1
|
Brunette MF, Roth RM, Trask C, Khokhar JY, Ford JC, Park SH, Hickey SM, Zeffiro T, Xie H. Randomized Laboratory Study of Single-Dose Cannabis, Dronabinol, and Placebo in Patients With Schizophrenia and Cannabis Use Disorder. Schizophr Bull 2024:sbae097. [PMID: 38900958 DOI: 10.1093/schbul/sbae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND HYPOTHESIS Up to 43% of people with schizophrenia have a lifetime cannabis use disorder (CUD). Tetrahydrocannabinol (THC) has been shown to exacerbate psychosis in a dose-dependent manner, but little research has assessed its effects on schizophrenia and co-occurring CUD (SCZ-CUD). In this double-dummy, placebo-controlled trial (total n = 130), we hypothesized that a modest dose of THC would worsen cognitive function but not psychosis. STUDY DESIGN Effects of single-dose oral THC (15 mg dronabinol) or smoked 3.5% THC cigarettes vs placebo in SCZ-CUD or CUD-only on positive and negative symptoms of schizophrenia (only for SCZ-CUD), cognition, and drug experiences assessed several hours after drug administration. SCZ-only and healthy control participants were also assessed. STUDY RESULTS Drug liking was higher in THC groups vs placebo. Neither smoked THC nor oral dronabinol predicted positive or negative symptom subscale scores 2 and 5 h, respectively, after drug exposure in SCZ-CUD participants. The oral dronabinol SCZ-CUD group, but not smoked THC SCZ-CUD group, performed worse than placebo on verbal learning (B = -9.89; 95% CI: -16.06, -3.18; P = .004) and attention (B = -0.61; 95% CI: -1.00, -0.23; P = .002). Every 10-point increment in serum THC + THCC ng/ml was associated with increased negative symptoms (0.40 points; 95% CI: 0.15, 0.65; P = .001; subscale ranges 7-49) and trends were observed for worse positive symptoms and performance in verbal learning, delayed recall, and working memory. CONCLUSIONS In people with SCZ-CUD, a modest single dose of oral THC was associated with worse cognitive functioning without symptom exacerbation several hours after administration, and a THC dose-response effect was seen for negative symptoms.
Collapse
Affiliation(s)
- Mary F Brunette
- Dartmouth College Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
- Dartmouth-Health, Department of Psychiatry, Lebanon, NH, USA
| | - Robert M Roth
- Dartmouth College Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
- Dartmouth-Health, Department of Psychiatry, Lebanon, NH, USA
| | - Christi Trask
- Ohio State University College of Medicine, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jibran Y Khokhar
- University of Western Ontario Schulich School of Medicine and Dentistry, Department of Anatomy and Cell Biology, London, Ontario, Canada
| | - James C Ford
- Dartmouth College Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
- Dartmouth-Health, Department of Psychiatry, Lebanon, NH, USA
| | - Soo Hwan Park
- Dartmouth College Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| | - Sara M Hickey
- Dartmouth-Health, Department of Psychiatry, Lebanon, NH, USA
| | - Thomas Zeffiro
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Oncology, Baltimore, Maryland, USA
| | - Haiyi Xie
- Dartmouth College Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| |
Collapse
|
2
|
Cattarinussi G, Grimaldi DA, Sambataro F. Spontaneous Brain Activity Alterations in First-Episode Psychosis: A Meta-analysis of Functional Magnetic Resonance Imaging Studies. Schizophr Bull 2023; 49:1494-1507. [PMID: 38029279 PMCID: PMC10686347 DOI: 10.1093/schbul/sbad044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Several studies have shown that spontaneous brain activity, including the total and fractional amplitude of low-frequency fluctuations (LFF) and regional homogeneity (ReHo), is altered in psychosis. Nonetheless, neuroimaging results show a high heterogeneity. For this reason, we gathered the extant literature on spontaneous brain activity in first-episode psychosis (FEP), where the effects of long-term treatment and chronic disease are minimal. STUDY DESIGN A systematic research was conducted on PubMed, Scopus, and Web of Science to identify studies exploring spontaneous brain activity and local connectivity in FEP estimated using functional magnetic resonance imaging. 20 LFF and 15 ReHo studies were included. Coordinate-Based Activation Likelihood Estimation Meta-Analyses stratified by brain measures, age (adolescent vs adult), and drug-naïve status were performed to identify spatially-convergent alterations in spontaneous brain activity in FEP. STUDY RESULTS We found a significant increase in LFF in FEP compared to healthy controls (HC) in the right striatum and in ReHo in the left striatum. When pooling together all studies on LFF and ReHo, spontaneous brain activity was increased in the bilateral striatum and superior and middle frontal gyri and decreased in the right precentral gyrus and the right inferior frontal gyrus compared to HC. These results were also replicated in the adult and drug-naïve samples. CONCLUSIONS Abnormalities in the frontostriatal circuit are present in early psychosis independently of treatment status. Our findings support the view that altered frontostriatal can represent a core neural alteration of the disorder and could be a target of treatment.
Collapse
Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Department of Neuroscience (DNS), Padova Neuroscience Center, University of Padova, Padua, Italy
| | | | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Department of Neuroscience (DNS), Padova Neuroscience Center, University of Padova, Padua, Italy
| |
Collapse
|
3
|
Patel R, Chan KMY, Palmer EOC, Valko M, Guruswamy G, Ker S, Batra G, Rentería ME, Kollins SH. Associations of comorbid substance use disorders with clinical outcomes in schizophrenia using electronic health record data. Schizophr Res 2023; 260:191-197. [PMID: 37683509 PMCID: PMC10881404 DOI: 10.1016/j.schres.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 07/10/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND HYPOTHESIS Schizophrenia and comorbid substance use disorders (SUDs) are associated with poor treatment outcomes but differences between the associations of different SUDs with clinical outcomes are poorly characterized. This study examines the associations of comorbid SUDs with clinical outcomes in schizophrenia using a largescale electronic health record (EHR) database. DESIGN Real-world data (RWD) analysis using the NeuroBlu database; de-identified EHR data were analysed. Multivariable logistic regression, Poisson and CoxPH models were used to compare the associations of specific comorbid SUDs with outcome variables. RESULTS Comorbid SUD was significantly different on all outcome measures compared to no SUD (U = 1.44e7-1.81e7, all ps < .001), except number of unique antipsychotics (U = 1.61e7, p = .43). Cannabis (OR = 1.58, p < .001) and polysubstance (OR = 1.22, p = .007) use disorders were associated with greater CGI-S. Cannabis (IRR = 1.13, p = .003) and polysubstance (IRR = 1.08, p = .003) use disorders were associated with greater number of unique antipsychotics prescribed, while cocaine (HR = 1.87, p < .001), stimulants (HR = 1.64, p = .024), and polysubstance (HR = 1.46, p < .001) use disorders were associated with a shorter time to antipsychotic discontinuation. Conversely, alcohol use (IRR = 0.83, p < .001), cocaine use (IRR = 0.61, p < .001), opioid use (IRR = 0.61, p < .001), stimulant use (IRR = 0.57, p < .001) and polysubstance use (IRR = 0.87, p < .001) disorders were associated fewer inpatient days. CONCLUSION Comorbid SUDs were generally associated with greater CGI-S and poorer clinical outcomes in patients with schizophrenia. Treatment strategies should target not only schizophrenia symptoms but also comorbid SUD to improve management of both conditions.
Collapse
Affiliation(s)
- Rashmi Patel
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | | | | | | | | | - Sheryl Ker
- Holmusk Technologies Inc., New York, NY, USA
| | | | | | | |
Collapse
|
4
|
The Role of Reduced Motivational Salience in a Survey Study on Cannabis Use Pre-Post Legalization in Patients with Schizophrenia. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
5
|
Salehi A, Namaei P, TaghaviZanjani F, Bagheri S, Moradi K, Khodaei Ardakani MR, Akhondzadeh S. Adjuvant palmitoylethanolamide therapy with risperidone improves negative symptoms in patients with schizophrenia: A randomized, double-blinded, placebo-controlled trial. Psychiatry Res 2022; 316:114737. [PMID: 35917650 DOI: 10.1016/j.psychres.2022.114737] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Primary negative symptoms of schizophrenia are usually resistant to monotherapy with antipsychotics. The present study sought to assess the efficacy and tolerability of Palmitoylethanolamide (PEA) adjunctive therapy in treatment of negative symptoms in patients with stable schizophrenia. METHODS This 8-week (trial timepoints: baseline, week 4, week 8), double-blind, placebo-controlled clinical trial randomized patients with schizophrenia in a 1:1 ratio to compare the efficacy and safety of 600 mg twice a day of PEA and matched placebo alongside a stable dose of risperidone. Outcome measures were the positive and the negative syndrome scale (PANSS), the extrapyramidal symptom rating scale (ESRS), and the Hamilton depression rating scale (HDRS). The primary outcome was change in the negative subscale score during the trial period between the groups. Safety of interventions were controlled and addressed during the trial. RESULTS A total of 50 participants completed the trial (25 in each group). Baseline characteristics of the groups were comparable (p>0.05). There was significant effect from time-treatment interaction on negative symptoms (p = 0.012) suggesting greater symptom improvement in the PEA group. In contrast, the longitudinal changes in positive symptoms and depressive symptoms were similar between groups (p values>0.05). Safety assessments showed no significant difference regarding extrapyramidal symptoms, measured by ESRS, and also frequency of other complications between PEA and placebo groups (p values>0.05). CONCLUSIONS Adjunctive therapy with PEA and risperidone alleviates schizophrenia-related primary negative symptoms in a safe manner.
