Efficacy of Hypnosis and Catalepsy Induction in Functional Neurological Disorders

BACKGROUND

Patients with Functional Neurological Disorder (FND) experience complex patterns of motor and/or sensory symptoms. Treatment studies of psychological interventions are promising but limited.

OBJECTIVES

The aim of the current pilot study is to investigate the effect of treatment consisting of a combination of hypnosis and catalepsy induction on FND symptom severity.

METHODS

A within-subject waiting list-control design was used with 46 patients diagnosed with FND. The treatment consisted of 10 sessions. The primary outcome measure was FND symptom severity (The Psychogenic Movement Disorder Rating Scale; PMDRS). The secondary outcome measures were psychological distress and quality of life.

RESULTS

The repeated measures (RM) ANOVA for the PMDRS as outcome measure revealed a significant effect for time with a large effect size (η2  = 0.679). Pairwise comparisons indicated that the effect of time in the treatment period was significant for the measure of FND symptom severity, whereas the waiting list period was not. The effect remained stable even at 8 weeks post treatment. As for the additional measurement, general psychological distress and quality of life, no statistically significant differences between individual time points were found.

CONCLUSIONS

This pilot study showed that eight sessions of treatment consisting of a combination of hypnosis and catalepsy induction was effective in reducing FND symptom severity. Some explanations and limitations are provided in the paper as well as several avenues of future research.

Inhibition of PDE10A in a New Rat Model of Severe Dopamine Depletion Suggests New Approach to Non-Dopamine Parkinson's Disease Therapy

Parkinson's disease is the second most common neurodegenerative pathology. Due to the limitations of existing therapeutic approaches, novel anti-parkinsonian medicines with non-dopamine mechanisms of action are clearly needed. One of the promising pharmacological targets for anti-Parkinson drug development is phosphodiesterase (PDE) 10A. The stimulating motor effects of PDE10A inhibition were detected only under the conditions of partial dopamine depletion. The results raise the question of whether PDE10A inhibitors are able to restore locomotor activity when dopamine levels are very low. To address this issue, we (1) developed and validated the rat model of acute severe dopamine deficiency and (2) tested the action of PDE10A inhibitor MP-10 in this model. All experiments were performed in dopamine transporter knockout (DAT-KO) rats. A tyrosine hydroxylase inhibitor, α-Methyl-DL-tyrosine (αMPT), was used as an agent to cause extreme dopamine deficiency. In vivo tests included estimation of locomotor activity and catalepsy levels in the bar test. Additionally, we evaluated the tissue content of dopamine in brain samples by HPLC analysis. The acute administration of αMPT to DAT-KO rats caused severe depletion of dopamine, immobility, and catalepsy (Dopamine-Deficient DAT-KO (DDD) rats). As expected, treatment with the L-DOPA and carbidopa combination restored the motor functions of DDD rats. Strikingly, administration of MP-10 also fully reversed immobility and catalepsy in DDD rats. According to neurochemical studies, the action of MP-10, in contrast to L-DOPA + carbidopa, seems to be dopamine-independent. These observations indicate that targeting PDE10A may represent a new promising approach in the development of non-dopamine therapies for Parkinson's disease.

Effects of a Peripherally Restricted Hybrid Inhibitor of CB1 Receptors and iNOS on Alcohol Drinking Behavior and Alcohol-Induced Endotoxemia

Alcohol consumption is associated with gut dysbiosis, increased intestinal permeability, endotoxemia, and a cascade that leads to persistent systemic inflammation, alcoholic liver disease, and other ailments. Craving for alcohol and its consequences depends, among other things, on the endocannabinoid system. We have analyzed the relative role of central vs. peripheral cannabinoid CB1 receptors (CB1R) using a "two-bottle" as well as a "drinking in the dark" paradigm in mice. The globally acting CB1R antagonist rimonabant and the non-brain penetrant CB1R antagonist JD5037 inhibited voluntary alcohol intake upon systemic but not upon intracerebroventricular administration in doses that elicited anxiogenic-like behavior and blocked CB1R-induced hypothermia and catalepsy. The peripherally restricted hybrid CB1R antagonist/iNOS inhibitor S-MRI-1867 was also effective in reducing alcohol consumption after oral gavage, while its R enantiomer (CB1R inactive/iNOS inhibitor) was not. The two MRI-1867 enantiomers were equally effective in inhibiting an alcohol-induced increase in portal blood endotoxin concentration that was caused by increased gut permeability. We conclude that (i) activation of peripheral CB1R plays a dominant role in promoting alcohol intake and (ii) the iNOS inhibitory function of MRI-1867 helps in mitigating the alcohol-induced increase in endotoxemia.

