Neuropsychological and conditioned blocking performance in patients with schizophrenia: assessment of the contribution of neuroleptic dose, serum levels and dopamine D2-receptor occupancy

The prediction-error hypothesis of schizophrenia: new data point to circuit-specific changes in dopamine activity

Schizophrenia is a severe psychiatric disorder affecting 21 million people worldwide. People with schizophrenia suffer from symptoms including psychosis and delusions, apathy, anhedonia, and cognitive deficits. Strikingly, schizophrenia is characterised by a learning paradox involving difficulties learning from rewarding events, whilst simultaneously 'overlearning' about irrelevant or neutral information. While dysfunction in dopaminergic signalling has long been linked to the pathophysiology of schizophrenia, a cohesive framework that accounts for this learning paradox remains elusive. Recently, there has been an explosion of new research investigating how dopamine contributes to reinforcement learning, which illustrates that midbrain dopamine contributes in complex ways to reinforcement learning, not previously envisioned. This new data brings new possibilities for how dopamine signalling contributes to the symptomatology of schizophrenia. Building on recent work, we present a new neural framework for how we might envision specific dopamine circuits contributing to this learning paradox in schizophrenia in the context of models of reinforcement learning. Further, we discuss avenues of preclinical research with the use of cutting-edge neuroscience techniques where aspects of this model may be tested. Ultimately, it is hoped that this review will spur to action more research utilising specific reinforcement learning paradigms in preclinical models of schizophrenia, to reconcile seemingly disparate symptomatology and develop more efficient therapeutics.

Classics in Chemical Neuroscience: Chlorpromazine

The discovery of chlorpromazine in the early 1950s revolutionized the clinical treatment of schizophrenia, galvanized the development of psychopharmacology, and standardized protocols used for testing the clinical efficacy of antipsychotics. Furthermore, chlorpromazine expanded our understanding of the role of chemical messaging in neurotransmission and reduced the stigma associated with mental illness, facilitating deinstitutionalization in the 1960s and 1970s. In this review, we will discuss the synthesis, manufacturing, metabolism and pharmacokinetics, pharmacology, structure-activity relationship, and adverse effects of chlorpromazine. In conclusion, we summarize the history and significant contributions of chlorpromazine that have resulted in this potent first-generation antipsychotic maintaining its clinical relevance for nearly 70 years.

Irrelevance by inhibition: Learning, computation, and implications for schizophrenia

Symptoms of schizophrenia may arise from a failure of cortical circuits to filter-out irrelevant inputs. Schizophrenia has also been linked to disruptions in cortical inhibitory interneurons, consistent with the possibility that in the normally functioning brain, these cells are in some part responsible for determining which sensory inputs are relevant versus irrelevant. Here, we develop a neural network model that demonstrates how the cortex may learn to ignore irrelevant inputs through plasticity processes affecting inhibition. The model is based on the proposal that the amount of excitatory output from a cortical circuit encodes the expected magnitude of reward or punishment ("relevance"), which can be trained using a temporal difference learning mechanism acting on feedforward inputs to inhibitory interneurons. In the model, irrelevant and blocked stimuli drive lower levels of excitatory activity compared with novel and relevant stimuli, and this difference in activity levels is lost following disruptions to inhibitory units. When excitatory units are connected to a competitive-learning output layer with a threshold, the relevance code can be shown to "gate" both learning and behavioral responses to irrelevant stimuli. Accordingly, the combined network is capable of recapitulating published experimental data linking inhibition in frontal cortex with fear learning and expression. Finally, the model demonstrates how relevance learning can take place in parallel with other types of learning, through plasticity rules involving inhibitory and excitatory components, respectively. Altogether, this work offers a theory of how the cortex learns to selectively inhibit inputs, providing insight into how relevance-assignment problems may emerge in schizophrenia.

