Dopamine and Social Anxiety

The effects of porn addiction can include a roller coaster of lows and highsThis section highlights the science on dopamine/dopamine receptors and anxiety. Remission of social anxiety is one of the benefits experienced by men as they reboot. See - Was the Cowardly Lion Just Masturbating With Porn Too Much? Addiction affects dopamine and dopamine receptors altering our perception - sometimes drastically. Addictions are classically seen as chronically low dopamine/dopamine receptors, punctuated by cues and use that jack up dopamine. Having a serious addiction is like being on a dopamine roller coaster, with little time spent in neurochemical equilibrium.

This section contains both lay articles for the general public, and research articles. The lay articles are marked with an "L."

A placebo controlled trial of risperidone in Tourette syndrome (2003)

Risperidone is dopamine antagonist, which means it reduces the binding of dopamine to dopamine receptors. As with other dopamine antagonists, risperidone initiated social anxiety in some users.  

Neurology. 2003 Apr 8;60(7):1130-5.

Scahill L, Leckman JF, Schultz RT, Katsovich L, Peterson BS.

Source

Child Study Center, School of Nursing, Yale University, New Haven, CT 06520, USA. lawrence.scahill@yale.edu

Abstract

OBJECTIVE:

To evaluate the efficacy and safety of risperidone in children and adults with Tourette syndrome.

METHODS:

This was an 8-week, randomized, double-blind, placebo-controlled trial. The primary outcome measure was the Total Tic score of the Yale Global Tic Severity Scale (YGTSS).

RESULTS:

Thirty-four medication-free subjects (26 children and 8 adults) ranging in age from 6 to 62 years (mean = 19.7 +/- 17.0 years) participated. YGTSS Total Tic scores were similar at baseline (26.0 +/- 5.1 for risperidone vs 27.4 +/- 8.5 for placebo). After 8 weeks of treatment (mean daily dose of 2.5 +/- 0.85), the 16 subjects on risperidone showed a 32% reduction in tic severity from baseline, compared to a 7% reduction for placebo patients (n = 18) (F[2,64] = 6.07; p = 0.004). The 12 children randomized to risperidone showed a 36% reduction in tic symptoms compared to an 11% decrease in the 14 children on placebo (F[2,48] = 6.38; p = 0.004). Two children on risperidone showed acute social phobia, which resolved with dose reduction in one subject but resulted in medication discontinuation in the other. A mean increase in body weight of 2.8 kg was observed in the risperidone group compared to no change in placebo (F[2,64] = 10.68; p = 0.0001). No extrapyramidal symptoms and no clinically significant alterations in cardiac conduction times or laboratory measures were observed.

CONCLUSION:

Risperidone appears to be safe and effective for short-term treatment of tics in children or adults with Tourette syndrome. Longer-term studies are needed to evaluate the durability of efficacy and safety over time.

Association between striatal and extrastriatal dopamine D2-receptor binding and social desirability. (2010)

 

Source

Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. simon.cervenka@ki.se

Abstract

Research on the biological underpinnings of personality can provide leads to the pathophysiology of psychiatric disorders. In particular, interpersonal aspects of behavior are a common problem during the course of psychiatric illness. Animal research has demonstrated a role for the dopamine system in social behaviour, and recent molecular imaging studies have shown a negative correlation between dopamine D2-receptor binding in the striatum and social desirability. The emotional and cognitive aspects of social behavior suggest involvement of brain regions outside of the striatum, such as limbic structures. The aim of the present study was to explore associations between the personality trait social desirability and dopamine D2-receptor binding in both striatal and extrastriatal brain regions. We examined 16 control subjects with Positron Emission Tomography and the radioligands [(11)C]raclopride and [(11)C]FLB 457, in relation to social desirability in the inventory Swedish universities Scales of Personality. [(11)C]raclopride D2-receptor binding in the striatum showed negative correlations to social desirability scores, corroborating previous findings. Furthermore, a correlation of a higher statistical significance was demonstrated for [(11)C]FLB 457 binding in the hippocampal-amygdala complex. A separate analysis of social desirability items in relation to a model of interpersonal behaviour revealed that the associations were driven by items reflecting high submissiveness and high affiliation. Taken together with previous evidence on D2-receptor binding and social behaviour, a role for dopaminergic neurotransmission in regulating displays of dominance vs. submissive behaviour is proposed.

 

Changes in dopamine D2-receptor binding are associated to symptom reduction after psychotherapy in social anxiety disorder (2012)

Citation: Translational Psychiatry (2012) 2, e120; doi:10.1038/tp.2012.40

S Cervenka1, E Hedman1,2, Y Ikoma1,3, D Radu Djurfeldt1, C Rück1, C Halldin1 and N Lindefors1

  1. 1Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology, Karolinska Institutet, Stockholm, Sweden
  3. 3Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan

Correspondence: Dr S Cervenka, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Karolinska University Hospital Solna, Building R5, 171 76 Stockholm, Sweden. E-mail: simon.cervenka@ki.se

Received 19 March 2012; Accepted 10 April 2012

 Abstract

The dopamine system has been suggested to play a role in social anxiety disorder (SAD), partly based on molecular imaging studies showing reduced levels of striatal dopaminergic markers in patients compared with control subjects. However, the dopamine system has not been examined in frontal and limbic brain regions proposed to be central in the pathophysiology of SAD. In the present study, we hypothesized that extrastriatal dopamine D2-receptor (D2-R) levels measured using positron emission tomography (PET) would predict symptom reduction after cognitive behavior therapy (CBT). Nine SAD patients were examined using high-resolution PET and the high-affinity D2-R antagonist radioligand [11C]FLB 457, before and after 15 weeks of CBT. Symptom levels were assessed using the anxiety subscale of Liebowitz Social Anxiety Scale (LSASanx). At posttreatment, there was a statistically significant reduction of social anxiety symptoms (P<0.005). Using a repeated measures analysis of covariance, significant effects for time and time × LSASanx change on D2-R-binding potential (BPND) were shown (P<0.05). In a subsequent region-by-region analysis, negative correlations between change in D2-R BPND and LSASanx change were found for medial prefrontal cortex and hippocampus (P<0.05). This is the first study to report a direct relationship between symptom change after psychological treatment and a marker of brain neurotransmission. Using an intra-individual comparison design, the study supports a role for the dopamine system in cortical and limbic brain regions in the pathophysiology of SAD.

Introduction

The dopamine system is involved in social behavior, learning and emotional regulation, predicting a role in the pathophysiology of social anxiety disorder (SAD). Molecular imaging studies have provided preliminary support for this hypothesis, showing reduced levels of striatal dopaminergic markers both pre- and postsynaptically in patients compared with control subjects.1, 2, 3 However, negative results have also been reported.4 A possible explanation for this inconsistency may be that none of the studies performed thus far have examined the dopamine system in limbic or prefrontal brain regions, which have shown to be involved in SAD based on brain activation studies (for a review, see ref. 5). In part, this has been due to methodological limitations, as the first generation D2-receptor (D2-R) positron emission tomography (PET) radioligands such as [11C]raclopride have insufficient affinity for measurements in low-density extrastriatal brain regions.

PET studies have shown a marked inter-individual variability in levels of dopaminergic markers in healthy control subjects.6 This constitutes a drawback in studies where patients and control subjects are compared, as large sample sizes are needed in order to detect small differences. Furthermore, group differences in biomarker levels do not directly infer causal links to disease symptoms. An experimental design where the biological marker is observed as a function of change in disease state could be considered a more powerful strategy in these respects. In psychiatry, the development of effective forms of psychotherapy offers a unique opportunity to improve symptoms without directly interfering with brain biochemistry. For SAD, cognitive behavior therapy (CBT) leads to clinical improvement in up to 75% of patients.7, 8

Although several studies have investigated the effect of psychotherapy on brain activation as assessed using PET and functional magnetic resonance imaging (MRI), reports on changes in neurotransmission have been scarce. Increased binding to the serotonin transporter in the midbrain after 12 months of psychodynamic therapy was demonstrated in a subgroup of patients with depression. No change was shown in dopamine transporter levels.9 In a subsequent study using PET and [11C]WAY-100635, 5HT1a-receptor binding was shown to increase in patients with major depressive disorder after brief psychodynamic psychotherapy.10 However, in neither of these studies a relationship could be shown between change in biomarker levels and symptom improvement. Finally, in a recent study in patients with depression, no effect of psychodynamic psychotherapy was shown on dopamine D2-R binding in the striatum.11 To date, no studies have examined the effect of CBT on markers of brain neurotransmission. As CBT is an intensive treatment with emphasis on repeated exposure to feared stimuli in order to reduce anxiety levels (for example, see ref. 12), this form of psychotherapy could be a more promising venue for detecting neurobiological correlates to symptom change.

In the present study, the primary objective was to investigate the role of the dopamine system in SAD using an inter-individual comparison design, by examining the relationship between change in symptom levels after CBT and change in dopamine D2-R binding. We predicted that increased binding potential (BPND) would be associated specifically with reduced anxiety levels in social situations. The study was performed using the high-affinity D2-R antagonist radioligand [11C]FLB 457,13 which enables measurements in extrastriatal brain regions of particular interest for SAD, and examinations were conducted on an high-resolution research tomograph PET system for increased anatomical precision.14

Materials and methods

Subjects

Nine patients with SAD were recruited from a study comparing CBT administered via the Internet versus group therapy, the results of which have been reported elsewhere.15 As part of the treatment study, all subjects were interviewed by a senior psychiatrist and were found to fulfill DSM IV criteria for SAD16 using the Structured Clinical Interview for DSM-IV axis I disorders. Comorbidity, including drug addiction and abuse, was assessed using the Mini-International Neuropsychiatric Interview.17 After inclusion in the PET study, patients were randomized to treatment either in group format or treatment via the Internet. Subjects were healthy as determined by a physical examination and routine blood tests as well as a brain MRI examination. Three subjects had previously been treated with serotonin or serotonin and noradrenaline reuptake inhibitors, but none had received pharmacological treatment for SAD during the 2 months preceding the study. None were nicotine users. One patient fulfilled criteria for concurrent panic disorder with agoraphobia, otherwise no comorbidity was present. For additional subject characteristics, see Table 1. The study was approved by the Regional Ethics Review Board as well as the Radiation Safety Committee at the Karolinska Hospital, Stockholm. Subjects were included only after giving informed consent in writing.

Table 1

Table 1

Patient demographics

Symptom ratings

At inclusion in the treatment study and after treatment, patients were assessed with the clinician-administered Liebowitz Social Anxiety Scale (LSAS).18 A self-rating version of the same scale (LSAS-SR)19 was completed via the Internet directly before and after treatment. LSAS is composed of two subscales, one measuring anxiety in a range of different situations (LSASanx), and the other assessing the degree of avoidance in the same situations (LSASavoid). As we hypothesized that D2-R binding would be related primarily to anxiety levels, LSASanx was the outcome variable of main interest. In several cases, the time between clinical rating and PET examinations was extended up to several months, and in some instances the rating was performed by different psychiatrists before and after treatment. Therefore, only LSAS-SR scores were included in the analysis. PET1 was performed on average 13±14 (mean±s.d.) days before pre-treatment ratings, and the time between posttreatment ratings and PET 2 was 17±15 days.

Treatment

Three patients received cognitive behavioral group therapy12 and six patients Internet-based CBT.20 The duration of treatment was 15 weeks in both conditions. The treatment employed in the study, in both delivery formats, followed a CBT-model stressing the importance of avoidance and safety behaviors as well as misinterpretations of social events and internal focus as maintaining factors of SAD.21, 22 The theoretical basis and proposed mechanisms were the same and the main finding from the treatment study, from which the present sample was recruited, was that Internet-based CBT and group CBT yield equivalent treatment effects.15 The median number of completed sessions or modules for both delivery formats was 13 of 15 (mean=11.5; s.d.=3.5). All participants were exposed to the main components of the treatment.

MR examinations

As part of the inclusion process, all patients performed a T1- and T2-weighted MRI examination using a 1.5T GE Signa Scanner (Milwaukee, WI, USA). The T2 image was inspected for macroscopic pathology, and the T1 image was used for the subsequent image analysis.

Radiochemistry

The radioligand [11C]FLB457 is a substituted benzamide with the affinity of 0.02 nmol l−1 for D2 and D3 dopamine receptors in vitro, which is significantly higher than that of [11C]raclopride (1–2 nmol l−1).13 This characteristic allows for examination of extrastriatal brain regions where D2-R densities are low. [11C]FLB457 was synthesized as described previously.23 The injected dose for PET1 and PET2 was 468±16 and 465±19 MBq, respectively. For technical reasons, information on specific activity and total mass injected was lost for one PET1 and one PET2, respectively. For the remaining examinations, the average specific activity was 1436±2348 and 658±583 GBq μmol−1 for PET1 and PET2, and the mass of injected FLB 457 was 0.41±0.3 and 0.58±0.6 μg, respectively. The injected dose, specific activity and mass did not differ between pre- and posttreatment (P>0.5, paired t-test), and importantly, there was no correlation between injected mass and either BPND or symptom change.

