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McCunn P, Chen X, Gimi B, Green AI, Khokhar JY. Glutamine and GABA alterations in cingulate cortex may underlie alcohol drinking in a rat model of co-occurring alcohol use disorder and schizophrenia: an 1H-MRS study. Schizophrenia (Heidelb) 2022; 8:67. [PMID: 35999232 PMCID: PMC9399110 DOI: 10.1038/s41537-022-00272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
Alcohol use disorder commonly occurs in patients with schizophrenia and significantly worsens the clinical course of the disorder. The neurobiological underpinnings of alcohol drinking are not well understood. Magnetic resonance spectroscopy (MRS) has been used to assess the neurochemical substrates that may be associated with alcohol drinking in patients; however, the causal impact of these findings remains elusive, highlighting the need for studies in animal models. This study performed MRS in the neonatal ventral hippocampal lesioned (NVHL) rat model, a model of co-occurring schizophrenia and substance use disorders. NVHL lesions (or sham surgeries) were performed on post-natal day 7 and animals were given brief exposure to alcohol during adolescence (10% v/v in a 2-bottle choice design). Animals were re-exposed to alcohol during adulthood (20% v/v) until a stable drinking baseline was established, and then forced into abstinence to control for the effects of differential alcohol drinking. Animals were scanned for MRS after one month of abstinence. NVHL rats consumed significantly more alcohol than sham rats and in the cingulate cortex showed significantly higher levels of GABA and glutamine. Significantly lower GABA levels were observed in the nucleus accumbens. No differences between the NVHL and sham animals were observed in the hippocampus. Correlation analysis revealed that GABA and glutamine concentrations in the cingulate cortex significantly correlated with the rats' alcohol drinking prior to 30 days of forced abstinence. These findings suggest that a potential dysfunction in the glutamate/GABA-glutamine cycle may contribute to alcohol drinking in a rat model of schizophrenia, and this dysfunction could be targeted in future treatment-focused studies.
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Affiliation(s)
- Patrick McCunn
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Xi Chen
- Department of Radiology, Biomedical NMR Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Barjor Gimi
- Department of Radiology, Biomedical NMR Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jibran Y Khokhar
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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Brunette MF, Correll CU, O'Malley SS, McDonnell D, DiPetrillo L, Jiang Y, Simmons A, Silverman BL, Citrome L, Green AI. Olanzapine Plus Samidorphan (ALKS 3831) in Schizophrenia and Comorbid Alcohol Use Disorder: A Phase 2, Randomized Clinical Trial. J Clin Psychiatry 2020; 81. [PMID: 32160422 DOI: 10.4088/jcp.19m12786] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/23/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a common comorbidity of schizophrenia. No effective pharmacologic treatment is available for both disorders to date. METHODS In a phase 2, double-blind study, patients with schizophrenia and AUD experiencing ≥ 10 drinking and ≥ 2 heavy-drinking days in the previous month and recent (≤ 6 mo) disease symptom exacerbation were recruited between June 2014 and March 2017. DSM-IV-TR and DSM-5 criteria were used to assign the diagnoses of schizophrenia and AUD, respectively. After a 6-week lead-in period, 234 eligible patients were randomized (1:1) to olanzapine + 10 mg samidorphan tablets (OLZ/SAM) or olanzapine + placebo tablets (olanzapine) for 36-60 weeks of treatment. The primary outcome of time to the first event of exacerbation of disease symptoms (EEDS) was evaluated using the log rank test for treatment comparison, and the Cox proportional-hazards model was used to estimate hazard ratio. Safety was assessed as adverse events and laboratory measures. RESULTS No significant difference was observed between groups in the time to first EEDS (hazard ratio = 0.91; 95% CI, 0.53-1.56; P = .746). Patients treated with OLZ/SAM vs olanzapine had numerically lower rates in 6 of 8 criteria to evaluate EEDS. Change from baseline in percentage of heavy-drinking days during the double-blind treatment period was similar in OLZ/SAM- vs olanzapine-treated patients. OLZ/SAM was generally well tolerated with a safety profile similar to olanzapine. CONCLUSIONS OLZ/SAM was not superior to olanzapine in the time to EEDS and was well tolerated in patients with schizophrenia and AUD. Further research is needed to identify effective treatments for this difficult-to-treat population. TRIAL REGISTRATIONS ClinicalTrials.gov identifier: NCT02161718; EudraCT number: 2014-001211-39 .
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. .,Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Christoph U Correll
- Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | | - Ying Jiang
- Alkermes, Inc, Waltham, Massachusetts, USA
| | | | | | | | - Alan I Green
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Abstract
Schizophrenia and schizoaffective disorder are schizophrenia spectrum disorders that cause significant disability. Among individuals who have schizophrenia or schizoaffective disorder, alcohol use disorder (AUD) is common, and it contributes to worse outcomes than for those who do not have co-occurring substance use disorder. Common neurobiological mechanisms, including dysfunction in brain reward circuitry, may explain the high rates of co-occurrence of schizophrenia and AUD or other substance use disorders. Optimal treatment combines pharmacologic intervention and other therapeutic modalities to address both the psychotic disorder and AUD. Further research on the etiology of these co-occurring disorders and on treatment of affected individuals is needed.
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Affiliation(s)
- Luke Archibald
- Luke Archibald, M.D., is an assistant professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Mary F Brunette
- Mary F. Brunette, M.D., is an associate professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Diana J Wallin
- Diana J. Wallin, Ph.D., is a postdoctoral fellow in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Alan I Green
- Alan I. Green, M.D., is the Raymond Sobel Professor of Psychiatry, a professor in the Department of Molecular and Systems Biology, and the chair of the Department of Psychiatry, Geisel School of Medicine at Dartmouth, as well as the director, Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, New Hampshire
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Henricks AM, Sullivan EDK, Dwiel LL, Keus KM, Adner ED, Green AI, Doucette WT. Sex differences in the ability of corticostriatal oscillations to predict rodent alcohol consumption. Biol Sex Differ 2019; 10:61. [PMID: 31849345 PMCID: PMC6918672 DOI: 10.1186/s13293-019-0276-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Background Although male and female rats differ in their patterns of alcohol use, little is known regarding the neural circuit activity that underlies these differences in behavior. The current study used a machine learning approach to characterize sex differences in local field potential (LFP) oscillations that may relate to sex differences in alcohol-drinking behavior. Methods LFP oscillations were recorded from the nucleus accumbens shell and the rodent medial prefrontal cortex of adult male and female Sprague-Dawley rats. Recordings occurred before rats were exposed to alcohol (n = 10/sex × 2 recordings/rat) and during sessions of limited access to alcohol (n = 5/sex × 5 recordings/rat). Oscillations were also recorded from each female rat in each phase of estrous prior to alcohol exposure. Using machine learning, we built predictive models with oscillation data to classify rats based on: (1) biological sex, (2) phase of estrous, and (3) alcohol intake levels. We evaluated model performance from real data by comparing it to the performance of models built and tested on permutations of the data. Results Our data demonstrate that corticostriatal oscillations were able to predict alcohol intake levels in males (p < 0.01), but not in females (p = 0.45). The accuracies of models predicting biological sex and phase of estrous were related to fluctuations observed in alcohol drinking levels; females in diestrus drank more alcohol than males (p = 0.052), and the male vs. diestrus female model had the highest accuracy (71.01%) compared to chance estimates. Conversely, females in estrus drank very similar amounts of alcohol to males (p = 0.702), and the male vs. estrus female model had the lowest accuracy (56.14%) compared to chance estimates. Conclusions The current data demonstrate that oscillations recorded from corticostriatal circuits contain significant information regarding alcohol drinking in males, but not alcohol drinking in females. Future work will focus on identifying where to record LFP oscillations in order to predict alcohol drinking in females, which may help elucidate sex-specific neural targets for future therapeutic development.