Collapse
Affiliation(s)
- Anahita Salehi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical, Sciences, Tehran, Iran
| | - Parsa Namaei
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical, Sciences, Tehran, Iran
| | - Fateme TaghaviZanjani
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical, Sciences, Tehran, Iran
| | - Sayna Bagheri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical, Sciences, Tehran, Iran
| | - Kamyar Moradi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical, Sciences, Tehran, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical, Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Greco LA, Reay WR, Dayas CV, Cairns MJ. Pairwise genetic meta-analyses between schizophrenia and substance dependence phenotypes reveals novel association signals with pharmacological significance. Transl Psychiatry 2022; 12:403. [PMID: 36151087 PMCID: PMC9508072 DOI: 10.1038/s41398-022-02186-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 12/04/2022] Open
Abstract
Almost half of individuals diagnosed with schizophrenia also present with a substance use disorder, however, little is known about potential molecular mechanisms underlying this comorbidity. We used genetic analyses to enhance our understanding of the molecular overlap between these conditions. Our analyses revealed a positive genetic correlation between schizophrenia and the following dependence phenotypes: alcohol (rg = 0.368, SE = 0.076, P = 1.61 × 10-6), cannabis use disorder (rg = 0.309, SE = 0.033, P = 1.97 × 10-20) and nicotine (rg = 0.117, SE = 0.043, P = 7.0 × 10-3), as well as drinks per week (rg = 0.087, SE = 0.021, P = 6.36 × 10-5), cigarettes per day (rg = 0.11, SE = 0.024, P = 4.93 × 10-6) and life-time cannabis use (rg = 0.234, SE = 0.029, P = 3.74 × 10-15). We further constructed latent causal variable (LCV) models to test for partial genetic causality and found evidence for a potential causal relationship between alcohol dependence and schizophrenia (GCP = 0.6, SE = 0.22, P = 1.6 × 10-3). This putative causal effect with schizophrenia was not seen using a continuous phenotype of drinks consumed per week, suggesting that distinct molecular mechanisms underlying dependence are involved in the relationship between alcohol and schizophrenia. To localise the specific genetic overlap between schizophrenia and substance use disorders (SUDs), we conducted a gene-based and gene-set pairwise meta-analysis between schizophrenia and each of the four individual substance dependence phenotypes in up to 790,806 individuals. These bivariate meta-analyses identified 44 associations not observed in the individual GWAS, including five shared genes that play a key role in early central nervous system development. The results from this study further supports the existence of underlying shared biology that drives the overlap in substance dependence in schizophrenia, including specific biological systems related to metabolism and neuronal function.
Collapse
Affiliation(s)
- Laura A Greco
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - William R Reay
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Christopher V Dayas
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Murray J Cairns
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia.
- Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton, NSW, Australia.
| |
Collapse
|
7
|
Maternal immune activation and adolescent alcohol exposure increase alcohol drinking and disrupt cortical-striatal-hippocampal oscillations in adult offspring. Transl Psychiatry 2022; 12:288. [PMID: 35859084 PMCID: PMC9300672 DOI: 10.1038/s41398-022-02065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
Maternal immune activation (MIA) is strongly associated with an increased risk of developing mental illness in adulthood, which often co-occurs with alcohol misuse. The current study aimed to begin to determine whether MIA, combined with adolescent alcohol exposure (AE), could be used as a model with which we could study the neurobiological mechanisms behind such co-occurring disorders. Pregnant Sprague-Dawley rats were treated with polyI:C or saline on gestational day 15. Half of the offspring were given continuous access to alcohol during adolescence, leading to four experimental groups: controls, MIA, AE, and Dual (MIA + AE). We then evaluated whether MIA and/or AE alter: (1) alcohol consumption; (2) locomotor behavior; and (3) cortical-striatal-hippocampal local field potentials (LFPs) in adult offspring. Dual rats, particularly females, drank significantly more alcohol in adulthood compared to all other groups. MIA led to reduced locomotor behavior in males only. Using machine learning to build predictive models from LFPs, we were able to differentiate Dual rats from control rats and AE rats in both sexes, and Dual rats from MIA rats in females. These data suggest that Dual "hits" (MIA + AE) increases substance use behavior and disrupts activity in reward-related circuits, and that this may be a valuable heuristic model we can use to study the neurobiological underpinnings of co-occurring disorders. Our future work aims to extend these findings to other addictive substances to enhance the translational relevance of this model, as well as determine whether amelioration of these circuit disruptions can reduce substance use behavior.
Collapse
|
8
|
Ahmed S, Roth RM, Stanciu CN, Brunette MF. The Impact of THC and CBD in Schizophrenia: A Systematic Review. Front Psychiatry 2021; 12:694394. [PMID: 34366924 PMCID: PMC8343183 DOI: 10.3389/fpsyt.2021.694394] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: People with schizophrenia are more likely to develop cannabis use disorder (CUD) and experience worse outcomes with use. Yet as cannabis is legalized for medical and recreational use, there is interest in its therapeutic potential. Objectives: To conduct a systematic review summarizing the design and results of controlled trials using defined doses of THC and CBD in schizophrenia. Method: A keyword search of eight online literature databases identified 11 eligible reports. Results: One placebo controlled trial (13 stable patients without CUD) found that intravenous THC increased psychosis and worsened learning/recall. Two reports of a functional magnetic resonance (fMRI) study of smoked or oral THC in 12 abstinent patients with schizophrenia and CUD found no change in symptoms and cognition, and an amelioration of impaired resting state brain function in areas implicated in reward function and the default mode network. One 4 week trial in acutely psychotic inpatients without CUD (mean age 30 y) found 800 mg CBD to be similarly efficacious to amisupride in improving psychosis and cognition. Two 6 week studies of CBD augmentation of antipsychotics in stable outpatients reported mixed results: CBD 600 mg was not more effective than placebo; CBD 1,000 mg reduced symptoms in a sample that did not exclude cannabis use and CUD. A brain fMRI and proton magnetic resonance spectroscopy study of single dose CBD in a sample that did not exclude CUD and cannabis use found that CBD improved symptoms and brain function during a learning/recall task and was associated with increased hippocampal glutamate. Discussion: There is substantial heterogeneity across studies in dose, method of drug delivery, length of treatment, patient age, whether patients with cannabis use/CUD were included or excluded, and whether patients were using antipsychotic medication. Conclusion: There is insufficient evidence for an effect of THC or CBD on symptoms, cognition, and neuroimaging measures of brain function in schizophrenia. At this time, research does not support recommending medical cannabis (THC or CBD) for treating patients with schizophrenia. Further research should examine THC and CBD in schizophrenia with and without comorbid CUD and consider the role of CBD in mitigating symptom exacerbation from THC.
Collapse
Affiliation(s)
- Saeed Ahmed
- Department of Psychiatry, Rutland Regional Medical Center, Rutland, VT, United States
- Vermont Hub-and-Spoke System of Care, West Ridge Center at Rutland Regional Medical Center, Rutland, VT, United States
| | - Robert M. Roth
- New Hampshire Hospital, Concord, NH, United States
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Corneliu N. Stanciu
- New Hampshire Hospital, Concord, NH, United States
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Mary F. Brunette
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Bureau of Mental Health Services, Concord, NH, United States
| |
Collapse
|
9
|
Mohammadi-Nejad AR, Hossein-Zadeh GA, Shahsavand Ananloo E, Soltanian-Zadeh H. The effect of groupness constraint on the sensitivity and specificity of canonical correlation analysis, a multi-modal anatomical and functional MRI study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Seillier A. The endocannabinoid system as a therapeutic target for schizophrenia: Failures and potentials. Neurosci Lett 2021; 759:136064. [PMID: 34146641 DOI: 10.1016/j.neulet.2021.136064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/16/2022]
Abstract
Owing to its psychotropic effects, Cannabis has been stigmatized by its recreational use leading to a dramatic decline in the experimentations about its medical use in the twentieth century. The medical properties of the plant - known since ancient times - have received increased attention over recent years; yet, the research on its potential application in the field of psychiatry is still nascent. In this connection, the non-psychotropic cannabidiol (CBD) has emerged as a phytocannabinoid compound with promising antipsychotic effects. In addition, advances in our understanding of the endocannabinoid system, along with accumulating evidence implicating this system in the pathophysiology of schizophrenia, have stimulated research by the pharmaceutical industry to explore whether alteration of this system can be of medical benefit. This review examines the current state of evidence regarding the clinical potential of cannabinoid-based drugs as a treatment for schizophrenia, while discussing various limitations with the therapeutic approaches considered so far. In the second part, the author highlights the most promising strategies, as well as the most interesting directions one could follow, in the emerging field of cannabinoid therapies for schizophrenia.
Collapse
Affiliation(s)
- Alexandre Seillier
- RP1 Experimental Neurobiology, National Institute of Mental Health, Topolova 748, 250 67 Klecany, Prague East, Czech Republic.
| |
Collapse
|
11
|
Fish S, Christidi F, Karavasilis E, Velonakis G, Kelekis N, Klein C, Stefanis NC, Smyrnis N. Interaction of schizophrenia and chronic cannabis use on reward anticipation sensitivity. NPJ SCHIZOPHRENIA 2021; 7:33. [PMID: 34135344 PMCID: PMC8209034 DOI: 10.1038/s41537-021-00163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
Chronic cannabis use and schizophrenia are both thought to affect reward processing. While behavioural and neural effects on reward processing have been investigated in both conditions, their interaction has not been studied, although chronic cannabis use is common among these patients. In the present study eighty-nine participants divided into four groups (control chronic cannabis users and non-users; schizophrenia patient cannabis users and non-users) performed a two-choice decision task, preceded by monetary cues (high/low reward/punishment or neutral), while being scanned using functional magnetic resonance imaging. Reward and punishment anticipation resulted in activation of regions of interest including the thalamus, striatum, amygdala and insula. Chronic cannabis use and schizophrenia had opposing effects on reward anticipation sensitivity. More specifically control users and patient non-users showed faster behavioural responses and increased activity in anterior/posterior insula for high magnitude cues compared to control non-users and patient users. The same interaction pattern was observed in the activation of the right thalamus for reward versus punishment cues. This study provided evidence for interaction of chronic cannabis use and schizophrenia on reward processing and highlights the need for future research addressing the significance of this interaction for the pathophysiology of these conditions and its clinical consequences.
