the first place, but once started 8-OH-DPAT increased gambling choices in a dose-sensitive manner. Modafinil effects were different to the serotonergic drugs in both decreasing the propensity to initiate gambling and chase losses. CONCLUSIONS We present evidence for dissociable effects of systemic drug administration on different aspects of gambling behaviour. These data extend and reinforce the importance of serotonergic mechanisms in mediating discrete components of gambling behaviour. They further demonstrate the ability of modafinil to reduce gambling behaviour. Our work using a novel mouse paradigm may be of utility in modelling the complex psychological and neurobiological underpinnings of gambling problems, including the analysis of genetic and environmental factors.
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Ortiz‐Orendain J, Covarrubias‐Castillo SA, Vazquez‐Alvarez AO, Castiello‐de Obeso S, Arias Quiñones GE, Seegers M, Colunga‐Lozano LE. Modafinil for people with schizophrenia or related disorders. Cochrane Database Syst Rev 2019; 12:CD008661. [PMID: 31828767 PMCID: PMC6906203 DOI: 10.1002/14651858.cd008661.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with schizophrenia have a range of different symptoms, including positive symptoms (hallucinations and delusions), negative symptoms (such as social withdrawal and lack of affect), and cognitive impairment. The standard medication for people with schizophrenia is antipsychotics. However, these medications may not be effective for all symptoms of schizophrenia, as cognitive and negative symptoms are usually hard to treat. Additional therapies or medications are available for the management of these symptoms. Modafinil, a wakefulness-promoting agent most frequently used in narcolepsy or shift work sleep disorder, is one intervention that is theorised to have an effect of these symptoms. OBJECTIVES The primary objective of this review was to assess the effects of modafinil for people with schizophrenia or related disorders. SEARCH METHODS On 27 April 2015, 24 May 2017, and 31 October 2019, we searched the Cochrane Schizophrenia Group's register of trials, which is based on regular searches of CENTRAL, MEDLINE, Embase, AMED, BIOSIS, CINAHL, PsycINFO, PubMed, and registries of clinical trials. There are no language, time, document type, or publication status limitations for the inclusion of records in the register. SELECTION CRITERIA We selected all randomised controlled trials comparing modafinil with placebo or other treatments for people with schizophrenia or schizophrenia-spectrum disorders. DATA COLLECTION AND ANALYSIS We independently extracted data from the included studies. We analysed dichotomous data using risk ratios (RR) and 95% confidence intervals (CI). We analysed continuous data using mean difference (MD) with a 95% CI. We used a random-effects model for the meta-analysis. We used GRADE to complete a 'Summary of findings' table and assessed risk of bias for the included studies. MAIN RESULTS Eleven studies including a total of 422 participants contributed to data analyses. Most studies had a small population size (average 38 people per study) and were of short duration. We also detected a high risk of bias for selective outcome reporting in just under 50% of the trials. We therefore rated the overall methodological quality of the included studies as low. We considered seven main outcomes of interest: clinically important change in overall mental state, clinically important change in cognitive functioning, incidence of a clinically important adverse effect/event, clinically important change in global state, leaving the study early for any reason, clinically important change in quality of life, and hospital admission. All studies assessed the effects of adding modafinil to participants' usual antipsychotic treatment compared to adding placebo to usual antipsychotic treatment. Six studies found that adding modafinil to antipsychotic treatment may have little or no effect on overall mental state of people with schizophrenia, specifically the risk of worsening psychosis (RR 0.91, 95% CI 0.28 to 2.98; participants = 209; studies = 6, low-quality evidence). Regarding the effect of modafinil on cognitive function, the trials did not report clinically important change data, but one study reported endpoint scores on the MATRICS Consensus Cognitive Battery (MCCB): in this study we found no clear difference in scores between modafinil and placebo treatment groups (MD -3.10, 95% CI -10.9 to 4.7; participants = 48; studies = 1, very low-quality evidence). Only one study (N = 35) reported adverse effect/event data. In this study one serious adverse event occurred in each group (RR 0.84, 95% CI 0.06 to 12.42; participants = 35; studies = 1, very low-quality evidence). One study measured change in global state using the Clinical Global Impression - Improvement Scale. This study found that adding modafinil to antipsychotic treatment may have little or no effect on global state (RR 6.36, 95% CI 0.94 to 43.07, participants = 21; studies = 1, very low-quality evidence). Nine studies found that modafinil has no effect on numbers of participants leaving the study early (RR 1.26, 95% CI 0.63 to 2.52 participants = 357; studies = 9, moderate-quality evidence). None of the trials reported clinically important change in quality of life, but one study did report quality of life using endpoint scores on the Quality of Life Inventory, finding no clear difference between treatment groups (MD -0.2, 95% CI -1.18 to 0.78; participants = 20; studies = 1, very low-quality evidence). Finally, one study reported data for number of participants needing hospitalisation: one participant in each group was hospitalised (RR 0.84, 95% CI 0.06 to 12.42; participants = 35; studies = 1, very low-quality evidence). AUTHORS' CONCLUSIONS Due to methodological issues, low sample size, and short duration of the clinical trials as well as high risk of bias for outcome reporting, most of the evidence available for this review is of very low or low quality. For results where quality is low or very low, we are uncertain or very uncertain if the effect estimates are true effects, limiting our conclusions. Specifically, we found that modafinil is no better or worse than placebo at preventing worsening of psychosis; however, we are uncertain about this result. We have more confidence that participants receiving modafinil are no more likely to leave a trial early than participants receiving placebo. However, we are very uncertain about the remaining equivocal results between modafinil and placebo for outcomes such as improvement in global state or cognitive function, incidence of adverse events, and changes in quality of life. More high-quality data are needed before firm conclusions regarding the effects of modafinil for people with schizophrenia or related disorders can be made.
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Affiliation(s)
- Javier Ortiz‐Orendain
- Mayo ClinicDepartment of Psychiatry and Psychology200 First Street SWRochesterMinnesotaUSA55905
| | - Sergio A. Covarrubias‐Castillo
- Hospital Civil de Guadalajara "Fray Antonio Alcalde"Department of PsychiatryHospital 278. El RetiroGuadalajaraJaliscoMexico44280
| | - Alan Omar Vazquez‐Alvarez
- Health Sciences University Center, University of GuadalajaraInstitute of Experimental and Clinical Therapeutics, Department of PhysiologyGuadalajaraJaliscoMexico
| | - Santiago Castiello‐de Obeso
- Western Institute of Technology and Higher Education (ITESO)Psychophysiology Laboratory#8585 Anillo Perif. Sur Manuel Gómez MorínCol. Santa María TequepexpanGuadalajaraJaliscoMexico45604
| | - Gustavo E Arias Quiñones
- University of GuadalajaraDepartment of Neurosurgery. Hospital Civil "Fray Antonio Alcalde"Hospital 278. El RetiroGuadalajaraJaliscoMexico44340
| | - Maya Seegers
- Ben Gurion UniversityMedical School for International HealthNew YorkUSA
| | - Luis Enrique Colunga‐Lozano
- McMaster UniversityDepartments of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonOntarioCanadaL8S 4L8
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Teutsch J, Kätzel D. Operant Assessment of DMTP Spatial Working Memory in Mice. Front Behav Neurosci 2019; 13:193. [PMID: 31507388 PMCID: PMC6718719 DOI: 10.3389/fnbeh.2019.00193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
Working memory (WM) is required to bridge the time between the moment of sensory perception and the usage of the acquired information for subsequent actions. Its frequent and pharmacoresistent impairment in mental health disorders urges the development of rodent paradigms through back-translation of human WM tests, ideally avoiding the confounds of alternation-based assays. Here we show, that mice can acquire a delayed-matching-to-position (DMTP) operant spatial WM (SWM) paradigm that is akin to the combined attention and memory (CAM) task previously developed for rats, and that relies on a 5-choice wall [5-CSWM, 5-choice based operant testing of SWM (5-CSWM)]. Requiring ca. 3 months of daily training with a non-illuminated operant box in the default state, mice could attain a performance level of ≥70% choice accuracy with short (2 s) delays in the DMTP 5-CSWM task. Performance decreased with extended delays, as expected for WM processes. Modafinil (15 and 30 mg/kg) and guanfacine (0.3 and 1 mg/kg) showed no consistent efficacy in enhancing task performance. We also found, that mice did not improve beyond chance level, when trained in the DNMTP-version of the 5-CSWM. Our results outline the methodical possibility and constraints of assessing spatial WM in mice with an operant paradigm that provides high control over potentially confounding variables, such as cue-directed attention, motivation or mediating strategies like body-positioning.