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Affiliation(s)
- Angela M Henricks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH 03756, USA.
| | - Emily D K Sullivan
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH 03756, USA
| | - Lucas L Dwiel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH 03756, USA
| | | | | | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH 03756, USA.,Dartmouth College, Hanover, USA.,The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, USA
| | - Wilder T Doucette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH 03756, USA.,Dartmouth College, Hanover, USA.,The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, USA
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Whitton AE, Green AI, Pizzagalli DA, Roth RM, Williams JM, Brunette MF. Potent Dopamine D2 Antagonists Block the Reward-Enhancing Effects of Nicotine in Smokers With Schizophrenia. Schizophr Bull 2019; 45:1300-1308. [PMID: 30690638 PMCID: PMC6811816 DOI: 10.1093/schbul/sby185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antipsychotics that are potent dopamine (DA) D2 receptor antagonists have been linked to elevated levels of nicotine dependence in smokers with schizophrenia. Because activation of D2 receptors mediates motivation for nicotine, we examined whether potent D2 antagonists would diminish nicotine's ability to stimulate reward processing-a mechanism that may drive compensatory increases in smoking. Smokers with schizophrenia (n = 184) were recruited and stratified into medication groups based on D2 receptor antagonist potency. The effects of smoking on reward function were assessed using a probabilistic reward task (PRT), administered pre- and post-smoking. The PRT used an asymmetrical reinforcement schedule to produce a behavioral response bias, previously found to increase under conditions (including smoking) that enhance mesolimbic DA signaling. Among the 98 participants with valid PRT data and pharmacotherapy that could be stratified into D2 receptor antagonism potency, a medication × smoking × block interaction emerged (P = .005). Post-hoc tests revealed a smoking × block interaction only for those not taking potent D2 antagonists (P = .007). This group exhibited smoking-related increases in response bias (P < .001) that were absent in those taking potent D2 antagonists (P > .05). Our findings suggest that potent D2 antagonists diminish the reward-enhancing effects of nicotine in smokers with schizophrenia. This may be a mechanism implicated in the increased rate of smoking often observed in patients prescribed these medications. These findings have important clinical implications for the treatment of nicotine dependence in schizophrenia.
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Affiliation(s)
- Alexis E Whitton
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH,Dartmouth Clinical and Translational Science Institute, Hanover, NH
| | - Diego A Pizzagalli
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Robert M Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jill M Williams
- Department of Psychiatry, Rutgers University, New Brunswick, NJ
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH,To whom correspondence should be addressed; Department of Psychiatry, Dartmouth-Hitchcock, 2 Pillsbury Street, Suite 40, Concord, NH 03301, US; tel: 603-229-5419, fax: 603-271-5262, e-mail:
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Henricks AM, Dwiel LL, Deveau NH, Simon AA, Ruiz-Jaquez MJ, Green AI, Doucette WT. Corticostriatal Oscillations Predict High vs. Low Drinkers in a Rat Model of Limited Access Alcohol Consumption. Front Syst Neurosci 2019; 13:35. [PMID: 31456669 PMCID: PMC6700217 DOI: 10.3389/fnsys.2019.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023] Open
Abstract
Individuals differ in their vulnerability to develop alcohol dependence, which is determined by innate and environmental factors. The corticostriatal circuit is heavily involved in the development of alcohol dependence and may contain neural information regarding vulnerability to drink excessively. In the current experiment, we hypothesized that we could characterize high and low alcohol-drinking rats (HD and LD, respectively) based on corticostriatal oscillations and that these subgroups would differentially respond to corticostriatal brain stimulation. Male Sprague–Dawley rats (n = 13) were trained to drink 10% alcohol in a limited access paradigm. In separate sessions, local field potentials (LFPs) were recorded from the nucleus accumbens shell (NAcSh) and medial prefrontal cortex (mPFC). Based on training alcohol consumption levels, we classified rats using a median split as HD or LD. Then, using machine-learning, we built predictive models to classify rats as HD or LD by corticostriatal LFPs and compared the model performance from real data to the performance of models built on data permutations. Additionally, we explored the impact of NAcSh or mPFC stimulation on alcohol consumption in HD vs. LD. Corticostriatal LFPs were able to predict HD vs. LD group classification with greater accuracy than expected by chance (>80% accuracy). Moreover, NAcSh stimulation significantly reduced alcohol consumption in HD, but not LD (p < 0.05), while mPFC stimulation did not alter drinking behavior in either HD or LD (p > 0.05). These data collectively show that the corticostriatal circuit is differentially involved in regulating alcohol intake in HD vs. LD rats, and suggests that corticostriatal activity may have the potential to predict a vulnerability to develop alcohol dependence in a clinical population.
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Affiliation(s)
- Angela M Henricks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Lucas L Dwiel
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Nicholas H Deveau
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Amanda A Simon
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Metztli J Ruiz-Jaquez
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Wilder T Doucette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
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Affiliation(s)
- Alan I Green
- a Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - E Sherwood Brown
- b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
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Affiliation(s)
- Alan I Green
- a a Department of Psychiatry , Geisel School of Medicine at Dartmouth , Hanover , NH , USA
| | - E Sherwood Brown
- b b Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , TX , USA
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Falk DE, Ryan ML, Fertig JB, Devine EG, Cruz R, Brown ES, Burns H, Salloum IM, Newport DJ, Mendelson J, Galloway G, Kampman K, Brooks C, Green AI, Brunette MF, Rosenthal RN, Dunn KE, Strain EC, Ray L, Shoptaw S, Ait-Daoud Tiouririne N, Gunderson EW, Ransom J, Scott C, Leggio L, Caras S, Mason BJ, Litten RZ. Gabapentin Enacarbil Extended-Release for Alcohol Use Disorder: A Randomized, Double-Blind, Placebo-Controlled, Multisite Trial Assessing Efficacy and Safety. Alcohol Clin Exp Res 2018; 43:158-169. [PMID: 30403402 DOI: 10.1111/acer.13917] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several single-site alcohol treatment clinical trials have demonstrated efficacy for immediate-release (IR) gabapentin in reducing drinking outcomes among individuals with alcohol dependence. The purpose of this study was to conduct a large, multisite clinical trial of gabapentin enacarbil extended-release (GE-XR) (HORIZANT® ), a gabapentin prodrug formulation, to determine its safety and efficacy in treating alcohol use disorder (AUD). METHODS Men and women (n = 346) who met DSM-5 criteria for at least moderate AUD were recruited across 10 U.S. clinical sites. Participants received double-blind GE-XR (600 mg twice a day) or placebo and a computerized behavioral intervention (Take Control) for 6 months. Efficacy analyses were prespecified for the last 4 weeks of the treatment period. RESULTS The GE-XR and placebo groups did not differ significantly on the primary outcome measure, percentage of subjects with no heavy drinking days (28.3 vs. 21.5, respectively, p = 0.157). Similarly, no clinical benefit was found for other drinking measures (percent subjects abstinent, percent days abstinent, percent heavy drinking days, drinks per week, drinks per drinking day), alcohol craving, alcohol-related consequences, sleep problems, smoking, and depression/anxiety symptoms. Common side-effects were fatigue, dizziness, and somnolence. A population pharmacokinetics analysis revealed that patients had lower gabapentin exposure levels compared with those in other studies using a similar dose but for other indications. CONCLUSIONS Overall, GE-XR at 600 mg twice a day did not reduce alcohol consumption or craving in individuals with AUD. It is possible that, unlike the IR formulation of gabapentin, which showed efficacy in smaller Phase 2 trials at a higher dose, GE-XR is not effective in treating AUD, at least not at doses approved by the U.S. Food and Drug Administration for treating other medical conditions.