Chronic nicotine interactions with clozapine and risperidone and attentional function in rats

Although antipsychotic drugs are therapeutically effective in attenuating the hallmark symptoms of schizophrenia, these improvements do not return most patients to normative standards of cognitive function. Thus, complementary drug treatment may be needed to treat the attentional deficits of schizophrenia as well as to counteract the potential attentional impairments caused by some antipsychotic drugs. Nicotine, a drug commonly self-administered by a great majority of individuals with schizophrenia, has been shown to significantly improve cognitive function in some studies. The current study was conducted to determine the interactive effects of the atypical antipsychotic drugs clozapine and risperidone with chronic nicotine administration on attentional performance. Adult female Sprague-Dawley rats (N=35) were trained to perform an attentional task using an operant visual signal detection task. After training, rats were infused with a dose of 5 mg/kg/day (s.c.) nicotine base (n=18) or saline (n=17) for 28 consecutive days via osmotic pump. In Exp. 1, while being administered chronic nicotine or saline, rats were given acute doses of clozapine (0, 0.625, 1.25 and 2.5 mg/kg, s.c.) and were tested for attentional function. In Exp. 2, while on chronic nicotine or saline, other rats were challenged with acute doses of risperidone (0, 0.025, 0.05 and 0.1 mg/kg, s.c.) and were tested for attentional function. Results showed that acute administration of clozapine caused a significant dose-dependent impairment in choice accuracy (percent hit) in animals treated with chronic saline. Chronic nicotine treatment itself lowered accuracy, but attenuated further declines with acute clozapine treatment. Acute administration of risperidone at high dose significantly reduced performance (percent correct rejection) in chronically saline-treated rats, but in a similar fashion as in Exp. 1, chronic nicotine lowered accuracy but attenuated further impairment with acute risperidone. In summary, atypical antipsychotic drugs clozapine and risperidone significantly impaired choice accuracy in the visual signal detection task. Clozapine was more detrimental than risperidone but the adverse effects of both clozapine and risperidone on attentional performance were masked in rats chronically treated with nicotine.

Neuropsychological measures of attention and memory function in schizophrenia: relationships with symptom dimensions and serum monoamine activity

BACKGROUND

Some clinical symptoms or cognitive functions have been related to the overall state of monoamine activity in patients with schizophrenia, (e.g. inverse correlation of the dopamine metabolite HVA with delusions or visual-masking performance). However, profiles (as presented here) of the relations of the activity of dopamine, noradrenaline and serotonin to neuropsychologic (dys)functions in major patient sub-groups with their very different symptomatic and cognitive characteristics have not been reported.

METHODS

Serum measures of dopamine, noradrenaline and serotonin turnover were examined by regression analyses for the prediction of performance on 10 neuropsychological measures reflecting left- and right-hemispheric and frontal-, parietal- and temporal-lobe function in 108 patients with schizophrenia and 63 matched controls. The neuropsychological battery included tests of verbal fluency, Stroop interference, trail-making, block-design, Mooney faces recognition, picture-completion, immediate and delayed visual and verbal recall. Paranoid and nonparanoid subgroups were based on ratings from the Positive and Negative Syndrome Scale (PANSS). Groups with high and low ratings of ideas-of-reference and thought-disorder were formed from a median split on the Scale for Assessment of Positive Symptoms (SAPS).

RESULTS

Verbal-fluency and Stroop-interference (left frontal and fronto-cingulate function) were negatively associated with noradrenergic turnover in nonparanoid and thought-disordered patients. High dopamine turnover related to speeded trail-making (frontal modulation of set switching) in those with many ideas-of-reference. In contrast, low dopamine turnover predicted poor recall in nonparanoid patients and those with little thought disorder. Serotonin metabolism did not independently contribute to the prediction any measure of cognitive performance. But, with regard to the relative activity between monoaminergic systems, increased HVA/5-HIAA ratios predicted visual-reproduction and Mooney's face-recognition performance (right-hemisphere functions) in highly symptomatic patients. Decreased HVA/MHPG predicted non-verbal recall.

