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Clinical Instructor
Partial Dopamine D2/ Serotonin 5-HT1A Receptor Agonists as New Therapeutic Agents
Adeline Etievant, Ccile Btry, and Nasser Haddjeri
Laboratory of Neuropharmacology, Faculty of Pharmacy, University Lyon I, EAC CNRS 5006, 8 Avenue Rockefeller 69373 LYON Cedex 08 France
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
CONTENTS (1)
ABSTRACT INTRODUCTION - Regulation of brain DA and 5-HT transmission DA system DA partial agonist 5-HT system PARTIAL DOPAMINE D2/SEROTONIN 5-HT1A RECEPTOR AGONISTS AND SCHIZOPHRENIA - Therapeutic Agent for Schizophrenia - Partial D2-Like Receptor Agonists in Schizophrenia - 5-HT1A Receptor Agonists in Schizophrenia
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Abstract
The therapeutic efficacy of current antipsychotic or antidepressant agents still present important drawbacks, such as delayed onset of action and a high percentage of non-responders. The present review discusses the usefulness of partial dopamine D2/serotonin 5-HT1A receptors agonists in the treatment of schizophrenia, major depression and bipolar disorder as well as in Parkinsons disease.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Abstract
Partial agonists can behave as modulators since their intrinsic activity or efficacy of a partial agonist depends on the target receptor population and the local concentrations of the natural neurotransmitter. These drugs may restore adequate neurotransmission while inducing less side effects.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Abstract
In schizophrenia, partial DA D2/5-HT1A receptor agonists (like aripiprazole or bifeprunox), by stabilizing DA system via a preferential reduction of phasic DA release, reduce side effects i.e. extrapyramidal symptoms and improve cognition by acting on 5-HT1A receptors. Aripiprazole a promising agent for the treatment of depression since it potentiates the effect of SSRIs in resistant treatment depression. Concerning bipolar disorders, aripiprazole may have only a benefit effect in the treatment of manic episodes.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Abstract
Treatment of Parkinsons disease with partial DA D2/5-HT1A receptor agonists remains still experimental. Several studies suggest that these drugs decrease usually observed side effects (dyskinesia, psychotic-like symptoms) in Parkinsons disease treatment.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA SYSTEM
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA SYSTEM
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA SYSTEM
1. THE MESOLIMBIC DOPAMINERGIC PATHWAY Located within the ventral tegmental area. Efferent target in the ventral striatum including nucleus accumbens (Nacc) and limbic structures (e.g amygdala and hippocampus). Involved in emotional and motivational processing. In schizophrenia, the hyperactivation of this pathway seems to lead to positive symptoms like hallucinations.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA SYSTEM
2. THE MESOCORTICAL DOPAMINERGIC PATHWAY Efferent targets in prefrontal cortex. This pathway is hypoactive in schizophrenia which can be responsible for cognitive and negative symptoms.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA SYSTEM
3. THE NIGROSTRIATAL DOPAMINERGIC PATHWAY Consists of the subst. nigra pars compacta (SNc-A9). Efferent targets in the dorsal striatum. Contains the majority of brain DA. This pathway is involved in motor learning and control. Degeneration of this pathway leads to Parkinsons disease. Blockade of this pathway is associated with movement disorders like EPS and dyskinesia.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA SYSTEM
4. THE TUBERO-INFUNDIBULAR DA PATHWAY Consists of DA neurons that project from the periventricular and arcuate nuclei of the hypothalamus to the intermediate lobe of the pituitary. Secretion of prolactine under the control of DA. Blockade of DA receptors hyperprolactinemia.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA PARTIAL AGONISTS
A partial agonist induces a reduced signaling response compared to the maximum achievable response by a full agonist. The intrinsic activity or efficacy of a partial agonist depends on the sensitivity and responsiveness of the receptors. A partial agonist can behave as an agonist or antagonist, depending on the target receptor population and the local concentration of the natural neurotransmitter.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
DA PARTIAL AGONIST
(Hypothetic of the mechanism of action of partial D2/5-HT1A agonists)
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
5-HT SYSTEM
Located in the brainstem near or on the midline. There is nine 5-HT nuclei in the brainstem. The superior group : the caudal linear nucleus, median raphe nuclei (MRN), dorsal raphe nuclei (DRN), lateral nucleus. The inferior group : the nuclei raphe obscursus, raphe pallidus, raphe magnus. Efferent 5-HT projections to the forebrain originate mainly from the superior group of raphe nuclei.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
5-HT SYSTEM
The DRN contains about 50-60% of 5-HT neurons in human CNS, whereas the MRN contains about 5%. In the DRN, about 70% of the cells are 5-HT neurons. Non-5-HT cells found in the DRN : peptidergic neurons (Substance P) and non-peptidegric neurons (DA and GABA).
