The dopamine D4 receptor in schizophrenia: an update

Atypical antipsychotics: new directions and new challenges in the treatment of schizophrenia

"Atypical" antipsychotics represent a new generation of antipsychotics with a significantly lower incidence of extrapyramidal side effects (EPS), as well as little or no effect on prolactin elevation. These advantages constitute a major improvement in the treatment of patients with schizophrenia. The exact mechanisms that make these drugs atypical is not clear. However, a preferential action on serotonin 5-HT2 or D4 receptors, or a more rapid dissociation from the dopamine D2 receptor, may account for atypicality. Although the atypical antipsychotics have overcome EPS, other side effects such as weight gain and impaired glucose tolerance/lipid abnormalities have come to the fore. Thus, the challenges are far from over. The current atypicals are much more effective against the psychosis of schizophrenia than against the other, more enduring aspects of this disorder, e.g. negative symptoms and cognitive dysfunction. At present, the atypicals use a "pharmacological shotgun" strategy to treat aspects of the disease in all patients. A more sophisticated and perhaps effective approach to schizophrenia may lie in independently targeting the pathophysiological mechanisms of each clinical dimension (i.e. positive, negative, cognitive, and affective) with more selective drugs that can be combined and individually titrated to the needs of each patient.

Dopamine release in the nucleus accumbens and latent inhibition in the rat following microinjections of a 5-HT1B agonist into the dorsal subiculum: implications for schizophrenia

Microinjection of a serotonergic 5-HT1B agonist (S-CM-GTNH2, 3 microg/l) into the dorsal subiculum (DS) induced long-lasting increases in dopamine (DA; +58%), dihydroxyphenylacetic acid (DOPAC; +15%) and homovanillic acid (HVA; +31%), without changing extracellular levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), measured by microdialysis in freely moving rats in the shell area of the nucleus accumbens (n. acc). Perfusion of a glutamate-N-methyl-D-aspartate (NMDA) receptor antagonist (MK 801, dizocilpine, 10 microM) through the dialysis probe in the n. acc induced similar long-lasting increases in DA and DOPAC, whereas the glutamate-quisqualate/kainate receptor antagonist (CNQX, 50 microM) had no effect. In the presence of dizocilpine in the n. acc, microinjection of S-CM-GTNH2 into the DS could still increase DOPAC and HVA, but DA levels were not further changed, whereas in the presence of CNQX, microinjection of S-CM-GTNH2 into the DS still increased not only DOPAC and HVA, but also DA levels in a way similar to that in the absence of glutamate antagonist. Therefore, activation of 5-HT1B receptors located in the DS increases the release of DA in the n. acc, presumably via the glutamatergic projection to this structure and acting through NMDA receptors in it. This implies either the suppression of a tonic indirect inhibitory influence and/or stimulation of a phasic excitatory effect of glutamate. Disruption of latent inhibition (LI) has been suggested as a model for a cognitive deficit in schizophrenia (hyperattention to irrelevant stimuli) and is usually associated with an increase in DA release in the n. acc. However, s.c. injection of RU 24 969 (0.5 mg/kg), a mixed 5-HT1A-5-HT1B agonist, which was previously shown to increase DA release in the n. acc, left LI unchanged. Moreover, bilateral microinjections of S-CM-GTNH2 into the rat DS tended to potentiate LI, in spite of the increase in DA in n. acc demonstrated here. It is concluded that not all increases in DA release in the n. acc are functionally equivalent. Sensitization of receptors or impulse-dependent increase in DA release might be necessary to disrupt LI. The possible role of altered serotonergic transmission, through h5-HT1B receptors (human homologue of the rat 5-HT1B receptors) located in the DS, in acute schizophrenia needs to be further investigated.

Schizophrenia, psychosis, and the basal ganglia

Schizophrenia is one of the most common and perhaps the most disabling of mental disorders, for which effective forms of treatment have not yet been established definitively. The findings reviewed in this article strongly suggest that basal ganglia abnormalities are involved in the pathophysiology of psychotic syndromes in general, and schizophrenia in particular.

Progress in research into the neurobiological bases of schizophrenia: A review and commentary

Schizophrenia is a severe, often disabling, and sometimes enduring psychiatric disorder. Ever since its characterisation as a mental illness at the beginning of this century, its nature, course and aetiology have been the subject of debate. As understanding of genetic mechanisms, brain biochemistry, and the relationship between brain structure and function has recently developed, researchers are now making considerable progress in their attempts to unravel some of the neurobiological factors of importance in the development, manifestation, and treatment of schizophrenia.

Current research in three main areas of interest is described in this review paper. Findings from genetic research suggest that, in many cases, schizophrenia may have a neurodevelopmental origin, which is, in turn, influenced by genetic factors. Biochemical research indicates that disturbances to the functioning of several brain neurotransmitters may collectively contribute to the changes in behaviour that are identified as the signs and symptoms of the condition. Neuropsychological research reinforces the view that schizophrenia is not a unitary condition, and that disturbances to discrete networks of neurons may be responsible for different sub-types of the disorder.

The regional pattern of D4 gene expression in human brain

Using a competitive reverse transcription-polymerase chain reaction (RT-PCR) assay levels of D4 gene expression have been determined in 16 regions obtained from a single control brain. Relatively high levels of expression were detected in the prefrontal and temporolimbic structures whilst low levels were detected in striatal regions. This pattern correlates with the reported distribution of the D4 receptor.