Bee Venom Alleviates Motor Deficits and Modulates the Transfer of Cortical Information through the Basal Ganglia in Rat Models of Parkinson's Disease

Recent evidence points to a neuroprotective action of bee venom on nigral dopamine neurons in animal models of Parkinson’s disease (PD). Here we examined whether bee venom also displays a symptomatic action by acting on the pathological functioning of the basal ganglia in rat PD models. Bee venom effects were assessed by combining motor behavior analyses and in vivo electrophysiological recordings in the substantia nigra pars reticulata (SNr, basal ganglia output structure) in pharmacological (neuroleptic treatment) and lesional (unilateral intranigral 6-hydroxydopamine injection) PD models. In the hemi-parkinsonian 6-hydroxydopamine lesion model, subchronic bee venom treatment significantly alleviates contralateral forelimb akinesia and apomorphine-induced rotations. Moreover, a single injection of bee venom reverses haloperidol-induced catalepsy, a pharmacological model reminiscent of parkinsonian akinetic deficit. This effect is mimicked by apamin, a blocker of small conductance Ca2+-activated K+ (SK) channels, and blocked by CyPPA, a positive modulator of these channels, suggesting the involvement of SK channels in the bee venom antiparkinsonian action. In vivo electrophysiological recordings in the substantia nigra pars reticulata (basal ganglia output structure) showed no significant effect of BV on the mean neuronal discharge frequency or pathological bursting activity. In contrast, analyses of the neuronal responses evoked by motor cortex stimulation show that bee venom reverses the 6-OHDA- and neuroleptic-induced biases in the influence exerted by the direct inhibitory and indirect excitatory striatonigral circuits. These data provide the first evidence for a beneficial action of bee venom on the pathological functioning of the cortico-basal ganglia circuits underlying motor PD symptoms with potential relevance to the symptomatic treatment of this disease.

Pallidal hyperdopaminergic innervation underlying D2 receptor-dependent behavioral deficits in the schizophrenia animal model established by EGF

Epidermal growth factor (EGF) is one of the ErbB receptor ligands implicated in schizophrenia neuropathology as well as in dopaminergic development. Based on the immune inflammatory hypothesis for schizophrenia, neonatal rats are exposed to this cytokine and later develop neurobehavioral abnormality such as prepulse inhibition (PPI) deficit. Here we found that the EGF-treated rats exhibited persistent increases in tyrosine hydroxylase levels and dopamine content in the globus pallidus. Furthermore, pallidal dopamine release was elevated in EGF-treated rats, but normalized by subchronic treatment with risperidone concomitant with amelioration of their PPI deficits. To evaluate pathophysiologic roles of the dopamine abnormality, we administered reserpine bilaterally to the globus pallidus to reduce the local dopamine pool. Reserpine infusion ameliorated PPI deficits of EGF-treated rats without apparent aversive effects on locomotor activity in these rats. We also administered dopamine D1-like and D2-like receptor antagonists (SCH23390 and raclopride) and a D2-like receptor agonist (quinpirole) to the globus pallidus and measured PPI and bar-hang latencies. Raclopride (0.5 and 2.0 µg/site) significantly elevated PPI levels of EGF-treated rats, but SCH23390 (0.5 and 2.0 µg/site) had no effect. The higher dose of raclopride induced catalepsy-like changes in control animals but not in EGF-treated rats. Conversely, local quinpirole administration to EGF-untreated control rats induced PPI deficits and anti-cataleptic behaviors, confirming the pathophysiologic role of the pallidal hyperdopaminergic state. These findings suggest that the pallidal dopaminergic innervation is vulnerable to circulating EGF at perinatal and/or neonatal stages and has strong impact on the D2-like receptor-dependent behavioral deficits relevant to schizophrenia.

Protective effects of aqueous fruit extract from Sea Buckthorn (Hippophae rhamnoides L. Spp. Turkestanica) on haloperidol-induced orofacial dyskinesia and neuronal alterations in the striatum

BACKGROUND

Long-term treatment of haloperidol, a neuroleptic, induces neurodegeneration specifically in the striatum (caudate and putamen), which plays an important role in the development of orofacial dyskinesia, a putative model of tardive dyskinesia (TD). This study investigated the protective effects of a concomitant treatment of aqueous fruit extract of Sea buckthorn (Hippophae rhamnoides L. spp. Turkestanica) (SBT-FE) (40 mg/kg, orally) plus haloperidol (3.0 mg/kg, ip) administration on an animal model of TD and on striatal neuronal alterations.