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Affiliation(s)
- Jasper Teutsch
- Institute of Applied Physiology, Ulm University, Ulm, Germany
| | - Dennis Kätzel
- Institute of Applied Physiology, Ulm University, Ulm, Germany
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Molinari E, Oto M, Waterston A, Fullerton N. Modafinil in the rehabilitation of a patient with post-surgical posterior fossa syndrome: a lesson to be learned? CEREBELLUM & ATAXIAS 2019; 6:11. [PMID: 31428435 PMCID: PMC6694614 DOI: 10.1186/s40673-019-0105-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/02/2019] [Indexed: 11/10/2022]
Abstract
Disorders of the cerebellum may present with motor, cognitive, behavioral and affective symptoms. There is a growing interest in developing neuroanatomical models of symptoms generation that involve the cerebellum and the cerebello-cortical connections. We describe an exciting first case report of successful use of Modafinil in an adult patient with post-operative posterior fossa syndrome. Following resection of a melanoma metastasis in the cerebellum the patient developed striking affective and behavioral symptoms in the form of withdrawn flat mood and disengagement. This neurobehavioral presentation severely impacted on his quality of life, independence, and ability to engage in the neuro-rehabilitative program. Pharmacological treatment with Modafinil ameliorated these emotional and behavioral aspects, and also fatigue. Treatment with Modafinil hence affected recovery and outcome for the patient. To our knowledge, this is the first description of a successful pharmacological intervention in an adult with post-surgical posterior fossa syndrome and negative neurobehavioral presentation. Our findings illustrate the variability of the presentation of post-operative posterior fossa syndrome in adults, and the importance of delivering targeted treatment to maximize the benefits of neurorehabilitation. The manuscript highlights the following points: 1. post-operative consequences currently under the wide umbrella of posterior fossa syndrome, can indeed manifest in adults; 2. a wide spectrum of neurobehavioral symptoms can occur, including a presentation with predominantly negative features; 3. the type of neurobehavioral presentation should guide the treatment choice with particular consideration of drugs that potentially modulate the cerebello-frontal connections; 4. Modafinil can be a candidate for effective treatment in presentations with predominantly negative behavioral symptoms.
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Affiliation(s)
- Emanuela Molinari
- 1Department of Neurology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF UK.,2College of MVLS, School of Medicine, Dentistry & Nursing, University of Glasgow, University Avenue, Glasgow, G12 8QQ UK
| | - Maria Oto
- Scottish Epilepsy Centre, 20 St Kenneth Drive, Glasgow, G51 4QD UK
| | - Ashita Waterston
- Department of Medical Oncology, Beaton West of Scotland Cancer Centre, 1053 Great Western Rd, Glasgow, G12 0YN UK
| | - Natasha Fullerton
- 5Department of Neuroradiology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF UK
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17
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Dias VT, Rosa HZ, D'avila LF, Vey LT, Barcelos RCS, Burger ME. Modafinil reduces amphetamine preference and prevents anxiety-like symptoms during drug withdrawal in young rats: Involvement of dopaminergic targets in VTA and striatum. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:199-206. [PMID: 30664970 DOI: 10.1016/j.pnpbp.2019.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/25/2022]
Abstract
Drug abuse and addiction are overwhelming health problems mainly during adolescence. Based on a previous study of our research group, the rats that received modafinil (MD) during the adolescence showed less preference for amphetamine (AMPH) in adulthood. Our current hypothesis is that MD will show beneficial effects against AMPH preference and abstinence symptoms during adolescence, a critical lifetime period when drug hedonic effects are more pronounced. We investigated the influence of MD pretreatment on AMPH preference in conditioned place preference (CPP) paradigm in adolescent rats and anxiety-like symptoms during drug withdrawal (48 h after the last AMPH dose) in elevated plus maze (EPM) task. Besides that, oxidative and molecular status were evaluated in the ventral tegmental area (VTA) and striatum. Our findings showed, as it was expected, that adolescent animals developed AMPH preference together with anxiety-like symptoms during the drug withdrawal while the MD pretreatment prevented those behaviors. Besides promoting benefits on reward parameters, MD was able to preserve VTA and striatum from oxidative damages. This was observed by the increased catalase activity and reduced generation of reactive species and lipid peroxidation, which were inversely modified by AMPH exposure. At molecular level, MD exerted an interesting modulatory activity on the VTA and induced an up-regulation in striatal dopaminergic targets (TH, DAT, D1R and D2R). So far, during the adolescence, MD presented beneficial behavioral outcomes that could be attributed to its modulatory activity on the striatal dopaminergic system in an attempt to maintain the adequate dopamine levels.
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Affiliation(s)
- Verônica Tironi Dias
- Graduate Program of Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Higor Zuquetto Rosa
- Graduate Program of Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Lívia Ferraz D'avila
- Graduate Program of Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Luciana Taschetto Vey
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | | | - Marilise Escobar Burger
- Graduate Program of Pharmacology, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil.
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Sahakian BJ, Savulich G. Innovative methods for improving cognition, motivation and wellbeing in schizophrenia. World Psychiatry 2019; 18:168-170. [PMID: 31059610 PMCID: PMC6502422 DOI: 10.1002/wps.20649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Barbara J. Sahakian
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - George Savulich
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Nilsson SRO, Heath CJ, Takillah S, Didienne S, Fejgin K, Nielsen V, Nielsen J, Saksida LM, Mariani J, Faure P, Didriksen M, Robbins TW, Bussey TJ, Mar AC. Continuous performance test impairment in a 22q11.2 microdeletion mouse model: improvement by amphetamine. Transl Psychiatry 2018; 8:247. [PMID: 30429456 PMCID: PMC6235862 DOI: 10.1038/s41398-018-0295-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 02/03/2023] Open
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) confers high risk of neurodevelopmental disorders such as schizophrenia and attention-deficit hyperactivity disorder. These disorders are associated with attentional impairment, the remediation of which is important for successful therapeutic intervention. We assessed a 22q11.2DS mouse model (Df(h22q11)/+) on a touchscreen rodent continuous performance test (rCPT) of attention and executive function that is analogous to human CPT procedures. Relative to wild-type littermates, Df(h22q11)/+ male mice showed impaired attentional performance as shown by decreased correct response ratio (hit rate) and a reduced ability to discriminate target stimuli from non-target stimuli (discrimination sensitivity, or d'). The Df(h22q11)/+ model exhibited decreased prefrontal cortical-hippocampal oscillatory synchrony within multiple frequency ranges during quiet wakefulness, which may represent a biomarker of cognitive dysfunction. The stimulant amphetamine (0-1.0 mg/kg, i.p.) dose-dependently improved d' in Df(h22q11)/+ mice whereas the highest dose of modafinil (40 mg/kg, i.p.) exacerbated their d' impairment. This is the first report to directly implicate attentional impairment in a 22q11.2DS mouse model, mirroring a key endophenotype of the human disorder. The capacity of the rCPT to detect performance impairments in the 22q11.2DS mouse model, and improvement following psychostimulant-treatment, highlights the utility and translational potential of the Df(h22q11)/+ model and this automated behavioral procedure.
