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Halahakoon DC, Kaltenboeck A, Martens M, Geddes JG, Harmer CJ, Cowen P, Browning M. Pramipexole Enhances Reward Learning by Preserving Value Estimates. Biol Psychiatry 2024; 95:286-296. [PMID: 37330165 DOI: 10.1016/j.biopsych.2023.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/02/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Dopamine D2-like agonists show promise as treatments for depression. They are thought to act by enhancing reward learning; however, the mechanisms by which they achieve this are not clear. Reinforcement learning accounts describe 3 distinct candidate mechanisms: increased reward sensitivity, increased inverse decision-temperature, and decreased value decay. As these mechanisms produce equivalent effects on behavior, arbitrating between them requires measurement of how expectations and prediction errors are altered. We characterized the effects of 2 weeks of the D2-like agonist pramipexole on reward learning and used functional magnetic resonance imaging measures of expectation and prediction error to assess which of these 3 mechanistic processes were responsible for the behavioral effects. METHODS Forty healthy volunteers (50% female) were randomized to 2 weeks of pramipexole (titrated to 1 mg/day) or placebo in a double-blind, between-subject design. Participants completed a probabilistic instrumental learning task before and after the pharmacological intervention, with functional magnetic resonance imaging data collected at the second visit. Asymptotic choice accuracy and a reinforcement learning model were used to assess reward learning. RESULTS Pramipexole increased choice accuracy in the reward condition with no effect on losses. Participants who received pramipexole had increased blood oxygen level-dependent response in the orbital frontal cortex during the expectation of win trials but decreased blood oxygen level-dependent response to reward prediction errors in the ventromedial prefrontal cortex. This pattern of results indicates that pramipexole enhances choice accuracy by reducing the decay of estimated values during reward learning. CONCLUSIONS The D2-like receptor agonist pramipexole enhances reward learning by preserving learned values. This is a plausible mechanism for pramipexole's antidepressant effect.
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Affiliation(s)
- Don Chamith Halahakoon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Alexander Kaltenboeck
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marieke Martens
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John G Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Philip Cowen
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom.
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Halahakoon DC, Browning M. Pramipexole for the Treatment of Depression: Efficacy and Mechanisms. Curr Top Behav Neurosci 2024; 66:49-65. [PMID: 37982928 DOI: 10.1007/7854_2023_458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Dopaminergic mechanisms are a plausible treatment target for patients with clinical depression but are relatively underexplored in conventional antidepressant medications. There is continuing interest in the potential antidepressant effects of the dopamine receptor agonist, pramipexole, with data from both case series and controlled trials indicating that this agent may produce benefit for patients with difficult-to-treat depression. Pramipexole's therapeutic utility in depression is likely to be expressed through alterations in reward mechanisms which are strongly influenced by dopamine pathways and are known to function abnormally in depressed patients. Our work in healthy participants using brain imaging in conjunction with computational modelling suggests that repeated pramipexole facilitates reward learning by inhibiting value decay. This mechanism needs to be confirmed in larger clinical trials in depressed patients. Such studies will also allow assessment of whether baseline performance in reward learning in depression predicts therapeutic response to pramipexole treatment.
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Affiliation(s)
- Don Chamith Halahakoon
- Department of Psychiatry, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Michael Browning
- Department of Psychiatry, Warneford Hospital, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
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3
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Mesbah R, Koenders MA, van der Wee NJA, Giltay EJ, van Hemert AM, de Leeuw M. Association Between the Fronto-Limbic Network and Cognitive and Emotional Functioning in Individuals With Bipolar Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:432-440. [PMID: 36988918 PMCID: PMC10061312 DOI: 10.1001/jamapsychiatry.2023.0131] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/04/2023] [Indexed: 03/30/2023]
Abstract
Importance Individuals with bipolar disorder (BD) experience cognitive and emotional dysfunctions. Various brain circuits are implicated in BD but have not been investigated in a meta-analysis of functional magnetic resonance imaging (fMRI) studies. Objective To investigate the brain functioning of individuals with BD compared with healthy control individuals in the domains of emotion processing, reward processing, and working memory. Data Sources All fMRI experiments on BD published before March 2020, as identified in a literature search of PubMed, Embase, Web of Science, Cochrane Library, PsycInfo, Emcare, Academic Search Premier, and ScienceDirect. The literature search was conducted on February 21, 2017, and March 2, 2020, and data were analyzed from January 2021 to January 2022. Study Selection fMRI experiments comparing adult individuals with BD and healthy control individuals were selected if they reported whole-brain results, including a task assessing at least 1 of the domains. In total, 2320 studies were screened, and 253 full-text articles were evaluated. Data Extraction and Synthesis A total of 49 studies were included after selection procedure. Coordinates reporting significant activation differences between individuals with BD and healthy control individuals were extracted. Differences in brain region activity were tested using the activation likelihood estimation method. Main Outcomes and Measures A whole-brain meta-analysis evaluated whether reported differences in brain activation in response to stimuli in 3 cognitive domains between individuals with BD and healthy control individuals were different. Results The study population included 999 individuals with BD (551 [55.2%] female) and 1027 healthy control individuals (532 [51.8%] female). Compared with healthy control individuals, individuals with BD showed amygdala and hippocampal hyperactivity and hypoactivation in the inferior frontal gyrus during emotion processing (20 studies; 324 individuals with BD and 369 healthy control individuals), hyperactivation in the orbitofrontal cortex during reward processing (9 studies; 195 individuals with BD and 213 healthy control individuals), and hyperactivation in the ventromedial prefrontal cortex and subgenual anterior cingulate cortex during working memory (20 studies; 530 individuals with BD and 417 healthy control individuals). Limbic hyperactivation was only found during euthymia in the emotion and reward processing domains; abnormalities in frontal cortex activity were also found in individuals with BD with mania and depression. Conclusions and Relevance This systematic review and meta-analysis revealed evidence for activity disturbances in key brain areas involved in cognitive and emotion processing in individuals with BD. Most of the regions are part of the fronto-limbic network. The results suggest that aberrations in the fronto-limbic network, present in both euthymic and symptomatic individuals, may be underlying cognitive and emotional dysfunctions in BD.