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Affiliation(s)
- Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Megan L Ryan
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Joanne B Fertig
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Ricardo Cruz
- Section of General Internal Medicine, Department of Medicine, School of Medicine and Boston Medical Center, Section of General Internal Medicine, Boston University, Boston, Massachusetts
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather Burns
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Kyle Kampman
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Brooks
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Richard N Rosenthal
- Division of Addiction Psychiatry, Stony Brook University, Stony Brook, New York.,Mount Sinai St. Luke's Hospital, New York, New York
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lara Ray
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Steven Shoptaw
- Department of Family Medicine and of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Erik W Gunderson
- Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Janet Ransom
- Fast Track Drugs and Biologics, North Potomac, Maryland
| | - Charles Scott
- Fast Track Drugs and Biologics, North Potomac, Maryland
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Barbara J Mason
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Khokhar JY, Dwiel L, Henricks A, Doucette WT, Green AI. The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophr Res 2018; 194:78-85. [PMID: 28416205 PMCID: PMC6094954 DOI: 10.1016/j.schres.2017.04.016] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 11/29/2022]
Abstract
Substance use disorders occur commonly in patients with schizophrenia and dramatically worsen their overall clinical course. While the exact mechanisms contributing to substance use in schizophrenia are not known, a number of theories have been put forward to explain the basis of the co-occurrence of these disorders. We propose here a unifying hypothesis that combines recent evidence from epidemiological and genetic association studies with brain imaging and pre-clinical studies to provide an updated formulation regarding the basis of substance use in patients with schizophrenia. We suggest that the genetic determinants of risk for schizophrenia (especially within neural systems that contribute to the risk for both psychosis and addiction) make patients vulnerable to substance use. Since this vulnerability may arise prior to the appearance of psychotic symptoms, an increased use of substances in adolescence may both enhance the risk for developing a later substance use disorder, and also serve as an additional risk factor for the appearance of psychotic symptoms. Future studies that assess brain circuitry in a prospective longitudinal manner during adolescence prior to the appearance of psychotic symptoms could shed further light on the mechanistic underpinnings of these co-occurring disorders while identifying potential points of intervention for these difficult-to-treat co-occurring disorders.
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Affiliation(s)
| | - Lucas Dwiel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | - Angela Henricks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | | | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth,Dartmouth Clinical and Translational Science Institute, Dartmouth College
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Whitfield-Gabrieli S, Fischer AS, Henricks AM, Khokhar JY, Roth RM, Brunette MF, Green AI. Understanding marijuana's effects on functional connectivity of the default mode network in patients with schizophrenia and co-occurring cannabis use disorder: A pilot investigation. Schizophr Res 2018; 194:70-77. [PMID: 28823723 PMCID: PMC6886576 DOI: 10.1016/j.schres.2017.07.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
Nearly half of patients with schizophrenia (SCZ) have co-occurring cannabis use disorder (CUD), which has been associated with decreased treatment efficacy, increased risk of psychotic relapse, and poor global functioning. While reports on the effects of cannabis on cognitive performance in patients with SCZ have been mixed, study of brain networks related to executive function may clarify the relationship between cannabis use and cognition in these dual-diagnosis patients. In the present pilot study, patients with SCZ and CUD (n=12) and healthy controls (n=12) completed two functional magnetic resonance imaging (fMRI) resting scans. Prior to the second scan, patients smoked a 3.6% tetrahydrocannabinol (THC) cannabis cigarette or ingested a 15mg delta-9-tetrahydrocannabinol (THC) pill. We used resting-state functional connectivity to examine the default mode network (DMN) during both scans, as connectivity/activity within this network is negatively correlated with connectivity of the network involved in executive control and shows reduced activity during task performance in normal individuals. At baseline, relative to controls, patients exhibited DMN hyperconnectivity that correlated with positive symptom severity, and reduced anticorrelation between the DMN and the executive control network (ECN). Cannabinoid administration reduced DMN hyperconnectivity and increased DMN-ECN anticorrelation. Moreover, the magnitude of anticorrelation in the controls, and in the patients after cannabinoid administration, positively correlated with WM performance. The finding that DMN brain connectivity is plastic may have implications for future pharmacotherapeutic development, as treatment efficacy could be assessed through the ability of therapies to normalize underlying circuit-level dysfunction.
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Affiliation(s)
- Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Adina S. Fischer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Angela M. Henricks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jibran Y. Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert M. Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, USA.,Corresponding Author: Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA.
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Eisenberg IW, Bissett PG, Canning JR, Dallery J, Enkavi AZ, Whitfield-Gabrieli S, Gonzalez O, Green AI, Greene MA, Kiernan M, Kim SJ, Li J, Lowe MR, Mazza GL, Metcalf SA, Onken L, Parikh SS, Peters E, Prochaska JJ, Scherer EA, Stoeckel LE, Valente MJ, Wu J, Xie H, MacKinnon DP, Marsch LA, Poldrack RA. Applying novel technologies and methods to inform the ontology of self-regulation. Behav Res Ther 2018; 101:46-57. [PMID: 29066077 PMCID: PMC5801197 DOI: 10.1016/j.brat.2017.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 09/25/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
Self-regulation is a broad construct representing the general ability to recruit cognitive, motivational and emotional resources to achieve long-term goals. This construct has been implicated in a host of health-risk behaviors, and is a promising target for fostering beneficial behavior change. Despite its clear importance, the behavioral, psychological and neural components of self-regulation remain poorly understood, which contributes to theoretical inconsistencies and hinders maximally effective intervention development. We outline a research program that seeks to define a neuropsychological ontology of self-regulation, articulating the cognitive components that compose self-regulation, their relationships, and their associated measurements. The ontology will be informed by two large-scale approaches to assessing individual differences: first purely behaviorally using data collected via Amazon's Mechanical Turk, then coupled with neuroimaging data collected from a separate population. To validate the ontology and demonstrate its utility, we will then use it to contextualize health risk behaviors in two exemplar behavioral groups: overweight/obese adults who binge eat and smokers. After identifying ontological targets that precipitate maladaptive behavior, we will craft interventions that engage these targets. If successful, this work will provide a structured, holistic account of self-regulation in the form of an explicit ontology, which will better clarify the pattern of deficits related to maladaptive health behavior, and provide direction for more effective behavior change interventions.