PET examinations

PET examinations were performed on a high-resolution research tomograph system (Siemens Molecular Imaging, Knoxville, TN, USA). Before the first PET examination, a plaster helmet was manufactured for each subject individually to reduce head movement during measurements. The time between PET1 and PET2 was 146±23 days. Average time for injection was 12:24 for PET 1 and 11:53 for PET2. Before the emission, a 5-min transmission scan was performed to correct for attenuation and scatter. [11C]FLB 457 was injected in the antecubital vein as a bolus dose and radioactivity was measured for 87 min. For two subjects, the second examination was interrupted between 910 and 1416 s and 3361 and 3623 s, respectively. These intervals were excluded from the subsequent kinetic analysis. Images were reconstructed using the ordinary Poisson three-dimensional ordered subset expectation maximization including the point spread function algorithm, yielding in an in-plane resolution of 1.5 mm at half-maximum at the center of field-of-view.14

Image analysis

PET images were corrected for head movement using a frame-by-frame realignment procedure,24 with each frame of the image serving as a reference to the next. T1 MR images were realigned to the anterior commissure – posterior commissure plane. Regions of interest (ROIs) were manually defined on the MRI for each subject individually, using Human Brain Atlas software25 (Figure 1). Regions chosen were amygdala, hippocampus and prefrontal cortices, based on their proposed role in SAD,5 and ROIs were defined using previously published guidelines.26, 27 The prefrontal cortex was divided into dorsolateral, medial and orbitofrontal regions.27 Striatal regions were not evaluated, as the high affinity of [11C]FLB 457 does not allow for equilibrium within the frame of a PET experiment, thus preventing meaningful calculations of radioligand binding.28 MRIs were segmented into gray matter, white matter and cerebrospinal fluid, and coregistered to each of the two PET images using SPM5. The transformation parameters obtained were used to subsequently apply the ROIs on the dynamic PET images to generate time activity curves (TACs). For frontal cortical regions, only voxels belonging to the gray matter segment was included in the ROI. Also, partial volume effect correction using the Meltzer method was applied for these regions to avoid smearing effects from neighboring CSF voxels.29 Image processing was performed on SPM5 operating on Matlab R2007b (MathWorks, Natick, MA, USA).

Figure 1

Figure 1

(ac) Magnetic resonance images with regions of interests for amygdala (red), hippocampus (yellow), dorsolateral prefrontal cortex (cyan), medial prefrontal cortex (blue) and orbitofrontal cortex (green). (df) Summed images of [11C]FLB (more ...)

BPND was calculated from the TACs using the simplified reference tissue model (SRTM), with cerebellum as reference. In this context, BPND represents the ratio at equilibrium of specifically bound radioligand to that of nondisplaceable radioligand in tissue.30 The SRTM has previously been validated for [11C]FLB 457.28 Since we had no hypothesis of side differences in the involvement of dopaminergic neurotransmission in SAD, BPND for all regions was calculated using spatially averaged TACs for right and left sides in order to improve TAC statistics.

Statistical analysis

Changes in LSAS scores and D2-R BPND were assessed using a paired t-test. Associations between D2-R BPND and LSAS scores at baseline were calculated using partial correlations, controlling for age. The relationship between changes in regional D2-R binding and changes in LSASanx scores was assessed using a repeated measures analysis of covariance, with time and region as within-subject factors and LSASanx percent change as a covariate. Secondary analyses were performed for LSASavoid and the two subscales combined. Subsequently, correlation coefficients were calculated between percent change in D2 BPND and percent change in LSASanx scores. In a post-hoc analysis, individuals were divided into responders ([gt-or-equal, slanted]50% symptom reduction) and non-responders, and group differences in change in BPND values were explored using a one-way analysis of variance. For all tests, results were considered significant at P<0.05. Statistical analysis was performed using PASW 18 (SPSS, Chicago, IL, USA).

Results

Changes in social anxiety levels and D2-R BPND

All patients improved after treatment, and the change in total LSAS scores as well as anxiety and avoidance subscales was statistically significant (Table 2). There was no difference in LSAS change between patients receiving group therapy and patients treated via the internet, either for the whole scale or for subscales (P>0.74). At posttreatment, four (44%) participants no longer met diagnostic criteria for SAD. On a group level, the difference in D2-R-binding pre- and posttreatment did not reach statistical significance for any of the regions, as assessed using a paired t-test (Table 2). However, the direction and degree of change showed a considerable interindividual variability, which enabled computation of meaningful correlations with symptom change.

Table 2

Table 2

D2-receptor-binding potential and symptom scores pre- and posttreatment

Associations between D2-R BPND change and social anxiety change

In the repeated measures analysis of covariance, significant effects for time and time × symptom score change were shown for LSASanx (F=7.61, P=0.028 and F=7.77, P=0.027). In a subsequent region-by-region analysis, negative correlations between change in D2-R BPND and LSASanx change were shown for dorsolateral prefrontal cortex (r=−0.78, P=0.013), medial prefrontal cortex (r=−0.82, P=0.007) as well as for hippocampus (r=−0.81, P=0.008; Figure 2). The correlations in medial prefrontal cortex and hippocampus survived Bonferroni correction (adjusted P-value <0.01). In these regions, responders showed an increase in binding (5.0% and 9.5%, respectively, n=4), whereas non-responders on average showed a decrease (−8.6% and −8.3%, n=5). Despite few individuals in each group, this difference was significant for MFC (P=0.003) and trend-level significant for hippocampus (P=0.097). There was no significant effect of time or time × symptom change on the avoidance subscale. This difference of effects between subscales was also reflected in that when combining the two scales as covariate, trend-level effects were observed for time (F=3.93, P=0.088) and the interaction term for time × change (F=3.74, P=0.095).

Figure 2

Figure 2

Scatterplots indicating relationships between change in Liebowitz Social Anxiety Scale (LSAS) anxiety scores and dopamine D2-receptor-binding potential (BP) in dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MFC) and hippocampus (HIP). (more ...)

Pre- and posttreatment correlations between D2-R BPND and social anxiety

There was no correlation between D2-R BPND and LSASanx or LSASavoid scores pre- or posttreatment, after controlling for age.

Discussion

In this study, we assessed the role of the extrastriatal dopamine system in SAD, by examining changes in dopamine D2-R binding as a function of symptom change after CBT. Importantly, the aim of this study was not to examine the effects of psychological treatment on D2-R binding in SAD, as this would entail the use of a control condition. Instead, CBT was used as a tool to alter the disease state non-pharmacologically. Consequently, the association between change in symptom scores and changes in receptor binding was the primary outcome, rather than changes pre- and posttreatment on a group level. Accordingly, whereas the average difference between PET1 and PET2 was within the test-retest variability shown previously for [11C]FLB 457,31 the interindividual variability in change was sufficient for correlative analyses. Using a similar design, changes in D1-receptor binding was recently shown to be related to improvement in working memory capacity after working memory training,32 and we now the first time demonstrate a direct relationship between symptom reduction after psychotherapy and change in a marker of brain neurotransmission.

A role for the dopamine system in social behavior has been demonstrated in both animal research and human studies. Molecular imaging studies have shown negative correlations between striatal DA markers and the personality trait detachment as well as different measures of social conformity and low social status.33, 34, 35, 36, 37, 38, 39 Recently, we extended this line of research by demonstrating a relationship between social desirability and D2-R binding in the medial temporal lobe as measured using [11C]FLB 457.40 In the interpersonal domain, these personality traits can be viewed to indicate social submission as opposed to social dominance,40 and the results thus mirror research on rodents and non-human primates where dopaminergic neurotransmission has been linked to the dimension of dominance-submissive behavior.41, 42, 43, 44 Of particular interest is the study by Morgan et al.,44 where D2-R binding in monkeys was shown to change as a function of hierarchical rank as the animals moved from individual to social housing. The observation of a relationship between change in D2-R binding and social anxiety symptoms is congruent with these lines of research and can be viewed as support for a suggested link between the dominant-submissive dimension of interpersonal behavior and SAD.45 The correlation was not significant for LSASavoid, which may be explained by the more heterogeneous nature of avoidant behavior. For instance, reduced avoidance with maintained safety behaviors is not expected to yield less anxiety.21

SPECT studies have previously shown reduced dopamine D2-R binding in the striatum in 10 patients with SAD, as well as in a sample of 7 with comorbid OCD in comparison to control subjects.1, 2 On the presynaptic side, lower dopamine transporter binding was demonstrated in 11 patients.3 In a more recent study using PET, no difference was shown in D2-R availability, either at baseline or after an amphetamine challenge, and there was also no difference in binding to the dopamine transporter (n=15, 12 and 12, respectively).4 However, none of these studies assessed dopamine receptors in extrastriatal brain regions.

In brain activation studies, one of the most replicated findings is increased activation in amygdala in response to fearful social stimuli46, 47, 48 but notably, negative findings have also been reported.49, 50 Other regions showing altered activation in SAD include hippocampal and prefrontal cortices.5, 46, 47, 51, 52, 53 For the medial prefrontal cortex, a role specifically for monitoring social evaluation has been shown in SAD patients51, 52 and this region is also implicated in fear extinction.54, 55 Dopaminergic transmission in the hippocampus has shown to be involved in memory function in animal research as well as in molecular imaging studies.56, 57, 58, 59 Taken together, the present findings of a correlation between dopaminergic function in hippocampus and prefrontal cortical regions may be related to the role of these regions in learning and social evaluation.

The primary limitation of this study is the small sample size. Although a total of 126 patients were included in the treatment study,15 for the present study we applied more strict inclusion criteria in order to avoid confounding effects on D2-R availability, for instance by the use of concomitant pharmacological treatment or nicotine. Furthermore, some patients were lost due to time constraints. Second, we cannot determine whether the changes in BPND are due to changes in receptor density or apparent affinity, as these parameters cannot be dissociated based on a single PET measurement.30 Among the factors influencing apparent affinity, endogenous dopamine levels have shown to affect [11C]FLB 457 binding,60, 61, 62 however, other studies have been negative.63, 64 In rodents, where neurotransmitter levels are more accessible, increased DA release has been observed in response to stressful stimuli.65, 66 Although studies employing multiple PET examinations with different specific activity of [11C]FLB 457 have shown that receptor density accounts for most of the variance in BPND,67 it cannot be excluded that differences in endogenous dopamine levels could partly account for the associations observed, for instance reflecting higher DA reactivity during the examination procedure in patients with lesser improvement after treatment.

In conclusion, the results from this preliminary study indicate that plastic changes in the dopamine system may underlie reduced anxiety symptoms in SAD patients after treatment with CBT. The study supports a role for the dopamine system in SAD, and shows that intra-individual comparisons can be a promising approach in identifying brain biomarkers for psychiatric disorders.

Acknowledgments

The study was supported by Söderström Königska Stiftelsen, The National Board of Health and Welfare, Stockholm County Council and Psykiatrifonden. The staff at the Karolinska PET Center and at the Internet Psychiatry Unit at the Karolinska University Hospital Huddinge are thankfully acknowledged.

Notes

The authors declare no conflict of interest.

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D2-subtype of dopaminergic receptors is involved in anxiety behavior in ovariectomized rats (2008)

Comments: D2 receptor agonists reduce anxiety

Patol Fiziol Eksp Ter. 2008 Jul-Sep;(3):10-3.
 
[Article in Russian]

Abstract

To compare the role of D2-subtype dopaminergic receptors in mechanisms of anxiety behavior in adult intact female rats during ovary cycle and ovariectomized (OVX) female rats, influence of chronic administration of D2-dopaminergic receptors agonist--quinperole (0.1 mg/kg) and D2-dopaminergic receptors antagonist--sulpiride (10.0 mg/kg) injected separately or in combination with 17beta-es-tradiol (0.5 mcg for each animal) within 14 days on behavioral status of adult intact and ovariectomized (OVX) female rats was investigated. The level of anxiety was assessed in the elevated plus maze, behavior of the animals was estimated in the open field test. It was established that chronic administration of sulpiride to intact rats resulted in anxiogenic behavior in the elevated plus maze in all phases of ovary cycle except proestrous. Quinperole administration to the intact rats had an anxiolytic action on behavior in the elevated plus maze in the metestrous, diestrous and proestrous. Chronic quinperole administration alone or in combination with 17beta-estradiol in OVX rats resulted in an anxiolytic effect on behavior in the elevated plus maze. On the contrary, sulpiride administration alone in OVX rats failed to modify an anxiety level, while in its combination with 17beta-estradiol an anxiolytic effect of the hormone drug was com-pletely blocked. In the open field test quinperole administration to OVX rats increased horizontal locomotor activity, exploratory and grooming behavior. Thus, the results obtained suggest a modulating role of D2-subtype dopaminergic receptors in the mechanisms of anxiety behavior in imbalance of estrogen.

Dopamine and social anxiety disorder (2006)

LINK TO PDF

Rev Bras Psiquiatr. 2006 Dec;28(4):263-4.

Robinson HM, Hood SD, Bell CJ, Nutt DJ.

 

Dopamine improves deficiencies in social behavior could have implications for neuropsychiatric disorders (2013)

Dopamine improves deficiencies in social behavior could have implications for neuropsychiatric disorders

A stressful pregnancy might be the last thing a future mother needs, but it is to her unborn baby that this stress spells real trouble. All because stress hormones (called glucocorticoids or GCs) can disturb normal foetal brain development, leading to behavioural and/or emotional problems later in life. Despite this danger we are still far from understanding how GCs work. But now a study in rats by a Portuguese team has discovered that the prenatal (before birth) effects of GCs on behaviour are linked to low dopamine (a brain messenger) in the brain areas linked to pleasure, but also that this could be treated.

Sonia Borges and Barbara Coimbra from the University of Minho found that rats exposed to prenatal stress developed emotional and social behavioural problems and that this was linked to reduced levels of dopamine, but also that once dopmaine levels were restored to normal (what was very easy to do) there was a complete reversion of the social problems. This supports the idea that changes in the brain by early life trauma can be reversed.