Collapse
Affiliation(s)
- Simon Fish
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece.,1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Foteini Christidi
- Department of Medical Physics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - Christoph Klein
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece.,Department of Child and Adolescent Psychiatry, Medical Faculty, University of Freiburg, Freiburg, Germany.,Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nicholas C Stefanis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece. .,2nd Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece.
| |
Collapse
|
12
|
Guo H, Xiao Y, Sun D, Yang J, Wang J, Wang H, Pan C, Li C, Zhao P, Zhang Y, Wu J, Zhang X, Wang F. Early-Stage Repetitive Transcranial Magnetic Stimulation Altered Posterior-Anterior Cerebrum Effective Connectivity in Methylazoxymethanol Acetate Rats. Front Neurosci 2021; 15:652715. [PMID: 34093113 PMCID: PMC8176023 DOI: 10.3389/fnins.2021.652715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of the current resting-state functional magnetic resonance imaging (fMRI) study was to investigate the potential mechanism of schizophrenia through the posterior-anterior cerebrum imbalance in methylazoxymethanol acetate (MAM) rats and to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as an early-stage intervention. The rats were divided into four groups: the MAM-sham group, vehicle-sham group, MAM-rTMS group, and vehicle-rTMS group. The rTMS treatment was targeted in the visual cortex (VC) in adolescent rats. Granger Causality Analysis (GCA) was used to evaluate the effective connectivity between regions of interest. Results demonstrated a critical right VC-nucleus accumbens (Acb)-orbitofrontal cortex (OFC) pathway in MAM rats; significant differences of effective connectivity (EC) were found between MAM-sham and vehicle-sham groups (from Acb shell to OFC: t = -2.553, p = 0.021), MAM-rTMS and MAM-sham groups (from VC to Acb core: t = -2.206, p = 0.043; from Acb core to OFC: t = 4.861, p < 0.001; from Acb shell to OFC: t = 4.025, p = 0.001), and MAM-rTMS and vehicle-rTMS groups (from VC to Acb core: t = -2.482, p = 0.025; from VC to Acb shell: t = -2.872, p = 0.012; from Acb core to OFC: t = 4.066, p = 0.001; from Acb shell to OFC: t = 3.458, p = 0.004) in the right hemisphere. Results of the early-stage rTMS intervention revealed that right nucleus accumbens played the role as a central hub, and VC was a potentially novel rTMS target region during adolescent schizophrenia. Moreover, the EC of right nucleus accumbens shell and orbitofrontal cortex was demonstrated to be a potential biomarker. To our knowledge, this was the first resting-state fMRI study using GCA to assess the deficits of a visual-reward neural pathway and the effectiveness of rTMS treatment in MAM rats. More randomized controlled trials in both animal models and schizophrenia patients are needed to further elucidate the disease characteristics.
Collapse
Affiliation(s)
- Huiling Guo
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Yao Xiao
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.,Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dandan Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingyu Yang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chunyu Pan
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China.,School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Chao Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pengfei Zhao
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanbo Zhang
- Department of Psychiatry, Faculty of Medicine and Dentistry, The Neuroscience and Mental Health Institute (NMHI), University of Alberta, Alberta, AB, Canada
| | - Jinfeng Wu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China.,Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| |
Collapse
|
13
|
Hoffman AF, Hwang EK, Lupica CR. Impairment of Synaptic Plasticity by Cannabis, Δ 9-THC, and Synthetic Cannabinoids. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a039743. [PMID: 32341064 PMCID: PMC8091957 DOI: 10.1101/cshperspect.a039743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The ability of neurons to dynamically and flexibly encode synaptic inputs via short- and long-term plasticity is critical to an organism's ability to learn and adapt to the environment. Whereas synaptic plasticity may be encoded by pre- or postsynaptic mechanisms, current evidence suggests that optimization of learning requires both forms of plasticity. Endogenous cannabinoids (eCBs) play critical roles in modulating synaptic transmission via activation of cannabinoid CB1 receptors (CB1Rs) in many central nervous system (CNS) regions, and the eCB system has been implicated, either directly or indirectly, in several forms of synaptic plasticity. Because of this, perturbations within the eCB signaling system can lead to impairments in a variety of learned behaviors. One agent of altered eCB signaling is exposure to "exogenous cannabinoids" such as the primary psychoactive constituent of cannabis, Δ9-THC, or illicit synthetic cannabinoids that in many cases have higher potency and efficacy than Δ9-THC. Thus, by targeting the eCB system, these agonists can produce widespread impairment of synaptic plasticity by disrupting ongoing eCB function. Here, we review studies in which Δ9-THC and synthetic cannabinoids impair synaptic plasticity in a variety of neuronal circuits and examine evidence that this contributes to their well-documented ability to disrupt cognition and behavior.
Collapse
Affiliation(s)
- Alexander F Hoffman
- Electrophysiology Research Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Eun-Kyung Hwang
- Electrophysiology Research Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland 21224, USA
| | - Carl R Lupica
- Electrophysiology Research Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland 21224, USA
| |
Collapse
|
14
|
Affiliation(s)
- Mary F Brunette
- Medical Director, Bureau of Mental Health Services, NH DHHS, Assoc. Prof. Psychiatry, Geisel School of Medicine, Dartmouth, New Hampshire, USA.,Research Division, Department of Psychiatry, Dartmouth-Hitchcock, 46 Centerra Parkway, Lebanon, New Hampshire, USA.,Bureau of Mental Health Services, Main Bldg, Level 2, Hugh Gallen State Office Park, 105 Pleasant Street, Concord, New Hampshire, USA
| |
Collapse
|
15
|
Blum K, Khalsa J, Cadet JL, Baron D, Bowirrat A, Boyett B, Lott L, Brewer R, Gondré-Lewis M, Bunt G, Kazmi S, Gold MS. Cannabis-Induced Hypodopaminergic Anhedonia and Cognitive Decline in Humans: Embracing Putative Induction of Dopamine Homeostasis. Front Psychiatry 2021; 12:623403. [PMID: 33868044 PMCID: PMC8044913 DOI: 10.3389/fpsyt.2021.623403] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/05/2021] [Indexed: 02/01/2023] Open
Abstract
Over years, the regular use of cannabis has substantially increased among young adults, as indicated by the rise in cannabis use disorder (CUD), with an estimated prevalence of 8. 3% in the United States. Research shows that exposure to cannabis is associated with hypodopaminergic anhedonia (depression), cognitive decline, poor memory, inattention, impaired learning performance, reduced dopamine brain response-associated emotionality, and increased addiction severity in young adults. The addiction medicine community is increasing concern because of the high content of delta-9-tetrahydrocannabinol (THC) currently found in oral and vaping cannabis products, the cognitive effects of cannabis may become more pronounced in young adults who use these cannabis products. Preliminary research suggests that it is possible to induce 'dopamine homeostasis,' that is, restore dopamine function with dopamine upregulation with the proposed compound and normalize behavior in chronic cannabis users with cannabis-induced hypodopaminergic anhedonia (depression) and cognitive decline. This psychological, neurobiological, anatomical, genetic, and epigenetic research also could provide evidence to use for the development of an appropriate policy regarding the decriminalization of cannabis for recreational use.
Collapse
Affiliation(s)
- Kenneth Blum
- Western University Health Sciences, Pomona, CA, United States
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Division of Nutrigenomics, Precision Translational Medicine, LLC., San Antonio, TX, United States
- Division of Nutrigenomics, Genomic Testing Center, Geneus Health, LLC., San Antonio, TX, United States
- Department of Psychiatry, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Wright University Boonshoff School of Medicine, Dayton, OH, United States
| | - Jag Khalsa
- Department of Microbiology, Immunology and Tropical Medicine, George Washington University, School of Medicine, Washington, DC, United States
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, DHHS/NIH/NIDA Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - David Baron
- Western University Health Sciences, Pomona, CA, United States
| | - Abdalla Bowirrat
- Department of Neuroscience, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Brent Boyett
- Bradford Health Services, Madison, AL, United States
| | - Lisa Lott
- Division of Nutrigenomics, Genomic Testing Center, Geneus Health, LLC., San Antonio, TX, United States
| | - Raymond Brewer
- Division of Nutrigenomics, Precision Translational Medicine, LLC., San Antonio, TX, United States
- Division of Nutrigenomics, Genomic Testing Center, Geneus Health, LLC., San Antonio, TX, United States
| | - Marjorie Gondré-Lewis
- Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, DC, United States
| | - Gregory Bunt
- Good Samaritan/Day Top Treatment Center, and NYU School of Medicine, New York, NY, United States
| | - Shan Kazmi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| |
Collapse
|
16
|
Yoo HB, Moya BE, Filbey FM. Dynamic functional connectivity between nucleus accumbens and the central executive network relates to chronic cannabis use. Hum Brain Mapp 2020; 41:3637-3654. [PMID: 32432821 PMCID: PMC7416060 DOI: 10.1002/hbm.25036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/13/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023] Open
Abstract
The neural mechanisms of drug cue‐reactivity regarding the temporal fluctuations of functional connectivity, namely the dynamic connectivity, are sparsely studied. Quantifying the task‐modulated variability in dynamic functional connectivity at cue exposure can aid the understanding. We analyzed changes in dynamic connectivity in 54 adult cannabis users and 90 controls during a cannabis cue exposure task. The variability was measured as standard deviation in the (a) connectivity weights of the default mode, the central executive, and the salience networks and two reward loci (amygdalae and nuclei accumbens); and (b) topological indexes of the whole brain (global efficiency, modularity and network resilience). These were compared for the main effects of task conditions and the group (users vs. controls), and correlated with pre‐ and during‐scan subjective craving. The variability of connectivity weights between the central executive network and nuclei accumbens was increased in users throughout the cue exposure task, and, was positively correlated with during‐scan craving for cannabis. The variability of modularity was not different by groups, but positively correlated with prescan craving. The variability of dynamic connectivity during cannabis cue exposure task between the central executive network and the nuclei accumbens, and, the level of modularity, seem to relate to the neural underpinning of cannabis use and the subjective craving.
Collapse
Affiliation(s)
- Hye Bin Yoo
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Blake Edward Moya
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, TX, USA
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, TX, USA
| |
Collapse
|
17
|
Hwang EK, Lupica CR. Altered Corticolimbic Control of the Nucleus Accumbens by Long-term Δ 9-Tetrahydrocannabinol Exposure. Biol Psychiatry 2020; 87:619-631. [PMID: 31543247 PMCID: PMC7002212 DOI: 10.1016/j.biopsych.2019.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The decriminalization and legalization of cannabis and the expansion of availability of medical cannabis in North America have led to an increase in cannabis use and the availability of high-potency strains. Cannabis potency is determined by the concentration of Δ9-tetrahydrocannabinol (Δ9-THC), a psychoactive constituent that activates cannabinoid CB1 and CB2 receptors. The use of high-potency cannabis is associated with cannabis use disorder and increased susceptibility to psychiatric illness. The nucleus accumbens (NAc) is part of a brain reward circuit affected by Δ9-THC through modulation of glutamate afferents arising from corticolimbic brain areas implicated in drug addiction and psychiatric disorders. Moreover, brain imaging studies show alterations in corticolimbic and NAc properties in human cannabis users. METHODS Using in vitro electrophysiology and optogenetics, we examined how Δ9-THC alters corticolimbic input to the NAc in rats. RESULTS We found that long-term exposure to Δ9-THC weakens prefrontal cortex glutamate input to the NAc shell and strengthens input from basolateral amygdala and ventral hippocampus. Further, whereas long-term exposure to Δ9-THC had no effect on net strength of glutamatergic input to NAc shell arising from midbrain dopamine neurons, it alters fundamental properties of these synapses. CONCLUSIONS Long-term exposure to Δ9-THC shifts control of the NAc shell from cortical to limbic input, likely contributing to cognitive and psychiatric dysfunction that is associated with cannabis use.