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Affiliation(s)
- Ian W Eisenberg
- Department of Psychology, Stanford University, Stanford, CA 94305, USA.
| | - Patrick G Bissett
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
| | - Jessica R Canning
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - A Zeynep Enkavi
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
| | - Susan Whitfield-Gabrieli
- Brain and Cognitive Sciences Department, The McGovern Institute for Brain Research, MIT, Cambridge, MA 02139, USA
| | - Oscar Gonzalez
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - Mary Ann Greene
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - Michaela Kiernan
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Sunny Jung Kim
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - Jamie Li
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
| | - Michael R Lowe
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Gina L Mazza
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA
| | - Stephen A Metcalf
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - Lisa Onken
- National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sadev S Parikh
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
| | - Ellen Peters
- Department of Psychology, The Ohio State University, Columbus, OH 43206, USA
| | | | - Emily A Scherer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - Luke E Stoeckel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Matthew J Valente
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA
| | - Jialing Wu
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - Haiyi Xie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
| | - David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA
| | - Lisa A Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH 03766, USA
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Abstract
Schizophrenia is a heterogenous and severe neuropsychiatric disorder that affects nearly 1% of the population worldwide. Antipsychotic drugs are the mainstay of treatment, but not all patients with schizophrenia respond to treatment with these agents. Clozapine, the first atypical antipsychotic, is a highly effective medication for patients with schizophrenia who do not respond to other antipsychotics. Although clozapine tends not to produce extrapyramidal symptoms, other side effects of the drug (e.g., agranulocytosis, myocarditis, seizures) limit its widespread use. This chapter reviews clozapine's unique clinical effects and unusual pharmacological profile. In addition to its effects in treatment-resistant schizophrenia, clozapine has been shown to decrease suicidality, which occurs at an increased rate in patients with schizophrenia. Still preliminary, but consistent data, also suggest that clozapine limits substance use in these patients, an important effect since substance use disorders are common in patients with schizophrenia and are associated with a poor outcome, including an increased risk for suicide and poor response to treatment. We have suggested, from animal studies, that clozapine's apparent ability to limit substance use may occur through its actions as a weak dopamine D2 receptor antagonist, a potent norepinephrine α-2 receptor antagonist and a norepinephrine reuptake inhibitor. Using animal models, we have built combinations of agents toward creation of safer clozapine-like drugs to reduce substance use in these patients. Future research into the mechanisms of action of clozapine toward the development of safe clozapine-like agents is of great public health importance.
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Affiliation(s)
- Jibran Y Khokhar
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Angela M Henricks
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Emily D K Sullivan
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Alan I Green
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States.
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Brown ES, Green AI. Tobacco Use, Medical Illness, and Service Utilization. J Dual Diagn 2018; 14:1. [PMID: 29166211 DOI: 10.1080/15504263.2017.1406230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E Sherwood Brown
- a Department of Psychiatry , The University of Texas Southwestern Medical Center, Dallas , Texas , USA
| | - Alan I Green
- b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Doucette WT, Dwiel L, Boyce JE, Simon AA, Khokhar JY, Green AI. Machine Learning Based Classification of Deep Brain Stimulation Outcomes in a Rat Model of Binge Eating Using Ventral Striatal Oscillations. Front Psychiatry 2018; 9:336. [PMID: 30123143 PMCID: PMC6085408 DOI: 10.3389/fpsyt.2018.00336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022] Open
Abstract
Neuromodulation-based interventions continue to be evaluated across an array of appetitive disorders but broader implementation of these approaches remains limited due to variable treatment outcomes. We hypothesize that individual variation in treatment outcomes may be linked to differences in the networks underlying these disorders. Here, Sprague-Dawley rats received deep brain stimulation separately within each nucleus accumbens (NAc) sub-region (core and shell) using a within-animal crossover design in a rat model of binge eating. Significant reductions in binge size were observed with stimulation of either target but with significant variation in effectiveness across individuals. When features of local field potentials (LFPs) recorded from the NAc were used to classify the pre-defined stimulation outcomes (response or non-response) from each rat using a machine-learning approach (lasso), stimulation outcomes could be classified with greater accuracy than expected by chance (effect sizes: core = 1.13, shell = 1.05). Further, these LFP features could be used to identify the best stimulation target for each animal (core vs. shell) with an effect size = 0.96. These data suggest that individual differences in underlying network activity may relate to the variable outcomes of circuit based interventions, and measures of network activity could have the potential to individually guide the selection of an optimal stimulation target to improve overall treatment response rates.
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Affiliation(s)
- Wilder T Doucette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States
| | - Lucas Dwiel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Jared E Boyce
- Department of Psychological and Brain Sciences, Hanover, NH, United States
| | - Amanda A Simon
- Department of Psychological and Brain Sciences, Hanover, NH, United States
| | - Jibran Y Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Biomedical Sciences, University of Guelph, Guelph, ON, Canada
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Brown ES, Green AI. Hispanic Populations, Veterans, and Symptom Assessment. J Dual Diagn 2017; 13:237. [PMID: 29166212 DOI: 10.1080/15504263.2017.1364955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E Sherwood Brown
- a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Alan I Green
- b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Affiliation(s)
- E Sherwood Brown
- a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Alan I Green
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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18
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Brown ES, Green AI. Trauma, Case Studies, and Dual Diagnosis Consequences. J Dual Diagn 2017; 13:81. [PMID: 28494224 DOI: 10.1080/15504263.2017.1306990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E Sherwood Brown
- a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Alan I Green
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Affiliation(s)
- Alan I Green
- a Darthmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.,b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Affiliation(s)
- E Sherwood Brown
- a Department of Psychiatry , The University of Texas Southwestern Medical Center , Dallas , Texas , USA
| | - Alan I Green
- b Darthmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.,c Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Brunette MF, Akerman SC, Dawson R, O'Keefe CD, Green AI. An open-label pilot study of quetiapine plus mirtazapine for heavy drinkers with alcohol use disorder. Alcohol 2016; 53:45-50. [PMID: 27256763 DOI: 10.1016/j.alcohol.2016.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/03/2023]
Abstract
Animal research suggests that medications that produce a weak dopamine D2 receptor blockade and potentiate noradrenergic activity may decrease alcohol drinking. In an open-label pilot study of subjects with alcohol dependence, we tested whether the combination of quetiapine, a weak dopamine D2 receptor antagonist, whose primary metabolite, desalkylquetiapine, is a norepinephrine reuptake inhibitor, and mirtazapine, a potent α2 norepinephrine receptor antagonist, would decrease alcohol drinking and craving. Twenty very heavy drinkers with alcohol dependence entered a trial of 8 weeks of treatment with quetiapine followed by 8 weeks of treatment with a combination of quetiapine plus mirtazapine. Alcohol use was assessed weekly with a Timeline Follow-Back interview and craving with the Penn Alcohol Craving Scale. Among the 11 completers, subjects reported improved outcomes in the quetiapine plus mirtazapine period compared to the quetiapine alone period: fewer very heavy drinking days per week (1.3 [SD = 2.4] vs. 2.1 [SD = 2.8]; t = 2.3, df = 10, p = 0.04); fewer total number of drinks per week (39.7 [SD = 61.6] vs. 53.4 [SD = 65.0]; t = 2.8, df = 10, p = 0.02); and lower craving scores (2.5 [SD = 1.4] vs. 3.2 [SD = 1.2]; t = 2.4, df = 10, p = 0.04). All subjects reported at least one adverse event; 72.7% reported somnolence. In this open-label pilot study, treatment with quetiapine plus mirtazapine was associated with a decrease in alcohol drinking and craving. These findings are consistent with our previous work in animal models of alcohol use disorders and suggest that further study of medications or combinations of medications with this pharmacologic profile is warranted.