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Affiliation(s)
- Rahele Mesbah
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Psychiatric Institute, Department of Mood Disorders, PsyQ Kralingen, Rotterdam, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Manja A. Koenders
- Psychiatric Institute, Department of Mood Disorders, PsyQ Kralingen, Rotterdam, the Netherlands
- Institute of Psychology, Faculty of Social Sciences, Leiden University, Leiden, the Netherlands
| | - Nic J. A. van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Max de Leeuw
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
- Psychiatric Institute, GGZ Rivierduinen, Bipolar Disorder Outpatient Clinic, Leiden, the Netherlands
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Johnson DE, McIntyre RS, Mansur RB, Rosenblat JD. An update on potential pharmacotherapies for cognitive impairment in bipolar disorder. Expert Opin Pharmacother 2023; 24:641-654. [PMID: 36946229 DOI: 10.1080/14656566.2023.2194488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cognitive impairment is a core feature of bipolar disorder (BD) that impedes recovery by preventing the return to optimal socio-occupational functioning and reducing quality of life. Presently, there are no efficacious treatments for cognitive impairment in BD, but many pharmacological interventions are being considered as they have the potential to target the underlying pathophysiology of the disorder. AREAS COVERED This review summarizes the available evidence for pharmacological interventions for cognitive impairment in bipolar disorder. We searched PubMed, MedLine, and PsycInfo from inception to December 1st, 2022. Traditional treatments, such as lithium, anticonvulsants (lamotrigine), antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, and olanzapine), antidepressants (vortioxetine, fluoxetine, and tianeptine) and psychostimulants (modafinil), and emerging interventions, such as acetylcholinesterase inhibitors (galantamine and donepezil), dopamine agonists (pramipexole), erythropoietin, glucocorticoid receptor antagonists (mifepristone), immune modulators (infliximab, minocycline and doxycycline), ketamine, metabolic agents (insulin, metformin, and liraglutide), probiotic supplements, and Withania somnifera are discussed. EXPERT OPINION The investigation of interventions for cognitive impairment in BD is a relatively under-researched area. In the past, methodological pitfalls in BD cognition trials have also been a critical limiting factor. Expanding on the existing literature and identifying novel pharmacological and non-pharmacological treatments for cognitive impairment in BD should be a priority.
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Affiliation(s)
- Danica E Johnson
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Institute of Medical Science, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry and Pharmacology, University of Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
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Jia A, Guo X, Tian S. Experimental study on the influence of mental fatigue on risk decision-making of miners. Sci Rep 2022; 12:11902. [PMID: 35831380 PMCID: PMC9279497 DOI: 10.1038/s41598-022-14045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Mental fatigue increases risk-taking behavior. Using data collected between June 15 and August 6, 2020, this study investigates the impact of miners’ mental fatigue on risk decision-making to improve risk prevention and prediction abilities, and to reduce the occurrence of coal mine safety accidents. A total of 273 and 33 people participated in the preliminary and formal experiments, respectively. The participants, coal miners, visited a lab thrice to complete the pre-experiment, Balloon Analog Risk Task (BART), and Iowa Gambling Task (IGT). On the BART, mental fatigue displayed a significantly positive association with risk preference. On the IGT, as mental fatigue increased, net scores continuously decreased, while the frequency of making unfavorable decisions and the probability of taking risks increased. The BART value had no or weak correlations with the net score. Results suggest that mental fatigue leads to an increasing propensity to take risks. Therefore, regarding coal mine safety management, further attention is necessary concerning miners’ mental health, addressing mental fatigue, increasing rest time, and reducing night work. Furthermore, reasonable diet, improved working environments, and a positive attitude toward work should be promoted to reduce or eliminate mental fatigue and avoid decision-making errors that could cause accidents.
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Affiliation(s)
- Aifang Jia
- College of Safety Science and Engineering, Xi'an University of Science and Technology, Xi'an, China. .,Department of Mining Engineering, Jincheng Institute and Technical College, Jincheng, China.
| | - Xinyue Guo
- College of Computer and Information Science, Southwest University, Chongqing, China
| | - Shuicheng Tian
- College of Safety Science and Engineering, Xi'an University of Science and Technology, Xi'an, China.
