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Biomedical subjects

Shitij Kapur

Publications and source records attributed to Shitij Kapur.

At least 55 records · Page 3Linked to original sources
PubMed2005

Amoxapine as an atypical antipsychotic: a comparative study vs risperidone.

Amoxapine is marketed as an antidepressant. However, its in-vitro profile, receptor occupancy and preclinical effects are very similar to atypical antipsychotics. Amoxapine has also shown efficacy as an atypical antipsychotic in open trials. The objective of this study was to compare the antipsychotic and side effect profile of amoxapine and risperidone in a randomised assignment, standardized dosing, double-blind trial of acutely psychotic patients with schizophrenia. A total of 48 schizophrenic patients were enrolled and randomized in a double-blind 6-week trial to receive either risperidone (up to 5 mg/day) or amoxapine (up to 250 mg/day). Positive, negative, affective symptoms and motor side effects were measured using standardized weekly assessments. Prolactin levels were also determined at baseline and at the end of the study. A total of 39 patients (amoxapine, n=22; risperidone, n=21) completed the trial. Both pharmacological treatments, amoxapine 228.0 mg/day (SD=34.6) and risperidone 4.5 mg/day (SD=0.7), showed equivalent improvement in positive, negative, and depressive symptoms. Amoxapine was associated with less EPS and less prolactin elevation than risperidone. These data support previous reports about the efficacy of amoxapine as an atypical antipsychotic. Since amoxapine is off-patent, it may be a valuable low-cost alternative to new atypical antipsychotics, particularly in low-income countries where the majority of the patients are still treated with typical antipsychotics.

Adolescent↗
PubMed2005

A computational model of the functional role of the ventral-striatal D2 receptor in the expression of previously acquired behaviors.

The functional role of dopamine has attracted a great deal of interest ever since it was empirically discovered that dopamine-blocking drugs could be used to treat psychosis. Specifically, the D2 receptor and its expression in the ventral striatum have emerged as pivotal in our understanding of the complex role of the neuromodulator in schizophrenia, reward, and motivation. Our departure from the ubiquitous temporal difference (TD) model of dopamine neuron firing allows us to account for a range of experimental evidence suggesting that ventral striatal dopamine D2 receptor manipulation selectively modulates motivated behavior for distal versus proximal outcomes. Whether an internal model or the TD approach (or a mixture) is better suited to a comprehensive exposition of tonic and phasic dopamine will have important implications for our understanding of reward, motivation, schizophrenia, and impulsivity. We also use the model to help unite some of the leading cognitive hypotheses of dopamine function under a computational umbrella. We have used the model ourselves to stimulate and focus new rounds of experimental research.

Animals↗
PubMed2005

Evidence for onset of antipsychotic effects within the first 24 hours of treatment.

OBJECTIVE: It is widely held that there is a delayed onset of antipsychotic action and that any early effects represent nonspecific behavioral effects. Recent research has shown that antipsychotic action begins within the first week. The authors tested the hypothesis that psychosis improves within the first 24 hours of antipsychotic treatment. METHOD: In this multicenter, double-blind, placebo-controlled study, 311 patients with a diagnosis of schizophrenia spectrum disorder and an acute exacerbation were randomly assigned to receive 10 mg i.m. of olanzapine, 7.5 mg i.m. of haloperidol, or intramuscular placebo. Subjects were rated with structured rating scales (Positive and Negative Syndrome Scale and Clinical Global Impression) at baseline, 2 hours, and 24 hours. RESULTS: The olanzapine and haloperidol groups showed greater resolution of overall symptoms than the placebo group; for the olanzapine group, this effect was evident at 2 hours. A factor analysis showed that an independent change in psychosis (which included conceptual disorganization, hallucinatory behavior, unusual thought content) was evident within the first 24 hours for both drugs. This improvement in core psychosis was not mediated unidirectionally by changes in nonspecific behavioral effects or other psychopathology. CONCLUSIONS: These data suggest that the onset of antipsychotic action is early and that the magnitude of this action grows with time. This clinical reality calls into question some prevailing hypotheses regarding the mechanism of action of antipsychotics and suggests that antipsychotic action may be more proximally related to the blockade of dopamine transmission than was originally thought.