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Khokhar JY, Green AI. Effects of iloperidone, combined with desipramine, on alcohol drinking in the Syrian golden hamster. Neuropharmacology 2016; 105:25-34. [PMID: 26796639 PMCID: PMC4873404 DOI: 10.1016/j.neuropharm.2016.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/09/2016] [Accepted: 01/10/2016] [Indexed: 12/20/2022]
Abstract
Alcohol use disorder in patients with schizophrenia dramatically worsens their clinical course, and few treatment options are available. Clozapine appears to reduce alcohol use in these patients, but its toxicity limits its use. To create a safer clozapine-like drug, we tested whether the antipsychotic iloperidone, a drug that combines a weak dopamine D2 receptor blockade and a potent norepinephrine alpha-2 receptor blockade would reduce alcohol drinking, and whether its effect on alcohol drinking could be increased if combined with an agent to facilitate norepinephrine activity. Syrian golden hamsters (useful animal model for screening drugs that reduce alcohol drinking in patients with schizophrenia) were given free access to water and alcohol (15% v/v) until stable drinking was established. Animals (n = 6-7/group), matched according to alcohol intake, were treated daily with each drug (iloperidone; clozapine; haloperidol; desipramine [norepinephrine reuptake inhibitor]; with idazoxan [norepinephrine alpha-2 receptor antagonist]) or with a two-drug (iloperidone + desipramine; iloperidone + idazoxan) combination for 14 days. Moderate doses of iloperidone (1-5 mg/kg) significantly reduced alcohol drinking (p < 0.05) in the hamster, whereas higher doses (10-20 mg/kg) did not. In addition, 5 mg/kg of iloperidone reduced alcohol drinking to the same extent as clozapine (8 mg/kg), whereas haloperidol (0.2 mg/kg) did not. Moreover, iloperidone's effects were enhanced via the addition of desipramine (3 mg/kg), but not idazoxan (1.5/3 mg/kg). In this animal model, iloperidone decreases alcohol drinking as effectively as clozapine, and desipramine appears to amplify this effect. The data suggest that iloperidone, alone or in combination with desipramine, should be tested in patients with schizophrenia and alcohol use disorder.
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Affiliation(s)
- Jibran Y Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA; The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, USA.
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Drake RE, Green AI. Illuminating the Interstices: What Small Studies Add to Science. J Dual Diagn 2016; 12:107-8. [PMID: 27070957 DOI: 10.1080/15504263.2016.1177374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Alan I Green
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.,b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Drake RE, Green AI. Trauma, Technology, and Routine Outcome Measures. J Dual Diagn 2016; 12:1-3. [PMID: 26829002 DOI: 10.1080/15504263.2016.1147776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Alan I Green
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.,b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Green AI, Brunette MF, Dawson R, Buckley P, Wallace AE, Hafez H, Herz M, Narasimhan M, Noordsy DL, O'Keefe C, Sommi RW, Steinbook RM, Weeks M. Long-acting injectable vs oral risperidone for schizophrenia and co-occurring alcohol use disorder: a randomized trial. J Clin Psychiatry 2015; 76:1359-65. [PMID: 26302441 DOI: 10.4088/jcp.13m08838] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 08/05/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Alcohol use disorders worsen the course of schizophrenia. Although the atypical antipsychotic clozapine appears to decrease alcohol use in schizophrenia, risperidone does not. We have proposed that risperidone's relatively potent dopamine D2 receptor blockade may partly underlie its lack of effect on alcohol use. Since long-acting injectable (LAI) risperidone both results in lower average steady-state plasma concentrations than oral risperidone (with lower D2 receptor occupancy) and encourages adherence, it may be more likely to decrease heavy alcohol use (days per week of drinking 5 or more drinks per day) than oral risperidone. METHOD Ninety-five patients with DSM-IV-TR diagnoses of schizophrenia and alcohol use disorder were randomized to 6 months of oral or LAI risperidone between 2005 and 2008. Explanatory (efficacy) analyses were carried out to evaluate the potential benefits of LAI under suitably controlled conditions (in contrast to real-world settings), with intent-to-treat analyses being secondary. RESULTS Explanatory analyses showed that heavy drinking in the oral group worsened over time (P = .024) and that there was a statistical trend toward significance in the difference between the changes in heavy drinking days in the oral and LAI groups (P = .054). Furthermore, the 2 groups differed in the mean number of drinking days per week (P = .035). The intent-to-treat analyses showed no difference in heavy drinking but did show a difference in average drinking days per week similar to that obtained from the explanatory analyses (P = .018). Neither explanatory nor intent-to-treat analyses showed any between-group differences in alcohol use as measured by intensity or the Alcohol Use Scale. The plasma concentrations of the active metabolite 9-hydroxyrisperidone were significantly lower in patients taking LAI (P < .05), despite their significantly (overall) better treatment adherence (P < .005). CONCLUSION For the population considered here, schizophrenia patients with alcohol use disorder appear to continue drinking some alcohol while taking either form of risperidone. Nonetheless, our data suggest that injectable risperidone may be a better choice than the oral form for these dual diagnosis patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00130923.
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Affiliation(s)
- Alan I Green
- One Medical Center Drive, HB 7750, Lebanon, NH 03756
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Chau DT, Khokhar JY, Gulick D, Dawson R, Green AI. Desipramine enhances the ability of paliperidone to decrease alcohol drinking. J Psychiatr Res 2015; 69:9-18. [PMID: 26343589 PMCID: PMC4561861 DOI: 10.1016/j.jpsychires.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/16/2015] [Accepted: 07/09/2015] [Indexed: 01/07/2023]
Abstract
Alcohol use disorder commonly occurs in patients with schizophrenia and dramatically worsens their course. The atypical antipsychotic clozapine has been associated with reduced drinking in these patients, but its toxicity reduces its use. We have attempted to create a clozapine-like drug by combining agents that capture components of clozapine's pharmacologic action, including its weak dopamine D2 blockade and noradrenergic modulation. The current study assessed whether paliperidone, a dopamine D2 receptor and adrenergic alpha-2 receptor antagonist like clozapine, would attenuate alcohol drinking in the alcohol-preferring P rat and the Syrian golden hamster, and whether desipramine, a norepinephrine reuptake inhibitor, would potentiate the ability of paliperidone to attenuate alcohol drinking in the P rat and the Syrian golden hamster. Daily subcutaneous injections of paliperidone (5 mg/kg for the rat; 1 mg/kg for the hamster) over 20 days slightly and transiently attenuated initiation of alcohol consumption in both animals. Desipramine (3 mg/kg) or lower doses of paliperidone alone did not affect alcohol drinking. However, the combination of desipramine (3 mg/kg) and paliperidone essentially prevented initiation of alcohol drinking and acquisition of alcohol preference in the P rat (2.5 or 5 mg/kg), and almost as dramatically suppressed chronic alcohol intake and alcohol preference in the hamster (2.5 mg/kg). Taken together, the current data suggest that (1) the desipramine and paliperidone combination attenuates alcohol drinking in a synergistic manner, and (2) desipramine and paliperidone may serve as an effective new treatment for alcohol use disorder in patients with schizophrenia.
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Affiliation(s)
- David T Chau
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Jibran Y Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Danielle Gulick
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Ree Dawson
- Frontier Science and Technology Research Foundation, Inc., Boston, MA 02215, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA; Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, USA.