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Au-Yeung SK, Griffiths J, Roberts S, Edwards C, Yu LM, Bogacz R, Rendell J, Attenburrow MJ, Watson S, Chan F, Cipriani A, Cleare A, Harmer CJ, Kessler D, Evans J, Lewis G, Singh I, Simon J, Harrison PJ, Cowen P, Shanyinde M, Geddes J, Browning M. PAX-D: study protocol for a randomised placebo-controlled trial evaluating the efficacy and mechanism of pramipexole as add-on treatment for people with treatment resistant depression. EVIDENCE-BASED MENTAL HEALTH 2021; 25:77-83. [PMID: 34810175 PMCID: PMC9046747 DOI: 10.1136/ebmental-2021-300282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Clinical depression is usually treated in primary care with psychological therapies and antidepressant medication. However, when patients do not respond to at least two or more antidepressants within a depressive episode, they are considered to have treatment resistant depression (TRD). Previous small randomised controlled trials suggested that pramipexole, a dopamine D2/3 receptor agonist, may be effective for treating patients with unipolar and bipolar depression as it is known to influence motivational drive and reward processing. PAX-D will compare the effects of pramipexole vs placebo when added to current antidepressant medication for people with TRD. Additionally, PAX-D will investigate the mechanistic effect of pramipexole on reward sensitivity using a probabilistic decision-making task. Methods and analysis PAX-D will assess effectiveness in the short- term (during the first 12 weeks) and in the longer-term (48 weeks) in patients with TRD from the UK. The primary outcome will be change in self-reported depressive symptoms from baseline to week 12 post-randomisation measured using the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Performance on the decision-making task will be measured at week 0, week 2 and week 12. Secondary outcomes include anhedonia, anxiety and health economic measures including quality of life, capability, well-being and costs. PAX-D will also assess the adverse effects of pramipexole including impulse control difficulties. Discussion Pramipexole is a promising augmentation agent for TRD and may be a useful addition to existing treatment regimes. PAX-D will assess its effectiveness and test for a potential mechanism of action in patients with TRD. Trial registration number ISRCTN84666271
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Affiliation(s)
| | | | - Sophie Roberts
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Chloe Edwards
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | - Rafal Bogacz
- Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Jennifer Rendell
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Inpatient Services, Cumbria, Northumberland, Tyne and Wear NHS Mental Health Trust, Northumberland, UK
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Bristol, UK
| | | | - David Kessler
- Bristol Medical School, Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Jonathan Evans
- Bristol Medical School, Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judit Simon
- Department of Health Economics, Medical University of Vienna, Wien, Austria
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Phil Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Milensu Shanyinde
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Michael Browning
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
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Lukacs JN, Sicilia AC, Jones S, Algorta GP. Interactions and implications of Fuzzy-Trace theory for risk taking behaviors in bipolar disorder. J Affect Disord 2021; 293:305-313. [PMID: 34229283 DOI: 10.1016/j.jad.2021.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND According to Fuzzy-Trace Theory (FTT), qualitative, bottom-line, "gist" reasoning leads to less risk taking and more mature decision-making, less easily swayed by emotions than quantitative, detail-oriented, "verbatim" reasoning. In Bipolar disorder deleterious risky behaviors are common. Prior research confirmed the relationships posited between FTT and risk taking. We aim to understand whether FTT acts upon risk taking in the manner proposed in the FTT framework, namely, that (a) gist "values" mediate the role of "categorical gist". Furthermore, the roles of mania and impulsivity, cited as factors for risk-taking, remain to be clarified. In this study, we investigate if (b) manic symptoms and impulsivity moderate these relationships. METHODS Participants (N = 105) completed an online survey including demographics, clinical variables, symptomatology, FTT, risk taking and risk perception. RESULTS Mediational models indicated that (a) Gist Values mediated Categorical Gist's effect on risk taking, as expected by the FTT framework. (b) Impulsivity moderates risk taking, but manic-type symptomatology does not. LIMITATIONS Voluntary, self-report surveys may have low participant motivation and limit the diagnostic validity and the inpatient generalizability of the results. CONCLUSIONS The results move beyond a focus on mood-related aspects of Bipolar disorder and confirm the importance of understanding reasoning processes like FTT in combination with impulsivity, as potential behavioral factors of risk taking in Bipolar disorder. The clarifications on FTT's functioning as a mechanism prescribe possible openings for more efficacious reduction of risky behaviors through behavioral interventions focusing on value creation.
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Affiliation(s)
- Julia N Lukacs
- Department of Psychology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby, CA, USA
| | - Anna Chiara Sicilia
- Sussex Partnership NHS Foundation Trust, Worthing, UK; Director at in2gr8mentalhealth Ltd., London, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Guillermo Perez Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
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Reactivating a positive feedback loop VTA-BLA-NAc circuit associated with positive experience ameliorates the attenuated reward sensitivity induced by chronic stress. Neurobiol Stress 2021; 15:100370. [PMID: 34381852 PMCID: PMC8334743 DOI: 10.1016/j.ynstr.2021.100370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Both genetic predisposition and life events, particularly life stress, are thought to increase the risk for depression. Reward sensitivity appears to be attenuated in major depressive disorder (MDD), suggesting deficits in reward processing in these patients. We identified the VTA-BLA-NAc circuit as being activated by sex reward, and the VTA neurons that respond to sex reward are mostly dopaminergic. Acute or chronic reactivation of this circuit ameliorates the reward insensitivity induced by chronic restraint stress. Our histological and electrophysiological results show that the VTA neuron subpopulation responding to restraint stress, predominantly GABAergic neurons, inhibits the responsiveness of VTA dopaminergic neurons to reward stimuli, which is probably the mechanism by which stress modulates the reward processing neural circuits and subsequently disrupts reward-related behaviours. Furthermore, we found that the VTA-BLA-NAc circuit is a positive feedback loop. Blocking the projections from the BLA to the NAc associated with sex reward increases the excitability of VTA GABAergic neurons and decreases the excitability of VTA dopaminergic neurons, while activating this pathway decreases the excitability of VTA GABAergic neurons and increases the excitability of VTA dopaminergic neurons, which may be the cellular mechanism by which the VTA-BLA-NAc circuit associated with sex reward ameliorates the attenuated reward sensitivity induced by chronic stress.
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Van Meter AR, Perez-Rodriguez MM, Braga RJ, Shanahan M, Hanna L, Malhotra AK, Burdick KE. Pramipexole to Improve Cognition in Bipolar Disorder: A Randomized Controlled Trial. J Clin Psychopharmacol 2021; 41:421-427. [PMID: 33956703 PMCID: PMC8238822 DOI: 10.1097/jcp.0000000000001407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adults with bipolar disorder (BD) often experience neurocognitive impairment that negatively impacts functioning and quality of life. Previous trials have found that dopamine agonist agents improve cognition in healthy volunteers and that adults with BD who have stable mood and mild cognitive deficits may also benefit. We hypothesized that pramipexole, a dopamine agonist, would improve neurocognitive function in patients with BD. METHODS We recruited 60 adults (aged 18-65 years) with a diagnosis of BD I or II for an 8-week, double-blind, placebo-controlled trial (NCT02397837). All had stable mood and clinically significant neurocognitive impairment at baseline. Participants were randomized to receive pramipexole (n = 31) or a placebo (n = 29), dose was initiated at 0.125 mg 2 times a day and increased to a target of 4.5 mg/d. RESULTS At trial end, the primary outcome, MATRICS Consensus Cognitive Battery composite score, had not improved more in the pramipexole group (mean [SD] = 1.15 [5.4]) than in the placebo group (mean [SD] = 4.12 [5.2], Cohen's d = 0.56, P = 0.049), and mixed models, controlling for symptoms, showed no association between treatment group and MATRICS Consensus Cognitive Battery scores. No serious adverse events were reported. CONCLUSIONS These results suggest that pramipexole is not an efficacious cognitive enhancement agent in BD, even in a sample enriched for characteristics that were associated with a beneficial response in prior work. There are distinct cognitive subgroups among adults with BD and may be related differences in neurobiology that affect response to pramipexole. Additional research to better understand the onset and nature of the cognitive deficits in people with BD will be an important step toward a more personalized approach to treatment.