Collapse
|
18
|
Seillier A, Martinez AA, Giuffrida A. Differential effects of Δ9-tetrahydrocannabinol dosing on correlates of schizophrenia in the sub-chronic PCP rat model. PLoS One 2020; 15:e0230238. [PMID: 32163506 PMCID: PMC7067407 DOI: 10.1371/journal.pone.0230238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/25/2020] [Indexed: 01/01/2023] Open
Abstract
Social withdrawal in the sub-chronic phencyclidine (PCP) rat model, a behavioral correlate of the negative symptoms of schizophrenia, results from deficits in brain endocannabinoid transmission. As cannabis intake has been shown to affect negatively the course and expression of psychosis, we tested whether the beneficial effects of endocannabinoid-mediated CB1 activation on social withdrawal in PCP-treated rats (5 mg/kg, twice daily for 7 days)also occurred after administration of Δ9-tetrahydrocannabinol (THC; 0.1, 0.3, 1.0 mg/kg, i.p.). In addition, we assessed whether THC affected two correlates of positive symptoms: 1) motor activity induced by d-amphetamine (0.5 mg/kg, i.p.), and 2) dopamine neuron population activity in the ventral tegmental area (VTA). After the motor activity test, the brains from d-amphetamine-treated animals were collected and processed for measurements of endocannabinoids and activation of Akt/GSK3β, two molecular markers involved in the pathophysiology of schizophrenia. In control rats, THC dose-dependently produced social interaction deficits and aberrant VTA dopamine neuron population activity similar to those observed in PCP-treated animals. In PCP-treated rats, only the lowest dose of THC reversed PCP-induced deficits, as well as PCP-induced elevation of the endocannabinoid anandamide (AEA) in the nucleus accumbens. Last, THC activated the Akt/GSK3β pathway dose-dependently in both control and PCP-treated animals. Taken together, these data suggest that only low doses of THC have beneficial effects on behavioral, neurochemical and electrophysiological correlates of schizophrenia symptoms. This observation may shed some light on the controversial hypothesis of marijuana use as self-medication in schizophrenic patients.
Collapse
Affiliation(s)
- Alexandre Seillier
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- * E-mail:
| | - Alex A. Martinez
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Andrea Giuffrida
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| |
Collapse
|
19
|
Blair Thies M, DeRosse P, Sarpal DK, Argyelan M, Fales CL, Gallego JA, Robinson DG, Lencz T, Homan P, Malhotra AK. Interaction of Cannabis Use Disorder and Striatal Connectivity in Antipsychotic Treatment Response. SCHIZOPHRENIA BULLETIN OPEN 2020; 1:sgaa014. [PMID: 32803161 PMCID: PMC7418867 DOI: 10.1093/schizbullopen/sgaa014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Antipsychotic (AP) medications are the mainstay for the treatment of schizophrenia spectrum disorders (SSD), but their efficacy is unpredictable and widely variable. Substantial efforts have been made to identify prognostic biomarkers that can be used to guide optimal prescription strategies for individual patients. Striatal regions involved in salience and reward processing are disrupted as a result of both SSD and cannabis use, and research demonstrates that striatal circuitry may be integral to response to AP drugs. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between a history of cannabis use disorder (CUD) and a striatal connectivity index (SCI), a previously developed neural biomarker for AP treatment response in SSD. Patients were part of a 12-week randomized, double-blind controlled treatment study of AP drugs. A sample of 48 first-episode SSD patients with no more than 2 weeks of lifetime exposure to AP medications, underwent a resting-state fMRI scan pretreatment. Treatment response was defined a priori as a binary (response/nonresponse) variable, and a SCI was calculated in each patient. We examined whether there was an interaction between lifetime CUD history and the SCI in relation to treatment response. We found that CUD history moderated the relationship between SCI and treatment response, such that it had little predictive value in SSD patients with a CUD history. In sum, our findings highlight that biomarker development can be critically impacted by patient behaviors that influence neurobiology, such as a history of CUD.
Collapse
Affiliation(s)
- Melanie Blair Thies
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Pamela DeRosse
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Miklos Argyelan
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Christina L Fales
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Juan A Gallego
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Graduate Center—City University of New York, New York, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Delbert G Robinson
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Todd Lencz
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Philipp Homan
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
| | - Anil K Malhotra
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| |
Collapse
|
20
|
Raymond DR, Paneto A, Yoder KK, O'Donnell BF, Brown JW, Hetrick WP, Newman SD. Does Chronic Cannabis Use Impact Risky Decision-Making: An Examination of fMRI Activation and Effective Connectivity? Front Psychiatry 2020; 11:599256. [PMID: 33329150 PMCID: PMC7728610 DOI: 10.3389/fpsyt.2020.599256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
With the increase in use of cannabis and its shifting legal status in the United States, cannabis use has become an important research focus. While studies of other drug populations have shown marked increases in risky decision-making, the literature on cannabis users is not as clear. The current study examined the performance of 17 cannabis users and 14 non-users on the Balloon Analog Risk Task (BART) using behavioral, fMRI and effective connectivity methods. Significant attenuation was found in a functional pathway projecting from the dorsal anterior cingulate cortex (dACC) to the nucleus accumbens (NAc) in cannabis users compared to non-using controls as well as decreases in risk-taking behaviors. These findings suggest that cannabis users may process and evaluate risks and rewards differently than non-users.
Collapse
Affiliation(s)
- David R Raymond
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Adrian Paneto
- Department of Counseling Psychology, Indiana University Bloomington, Bloomington, IN, United States
| | - Karmen K Yoder
- Department of Radiology, Indiana University Medical School, Indianapolis, IN, United States
| | - Brian F O'Donnell
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States.,Program in Neuroscience, Indiana University Bloomington, Bloomington, IN, United States
| | - Joshua W Brown
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States.,Program in Neuroscience, Indiana University Bloomington, Bloomington, IN, United States
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States.,Program in Neuroscience, Indiana University Bloomington, Bloomington, IN, United States
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States.,Program in Neuroscience, Indiana University Bloomington, Bloomington, IN, United States.,Department of Psychology, Alabama Life Research Institute, University of Alabama Tuscaloosa, Tuscaloosa, AL, United States
| |
Collapse
|
21
|
Archibald L, Brunette MF, Wallin DJ, Green AI. Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder. Alcohol Res 2019; 40:arcr.v40.1.06. [PMID: 31886105 PMCID: PMC6927747 DOI: 10.35946/arcr.v40.1.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Schizophrenia and schizoaffective disorder are schizophrenia spectrum disorders that cause significant disability. Among individuals who have schizophrenia or schizoaffective disorder, alcohol use disorder (AUD) is common, and it contributes to worse outcomes than for those who do not have co-occurring substance use disorder. Common neurobiological mechanisms, including dysfunction in brain reward circuitry, may explain the high rates of co-occurrence of schizophrenia and AUD or other substance use disorders. Optimal treatment combines pharmacologic intervention and other therapeutic modalities to address both the psychotic disorder and AUD. Further research on the etiology of these co-occurring disorders and on treatment of affected individuals is needed.
Collapse
Affiliation(s)
- Luke Archibald
- Luke Archibald, M.D., is an assistant professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Mary F Brunette
- Mary F. Brunette, M.D., is an associate professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Diana J Wallin
- Diana J. Wallin, Ph.D., is a postdoctoral fellow in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Alan I Green
- Alan I. Green, M.D., is the Raymond Sobel Professor of Psychiatry, a professor in the Department of Molecular and Systems Biology, and the chair of the Department of Psychiatry, Geisel School of Medicine at Dartmouth, as well as the director, Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, New Hampshire
| |
Collapse
|
22
|
Pua EPK, Barton S, Williams K, Craig JM, Seal ML. Individualised MRI training for paediatric neuroimaging: A child-focused approach. Dev Cogn Neurosci 2019; 41:100750. [PMID: 31999567 PMCID: PMC6994628 DOI: 10.1016/j.dcn.2019.100750] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 12/06/2019] [Accepted: 12/13/2019] [Indexed: 12/21/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) in paediatric cohorts is often complicated by reluctance to enter the scanner and head motion-related imaging artefacts. The process is particularly challenging for children with neurodevelopmental disorders where coping with novel task demands in an unfamiliar setting may be more difficult due to symptom-related deficits or distress. These issues often give rise to excessive head motion that can significantly reduce the quality of images acquired, or render data unusable. Here we report an individualised MRI training procedure that enables children with Autism Spectrum Disorders (ASD) to better tolerate the MRI scanner environment based on a child-focused approach and individualised familiarisation strategies, including a pre-visit interview, familiarisation package, and personalised rewards. A medical imaging mobile application was utilised to familiarise participants to multi-sensory aspects of the neuroimaging experience through a variety of themed mini-games and activities. The MRI training procedure was implemented for monozygotic twins (n = 12; 6 twin pairs; age range 7.1–12.9 years) concordant or discordant for ASD. MRI image quality indices were better or comparable to images acquired from a large independent multi-centre ASD cohort. Present findings are promising and suggest that child-focused strategies could improve the quality of paediatric neuroimaging in clinical populations.