CONCLUSION

Clinical state and function are differentially sensitive to overall levels of monoamine activity. In particular, right-lateralised cerebral function was sensitive to the relative activities of the monoamines. Increased noradrenergic activity was associated with enhanced frontal but impaired temporal lobe function in nonparanoid syndromes. Low dopaminergic activity predicted poor attentional set control in those with ideas-of-reference, but poor recall in nonparanoid patients. These data, especially the HVA/5-HIAA ratios, provide a basis for planning the nature of antipsychotic treatment aimed at patient specific symptom dimensions and cognitive abilities.

The effect of sulpiride on amphetamine-induced disruption of overshadowing in the rat

Previous studies have demonstrated dopaminergic (DA) modulation of stimulus selection performance in the overshadowing and Kamin blocking (KB) tasks. Systemic administration of the DA agonist D-amphetamine selectively disrupted overshadowing in the rat. In the present study, we examined the ability of the selective DA D2 receptor antagonist sulpiride to reverse amphetamine-induced disruption of overshadowing, in the conditioned emotional response (CER) procedure. In the overshadowing task, two stimuli (light and tone) are presented simultaneously alongside an aversive unconditioned stimulus (CS) (mild footshock); overshadowing consists in the decrease in learning to the less salient stimulus, as compared to when it is conditioned alone. Systemic D-amphetamine (1 mg/kg, i.p.) prevented overshadowing, while having no effect on control learning. Pre-administration of sulpiride (50 and 100 mg/kg, i.p.) did not prevent the ability of D-amphetamine to impair overshadowing. In addition, sulpiride had no significant effect on overshadowing when administered alone. The results are in agreement with previous data indicating that DA modulation of stimulus selection performance is mediated by activation of the DA D1 rather than DA D2 receptor subtype.

Nicotine–antipsychotic drug interactions and attentional performance in female rats

Schizophrenia is marked by pronounced cognitive impairments in addition to the hallmark psychotic symptoms like hallucinations. Antipsychotic drugs can effectively reduce these hallucinations; however, the drugs have not resolved the cognitive impairment. Interestingly, nicotine, a drug commonly self-administered by people with schizophrenia, has been shown to significantly improve cognitive function of people with schizophrenia. The current study was conducted to determine the effect of typical (haloperidol) and atypical (clozapine and risperidone) antipsychotic drug treatment on sustained attention in rats performing a visual signal detection task. In addition, the interaction of haloperidol with chronic nicotine administration was assessed. Female Sprague-Dawley rats were injected subcutaneously with clozapine (0, 0.6, 1.25 and 2.5 mg/kg), risperidone (0, 0.025, 0.05 and 0.1 mg/kg) or haloperidol (0, 0.01, 0.02 and 0.04 mg/kg). In the second part of the study, the interaction of acute haloperidol (0, 0.005, 0.01 and 0.02 mg/kg) and chronic nicotine (5 mg/kg/day, for 4 weeks via osmotic minipump) was characterized. Clozapine, risperidone and haloperidol all caused dose-related impairments in percent hit performance. There was a significant linear dose-related impairment in percent hit caused by risperidone. All the doses of clozapine caused a significant impairment in percent hit at the higher luminance intensities in the visual signal detection task. The 0.01 and 0.02 mg/kg haloperidol doses caused significant decreases in percent hit. The 0.04 mg/kg haloperidol dose impaired performance of the task to the point that reliable choice accuracy measurements could not be made. Chronic nicotine infusion significantly diminished the impairing effects of haloperidol on performance during weeks 1-2. In summary, both typical and atypical antipsychotic drugs significantly impaired sustained attention in rats. Haloperidol was more detrimental than clozapine and risperidone. Chronic nicotine diminished the adverse effects of haloperidol on performance. This study establishes a paradigm to reliably determine the attentional impairment caused by antipsychotic drugs.