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Affiliation(s)
- Anna R. Van Meter
- From the Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks
- Feinstein Institutes for Medical Research, Institute for Behavioral Science, Manhasset
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead
| | | | - Raphael J. Braga
- From the Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead
| | - Megan Shanahan
- Brigham and Women's Hospital, Mood and Psychosis Research Program, Boston
| | - Lauren Hanna
- From the Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead
| | - Anil K. Malhotra
- From the Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks
- Feinstein Institutes for Medical Research, Institute for Behavioral Science, Manhasset
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead
| | - Katherine E. Burdick
- Brigham and Women's Hospital, Mood and Psychosis Research Program, Boston
- Department of Psychiatry, Harvard Medical School, Cambridge, MA
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10
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Yang X, Huang J, Harrision P, Roser ME, Tian K, Wang D, Liu G. Motivational differences in unipolar and bipolar depression, manic bipolar, acute and stable phase schizophrenia. J Affect Disord 2021; 283:254-261. [PMID: 33571794 DOI: 10.1016/j.jad.2021.01.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/10/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Motivational anhedonia has been observed in patients with a wide range of mental disorders. However, the similarity and uniqueness of this deficit across diagnostic groups has not been thoroughly investigated. METHOD The study compared motivational deficits in 37 patients with major depressive disorder (MDD), 32 with bipolar depression, 33 with manic bipolar disorder (BD), 30 with acute phase and 33 with stable phase schizophrenia, as well as 47 healthy controls. Participants were administered the Effort-Expenditure for Reward Task which measures allocation of effort between a high-effort and a low-effort task for monetary rewards at varying magnitudes and probabilities. RESULTS Compared with healthy controls, BD manic, acute and stable phase schizophrenia patients were significantly less likely to choose the high-effort task in the high reward magnitude condition. BD manic and acute phase schizophrenia patients were significantly less likely to choose the high-effort task in the high probability condition. Acute and stable phase schizophrenia patients made less effort in the high estimated value condition. Bipolar manic patients made excessive effort in low estimated value but less effort in high estimated value. Contrary to expectations, both the unipolar and bipolar depression patients did not differ significantly from healthy controls in reward magnitude, probability, and estimated value conditions. Anhedonia and negative symptoms were associated with fewer high-effort task choices in schizophrenia patients. CONCLUSION Motivation anhedonia showed distinct patterns across psychiatric patients: acute phase schizophrenia was the most severely affected, bipolar mania was similar to schizophrenia, but bipolar depression was similar to unipolar depression.
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Affiliation(s)
- Xinhua Yang
- Department of Psychology, Hunan Agricultural University, Changsha, China; Brain Research & Imaging Centre, School of Psychology, Cognition Institute, Faculty of Health & Human Sciences, Plymouth University, UK..
| | - Jia Huang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China.
| | - Phillippa Harrision
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK..
| | - Matthew E Roser
- Brain Research & Imaging Centre, School of Psychology, Cognition Institute, Faculty of Health & Human Sciences, Plymouth University, UK..
| | - Kai Tian
- Department of Psychology, Hunan Agricultural University, Changsha, China.
| | - Dongfang Wang
- Department of Psychology, Hunan Agricultural University, Changsha, China.
| | - Guangya Liu
- Department of psychiatry, Brains Hospital of Hunan province, Changsha, China.
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11
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A qualitative exploration of how people with bipolar disorder consider risk-taking in everyday decisions. Behav Cogn Psychother 2020; 49:314-327. [PMID: 33334387 DOI: 10.1017/s1352465820000946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Difficulties with decision making and risk taking in individuals with bipolar disorder (BD) have been associated with mood episodes. However, there is limited information about these experiences during euthymia, the mood state where people with BD spent the majority of their time. AIMS To examine how individuals with BD consider risk in everyday decisions during their euthymic phase. METHOD We conducted a qualitative study that used semi-structured audio recorded interviews. Eight euthymic participants with confirmed BD were interviewed, and we used interpretative phenomenological analysis to analyse the data. RESULTS We identified four themes. The first theme, 'Who I really am', involves the relationship between individual identity and risks taken. The second theme, 'Taking back control of my life', explored the relationship between risks taken as participants strove to keep control of their lives. The third theme, 'Fear of the "what ifs"', represents how the fear of negative consequences from taking risks impacts risk decisions. Finally, the fourth theme, 'The role of family and friends', highlights the important role that a supporting network can play in their lives in the context of taking risks. CONCLUSIONS The study highlights aspects that can impact on an individual with BD's consideration of risk during euthymia. Identity, control, fear and support all play a role when a person considers risk in their decision-making process, and they should be taken into consideration when exploring risk with individuals with BD in clinical settings, and inform the design of future interventions.
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Miskowiak KW, Burdick KE, Martinez‐Aran A, Bonnin CM, Bowie CR, Carvalho AF, Gallagher P, Lafer B, López‐Jaramillo C, Sumiyoshi T, McIntyre RS, Schaffer A, Porter RJ, Torres IJ, Yatham LN, Young AH, Kessing LV, Vieta E. Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disord 2017; 19:614-626. [PMID: 28895274 PMCID: PMC6282834 DOI: 10.1111/bdi.12534] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus-based guidance paper for the methodology and design of cognition trials in bipolar disorder. METHODS The task force was launched in September 2016, consisting of 18 international experts from nine countries. A series of methodological issues were identified based on literature review and expert opinion. The issues were discussed and expanded upon in an initial face-to-face meeting, telephone conference call and email exchanges. Based upon these exchanges, recommendations were achieved. RESULTS Key methodological challenges are: lack of consensus on how to screen for entry into cognitive treatment trials, define cognitive impairment, track efficacy, assess functional implications, and manage mood symptoms and concomitant medication. Task force recommendations are to: (i) enrich trials with objectively measured cognitively impaired patients; (ii) generally select a broad cognitive composite score as the primary outcome and a functional measure as a key secondary outcome; and (iii) include remitted or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non-study medications stable. Additional methodological considerations include neuroimaging assessments, targeting of treatments to illness stage and using a multimodal approach. CONCLUSIONS This ISBD task force guidance paper provides the first consensus-based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy in future trials and increase comparability between studies.