The study, that is coming out in the September issue of the journal Neuropsychopharmacology, could have implications for neuropsychiatric disorders associated with dopamine and early neurodevelopmental problems such as depression, anxiety, attention-deficit hyperactivity disorder (ADHD), schizophrenia and autism. Ana João Rodrigues, one of study leaders (together with Nuno Sousa) warns for the need to be very cautious though " Although there are some clues that prenatal stress may affect emotional and social behaviour in humans, our work is still at very early stage. All we can really say" - she points - "is that dopamine is able to improve deficiencies in social behaviour and this might have important implications for diseases characterised by social impairment"

While GCs mediate the negative effects of stress, they are also of crucial importance for the normal functioning of the body; from controlling the immune system to help the maturation of foetal organs, GCs are indispensable to life. In fact, even if prenatal stress can provoke problems in the brain, GCs are still routinely given to pregnant women with danger of premature births for foetal lung maturation. So it is urgent to understand better how GCs work to be able to make better crucial, even life dependent,  decisions

In the study soon to be published Borges, Coimbra and colleagues exposed rats still in the uterus to high levels of GCs (the equivalent of having a very stressed mother), and found that these animals go to develop signs of depression and lack of motivation later in life like previously reported, but, surprisingly, they also found they developed social impairments. Animals exposed to prenatal stress played less, interacted awkwardly with others and had less "happy" calls ("happy" and "sad" calls can be differentiated by their sound frequencies).

" Since our group had seen before that exposure to prenatal GCs affected a neural circuit important for the feelings of reward and pleasure (the mesolimbic system) " - explains Rodrigues - "and in juvenile rats rough tumble and play is one of the most rewarding behaviours, we wondered if the problem could be dopamine, a key molecule in this system."

And in fact, it was found found that "prenatal stress" rats lacked dopamine in both the amygdala and the nucleus accumbens (NAc), which are regions of the mesolimbic system.
But what was remarkable was the finding that by simply adding L-dopa (a precursor of dopamine given to Parkinson's patients who also lack it) to the water of the affected animals, their social and emotional abnormalities disappeared turning them indistinguishable from those rats that went through normal pregnancies.

So the new study reveals that high GC levels/prenatal stress can lead to social impairments, as well as the emotional problems, by reducing dopamine levels in the brain areas linked to pleasure perception. But also that once these dopamine levels are corrected, the problems disappear completely.

So could things work similarly in humans?  In diseases like depression, autism and schizophrenia, which are characterised by emotional and social inadequacies and have already been linked to prenatal stress? Rodrigues alerts "To transfer these results to humans requires caution. These results do not mean that L-dopa is a miraculous drug to treat lack of motivation or depression, although it certainly appears that the mesolimbic dopamine system is critical in these problems. For now the most important thing is that we are starting to unveil GCs' induced molecular changes in specific neuronal circuits, which will help in the understanding of some of these problems".

What is most interesting about Borges and Coimbra's study too is the fact that it "links the dots" - prenatal stress has already been associated to an increased incidence of several neurologic diseases and some of these to problems in dopamine. Social impairments like those seen autism and ADTH, for example, are more common in individuals that went through stressful prenatal periods. The new study now reveals the "underneath story" (or a version of it at least).

But the study had another interesting result: when the social behaviour of the animals was tested, and while two "prenatal stress" rats put together didn't play, surprisingly, the interaction of a "prenatal stress" rat in the presence of a normal one was very different. This because the normal animal would incite and provoke the "stressed" rat to play until it responded and started interacting. This supports the idea that interaction with other individuals can make a vital difference to revert the negative effects of pre-natal or early life stress on the brain. It also reveals an interesting degree of empathy between the animals, an idea that recently has started to receive much attention.

http://www.nature.com/npp/journal/v38/n10/index.html
 

Dopamine reuptake site densities in patients with social phobia (1997)

Am J Psychiatry. 1997 Feb;154(2):239-42.

Tiihonen J, Kuikka J, Bergström K, Lepola U, Koponen H, Leinonen E.

Source

Department of Forensic Psychiatry, University of Kuopio, Finland.

Abstract

OBJECTIVE:

It has been suggested that social phobia is associated with dysfunction of the noradrenergic and dopaminergic systems, but there are no published anatomic data on the monoaminergic abnormalities found in the brains of phobic patients. The authors studied the density of dopamine reuptake sites in patients with social phobia.

METHOD:

The study included 11 patients with social phobia and 28 healthy comparison subjects, 11 of whom were age- and gender-matched to the patients for the analyses. Measurement of the density of dopamine reuptake sites was performed by using a 123I-labeled cocaine analogue, [123I]beta-CIT, with single photon emission computed tomography (SPECT).

RESULTS:

Blind quantitative analysis revealed that striatal dopamine reuptake site densities were markedly lower in the patients with social phobia than in the age- and gender-matched comparison subjects.

CONCLUSIONS:

The results indicate that social phobia may be associated with a dysfunction of the striatal dopaminergic system.

Dopaminergic challenges in social anxiety disorder evidence for dopamine D3 desensitisation following successful treatment with serotonergic antidepressants (2008)

Comments: Dopamine agonist (mimics dopamine) helped reduce anxiety.

J Psychopharmacol. 2008 Oct 6;

Hood S, Potokar J, Davies S, Hince D, Morris K, Seddon K, Nutt D, Argyropoulos S.

Psychopharmacology Unit, Dorothy Hodgkin Building, Bristol, UK; School of Psychiatry and Clinical Neurosciences (M521), University of Western Australia, Perth, Australia.

Abstract

Serotonergic antidepressants (SSRIs) are first-line treatments for social anxiety disorder [SAnD], though there is evidence of dopaminergic system dysfunction.

Twenty subjects with DSM-IV SAnD, untreated (n = 10) and SSRI-remitted DSM-IV SAnD (n = 10), were administered a single dose of 1) a dopamine agonist (pramipexole 0.5 mg) and 2) a dopamine antagonist (sulpiride 400 mg), followed by anxiogenic challenges (verbal tasks and autobiographical scripts) in a double-blind crossover design, the two test days being one week apart.

Anxiety symptoms were measured by self-reported changes in Visual Analogue Scales, specific SAnD scales and anxiety questionnaires. Plasma levels of prolactin were obtained. Untreated SAnD subjects experienced significant increases in anxiety symptoms following behavioural challenges after either sulpiride or pramipexole.

Following remission with SSRIs, the socially anxiogenic effect of behavioural provocation was significantly attenuated under dopamine agonist pramipexole, whereas under sulpiride effects remained significantly elevated. There appears to be instability of the dopamine system under behavioural stress in social anxiety subjects that is only partly rectified by successful treatment with an SSRI, which may induce a desensitisation of postsynaptic dopamine D3 receptors.

Effects of acute tryptophan depletion in serotonin reuptake inhibitor-remitted patients with generalized anxiety disorder (2010)

Psychopharmacology (Berl). 2010 Feb;208(2):223-32. doi: 10.1007/s00213-009-1722-1.

Hood SD, Hince DA, Davies SJ, Argyropoulos S, Robinson H, Potokar J, Nutt DJ.

Abstract

BACKGROUND:

Serotonergic antidepressants [selective serotonin reuptake inhibitor (SSRI)] are first-line treatments for generalised anxiety disorder (GAD); however, it is not known if synaptic serotonin (5-HT) availability is important for SSRI efficacy. The present study tested the hypothesis that temporary reduction in central 5-HT transmission, through acute tryptophan depletion (ATD), would reverse the therapeutic effect of the SSRIs in GAD patients.

METHODS:

Twelve patients (six males) with GAD, who showed sustained clinical improvement with SSRI treatment, underwent ATD in a double-blind, placebo-controlled, within-subjects design over 2 days, 1 week apart. At the peak time of depletion, the participants inhaled 7.5% CO2 and air in random order for at least 12 min each. Psychological responses were measured using the Spielberger State Anxiety Inventory (STAI-S) and GAD-symptom visual analogue scales (VASs; e.g., worry and tense) and Profile of Mood States.

RESULTS:

Free plasma tryptophan to large neutral amino acid (LNAA) ratio decreased by 92% on the depletion day and decreased by 2% on the control day. Irrespective of depletion condition, 7.5% CO(2) inhalation significantly increased STAI-S and GAD-related VAS scores (all p < 0.05) compared with air inhalation. ATD had no effect on any of these measures despite the substantial reduction in free tryptophan/LNAA ratio.

CONCLUSIONS:

Although SSRIs treat GAD effectively, the present results suggest that the mechanism of action is different to that seen in panic, social anxiety, and post-traumatic stress disorders. Successful SSRI treatment of GAD may involve long-term receptor changes or alterations in other neurotransmitter systems downstream of serotonin.

 

Increased Dopamine Receptor Activity in the Nucleus Accumbens Shell Ameliorates Anxiety during Drug Withdrawal (2012)

Neuropsychopharmacology. 2012 Jun 13. doi: 10.1038/npp.2012.97.

Radke AK, Gewirtz JC.

Source

Graduate Program in Neuroscience, Minneapolis, MN, USA.

Abstract

A number of lines of evidence suggest that negative emotional symptoms of withdrawal involve reduced activity in the mesolimbic dopamine system. This study examined the contribution of dopaminergic signaling in structures downstream of the ventral tegmental area to withdrawal from acute morphine exposure, measured as potentiation of the acoustic startle reflex. Systemic administration of the general dopamine receptor agonist apomorphine or a cocktail of the D1-like receptor agonist SKF82958 and the D2-like receptor agonist quinpirole attenuated potentiated startle during morphine withdrawal. This effect was replicated by apomorphine infusion into the nucleus accumbens shell. Finally, apomorphine injection was shown to relieve startle potentiation during nicotine withdrawal and conditioned place aversion to morphine withdrawal. These results suggest that transient activation of the ventral tegmental area mesolimbic dopamine system triggers the expression of anxiety and aversion during withdrawal from multiple classes of abused drugs.

Increased Serotonin and Dopamine Transporter Binding in Psychotropic Medication Naïve Patients with Generalized Social Anxiety Disorder Shown by 123I-β-(4-Iodophenyl)-Tropane SPECT (2008)

J Nucl Med May 2008 vol. 49 no. 5 757-763

Nic J. van der Wee1, J. Frederieke van Veen1, Henk Stevens2, Irene M. van Vliet1, Peter P. van Rijk2 and Herman G. Westenberg1

+ Author Affiliations

1Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands; and 2Department of Nuclear Medicine, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands

For correspondence or reprints contact: Nic J. van der Wee, Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, HP B01.206, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. E-mail: n.j.a.van_der_wee@lumc.nl

Abstract

In the present study, using SPECT imaging we examined the 123I-β-(4-iodophenyl)-tropane binding potential for the serotonin and dopamine transporters in patients with a generalized social anxiety disorder and in age- and sex-matched healthy controls.

Methods: Twelve psychotropic medication–naïve patients with social anxiety disorder, generalized type (5 women and 7 men) and 12 sex- and age-matched healthy controls were studied. Volumes of interest were constructed on MRI-coregistered SPECT scans. Binding ratios were compared using the Mann–Whitney U test. Possible correlations between binding patterns and symptomatology were assessed using the Spearman rank correlation coefficient.

Results: Significantly higher binding potentials were found for the serotonin in the left and right thalamus of patients. Patients had also a significantly higher binding potential for the dopamine transporter in the striatum.

Conclusion: The present study provided direct evidence for abnormalities in both the dopaminergic and the serotonergic systems in patients with generalized social anxiety disorder.

Introduction

Social anxiety disorder (also known as social phobia) is a disabling condition that afflicts a large part of the general population. It tends to run a chronic and unremitting course and often leads to the development of alcoholism and depression. The essential feature of social anxiety disorder is the fear of being evaluated by others with the expectation that such an assessment will be negative and embarrassing. Social anxiety disorder has been subdivided into 2 subtypes. The first subtype, referred to in the DSM-IV (1) as generalized social phobia, involves fear of a broad array of social situations. The second subtype, referred to as discrete or specific social anxiety disorder, is usually confined to 1 or 2 performance situations, of which public speaking is the most common (2). Given the clinical importance of social anxiety disorder, the neurobiology of this condition has received little attention to date.

Treatment studies demonstrating that selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors are effective in social anxiety disorder hint that serotonergic and catecholaminergic pathways have a role, but these findings can be only a rough guide in determining the neurobiology. Challenge tests with fenfluramine and m-chlorophenylpiperazine have provided other circumstantial evidence for the role of serotonin (5-hydroxytryptamine, or 5-HT) in social anxiety disorder (3,4). An involvement of the dopaminergic system in social anxiety was suggested by findings that homovanillic acid levels in cerebrospinal fluid tended to be lower in panic disorder patients with comorbid social anxiety disorder than in those without (5). Moreover, the prevalence of social anxiety disorder is increased in patients in whom Parkinson's disease develops (6). More recently, 2 neuroimaging studies have provided direct evidence that dopamine systems may play a role in the neurobiology of social anxiety disorder. Using 123I-labeled 2-β-carbomethoxy-3-β-(4-iodophenyl)-tropane (123I-β-CIT) as a tracer and SPECT, Tiihonen et al. found that the density of the dopamine transporter (DAT) in the striatum was reduced in patients with generalized social anxiety disorder (7). Schneier et al., using 123I-iodobenzamide SPECT, found a reduced dopamine D2 binding potential in this psychiatric condition (8). Although neuroimaging studies potentially could also provide direct evidence for a role of serotonergic systems in social anxiety disorder, to our knowledge only 1 such study has been published to date (9). In this study, by Lanzenberger et al., 5-HT receptor 1A binding in several limbic and paralimbic areas was found to be reduced in patients with social anxiety disorder.