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
5-HT SYSTEM
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
INTRODUCTION
5-HT SYSTEM
5-HT1A receptors
Located presynaptically on 5-HT neurons in the raphe nuclei and post-synaptic neurons in the brain and spinal cord. Exert negative feedback on firing activity. Abundant in limbic structures, exert an inhibitory function on neuronal activity.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
SCHIZOPHRENIA
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
SCHIZOPHRENIA
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
SCHIZOPHRENIA
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
SCHIZOPHRENIA
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
CONTENTS (2)
PARTIAL DOPAMINE D2/SEROTONIN 5-HT1A RECEPTOR AGONISTS AND AFFECTIVE DISORDERS - Major Depression - Therapeutic Agents for Major Depression - D2-Like Receptor Agonists in Major Depression - 5-HT1A Receptor Agonists in Major Depression - Bipolar Disorder - Therapeutic Agents for Bipolar Disorder - Partial D2-Like Receptor Agonists in Manic Episodes PARTIAL DOPAMINE D2/SEROTONIN 5-HT1A RECEPTOR AGONISTS AND PARKINSONS DISEASE - Therapeutic Agents for Parkinsons Disease - Partial D2-Like Receptor Agonists in PD - 5-HT1A Receptor Agonists in PD
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
MAJOR DEPRESSION
Prevalence rate 12% men and 20% women Changes in mood Several psychosiological Decreased ability to concentrate Reccurent thought of death
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
MAJOR DEPRESSION
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Have fewer and less severe side effects than these first generation drugs due to their lack of affinity for amines and acetylcholine receptors
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Second, there is evidence tha neurogenesis, which is a crucial phenomenon in the antidepressant action, can be mediated via 5-HT receptor activation.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Wilcox et al. showed that gepirone ER administration had antidepressant efficacy 1 week until 6 weeks of treatment with a daily dose of 70mg but not with 40mg
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
BIPOLAR DISORDER
Bipolar disorder is a severe chronic illness associated with abnormal structure and function of the central nervous system with high rates of recurrence, disability, social impairment1-6% of the population.
Specifically, the depressive episodes are more numerous,last longer, and are less responsive to treatment than the manic episodes
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
20%-40% patient have side effects such as : Tremors Gastrointestinal disorders, Tiredness Somnolence, and cognitive Impairment in memory and concentration
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
PARKINSONS DISEASE
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
High frequency stimulation of the subthalamus nucleus, a well admit antiparkinsonian therapy, has been shown to reduce 5-HT neuronal firing , further suggesting the involvement of 5-HT system in the pathophysiology of PD.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
CONCLUSION
Several studies are in accordance with the marked interest of partial D2/5-HT1A agonists in reducing side effects i.e. extrapyramidal symptoms and cognitive impairments in schizophrenia, various researches are still needed to emphasize their beneficial utility in major depression, bipolar disorders and Parkinsons disease.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
CONCLUSION
Treatment with aripiprazole in major depression as monotherapy or as adjuvant with a classical antidepressants seems to improve the antidepressant response whereas, in bipolar disorder, only partial dopamin D2 1A receptors agonists show advantages in the treatment of manic episodes. Differently, if treatment of Parkinsons disease with partial D2 and 5-HT receptors agonists is still at the experimental phase, increasing studies report a decrease of side effects with these drugs. Hence, these relatively recent researches provide an exciting future in the discovery of novel stabilizators agents for the management of the latter diseases.
Journal Reading from Medical Students of Christian University of Indonesia Clinical Instructor dr. Sabar Siregar, Sp.KJ Magelang, 28 September 2012
JOURNAL READING
Partial Dopamine D2/ Serotonin 5-HT1A Receptor Agonists as New Therapeutic Agents
CRITICAL APPRESIAL
Abstrak
1. 2. 3. The structure : Consist of 1 part Informative : Yes Less than 250 word : No (255 word)
Introduction
1. 2. 3. 4. Consist of 2 paragraph or part : No (10 paragraph, 3 parts) The first paragraph explain background of the research : Yes The second paragraph explain hypothesis or objective : Not pattern Less than 1 page : Yes (3 pages)
The Discussion
1. The data from the research related back to the literature and to other findings : Yes 2. The research support or challenge existing thinking or practice : Yes 3. The research suggest recommendations for practice, or areas for further research : Yes 4. The author reflective on her/his work or self-critical : Not pattern
The Conclusion
1. The threads of the argument was drawn together clearly : Yes 2. The research questions was answered and research aims fulfilled : Yes 3. The research contribute to the field : Clinicians, Psychiatrist
Thank You