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Affiliation(s)
- KW Miskowiak
- Copenhagen Affective Disorder Research CentrePsychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - KE Burdick
- Department of PsychiatryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - A Martinez‐Aran
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaCataloniaSpain
| | - CM Bonnin
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaCataloniaSpain
| | - CR Bowie
- Department of PsychologyQueen's UniversityKingstonCanada
| | - AF Carvalho
- Department of Clinical MedicineFederal University of CearáFortalezaBrazil
| | - P Gallagher
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - B Lafer
- Bipolar Disorder Research ProgramInstitute of PsychiatryUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - C López‐Jaramillo
- Research Group in PsychiatryDepartment of PsychiatryUniversidad de AntioquiaMedellínColombia
| | - T Sumiyoshi
- Department of Clinical EpidemiologyNational Center of Neurology and PsychiatryTokyoJapan
| | - RS McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation, University of TorontoTorontoCanada
| | - A Schaffer
- Department of PsychiatryUniversity of TorontoTorontoCanada
| | - RJ Porter
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - IJ Torres
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - LN Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - AH Young
- Department of Psychological MedicineInstitute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - LV Kessing
- Copenhagen Affective Disorder Research CentrePsychiatric Centre CopenhagenCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - E Vieta
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaCataloniaSpain
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13
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Milienne-Petiot M, Groenink L, Minassian A, Young JW. Blockade of dopamine D 1-family receptors attenuates the mania-like hyperactive, risk-preferring, and high motivation behavioral profile of mice with low dopamine transporter levels. J Psychopharmacol 2017; 31:1334-1346. [PMID: 28950781 PMCID: PMC10773978 DOI: 10.1177/0269881117731162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with bipolar disorder mania exhibit poor cognition, impulsivity, risk-taking, and goal-directed activity that negatively impact their quality of life. To date, existing treatments for bipolar disorder do not adequately remediate cognitive dysfunction. Reducing dopamine transporter expression recreates many bipolar disorder mania-relevant behaviors (i.e. hyperactivity and risk-taking). The current study investigated whether dopamine D1-family receptor blockade would attenuate the risk-taking, hypermotivation, and hyperactivity of dopamine transporter knockdown mice. METHODS Dopamine transporter knockdown and wild-type littermate mice were tested in mouse versions of the Iowa Gambling Task (risk-taking), Progressive Ratio Breakpoint Test (effortful motivation), and Behavioral Pattern Monitor (activity). Prior to testing, the mice were treated with the dopamine D1-family receptor antagonist SCH 23390 hydrochloride (0.03, 0.1, or 0.3 mg/kg), or vehicle. RESULTS Dopamine transporter knockdown mice exhibited hyperactivity and hyperexploration, hypermotivation, and risk-taking preference compared with wild-type littermates. SCH 23390 hydrochloride treatment decreased premature responding in dopamine transporter knockdown mice and attenuated their hypermotivation. SCH 23390 hydrochloride flattened the safe/risk preference, while reducing activity and exploratory levels of both genotypes similarly. CONCLUSIONS Dopamine transporter knockdown mice exhibited mania-relevant behavior compared to wild-type mice. Systemic dopamine D1-family receptor antagonism attenuated these behaviors in dopamine transporter knockdown, but not all effects were specific to only the knockdown mice. The normalization of behavior via blockade of dopamine D1-family receptors supports the hypothesis that D1 and/or D5 receptors could contribute to the mania-relevant behaviors of dopamine transporter knockdown mice.
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Affiliation(s)
- Morgane Milienne-Petiot
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States of America
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Lucianne Groenink
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States of America
| | - Jared W. Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, United States of America
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States of America
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14
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Temple JL, Ziegler AM, Graczyk AM, Crandall A. Effects of acute and chronic caffeine on risk-taking behavior in children and adolescents. J Psychopharmacol 2017; 31:561-568. [PMID: 28198658 DOI: 10.1177/0269881117691568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Consumption of caffeinated beverages is associated with increased risk-taking behavior. The purpose of this study was to determine if acute caffeine administration influences risk-taking behavior in a dose-dependent manner. Participants were pre- (ages 8-9) and post-pubertal (ages 15-17) children who visited the laboratory three times and consumed a beverage containing 0, 1, or 2 mg/kg of caffeine. Thirty minutes later, participants completed the balloon analogue risk task (BART), the Iowa gambling task (IGT), and a delay discounting task. The number of balloons exploded on the BART task was significantly increased after 2 mg/kg of caffeine in moderate caffeine consumers, but was decreased after 2 mg/kg of caffeine in high caffeine consumers. There were no main effects of caffeine dose on the delay discounting task or on the IGT. Post-pubertal participants showed reduced delay discounting compared with pre-pubertal participants. Finally, average daily caffeine use was significantly, positively correlated with scores on a risk-taking questionnaire. These data suggest that caffeine dose-dependently influences decision making and risk taking. More research is needed to determine the mechanism of this difference as well as the extent to which sex and pubertal phase influence these relationships.