Acute Disease↗
PubMed2005

Treatment response to olanzapine and haloperidol and its association with dopamine D receptor occupancy in first-episode psychosis.

OBJECTIVE: Response to typical antipsychotic medication has been associated with achieving a level of striatal dopamine D2 receptor occupancy in the range of 65% to 70%. We undertook this study to determine whether response to the atypical antipsychotic olanzapine occurs at lower levels of D2 receptor occupancy. METHOD: Eighteen patients who presented with a first episode of psychosis were randomized to receive olanzapine 5 mg daily or haloperidol 2 mg daily in a double-blind design. We acquired positron emission tomography (PET) scans using the D2 ligand [11C]raclopride within the first 15 days of treatment to determine the percentage of D2 receptors occupied by the medication. According to response, dosage was then adjusted to a maximum dosage of 20 mg daily of either drug. PET scans were repeated after 10 to 12 weeks of treatment. RESULTS: At the first PET scan, the 8 olanzapine-treated patients had significantly lower D2 receptor occupancies (mean 63.4%, SD 7.3) than those observed in the 10 patients treated with haloperidol (mean 73.0%, SD 6.1). When patients were rescanned following dosage adjustment, mean D2 receptor occupancies were greater than 70% in both groups. D2 receptor occupancies did not differ significantly between the olanzapine-treated group (mean 72.0%, SD 5.7) and the haloperidol-treated group (mean 78.7%, SD 7.6). CONCLUSIONS: These results suggest that, in patients being treated for a first episode of psychosis, olanzapine has its antipsychotic effect at approximately the same levels of D2 receptor occupancy as are achieved with low dosages of haloperidol.

Acute Disease↗
PubMed2004

Effects of typical and atypical antipsychotic drugs on maternal behavior in postpartum female rats.

Understanding the effects of antipsychotic drugs (APDs) on social behaviors such as maternal behavior is valuable for understanding the complete spectrum of therapeutic and side-effects of antipsychotics. Although previous studies have suggested that typical antipsychotics impair maternal behavior, the effects of the atypical antipsychotics have not been systematically explored. The purpose of the present report was to examine the effects of typical (haloperidol, HAL) and several atypical (clozapine, CLZ; risperidone, RIS; quetiapine, QUE) antipsychotics on maternal behavior in female rats. Maternal behaviors were examined repeatedly over a period of 24 h after a single injection of a range of doses of HAL, CLZ, RIS or QUE on Day 6 postpartum. All antipsychotic drugs, typical or atypical, elicited a qualitatively similar disruptive effect on the active components of maternal behavior such as pup approach, pup retrieval and nest building at clinically relevant doses. However, HAL caused a prolonged disruption, whereas CLZ, RIS and QUE induced an early onset but shorter duration disruption. In addition, only the atypical antipsychotics showed some inhibitory effects on nursing behavior, possibly due to sedative side-effects shared by all atypical antipsychotics. The current generation of atypical antipsychotics shows a disruptive influence on maternal behavior similar to that of the typical antipsychotics. This effect may be intrinsic to antipsychotic activity or may be reflective of a side-effect. Since the latter is more likely, this may be an effect to avoid in the design of future antipsychotics.

Animals↗
PubMed2004

Amphetamine pretreatment induces a change in both D2-Receptor density and apparent affinity: a [11C]raclopride positron emission tomography study in cats.

BACKGROUND: Measuring changes in dopamine (DA) levels in humans using radioligand-displacement studies and positron emission tomography (PET) has provided important empirical findings in disease and normal neurophysiology. These studies are based on the assumption that DA exerts a competitive inhibition on radioligand binding. To test this, we used PET and a Scatchard approach to investigate whether the decrease in [11C]raclopride binding following amphetamine results from competitive or noncompetitive interactions with DA. METHODS: Scatchard analyses of [11C]raclopride/PET data were used to quantify changes in apparent D2-receptor density (Bmax) and radioligand apparent affinity (K'D) at baseline and after amphetamine pretreatment (2 mg/kg; intravenous) in cats. RESULTS: Amphetamine induced a 46% decrease in [11C]raclopride binding in the striatum of five cats. Scatchard analyses revealed that this decrease in binding was due to a 28% decrease in Bmax and a concomitant 35% increase in K'D. CONCLUSIONS: Competition with DA is an insufficient explanation for the decrease in [11C]raclopride binding observed after amphetamine. Noncompetitive interactions, likely representing D2-receptor internalization, also play an important role in this phenomenon. This finding may have important implications for the interpretation of amphetamine-raclopride PET studies in schizophrenia because dysregulation of the agonist-induced internalization of D2 receptors was recently suggested in this disorder.