Collapse
Affiliation(s)
- Emmanuel Peng Kiat Pua
- Melbourne School of Psychological Sciences, University of Melbourne, Australia; Developmental Imaging, Murdoch Children's Research Institute, Australia.
| | - Sarah Barton
- Developmental Imaging, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Neurology, The Royal Children's Hospital, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Australia; Department of Paediatrics, Monash University, Australia; Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Australia
| | - Jeffrey M Craig
- Department of Paediatrics, University of Melbourne, Australia; Molecular Epidemiology, Murdoch Children's Research Institute, Australia; Centre for Molecular and Medical Research, Deakin University School of Medicine, Geelong, Australia
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia
| |
Collapse
|
23
|
Olla P, Rykulski N, Hurtubise JL, Bartol S, Foote R, Cutler L, Abeare K, McVinnie N, Sabelli AG, Hastings M, Erdodi LA. Short-term effects of cannabis consumption on cognitive performance in medical cannabis patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:647-657. [PMID: 31790276 DOI: 10.1080/23279095.2019.1681424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This observational study examined the acute cognitive effects of cannabis. We hypothesized that cognitive performance would be negatively affected by acute cannabis intoxication. Twenty-two medical cannabis patients from Southwestern Ontario completed the study. The majority (n = 13) were male. Mean age was 36.0 years, and mean level of education was 13.7 years. Participants were administered the same brief neurocognitive battery three times during a six-hour period: at baseline ("Baseline"), once after they consumed a 20% THC cannabis product ("THC"), and once again several hours later ("Recovery"). The average self-reported level of cannabis intoxication prior to the second assessment (i.e., during THC) was 5.1 out of 10. Contrary to expectations, performance on neuropsychological tests remained stable or even improved during the acute intoxication stage (THC; d: .49-.65, medium effect), and continued to increase during Recovery (d: .45-.77, medium-large effect). Interestingly, the failure rate on performance validity indicators increased during THC. Contrary to our hypothesis, there was no psychometric evidence for a decline in cognitive ability following THC intoxication. There are several possible explanations for this finding but, in the absence of a control group, no definitive conclusion can be reached at this time.
Collapse
Affiliation(s)
| | - Nicholas Rykulski
- College of Human Medicine, Michigan State University, Lansing, MI, USA
| | | | - Stephen Bartol
- School of Medicine, Wayne State University, Detroit, MI, USA
| | | | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kaitlyn Abeare
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Nora McVinnie
- Brain-Cognition-Neuroscience Program, University of Windsor, Windsor, ON, Canada
| | - Alana G Sabelli
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Maurissa Hastings
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Laszlo A Erdodi
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| |
Collapse
|
24
|
Zaytseva Y, Horáček J, Hlinka J, Fajnerová I, Androvičová R, Tintěra J, Salvi V, Balíková M, Hložek T, Španiel F, Páleníček T. Cannabis-induced altered states of consciousness are associated with specific dynamic brain connectivity states. J Psychopharmacol 2019; 33:811-821. [PMID: 31154891 DOI: 10.1177/0269881119849814] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cannabis, and specifically one of its active compounds delta-9-tetrahydrocannabinol in recreational doses, has a variety of effects on cognitive processes. Most studies employ resting state functional magnetic resonance imaging techniques to assess the stationary effects of cannabis and to-date one report addressed the impact of delta-9-tetrahydrocannabinol on the dynamics of whole-brain functional connectivity. METHODS Using a repeated-measures, within-subjects design, 19 healthy occasional cannabis users (smoking cannabis ⩽2 per week) underwent resting state functional magnetic resonance imaging scans. Each subject underwent two scans: in the intoxicated condition, shortly after smoking a cannabis cigarette, and in the non-intoxicated condition, with the subject being free from cannabinoids for at least one week before. All sessions were randomized and performed in a four-week interval. Data were analysed employing a standard independent component analysis approach with subsequent tracking of the functional connectivity dynamics, which allowed six connectivity clusters (states) to be individuated. RESULTS Using standard independent component analysis in resting state functional connectivity, a group effect was found in the precuneus connectivity. With a dynamic independent component analysis approach, we identified one transient connectivity state, characterized by high connectivity within and between auditory and somato-motor cortices and anti-correlation with subcortical structures and the cerebellum that was only found during the intoxicated condition. Behavioural measures of the subjective experiences of changed perceptions and tetrahydrocannabinol plasma levels during intoxication were associated with this state. CONCLUSIONS With the help of the dynamic connectivity approach we could elucidate neural correlates of the transitory perceptual changes induced by delta-9-tetrahydrocannabinol in cannabis users, and possibly identify a biomarker of cannabis intoxication.
Collapse
Affiliation(s)
- Yuliya Zaytseva
- 1 National Institute of Mental Health, Klecany, Czech Republic.,3 Human Science Centre, Ludwig-Maximilian University, Munich, Germany
| | - Jiří Horáček
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jaroslav Hlinka
- 1 National Institute of Mental Health, Klecany, Czech Republic.,4 Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
| | - Iveta Fajnerová
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Renata Androvičová
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Virginio Salvi
- 5 Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Marie Balíková
- 6 Institute of Forensic Medicine and Toxicology, Charles University in Prague, Czech Republic
| | - Tomáš Hložek
- 6 Institute of Forensic Medicine and Toxicology, Charles University in Prague, Czech Republic
| | - Filip Španiel
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Páleníček
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| |
Collapse
|
25
|
Roberts BA. Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects. West J Emerg Med 2019; 20:557-572. [PMID: 31316694 PMCID: PMC6625695 DOI: 10.5811/westjem.2019.4.39935] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/11/2022] Open
Abstract
Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers (“budtenders”) without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.
Collapse
Affiliation(s)
- Brad A Roberts
- University of New Mexico, Department of Emergency Medicine, Albuquerque, New Mexico Partner, Southern Colorado Emergency Medicine Associates, Pueblo, Colorado
| |
Collapse
|
26
|
Schnakenberg Martin AM, Lysaker PH. Individuals with psychosis and a lifetime history of cannabis use show greater deficits in emotional experience compared to non-using peers. J Ment Health 2019; 29:77-83. [PMID: 30822177 DOI: 10.1080/09638237.2018.1487540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: While previous research suggests that active cannabis use is a barrier to the emotional experiences of anticipating pleasure and expressing emotion in early psychosis, the relationship between lifetime cannabis use, emotional experience and social function over time has been understudied.Aims: This study sought to characterize the influence of lifetime cannabis use on emotional experience in prolonged psychosis and the influence of the interaction of cannabis use and emotional expression on social function.Methods: Emotional expression, experience of pleasure in the moment, anticipatory anhedonia and social functioning were measured concurrently using the Emotional Expressivity Scale (EES), Temporal Experience of Pleasure Scale (TEPS) and Social Functioning Scale (SFS), respectively. Participants were adults with schizophrenia either with (n = 35) or without (n = 36) a lifetime history of cannabis use.Results: Compared to non-using participants, individuals with a history of cannabis use expressed lesser abilities to express emotion, were less likely to expect pleasure and had poorer social function. Cannabis use moderated the relationship between anticipatory pleasure and prosocial activities.Conclusions: Lifetime cannabis use in schizophrenia may be associated with greater deficits in emotional expressivity, anticipation of pleasure and social function. Cannabis use may disrupt the relationship between anticipatory pleasure and social functioning.
Collapse
Affiliation(s)
- Ashley M Schnakenberg Martin
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN, USA.,Department of Psychiatry, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
27
|
Potvin S, Dugré JR, Fahim C, Dumais A. Increased Connectivity Between the Nucleus Accumbens and the Default Mode Network in Patients With Schizophrenia During Cigarette Cravings. J Dual Diagn 2019; 15:8-15. [PMID: 30445892 DOI: 10.1080/15504263.2018.1526432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Compared to the general population, tobacco smoking cessation rates are lower in populations with schizophrenia. Unfortunately, the potential neurophysiologic mechanisms underlying these low cessation rates in schizophrenia have been seldom studied using functional neuroimaging. Recently, it has been shown that tobacco cravings are increased in smokers with schizophrenia compared to smokers with no comorbid psychiatric disorder. Given the critical role of the brain reward system in the neurobiology of addiction, we sought to examine the functional connectivity of core regions of this system in smokers with schizophrenia during the viewing of appetitive smoking cues. Methods: Smokers with (n = 18) and without (n = 24) schizophrenia were scanned using functional magnetic resonance imaging while viewing appetitive cigarette images. Functional connectivity analyses were performed using the bilateral nucleus accumbens as the seed regions. Results: Smokers with schizophrenia and smokers with no psychiatric comorbidity did not differ in subjective cravings in response to appetitive smoking cues. However, in smokers with schizophrenia relative to control smokers, we found an increased connectivity between the nucleus accumbens and regions involved in the default mode network (e.g., middle temporal gyrus and precuneus), which are involved in self-referential processes. Moreover, a positive correlation was observed between the left nucleus accumbens and left middle temporal gyrus connectivity and cigarette cravings across both groups of smokers. Conclusions: These results highlight a key role of the nucleus accumbens in cigarette craving in schizophrenia and suggest that the subjective valuation of cigarette cues is increased in this population. Similar neurofunctional studies on cravings for other psychoactive substances in schizophrenia are warranted.
Collapse
Affiliation(s)
- Stéphane Potvin
- a Centre de Recherche de l'Institut , Universitaire en Santé Mentale de Montréal , Montréal , Canada.,b Department of Psychiatry , University of Montreal , Montreal , Canada
| | - Jules R Dugré
- a Centre de Recherche de l'Institut , Universitaire en Santé Mentale de Montréal , Montréal , Canada.,b Department of Psychiatry , University of Montreal , Montreal , Canada
| | - Cherine Fahim
- a Centre de Recherche de l'Institut , Universitaire en Santé Mentale de Montréal , Montréal , Canada.,b Department of Psychiatry , University of Montreal , Montreal , Canada.,c Centre de Recherche du CHU Ste-Justine , Montreal , Canada
| | - Alexandre Dumais
- a Centre de Recherche de l'Institut , Universitaire en Santé Mentale de Montréal , Montréal , Canada.,b Department of Psychiatry , University of Montreal , Montreal , Canada.,d Institut Philippe-Pinel de Montréal , Montreal , Canada
| |
Collapse
|
28
|
Shi J, Geng J, Yan R, Liu X, Chen Y, Zhu R, Wang X, Shao J, Bi K, Xiao M, Yao Z, Lu Q. Differentiation of Transformed Bipolar Disorder From Unipolar Depression by Resting-State Functional Connectivity Within Reward Circuit. Front Psychol 2018; 9:2586. [PMID: 30622492 PMCID: PMC6308204 DOI: 10.3389/fpsyg.2018.02586] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/03/2018] [Indexed: 01/23/2023] Open
Abstract
Previous studies have found that neural functional abnormalities detected by functional magnetic resonance imaging (fMRI) in brain regions implicated in reward processing during reward tasks show promise to distinguish bipolar from unipolar depression (UD), but little is known regarding resting-state functional connectivity (rsFC) within the reward circuit. In this study, we investigated neurobiomarkers for early recognition of bipolar disorder (BD) by retrospectively comparing rsFC within the reward circuit between UD and depressed BD. Sixty-six depressed patients were enrolled, none of whom had ever experienced any manic/hypomanic episodes before baseline. Simultaneously, 40 matched healthy controls (HC) were also recruited. Neuroimaging data of each participant were obtained from resting-state fMRI scans. Some patients began to manifest bipolar disorder (tBD) during the follow-up period. All patients were retrospectively divided into two groups (33 tBD and 33 UD) according to the presence or absence of mania/hypomania in the follow-up. rsFC between key regions of the reward circuit was calculated and compared among groups. Results showed decreased rsFC between the left ventral tegmental area (VTA) and left ventral striatum (VS) in the tBD group compared with the UD group, which showed good accuracy in predicting diagnosis (tBD vs. UD) according to receiver operating characteristic (ROC) analysis. No significant different rsFC was found within the reward circuit between any patient group and HC. Our preliminary findings indicated that bipolar disorder, in early depressive stages before onset of mania/hypomania attacks, already differs from UD in the reward circuit of VTA-VS functional synchronicity at the resting state.