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Affiliation(s)
- Simon R. O. Nilsson
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK ,0000000121885934grid.5335.0MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK ,0000 0001 2109 4251grid.240324.3Neuroscience Institute, New York University Medical Center, New York, NY USA ,0000 0004 1936 8753grid.137628.9Department of Neuroscience and Physiology, School of Medicine, New York University, New York, NY USA
| | - Christopher J. Heath
- 0000000096069301grid.10837.3dSchool of Life, Health and Chemical Sciences, The Open University, Walton Hall, Milton Keynes, UK
| | - Samir Takillah
- Fatigue and Vigilance team, Neuroscience and Operational Constraints Department, French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France ,0000 0001 2188 0914grid.10992.33VIFASOM team (EA 7330), Paris Descartes University, Sorbonne Paris Cité, Hôtel Dieu, Paris, France ,0000 0001 2097 0141grid.121334.6Sorbonne Universités, Université Pierre et Marie Curie (UPMC), CNRS, INSERM, U1130, Institut de Biologie Paris Seine (IBPS), UMR 8246 Neuroscience Paris Seine (NPS), Team Neurophysiology and Behavior, Paris, France ,Sorbonne Universités, Université Pierre et Marie Curie (UPMC), CNRS, Institut de Biologie Paris Seine (IBPS), UMR 8256 Biological adaptation and ageing (B2A), Team Brain Development, Repair and Ageing, Paris, France ,APHP Hôpital, DHU Fast, Institut de la Longévité, Ivry-Sur-Seine, France
| | - Steve Didienne
- 0000 0001 2097 0141grid.121334.6Sorbonne Universités, Université Pierre et Marie Curie (UPMC), CNRS, INSERM, U1130, Institut de Biologie Paris Seine (IBPS), UMR 8246 Neuroscience Paris Seine (NPS), Team Neurophysiology and Behavior, Paris, France
| | - Kim Fejgin
- 0000 0004 0476 7612grid.424580.fH. Lundbeck A/S, Synaptic Transmission, Neuroscience Research DK, Copenhagen, Denmark
| | - Vibeke Nielsen
- 0000 0004 0476 7612grid.424580.fH. Lundbeck A/S, Synaptic Transmission, Neuroscience Research DK, Copenhagen, Denmark
| | - Jacob Nielsen
- 0000 0004 0476 7612grid.424580.fH. Lundbeck A/S, Synaptic Transmission, Neuroscience Research DK, Copenhagen, Denmark
| | - Lisa M. Saksida
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK ,0000000121885934grid.5335.0MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK ,0000 0004 1936 8884grid.39381.30Molecular Medicine Research Group, Robarts Research Institute & Department of Physiology, Western University, London, ON Canada ,0000 0004 1936 8884grid.39381.30Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON Canada ,0000 0004 1936 8884grid.39381.30The Brain and Mind Institute, Western University, London, ON Canada
| | - Jean Mariani
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC), CNRS, Institut de Biologie Paris Seine (IBPS), UMR 8256 Biological adaptation and ageing (B2A), Team Brain Development, Repair and Ageing, Paris, France ,APHP Hôpital, DHU Fast, Institut de la Longévité, Ivry-Sur-Seine, France
| | - Philippe Faure
- 0000 0001 2188 0914grid.10992.33VIFASOM team (EA 7330), Paris Descartes University, Sorbonne Paris Cité, Hôtel Dieu, Paris, France
| | - Michael Didriksen
- 0000 0004 0476 7612grid.424580.fH. Lundbeck A/S, Synaptic Transmission, Neuroscience Research DK, Copenhagen, Denmark
| | - Trevor W. Robbins
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK ,0000000121885934grid.5335.0MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Timothy J. Bussey
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK ,0000000121885934grid.5335.0MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK ,0000 0004 1936 8884grid.39381.30Molecular Medicine Research Group, Robarts Research Institute & Department of Physiology, Western University, London, ON Canada ,0000 0004 1936 8884grid.39381.30Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON Canada ,0000 0004 1936 8884grid.39381.30The Brain and Mind Institute, Western University, London, ON Canada
| | - Adam C. Mar
- 0000 0001 2109 4251grid.240324.3Neuroscience Institute, New York University Medical Center, New York, NY USA ,0000 0004 1936 8753grid.137628.9Department of Neuroscience and Physiology, School of Medicine, New York University, New York, NY USA
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Efficacy of different types of cognitive enhancers for patients with schizophrenia: a meta-analysis. NPJ SCHIZOPHRENIA 2018; 4:22. [PMID: 30361502 PMCID: PMC6202388 DOI: 10.1038/s41537-018-0064-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/13/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022]
Abstract
Cognitive impairment is a core feature of schizophrenia, which is predictive for functional outcomes and is, therefore, a treatment target in itself. Yet, literature on efficacy of different pharmaco-therapeutic options is inconsistent. This quantitative review provides an overview of studies that investigated potential cognitive enhancers in schizophrenia. We included pharmacological agents, which target different neurotransmitter systems and evaluated their efficacy on overall cognitive functioning and seven separate cognitive domains. In total, 93 studies with 5630 patients were included. Cognitive enhancers, when combined across all different neurotransmitter systems, which act on a large number of different mechanisms, showed a significant (yet small) positive effect size of 0.10 (k = 51, p = 0.023; 95% CI = 0.01 to 0.18) on overall cognition. Cognitive enhancers were not superior to placebo for separate cognitive domains. When analyzing each neurotransmitter system separately, agents acting predominantly on the glutamatergic system showed a small significant effect on overall cognition (k = 29, Hedges’ g = 0.19, p = 0.01), as well as on working memory (k = 20, Hedges’ g = 0.13, p = 0.04). A sub-analysis of cholinesterase inhibitors (ChEI) showed a small effect on working memory (k = 6, Hedges’ g = 0.26, p = 0.03). Other sub-analyses were positively nonsignificant, which may partly be due to the low number of studies we could include per neurotransmitter system. Overall, this meta-analysis showed few favorable effects of cognitive enhancers for patients with schizophrenia, partly due to lack of power. There is a lack of studies involving agents acting on other than glutamatergic and cholinergic systems, especially of those targeting the dopaminergic system.
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Lu C, Lv J, Dong L, Jiang N, Wang Y, Fan B, Wang F, Liu X. The protective effect of 20(S)-protopanaxadiol (PPD) against chronic sleep deprivation (CSD)-induced memory impairments in mice. Brain Res Bull 2018; 137:249-256. [DOI: 10.1016/j.brainresbull.2017.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/06/2017] [Accepted: 12/24/2017] [Indexed: 12/31/2022]
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Kristofova M, Aher YD, Ilic M, Radoman B, Kalaba P, Dragacevic V, Aher NY, Leban J, Korz V, Zanon L, Neuhaus W, Wieder M, Langer T, Urban E, Sitte HH, Hoeger H, Lubec G, Aradska J. A daily single dose of a novel modafinil analogue CE-123 improves memory acquisition and memory retrieval. Behav Brain Res 2018; 343:83-94. [PMID: 29410048 DOI: 10.1016/j.bbr.2018.01.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 01/25/2023]
Abstract
Dopamine reuptake inhibitors have been shown to improve cognitive parameters in various tasks and animal models. We recently reported a series of modafinil analogues, of which the most promising, 5-((benzhydrylsulfinyl)methyl) thiazole (CE-123), was selected for further development. The present study aims to characterize pharmacological properties of CE-123 and to investigate the potential to enhance memory performance in a rat model. In vitro transporter assays were performed in cells expressing human transporters. CE-123 blocked uptake of [3H] dopamine (IC50 = 4.606 μM) while effects on serotonin (SERT) and the norepinephrine transporter (NET) were negligible. Blood-brain barrier and pharmacokinetic studies showed that the compound reached the brain and lower elimination than R-modafinil. The Pro-cognitive effect was evaluated in a spatial hole-board task in male Sprague-Dawley rats and CE-123 enhances memory acquisition and memory retrieval, represented by significantly increased reference memory indices and shortened latency. Since DAT blockers can be considered as indirect dopamine receptor agonists, western blotting was used to quantify protein levels of dopamine receptors D1R, D2R and D5R and DAT in the synaptosomal fraction of hippocampal subregions CA1, CA3 and dentate gyrus (DG). CE-123 administration in rats increased total DAT levels and D1R protein levels were significantly increased in CA1 and CA3 in treated/trained groups. The increase of D5R was observed in DG only. Dopamine receptors, particularly D1R, seem to play a role in mediating CE-123-induced memory enhancement. Dopamine reuptake inhibition by CE-123 may represent a novel and improved stimulant therapeutic for impairments of cognitive functions.
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Affiliation(s)
- Martina Kristofova
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Yogesh D Aher
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Marija Ilic
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Bojana Radoman
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Predrag Kalaba
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Vladimir Dragacevic
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Nilima Y Aher
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Johann Leban
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Volker Korz
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lisa Zanon
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Winfried Neuhaus
- Competence Unit Molecular Diagnostics, Competence Center Health and Bioresources, Austrian Institute of Technology (AIT) GmbH, Vienna, Austria
| | - Marcus Wieder
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Thierry Langer
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Ernst Urban
- Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Harald H Sitte
- Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Harald Hoeger
- Core Unit of Biomedical Research, Division of Laboratory Animal Science and Genetics, Medical University of Vienna, Himberg, Austria
| | - Gert Lubec
- Department of Neuroproteomics, Paracelsus Medical University, Salzburg, Austria.
| | - Jana Aradska
- Department of Neuroproteomics, Paracelsus Medical University, Salzburg, Austria.
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Pratt JA, Morris B, Dawson N. Deconstructing Schizophrenia: Advances in Preclinical Models for Biomarker Identification. Curr Top Behav Neurosci 2018; 40:295-323. [PMID: 29721851 DOI: 10.1007/7854_2018_48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Schizophrenia is considered to develop as a consequence of genetic and environmental factors impacting on brain neural systems and circuits during vulnerable neurodevelopmental periods, thereby resulting in symptoms in early adulthood. Understanding of the impact of schizophrenia risk factors on brain biology and behaviour can help in identifying biologically relevant pathways that are attractive for informing clinical studies and biomarker development. In this chapter, we emphasize the importance of adopting a reciprocal forward and reverse translation approach that is iteratively updated when additional new information is gained, either preclinically or clinically, for offering the greatest opportunity for discovering panels of biomarkers for the diagnosis, prognosis and treatment of schizophrenia. Importantly, biomarkers for identifying those at risk may inform early intervention strategies prior to the development of schizophrenia.Given the emerging nature of this approach in the field, this review will highlight recent research of preclinical biomarkers in schizophrenia that show the most promise for informing clinical needs with an emphasis on relevant imaging, electrophysiological, cognitive behavioural and biochemical modalities. The implementation of this reciprocal translational approach is exemplified firstly by the production and characterization of preclinical models based on the glutamate hypofunction hypothesis, genetic and environmental risk factors for schizophrenia (reverse translation), and then the recent clinical recognition of the thalamic reticular thalamus (TRN) as an important locus of brain dysfunction in schizophrenia as informed by preclinical findings (forward translation).