Amphetamine↗
PubMed2004

Oral D-amphetamine causes prolonged displacement of [11C]raclopride as measured by PET.

Parenterally administered D-amphetamine has been used as a challenge drug to release dopamine, which in turns inhibits [11C]raclopride binding to dopaminergic D2 receptors as measured using positron emission tomography (PET) techniques. The primary objective of this study was to determine whether orally administered D-amphetamine would inhibit [11C]raclopride binding in a manner similar to that produced by intravenously administered D-amphetamine. The secondary objective was to assess the timeline of these effects. Twelve healthy human volunteers participated in this study. Subjects were scanned at baseline and 2 h after D-amphetamine administration (n = 5); at baseline, 2 and 6 h postdrug (n = 4); or at baseline, 2 and 24 h postdrug (n = 3). Orally administered D-amphetamine caused a significant decrease in [11C]raclopride binding at 2 h (13% +/- 5%). Receptor availability was still decreased at 6 h (18% +/- 6%), even though physiological effects had completely returned to baseline. [11C]Raclopride binding returned to baseline at 24 h. The percentage of [11C]raclopride displacement was not correlated with plasma D-amphetamine concentrations. In conclusion, orally administered D-amphetamine caused a reliable and prolonged [11C]raclopride displacement, the magnitude of which is similar to that observed after intravenous administration. Possible mechanisms for the observed prolonged displacement may include persistence of intrasynaptic dopamine and/or receptor internalization.

Administration, Oral↗
PubMed2004

Quantitative validation of an intracerebral beta-sensitive microprobe system to determine in vivo drug-induced receptor occupancy using [11C]raclopride in rats.

In this study, we evaluated the potential of using a new beta-sensitive microprobe system for in vivo quantification of [11C]raclopride binding and for in vivo determination of drug-induced receptor occupancy in the rat striatum. To validate this system, an ex vivo tissue dissection method was used to corroborate in vivo beta-microprobe measurements. Our data showed that the beta-microprobe-derived [11C]raclopride binding kinetics in striatum could be quantified using a tissue compartmental model with a cerebellar reference region. Haloperidol (0.001-0.1 mg/kg; i.v.) induced a dose-dependent decrease in [11C]raclopride binding in striatum as measured using the beta-microprobe with an ED50 value of 0.013 mg/kg. Highly significant relationships (P < 0.0001) were observed, within the same animals, between in vivo and ex vivo measures of haloperidol-induced D2-receptor occupancy (r = 0.98) as well as between in vivo and ex vivo measures of [11C]raclopride binding potentials (r = 0.99). Results from pretreatment and displacement studies with unlabeled raclopride and amphetamine conformed to the effect of these drugs as observed in humans using [11C]raclopride and PET and allowed estimation of the in vivo k(off) value of raclopride to 0.025 +/- 0.004 min(-1). However, allowing the system to stabilize before measurements and shielding the photomultiplier tubes were critical for obtaining these consistent results. This study demonstrates that the beta-microprobe provides reliable measurements of [11C]raclopride binding kinetics in rodents, allows for quantitative in vivo measurements of antipsychotic drug action in brain, and represents a valid and cost-effective alternative to positron emission tomography imaging in small animals.

Animals↗
PubMed2004

Effect of acute antipsychotic administration on dopamine synthesis in rodents and human subjects using 6-[18F]-L-m-tyrosine.