123I-β-CIT SPECT can be used to visualize both DAT and 5-HT transporter (5-HTT) in the human brain after a single administration of the ligand. Binding of 123I-β-CIT in the striatal region has been shown to reflect mainly binding to DAT; binding in the thalamus, midbrain, and pons reflects predominantly binding to 5-HTT (10,11). The binding to DAT and 5-HTT can be further differentiated by using the difference in time course of 123I-β-CIT uptake in DAT- and 5-HTT–rich brain regions (10). In the present study, we used this approach to investigate DAT and 5-HTT binding potentials in right-handed psychotropic medication–naïve patients with generalized social anxiety disorder (according to DSM-IV criteria) and no comorbidity and in healthy controls matched pairwise by age, sex, and handedness. We expected the binding pattern of 123I-β-CIT to reflect abnormalities at the level of both 5-HTT and DAT.

MATERIALS AND METHODS

Subjects

The study was approved by the ethics committee of the University Medical Center, Utrecht, The Netherlands, and was performed in accordance with the ethical standards of the declaration of Helsinki. After a complete description of the study had been provided to the subjects, written informed consent was obtained. The patients came from direct physician referrals to our specialized anxiety clinic or reacted to advertisements. Healthy controls were enrolled through advertisements in flyers and newspapers or obtained from an existing database. Only subjects without a lifetime history of psychosis, substance abuse, recurrent major depression, bipolar disorder, eating disorders, other anxiety disorders, tics, and stuttering were included. All participants had no lifetime history of illnesses with possible central nervous system sequelae and were in good physical health, as confirmed by physical and laboratory examinations. Subjects consumed fewer than 6 cups of coffee and 3 units of alcohol a day and smoked fewer than 6 cigarettes a day. Screening for current and prior adult psychopathology was done by administering the Mini International Neuropsychiatric Interview Plus, version 5.0.0 (13). Diagnoses were confirmed by an experienced clinician. In addition, the Liebowitz Social Anxiety Scale (LSAS) was used to assess the severity of the social anxiety symptoms at entry (14). Handedness was determined by administering the Edinburgh Handedness Scale (15).

Subjects were excluded when they had a score of more than 13 on the 17-item Hamilton Depression Rating Scale (16). Subjects underwent imaging within 2 wk after inclusion. Any cognitive behavioral therapy had been terminated at least 3 mo before the study.

Twelve patients and 12 healthy controls were enrolled. All subjects completed the study. The patients and controls were perfectly matched for sex and did not differ significantly in age and handedness. Demographic and clinical characteristics are shown in Table 1.                                            

TABLE 1 Demographic and Clinical Characteristics of Study Population

Image Acquisition and Analysis

Images were acquired and analyzed using the same methods as in our previously reported study on patients with obsessive–compulsive disorder (17). On the first day of scanning, the subjects received an intravenous injection of approximately 150 MBq of 123I-β-CIT (MAP Medical Technologies; radionuclidic purity [125I/123I] of at least 9.5 × 10−3 at calibration time and a radiochemical purity of at least 95%). We used a Prism 3000 triple-head γ-camera (Picker) with ultra-high-resolution fanbeam collimators and a full width at half maximum of approximately 12 mm. Four hours after the injection, the first scan was made to assess binding to 5-HTT. Between 22 and 24 h after the injection, the second scan was obtained to measure binding to DAT (1820). The subjects refrained from coffee and nicotine in the 6–10 h preceding each SPECT scan. Immediately after the first scan, the subjects received 20 mg of paroxetine to displace the 123I-β-CIT from 5-HTT so that binding to DAT could be determined more precisely (18). Several studies have demonstrated that at modest dosages (e.g., 10 mg) of paroxetine and other potent 5-HT reuptake blockers, occupation of 5-HTT is already virtually maximal (10,21,22). To control for possible differences in metabolism between subjects, we chose a higher oral dose of 20 mg. The 20-mg dose of paroxetine was well tolerated by all subjects. During scanning, subjects were supine, with eyes and ears open and head fixed in a head holder. We ensured that the patients stayed awake and did not move. For an accurate determination of each subject's volumes of interest (VOIs), all subjects also underwent structural MRI (3-dimensional fast field echo; echo time/repetition time, 4.6/30 ms; flip angle, 30°; field of view, 256 × 256 mm; matrix, 128 × 128 × 130 mm; slice thickness, 2 mm) 2 h before the injection of 123I-β-CIT. The MRI scans were reoriented to the standardized coordinate system of the Montreal standard brain (23). VOIs were delineated manually on the reoriented MRI scans by a researcher who was unaware of the subject's identity and diagnosis, by means of the display software from the Brain Imaging Center of the Montreal Neuroimaging Institute (24). Because the focus of our study was putative abnormalities at the level of 5-HTT in social anxiety disorder, the VOIs for 5-HTT included the left and right thalamus and the midbrain/pons region, whereas we limited the VOI for DAT to the left and right striatum taken together. Furthermore, this choice allowed a direct comparison of DAT findings with a previous study of Tiihonen et al. (7). We planned an exploratory post hoc analysis in which left and right striatal subregions would be delineated in cases in which the ROI striatum showed a significant difference between patients and controls. The cerebellum was used as a reference region, representing nonspecific binding for 123I-β-CIT.

To allow exact coregistration of MRI and SPECT scans, we used fiducial markers. Fiducial markers were cone-shaped, with cross-shaped feet, and were placed on the nose bridge and preauricularly above the mandibular joints. The position of each marker was indicated with 4 dots on the subject's skin to allow for repositioning of markers immediately before the SPECT scans. Vitamin A and 57Co were used as contrast agents for the MRI and SPECT scans, respectively. The energy was set at a peak of 160 keV with a window of 20% for 123I-β-CIT and at a peak of 120 keV with a window of 15% for 57Co. After standard processing, brain SPECT images were resliced to isotropic voxels with dimensions of 2 mm and further treated as 3-dimensional volumes to coregister within the 3-dimensional orientation of the MRI scans. Coregistration was performed semiautomatically and was based on the position of the fiducial markers, using the Register multimodality software package and additional software developed at the Brain Imaging Center of the Montreal Neurologic Institute (25). The researcher performing the coregistration was unaware of subject identity and diagnosis.

For each separate VOI, the ratio of specific binding of 123I-β-CIT to 5-HTT or DAT was calculated according to methodology used in previously published 123I-β-CIT studies: the average radioactivity count per voxel per VOI minus the average radioactivity count per voxel in the cerebellum, divided by the average radioactivity count per voxel in the cerebellum.

Statistical Analysis

Age was compared using the Student t test. The interrater and intrarater reliability for VOI registration was assessed by calculating the intraclass correlation coefficients according to the method published by Bartko and Carpenter (26). The specific binding ratios for 123I-β-CIT were compared using the Mann–Whitney U test. For 5-HTT binding, ratios in the midbrain/pons region and in the left and right thalamus were assessed; for DAT binding, the ratio in the striatum was assessed. Spearman rank correlation coefficients were calculated to assess correlations between specific binding ratios and LSAS scores. Two-tailed significance is reported throughout. Bonferroni correction for multiple comparisons (4 regions of interest) yielded an adjusted P value of less than 0.0125.

RESULTS

The intraclass correlation coefficients for the interrater and the intrarater reliability procedure for determining VOIs were between 0.86 and 0.99 (mean ± SD, 0.95 ± 0.05) and 0.61 and 0.98 (mean, 0.81 ± 0.14), respectively. In 1 patient, only the 5-HTT uptake could be calculated; the last SPECT scan could not be reliably coregistered to the MRI scan because of motion artifacts.

The VOIs for the cerebellum were 104,208 ± 16,211 mm3 for patients and 93,943 ± 11,445 mm3 for controls. The VOIs for the midbrain/pons regions were 6,441 ± 1,370 mm3 for patients and 6,127 ± 1,455 mm3 for controls. The VOIs for the right thalamus were 3,962 ± 855 mm3 for patients and 4,544 ± 1,678 mm3 for controls, and the VOIs for the left thalamus were 4,051 ± 914 for patients and 4,610 ± 686 mm3 for controls. The VOIs for the right caudate were 3,142 ± 519 mm3 for patients and 2,933 ± 608 mm3 for controls, and the VOIs for the right putamen were 2,064 ± 407 mm3 for patients and 1,990 ± 497 mm3 for controls. The VOIs for the left caudate were 2,899 ± 598 mm3 for patients and 3,181 ± 573 mm3 for controls, and the VOIs for the left putamen were 2,022 ± 478 mm3 for patients and 2,064 ± 407 mm3 for controls. There were no significant differences in the sizes of the delineated VOIs between patients and controls.

There were no significant differences in normalized binding in the reference region between patients and controls; normalized cerebellar counts at 4 h were 20.38 ± 3.70 in controls and 20.90 ± 4.12 in patients, and at 22–24 h the counts were 3.75 ± 1.15 in controls and 3.37 ± 1.02 in patients.

The Mann–Whitney U test revealed that the average binding ratio for 5-HTT in the left and right thalamus was significantly higher in patients than in matched healthy controls (P = 0.001) (Fig. 1). No significant differences were found in the midbrain/pons region. The average binding ratio for DAT in the striatum was significantly higher in patients than in matched controls (P = 0.011) (Fig. 2). The binding ratios for 5-HTT and DAT in the regions of interest in patients and controls are summarized in Table 2. No significant correlations were found between LSAS score and DAT or 5-HTT binding potential in patients.

FIGURE 1.Binding ratios for 5-HTT in left and right thalamus of psychotropic medication–naïve patients with generalized social anxiety disorder (n = 12) and age- and sex-matched controls (n = 12) measured with 123I-β-CIT SPECT. *P = 0.001; 2-tailed Mann–Whitney U test.

 
FIGURE 2. Binding ratios for DAT in striatum of psychotropic medication–naïve patients with generalized social anxiety disorder (n = 12) and age- and sex-matched controls (n = 12) measured with 123I-β-CIT SPECT. *P = 0.011; 2-tailed Mann–Whitney U test.
 
TABLE 2  Average Binding Potentials for DAT and 5-HTT in Study Population  
 
We performed an exploratory post hoc delineation and analysis for right and left striatum and for left and right putamen and caudate. This analysis revealed that DAT binding in the right putamen was significant higher in patients than in matched healthy controls, at a significance level uncorrected for multiple comparisons (P = 0.012).

DISCUSSION

We found significantly higher 123I-β-CIT binding ratios in the left and right thalamus (specific for 5-HTT) and in the striatum (specific for DAT) of psychotropic medication–naïve patients with generalized social anxiety disorder with no comorbid diagnosis, relative to the findings in healthy controls pairwise matched for age, sex, and handedness. No abnormalities in binding ratios in the 5-HTT–rich midbrain/pons region were found. No significant correlations were found between 5-HTT and DAT binding ratios and scores on the symptom rating scale (LSAS).

To our knowledge, this was the first study examining 123I-β-CIT binding ratios both to 5-HTT–rich regions and to DAT-rich regions in patients with generalized social anxiety disorder. Our finding of an altered 5-HTT binding potential in the thalamus provides a direct indication that 5-HT has a role in the pathophysiology of generalized social anxiety disorder. Converging data have implicated a network of brain regions, including the prefrontal cortex, striatum, thalamus, and amygdala, in the pathophysiology of generalized social anxiety disorder (27,28).

Most regions of this putatively involved network in social anxiety disorder are densely innervated by serotonergic or dopaminergic neurons. Impaired striatal–thalamic filtering of information relevant for social evaluation and an excessive conditionability of striatal–amygdalal circuits may play a central role in the pathophysiology of social anxiety disorder (29).

Our finding of higher binding potentials of 123I-β-CIT for 5-HTT in the thalamus of patients with social anxiety disorder can be interpreted as resulting from a decreased extracellular 5-HT concentration near the transporter (allowing 123I-β-CIT to bind with higher density), from an elevated density of 5-HTT, or from a combination of both.

Decreased extracellular 5-HT levels in the brain of patients with social anxiety disorder would seem to be compatible with the fact that SSRIs are effective in social anxiety disorder (30). In line with this notion, it has been reported that repeated administration of SSRIs to healthy volunteers may increase social affiliation (31). More recently, Argyropoulos et al. showed that reducing 5-HT availability in the brain through tryptophan depletion resulted in a significant increase in challenge-related anxiety in successfully treated patients with social anxiety disorder (32). The hypothesis of a decreased serotonergic transmission remains in contrast to other reports suggesting that increased 5-HT neurotransmission is anxiogenic. Harmer et al. recently reported an impaired recognition of fearful facial expression in female volunteers after tryptophan depletion, whereas acute administration of the SSRI citalopram to healthy volunteers increased the recognition of fearful faces (33,34). Remarkably, SSRIs often display an acute anxiogenic effect that converts into anxiolysis on repeated administration. The mechanism responsible for this reversal is unknown but might be explained by adaptive changes (dampening) in the serotonergic system or in other more distal neuronal networks.