Collapse
Affiliation(s)
- Jiabo Shi
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Jiting Geng
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xiaoxue Liu
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yu Chen
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Rongxin Zhu
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xinyi Wang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science, Southeast University, Nanjing, China
| | - Junneng Shao
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science, Southeast University, Nanjing, China
| | - Kun Bi
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science, Southeast University, Nanjing, China
| | - Ming Xiao
- Nanjing Medical University, Nanjing, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science, Southeast University, Nanjing, China
| |
Collapse
|
29
|
Bloomfield MAP, Hindocha C, Green SF, Wall MB, Lees R, Petrilli K, Costello H, Ogunbiyi MO, Bossong MG, Freeman TP. The neuropsychopharmacology of cannabis: A review of human imaging studies. Pharmacol Ther 2018; 195:132-161. [PMID: 30347211 PMCID: PMC6416743 DOI: 10.1016/j.pharmthera.2018.10.006] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The laws governing cannabis are evolving worldwide and associated with changing patterns of use. The main psychoactive drug in cannabis is Δ9-tetrahydrocannabinol (THC), a partial agonist at the endocannabinoid CB1 receptor. Acutely, cannabis and THC produce a range of effects on several neurocognitive and pharmacological systems. These include effects on executive, emotional, reward and memory processing via direct interactions with the endocannabinoid system and indirect effects on the glutamatergic, GABAergic and dopaminergic systems. Cannabidiol, a non-intoxicating cannabinoid found in some forms of cannabis, may offset some of these acute effects. Heavy repeated cannabis use, particularly during adolescence, has been associated with adverse effects on these systems, which increase the risk of mental illnesses including addiction and psychosis. Here, we provide a comprehensive state of the art review on the acute and chronic neuropsychopharmacology of cannabis by synthesizing the available neuroimaging research in humans. We describe the effects of drug exposure during development, implications for understanding psychosis and cannabis use disorder, and methodological considerations. Greater understanding of the precise mechanisms underlying the effects of cannabis may also give rise to new treatment targets.
Collapse
Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, United Kingdom.
| | - Chandni Hindocha
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Sebastian F Green
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, United Kingdom; Invicro UK, Hammersmith Hospital, London, United Kingdom
| | - Rachel Lees
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Katherine Petrilli
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Harry Costello
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - M Olabisi Ogunbiyi
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthijs G Bossong
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Tom P Freeman
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Department of Psychology, University of Bath, United Kingdom; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| |
Collapse
|
30
|
Modulation of acute effects of delta-9-tetrahydrocannabinol on psychotomimetic effects, cognition and brain function by previous cannabis exposure. Eur Neuropsychopharmacol 2018; 28:850-862. [PMID: 29935939 DOI: 10.1016/j.euroneuro.2018.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 01/31/2023]
Abstract
Cannabis use has been associated with psychosis and cognitive dysfunction. Some evidence suggests that the acute behavioral and neurocognitive effects of the main active ingredient in cannabis, (-)-trans-Δ9-tetrahydrocannabinol (∆9-THC), might be modulated by previous cannabis exposure. However, this has not been investigated either using a control group of non-users, or following abstinence in modest cannabis users, who represent the majority of recreational users. Twenty-four healthy men participated in a double-blind, randomized, placebo-controlled, repeated-measures, within-subject, ∆9-THC challenge study. Compared to non-users (N=12; <5 lifetime cannabis joints smoked), abstinent modest cannabis users (N=12; 24.5±9 lifetime cannabis joints smoked) showed worse performance and stronger right hemispheric activation during cognitive processing, independent of the acute challenge (all P≤0.047). Acute ∆9-THC administration produced transient anxiety and psychotomimetic symptoms (all P≤0.02), the latter being greater in non-users compared to users (P=0.040). Non-users under placebo (control group) activated specific brain areas to perform the tasks, while deactivating others. An opposite pattern was found under acute (∆9-THC challenge in non-users) as well as residual (cannabis users under placebo) effect of ∆9-THC. Under ∆9-THC, cannabis users showed brain activity patterns intermediate between those in non-users under placebo (control group), and non-users under ∆9-THC (acute effect) and cannabis users under placebo (residual effect). In non-users, the more severe the ∆9-THC-induced psychotomimetic symptoms and cognitive impairments, the more pronounced was the neurophysiological alteration (all P≤0.036). Previous modest cannabis use blunts the acute behavioral and neurophysiological effects of ∆9-THC, which are more marked in people who have never used cannabis.
Collapse
|
31
|
Khokhar JY, Dwiel L, Henricks A, Doucette WT, Green AI. The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophr Res 2018; 194:78-85. [PMID: 28416205 PMCID: PMC6094954 DOI: 10.1016/j.schres.2017.04.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 11/29/2022]
Abstract
Substance use disorders occur commonly in patients with schizophrenia and dramatically worsen their overall clinical course. While the exact mechanisms contributing to substance use in schizophrenia are not known, a number of theories have been put forward to explain the basis of the co-occurrence of these disorders. We propose here a unifying hypothesis that combines recent evidence from epidemiological and genetic association studies with brain imaging and pre-clinical studies to provide an updated formulation regarding the basis of substance use in patients with schizophrenia. We suggest that the genetic determinants of risk for schizophrenia (especially within neural systems that contribute to the risk for both psychosis and addiction) make patients vulnerable to substance use. Since this vulnerability may arise prior to the appearance of psychotic symptoms, an increased use of substances in adolescence may both enhance the risk for developing a later substance use disorder, and also serve as an additional risk factor for the appearance of psychotic symptoms. Future studies that assess brain circuitry in a prospective longitudinal manner during adolescence prior to the appearance of psychotic symptoms could shed further light on the mechanistic underpinnings of these co-occurring disorders while identifying potential points of intervention for these difficult-to-treat co-occurring disorders.
Collapse
Affiliation(s)
| | - Lucas Dwiel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | - Angela Henricks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | | | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth,Dartmouth Clinical and Translational Science Institute, Dartmouth College
| |
Collapse
|
32
|
Whitfield-Gabrieli S, Fischer AS, Henricks AM, Khokhar JY, Roth RM, Brunette MF, Green AI. Understanding marijuana's effects on functional connectivity of the default mode network in patients with schizophrenia and co-occurring cannabis use disorder: A pilot investigation. Schizophr Res 2018; 194:70-77. [PMID: 28823723 PMCID: PMC6886576 DOI: 10.1016/j.schres.2017.07.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
Nearly half of patients with schizophrenia (SCZ) have co-occurring cannabis use disorder (CUD), which has been associated with decreased treatment efficacy, increased risk of psychotic relapse, and poor global functioning. While reports on the effects of cannabis on cognitive performance in patients with SCZ have been mixed, study of brain networks related to executive function may clarify the relationship between cannabis use and cognition in these dual-diagnosis patients. In the present pilot study, patients with SCZ and CUD (n=12) and healthy controls (n=12) completed two functional magnetic resonance imaging (fMRI) resting scans. Prior to the second scan, patients smoked a 3.6% tetrahydrocannabinol (THC) cannabis cigarette or ingested a 15mg delta-9-tetrahydrocannabinol (THC) pill. We used resting-state functional connectivity to examine the default mode network (DMN) during both scans, as connectivity/activity within this network is negatively correlated with connectivity of the network involved in executive control and shows reduced activity during task performance in normal individuals. At baseline, relative to controls, patients exhibited DMN hyperconnectivity that correlated with positive symptom severity, and reduced anticorrelation between the DMN and the executive control network (ECN). Cannabinoid administration reduced DMN hyperconnectivity and increased DMN-ECN anticorrelation. Moreover, the magnitude of anticorrelation in the controls, and in the patients after cannabinoid administration, positively correlated with WM performance. The finding that DMN brain connectivity is plastic may have implications for future pharmacotherapeutic development, as treatment efficacy could be assessed through the ability of therapies to normalize underlying circuit-level dysfunction.
Collapse
Affiliation(s)
- Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Adina S. Fischer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Angela M. Henricks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jibran Y. Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert M. Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, USA.,Corresponding Author: Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
33
|
Dong D, Wang Y, Chang X, Luo C, Yao D. Dysfunction of Large-Scale Brain Networks in Schizophrenia: A Meta-analysis of Resting-State Functional Connectivity. Schizophr Bull 2018; 44:168-181. [PMID: 28338943 PMCID: PMC5767956 DOI: 10.1093/schbul/sbx034] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Schizophrenia is a complex mental disorder with disorganized communication among large-scale brain networks, as demonstrated by impaired resting-state functional connectivity (rsFC). Individual rsFC studies, however, vary greatly in their methods and findings. We searched for consistent patterns of network dysfunction in schizophrenia by using a coordinate-based meta-analysis. Fifty-six seed-based voxel-wise rsFC datasets from 52 publications (2115 patients and 2297 healthy controls) were included in this meta-analysis. Then, coordinates of seed regions of interest (ROI) and between-group effects were extracted and coded. Seed ROIs were categorized into seed networks by their location within an a priori template. Multilevel kernel density analysis was used to identify brain networks in which schizophrenia was linked to hyper-connectivity or hypo-connectivity with each a priori network. Our results showed that schizophrenia was characterized by hypo-connectivity within the default network (DN, self-related thought), affective network (AN, emotion processing), ventral attention network (VAN, processing of salience), thalamus network (TN, gating information) and somatosensory network (SS, involved in sensory and auditory perception). Additionally, hypo-connectivity between the VAN and TN, VAN and DN, VAN and frontoparietal network (FN, external goal-directed regulation), FN and TN, and FN and DN were found in schizophrenia. Finally, the only instance of hyper-connectivity in schizophrenia was observed between the AN and VAN. Our meta-analysis motivates an empirical foundation for a disconnected large-scale brain networks model of schizophrenia in which the salience processing network (VAN) plays the core role, and its imbalanced communication with other functional networks may underlie the core difficulty of patients to differentiate self-representation (inner world) and environmental salience processing (outside world).