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Affiliation(s)
- Judith A Pratt
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
| | - Brian Morris
- Institute of Neuroscience and Psychology, College of Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neil Dawson
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Rohde C, Polcwiartek C, Asztalos M, Nielsen J. Effectiveness of Prescription-Based CNS Stimulants on Hospitalization in Patients With Schizophrenia: A Nation-Wide Register Study. Schizophr Bull 2018; 44:93-100. [PMID: 28379483 PMCID: PMC5768038 DOI: 10.1093/schbul/sbx043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Negative symptoms and cognitive deficits are main features of schizophrenia but with limited treatment options. Earlier studies have suggested that central nervous system (CNS) stimulants have a small effect on these domains, but with inconclusive results. As the first study to date, we aimed to investigate whether CNS stimulants improve naturalistic outcomes (psychiatric admissions and antipsychotic use) in patients with schizophrenia. METHODS By using extensive health registers all patients with schizophrenia and their use of CNS stimulants in Denmark were identified. Two models were used to investigate the effectiveness of CNS stimulants in patients with schizophrenia between 1995 and 2014; a mirror-image model with 605 individuals, using paired t tests and Wilcoxon signed rank tests, and a follow-up study with 789 individuals, using a conditional risk-set model. RESULTS CNS stimulants use was associated with a reduction in number of psychiatric admissions from 3.43 (95% CI = 2.86 to 4.01) to 2.62 (95% CI = 1.99 to 3.25) (P = .009), with a more pronounced reduction for women (mean difference: -1.37, 95% CI = -2.34 to -0.40, P = .006). Psychiatric bed-days were reduced by 40 (95% CI = 24.5 to 55.6, P < .001) for individuals with at least 1 admission before CNS stimulant use. In addition, the total amount of antipsychotic use (Defined Daily Dose [DDD]) was reduced (P = .001). The Hazard rate ratio in psychiatric admissions between women taking CNS stimulants compared to women not taking CNS stimulants was 0.77 (95% CI = 0.67 to 0.88). CONCLUSION CNS stimulants may have clinical potentials for improving functional outcomes in patients with schizophrenia and randomized clinical studies evaluating this topic are warranted.
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Affiliation(s)
- Christopher Rohde
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark,To whom correspondence should be addressed; Department of Psychiatry, Center for Psychosis, Aalborg University Hospital, Brandevej 5, Aalborg Ø 9220, Denmark; tel: +45-28-26-09-90, e-mail:
| | - Christoffer Polcwiartek
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Marton Asztalos
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark,School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Jimmi Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark,Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
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25
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Lees J, Michalopoulou PG, Lewis SW, Preston S, Bamford C, Collier T, Kalpakidou A, Wykes T, Emsley R, Pandina G, Kapur S, Drake RJ. Modafinil and cognitive enhancement in schizophrenia and healthy volunteers: the effects of test battery in a randomised controlled trial. Psychol Med 2017; 47:2358-2368. [PMID: 28464963 DOI: 10.1017/s0033291717000885] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive deficits in schizophrenia have major functional impacts. Modafinil is a cognitive enhancer whose effect in healthy volunteers is well-described, but whose effects on the cognitive deficits of schizophrenia appear to be inconsistent. Two possible reasons for this are that cognitive test batteries vary in their sensitivity, or that the phase of illness may be important, with patients early in their illness responding better. METHODS A double-blind, randomised, placebo-controlled single-dose crossover study of modafinil 200 mg examined this with two cognitive batteries [MATRICS Consensus Cognitive Battery (MCCB) and Cambridge Neuropsychological Test Automated Battery (CANTAB)] in 46 participants with under 3 years' duration of DSM-IV schizophrenia, on stable antipsychotic medication. In parallel, the same design was used in 28 age-, sex-, and education-matched healthy volunteers. Uncorrected p values were calculated using mixed effects models. RESULTS In patients, modafinil significantly improved CANTAB Paired Associate Learning, non-significantly improved efficiency and significantly slowed performance of the CANTAB Stockings of Cambridge spatial planning task. There was no significant effect on any MCCB domain. In healthy volunteers, modafinil significantly increased CANTAB Rapid Visual Processing, Intra-Extra Dimensional Set Shifting and verbal recall accuracy, and MCCB social cognition performance. The only significant differences between groups were in MCCB visual learning. CONCLUSIONS As in earlier chronic schizophrenia studies, modafinil failed to produce changes in cognition in early psychosis as measured by MCCB. CANTAB proved more sensitive to the effects of modafinil in participants with early schizophrenia and in healthy volunteers. This confirms the importance of selecting the appropriate test battery in treatment studies of cognition in schizophrenia.
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Affiliation(s)
- J Lees
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - P G Michalopoulou
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - S W Lewis
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - S Preston
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - C Bamford
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - T Collier
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - A Kalpakidou
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - T Wykes
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - R Emsley
- Division of Population Health,Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
| | - G Pandina
- Janssen Research & Development, LLC,New Brunswick,New Jersey,USA
| | - S Kapur
- Institute of Psychiatry,Psychology and Neuroscience,King's Health Partners,London,UK
| | - R J Drake
- Division of Psychology & Mental Health,School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre,Manchester,UK
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Mar AC, Nilsson SRO, Gamallo-Lana B, Lei M, Dourado T, Alsiö J, Saksida LM, Bussey TJ, Robbins TW. MAM-E17 rat model impairments on a novel continuous performance task: effects of potential cognitive enhancing drugs. Psychopharmacology (Berl) 2017; 234:2837-2857. [PMID: 28744563 PMCID: PMC5591806 DOI: 10.1007/s00213-017-4679-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/18/2017] [Indexed: 12/02/2022]
Abstract
RATIONALE Impairments in attention and inhibitory control are endophenotypic markers of neuropsychiatric disorders such as schizophrenia and represent key targets for therapeutic management. Robust preclinical models and assays sensitive to clinically relevant treatments are crucial for improving cognitive enhancement strategies. OBJECTIVES We assessed a rodent model with neural and behavioral features relevant to schizophrenia (gestational day 17 methylazoxymethanol acetate treatment (MAM-E17)) on a novel test of attention and executive function, and examined the impact of putative nootropic drugs. METHODS MAM-E17 and sham control rats were trained on a novel touchscreen-based rodent continuous performance test (rCPT) designed to closely mimic the human CPT paradigm. Performance following acute, systemic treatment with an array of pharmacological compounds was investigated. RESULTS Two cohorts of MAM-E17 rats were impaired on rCPT performance including deficits in sensitivity (d') and increased false alarm rates (FARs). Sulpiride (0-30 mg/kg) dose-dependently reduced elevated FAR in MAM-E17 rats whereas low-dose modafinil (8 mg/kg) only improved d' in sham controls. ABT-594 (5.9-19.4 μg/kg) and modafinil (64 mg/kg) showed expected stimulant-like effects, while LSN2463359 (5 mg/kg), RO493858 (10 mg/kg), atomoxetine (0.3-1 mg/kg), and sulpiride (30 mg/kg) showed expected suppressant effects on performance across all animals. Donepezil (0.1-1 mg/kg) showed near-significant enhancements in d', and EVP-6124 (0.3-3 mg/kg) exerted no effects in the rCPT paradigm. CONCLUSION The MAM-E17 model exhibits robust and replicable impairments in rCPT performance that resemble attention and inhibitory control deficits seen in schizophrenia. Pharmacological profiles were highly consistent with known drug effects on cognition in preclinical and clinical studies. The rCPT is a sensitive and reliable tool with high translational potential for understanding the etiology and treatment of disorders affecting attention and executive dysfunction.
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Affiliation(s)
- Adam C Mar
- Neuroscience Institute, New York University Medical Center, New York, NY, 10016, USA.
- Department of Neuroscience and Physiology, New York University Medical Center, New York, NY, USA.
- Department of Psychology, University of Cambridge, Cambridge, UK.
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
| | - Simon R O Nilsson
- Neuroscience Institute, New York University Medical Center, New York, NY, 10016, USA
- Department of Neuroscience and Physiology, New York University Medical Center, New York, NY, USA
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Begoña Gamallo-Lana
- Neuroscience Institute, New York University Medical Center, New York, NY, 10016, USA
- Department of Neuroscience and Physiology, New York University Medical Center, New York, NY, USA
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Ming Lei
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Health Industry Management, Beijing International Studies University, 1 Dingfuzhuang Nanli, Beijing, China
| | - Theda Dourado
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Johan Alsiö
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Neuroscience, Unit of Functional Neurobiology, University of Uppsala, Uppsala, Sweden
| | - Lisa M Saksida
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Molecular Medicine Research Group, Robarts Research Institute, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- The Brain and Mind Institute, Western University, London, ON, Canada
| | - Timothy J Bussey
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Molecular Medicine Research Group, Robarts Research Institute, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- The Brain and Mind Institute, Western University, London, ON, Canada
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, UK
- MRC and Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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Dias VT, Vey LT, Rosa HZ, D'avila LF, Barcelos RCS, Burger ME. Could Modafinil Prevent Psychostimulant Addiction? An Experimental Study in Rats. Basic Clin Pharmacol Toxicol 2017; 121:400-408. [DOI: 10.1111/bcpt.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Verônica Tironi Dias
- Graduate Program of Pharmacology; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
| | - Luciana Taschetto Vey
- Graduate Program in Biological Sciences: Toxicological Biochemistry; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
| | - Higor Zuquetto Rosa
- Department of Physiology and Pharmacology; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
| | - Lívia Ferraz D'avila
- Graduate Program of Pharmacology; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
| | | | - Marilise Escobar Burger
- Graduate Program of Pharmacology; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
- Graduate Program in Biological Sciences: Toxicological Biochemistry; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
- Department of Physiology and Pharmacology; Federal University of Santa Maria (UFSM) - RS; Santa Maria Brazil
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28
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Neto D, Spínola C, Gago J. Modafinil in schizophrenia: is the risk worth taking? BMJ Case Rep 2017; 2017:bcr-2017-219218. [PMID: 28583922 DOI: 10.1136/bcr-2017-219218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Schizophrenia is a severe mental disorder characterised by positive and negative symptoms. Negative symptoms are difficult to treat and there is no specific treatment. In small trials, modafinil has been studied in association with antipsychotic treatment. We present three cases of its use; two have developed positive symptoms and one developed renal impairment. Further studies are needed to assess its usefulness in schizophrenia and safety in this group of patients.