Clinical effects of antipsychotic drugs are thought to be mediated primarily through antagonism of the dopamine D2 receptors. Recent studies have demonstrated increased aromatic decarboxylase activity following acute administration of dopamine D2 receptor antagonists both in vivo and ex vivo. However, this effect has never been demonstrated in human subjects. We studied the effect of acute antipsychotic administration on dopamine synthesis in rodents and healthy human subjects using 6-[18F]-L-m-tyrosine. In rats, we studied the effect of a single subcutaneous injection of haloperidol and risperidone on dopamine synthesis using 6-[18F]-L-m-tyrosine. In our human study, six healthy volunteers underwent two 6-[18F]-L-m-tyrosine PET scans, before and after 3 mg risperidone to measure the rate of accumulation of radioactivity in the striatum as an index of dopamine synthesis. The striatal/cerebellar radioactivity count ratio and the ratio of dopamine metabolites to dopamine concentration was significantly higher in all rodent treatment groups compared to controls. In the PET study we found no significant change in the rate of uptake in the striatum. Our results suggest that 6-[18F]-L-m-tyrosine PET may not be a useful tool in the study of the effect of antipsychotics on dopamine synthesis in human subjects.

Adult↗
PubMed2004

EMD 281014, a specific and potent 5HT2 antagonist in humans: a dose-finding PET study.

While serotonin 5HT2-receptors have been implicated in the etiology and pharmacological treatment of a number of neuropsychiatric conditions, there are few potent and specific agents available for use in human clinical studies. EMD 281014 is a highly specific 5HT2-receptor antagonist that is currently under development. To find optimal doses for early clinical studies, we conducted a PET study using [18F]setoperone in nine healthy subjects scanned at baseline and following the administration of 1, 3, and 7 mg EMD 281014. The study drug was well tolerated by all study participants, and all doses resulted in > or =70% occupancy at frontal 5HT2-receptors 3 h after drug administration. The data suggest that daily dosing of > or =3 mg EMD 281014 should be sufficient to provide sustained high levels of 5HT2-receptor occupancy in future clinical trials.

Adult↗
PubMed2004

Evaluation of the motor initiation hypothesis of APD-induced conditioned avoidance decreases.

Antipsychotic drugs (APDs) selectively disrupt conditioned avoidance responding (CAR)--a feature that distinguishes them from all other psychotropics. It is thought that this effect reflects their effect on motor initiation; however, this conclusion is questionable because most studies it relies on have often examined avoidance responding under APD treatment, and tested animals with preshock stimuli followed by the footshock. APD-induced CAR effects are confounded by APDs' motor effects and by the presence of footshock. The objective of this study was to evaluate the motor initiation hypothesis by testing animals without drug and under extinction conditions. In Experiment 1, we administered haloperidol, clozapine or chlordiazepoxide (an anxiolytic as a pharmacological control) during the acquisition phase of CAR, but tested animals 2 days later. The APD-induced CAR disruption was present even in the absence of the drug and footshock. In Experiment 2, we first trained rats to a learning criterion, and then subjected them to 4 days of CAR extinction training under drug or vehicle. In the subsequent CAR extinction tests, the rats previously treated with APDs still showed significantly lower avoidance responses. In both experiments, the effects of haloperidol and clozapine were distinct from those of chlordiazepoxide. These data suggest that APD-induced CAR decreases cannot be explained as the unconditioned motor impairment effects of APDs, but probably reflect a dopamine-blockade-mediated change in incentive motivation.

Animals↗
PubMed2004

How antipsychotics become anti-"psychotic"--from dopamine to salience to psychosis.

The relationship between dopamine, psychosis and antipsychotics has been challenged by the suggestion that there is a delay, of weeks, between the onset of dopamine receptor blockade and improvement in psychosis. However, recent data show that there is no significant delay. In light of these new findings, it is proposed that dopamine, through its role in reward prediction and motivational salience, provides a link to psychosis. Psychosis results from aberrant reward prediction and aberrant attribution of salience that is caused by disordered dopamine transmission. Antipsychotics become anti-"psychotic" by blocking dopamine transmission and attenuating the motivational salience of the symptoms, leading to the common statement from patients that symptoms "don't bother me as much anymore". This attenuation of salience also impacts on normal motivational drives, providing an explanation for why antipsychotics might induce iatrogenic negative symptoms and dysphoria, often leading to non-compliance by patients. The implications of this framework for relapse and other clinical phenomena, animal models and future studies are discussed.