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Affiliation(s)
- Jennifer L Temple
- Departments of Exercise and Nutrition Sciences and Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Amanda M Ziegler
- Departments of Exercise and Nutrition Sciences and Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Adam M Graczyk
- Departments of Exercise and Nutrition Sciences and Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Amanda Crandall
- Departments of Exercise and Nutrition Sciences and Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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15
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Buelow MT, Barnhart WR. Test–Retest Reliability of Common Behavioral Decision Making Tasks. Arch Clin Neuropsychol 2017; 33:125-129. [DOI: 10.1093/arclin/acx038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 04/05/2017] [Indexed: 01/21/2023] Open
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16
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Zhao C, Liu J, Gong P, Hu J, Zhou X. Investigating the Genetic Basis of Social Conformity: The Role of the Dopamine Receptor 3 (DRD3) Gene. Neuropsychobiology 2017; 74:32-40. [PMID: 27784028 DOI: 10.1159/000450710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND People often change their opinions or behavior to match the responses of others, a phenomenon known as social conformity. Conforming behavior varies substantially across individuals. However, little is known about the genetic basis underlying individual differences in social conformity. A recent study demonstrated an association between enhanced dopaminergic function and increased conforming behavior. Given the effect of the dopamine receptor 3 gene (DRD3) Ser9Gly polymorphism (rs6280) on dopamine release in the striatum, this study investigated to what extent this polymorphism affects conforming behavior. METHODS We categorized Han Chinese individuals according to the polymorphism and tested them with a facial-attractiveness rating task. RESULTS We found that individuals with a greater number of the Gly alleles, which are related to an increased dopamine release in the striatum, were more susceptible to social influence and more likely to change their ratings to match those of other people. CONCLUSIONS This finding demonstrates the importance of DRD3 Ser9Gly as a genetic basis for social conformity and in predicting individual differences in social learning.
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Affiliation(s)
- Chunli Zhao
- Center for Brain and Cognitive Sciences, Peking University, Beijing, China
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17
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Ryu V, Ha RY, Lee SJ, Ha K, Cho HS. Behavioral and Electrophysiological Alterations for Reinforcement Learning in Manic and Euthymic Patients with Bipolar Disorder. CNS Neurosci Ther 2017; 23:248-256. [PMID: 28098430 DOI: 10.1111/cns.12671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 12/28/2022] Open
Abstract
AIMS Bipolar disorder is characterized by behavioral changes such as risk-taking and increasing goal-directed activities, which may result from altered reward processing. Patients with bipolar disorder show impaired reward learning in situations that require the integration of reinforced feedback over time. In this study, we examined the behavioral and electrophysiological characteristics of reward learning in manic and euthymic patients with bipolar disorder using a probabilistic reward task. METHODS Twenty-four manic and 20 euthymic patients with bipolar I disorder and 24 healthy control subjects performed the probabilistic reward task. We assessed response bias (RB) as a preference for the stimulus paired with the more frequent reward and feedback-related negativity (FRN) to correct identification of the rich stimulus. RESULTS Both manic and euthymic patients showed significantly lower RB scores in the early learning stage (block 1) in comparison with the late learning stage (block 2 or block 3) of the task, as well as significantly lower RB scores in the early stage compared to healthy subjects. Relatively more negative FRN amplitude is elicited by no presentation of an expected reward, compared to that elicited by presentation of expected feedback. The FRN became significantly more negative from the early (block 1) to the later stages (blocks 2 and 3) in both manic and euthymic patients, but not in healthy subjects. Changes in RB scores and FRN amplitudes between blocks 2 and 3 and block 1 correlated positively in healthy controls, but correlated negatively in manic and euthymic patients. The severity of manic symptoms correlated positively with reward learning scores and negatively with the FRN. CONCLUSIONS These findings suggest that patients with bipolar disorder during euthymic or manic states have behavioral and electrophysiological alterations in reward learning compared to healthy subjects. This dysfunctional reward processing may be related to the abnormal decision-making or altered goal-directed activities frequently seen in patients with bipolar disorder.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Ra Yeon Ha
- Department of Psychiatry, Seoul Bukbu Hospital, Seoul, South Korea
| | - Su Jin Lee
- Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, South Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hyun-Sang Cho
- Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, South Korea.,Department of Psychiatry, College of Medicine, Yonsei University, Seoul, South Korea
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18
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Stenberg G. Impulse Control Disorders - The Continuum Hypothesis. JOURNAL OF PARKINSONS DISEASE 2017; 6:67-75. [PMID: 27031861 DOI: 10.3233/jpd-150770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The group Parkinson Inside Out is composed of health professionals and academic researchers who have been diagnosed with Parkinson's Disease. In our discussions we try to make use of both our inside perspective as patients, and our outside perspective as professionals. In this paper, we apply the two perspectives to the Impulse Control Disorders. These impulsive behaviour patterns are thought to be relatively uncommon side effects of some of the medication used in dopamine replacement therapy. The phenomenon is usually described as relatively rare (<15%), and mainly confined to patients with special vulnerabilities. In contrast, we propose that having some problems with controlling impulses is a very common experience for patients undergoing dopamine replacement therapy. They result from difficulties in decision making engendered by variations in dopamine accessibility in the reward centre of the brain. Only in a minority do the consequences grow to the damaging proportions of a disorder, but most patients are probably affected to some degree. Seeing, and measuring, decision difficulties as a continuous dimension, rather than as a discrete category, brings increased possibilities for early detection and continuous monitoring. With reliable measures of the propensity for impulsive decision making, it may become possible to both reap the benefits and avoid the dangers of the dopamine agonists. We point to ways of empirically testing our continuity hypothesis.