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Affiliation(s)
- Daniel Neto
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,Departamento de Saúde Mental, NOVA Medical School - Faculdade de Ciências Médicas, Lisboa, Portugal
| | - Carla Spínola
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Joaquim Gago
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,Departamento de Saúde Mental, NOVA Medical School - Faculdade de Ciências Médicas, Lisboa, Portugal
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29
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Brühl AB, Sahakian BJ. Neuroscience-based Nomenclature: improving clinical and scientific terminology in research and clinical psychopharmacology. Psychol Med 2017; 47:1339-1341. [PMID: 28095940 DOI: 10.1017/s0033291716003603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A B Brühl
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute,University of Cambridge,Cambridge,UK
| | - B J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute,University of Cambridge,Cambridge,UK
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30
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d'Angelo LSC, Savulich G, Sahakian BJ. Lifestyle use of drugs by healthy people for enhancing cognition, creativity, motivation and pleasure. Br J Pharmacol 2017; 174:3257-3267. [PMID: 28427114 DOI: 10.1111/bph.13813] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 12/24/2022] Open
Abstract
Today, there is continued, and in some cases growing, availability of not only psychoactive substances, including treatments for mental health disorders such as cognitive enhancers, which can enhance or restore brain function, but also 'recreational' drugs such as novel psychoactive substances (NPS). The use of psychoactive drugs has both benefits and risks: whilst new drugs to treat cognitive symptoms in neuropsychiatric or neurodegenerative disorders could have great benefits for many patient groups, the increasing ease of accessibility to recreational NPS and the increasing lifestyle use of cognitive enhancers by healthy people means that the effective management of psychoactive substances will be an issue of increasing importance. Clearly, the potential benefits of cognitive enhancers are large and increasingly relevant, particularly as the population ages, and for this reason, we should continue to devote resources to the development of cognitive enhancers as treatments for neurodegenerative diseases and psychiatric disorders, including Alzheimer's disease, attention deficit hyperactivity disorder and schizophrenia. However, the increasing use of cognitive enhancers by healthy individuals raises safety, ethical and regulatory concerns, which should not be ignored. Similarly, understanding the short- and long-term consequences of the use of NPS, as well as better understanding the motivations and profiles of users could promote more effective prevention and harm reduction measures. Linked Articles This article is part of a themed section on Pharmacology of Cognition: a Panacea for Neuropsychiatric Disease? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.19/issuetoc.
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Affiliation(s)
- L-S Camilla d'Angelo
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - George Savulich
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
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Abstract
Cognitive dysfunction in depression is associated with poorer clinical outcomes and impaired psychosocial functioning. However, most treatments for depression do not specifically target cognition. Neurocognitive deficits such as memory and concentration problems tend to persist after mood symptoms recover. Improving cognition in depression requires a better understanding of brain systems implicated in depression. A comprehensive approach is warranted for refined methods of assessing and treating cognitive dysfunction in depression.
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Affiliation(s)
- M Kaser
- Department of Psychiatry, University of Cambridge, Cambridge,UK
| | - R Zaman
- Department of Psychiatry, University of Cambridge, Cambridge,UK
| | - B J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge,UK
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32
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Kaser M, Deakin JB, Michael A, Zapata C, Bansal R, Ryan D, Cormack F, Rowe JB, Sahakian BJ. Modafinil Improves Episodic Memory and Working Memory Cognition in Patients With Remitted Depression: A Double-Blind, Randomized, Placebo-Controlled Study. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:115-122. [PMID: 28299368 PMCID: PMC5339412 DOI: 10.1016/j.bpsc.2016.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Abstract
Background Cognitive dysfunction is a core feature of depression and tends to persist even after mood symptoms recover, leading to detrimental effects on clinical and functional outcomes. However, most currently available treatments have not typically addressed cognition. Modafinil has been shown to have beneficial effects on cognitive function and therefore has the potential to improve cognition in depression. The objective of this double-blind, placebo-controlled study was to investigate the effects of modafinil on cognitive functions in patients with remitted depression. Methods In total, 60 patients with remitted depression participated in the study. Cognitive functions were evaluated with tests of working memory, planning, attention, and episodic memory from the Cambridge Neuropsychological Test Automated Battery at the baseline session and after treatment. A double-blind, randomized, placebo-controlled, parallel groups design was used to assess the effects of single-dose (200 mg) modafinil (n = 30) or placebo (n = 30) on cognition and fatigue. The main outcome measures were neurocognitive test scores from the Cambridge Neuropsychological Test Automated Battery. Visual analogue scales for subjective feelings and fatigue were used as secondary measures. Results The modafinil group had significantly better performance on tests of episodic memory (p = .01, ηp2 = .10) and working memory (p = .04, ηp2 = .06). Modafinil did not improve planning or sustained attention. Conclusions This study suggested that modafinil (200 mg) could improve episodic memory and working memory performance in patients with remitted depression. Modafinil may have potential as a therapeutic agent to help remitted depressed patients with persistent cognitive difficulties.
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Affiliation(s)
- Muzaffer Kaser
- Department of Psychiatry, University of Cambridge; Behavioural and Clinical Neuroscience Institute, University of Cambridge; Department of Psychiatry (MK), Bahcesehir University, Istanbul, Turkey
| | - Julia B Deakin
- Department of Psychiatry, University of Cambridge; Cambridgeshire and Peterborough NHS Foundation Trust
| | | | | | - Rachna Bansal
- North Essex Partnership NHS Foundation Trust, Essex, United Kingdom
| | - Dragana Ryan
- Cambridgeshire and Peterborough NHS Foundation Trust
| | | | - James B Rowe
- Behavioural and Clinical Neuroscience Institute, University of Cambridge; Department of Clinical Neurosciences, University of Cambridge; MRC Cognition and Brain Sciences Unit, Cambridge
| | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge; Behavioural and Clinical Neuroscience Institute, University of Cambridge
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33
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Goetghebeur PJ, Swartz JE. True alignment of preclinical and clinical research to enhance success in CNS drug development: a review of the current evidence. J Psychopharmacol 2016; 30:586-94. [PMID: 27147593 DOI: 10.1177/0269881116645269] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Central nervous system pharmacological research and development has reached a critical turning point. Patients suffering from disorders afflicting the central nervous system are numerous and command significant attention from the pharmaceutical industry. However, given the numerous failures of promising drugs, many companies are no longer investing in or, indeed, are divesting from this therapeutic area. Central nervous system drug development must change in order to develop effective therapies to treat these patients. Preclinical research is a cornerstone of drug development; however, it is frequently criticised for its lack of predictive validity. Animal models and assays can be shown to be more predictive than reported and, on many occasions, the lack of thorough preclinical testing is potentially to blame for some of the clinical failures. Important factors such as translational aspects, nature of animal models, variances in acute versus chronic dosing, development of add-on therapies and understanding of the full dose-response relationship are too often neglected. Reducing the attrition rate in central nervous system drug development could be achieved by addressing these important questions before novel compounds enter the clinical phase. This review illustrates the relevance of employing these criteria to translational central nervous system research, better to ensure success in developing new drugs in this therapeutic area.
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Affiliation(s)
| | - Jina E Swartz
- CNS Therapeutic Area Unit, Takeda Development Centre Europe Ltd, London, UK
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34
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Otto MW, Lee J, Hofmann SG, Hearon BA, Smits JAJ, Rosenfield D, Fava M, Wright JH. Examining the efficacy of d-cycloserine to augment therapeutic learning in depression. Contemp Clin Trials 2016; 48:146-52. [PMID: 27094721 PMCID: PMC10999219 DOI: 10.1016/j.cct.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 10/21/2022]
Abstract
Despite advances in individual and combined treatments for major depression, issues with non-response and partial-response remain relatively common, motivating the search for new treatment strategies. This study aims to develop one such novel treatment. In this proof-of-concept study, we are investigating whether the treatment enhancing effects of d-cycloserine (DCS) administration can be extended outside the extinction-learning paradigms where they have been primarily examined. Using uniform delivery of cognitive behavioral therapy (CBT) content via computer-administered interventions for depression, we are assessing the value of pre-session administrations of DCS for retention of therapeutic learning. Recall of this information is evaluated in conjunction with performance on standardized tests of memory recall with both emotional and non-emotional stimuli. Specifically, in a randomized, double-blind trial we will compare the benefits of two pre-session administrations of DCS augmentation to those achieved by similar administrations of modafinil or placebo. Because modafinil is associated with a number of discriminable effects in addition to cognitive enhancement (e.g., feelings of vigor, alertness, positive mood); whereas these effects would not be expected with DCS, we will assess drug context effects in relation to memory augmentation effects.