The heightened 5-HTT binding potential may also be the result of increased densities of 5-HTT in patients with social anxiety disorder, reflecting a higher homeostatic tone of the serotonergic system (with concomitant lower densities of 5-HT receptors). This possibility would be in line with results from Lanzenberger et al., who found reduced 5-HT receptor 1A levels in social anxiety disorder (9). Finally, the heightened 5-HTT binding potential may also be genetically determined. Arbelle et al. recently reported an association between the 5-HTT promoter region 44-base-pair insertion/deletion and shyness in a nonclinical sample of second-grade children (35). The investigators reported a significant association between the long 5-HTT promoter region 44-base-pair insertion/deletion polymorphism and shyness in their sample. Children who were homozygote for the long allele, which has been shown to produce higher gene transcription and presumably a higher density of 5-HTT, had significantly higher scores on the shyness scales (36). Insofar as shyness is an endophenotype for social anxiety disorder, the higher 5-HTT density may be interpreted as a risk factor for developing the disorder, which in turn may also explain our finding of a heightened 5-HTT binding potential. Unfortunately, the genetics of social anxiety disorder have not been adequately studied yet. Interestingly, a study by van Dyck et al. did not point at a direct association of higher central 5-HTT levels with the 5-HTT polymorphism but suggested a more complex relationship (37).

The higher DAT binding potential in the striatum observed in this study is at variance with data reported previously by Tiihonen et al., who found a decreased striatal dopamine binding potential in social anxiety disorder by using the same tracer (7). The difference in outcome between the 2 studies cannot be readily explained. The most obvious differences between the 2 studies are our more accurate assessment of the VOIs by using MRI scan coregistration and the inclusion of psychotropic medication–naïve patients without comorbidity in the present study. Both studies, however, had a small number of subjects—a limitation that always bears a risk of false-positive outcomes. As discussed above, when interpreting the data of our study, one must consider that the interaction between radiotracer and transporter is determined by the amount of radiotracer, the amount of transporter and its affinity, and the amount of competing ligands, that is, endogenous dopamine. Thus, the present finding can be interpreted as either a lower level of extracellular dopamine or an elevated density of DAT in patients with social anxiety disorder or a combination of both.

By and large, previous studies examining the dopaminergic system in social anxiety disorder seem to point to a decreased dopaminergic activity. Schneier et al. reported a lower 123I-iodobenzamide binding potential for dopamine D2 receptors in patients with social anxiety disorder. The authors attributed this finding to a lower dopamine activity (8). The lower binding potential, however, would also be reconcilable with either an enhanced dopaminergic activity or (transitory) high levels of dopamine near the receptors or an altered affinity of the receptor, as was discussed by Mathew et al. (28). Heightened dopaminergic activity may decrease the density or affinity of D2 receptors and simultaneously upregulate the density of DAT, whereas high levels of dopamine may compete with 123I-iodobenzamide for receptor binding.

Data from animal models have shown that a heightened dopaminergic activity in the striatum during stress can decrease D2 receptor density (38). In line with the notion of an enhanced dopaminergic activity, Barnett et al. recently reported beneficial effects for the atypical antipsychotic olanzapine in patients with social anxiety disorder (39). Taken together, these findings suggest that our observation of a heightened density of DAT in the striatum is probably best explained by an elevated dopaminergic transmission. Interestingly, a recent functional MRI study using an implicit learning task as a probe of striatal functioning showed a reduced task-related activation of the striatum in patients with social anxiety disorder (40). Although several studies have implicated the striatum in seasonal affective disorder, the involvement of specific striatal subregions has been less thoroughly examined. With our exploratory post hoc analysis, we found increased DAT binding in the right putamen in seasonal affective disorder. However, this increase was significant at a level uncorrected for multiple comparisons, and the involvement of the putamen in seasonal affective disorder should be corroborated in other studies using other methodologies.

Clearly, the possible role of abnormalities in the dopaminergic and serotonergic systems needs to be further elucidated. Both dopamine (through D1 and D2 receptors) and 5-HT (through 5-HT receptor 2) are known to modulate the activity of excitatory (i.e., glutamate) and inhibitory (i.e., γ-aminobutyric acid) neurotransmitters in the striatum and related corticothalamolimbic circuitry. Data on the exact nature of these interactions are still inconclusive.

Finally, based on the results of the present study, it is not possible to dissect out whether the found dopaminergic and serotonergic abnormalities are causal or epiphenomenonal to social anxiety disorder. In our study, we found no significant correlations between scores on the clinical rating scale and abnormalities in the serotonergic and dopaminergic systems. In general, neuroimaging studies in psychiatry tend to find no or only weak correlations between the often heterogeneous symptomatology and neuroimaging measures. The previous 123I-β-CIT study on social anxiety disorder also did not find correlations between binding ratios and symptomatology (7). The absence of any correlation in our and the previous study may be due to the psychometric properties of the used clinical scale and the heterogeneity of social anxiety disorder as defined by DSM-IV but can also be interpreted as pointing to the fact that the phenomena of social anxiety disorder are not directly related to the found abnormalities. It is also important to note the overlap between the binding patterns in patients and controls, suggesting that the found abnormalities may perhaps be more related to vulnerability or personality traits. Another explanation may be that the found abnormalities are a consequence of having social anxiety disorder (i.e., a “scar” hypothesis).

Our study had several strong points. The patients and controls were pairwise-matched. The patients were psychotropic medication–naïve and had no comorbid diagnosis on axis I, and most had not received prior psychotherapy. Furthermore, the SPECT data were analyzed using coregistered MRI scans, allowing for more precise determination of VOIs. There were some potential limitations to the present study. The sample size was relatively small and we used a limited number of VOIs.

We visualized binding to 5-HTT only at 4 h after administration of the ligand. This time point for visualization, however, could have limited the possibility of finding further abnormalities at the level of 5-HTT, as was illustrated by the study of Willeit et al. on seasonal affective disorder (20). In that study, 5-HTT was visualized at 4 h after injection of 123I-β-CIT and also at 24 h, when a pseudoequilibrium state is reached. Differences were found only in the SPECT acquisitions at 24 h after the injection. We followed the method described by Kuikka et al. and used paroxetine, 20 mg, to completely displace the 123I-β-CIT from 5-HTT (18). Administration of paroxetine could potentially lead to an increase in symptoms of (social) anxiety, but such an increase (mild) was reported by only 1 patient.

Finally, although SPECT is easier to use, is less expensive, and has a higher safety index than PET, it also uses semiquantitative techniques and has a poorer anatomic resolution.

CONCLUSION

Our data provide direct evidence for the involvement of both the dopaminergic and the serotonergic systems in the pathophysiology of social anxiety disorders. These findings need to be replicated and further explored in studies examining the effect of pharmacotherapy and psychotherapy on both the serotonergic and the dopaminergic transporter and receptor-binding capacities in generalized social anxiety disorder.

Acknowledgments

We thank Alice van Dongen, clinical research assistant at the Department of Nuclear Medicine, for her assistance and ideas on the study.

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  • Received for publication July 24, 2007.
  • Accepted for publication January 16, 2008.

Increased dopamine transporter density in Parkinsons disease patients with Social Anxiety Disorder (2011)

J Neurol Sci. 2011 Nov 15;310(1-2):53-7. Epub 2011 Jul 23.

Moriyama TS, Felicio AC, Chagas MH, Tardelli VS, Ferraz HB, Tumas V, Amaro-Junior E, Andrade LA, Crippa JA, Bressan RA.

Source

Instituto do Cérebro, Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, Sao Paulo, Brazil. taismoriyama@gmail.com

Abstract

Social Anxiety Disorder (SAD) is more common among PD patients than in the general population. This association may be explained by psychosocial mechanisms but it is also possible that neurobiological mechanism underlying PD can predispose to SAD. The aim of this study was to investigate a possible dopaminergic mechanism involved in PD patients with SAD, by correlating striatal dopamine transporter binding potential (DAT-BP) with intensity of social anxiety symptoms in PD patients using SPECT with TRODAT-1 as the radiopharmaceutical.

Eleven PD patients with generalized SAD and 21 PD patients without SAD were included in this study; groups were matched for age, gender, disease duration and disease severity. SAD diagnosis was determined according to DSM IV criteria assessed with SCID-I and social anxiety symptom severity with the Brief Social Phobia Scale (BSPS). Demographic and clinical data were also collected. DAT-BP was significantly correlated to scores on BSPS for right putamen (r=0.37, p=0.04), left putamen (r=0.43, p=0.02) and left caudate (r=0.39, p=0.03). No significant correlation was found for the right caudate (r=0.23, p=0.21).

This finding may reinforce the hypothesis that dopaminergic dysfunction might be implicated in the pathogenesis of social anxiety in PD.

Low Dopamine D2 Receptor Binding Potential In Social Phobia (2000)

Social anxiety seems to be increased by porn addiction, perhaps due to dopamine receptor drop Comments: Low levels of dopamine receptors (D2) are associated with social anxiety disorder. Many heavy porn users experience social anxiety. Some report an increase in social anxiety after a porn binge. For most the anxiety improves following abstinence - for some a short time, others a longer time. Keep in mind that excess stimulation (addictions) leads to a lowering of dopamine D2 receptors. Note: I am not saying that porn causes all cases of SAD.


Am J Psychiatry 2000 Mar;157(3):457-

Schneier FR, Liebowitz MR, Abi-Dargham A, Zea-Ponce Y, Lin SH, Laruelle M. Anxiety Disorders Clinic and the Brain Imaging Division, New York State Psychiatric Institute, New York 10032, USA.

OBJECTIVE: This study compared dopamine D(2) receptor binding potential in patients with social phobia and healthy comparison subjects.

METHOD: Dopamine D(2) receptor binding potential was assessed in 10 unmedicated subjects with generalized social phobia and no significant lifetime psychiatric comorbidity and 10 healthy comparison subjects matched for age and sex. Binding potential was measured in the striatum by using single photon emission computerized tomography and constant infusion of the D(2) receptor radiotracer [(123)I]iodobenzamide ([(123)I]IBZM).

RESULTS: Mean D(2) receptor binding potential was significantly lower in the subjects with social phobia than in the comparison subjects. Within the social phobia group, there was a nonsignificant correlation of binding potential with the Liebowitz Social Anxiety Scale score.

CONCLUSIONS: Generalized social phobia may be associated with low binding of [(123)I]IBZM to D(2) receptors in the striatum.

INTRO

The generalized subtype of social phobia, characterized by fear and/or avoidance of most social situations, is chronic (1), is heritable (2), and may share behavioral features with subordinate social status in animals (3), yet the biology of social phobia has been little studied. Evidence for an association of social phobia with subnormal transmission in the dopamine system includes treatment efficacy for monoamine oxidase inhibitors but not tricyclic antidepressants (4), low dopamine transporter density in generalized social phobia (5), low CSF levels of homovanillic acid among panic disorder patients with comorbid social phobia (6), a high rate of social phobia among patients with Parkinson’s disease (7), and increased social phobia symptoms during haloperidol treatment of patients with Tourette’s syndrome (8).

In this study we compared dopamine D2 receptor binding potential in patients with generalized social phobia and healthy comparison subjects.

METHOD

Ten subjects with social phobia were recruited by advertisement and clinical referrals; their mean age was 32.5 years (SD=10.4), and the group comprised five men and five women. All subjects were physically healthy as determined by complete medical evaluation, with no current or lifetime psychosis, organic mental disorders, major depression, bipolar disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, eating disorders, attention deficit hyperactivity disorder, substance abuse or dependence, schizotypal or borderline personality disorder, or family history of schizophrenia. Ten healthy comparison subjects, matched by age and sex and with no current or past mental disorders, were recruited by advertisement. Diagnoses were confirmed by using the Structured Clinical Interview for DSM-IV Axis I Disorders (9).

All subjects had been free of psychotropic medication for at least a year, and a drug screen was performed before scanning. After complete description of the study to the subjects, written informed consent was obtained.

The Liebowitz Social Anxiety Scale (10) was used to measure the severity of social phobia. D2 receptor binding potential was measured by using the radiotracer [123I]iodobenzamide ([123I]IBZM) with single photon emission computerized tomography, by means of the bolus plus constant infusion method, as previously described (11). A standard region-of-interest profile of constant size and shape was used to analyze the studies. Right and left striatal regions and occipital regions were positioned on summed images. Specific binding was calculated as the difference between striatal activity and occipital activity at equilibrium. [123I]IBZM binding potential (in ml/g), corresponding to the product of the free receptor density (Bmax, in nM or picomoles per gram of brain tissue) and affinity (1/KD, in 1/nM or milliliters of plasma per picomole of [123I]IBZM), was calculated as the ratio of striatal specific binding (in microcuries per gram of brain tissue) to steady-state free unmetabolized plasma tracer concentration (in microcuries per milliliter of plasma) (12).

The group comparisons used two-tailed unpaired t tests with an alpha of 0.05. Binding potential was related to clinical severity by means of rank-transformed data (Spearman rank correlation).

RESULTS

There were no significant group differences in age, sex, race, education, marital status, or handedness.

There was a significant difference in [123I]IBZM binding potential between groups (t=2.6, df=18, p=0.02), with lower binding potential in the patients with generalized social phobia (mean=93.6 ml/g, SD=29.8) than in the comparison subjects (mean=133.5 ml/g, SD=38.2) (F1). Within the social phobia group, there was a nonsignificant negative correlation of binding potential with the total score on the Liebowitz Social Anxiety Scale (rs=–0.59, N=10, p=0.07).