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19
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Douglas KM, Van Rheenen TE. Current Treatment Options for Cognitive Impairment in Bipolar Disorder: a Review. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40501-016-0092-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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20
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Malhi GS, Byrow Y, Fritz K, Das P, Baune BT, Porter RJ, Outhred T. Mood disorders: neurocognitive models. Bipolar Disord 2015; 17 Suppl 2:3-20. [PMID: 26688287 DOI: 10.1111/bdi.12353] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES In recent years, a number of neurocognitive models stemming from psychiatry and psychology schools of thought have conceptualized the pathophysiology of mood disorders in terms of dysfunctional neural mechanisms that underpin and drive neurocognitive processes. Though these models have been useful for advancing our theoretical understanding and facilitating important lines of research, translation of these models and their application within the clinical arena have been limited-partly because of lack of integration and synthesis. Cognitive neuroscience provides a novel perspective for understanding and modeling mood disorders. This selective review of influential neurocognitive models develops an integrative approach that can serve as a template for future research and the development of a clinically meaningful framework for investigating, diagnosing, and treating mood disorders. METHODS A selective literature search was conducted using PubMed and PsychINFO to identify prominent neurobiological and neurocognitive models of mood disorders. RESULTS Most models identify similar neural networks and brain regions and neuropsychological processes in the neurocognition of mood, however, they differ in terms of specific functions attached to neural processes and how these interact. Furthermore, cognitive biases, reward processing and motivation, rumination, and mood stability, which play significant roles in the manner in which attention, appraisal, and response processes are deployed in mood disorders, are not sufficiently integrated. The inclusion of interactions between these additional components enhances our understanding of the etiology and pathophysiology of mood disorders. CONCLUSIONS Through integration of key cognitive functions and understanding of how these interface with neural functioning within neurocognitive models of mood disorders, a framework for research can be created for translation to diagnosis and treatment of mood disorders.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Yulisha Byrow
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Kristina Fritz
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Tim Outhred
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.,Sydney Medical School Northern, The University of Sydney, NSW 2006, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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Orsini CA, Moorman DE, Young JW, Setlow B, Floresco SB. Neural mechanisms regulating different forms of risk-related decision-making: Insights from animal models. Neurosci Biobehav Rev 2015; 58:147-67. [PMID: 26072028 DOI: 10.1016/j.neubiorev.2015.04.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/13/2015] [Accepted: 04/24/2015] [Indexed: 11/18/2022]
Abstract
Over the past 20 years there has been a growing interest in the neural underpinnings of cost/benefit decision-making. Recent studies with animal models have made considerable advances in our understanding of how different prefrontal, striatal, limbic and monoaminergic circuits interact to promote efficient risk/reward decision-making, and how dysfunction in these circuits underlies aberrant decision-making observed in numerous psychiatric disorders. This review will highlight recent findings from studies exploring these questions using a variety of behavioral assays, as well as molecular, pharmacological, neurophysiological, and translational approaches. We begin with a discussion of how neural systems related to decision subcomponents may interact to generate more complex decisions involving risk and uncertainty. This is followed by an overview of interactions between prefrontal-amygdala-dopamine and habenular circuits in regulating choice between certain and uncertain rewards and how different modes of dopamine transmission may contribute to these processes. These data will be compared with results from other studies investigating the contribution of some of these systems to guiding decision-making related to rewards vs. punishment. Lastly, we provide a brief summary of impairments in risk-related decision-making associated with psychiatric disorders, highlighting recent translational studies in laboratory animals.
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Affiliation(s)
- Caitlin A Orsini
- Department of Psychiatry and Center for Addiction Research and Education, University of Florida College of Medicine, Gainesville, FL, United States
| | - David E Moorman
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, United States; VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, CA, United States
| | - Barry Setlow
- Department of Psychiatry and Center for Addiction Research and Education, University of Florida College of Medicine, Gainesville, FL, United States
| | - Stan B Floresco
- Department of Psychology and Brain Research Center, University of British Columbia, Vancouver, BC, Canada.
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22
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Oswald LM, Wand GS, Wong DF, Brown CH, Kuwabara H, Brašić JR. Risky decision-making and ventral striatal dopamine responses to amphetamine: a positron emission tomography [(11)C]raclopride study in healthy adults. Neuroimage 2015; 113:26-36. [PMID: 25795343 PMCID: PMC4433778 DOI: 10.1016/j.neuroimage.2015.03.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/05/2015] [Accepted: 03/10/2015] [Indexed: 02/06/2023] Open
Abstract
Recent functional magnetic resonance imaging (fMRI) studies have provided compelling evidence that corticolimbic brain regions are integrally involved in human decision-making. Although much less is known about molecular mechanisms, there is growing evidence that the mesolimbic dopamine (DA) neurotransmitter system may be an important neural substrate. Thus far, direct examination of DA signaling in human risk-taking has centered on gambling disorder. Findings from several positron emission tomography (PET) studies suggest that dysfunctions in mesolimbic DA circuits may play an important role in gambling behavior. Nevertheless, interpretation of these findings is currently hampered by a need for better understanding of how individual differences in regional DA function influence normative decision-making in humans. To further our understanding of these processes, we used [(11)C]raclopride PET to examine associations between ventral striatal (VS) DA responses to amphetamine (AMPH) and risky decision-making in a sample of healthy young adults with no history of psychiatric disorder, Forty-five male and female subjects, ages 18-29 years, completed a computerized version of the Iowa Gambling Task. Participants then underwent two 90-minute PET studies with high specific activity [(11)C]raclopride. The first scan was preceded by intravenous saline; the second, by intravenous AMPH (0.3mg/kg). Findings of primary analyses showed that less advantageous decision-making was associated with greater right VS DA release; the relationship did not differ as a function of gender. No associations were observed between risk-taking and left VS DA release or baseline D2/D3 receptor availability in either hemisphere. Overall, the results support notions that variability in striatal DA function may mediate inter-individual differences in risky decision-making in healthy adults, further suggesting that hypersensitive DA circuits may represent a risk pathway in this population.
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Affiliation(s)
- Lynn M Oswald
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Gary S Wand
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Dean F Wong
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Environmental Health Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Hiroto Kuwabara
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - James R Brašić
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Motivational Deficits in Schizophrenia and the Representation of Expected Value. Curr Top Behav Neurosci 2015; 27:375-410. [PMID: 26370946 DOI: 10.1007/7854_2015_385] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Motivational deficits (avolition and anhedonia) have historically been considered important negative symptoms of schizophrenia (SZ). Numerous studies have attempted to identify the neural substrates of avolition and anhedonia in schizophrenia , but these studies have not produced much agreement. Deficits in various aspects of reinforcement processing have been observed in individuals with schizophrenia, but it is not exactly clear which of these deficits actually engender motivational impairments in SZ. The purpose of this chapter is to examine how various reinforcement-related behavioral and neural signals could contribute to motivational impairments in both schizophrenia and psychiatric illness, in general. In particular, we describe different aspects of the concept of expected value (EV), such as the distinction between the EV of stimuli and the expected value of actions, the acquisition of value versus the estimation of value, and the discounting of value as a consequence of time or effort required. We conclude that avolition and anhedonia in SZ are most commonly tied to aberrant signals for expected value, in the context of learning. We discuss implications for further research on the neural substrates of motivational impairments in psychiatric illness.