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Affiliation(s)
- Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, United States.
| | - Josephine Lee
- Department of Psychological and Brain Sciences, Boston University, United States
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, United States
| | - Bridget A Hearon
- Department of Psychological and Brain Sciences, Boston University, United States
| | - Jasper A J Smits
- Institute for Mental Health Research and Department of Psychology, University of Texas at Austin, United States
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, United States
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, United States
| | - Jesse H Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, United States
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Brühl AB, Sahakian BJ. Drugs, games, and devices for enhancing cognition: implications for work and society. Ann N Y Acad Sci 2016; 1369:195-217. [PMID: 27043232 DOI: 10.1111/nyas.13040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 12/11/2022]
Abstract
As work environments change, the demands on working people change. Cognitive abilities in particular are becoming progressively more important for work performance and successful competition in a global environment. However, work-related stress, performance over long hours, lack of sleep, shift work, and jet lag affect cognitive functions. Therefore, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as noninvasive brain stimulation, to maintain or improve work performance. This review summarizes research on pharmacological and technical methods as well as cognitive training, including game apps for the brain, in healthy people. In neuropsychiatric disorders, impairments in cognitive functions can drastically reduce the chances of returning to work; therefore, this review also summarizes findings from pharmacological and cognitive-training studies in neuropsychiatric disorders.
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Affiliation(s)
- Annette B Brühl
- Department of Psychiatry, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zürich, Switzerland
| | - Barbara J Sahakian
- Department of Psychiatry, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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Cognitive enhancers versus addictive psychostimulants: The good and bad side of dopamine on prefrontal cortical circuits. Pharmacol Res 2016; 109:108-18. [PMID: 26826399 DOI: 10.1016/j.phrs.2016.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/19/2022]
Abstract
In this review we describe how highly addictive psychostimulants such as cocaine and methamphetamine actions might underlie hypoexcitabilty in frontal cortical areas observed in clinical and preclinical models of psychostimulant abuse. We discuss new mechanisms that describe how increments on synaptic dopamine release are linked to reduce calcium influx in both pre and postsynaptic compartments on medial PFC networks, therefore modulating synaptic integration and information. Sustained DA neuromodulation by addictive psychostimulants can "lock" frontal cortical networks in deficient states. On the other hand, other psychostimulants such as modafinil and methylphenidate are considered pharmacological neuroenhancement agents that are popular among healthy people seeking neuroenhancement. More clinical and preclinical research is needed to further clarify mechanisms of actions and physiological effects of cognitive enhancers which show an opposite pattern compared to chronic effect of addictive psychostimulants: they appear to increase cortical excitability. In conclusion, studies summarized here suggest that there is frontal cortex hypoactivity and deficient inhibitory control in drug-addicted individuals. Thus, additional research on physiological effects of cognitive enhancers like modafinil and methylphenidate seems necessary in order to expand current knowledge on mechanisms behind their therapeutic role in the treatment of addiction and other neuropsychiatric disorders.
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Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review. Eur Neuropsychopharmacol 2015; 25:1865-81. [PMID: 26381811 DOI: 10.1016/j.euroneuro.2015.07.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/22/2022]
Abstract
Modafinil is an FDA-approved eugeroic that directly increases cortical catecholamine levels, indirectly upregulates cerebral serotonin, glutamate, orexin, and histamine levels, and indirectly decreases cerebral gamma-amino-butrytic acid levels. In addition to its approved use treating excessive somnolence, modafinil is thought to be used widely off-prescription for cognitive enhancement. However, despite this popularity, there has been little consensus on the extent and nature of the cognitive effects of modafinil in healthy, non-sleep-deprived humans. This problem is compounded by methodological discrepancies within the literature, and reliance on psychometric tests designed to detect cognitive effects in ill rather than healthy populations. In order to provide an up-to-date systematic evaluation that addresses these concerns, we searched MEDLINE with the terms "modafinil" and "cognitive", and reviewed all resultant primary studies in English from January 1990 until December 2014 investigating the cognitive actions of modafinil in healthy non-sleep-deprived humans. We found that whilst most studies employing basic testing paradigms show that modafinil intake enhances executive function, only half show improvements in attention and learning and memory, and a few even report impairments in divergent creative thinking. In contrast, when more complex assessments are used, modafinil appears to consistently engender enhancement of attention, executive functions, and learning. Importantly, we did not observe any preponderances for side effects or mood changes. Finally, in light of the methodological discrepancies encountered within this literature, we conclude with a series of recommendations on how to optimally detect valid, robust, and consistent effects in healthy populations that should aid future assessment of neuroenhancement.
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Karabacak Y, Sase S, Aher YD, Sase A, Saroja SR, Cicvaric A, Höger H, Berger M, Bakulev V, Sitte HH, Leban J, Monje FJ, Lubec G. The effect of modafinil on the rat dopamine transporter and dopamine receptors D1-D3 paralleling cognitive enhancement in the radial arm maze. Front Behav Neurosci 2015; 9:215. [PMID: 26347626 PMCID: PMC4541367 DOI: 10.3389/fnbeh.2015.00215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/30/2015] [Indexed: 01/11/2023] Open
Abstract
A series of drugs have been reported to increase memory performance modulating the dopaminergic system and herein modafinil was tested for its working memory (WM) enhancing properties. Reuptake inhibition of dopamine, serotonin (SERT) and norepinephrine (NET) by modafinil was tested. Sixty male Sprague–Dawley rats were divided into six groups (modafinil-treated 1–5–10 mg/kg body weight, trained and untrained and vehicle treated trained and untrained rats; daily injected intraperitoneally for a period of 10 days) and tested in a radial arm maze (RAM), a paradigm for testing spatial WM. Hippocampi were taken 6 h following the last day of training and complexes containing the unphosphorylated or phosphorylated dopamine transporter (DAT-CC and pDAT-CC) and complexes containing the D1–3 dopamine receptor subunits (D1–D3-CC) were determined. Modafinil was binding to the DAT but insignificantly to SERT or NET and dopamine reuptake was blocked specifically (IC50 = 11.11 μM; SERT 1547 μM; NET 182 μM). From day 8 (day 9 for 1 mg/kg body weight) modafinil was decreasing WM errors (WMEs) in the RAM significantly and remarkably at all doses tested as compared to the vehicle controls. WMEs were linked to the D2R-CC and the pDAT-CC. pDAT and D1–D3-CC levels were modulated significantly and modafinil was shown to enhance spatial WM in the rat in a well-documented paradigm at all the three doses and dopamine reuptake inhibition with subsequent modulation of D1–3-CC is proposed as a possible mechanism of action.
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Affiliation(s)
- Yasemin Karabacak
- Department of Pharmaceutical Chemistry, University of Vienna Vienna, Austria
| | - Sunetra Sase
- Department of Pharmaceutical Chemistry, University of Vienna Vienna, Austria
| | - Yogesh D Aher
- Department of Pharmaceutical Chemistry, University of Vienna Vienna, Austria
| | - Ajinkya Sase
- Department of Pharmaceutical Chemistry, University of Vienna Vienna, Austria
| | | | - Ana Cicvaric
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna Vienna, Austria
| | - Harald Höger
- Core Unit of Biomedical Research, Division of Laboratory Animal Science and Genetics, Medical University of Vienna, Himberg Austria
| | - Michael Berger
- Center of Brain Research, Medical University of Vienna Vienna, Austria
| | | | - Harald H Sitte
- Institute of Pharmacology, Center of Physiology and Pharmacology, Medical University of Vienna Vienna, Austria
| | - Johann Leban
- Department of Pharmaceutical Chemistry, University of Vienna Vienna, Austria
| | - Francisco J Monje
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna Vienna, Austria
| | - Gert Lubec
- Department of Pharmaceutical Chemistry, University of Vienna Vienna, Austria
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The increasing lifestyle use of modafinil by healthy people: safety and ethical issues. Curr Opin Behav Sci 2015. [DOI: 10.1016/j.cobeha.2015.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Michalopoulou PG, Lewis SW, Drake RJ, Reichenberg A, Emsley R, Kalpakidou AK, Lees J, Bobin T, Gilleen JK, Pandina G, Applegate E, Wykes T, Kapur S. Modafinil combined with cognitive training: pharmacological augmentation of cognitive training in schizophrenia. Eur Neuropsychopharmacol 2015; 25:1178-89. [PMID: 25921551 DOI: 10.1016/j.euroneuro.2015.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/20/2015] [Accepted: 03/22/2015] [Indexed: 01/10/2023]
Abstract
Several efforts to develop pharmacological treatments with a beneficial effect on cognition in schizophrenia are underway, while cognitive remediation has shown modest effects on cognitive performance. Our goal was to test if pharmacological augmentation of cognitive training would result in enhancement of training-induced learning. We chose modafinil as the pharmacological augmenting agent, as it is known to have beneficial effects on learning and cognition. 49 participants with chronic schizophrenia were enroled in a double-blind, placebo-controlled study across two sites and were randomised to either modafinil (200mg/day) or placebo. All participants engaged in a cognitive training program for 10 consecutive weekdays. The primary outcome measure was the performance on the trained tasks and secondary outcome measures included MATRICS cognitive battery, proxy measures of everyday functioning and symptom measures. 84% of the participants completed all study visits. Both groups showed significant improvement in the performance of the trained tasks suggesting potential for further learning. Modafinil did not induce differential enhancement on the performance of the trained tasks or any differential enhancement of the neuropsychological and functional measures compared to placebo. Modafinil showed no significant effects on symptom severity. Our study demonstrated that combining pharmacological compounds with cognitive training is acceptable to patients and can be implemented in large double-blind randomised controlled trials. The lack of differential enhancement of training-induced learning raises questions, such as choice and optimal dose of drug, cognitive domains to be trained, type of cognitive training, intervention duration and chronicity of illness that require systematic investigation in future studies.