MATERIAL/METHODS

Rats received daily haloperidol (3.0 mg/kg ip) and saline injections for 15 days. Seven-day posttreatment, aqueous SBT-FE (40 mg/kg) was administered daily via a feeding tube. Hypolocomotive effects (home cage activity, exploratory activity, catalepsy, and vacuous chewing movements) were monitored consecutively in each group. On the last day of the experiments, changes in extracellular levels of striatal dopamine (DA), dihydroxyphenyl acetic acid (DOPAC) and homovanillic acid (HVA) were determined by HPLC-EC.

RESULTS

Aqueous SBT-FE attenuated haloperidol-induced VCMs after second week of treatment and locomotor activity was greater in rats treated with SBT-FE compared with the controls. The results indicate that DA and HVA levels in the striatum were significantly (P <.01) altered in rats given SBT-FE before injections of haloperidol.

CONCLUSIONS

Hippophae rhamnoides fruit extract has a protective role against haloperidol-induced orofacial dyskinesia. Consequently, use of Hippophae rhamnoides as a possible therapeutic agent for the treatment of tardive dyskinesia should be considered.

Motor and sensory dissociative phenomena associated with induced catalepsy: A brief communication

The purpose of this study was to investigate dissociative symptoms that may occur as an epiphenomenon of tactile-induced catalepsy. In 15 participants, catalepsy was induced in the right arm, and dissociative symptoms were evaluated using a self-report questionnaire. In comparison with the left, noncataleptic arm, the right cataleptic arm was perceived differently. In addition to increased rigidity, the cataleptic arm was characterized by the presence of paresthesias, a decreased perception of sense and a decreased awareness of the arm. Moreover, the self-reported changes in perception were significantly correlated to the hypnotically induced arm-immobilization part of the Stanford Hypnotic Susceptibility Scale. In conclusion, catalepsy induction elicits a variety of dissociative symptoms and provides a useful research paradigm for the study of motor-perceptual dissociative phenomena.

Effects of amantadine on modification of dopamine dependent behaviours by molindone

Amantadine, a dopamine agonist is reported to act by releasing dopamine from the dopaminergic nerve terminals as an anti-Parkinsonian drug. In the present behavioural study in the rat, molindone-induced catalepsy and ptosis, which are dopamine dependent-behaviors are reversed by amantadine. Amantadine has also revered molindone-induced inhibition of traction response in mice. Our study indicates that amantadine, like other DA agonists, e.g. amphetamine and apomorphine can antagonize or even reverse the neuroleptic induced dopaminergic behaviors.

[The effect of lithium chloride on the rat behavior after short-term oligemic hypoxia]

The experiments were carried out on male Wistar rats. The influence of brain oligemic hypoxia and lithium chloride (LiCl) on some behavioural parameters was investigated. Reduction of brain blood supply was performed by surgical clamping of both carotid arteries for 60 min in general anaesthesia induced by brietal (Methoxitone sodium, 10 mg/kg i.p.). Control animals had their vessels separated, but not clamped (sham operated). 6 days after surgery animals received LiCl (2.5 mEq/kg i.p.). Behavioral experiments were performed 24 h and 7 days after lithium administration. Experimental groups consisted of 12 animals. It was found that oligemic hypoxia reduced inconsiderably spontaneous locomotor and exploratory activity in rats. Similar influence of LiCl was observed. But LiCl administered to animals after oligemic hypoxia prevented them against locomotor and exploratory impairment. In addition, LiCl strongly enhanced amphetamine-induced hyperactivity and diminished haloperidol-induced catalepsy in hypoxic animals. These effects were not observed in sham operated animals. The above results could be connected with antidepressive action of LiCl and the model of moderate oligemic hypoxia used in present work could be a useful model for investigation of new antidepressive compounds.

Narcolepsy: unequivocal diagnosis after split-screen, video-polysomnographic analysis of a prolonged cataplectic attack

The clinical diagnosis of narcolepsy often depends on the coexistence of pathologic sleepiness and cataplectic attacks. We present a case of narcolepsy unequivocally diagnosed after daytime, split-screen, video-polysomnographic monitoring captured a prolonged cataplectic event during which the patient was coherent, conversant, and in electroencephalographic rapid eye movement sleep.