Collapse
Affiliation(s)
- Debo Dong
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yulin Wang
- Faculty of Psychological and Educational Sciences, Department of Experimental and Applied Psychology, Research Group of Biological Psychology, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Psychology and Educational Sciences, Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Xuebin Chang
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Cheng Luo
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Dezhong Yao
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
34
|
Khokhar JY, Henricks AM, Sullivan EDK, Green AI. Unique Effects of Clozapine: A Pharmacological Perspective. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2018; 82:137-162. [PMID: 29413518 DOI: 10.1016/bs.apha.2017.09.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Schizophrenia is a heterogenous and severe neuropsychiatric disorder that affects nearly 1% of the population worldwide. Antipsychotic drugs are the mainstay of treatment, but not all patients with schizophrenia respond to treatment with these agents. Clozapine, the first atypical antipsychotic, is a highly effective medication for patients with schizophrenia who do not respond to other antipsychotics. Although clozapine tends not to produce extrapyramidal symptoms, other side effects of the drug (e.g., agranulocytosis, myocarditis, seizures) limit its widespread use. This chapter reviews clozapine's unique clinical effects and unusual pharmacological profile. In addition to its effects in treatment-resistant schizophrenia, clozapine has been shown to decrease suicidality, which occurs at an increased rate in patients with schizophrenia. Still preliminary, but consistent data, also suggest that clozapine limits substance use in these patients, an important effect since substance use disorders are common in patients with schizophrenia and are associated with a poor outcome, including an increased risk for suicide and poor response to treatment. We have suggested, from animal studies, that clozapine's apparent ability to limit substance use may occur through its actions as a weak dopamine D2 receptor antagonist, a potent norepinephrine α-2 receptor antagonist and a norepinephrine reuptake inhibitor. Using animal models, we have built combinations of agents toward creation of safer clozapine-like drugs to reduce substance use in these patients. Future research into the mechanisms of action of clozapine toward the development of safe clozapine-like agents is of great public health importance.
Collapse
Affiliation(s)
- Jibran Y Khokhar
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Angela M Henricks
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Emily D K Sullivan
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Alan I Green
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States.
| |
Collapse
|
35
|
Lichenstein SD, Musselman S, Shaw DS, Sitnick S, Forbes EE. Nucleus accumbens functional connectivity at age 20 is associated with trajectory of adolescent cannabis use and predicts psychosocial functioning in young adulthood. Addiction 2017; 112:1961-1970. [PMID: 28547854 PMCID: PMC5633503 DOI: 10.1111/add.13882] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/29/2016] [Accepted: 05/23/2017] [Indexed: 01/05/2023]
Abstract
AIMS (1) To identify trajectories of cannabis use across adolescence, (2) to measure the influence of cannabis use characteristics on functional connectivity of the nucleus accumbens (NAcc) and (3) to assess whether patterns of functional connectivity related to cannabis use are associated with psychosocial functioning 2 years later. DESIGN The Pitt Mother and Child Project (PMCP) is a prospective, longitudinal study of male youth at high risk for psychopathology based on family income and gender. SETTING Participants were recruited between age 6 and 17 months from the Women, Infants and Children Nutritional Supplement program (WIC) in the Pittsburgh, Pennsylvania area. PARTICIPANTS A total of 158 PMCP young men contributed functional magnetic resonance imaging (fMRI) and substance use data at age 20 years. MEASUREMENTS Latent class growth analysis was used to determine trajectories of cannabis use frequency from age 14 to 19 years. Psychophysiological interaction (PPI) analysis was used to measure functional connectivity between the NAcc and prefrontal cortex (PFC). Adolescent cannabis use trajectory, recent frequency of use and age of initiation were considered as developmental factors. We also tested whether functional connectivity was associated with depressive symptoms, anhedonia and educational attainment at age 22. FINDINGS We identified three distinct trajectories of adolescent cannabis use, characterized by stable high, escalating or stable low use. The cannabis use trajectory group had a significant effect on NAcc functional connectivity to the medial PFC (F = 11.32, Z = 4.04, Pfamily-wise error-corrected (FWE-corr) = 0.000). The escalating trajectory group displayed a pattern of negative NAcc-mPFC connectivity that was linked to higher levels of depressive symptoms (r = -0.17, P < .05), anhedonia (r = -0.19, P < .05) and lower educational attainment (t = -2.77, P < .01) at age 22. CONCLUSIONS Pattern of cannabis use frequency across adolescence in US youth could have consequences for mood symptoms and educational attainment in early adulthood via altered function in neural reward circuitry.
Collapse
Affiliation(s)
- Sarah D. Lichenstein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15213 USA,Center for the Neural Bases of Cognition, University of Pittsburgh, Pittsburgh, PA, 15213 USA
| | - Samuel Musselman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213 USA
| | - Daniel S. Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15213 USA
| | - Stephanie Sitnick
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15213 USA
| | - Erika E. Forbes
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15213 USA,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213 USA,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15213 USA,Center for the Neural Bases of Cognition, University of Pittsburgh, Pittsburgh, PA, 15213 USA
| |
Collapse
|
36
|
Cannabis and cocaine decrease cognitive impulse control and functional corticostriatal connectivity in drug users with low activity DBH genotypes. Brain Imaging Behav 2017; 10:1254-1263. [PMID: 26667034 PMCID: PMC5167221 DOI: 10.1007/s11682-015-9488-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The dopamine β-hydroxylase (DβH) enzyme transforms dopamine into noradrenaline. We hypothesized that individuals with low activity DBH genotypes (rs1611115 CT/TT) are more sensitive to the influence of cannabis and cocaine on cognitive impulse control and functional connectivity in the limbic ‘reward’ circuit because they experience a drug induced hyperdopaminergic state compared to individuals with high activity DBH genotypes (rs1611115 CC). Regular drug users (N = 122) received acute doses of cannabis (450 μg/kg THC), cocaine HCl 300 mg and placebo. Cognitive impulse control was assessed by means of the Matching Familiar Figures Test (MFFT). Resting state fMRI was measured in a subset of participants to determine functional connectivity between the nucleus accumbens (NAc) and (sub)cortical areas. The influence of cannabis and cocaine on impulsivity and functional connectivity significantly interacted with DBH genotype. Both drugs increased cognitive impulsivity in participants with CT/TT genotypes but not in CC participants. Both drugs also reduced functional connectivity between the NAc and the limbic lobe, prefrontal cortex, striatum and thalamus and primarily in individuals with CT/TT genotypes. Correlational analysis indicated a significant negative association between cognitive impulsivity and functional connectivity in subcortical areas of the brain. It is concluded that interference of cannabis and cocaine with cognitive impulse control and functional corticostriatal connectivity depends on DBH genotype. The present data provide a neural substrate and behavioral mechanism by which drug users can progress to drug seeking and may also offer a rationale for targeted pharmacotherapy in chronic drug users with high risk DBH genotypes.
Collapse
|
37
|
Duquette LL, Mattiace F, Blum K, Waite RL, Boland T, McLaughlin T, Dushaj K, Febo M, Badgaiyan RD. Neurobiology of KB220Z-Glutaminergic-Dopaminergic Optimization Complex [GDOC] as a Liquid Nano: Clinical Activation of Brain in a Highly Functional Clinician Improving Focus, Motivation and Overall Sensory Input Following Chronic Intake. ACTA ACUST UNITED AC 2016; 3. [PMID: 29214221 PMCID: PMC5714519 DOI: 10.23937/2378-3656/1410104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background With neurogenetic and epigenetic tools utilized in research and neuroimaging, we are unraveling the mysteries of brain function, especially as it relates to Reward Deficiency (RDS). We encourage the development of pharmaceuticals or nutraceuticals that promote a reduction in dopamine resistance and balance brain neurochemistry, leading to dopamine homeostasis. We disclose self-assessment of a highly functional professional under work-related stress following KB220Z use, a liquid (aqua) nano glutaminergic-dopaminergic optimization complex (GDOC). Case presentation Subject took GDOC for one month. Subject self-administered GDOC using one-half-ounce twice a day. During first three days, unique brain activation occurred; resembling white noise after 30 minutes and sensation was strong for 45 minutes and then dissipated. He described effect as if his eyesight improved slightly and pointed out that his sense of smell and sleep greatly improved. Subject experienced a calming effect similar to meditation that could be linked to dopamine release. He also reported control of going over the edge after a hard day’s work, which was coupled with a slight increase in energy, increased motivation to work, increased focus and multi-tasking, with clearer purpose of task at hand. Subject felt less inhibited in a social setting and suggested Syndrome that GDOC increased his Behavior Activating System (reward), while having a decrease in the Behavior Inhibition System (caution). Conclusion These results and other related studies reveal an improved mood, work-related focus, and sleep. These effects as a subjective feeling of brain activation maybe due to direct or indirect dopaminergic interaction. While this case is encouraging, we must await more research in a larger randomized placebo-controlled study to map the role of GDOC, especially in a nano-sized product, to determine the possible effects on circuit inhibitory control and memory banks and the induction of dopamine homeostasis independent of either hypo- or hyper-dopaminergic traits/states.