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Khokhar JY, Chau DT, Dawson R, Green AI. Clozapine reconstructed: Haloperidol's ability to reduce alcohol intake in the Syrian golden hamster can be enhanced through noradrenergic modulation by desipramine and idazoxan. Drug Alcohol Depend 2015; 152:277-81. [PMID: 25979645 PMCID: PMC4458150 DOI: 10.1016/j.drugalcdep.2015.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alcohol use disorder commonly occurs in patients with schizophrenia. Most antipsychotic drugs do not lessen alcohol use; although the atypical antipsychotic clozapine has been shown to reduce alcohol use in patients with schizophrenia, its toxicity severely limits its use in patients. With an eye toward creation of a safer clozapine-like drug, we have investigated the pharmacological basis of the clozapine's effects on alcohol drinking in the Syrian golden hamster. In this animal, as in patients with schizophrenia, clozapine reduces alcohol drinking while the typical antipsychotic haloperidol does not. We have suggested that clozapine decreases alcohol drinking due to its weak dopamine D2 receptor blockade, its potent norepinephrine α-2 receptor antagonism, as well as its ability to elevate plasma norepinephrine. METHODS We recreated a clozapine-like drug to reduce alcohol drinking in the Syrian golden hamster by combining low dose haloperidol with a norepinephrine α-2 receptor antagonist, idazoxan, and a norepinephrine reuptake inhibitor, desipramine. Hamsters were given free access to water and alcohol (15% v/v) and were treated daily with each drug or with the three-drug combination for 23 days. RESULTS The drug combination reduced alcohol drinking and preference significantly as compared to vehicle or to haloperidol, idazoxan or desipramine, while not altering food-intake or body-weight. CONCLUSION These findings suggest that that haloperidol, which does not reduce alcohol drinking in patients with schizophrenia or the hamster, if combined with idazoxan and desipramine (producing a drug combination that mimics aspects of clozapine's pharmacology) is able to reduce alcohol drinking in the hamster.
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Affiliation(s)
- Jibran Y Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - David T Chau
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Ree Dawson
- Frontier Science Research and Technology Foundation, Boston, MA, United States
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States; The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, United States.
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Fischer AS, Whitfield-Gabrieli S, Roth RM, Brunette MF, Green AI. Response to "cortico-accumbens circuitry in schizophrenia: merely a reward system?" by Rolland and Jardri (SCHRES-14-D-00731). Schizophr Res 2015; 161:519. [PMID: 25465412 PMCID: PMC4785886 DOI: 10.1016/j.schres.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Adina S. Fischer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert M. Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA,Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA,Corresponding Author: Alan I. Green, M.D., Chair Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756, USA.
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Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.,b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Alan I Green
- a Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.,b Department of Psychiatry , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Affiliation(s)
- Alan I Green
- a Department of Psychiatry, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Akerman SC, Brunette MF, Green AI, Goodman DJ, Blunt HB, Heil SH. Treating tobacco use disorder in pregnant women in medication-assisted treatment for an opioid use disorder: a systematic review. J Subst Abuse Treat 2014; 52:40-7. [PMID: 25592332 DOI: 10.1016/j.jsat.2014.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/05/2014] [Accepted: 12/07/2014] [Indexed: 02/07/2023]
Abstract
Smoking is associated with adverse effects on pregnancy and fetal development, yet 88-95% of pregnant women in medication-assisted treatment for an opioid use disorder smoke cigarettes. This review summarizes existing knowledge about smoking cessation treatments for pregnant women on buprenorphine or methadone, the two forms of medication-assisted treatment for opioid use disorder indicated for prenatal use. We performed a systematic review of the literature using indexed terms and key words to capture the concepts of smoking, pregnancy, and opioid substitution and found that only three studies met search criteria. Contingency management, an incentive based treatment, was the most promising intervention: 31% of participants achieved abstinence within the 12-week study period, compared to 0% in a non-contingent behavior incentive group and a group receiving usual care. Two studies of brief behavioral interventions resulted in reductions in smoking but not cessation. Given the growing number of pregnant women in medication-assisted treatment for an opioid use disorder and the negative consequences of smoking on pregnancy, further research is needed to develop and test effective cessation strategies for this group.
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Affiliation(s)
- Sarah C Akerman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon NH, 03756, USA.
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon NH, 03756, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon NH, 03756, USA
| | - Daisy J Goodman
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon NH 03756, USA
| | - Heather B Blunt
- Biomedical Libraries, Geisel School of Medicine at Dartmouth, Hanover NH, 03755, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry and Department of Psychology, University of Vermont, Burlington, VT, 05401, USA
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Abstract
Substance use disorders, common in patients with schizophrenia, can lead to poor outcomes. Here we review the literature on the use of antipsychotics in patients with co-occurring schizophrenia and substance use disorder as well as evidence for the use of adjunctive pharmacological treatments targeting substance use in these patients. We also discuss a neurobiological formulation suggesting that the cooccurrence of these disorders may be related to a dysfunction in the dopamine mediated brain reward circuitry. Typical antipsychotics do not appear to decrease substance use in this population. Randomized, controlled trials provide some support for use of the atypical antipsychotic clozapine for co-occurring cannabis use disorder, naltrexone and disulfiram for alcohol use disorder, and also nicotine replacement therapy, sustained-release bupropion and varenicline for tobacco use disorder. Nonetheless, data regarding treatment in patients with these co-occurring disorders are still limited, and many studies reported to date have been either underpowered or did not include a control condition. Further research is needed to evaluate optimal pharmacotherapeutic strategies for this population.
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Affiliation(s)
- Sarah C. Akerman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Douglas L. Noordsy
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Alan I. Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
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Fischer AS, Whitfield-Gabrieli S, Roth RM, Brunette MF, Green AI. Impaired functional connectivity of brain reward circuitry in patients with schizophrenia and cannabis use disorder: Effects of cannabis and THC. Schizophr Res 2014; 158:176-82. [PMID: 25037524 PMCID: PMC4778557 DOI: 10.1016/j.schres.2014.04.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023]
Abstract
Cannabis use disorder (CUD) occurs in up to 42% of patients with schizophrenia and substantially worsens disease progression. The basis of CUD in schizophrenia is unclear and available treatments are rarely successful at limiting cannabis use. We have proposed that a dysregulated brain reward circuit (BRC) may underpin cannabis use in these patients. In the present pilot study, we used whole-brain seed-to-voxel resting state functional connectivity (rs-fc) to examine the BRC of patients with schizophrenia and CUD, and to explore the effects of smoked cannabis and orally administered delta-9-tetrahydrocannabinol (THC) on the BRC. 12 patients with schizophrenia and CUD and 12 control subjects each completed two fMRI resting scans, with patients administered either a 3.6% THC cannabis cigarette (n=6) or a 15 mg THC capsule (n=6) prior to their second scan. Results revealed significantly reduced connectivity at baseline in patients relative to controls, with most pronounced hypoconnectivity found between the nucleus accumbens and prefrontal cortical BRC regions (i.e., anterior prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex). Both cannabis and THC administration increased connectivity between these regions, in direct correlation with increases in plasma THC levels. This study is the first to investigate interregional connectivity of the BRC and the effects of cannabis and THC on this circuit in patients with schizophrenia and CUD. The findings from this pilot study support the use of rs-fc as a means of measuring the integrity of the BRC and the effects of pharmacologic agents acting on this circuit in patients with schizophrenia and CUD.