Excessive daytime somnolence in young men: prevalence and contributing factors

To investigate the prevalence of excessive daytime somnolence and contributing factors, 58,162 draftees between 17 and 22 years of age, registered in two selection centers of the French army, were screened by means of a 17-item questionnaire. In response, 8,201 subjects (14.1%) reported occasional daytime sleep episodes, 2,210 (3.8%) one or two daily episodes, and 640 (1.1%) more than two daily episodes. Of the total sample, five percent or 2,933 considered these sleep episodes to affect their lives. Different possible factors of daytime sleep episodes were investigated, including hours of nocturnal sleep, sleep-wake schedule, sleep difficulties, use of hypnotics, snoring, and occurrence of cataplexy. A strong association was found between these factors and excessive daytime somnolence. A stepwise multivariate analysis was performed on five of these factors: hours of nocturnal sleep, sleep-wake schedule, sleep difficulties, use of hypnotics, and snoring. All five factors were shown to be independently related to excessive daytime somnolence and were ranked in the following descending order: use of hypnotics, sleep difficulties, irregular sleep-wake schedule, snoring, and hours of sleep.

Transient supression by stress of haloperidol induced catalepsy by the activation of the adrenal medulla

Rats were injected with haloperidol (0.5-1.0 mg X kg-1). When the catalepsy score was almost maximal (60 s, measured by the bar-test), the rats were handled, exposed to cold (3 degrees C) or immobilized. After each of these stress procedures the catalepsy was significantly reduced. Handling of adrenalectomized rats gave no such reduction. Infusion of adrenaline (10 nmol X kg-1, given in 15 s), in contrast to that of isoprenaline and phenylephrine (both the same concentration as adrenaline) also reduced the haloperidol induced catalepsy. These findings indicate that neuroleptic catalepsy in rats is not only mediated through central but also through peripheral mechanisms, e.g. by the adrenal medulla.

Simultaneous catalepsy and apomorphine-induced stereotypic behavior in mice

Intraventricular administration of haloperidol or chlorpromazine produces catalepsy and blocks apomorphine-induced stereotypic behavior. Low intraventricular doses of domperidone, sulpiride and spiperone, equally cataleptogenic as haloperidol or chlorpromazine, augment rather than diminish stereotypic behavior produced by subsequent apomorphine treatment. The resultant stereotypic behavior continues even while the animal is in a rigid cataleptic posture and is marked by persistent gnawing and licking. Prior to the induction of catalepsy and after recovery from it, mice display the entire range of typical apomorphine-induced behavior including sniffing, climbing, gnawing, and licking. This animal model may be related to the clinical observation of the coexistence of tardive dyskinesia and drug-induced Parkinsonism in individual patients.

Serine and glycine-induced catalepsy in porphyric rats: an animal model for psychosis?

It was investigated whether an increased demand for glycine, as postulated to occur in patients who have suffered from episodic psychoses accompanied by multiple perceptual distortions, could evoke psychotic reactions. Catalepsy was used as a measure for psychosis and was observed after injection of serine or glycine in porphyric rats. Catalepsy was was shown to occur after serine as well as glycine administration in 2-allyl-2-isopropylacetamide (AIA) pretreated rats, while in lead (Pb) + phenobarbital pretreated rats only glycine was effective. Administration of AIA to rats resulted in a strongly enhanced excretion of porphobilinogen (PBG) in urine, while Pb + phenobarbital pretreated rats showed increased excretion of delta-aminolevulinic acid (delta-ALA). The Pb + phenobarbital pretreated animals showed elevated serine plasma levels and lowered glycine plasma levels 18 hours after injection, while no significant differences in plasma levels of these amino acids were found 24 hours after AIA administration. In AIA or saline pretreated animals, but not in those pretreated with Pb + phenobarbital, glycine formation from serine was elevated. It is concluded that the present animal model can be used to investigate episodic psychoses.

Dopaminergic function in two patients with catalepsy

Apomorphine HC1 (2 mg subcutaneously), a dopamine receptor agonist, was administered to two schizophrenic patients with catalepsy. In one of these patients the clinical response to apomorphine was compared with that of sodium amytal and the growth hormone response apomorphine (0.75 mg subcutaneously) was compared with that of 25 control subjects. Apomorphine had no effect whereas sodium amytal caused rapid disappearance of catatonic symptoms including catalepsy. The peak growth hormone response to apomorphine was similar to that of controls. These data suggest that unlike experimental catalepsy in animals, catalepsy associated with schizophrenia may not be dependent on impaired dopaminergic function. Further case studies as well as the use of other dopamine receptor agonists are required before definite conclusions can be drawn.