Collapse
Affiliation(s)
- Lucien L Duquette
- New Pathway Counseling Services Inc., Paramus, NJ, USA.,Behavior Wellness Center, Englewood, NJ, USA
| | | | - Kenneth Blum
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.,Division of Addiction Services, Dominion Diagnostics, LLC., North Kingstown, RI, USA.,Division of Neuroscience-Based Therapy, Summit Estate Recovery Center, Los Gatos, CA, USA.,Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA.,Department of Clinical Neurology, PATH Foundation NY, New York, NY, USA.,Department of Nutrigenomic Translational Research, LaVita RDS, Salt Lake City, UT, USA.,Division of Neuroscience Research & Addiction Therapy, Shores Treatment & Recovery Center, Port Saint Lucie, FL, USA
| | - Roger L Waite
- Department of Nutrigenomic Translational Research, LaVita RDS, Salt Lake City, UT, USA
| | | | | | - Kristina Dushaj
- Department of Clinical Neurology, PATH Foundation NY, New York, NY, USA
| | - Marcelo Febo
- Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, Laboratory of Molecular and Functional Imaging, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
38
|
Abstract
Interest in the relationship between cannabis use and psychosis has increased dramatically in recent years, in part because of concerns related to the growing availability of cannabis and potential risks to health and human functioning. There now exists a plethora of scientific articles addressing this issue, but few provide a clear verdict about the causal nature of the cannabis-psychosis association. Here, we review recent research reports on cannabis and psychosis, giving particular attention to how each report provides evidence relating to two hypotheses: (1) cannabis as a contributing cause and (2) shared vulnerability. Two primary kinds of data are brought to bear on this issue: studies done with schizophrenic patients and studies of first-episode psychosis. Evidence reviewed here suggests that cannabis does not in itself cause a psychosis disorder. Rather, the evidence leads us to conclude that both early use and heavy use of cannabis are more likely in individuals with a vulnerability to psychosis. The role of early and heavy cannabis use as a prodromal sign merits further examination, along with a variety of other problem behaviors (e.g., early or heavy use of cigarettes or alcohol and poor school performance). Future research studies that focus exclusively on the cannabis-psychosis association will therefore be of little value in our quest to better understand psychosis and how and why it occurs.
Collapse
Affiliation(s)
- Charles Ksir
- Department of Psychology and Neuroscience Program, University of Wyoming, Laramie, WY, USA
| | - Carl L Hart
- Division on Substance Abuse, New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., Unit 120, New York, NY, 10032, USA. .,Department of Psychology, Columbia College, 1190 Amsterdam Ave, Schermerhorn #406, New York, NY, 10027, USA. .,Department of Psychiatry, Columbia University, 1051 Riverside Dr., Unit 120, New York, NY, 10032, USA. .,Brocher Foundation, Geneva, Switzerland.
| |
Collapse
|
39
|
Schilbach L, Hoffstaedter F, Müller V, Cieslik E, Goya-Maldonado R, Trost S, Sorg C, Riedl V, Jardri R, Sommer I, Kogler L, Derntl B, Gruber O, Eickhoff S. Transdiagnostic commonalities and differences in resting state functional connectivity of the default mode network in schizophrenia and major depression. Neuroimage Clin 2015; 10:326-35. [PMID: 26904405 PMCID: PMC4724692 DOI: 10.1016/j.nicl.2015.11.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 01/10/2023]
Abstract
Schizophrenia and depression are prevalent psychiatric disorders, but their underlying neural bases remains poorly understood. Neuroimaging evidence has pointed towards the relevance of functional connectivity aberrations in default mode network (DMN) hubs, dorso-medial prefrontal cortex and precuneus, in both disorders, but commonalities and differences in resting state functional connectivity of those two regions across disorders has not been formally assessed. Here, we took a transdiagnostic approach to investigate resting state functional connectivity of those two regions in 75 patients with schizophrenia and 82 controls from 4 scanning sites and 102 patients with depression and 106 controls from 3 sites. Our results demonstrate common dysconnectivity patterns as indexed by a significant reduction of functional connectivity between precuneus and bilateral superior parietal lobe in schizophrenia and depression. Furthermore, our findings highlight diagnosis-specific connectivity reductions of the parietal operculum in schizophrenia relative to depression. In light of evidence that points towards the importance of the DMN for social cognitive abilities and well documented impairments of social interaction in both patient groups, it is conceivable that the observed transdiagnostic connectivity alterations may contribute to interpersonal difficulties, but this could not be assessed directly in our study as measures of social behavior were not available. Given the operculum's role in somatosensory integration, diagnosis-specific connectivity reductions may indicate a pathophysiological mechanism for basic self-disturbances that is characteristic of schizophrenia, but not depression.
Collapse
Affiliation(s)
- L. Schilbach
- Max-Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - F. Hoffstaedter
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - V. Müller
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - E.C. Cieslik
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - R. Goya-Maldonado
- Center for Translational Research in Systems Neuroscience and Psychiatry, Clinic for Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - S. Trost
- Center for Translational Research in Systems Neuroscience and Psychiatry, Clinic for Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - C. Sorg
- Department of Psychiatry, Technical University Munich, Germany
| | - V. Riedl
- Department of Psychiatry, Technical University Munich, Germany
| | - R. Jardri
- Divison of Psychiatry, Centre Hospitalier Régional Universitaire de Lille, France
| | - I. Sommer
- UMC Utrecht Brain Center Rudolf Magnus, Utrecht, Netherlands
| | - L. Kogler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - B. Derntl
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - O. Gruber
- Center for Translational Research in Systems Neuroscience and Psychiatry, Clinic for Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - S.B. Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| |
Collapse
|
40
|
Abstract
The capacity for self-regulation allows people to control their thoughts, behaviors, emotions, and desires. In spite of this impressive ability, failures of self-regulation are common and contribute to numerous societal problems, from obesity to drug addiction. Such failures frequently occur following exposure to highly tempting cues, during negative moods, or after self-regulatory resources have been depleted. Here we review the available neuroscientific evidence regarding self-regulation and its failures. At its core, self-regulation involves a critical balance between the strength of an impulse and an individual's ability to inhibit the desired behavior. Although neuroimaging and patient studies provide consistent evidence regarding the reward aspects of impulses and desires, the neural mechanisms that underlie the capacity for control have eluded consensus, with various executive control regions implicated in different studies. We outline the necessary properties for a self-regulation control system and suggest that the use of resting-state functional connectivity analyses may be useful for understanding how people regulate their behavior and why they sometimes fail in their attempts.
Collapse
Affiliation(s)
- William M. Kelley
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire 03755;
| | - Dylan D. Wagner
- Department of Psychology, The Ohio State University, Columbus, Ohio 43210
| | - Todd F. Heatherton
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire 03755;
| |
Collapse
|
41
|
Peeters SCT, Gronenschild EHBM, van de Ven V, Habets P, Goebel R, van Os J, Marcelis M. Altered mesocorticolimbic functional connectivity in psychotic disorder: an analysis of proxy genetic and environmental effects. Psychol Med 2015; 45:2157-2169. [PMID: 25804977 DOI: 10.1017/s0033291715000161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Altered dopaminergic neurotransmission in the mesocorticolimbic (MCL) system may mediate psychotic symptoms. In addition, pharmacological dopaminergic manipulation may coincide with altered functional connectivity (fc) 'in rest'. We set out to test whether MCL-fc is conditional on (familial risk for) psychotic disorder and/or interactions with environmental exposures. METHOD Resting-state functional magnetic resonance imaging data were obtained from 63 patients with psychotic disorder, 73 non-psychotic siblings of patients with psychotic disorder and 59 healthy controls. With the nucleus accumbens (NAcc) as seed region, fc within the MCL system was estimated. Regression analyses adjusting for a priori hypothesized confounders were used to assess group differences in MCL connectivity as well as gene (group) × environmental exposure interactions (G × E) (i.e., to cannabis, developmental trauma and urbanicity). RESULTS Compared with controls, patients and siblings had decreased fc between the right NAcc seed and the right orbitofrontal cortex (OFC) as well as the left middle cingulate cortex (MCC). Siblings showed decreased connectivity between the NAcc seed and lentiform nucleus compared with patients and controls. In addition, patients had decreased left NAcc connectivity compared with siblings in the left middle frontal gyrus. There was no evidence for a significant interaction between group and the three environmental exposures in the model of MCL-fc. CONCLUSIONS Reduced NAcc-OFC/MCC connectivity was seen in patients and siblings, suggesting that altered OFC connectivity and MCC connectivity are vulnerability markers for psychotic disorder. Differential exposure to environmental risk factors did not make an impact on the association between familial risk and MCL connectivity.
Collapse
Affiliation(s)
- S C T Peeters
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - E H B M Gronenschild
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - V van de Ven
- Department of Cognitive Neuroscience,Maastricht University,Maastricht,the Netherlands
| | - P Habets
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - R Goebel
- Department of Cognitive Neuroscience,Maastricht University,Maastricht,the Netherlands
| | - J van Os
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| | - M Marcelis
- Department of Psychiatry and Psychology,South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University,Maastricht,the Netherlands
| |
Collapse
|
42
|
Fischer AS, Whitfield-Gabrieli S, Roth RM, Brunette MF, Green AI. Response to "cortico-accumbens circuitry in schizophrenia: merely a reward system?" by Rolland and Jardri (SCHRES-14-D-00731). Schizophr Res 2015; 161:519. [PMID: 25465412 PMCID: PMC4785886 DOI: 10.1016/j.schres.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Adina S. Fischer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert M. Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA,Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA,Corresponding Author: Alan I. Green, M.D., Chair Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
43
|
Rolland B, Jardri R. Cortico-accumbens circuitry in schizophrenia: merely a "reward system"? Schizophr Res 2014; 160:233-4. [PMID: 25458864 DOI: 10.1016/j.schres.2014.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/08/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Benjamin Rolland
- Department of Addiction Medicine, CHRU Lille, Lille, France; Department of Pharmacology, EA1046, Univ Lille 2, Lille, France
| | - Renaud Jardri
- Department of Child and Adolescent Psychiatry, CHRU Lille, Lille, France; SCA-Lab, PSYChiC team, Lille University, Lille, France.
| |
Collapse
|
44
|
Akerman SC, Brunette MF, Noordsy DL, Green AI. Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders. CURRENT ADDICTION REPORTS 2014; 1:251-260. [PMID: 27226947 PMCID: PMC4877030 DOI: 10.1007/s40429-014-0034-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Substance use disorders, common in patients with schizophrenia, can lead to poor outcomes. Here we review the literature on the use of antipsychotics in patients with co-occurring schizophrenia and substance use disorder as well as evidence for the use of adjunctive pharmacological treatments targeting substance use in these patients. We also discuss a neurobiological formulation suggesting that the cooccurrence of these disorders may be related to a dysfunction in the dopamine mediated brain reward circuitry. Typical antipsychotics do not appear to decrease substance use in this population. Randomized, controlled trials provide some support for use of the atypical antipsychotic clozapine for co-occurring cannabis use disorder, naltrexone and disulfiram for alcohol use disorder, and also nicotine replacement therapy, sustained-release bupropion and varenicline for tobacco use disorder. Nonetheless, data regarding treatment in patients with these co-occurring disorders are still limited, and many studies reported to date have been either underpowered or did not include a control condition. Further research is needed to evaluate optimal pharmacotherapeutic strategies for this population.
Collapse
Affiliation(s)
- Sarah C. Akerman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Douglas L. Noordsy
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| |
Collapse
|