DISCUSSION

These findings suggest that generalized social phobia may be associated with low D2 receptor binding potential in the striatum. Low D2 receptor binding potential would be consistent with the findings of low dopamine system activity in social phobia.

This study is limited by the small number of subjects. Also, because only one high-specific-activity experiment was performed with each subject, D2 receptor density and affinity could not be measured.

The findings appear to parallel those from animal studies of subordinate social status, which has been suggested to share behavioral features with human social phobia (3). For example, a recent positron emission tomography study of female cynomolgus monkeys (13) showed lower striatal D2 binding in subordinates, similar to our finding in generalized social phobia. Animals of subordinate social status may be a useful model for understanding the brain function underlying human social phobia.

Low D2 receptor binding seems at least partially specific to social phobia, rather than representing a nonspecific correlate of stress or mental disorder. D2 binding has not been found to be low in schizophrenia (14) or major depression (15). It has been reported to be low in substance abuse disorders (16), which may often be comorbid with social phobia (17).

These data suggest that low D2 receptor binding potential might be associated with social phobia. Combined with results from other centers, these data add to the growing evidence that D2 receptor function modulates social behavior in humans.

Received Feb. 23, 1999; revisions received July 13 and Aug. 27, 1999; accepted Sept. 2, 1999. From the Anxiety Disorders Clinic and the Brain Imaging Division, New York State Psychiatric Institute; and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. No reprints are available. Address correspondence to Dr. Schneier, Anxiety Disorders Clinic, Unit 69, New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032; frs1@columbia.edu (e-mail). Supported by grants from the Sycamore Foundation and from Solvay Pharmaceuticals and by NIMH Independent Scientist Award MH-01603 to Dr. Laruelle. The authors thank Kathy Rivera, Tami Edwards, Janine Rodenhiser, Ph.D., Suehee Chung, Mali Pratap, Ted Pozniakoff, Richard Weiss, Dan Schneider, and Analea Arevalo for technical assistance.

FIGURE 1.

Dopamine D2 Receptor Binding Potential in Patients With Generalized Social Phobia and Healthy Comparison Subjects

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Copyright ©2012 American Psychiatric Association

 

 

 

Neurobiological Mechanisms of Social Anxiety Disorder (2001)

 FULL STUDY - Am J Psychiatry 158:1558-1567, October 2001

© 2001 American Psychiatric Association

Sanjay J. Mathew, M.D., Jeremy D. Coplan, M.D., and Jack M. Gorman, M.D.

Abstract

OBJECTIVE: The authors critically surveyed several preclinical and clinical neurobiological models of social anxiety disorder.
 
METHOD: The authors reviewed the recent literature regarding three animal models of particular relevance to social anxiety. They then examined the recent literature concerning clinical neurobiological aspects of social anxiety disorder, including the developmental neurobiology of anxiety, the genetics of fear and social anxiety, and challenge and imaging studies.
 
RESULTS: The available animal models are useful paradigms for understanding the features of social subordination stress, attachment behavior, and environmental rearing, but they incompletely account for the known neurobiology of human social anxiety disorder. The clinical neurobiology literature surveyed implicates specific neurotransmitter system abnormalities, most notably of the dopamine system, but largely ignores neurodevelopmental processes and the functional interactions between neurotransmitters. Both heritable factors and environmental stress factors appear to be responsible for the onset of social anxiety disorder.
 
CONCLUSIONS: Social anxiety disorder should be conceptualized as a chronic neurodevelopmental illness that might represent a fully compensated state in adulthood. Future investigations from this perspective are discussed.Abstract Teaser

Introduction

Social anxiety disorder, also known as social phobia, is a common and disabling psychiatric illness that is characterized by an excessive fear and/or avoidance of situations in which an individual feels scrutinized by others and is fearful of a negative evaluation by others. Although it is the most common of the DSM-IV anxiety disorders, there is a dearth of clinical neurobiological research on social anxiety disorder and few preclinical models. This review focuses on the generalized subtype, which involves the fear of a wide range of social situations, with the goal of proposing several neurobiological mechanisms that may account for the symptoms of this disorder. We begin with an overview of three nonhuman primate models that are particularly relevant to social anxiety. Next, we review recent literature in the clinical neurobiology of social anxiety disorder, focusing on important findings in developmental neurobiology and genetics. Our findings suggest that social anxiety disorder should be reconceptualized as a chronic neurodevelopmental illness instead of an episodic de novo adult disorder, a semantic distinction with important treatment implications.

Models Relevant to Social Anxiety

Subordination Stress Model

Like man, primates are particularly dependent on social relationships, and laboratory-based behavioral observations can be readily conducted. Shively (2) conducted informative nonhuman primate studies in social subordination and dominance in laboratory-housed female cynomolgus monkeys. Behavioral observations revealed that subordinates spent more time alone, fearfully scanning their social environment, than dominants. Biological studies of these subordinates revealed evidence of hyperactive hypothalamic-pituitary-adrenal (HPA) axis activity, impaired serotonergic functioning, and impaired dopaminergic neurotransmission. In a challenge study with ACTH, social subordinates hypersecreted cortisol, reflecting HPA axis activation. When investigators carried out the fenfluramine challenge test (which causes release of serotonin), laboratory-housed cynomolgus macaques exhibited a blunted prolactin response, which suggests reduced central serotonergic activity. These monkeys were more socially withdrawn and spent less time in passive body contact than those who showed a high prolactin response (3). When investigators carried out a haloperidol challenge test with a dopamine antagonist that enhances prolactin secretion through tubero-infundibular dopamine pathways, reduced prolactin responses were observed in subordinates (2). This result suggested a lowering of the sensitivity of postsynaptic dopamine receptors in this pathway in the subordinates. Consistent with the neuroendocrine data, a positron emission tomography (PET) study (4) of subordinates showed decreased striatal dopamine D2 receptor binding, which suggests abnormal central dopaminergic neurotransmission, a finding that mimics the results of a single photon emission computerized tomography (SPECT) study (5) in humans with social anxiety disorder.

Studies of socially subordinate baboons in the wild have revealed other neuroendocrine abnormalities that mimic findings in certain anxious and depressed human subjects. Hypercortisolemia, as well as resistance to feedback inhibition by dexamethasone, was reported by Sapolsky et al. (6) in baboons. Another interesting finding is that subordinate male baboons have lower insulin-like growth factor I levels than dominants (7). This finding might explain the observed association between short stature and social anxiety disorder found in one study (8).

There are several important limitations of this model as it applies to patients with social anxiety disorder. First, there is no evidence of an HPA axis disturbance in social anxiety disorder as measured by the degree of dexamethasone nonsuppression (9). Second, the prolactin response to fenfluramine differs in subordinate models versus patients with social anxiety disorder (10). Another important limitation of this and the other animal models is that humans with social anxiety disorder tend to be "hard wired" to act avoidant, submissive, and anxious in social settings, whereas nonhuman primates, because of environmental manipulations in dominance and submission, display a certain plasticity in response to environmental stresses. For example, dominant vervet monkeys have higher blood serotonin levels than subordinates, but their serotonin levels significantly decrease when they are removed from the group (11). Thus, it appears that the major correlative finding in the primate subordination stress model with social anxiety disorder is striatal dopaminergic dysfunction. Whether this dysfunction is a byproduct of social stress or a feature of social subordinance per se is not clear.

Variable-Foraging-Demand Model

Another model of potential use is the variable-foraging-demand model in nonhuman primates. Rosenblum and Paully (12) developed this model for social timidity and nonassertiveness by exposing nursing mothers to unpredictable foraging-demand conditions and experimentally inducing unstable attachment patterns to their infants. Grown animals raised under variable-foraging-demand conditions, in comparison to predictably reared comparison subjects, showed stable increases in levels of social timidity—e.g., social subordination, avoidance of antagonistic encounters—and decreased species-typical huddling, in comparison to predictably reared comparison subjects (13). From a biological standpoint, subjects reared under the variable-foraging-demand model exhibited longstanding increases in levels of CSF corticotropin-releasing factor (CRF) (14), the dopamine metabolite homovanillic acid (HVA), and the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA). Only in subjects reared under the variable-foraging-demand model did CRF levels correlate positively with HVA and 5-HIAA levels, which suggests a functional linkage between CRF level and both dopaminergic and serotonergic systems (15). Moreover, within the variable-foraging-demand group, relative increases in CRF levels were correlated with relative reductions in growth hormone (GH) response to the α2 adrenergic agonist clonidine (16), as well as exaggerated anxiety responses to yohimbine, an α2 antagonist (17).

Neurochemically, what appeared to be most relevant for social anxiety disorder is the finding of altered dopaminergic metabolites in CSF in primates reared under the variable-foraging-demand condition, which parallels the numerous dopaminergic abnormalities observed in patients with social anxiety disorder. Behaviorally, the primates reared under the variable-foraging-demand condition resembled what Kagan et al. (18) described in a group of young children who manifested characteristics of "behavioral inhibition to the unfamiliar." These children exhibited an exaggerated heart rate acceleration to stress, high early-morning salivary cortisol levels, and levels of behavioral inhibition correlated with high total norepinephrine activity. Thus, the variable-foraging-demand model is useful in its suggestion that early environmental stress, particularly of an affective nature, may shift behavior and neurobiology toward a trait-like socially anxious profile. Clinically, however, the neuroendocrine findings of dissociation between increased CRF levels and decreased cortisol levels most closely resembled the profile of patients with posttraumatic stress disorder (PTSD) (19, 20).

Animal Attachment Models

Historically, deficits in attachment behavior have been most closely associated conceptually with autistic disorders and schizoid personality disorders. In fact, an often-noted clinical distinction between patients with social anxiety disorder and those with autism and schizoid personality disorder is in the degree of desire for relatedness and attachment to others. Because patients with social anxiety disorder (and its closely related axis II variant avoidant personality disorder) have been generally regarded as persons who desire connections and attachments with others but are fearful of the negative consequences of such interactions, whereas autistic and schizoid persons generally do not desire these attachments and lack affiliative behaviors, attachment models have not been considered important in understanding social anxiety disorder. However, emerging genetic links between autism and social anxiety disorder suggest a reexamination of attachment neurobiology. For example, Smalley et al. (21) found that the first-degree relatives of autistic probands had an increase in social anxiety disorder relative to comparison subjects. A recent study (22) showed that the parents of autistic probands had significantly higher rates of social phobia than the parents of Down’s syndrome probands, although there was no evidence of an association within individuals between social anxiety disorder and the broad autism phenotype (defined as milder aspects of autism, including social and communication deficits and stereotypical repetitive behaviors). These studies point to a shared biology of attachment, which makes the neurobiology of animal attachment potentially more relevant to social anxiety disorder than previously acknowledged.

Numerous neurotransmitter systems have been investigated clinically in subjects with autism and preclinically in primate models of attachment and affiliation. Raleigh and colleagues (23) showed that enhancement of serotonergic function resulted in improved social affiliativeness in primates, whereas low serotonin levels promoted avoidance. In separate but related work, free-ranging primates with low levels of CSF 5-HIAA showed less social competence and were more likely to emigrate at a younger age from their social groups than primates with higher levels of CSF 5-HIAA (24).

The brain opioid system was the first neurochemical system to be implicated as a regulator of attachment behaviors in primates and other species. In one study of nonhuman primates (25), 10 juvenile macaques living in a stable social group with their mothers and other group companion subjects were administered naloxone, an opiate antagonist. The primates receiving naloxone made more grooming solicitations and received more grooming and increased their proximity with their mothers. Kalin et al. (26) studied reunions of nonhuman primate infants after separations from their mothers and demonstrated that both infants and mothers who were administered morphine showed a significant reduction in clinging behaviors, whereas those given naltrexone increased their clinging. Finally, there was evidence of complex interrelationships between endogenous opioid activity and other affiliative neurotransmitter systems, as it was suggested that opiate activity was increased by oxytocin injections in the rat (27). Clinically, there is some evidence that opioid abusers have high rates of social avoidance and anxiety (28).

The neurohormone oxytocin is well established in the initiation but not the maintenance of maternal behavior and pair bonding (29), as well as in social interactions in nonhuman primates (30). Recent data from Insel and Winslow (29) demonstrated that a genetically engineered mouse lacking oxytocin emitted few isolation calls and had reduced social interactions. They hypothesized that the neural substrates of attachment are "those pathways which couple social recognition (olfactory, auditory, and visual stimuli) to the neural pathways for reinforcement, such as the [dopaminergic] mesolimbic projections from the ventral tegmental area to the nucleus accumbens and prefrontal cortex" (p. 888). It is known that dopaminergic neurotransmission is implicated in brain reward pathway projections. Social anxiety disorder, as Stein (31) suggested, might therefore be an illness "characterized by dysfunction within the system(s) that evaluate(s) the risks and benefits of social affiliation" (p. 1280) by employment of brain reward pathways. Anatomically, many of these disparate attachment pathways traverse the anterior cingulate, a region recently implicated by functional magnetic resonance imaging (fMRI) in an aspect of the human maternal-infant bond: the response to infant cries (32). In summary, animal attachment models implicate not only oxytocin, but varied serotonergic, opioid, and dopaminergic pathways.

Although they are incomplete in explaining the varied cognitive misappraisals observed in patients with social anxiety disorder, preclinical attachment models provide a useful construct for understanding the aberrant social affiliativeness seen in subjects with social anxiety disorder and provide guides for future investigations of the clinical neurobiology of the disorder. Unfortunately, the amount of replicated data in primate attachment neurobiology is extremely sparse, particularly in neuroimaging. Thus, the direct applicability of these animal models to social anxiety disorder is necessarily limited at this time. (See t1 for a summary of preclinical models of social anxiety disorder.)