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Affiliation(s)
- Adina S Fischer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Susan Whitfield-Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert M Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Gulick D, Chau DT, Khokhar JY, Dawson R, Green AI. Desipramine enhances the ability of risperidone to decrease alcohol intake in the Syrian golden hamster. Psychiatry Res 2014; 218:329-34. [PMID: 24836200 PMCID: PMC4407141 DOI: 10.1016/j.psychres.2014.04.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 04/22/2014] [Accepted: 04/26/2014] [Indexed: 11/16/2022]
Abstract
The atypical antipsychotic clozapine reduces alcohol drinking in patients with schizophrenia. We have proposed that clozapine׳s ability to decrease alcohol drinking relates to its weak blockade of the dopamine D2 receptor and potent blockade of the norepinephrine α-2 receptor, as well as its ability to elevate plasma and brain norepinephrine. Another atypical antipsychotic, risperidone, which is a potent blocker of both the dopamine D2 receptor and norepinephrine α-2 receptor, does not decrease alcohol drinking. In this study, we used the Syrian golden hamster to test whether the ability of risperidone to reduce alcohol drinking would be enhanced if it was used in combination with the norepinephrine reuptake inhibitor desipramine. Hamsters were given free access to water and alcohol (15% v/v) until they reached a steady drinking baseline. They were then treated daily with each drug or drug combination for 20 days. Risperidone (0.2mg/kg) only transiently decreased alcohol drinking. However, 5.0mg/kg, and possibly 1.0mg/kg, desipramine added to 0.2mg/kg risperidone appeared to produce a more substantial and relatively sustained effect than risperidone alone. Data from this study provide leads toward the development of new treatments for patients with schizophrenia and alcoholism, and also for those with alcoholism alone.
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Affiliation(s)
- Danielle Gulick
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David T Chau
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jibran Y Khokhar
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Ree Dawson
- Frontier Science Research and Technology Foundation, Boston, MA, USA
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; The Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, NH, USA.
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Mesholam-Gately RI, Gibson LE, Seidman LJ, Green AI. Schizophrenia and co-occurring substance use disorder: reward, olfaction and clozapine. Schizophr Res 2014; 155:45-51. [PMID: 24685823 DOI: 10.1016/j.schres.2014.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 03/01/2014] [Accepted: 03/03/2014] [Indexed: 02/04/2023]
Abstract
Co-occurring substance use disorders (SUD), including alcohol, are common in schizophrenia (SZ) and are associated with poor outcome. Emerging data suggest that individuals with SZ have a dysfunctional brain reward circuit that may underlie their frequent use of alcohol and other substances, and further, that the atypical antipsychotic, clozapine (CLOZ), limits alcohol/substance use in these individuals, potentially by ameliorating this brain reward circuit dysfunction. To explore this hypothesis, reward functioning in a SZ sample with a history of co-occurring SUD, treated with either CLOZ (n=13) or typical antipsychotic agents (TYP), haloperidol or fluphenazine (n=14), as well as healthy controls (n=16), was evaluated through ratings of pleasurable and aversive odors, stimuli that are processed by several neural structures thought to play a key role in processing rewarding stimuli. Results suggest that CLOZ treatment is associated with broadening and strengthening the hedonic experience of these rewarding olfactory stimuli, both of a pleasant and unpleasant nature. This hedonic appraisal of odors appeared to be independent of odor perception (intensity ratings) and clinical symptoms. These preliminary findings provide important new data in support of the hypothesis that CLOZ ameliorates some aspects of abnormal brain reward functioning in individuals with co-occurring SZ and SUD. Further research may have valuable treatment implications for this population including interventions for other reward-associated deficits in learning, social interactions and other aspects of behavior and cognition.
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Affiliation(s)
- Raquelle I Mesholam-Gately
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Lauren E Gibson
- Psychology Department, Temple University, Philadelphia, PA, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan I Green
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth, The Dartmouth Clinical and Translational Science Institute, Hanover, NH, USA; Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, The Dartmouth Clinical and Translational Science Institute, Hanover, NH, USA
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Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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39
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Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center, The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Drake RE, Green AI. New awareness, new populations, new technologies, and new ideas. J Dual Diagn 2014; 10:1-2. [PMID: 25392056 DOI: 10.1080/15504263.2013.869656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robert E Drake
- a Dartmouth Psychiatric Research Center , The Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Chau DT, Khokhar JY, Dawson R, Ahmed J, Xie H, Green AI. The comparative effects of clozapine versus haloperidol on initiation and maintenance of alcohol drinking in male alcohol-preferring P rat. Alcohol 2013; 47:611-8. [PMID: 24280363 DOI: 10.1016/j.alcohol.2013.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/03/2013] [Accepted: 10/03/2013] [Indexed: 01/01/2023]
Abstract
Alcohol use disorder, characterized by modest levels of alcohol use, commonly occurs in patients with schizophrenia and dramatically worsens their course. Recent data indicate that the atypical antipsychotic clozapine, but not the typical antipsychotic haloperidol, decreases alcohol drinking both in patients with schizophrenia and also in the Syrian golden hamster, an animal model of moderate alcohol drinking. The present study was designed to assess the comparative effects of clozapine and haloperidol in the alcohol-preferring (P) rat, an animal model of alcoholism. First, the study investigated the comparative effects of clozapine and haloperidol on initiation of alcohol consumption in P rats, which models the early stage of alcoholism. Second, the study assessed the comparative effects of clozapine and haloperidol on maintenance of chronic alcohol consumption in P rats to provide a clue as to whether either drug may also limit alcohol consumption in alcohol-dependent patients. Clozapine attenuated the initiation of alcohol drinking and development of alcohol preference while haloperidol did not. However, neither clozapine nor haloperidol attenuated maintenance of chronic alcohol drinking. Taken together, the current data suggest that clozapine, but not haloperidol, may be effective at reducing alcohol abuse or non-dependent drinking and the P rat, used within an alcohol initiation paradigm, and may differentiate the effects of clozapine and haloperidol on alcohol drinking.
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Affiliation(s)
- David T Chau
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, One Medical Center Drive, Lebanon, NH 03756, USA
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Fetter JC, Brunette M, Green AI. N-3 Fatty Acids for Hypertriglyceridemia in Patients Taking Second-Generation Antipsychotics. ACTA ACUST UNITED AC 2013; 7:73-77A. [DOI: 10.3371/csrp.febr.012513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Gamsby JJ, Templeton EL, Bonvini LA, Wang W, Loros JJ, Dunlap JC, Green AI, Gulick D. The circadian Per1 and Per2 genes influence alcohol intake, reinforcement, and blood alcohol levels. Behav Brain Res 2013; 249:15-21. [PMID: 23608482 DOI: 10.1016/j.bbr.2013.04.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/09/2013] [Accepted: 04/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perturbations in the function of core circadian clock components such as the Period (Per) family of genes are associated with alcohol use disorder, and disruptions in circadian cycles may contribute to alcohol abuse and relapse. This study tested ethanol consumption, reinforcement, and metabolism in mice containing functional mutations in Per1 and/or Per2 genes on an ethanol-preferring background, C57BL/6J mice. METHODS Mice were tested in: (A) free-access intake with ascending concentrations of ethanol (2-16%, v/v), (B) conditioned place preference using ethanol (2g/kg for males; 2.5g/kg for females) vs. saline injections, (C) recovery of the righting reflex following a 4g/kg bolus of ethanol, and (D) blood ethanol levels 1h after a 2g/kg bolus of ethanol. RESULTS All Per mutant (mPer) mice showed increased ethanol intake and condition place preference compared to controls. There were also genotypic differences in blood ethanol concentration: in males, only mPer1 mice showed a significantly higher blood ethanol concentration than WT mice, but in females, all mPer mice showed higher blood ethanol levels than WT mice. CONCLUSIONS Mutation of either Per1 or Per2, as well as mutations of both genes, increases ethanol intake and reinforcement in an ethanol-preferring mouse model. In addition, this increase in ethanol seeking behavior seems to result both from a change in ethanol metabolism and a change in reward responding to ethanol, but not from any change in sensitivity to ethanol's sedating effects.