An investigation into age and gender differences in human Kamin blocking, using a computerized task

Kamin blocking (KB) is a function within selective attention found to be deficient in schizophrenia. Disparate results in the KB literature, specifically regarding age and gender effects, suggest that we do not yet have a comprehensive understanding of KB in normal human development. The aim of this study is to provide a thorough investigation into the development and occurrence of KB in a normal population. The design replicated and extended a study by Oades, Roepcke, and Schepker (1996). KB is measured using a computer game called the "mouse in the house." Participants must use a joystick to move an icon around a set floor plan, to find a hidden location. These locations are cued by sets of colors, which denote the KB paradigm. Data was collected on 222 participants across 5 age groups (6-8 years; 9-12 years; 13-17 years; 18-21 years; 22+ years). Comparisons were carried out for age and gender effects. KB was observed in all age groups, but there was no significant effect of age on mean KB score. A measure of frequency of participants who showed KB did show a significant increase with age. A significant difference was found between males and females, with females having higher KB score than males. The gender difference was present from the earliest age tested. Our findings suggest significant age and gender differences in the manifestation of selective attention and information processing abilities. This has implications for understanding the development of attention and the understanding of the age and gender dependence of the development of schizophrenia.

Reduced Kamin blocking in non paranoid schizophrenia: associations with schizotypy

Kamin blocking (KB) is an attentional phenomenon whereby prior learning about a stimulus (A) retards learning about a new stimulus (B) when later presented in compound (AB) with the original stimulus A. KB has been shown to be reduced in patients with schizophrenia. Using Oades' KB paradigm it has been suggested that drug treatment may influence the expression of KB abnormalities in patients. It is therefore unclear whether Reduced KB are due to drug treatment or to the illness itself. One experimental approach that circumvents drug treatment confounds is to study schizotypal traits in healthy volunteers. In the present study we investigated KB using the Oades paradigm in 27 healthy volunteers and 21 schizophrenic patients. We additionally investigated the relationship between KB performance and measures of schizotypal traits and a number of factors relevant to the experience of schizophrenia using the O-LIFE questionnaire. Our results indicate first a clear negative relationship between general schizotypy and more specifically, Unusual experiences (UNEX) and cognitive disorganisation (COGDIS) and KB performance. This relationship was qualitatively and quantitatively similar in both healthy volunteers and schizophrenic patients. Second we have independently replicated reduced KB in non-paranoid patients and no change in KB in paranoid patients using the Oades KB task. This study also confirms that reduced KB in non-paranoid patients is confined to early test trials (3-4) while the negative relationships with schizotypy scales UNEX and COGDIS that we have found are also confined to these early test trials confirming the psychological relevance of this specificity.

Effect of AD-5423 on animal models of schizophrenia: phencyclidine-induced behavioral changes in mice

The antipsychotic efficacy of AD-5423, which has the properties of both a serotonin 5-HT(2) and a dopamine D(2) receptor antagonist, was evaluated using animal models of schizophrenia. Sensitization to phencyclidine (PCP)-induced hyperlocomotion is considered a model of the positive symptoms of schizophrenia, and was significantly antagonized by AD-5423 and haloperidol. The PCP-induced enhancement of immobility induced by the forced swimming test, a model of the negative symptoms of schizophrenia, was attenuated by AD-5423 but not by haloperidol. Since this attenuated effect of AD-5423 was antagonized by DOI, a serotonin 5-HT(2) receptor agonist, it is postulated to be mediated by serotonin 5-HT(2) receptors. These findings suggest that AD-5423 would be clinically effective against both the positive and negative symptoms of schizophrenia.