Antipsychotic Agents↗
PubMed2004

A model of antipsychotic action in conditioned avoidance: a computational approach.

The selective ability of antipsychotic drugs (APDs) to attenuate conditioned avoidance responding (CAR) has been recognized for over 50 years. However, most efforts to account for this finding have been either neurochemically oriented (focusing on the neuromodulator dopamine) or behavioral, with little effort invested in uniting the two within a computational model. In this paper we propose a computational model, based on concepts from formal reinforcement learning theory, which accounts for the basic finding that noncataleptic doses of APDs disrupt avoidance without disrupting escape. The model formally separates out sensory, motor, and reward processes, and makes novel predictions pertaining to the dose- and time-dependent effects of APDs on response latencies--predictions which we verified in experimental studies using four different APDs (haloperidol, chlorpromazine, risperidone, and clozapine). The APD action in this model is most consistent with an effect on 'expected future reward'--an idea closely linked to motivational drives and consistent with several leading theories of dopamine action.

Animals↗
PubMed2004

Relation between cortical dopamine D(2) receptor occupancy and suppression of conditioned avoidance response in non-human primate.

Suppression of the conditioned avoidance response (CAR), a useful test for screening for antipsychotic effects, has been discussed in relation to the blockade of dopaminergic transmission. The purpose of the present paper was to investigate the relationship between cortical dopamine D(2) receptor occupancy and the suppression of CAR by haloperidol in non-human primate. The avoidance rate was measured for four different doses of haloperidol treatment in a rhesus monkey, and the cortical D(2) receptor occupancy was measured in a parallel session using positron emission tomography with [(11)C]FLB 457. The successful avoidance response rate was decreased for doses of 10 and 30 microg/kg of haloperidol, and this decrement was associated with 65-77% of D(2) receptor occupancy. It is suggested that the threshold level of cortical dopamine D(2) receptor occupancy for the suppression of CAR is demonstrated in the present study.

Animals↗
PubMed2004

A PET study of dopamine D2 and serotonin 5-HT2 receptor occupancy in patients with schizophrenia treated with therapeutic doses of ziprasidone.

OBJECTIVE: Ziprasidone is an atypical antipsychotic drug that shows a higher affinity for serotonin 5-HT(2) receptors compared with dopamine D(2) receptors in vitro. The affinity of ziprasidone for these receptors in vivo in patients was examined in a positron emission tomography (PET) study. METHOD: The authors conducted a PET study to evaluate D(2) occupancy (using [(11)C]raclopride) and 5-HT(2) occupancy (using [(18)F]setoperone) in brain regions of interest in 16 patients with schizophrenia or schizoaffective disorder randomly assigned to receive 40, 80, 120, or 160 mg/day of ziprasidone, which reflected the recommended dose range. PET scanning was done after 3 weeks of administration and at trough plasma levels, i.e., 12-16 hours after the last dose. RESULTS: The mean 5-HT(2) receptor occupancy was significantly higher than the mean D(2) receptor occupancy (mean=76%, SD=15%, and mean=56%, SD=18%, respectively). The estimated plasma ziprasidone concentration associated with 50% maximal 5-HT(2) receptor occupancy was almost four times lower than that for D(2) receptor occupancy. CONCLUSIONS: These data affirm that ziprasidone is similar to other novel antipsychotics in having greater 5-HT(2) than D(2) receptor occupancy at therapeutic doses and suggest that the optimal effective dose of ziprasidone is closer to 120 mg/day than to the lower doses suggested by previous PET studies. The relatively high D(2) receptor occupancy, even at trough plasma levels, suggests that ziprasidone is more similar to risperidone and olanzapine in receptor occupancy profile than to clozapine and quetiapine. Since ziprasidone plasma levels show significant (more than twofold) variation within a single dose cycle, studies that are aimed at peak plasma levels (6 hours after the last dose) and that examine extrastriatal regions are required to fully characterize the in vivo occupancy profile of ziprasidone.

Adult↗