Neuroplasticity, Neurogenesis, and Social Dominance

The explosion of research in neurodevelopment has afforded the opportunity of taking a specific animal model of anxiety, such as one concerned with dominance or subordination stress, and investigating its neurobiological correlates by means of in vivo neuroimaging or postmortem tissue sampling. One of the more important findings in human neurobiology in the past decade is accumulating evidence for the remarkable plasticity of the brain and the development of neurogenesis in diverse brain regions, such as the cortex, hippocampus, cerebellum, and olfactory bulb (33). Gould et al. (34) demonstrated altered neuroplasticity in tree shrews in an enduring dominant-subordinate relationship derived from a social dominance paradigm (35). Specifically, her group showed a rapid decrease in the number of new cells produced in the dentate gyrus of subordinate tree shrews compared to those who remained unexposed to a stressful experience (34). This finding was more recently replicated in marmoset monkeys by using a resident intruder paradigm, a psychosocial stress model similar to that of the dominant-subordinate model for the tree shrews (36). At this time, we do not know the nature of neuroplastic changes in the brains of human infants with early signs and symptoms of social anxiety; thus, the translational implications of stress-induced decreases in granule cell production in animal models is unknown. However, a recent study has shown that granule neurons are potentially involved in hippocampal-dependent learning tasks (37) and that consequent decreases in the number of granule neurons are likely to alter adult hippocampal formation (37). Stressful experiences, which increase levels of circulating glucocorticoids and stimulate hippocampal glutamate release (38), might thus inhibit granule cell neurogenesis. In adult social anxiety, we hypothesize that excessive glutamatergic transmission in hippocampal and cortical regions might be a key component of the dysfunctional circuitry, and successful treatments might serve to prevent the inhibition of neurogenesis while modifying glutamatergic neurotransmission.

Although most animal studies have focused on hippoampal formation, there is evidence that stressors affect cortical neurons as well (39). Neuroplastic changes are also dependent on levels of neurotrophins, such as nerve growth factor, which is known to be differentially modulated by experience (40). In fact, drugs such as the selective serotonin reuptake inhibitors (SSRIs), useful in treating social anxiety, are known to increase expression of brain-derived neurotrophic factor in the hippocampus (41, 42).

Course and Neural Circuitry of Precursors

Given the remarkable developmental plasticity of key neural structures, there is considerable interest in delineating the fear and anxiety circuitry across the stages of development (43, 44). Longitudinally, recent work has confirmed that a significant number of children classified as "inhibited" will develop generalized social anxiety by young adulthood (45, 46). Kagan (47) noted that 4-month-old infants who had a low threshold for becoming distressed and motorically aroused to unfamiliar stimuli were likely to become fearful and subdued in early childhood. Similarly, children identified as behaviorally inhibited at 21 months who remained inhibited at subsequent follow-up visits at ages 4, 5.5, and 7.5 years, showed higher rates of anxiety disorders than children who were not behaviorally inhibited (48), although the findings were not specific for social anxiety. However, a more recent prospective study by Pine et al. (43) has suggested a more specific association between childhood and adult social phobia, a finding consistent with those of family studies among adults (49).

The identification of neurobiological correlates to adult social anxiety disorder in children helps validate clinical and epidemiological observations linking behaviorally inhibited children with adult patients (50). The most notable neurobiological correlates of clinical observations have been the brain laterality studies performed in high-reactive and inhibited children (51, 52) and in animals (53). Davidson (52, 54) demonstrated in infants and adults that withdrawal-related emotions, such as anxiety, were associated with activation of the right frontal region, whereas left prefrontal cortex activation was related to approach-related emotions. Adult patients with social anxiety disorder showed a large increase in activations in right anterior temporal and lateral prefrontal scalp regions when anticipating making a speech in relation to comparison subjects (52, 55). In related preclinical work, EEG recordings in fearful rhesus macaques demonstrated relatively higher right frontal lobe activity, elevated cortisol and CSF CRF concentrations, and more intense defensive responses (53, 56). Although these findings are interesting, they might be relatively disorder nonspecific, in that Rauch et al. (57) demonstrated increased activation in the right inferior frontal cortex, among other regions, across three anxiety diagnoses (obsessive-compulsive disorder [OCD], PTSD, and simple phobia) in a PET symptom-provocation paradigm. Thus, although the epidemiological links between behavioral inhibition and adult social anxiety disorder appear to be validated by common regional alterations in brain activity, the biological associations might be disorder nonspecific.

The low genetic concordance rates for social anxiety disorder in monozygotic twins (62) have suggested that genetics plays a limited role in its development. As we suggested for panic disorder (1), what appears to be inherited is a susceptibility to social anxiety, not the disorder itself. Although no systematic genetic linkage studies employing a genomic scan or search among candidate genes have been conducted for social anxiety disorder so far, such studies are underway for panic disorder (63) and OCD (64). Likewise, molecular genetic studies of candidate genes for the several neurotransmitter systems implicated in social anxiety, notably the serotonin transporter and dopamine receptor and their various subtypes, have allowed for associations between specific genes and behavioral traits, such as harm avoidance and novelty seeking (65, 66)—characteristics relevant to the social anxiety disorder phenotype. Thus, genetic and family studies in social anxiety disorder are still in their infancy but support longitudinal clinical data that are suggestive of links between childhood and adult variants of the disorder.

Pharmacological Probes

Challenge studies have shown abnormalities in monoamine (dopamine, norepinephrine) and indoleamine (serotonin) neurotransmission. Of the serotonergic studies, Tancer et al. (10) reported an augmented cortisol response to fenfluramine in patients with social anxiety relative to comparison subjects, a finding similar to that observed in subjects with panic disorder. Hollander et al. (67) reported increased anxiety responses to the serotonergic probe m-CPP, but there were no notable neuroendocrine alterations. In studying dopamine function, Tancer’s group (10) did not find any abnormality of dopaminergic function when using l-dopa as the pharmacological probe (see F1 for a summary of dopaminergic abnormalities observed in social anxiety disorder [6872]). Other probes commonly used in studies of panic disorder, such as CO2, lactate, pentagastrin, and epinephrine, generally have produced an intermediate response, between those of patients with panic disorder and comparison subjects, in patients with social anxiety disorder (73, 74). A recent report by Pine et al. (75) revealed a lack of association between CO2 sensitivity and childhood social phobia, which is consistent with studies finding no association between childhood social phobia and adult panic disorder (76). We conclude from these limited studies that there exists an overlapping but distinct neurobiology of social anxiety disorder and panic disorder.  

Norepinephrine in Social Phobia

Since autonomic hyperarousal (manifested by flushing, tachycardia, and tremulousness) is a common symptom of patients with panic anxiety and social anxiety in performance situations, understanding autonomic nervous system function in these patients might shed light on the dysfunctional circuitry involved in social anxiety disorder. Stein et al. (77) performed an orthostatic challenge test in patients with social anxiety disorder, panic disorder, and healthy comparison subjects and found that the first group had higher plasma levels of norepinephrine before and after the challenge. This finding was not replicated in a subsequent study comparing subjects with social phobia with normal comparison subjects, and in fact there was a suggestion of impaired parasympathetic (not sympathetic) activity in the group with generalized social anxiety disorder in relation to comparison subjects (78).

Limited data have suggested that the α2 adrenergic antagonist yohimbine increases social anxiety in patients with social anxiety disorder and is associated with increased plasma 3-methoxy-4-hydroxyphenylglycol concentrations (79). In contrast, Papp et al. (80) infused intravenous epinephrine in patients with social anxiety disorder and observed that only one out of 11 patients experienced observable anxiety, which suggests that an increase in plasma epinephrine levels alone is inadequate to cause social anxiety. Notably, Tancer et al. (81) observed a reduced GH response to intravenous, but not oral, clonidine, an α2 adrenergic agonist. The blunted GH response to clonidine is also observed in subjects with panic disorder, major depressive disorder, and generalized anxiety disorder and is thought to possibly reflect reduced postsynaptic adrenergic-2 receptor functioning owing to norepinephrine overactivity. Alternatively, Coplan et al. (16) hypothesized that the blunted GH response to clonidine or other GH secretagogues may reflect an increased central activity of the fear-inducing neuropeptide CRF. In summary, although there are limited data on the role of autonomic nervous system dysfunction in social anxiety, the autonomic hyperarousal observed clinically in some patients bespeaks an underlying dysregulation of the autonomic nervous system.

Neuroimaging 

Neuroimaging studies to date have primarily focused on basal ganglia or striatal pathology and have shown preliminary evidence of impaired dopaminergic functioning in these regions. The interest in these specific brain regions followed accumulating clinically based evidence of dopaminergic deficits in social anxiety disorder (F1). Neuroanatomically, of the four major dopamine pathways in the CNS, dysfunctions of the mesocortical and mesolimbic (ventral striatal, including the nucleus accumbens) pathways appear most relevant to social anxiety, with a presumed lesser importance of tuberoinfundibular and nigrostriatal (dorsostriatal) pathways, although published imaging studies do not provide sufficient spatial resolution to make this determination.

A study by Tiihonen et al. (82) reported a decrease in striatal dopamine reuptake sites on SPECT in patients with social anxiety disorder compared to normal volunteers, which suggests a deficit of dopaminergic innervation into the striatum. The authors suggested that the lowered dopamine reuptake site density reflects an overall smaller number of dopaminergic synapses and neurons in the striatum of patients with social anxiety disorder. The recent [123I]iodobenzamide ([123I]IBZM) SPECT study of Schneier et al. (5), which showed reduced mean D2 receptor binding in the striatum, implicated dopaminergic hypofunction in the striatum. However, the interpretation of this report is difficult to reconcile with the report by Tiihonen et al. of decreased dopamine transporter binding, in that decreased binding potentials of the SPECT radiotracer [123I]IBZM could also reflect increased levels of free dopamine in the vicinity of D2 receptors, altered affinity of D2 receptors for dopamine, or some combination of these factors. It was recently argued that SPECT or PET studies measuring dopamine binding after changes in synaptic dopamine levels are probably more complex than accounted for by simple binding occupancy models and might involve changes in the subcellular distribution of receptors (83). Indeed, most of the variance in D2 receptor binding appears to be due to alterations in receptor expression, whereas endogenous dopamine levels contribute to only about 10%–20% of the variance (personal communication, Marc Laruelle, M.D., 2001).

Most neuroimaging studies not specifically focusing on dopamine systems have detected basal ganglia and cortical abnormalities, and one study suggested amygdala involvement. Using magnetic resonance spectroscopy (MRS), Davidson et al. (84) reported a decrease in choline and creatine signal-to-noise ratios in the subcortical, thalamic, and caudate areas, as well as lowered N-acetylaspartate signal-to-noise ratios in cortical and subcortical regions, which was interpreted as possible neuronal atrophy and degeneration. The use of signal-to-noise ratios and limited spatial resolution were notable limitations of this study, as more recent MRS studies have analyzed the ratios of metabolites (85). Potts et al. (86) showed in another MRS study that patients with social anxiety disorder had a greater decrease in putaminal volumes during aging than normal comparison subjects. In studies of cerebral blood flow (CBF), Stein and Leslie (87) found no basal metabolic cerebral differences between patients and comparison subjects on SPECT, which indicated that any posited subcortical abnormality might not affect resting metabolism. Bell et al. (88), in a symptom-provocation study measured by means of H215O-labeled PET, reported an array of anxiety-related changes but stated that the changes specific to social anxiety disorder included increased regional CSF in the right dorsolateral prefrontal cortex and left parietal cortex. Finally, a recent fMRI study (89) implicated the amygdala in the pathophysiology of social anxiety, suggesting the generation of a hypersensitive amygdala when patients are exposed to potentially fear-relevant stimuli. In this study, neutral face stimuli elicited greater amygdala activity bilaterally in patients versus comparison subjects, despite knowledge that the neutral faces were not harmful, as shown by subjective ratings of anxiety. The causal relationship between fear elicitation and amygdaloid activation is unclear; however, this preliminary study is the first direct evidence for a role of the amygdala in social anxiety disorder.

In summary, there are few replicated neuroimaging studies to date regarding social anxiety disorder, but the convergence of data thus far implicates basal ganglia structures, the amygdala, and varied cortical regions. SPECT studies of the dopamine transporter and D2 receptor in the striatum thus far are inconclusive in confirming a hypothesis of low dopamine innervation. Recent initiatives, such as the development of a PET D2 receptor agonist ligand (90), which allows for direct determinations of neurotransmitter-D2 receptor interactions, will potentially provide valuable information on the role of this receptor in social anxiety disorder.

There are many unanswered questions regarding the neurobiology of social anxiety disorder. Given our assertion that social anxiety disorder should be conceptualized as a chronic neurodevelopmental illness beginning in childhood, several issues require further inquiry. First, we have no knowledge of studies examining the use of early identification and treatment of social anxiety disorder and its comorbid disorders and childhood precursors. Childhood social anxiety disorder is often comorbid with generalized anxiety disorder or separation anxiety disorder (91), and these comorbid forms of the illness have a greater association with panic disorder (92). Comparisons of laboratory neurobiological and neuroimaging measures of successfully treated patients with early intervention and successfully treated patients who were managed only in adulthood would be of interest, as would analyses of treatment responsivity across comorbid subgroups. Such secondary prevention studies might be the natural extension of longitudinal studies of behaviorally inhibited children.