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Affiliation(s)
- Panayiota G Michalopoulou
- Section on Schizophrenia, Imaging and Therapeutics, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, PO Box 053, 16 De Crespigny Park, London SE5 8AF, UK.
| | - Shôn W Lewis
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Richard J Drake
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Abraham Reichenberg
- Icahn School of Medicine, Mount Sinai, New York, USA; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, UK
| | - Richard Emsley
- Institute of Population Health, University of Manchester, UK
| | - Anastasia K Kalpakidou
- Section on Schizophrenia, Imaging and Therapeutics, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, PO Box 053, 16 De Crespigny Park, London SE5 8AF, UK
| | - Jane Lees
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Tracey Bobin
- Section on Schizophrenia, Imaging and Therapeutics, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, PO Box 053, 16 De Crespigny Park, London SE5 8AF, UK
| | - James K Gilleen
- Section on Schizophrenia, Imaging and Therapeutics, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, PO Box 053, 16 De Crespigny Park, London SE5 8AF, UK
| | | | - Eve Applegate
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, UK
| | - Shitij Kapur
- Section on Schizophrenia, Imaging and Therapeutics, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, PO Box 053, 16 De Crespigny Park, London SE5 8AF, UK
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41
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Modafinil as a cognitive enhancer of spatial working memory in rats. Physiol Behav 2015; 142:126-30. [DOI: 10.1016/j.physbeh.2015.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 11/19/2022]
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Sahakian BJ, Morein-Zamir S. Pharmacological cognitive enhancement: treatment of neuropsychiatric disorders and lifestyle use by healthy people. Lancet Psychiatry 2015; 2:357-62. [PMID: 26360089 DOI: 10.1016/s2215-0366(15)00004-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
Abstract
Neuropsychiatric disorders typically manifest as problems with attentional biases, aberrant learning, dysfunctional reward systems, and an absence of top-down cognitive control by the prefrontal cortex. In view of the cost of common mental health disorders, in terms of distress to the individual and family in addition to the financial cost to society and governments, new developments for treatments that address cognitive dysfunction should be a priority so that all members of society can flourish. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used as treatments for the cognitive symptoms of Alzheimer's disease and attention deficit hyperactivity disorder. However, these drugs and others, including modafinil, are being increasingly used by healthy people for enhancement purposes. Importantly for ethical and safety reasons, the drivers for this increasing lifestyle use of so-called smart drugs by healthy people should be considered and discussions must occur about how to ensure present and future pharmacological cognitive enhancers are used for the benefit of society.
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Affiliation(s)
| | - Sharon Morein-Zamir
- Medical Research Council-Wellcome Trust Behavioural and Clinical Neuroscience Institute, Addenbrooke's Hospital, Cambridge, UK; Department of Psychology, University of Cambridge, Cambridge, UK
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43
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Behavioural and molecular endophenotypes in psychotic disorders reveal heritable abnormalities in glutamatergic neurotransmission. Transl Psychiatry 2015; 5:e540. [PMID: 25826115 PMCID: PMC4429170 DOI: 10.1038/tp.2015.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 01/02/2015] [Accepted: 01/20/2015] [Indexed: 02/02/2023] Open
Abstract
Psychotic disorders such as schizophrenia are biologically complex and carry huge population morbidity due to their prevalence, persistence and associated disability. Defined by features such as delusions and hallucinations, they involve cognitive dysfunction and neurotransmitter dysregulations that appear mostly to involve the dopaminergic and glutamatergic systems. A number of genetic and environmental factors are associated with these disorders but it has been difficult to identify the biological pathways underlying the principal symptoms. The endophenotype concept of stable, heritable traits that form a mechanistic link between genes and an overt expression of the disorder has potential to reduce the complexity of psychiatric phenotypes. In this study, we used a genetically sensitive design with individuals with a first episode of psychosis, their non-affected first-degree relatives and non-related healthy controls. Metabolomic analysis was combined with neurocognitive assessment to identify multilevel endophenotypic patterns: one concerned reaction times during the performance of cognitive and emotional tests that have previously been associated with the glutamate neurotransmission system, the other involved metabolites involved directly and indirectly in the co-activation of the N-methyl-D-aspartate receptor, a major receptor of the glutamate system. These cognitive and metabolic endophenotypes may comprise a single construct, such that genetically mediated dysfunction in the glutamate system may be responsible for delays in response to cognitive and emotional functions in psychotic disorders. This focus on glutamatergic neurotransmission should guide drug discovery and experimental medicine programmes in schizophrenia and related disorders.
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Young JW, Geyer MA. Developing treatments for cognitive deficits in schizophrenia: the challenge of translation. J Psychopharmacol 2015; 29:178-96. [PMID: 25516372 PMCID: PMC4670265 DOI: 10.1177/0269881114555252] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schizophrenia is a life-long debilitating mental disorder affecting tens of millions of people worldwide. The serendipitous discovery of antipsychotics focused pharmaceutical research on developing a better antipsychotic. Our understanding of the disorder has advanced however, with the knowledge that cognitive enhancers are required for patients in order to improve their everyday lives. While antipsychotics treat psychosis, they do not enhance cognition and hence are not antischizophrenics. Developing pro-cognitive therapeutics has been extremely difficult, however, especially when no approved treatment exists. In lieu of stumbling on an efficacious treatment, developing targeted compounds can be facilitated by understanding the neural mechanisms underlying altered cognitive functioning in patients. Equally importantly, these cognitive domains will need to be measured similarly in animals and humans so that novel targets can be tested prior to conducting expensive clinical trials. To date, the limited similarity of testing across species has resulted in a translational bottleneck. In this review, we emphasize that schizophrenia is a disorder characterized by abnormal cognitive behavior. Quantifying these abnormalities using tasks having cross-species validity would enable the quantification of comparable processes in rodents. This approach would increase the likelihood that the neural substrates underlying relevant behaviors will be conserved across species. Hence, we detail cross-species tasks which can be used to test the effects of manipulations relevant to schizophrenia and putative therapeutics. Such tasks offer the hope of providing a bridge between non-clinical and clinical testing that will eventually lead to treatments developed specifically for patients with deficient cognition.
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Affiliation(s)
- JW Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - MA Geyer
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
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45
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Andrade C, Kisely S, Monteiro I, Rao S. Antipsychotic augmentation with modafinil or armodafinil for negative symptoms of schizophrenia: systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res 2015; 60:14-21. [PMID: 25306261 DOI: 10.1016/j.jpsychires.2014.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/18/2014] [Accepted: 09/12/2014] [Indexed: 12/14/2022]
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of modafinil or armodafinil (ar/mod) augmentation in schizophrenia. We searched PubMed, clinical trial registries, reference lists, and other sources for parallel group, placebo-controlled RCTs. Our primary outcome variable was the effect of ar/mod on negative symptom outcomes. Eight RCTs (pooled N = 372; median duration, 8 weeks) met our selection criteria. Ar/mod (200 mg/day) significantly attenuated negative symptom ratings (6 RCTs; N = 322; standardized mean difference [SMD], -0.26; 95% CI, -0.48 to -0.04). This finding remained similar in all but one sensitivity analysis - when the only RCT in acutely ill patients was excluded, the outcome was no longer statistically significant (SMD, -0.17; 95% CI, -0.51 to 0.06). The absolute advantage for ar/mod was small: just 0.27 points on the PANSS-N (6 RCTs). Ar/mod attenuated total psychopathology ratings (7 RCTs; N = 342; SMD, -0.23; 95% CI, -0.45 to -0.02) but did not influence positive symptom ratings (5 RCTs; N = 302; mean difference, -0.58; 95% CI, -1.71 to 0.55). Although data were limited, cognition, fatigue, daytime drowsiness, adverse events, and drop out rates did not differ significantly between ar/mod and placebo groups. Fixed and random effects models yielded similar results. There was no heterogeneity in all but one analysis. Publication bias could not be tested. We conclude that ar/mod (200 mg/day) is safe and well tolerated in the short-term treatment of schizophrenia. Ar/mod reduces negative symptoms with a small effect size; the absolute advantage is also small, and the advantage disappears when chronically ill patients or those with high negative symptom burden are treated. Ar/mod does not benefit or worsen other symptom dimensions in schizophrenia.