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Affiliation(s)
- J J Gamsby
- Department of Genetics, Geisel School of Medicine at Dartmouth, United States
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Abstract
As more US states and other countries consider legalizing marijuana, clinicians need to know the possible effects of this drug. Research has shown a connection between marijuana use and an increased risk for schizophrenia in young people who are vulnerable to developing psychosis. An international panel of experts addresses topics such as risk factors for schizophrenia, the potency and effects of cannabis use on adolescents, the effects of concurrent drug use with cannabis on schizophrenia risk, and current attitudes toward marijuana.
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Affiliation(s)
- A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, USA
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Fertig JB, Ryan ML, Falk DE, Litten RZ, Mattson ME, Ransom J, Rickman WJ, Scott C, Ciraulo D, Green AI, Tiouririne NA, Johnson B, Pettinati H, Strain EC, Devine E, Brunette MF, Kampman K, A Tompkins D, Stout R. A double-blind, placebo-controlled trial assessing the efficacy of levetiracetam extended-release in very heavy drinking alcohol-dependent patients. Alcohol Clin Exp Res 2012; 36:1421-30. [PMID: 22324516 DOI: 10.1111/j.1530-0277.2011.01716.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/23/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite advances in the development of medications to treat alcohol dependence, few medications have been approved by the U.S. Food and Drug Administration. The use of certain anticonvulsant medications has demonstrated potential efficacy in treating alcohol dependence. Previous research suggests that the anticonvulsant levetiracetam may be beneficial in an alcohol-dependent population of very heavy drinkers. METHODS In this double-blind, randomized, placebo-controlled clinical trial, 130 alcohol-dependent patients who reported very heavy drinking were recruited across 5 clinical sites. Patients received either levetiracetam extended-release (XR) or placebo and a Brief Behavioral Compliance Enhancement Treatment intervention. Levetiracetam XR was titrated during the first 4 weeks to 2,000 mg/d. This target dose was maintained during weeks 5 through 14 and was tapered during weeks 15 and 16. RESULTS No significant differences were detected between the levetiracetam XR and placebo groups in either the primary outcomes (percent heavy drinking days and percent subjects with no heavy drinking days) or in other secondary drinking outcomes. Treatment groups did not differ on a number of nondrinking outcomes, including depression, anxiety, mood, and quality of life. The only difference observed was in alcohol-related consequences. The levetiracetam XR treatment group showed significantly fewer consequences than did the placebo group during the maintenance period (p = 0.02). Levetiracetam XR was well tolerated, with fatigue being the only significantly elevated adverse event, compared with placebo (53% vs. 24%, respectively; p = 0.001). CONCLUSIONS This multisite clinical trial showed no efficacy for levetiracetam XR compared with placebo in reducing alcohol consumption in heavy drinking alcohol-dependent patients.
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Affiliation(s)
- Joanne B Fertig
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA.
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Litten RZ, Fertig JB, Falk DE, Ryan ML, Mattson ME, Collins JF, Murtaugh C, Ciraulo D, Green AI, Johnson B, Pettinati H, Swift R, Afshar M, Brunette MF, Tiouririne NAD, Kampman K, Stout R. A double-blind, placebo-controlled trial to assess the efficacy of quetiapine fumarate XR in very heavy-drinking alcohol-dependent patients. Alcohol Clin Exp Res 2011; 36:406-16. [PMID: 21950727 DOI: 10.1111/j.1530-0277.2011.01649.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite advances in developing medications to treat alcohol dependence, few such medications have been approved by the Food and Drug Administration. Identified molecular targets are encouraging and can lead to the development and testing of new compounds. Atypical antipsychotic medications have been explored with varying results. Prior research suggests that the antipsychotic quetiapine may be beneficial in an alcohol-dependent population of very heavy drinkers. METHODS In this double-blind, placebo-controlled trial, 224 alcohol-dependent patients who reported very heavy drinking were recruited across 5 clinical sites. Patients received either quetiapine or placebo and Medical Management behavioral intervention. Patients were stratified on gender, clinical site, and reduction in drinking prior to randomization. RESULTS No differences between the quetiapine and placebo groups were detected in the primary outcome, percentage heavy-drinking days, or other drinking outcomes. Quetiapine significantly reduced depressive symptoms and improved sleep but had no effect on other nondrinking outcomes. Results from a subgroup analysis suggest that patients who reduced their drinking prior to randomization had significantly better drinking outcomes during the maintenance phase (p < 0.0001). No significant interactions, however, were observed between reducer status and treatment group. Finally, quetiapine was generally well tolerated. Statistically significant adverse events that were more common with quetiapine versus placebo include dizziness (14 vs. 4%), dry mouth (32 vs. 9%), dyspepsia (13 vs. 2%), increased appetite (11 vs. 1%), sedation (15 vs. 3%), and somnolence (34 vs. 9%). CONCLUSIONS This multisite clinical trial showed no efficacy for quetiapine compared with placebo at reducing alcohol consumption in heavy-drinking alcohol-dependent patients.
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Affiliation(s)
- Raye Z Litten
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892, USA
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Chau DT, Ahmed J, Wang TT, Xie H, Dawson R, Green AI. Raclopride lessens the ability of clozapine to suppress alcohol drinking in Syrian golden hamsters. Neuropharmacology 2011; 61:646-52. [DOI: 10.1016/j.neuropharm.2011.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 11/28/2022]
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Affiliation(s)
- Alan I Green
- a Department of Psychiatry, Dartmouth Medical School , Lebanon , New Hampshire , USA
| | - Robert E Drake
- b Dartmouth Psychiatric Research Center, Dartmouth Medical School , Lebanon , New Hampshire , USA
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Brunette MF, Dawson R, O'Keefe CD, Narasimhan M, Noordsy DL, Wojcik J, Green AI. A randomized trial of clozapine vs. other antipsychotics for cannabis use disorder in patients with schizophrenia. J Dual Diagn 2011; 7:50-63. [PMID: 25914610 PMCID: PMC4407140 DOI: 10.1080/15504263.2011.570118] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Cannabis use disorder is the most common co-occurring drug use disorder in people with schizophrenia and is associated with poor outcomes. We launched a randomized controlled trial to assess the impact of clozapine compared with treatment as usual on cannabis use in patients with schizophrenia and co-occurring cannabis use disorder. METHODS Thirty-one patients with schizophrenia and co-occurring cannabis use disorder were randomly assigned to switch to clozapine or to stay on their current antipsychotic and were then followed weekly for 12 weeks. Blinded raters assessed participants weekly with the Timeline Follow-back for substance use and the expanded Brief Psychiatric Rating Scale for symptoms. Longitudinal random effects models were used to investigate the time-varying differences in cannabis use and other outcomes between the treatment as usual and clozapine groups. RESULTS The two groups differed in average intensity of cannabis use by approximately 4.5 joints/week, with lesser use in the clozapine group (t = -1.77; df = 28.5; p=.086; effect size ~ 0.6). Symptoms and functioning were not different between the two groups. CONCLUSIONS Clozapine may reduce cannabis use among patients with schizophrenia and co-occurring cannabis use disorder. Further controlled trials are warranted.
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Affiliation(s)
- Mary F Brunette
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755
| | - Ree Dawson
- Frontier Science Research and Technology, Boston, MA
| | | | - Meera Narasimhan
- Department of Psychiatry, University of South Carolina, Columbia, SC
| | - Douglas L Noordsy
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755
| | - Joanne Wojcik
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alan I Green
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755
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