Evidence for the involvement of dopamine in ambulation promoted by menthol in mice

The present study examines the mechanism that underlies the ability of menthol (ME), a major constituent of peppermint oil, to promote mouse ambulation. We initially confirmed that bupropion (BUP), a dopamine (DA) uptake inhibitor, promotes ambulation in ICR mice. Since the subcutaneous administration of ME produced similar effects in mice, we investigated the effects of ME on ambulation when combined with BUP. The results showed that BUP potentiated the effect of ME on mouse ambulation. We then examined effects of the DA antagonists chlorpromazine, haloperidol, fluphenazine, spiperone, and SCH12679 on the ability of BUP and ME to promote ambulation. All of these DA antagonists attenuated the effects of BUP and ME. Prior exposure to reserpine, which depletes monoamines, caused decreased sensitivity to the ability of BUP and of ME in promoting ambulation. The tyrosine hydroxylase inhibitor alpha-methyl-p-tyrosine, similarly decreased subsequent sensitivity to the effects of BUP and ME. These results suggest that DA is involved in the abilities of ME and BUP to promote ambulation in mice.

Associative deficit accounts of disrupted latent inhibition and blocking in schizophrenia

Latent inhibition (attenuated responding to a signal due to signal-alone presentations preceding the signal-outcome pairings) and blocking (attenuated responding to Signal B due to Signal A being paired with the outcome prior to pairings of an AB compound with the outcome) are reportedly absent in acute schizophrenics. The common assumption that these phenomena reflect the normal functioning of attention and the observation that rats administered low doses of amphetamine show a similar disruption has resulted in the development of an animal model of attentional dysfunction in acute schizophrenia. Here, we selectively review the experimental and clinical literature concerning latent inhibition and blocking, their disruption in acute schizophrenia, and the current status of this model. We conclude that the construct validity of the model is compromised if latent inhibition and blocking are viewed in attentional terms because experimental data indicate both phenomena can be better understood in associative terms. We favor a framework in which disruption of latent inhibition and blocking in acute schizophrenics is viewed as an inability to compare and express stored representations (i.e. associative performance deficit). This change of perspective does not undermine the potential value of the model, but rather suggests that the nature of its validity should be reconsidered.

Relations of clinical features, subgroups and medication to serum monoamines in schizophrenia

BACKGROUND

Plasma and serum indices of monoaminergic activity reflect partly the illness of schizophrenia (e.g. HVA/deficit syndrome) and sometimes the symptoms (e.g. HVA/anhedonia). But, such studies have rarely taken both metabolites and parent amines or inter-amine activity ratios into account. We hypothesized that comparing the major symptom dimensions to measures of transmitter activity (with and without control for antipsychotic drug treatment) would show differential patterns of activity useful for the design of pharmacological treatments.

METHODS

Dopamine (DA), noradrenaline (NA), serotonin (5-HT), their three major metabolites and prolactin were measured in the serum of 108 patients with schizophrenia and 63 matched controls: DA D2-receptor blocking-activity was estimated from a regression of butyrophenone displacement in striatum in vitro on to PET reports of drug-binding in vivo. Symptoms were factored into four dimensions (disorganized/thought disorder, nonparanoid/negative, ideas-of-reference and paranoid/positive symptoms).

RESULTS

(1). Patients' DA activity did not differ from controls: but their 5-HT and NA turnovers increased/decreased, respectively, and the DA/5HT-metabolite ratio was lower. Increased DA-D2-receptor occupancy was predicted by decreased DA-metabolism and its ratio to 5-HT-metabolism. (2). Patients had higher levels of NA, DA-metabolites and DA-/5-HT-metabolite ratios on atypical vs typical drugs. (3). Increased D2-occupancy was associated with lower DA metabolism in paranoid patients but was unrelated to relative increases of DA/5-HT- and NA-metabolism in nonparanoid patients. (4). Low DA-/5-HT-metabolite ratios, high prolactin and low DA-metabolism characterized thought-disordered patients. (5). High DA-/5-HT-metabolite ratios paralleled many ideas-of-reference. The metabolites were sensitive, respectively, to control for D2-occupancy and prolactin.

CONCLUSIONS

The role of DA in paranoid, and 5-HT in thought-disordered and ideas-of-reference dimensions point both to the mechanisms underlying the features typical of these subgroups and the type of medication appropriate.