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Abstract
PURPOSE OF REVIEW This article reviews the recent literature on reward processing dysfunction in major depression (MDD), bipolar disorder and schizophrenia, with a focus on approach motivation, reward learning and reward-based decision-making. RECENT FINDINGS Emerging evidence indicates the presence of reward processing abnormalities across all three disorders, supporting a transdiagnostic approach. In particular, findings are consistent with a role of abnormal phasic striatal dopamine signaling, which is critical for reinforcement learning, efficient mobilization of effort to obtain reward and allocation of attention to reward-predictive cues. Specifically, reward-related striatal signaling appears blunted in MDD and the negative symptoms of schizophrenia, elevated in bipolar (hypo)mania, and contextually misallocated in the positive symptoms of psychosis. However, whether shared or distinct pathophysiological mechanisms contribute to abnormal striatal signaling across the three disorders remains unknown. SUMMARY New evidence of reward processing abnormalities in MDD, bipolar disorder and schizophrenia has led to a greater understanding of the neural processes associated with symptomatology common across these conditions (e.g., anhedonia). Dissecting various subcomponents of reward processing that map onto partially different neurobiological pathways and investigating their dysregulation in different psychiatric disorders holds promise for developing more targeted, and hopefully efficacious treatment and intervention strategies.
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Brown EC, Hack SM, Gold JM, Carpenter WT, Fischer BA, Prentice KP, Waltz JA. Integrating frequency and magnitude information in decision-making in schizophrenia: An account of patient performance on the Iowa Gambling Task. J Psychiatr Res 2015; 66-67:16-23. [PMID: 25959618 PMCID: PMC4458199 DOI: 10.1016/j.jpsychires.2015.04.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/02/2015] [Accepted: 04/09/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The Iowa Gambling Task (IGT; Bechara et al., 1994) has frequently been used to assess risky decision making in clinical populations, including patients with schizophrenia (SZ). Poor performance on the IGT is often attributed to reduced sensitivity to punishment, which contrasts with recent findings from reinforcement learning studies in schizophrenia. METHODS In order to investigate possible sources of IGT performance deficits in SZ patients, we combined data from the IGT from 59 SZ patients and 43 demographically-matched controls with data from the Balloon Analog Risk Task (BART) in the same participants. Our analyses sought to specifically uncover the role of punishment sensitivity and delineate the capacity to integrate frequency and magnitude information in decision-making under risk. RESULTS Although SZ patients, on average, made more choices from disadvantageous decks than controls did on the IGT, they avoided decks with frequent punishments at a rate similar to controls. Patients also exhibited excessive loss-avoidance behavior on the BART. CONCLUSIONS We argue that, rather than stemming from reduced sensitivity to negative consequences, performance deficits on the IGT in SZ patients are more likely the result of a reinforcement learning deficit, specifically involving the integration of frequencies and magnitudes of rewards and punishments in the trial-by-trial estimation of expected value.
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Affiliation(s)
- Elliot C Brown
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samantha M Hack
- Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA
| | - James M Gold
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William T Carpenter
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Bernard A Fischer
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Kristen P Prentice
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James A Waltz
- Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
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van Enkhuizen J, Henry BL, Minassian A, Perry W, Milienne-Petiot M, Higa KK, Geyer MA, Young JW. Reduced dopamine transporter functioning induces high-reward risk-preference consistent with bipolar disorder. Neuropsychopharmacology 2014; 39:3112-22. [PMID: 25005251 PMCID: PMC4229584 DOI: 10.1038/npp.2014.170] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 11/10/2022]
Abstract
Individuals with bipolar disorder (BD) exhibit deleterious decision making, negatively impacting their lives. Such aberrant decision making can be quantified using the Iowa Gambling Task (IGT), which requires choosing between advantageous and disadvantageous options based on different reward/punishment schedules. The mechanisms underlying this behavioral deficit are unknown, but may include the reduced dopamine transporter (DAT) functioning reported in BD patients. Using both human and mouse IGTs, we tested whether reduced DAT functioning would recreate patterns of deficient decision making of BD patients. We assessed the IGT performance of 16 BD subjects (7 female) and 17 healthy control (HC) subjects (12 female). We recorded standard IGT performance measures and novel post-reward and post-punishment decision-making strategies. We characterized a novel single-session mouse IGT using C57BL/6J mice (n = 44). The BD and HC IGT performances were compared with the effects of chronic (genetic knockdown (KD; n = 31) and wild-type (n = 28) mice) and acute (C57BL/6J mice (n = 89) treated with the DAT inhibitor GBR12909) reductions of DAT functioning in mice performing this novel IGT. BD patients exhibited impaired decision making compared with HC subjects. Both the good-performing DAT KD and GBR12909-treated mice exhibited poor decision making in the mouse IGT. The deficit of each population was driven by high-reward sensitivity. The single-session mouse IGT measures dynamic risk-based decision making similar to humans. Chronic and acute reductions of DAT functioning in mice impaired decision-making consistent with poor IGT performance of BD patients. Hyperdopaminergia caused by reduced DAT may impact poor decision making in BD patients, which should be confirmed in future studies.
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Affiliation(s)
- Jordy van Enkhuizen
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Brook L Henry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - William Perry
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Morgane Milienne-Petiot
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kerin K Higa
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Research Service, VA San Diego Healthcare System, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA 92093-0804, USA, Tel: +1 619 543 3582, Fax: +1 619 735 9205, E-mail:
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