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Affiliation(s)
- Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India.
| | - Steve Kisely
- School of Medicine, The University of Queensland, Level 4, Building 1, Princess Alexandra Hospital, Ipswich Road, Woolloongabba QLD 4102, Australia
| | - Ingrid Monteiro
- National Institute of Mental Health and Neurosciences, Bangalore 560 029, India
| | - Sanjay Rao
- Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada
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46
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Klement J, Mergelkuhl B, Born J, Lehnert H, Hallschmid M. Role of γ-aminobutyric acid signalling in the attenuation of counter-regulatory hormonal responses after antecedent hypoglycaemia in healthy men. Diabetes Obes Metab 2014; 16:1274-8. [PMID: 25059854 DOI: 10.1111/dom.12358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
The attenuated counter-regulatory response to hypoglycaemia after antecedent hypoglycaemic episodes has been observed in animals to be associated with an increase in γ-aminobutyric acid (GABA) signalling. We therefore tested the hypothesis that the pharmacological suppression of GABAergic activity during a repeated hypoglycaemic episode enhances counter-regulatory responses. Fourteen healthy men participated in two experimental sessions each comprising three insulin-induced hypoglycaemic episodes. Before the third hypoglycaemic episode, participants received the GABA-antagonistic drug modafinil (200 mg orally) and placebo, respectively. In the placebo condition, the secretion of norepinephrine, adrenocorticotropic hormone, cortisol and growth hormone, and the perception of neuroglycopenic symptoms were attenuated during the third as compared with the first hypoglycaemic episode (each p < 0.05). Modafinil reversed this effect for the noradrenergic response (p < 0.05), while not significantly altering the attenuation of other hormonal responses and symptom perception (p > 0.3). Our findings indicate that increased GABAergic transmission could contribute to aspects of the attenuated counter-regulatory response after recurrent hypoglycaemia in humans.
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Affiliation(s)
- J Klement
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
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47
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Abstract
The role of stimulants for treating severe depression remains controversial, especially when it comes to bipolar depression. Potential benefits have to be weighed against risks, including addictive potential and treatment-emergent mania. But not all stimulants are the same. Modafinil and its R-enantiomer armodafinil seem to have positive augmentation effects when coupled with standard treatment of bipolar depression, while also having a relative low risk of addiction and manic switches. A recent hypothesis derived from the observation of hypovigilance in manic patients postulates that modafinil may also have a beneficial effect in reducing manic behaviors. Further controlled studies are needed to clarify the benefits and risks of stimulants, both in bipolar depression and mania.
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Affiliation(s)
- Heinz Grunze
- From Newcastle University, Institute of Neuroscience, Academic Psychiatry Campus of Aging and Vitality, Wolfson Research Building, Westgate Road, Newcastle upon Tyne NE4 5PL, United Kingdom
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48
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Funayama T, Ikeda Y, Tateno A, Takahashi H, Okubo Y, Fukayama H, Suzuki H. Modafinil augments brain activation associated with reward anticipation in the nucleus accumbens. Psychopharmacology (Berl) 2014; 231:3217-28. [PMID: 24682502 DOI: 10.1007/s00213-014-3499-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE The nucleus accumbens (NAc) works as a key brain structure of the reward system, in which reward-related neural activity is well correlated with dopamine release from mesolimbic dopaminergic neurons. OBJECTIVES Since modafinil can modulate dopaminergic transmission through re-uptake inhibition of dopamine, we investigated whether modafinil affects the reward-related brain activity in the NAc in healthy subjects. METHODS Twenty healthy participants underwent two series of functional magnetic resonance imaging while performing monetary incentive delay task in which they were cued to anticipate and respond to a rapidly presented target to gain or avoid losing varying amounts of money, under modafinil or placebo condition. Blood oxygenation-level dependent (BOLD) activation signals during gain and loss anticipations were analyzed in the NAc as an a priori region of interest as well as the whole brain. RESULTS Modafinil significantly changed subjective feelings toward positive ones. The activation of BOLD signals was observed during gain anticipation under the placebo and modafinil conditions in the left and bilateral NAc, respectively. The modafinil condition showed significantly higher BOLD signal change at the highest gain (+¥500) cue compared to the placebo condition. CONCLUSIONS The present study showed that modafinil affects reward processing in the NAc in healthy subjects through enhancing more positive anticipation, and it may provide a basis for the use of this drug for treating anhedonia observed in psychiatric disorders.
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Affiliation(s)
- Takuya Funayama
- Anesthesiology and Clinical Physiology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Millan MJ, Fone K, Steckler T, Horan WP. Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol 2014; 24:645-92. [PMID: 24820238 DOI: 10.1016/j.euroneuro.2014.03.008] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 12/11/2022]
Abstract
Schizophrenia is a complex and multifactorial disorder generally diagnosed in young adults at the time of the first psychotic episode of delusions and hallucinations. These positive symptoms can be controlled in most patients by currently-available antipsychotics. Conversely, they are poorly effective against concomitant neurocognitive dysfunction, deficits in social cognition and negative symptoms (NS), which strongly contribute to poor functional outcome. The precise notion of NS has evolved over the past century, with recent studies - underpinned by novel rating methods - suggesting two major sub-domains: "decreased emotional expression", incorporating blunted affect and poverty of speech, and "avolition", which embraces amotivation, asociality and "anhedonia" (inability to anticipate pleasure). Recent studies implicate a dysfunction of frontocortico-temporal networks in the aetiology of NS, together with a disruption of cortico-striatal circuits, though other structures are also involved, like the insular and parietal cortices, amygdala and thalamus. At the cellular level, a disruption of GABAergic-glutamatergic balance, dopaminergic signalling and, possibly, oxytocinergic and cannibinoidergic transmission may be involved. Several agents are currently under clinical investigation for the potentially improved control of NS, including oxytocin itself, N-Methyl-d-Aspartate receptor modulators and minocycline. Further, magnetic-electrical "stimulation" strategies to recruit cortical circuits and "cognitive-behavioural-psychosocial" therapies likewise hold promise. To acquire novel insights into the causes and treatment of NS, experimental study is crucial, and opportunities are emerging for improved genetic, pharmacological and developmental modelling, together with more refined readouts related to deficits in reward, sociality and "expression". The present article comprises an integrative overview of the above issues as a platform for this Special Issue of European Neuropsychopharmacology in which five clinical and five preclinical articles treat individual themes in greater detail. This Volume provides, then, a framework for progress in the understanding - and ultimately control - of the debilitating NS of schizophrenia.
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Affiliation(s)
- Mark J Millan
- Pole of Innovation in Neuropsychiatry, Institut de Recherche Servier, 125 Chemin de Ronde, 78290 Croissy-sur-Seine, Paris, France.
| | - Kevin Fone
- School of Biomedical Sciences, Medical School, Queen׳s Medical Centre, Nottingham University, Nottingham NG72UH, UK
| | - Thomas Steckler
- Janssen Research and Development, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - William P Horan
- VA Greater Los Angeles Healthcare System, University of California, Los Angeles, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA
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Gilleen J, Michalopoulou PG, Reichenberg A, Drake R, Wykes T, Lewis SW, Kapur S. Modafinil combined with cognitive training is associated with improved learning in healthy volunteers--a randomised controlled trial. Eur Neuropsychopharmacol 2014; 24:529-39. [PMID: 24485800 DOI: 10.1016/j.euroneuro.2014.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Improving cognition in people with neuropsychiatric disorders remains a major clinical target. By themselves pharmacological and non-pharmacological approaches have shown only modest effects in improving cognition. In the present study we tested a recently-proposed methodology to combine CT with a 'cognitive-enhancing' drug to improve cognitive test scores and expanded on previous approaches by delivering combination drug and CT, over a long intervention of repeated sessions, and used multiple tasks to reveal the cognitive processes being enhanced. We also aimed to determine whether gains from this combination approach generalised to untrained tests. In this proof of principle randomised-controlled trial thirty-three healthy volunteers were randomised to receive either modafinil or placebo combined with daily cognitive training over two weeks. Volunteers were trained on tasks of new-language learning, working memory and verbal learning following 200 mg modafinil or placebo for ten days. Improvements in trained and untrained tasks were measured. Rate of new-language learning was significantly enhanced with modafinil, and effects were greatest over the first five sessions. Modafinil improved within-day learning rather than between-day retention. No enhancement of gains with modafinil was observed in working memory nor rate of verbal learning. Gains in all tasks were retained post drug-administration, but transfer effects to broad cognitive abilities were not seen. This study shows that combining CT with modafinil specifically elevates learning over early training sessions compared to CT with placebo and provides a proof of principle experimental paradigm for pharmacological enhancement of cognitive remediation.
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Affiliation(s)
- J Gilleen
- Institute of Psychiatry, King's College, London SE5 8AF, United Kingdom.
| | - P G Michalopoulou
- Institute of Psychiatry, King's College, London SE5 8AF, United Kingdom
| | - A Reichenberg
- Institute of Psychiatry, King's College, London SE5 8AF, United Kingdom
| | - R Drake
- Institute of Brain, Behaviour and Mental Health, University of Manchester, United Kingdom
| | - T Wykes
- Institute of Psychiatry, King's College, London SE5 8AF, United Kingdom
| | - S W Lewis
- Institute of Brain, Behaviour and Mental Health, University of Manchester, United Kingdom
| | - S Kapur
- Institute of Psychiatry, King's College, London SE5 8AF, United Kingdom
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