The Neurobiology of Schizophrenia
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1 The Neurobiology of Schizophrenia Dost Ongur, MD PhD
2 Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.
3 What is Psychosis? Response Language Affect Motor Representation Reception S A V
4 Neural circuitry Cortex M S, A, V Association BG Thalamus MTL DA NE 5-HT S, A, V ACh
5 The Reduced Neuropil Hypothesis Selemon and Goldman-Rakic, 1999
6
7 Lewis et al, 2005
8 Lewis et al, 2005
9 GABAergic synapse Gi Cl - GABA transporter GABA B receptor Gi GABA A receptor Modulators: α: BZD channel: Barbiturates Ethanol
10 Progressive Cortical Volume Loss Thompson et al., 2001
11
12 Kubicki et al, 2005
13 Thalamic Metabolism during Verbal Learning Hazlett et al., 1999
14 Dopaminergic system D1 D5 D4 Cortex D1 D1 D3 D2 D2 N. accumbens Caudate Putamen G. pallidus VTA SN Thalamus
15 Dopaminergic synapse DAT D1, D5 receptors Gs Gi D2, D3, D4 receptors P
16 Striatal Dopamine release Release Laruelle et al., 1999
17 Glutamatergic synapse Gi Glutamate transporter Na + /Ca ++ Metabotropic receptors: mglur 1-7 Gi Ca ++ Ionotropic receptors: a) NMDA b) AMPA c) Kainate P
18 NMDA receptor
19 Patil et al, 2007
20
21
22 Ross et al, 2006
23 Neurobiology of Schizophrenia 1) Multiple subtle abnormalities in most brain regions and chemical systems 2) No single lesion responsible for pathophysiology 3) Genetics points to neurodevelopment and synaptic plasticity 4) Deeper insights likely to come from meta level abnormalities in brain plasticity, connectivity, and information processing
24 Tsuang et al, 2001
25 Clinical Neuroscience in Mood Disorders Dost Öngür, M.D., Ph.D.
26 Episodic course Relevant Issues Symptoms not continuous following onset Certain but not all abnormalities found in euthymia Effects of the environment Variable presentation Manic vs. Depressive episodes It is almost as if mania and melancholia are part of the same disease Arateus the Cappadocian
27 A Framework A condition that can be triggered by environmental events or endogeneously Only in people with a vulnerability Once triggered, becomes an episode Relatively stereotyped features but clear subtypes Typically self-limiting and episode ends once it has run its course But vulnerability remains or is amplified
28
29 Phillips et al, 2003
30 Phillips et al, 2003
31 Schultz, 2004
32 Moghaddam 2002
33 McEwen 2004 From ed. Schulk
34 adapted from Stephan Heckers, MD
35 The case of ketamine Zarate et al 2010
36 Circadian Rhythm abnormalities in Bipolar Disorder
37 Evidence for circadian rhythm abnormalities Abnormal sleep and other circadian behaviors Seasonal pattern of episodes Induction of mania with sleep deprivation/travel across time zones Polymorphisms in genes controlling the biological pacemaker (Clock and related genes) Effect of sleep deprivation, phototherapy and sleepentrainment
38 Frank et al, 2005
39 Bunney and Bunney, 2000
40 Clock mutant Mice Mutation in CLOCK generates a dominantnegative protein CLOCK expression is not cyclical, not restricted to suprachiasmatic nucleus Mutant mice are hyperactive At baseline In response to novelty Hypersensitive to cocaine
41 Clock mutant mice are more sensitive to reward Roybal et al, 2007
42 Clock mutant mice show a less depressive-like phenotype FST LH open field elev maze latency to feed Roybal et al, 2007
43 Lithium reverses abnormalities in Clock mutant mice Roybal et al, 2007
44 Clock mutant mice Clock mutant mice display increased cell firing and bursting in the VTA Viral-mediated gene transfer of functional CLOCK into the VTA Hyperactivity and open-field abnormalities normalized
45 Antidepressants
46 The mechanism of action of antidepressants is: Upregulation of neurogenesis in the hippocampus?
47 Santarelli et al, 2003
48 Santarelli et al, 2003
49 Li et al 2010
50 Mood Stabilizers
51 The mechanism of action of mood stabilizers is: Modulation of intracellular signalling pathways to enhance cell survival and plasticity?
52 Gould et al, 2004
53 Moore et al, 2000
54 Conclusions Etiology is elusive Multiple intersecting factors of variable strength Complex systems break in complex ways Instead of searching for the lesion Look for mechanisms to harness Circadian rhythms Think outside the box Omega-3 FAs, inositol Statins, Oral hypoglycemics Ketamine
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