Second, a better understanding of the developmental neurobiology of the brain regions important in social anxiety, such as the amygdala and striatum, and their interactions with the cortex, ascending monoaminergic systems, and hippocampus, clearly is necessary. Related to this objective neurodevelopmental genetic research, we should attempt to target susceptibility genes for the broad social anxiety phenotype. We have a limited understanding of the interaction between genetic vulnerability and stress exposure in socially anxious individuals. Cross-fostering paradigms in which primates raised under the variable-foraging-demand condition are randomly assigned to the offspring of either socially withdrawn or socially competent mothers might help answer the question of whether stress exposure has a more pernicious effect on genetically susceptible individuals.

Third, MRS imaging can be used to study neurotransmitter systems that have not received extensive attention in social anxiety, such as the glutamatergic system. Preclinical rodent models contend that prefrontal cortical efferents, either directly or by means of thalamic nuclei efferents, use the glutamatergic system as a primary source of neuronal stimulation of the "fear" neurocircuitry, which originates from the central nucleus of the amygdala and bed nucleus of the stria terminalis (93, 94). Stressful situations faced by a person with social anxiety disorder might stimulate glutamate release in hippocampal (38) and other brain regions. In this light, agents that attenuate glutamatergic neurotransmission should reduce anxiety levels, as well as the concomitant biochemical alterations associated with stress. Clinical investigations of glutamatergic antagonists might be warranted, since the SSRIs have been only partially successful in the treatment of this disorder. MRS also allows investigators to explore neurotransmitter interactions in vivo, such as the interaction between serotonin and glutamate, elegantly recently explored by Rosenberg et al. (95) in pediatric OCD.

Finally, an important limitation of our understanding of the neurobiology of social anxiety is the difficulty in discriminating what findings are a response to anxiety or stress and what are true risk factors for the development of anxiety. It is of importance that the clinical neuroendocrinology of social anxiety suggests a fully compensated state in adulthood, in that no peripheral (i.e., HPA axis) pathology is evident. In this light it would be of interest to study patients with a recent onset of social anxiety disorder versus patients with distant onset in order to gauge which neuroendocrine findings persist and which ones change over the course of the illness. Another important contrast would be to study patients with active social anxiety disorder versus patients in remission. A more refined understanding of this compensatory phenomenon might offer valuable insights not only into social anxiety disorder but into other psychiatric disorders with prominent neuroendocrine abnormalities as well.

Footnotes

Received July 13, 2000; revision received Jan. 10, 2001; accepted Jan. 18, 2001. From the New York State Psychiatric Institute, the Departments of Psychiatry and Clinical Psychobiology, College of Physicians and Surgeons, Columbia University. Address reprint requests to Dr. Mathew, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Dr., Box 84, New York, NY 10032; sjmathew@hotmail.com (e-mail). Funded in part by NIH grant MH-00416 and Center for the Neural Systems of Fear and Anxiety grants MH-58911 and MH-00416 (to Dr. Gorman), a Scientist Development Awards for Clinicians grant MH-01039 (to Dr. Coplan), and a National Alliance for Research on Schizophrenia and Depression Young Investigator Award and a Psychiatric Institute Research Support grant (to Dr. Mathew). The authors thank Marc Laruelle, M.D., for his contributions.

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On the nature of extraversion: variation in conditioned contextual activation of dopamine-facilitated affective, cognitive, and motor processes (2013)

 

 

  • Human Development, Cornell University, Ithaca, NY, USA

 

Research supports an association between extraversion and dopamine (DA) functioning. DA facilitates incentive motivation and the conditioning and incentive encoding of contexts that predict reward. Therefore, we assessed whether extraversion is related to the efficacy of acquiring conditioned contextual facilitation of three processes that are dependent on DA: motor velocity, positive affect, and visuospatial working memory. We exposed high and low extraverts to three days of association of drug reward (methylphenidate, MP) with a particular laboratory context (Paired group), a test day of conditioning, and three days of extinction in the same laboratory. A Placebo group and an Unpaired group (that had MP in a different laboratory context) served as controls. Conditioned contextual facilitation was assessed by (i) presenting video clips that varied in their pairing with drug and laboratory context and in inherent incentive value, and (ii) measuring increases from day 1 to Test day on the three processes above. Results showed acquisition of conditioned contextual facilitation across all measures to video clips that had been paired with drug and laboratory context in the Paired high extraverts, but no conditioning in the Paired low extraverts (nor in either of the control groups). Increases in the Paired high extraverts were correlated across the three measures. Also, conditioned facilitation was evident on the first day of extinction in Paired high extraverts, despite the absence of the unconditioned effects of MP. By the last day of extinction, responding returned to day 1 levels. The findings suggest that extraversion is associated with variation in the acquisition of contexts that predict reward. Over time, this variation may lead to differences in the breadth of networks of conditioned contexts. Thus, individual differences in extraversion may be maintained by activation of differentially encoded central representations of incentive contexts that predict reward.

 

Introduction

Extraversion represents a higher-order personality trait that has been identified in virtually all classificatory systems of the structure of personality, including Eysenck and Gray's models (Gray, 1994), the Five-Factor model (Costa and McCrae, 1992), Tellegen's Multidimensional Personality Questionnaire (MPQ) model (Tellegen and Waller, 2008), and Zuckerman's Alternative Five-Factor model (Zuckerman, 2002). The phenomenology of extraversion is described similarly in all of these models, and is characterized by adjectives that connote a state of positive affect and strong motivation of desire and wanting, as well as by feelings of being excited, enthusiastic, active, peppy, strong, confident, and optimistic (Watson and Tellegen, 1985; Berridge, 2004).

Jung (1921) insightfully placed this positive motivational state in a larger context in his description of extraversion. He suggested that extraversion is characterized by broad engagement with the environment which is supported by the positive affective state emphasized by others. Jung's notion suggests that there is a broad class of environmental stimulus that elicits positive affective engagement, and Gray (1994) extended that notion by arguing that the stimulus class is composed of rewards. Thus, extraversion may represent individual differences in the extent to which environmental rewards elicit positive affective engagement as a means of obtaining those rewards.

Due to conceptually similar phenomenological features, we drew an analogy between this positive affective state in humans and incentive motivation as described in the animal literature (Depue and Collins, 1999; Depue and Morrone-Strupinsky, 2005; Depue and Fu, 2012). Incentive represents a motivational system identified in all mammals, and is elicited by the broad stimulus class of unconditioned and conditioned incentive stimuli that induce forward locomotion and strong subjective feelings of reward. This analogy suggested that, if extraversion represents the manifestation of an incentive reward system, then the trait may be in part influenced, as this motivation is in animals, by the activity of the mesocorticolimbic dopamine (DA) projection system. This projection system originates mainly in the ventral tegmental area (VTA) of the midbrain, and sends afferents to several limbic regions, including the nucleus accumbens (NAc) in the ventral striatum and the amygdala, and to many cortical regions, including the orbital cortex (Depue and Collins, 1999; Depue and Morrone-Strupinsky, 2005; Fields et al., 2007).

In rats and monkeys, dose-dependent DA receptor activation in the VTA-NAc pathway mediates the acute rewarding effects of stimulants, and facilitates a broad array of incentive motivated behaviors, including locomotor activity to novelty and food; as well as exploratory, aggressive, affiliative, and sexual behavior (Depue and Collins, 1999; Berridge, 2007). In single-unit recording studies in monkeys, large populations of VTA DA neurons are activated preferentially by appetitive incentive stimuli (Schultz et al., 1995, 1997; Mirenowicz and Schultz, 1996; D'Ardenne et al., 2008; Schroeder et al., 2008), and DA cells, most numerously in the VTA, respond in proportion to the magnitude of both conditioned and unconditioned incentive stimuli (Fields et al., 2007; Schultz, 2007; Bromberg-Martin et al., 2010). Similarly, NAc cells increase firing to primary and conditioned signals of reward and novelty during intervals when reward is expected, and during engagement in rewarding social activity.

In humans, incentive motivation is associated with both positive emotional feelings such as elation and euphoria, and motivational feelings of desire, wanting, craving, potency, and self-efficacy (Depue and Collins, 1999). This is in contrast to positive feelings that accompany reward consummation, which is associated with feelings of gratification, quiescence, liking, and calm pleasure (Depue and Morrone-Strupinsky, 2005; Smillie et al., 2012). DA activity is related to the former, but not the latter, subjective emotions. Thus, neuroimaging studies have found that, during acute cocaine or amphetamine administration, the intensity of a participant's subjective euphoria increased in a dose-dependent manner in proportion to DA-agonist binding to the DA uptake transporter (and hence DA levels) in the ventral striatum (Volkow et al., 1997). Moreover, DA-induced activity in the NAc was linked equally strongly (if not more strongly) to motivational feelings of desire, wanting, and craving, as to the emotional experience of euphoria (Breiter et al., 1997). And the degree of activation by positive or rewarding stimuli or agonist-induced DA release in healthy human ventral striatum and other regions of reward circuitry (e.g., amygdala, medial orbitofrontal cortex, and anterior cingulate cortex) assessed by fMRI and PET were correlated strongly with (i) feelings of euphoria, (ii) extraversion and similar traits of novelty seeking and affective impulsivity, (iii) DA-relevant gene polymorphisms, and (iv) pharmacological indicators of DA functioning (Depue et al., 1994; Depue, 1995; Berke and Hyman, 2000; Drevets, 2001; Canli et al., 2002; Kumari et al., 2004; Knutson and Cooper, 2005; Mobbs et al., 2005; Reuter and Hennig, 2005; Reuter et al., 2006; Deckersbach et al., 2006; D'Ardenne et al., 2008; Zald et al., 2008; Smillie et al., 2009; Bromberg-Martin et al., 2010; Buckholtz et al., 2010; Haber and Knutson, 2010; Baik et al., 2012). Hence, taken together, the animal and human evidence supports the notion that the VTA DA-NAc pathway is a primary neural circuit for incentive reward (Bromberg-Martin et al., 2010; Haber and Knutson, 2010; Sesack and Grace, 2010), and that extraversion is related to activity in that pathway (Wacker et al., 2006, 2012, 2013).

While VTA DA activation is critical for inducing incentive motivation in NAc, VTA DA neuron responses also play a role in facilitating the association between those stimuli that predict reward (i.e., conditioned stimuli) and motivated behavior that obtains reward (Schultz et al., 1997; Montague et al., 2004; Schultz, 2007). With regard to associative learning, mere DA neuron activation without exogenous reward produced a preference for the context paired with phasic DA firing. Concordantly, DA neuron firing was gradually time-locked to the presentation of a conditioned cue that predicted sucrose delivery, and phasic DA release correlated positively with conditioned approach behavior toward the cue (Stuber et al., 2008). This associative process includes the following steps. The optimal stimuli for activating VTA DA neurons are unpredicted unconditioned rewards (e.g., food, sweet liquid). Such biologically salient stimuli are evaluated for their emotional significance in the basolateral amygdala (BLA) and medial orbital frontal cortex (mOFC). If such stimuli have sufficient incentive salience, these and other corticolimbic areas then activate VTA DA neurons (Berke and Hyman, 2000; Myer-Lindenberg et al., 2005; Fields et al., 2007; Kauer and Malenka, 2007; Stuber et al., 2008; Zellner and Ranaldi, 2010), which release DA into the NAc as a means of increasing incentive motivation to obtain the reward. Subsequently, neutral cues in the current context that consistently predict reward are associated with reward (become CSs) in the BLA and mOFC (Elliott et al., 2003; Gottfried et al., 2003; Simmons et al., 2007; D'Ardenne et al., 2008), which in turn activate VTA DA neurons prior to the occurrence of primary reward (Zellner and Ranaldi, 2010). This process is shown in Figure 1 during an experiment's progression: VTA DA neurons show increased activity in the presence of neutral stimuli that consistently predict reward, and a concurrent decrease in activity to the unconditioned reward, until DA responding has transferred completely to the conditioned incentive stimuli (Schultz et al., 1997; Galvan et al., 2005; Day et al., 2007; Schultz, 2007; Stuber et al., 2008). Thus, VTA DA discharge ratchets backward in time so as to respond to earlier and earlier predictors of reward. Therefore, DA activity is critical to the control of appetitive behavior by conditioned incentive stimuli—specifically, to link stimuli predicting reward, which activate VTA neurons, to the response-facilitation mechanism in the NAc (Schultz et al., 1997; Depue and Collins, 1999; Nestler, 2001; Depue and Morrone-Strupinsky, 2005; Berridge, 2007; Stuber et al., 2008; Zellner and Ranaldi, 2010).

FIGURE 1
www.frontiersin.orgFigure 1. Relative ventral tegmental area (VTA) dopamine (DA) firing as a function of trial. VTA DA neurons show increased activity in the presence of neutral stimuli that consistently predict reward, and a concurrent decrease in activity to the unconditioned rewards, until DA responding has transferred completely to the conditioned incentive stimuli (Trials 1–5).

The acquisition of a reward-predictive neural structure is enhanced when VTA DA activation results in release of DA in the NAc. DA release in the NAc plays a critical role in the formation of complex contextual ensembles that predict the occurrence of reward in a much more detailed manner than do single CS incentives (Depue and Morrone-Strupinsky, 2005; Depue and Fu, 2012). The array of stimuli that comprise the full context that precedes the occurrence of primary reward converge on the NAc (O'Donnell, 1999). These corticolimbic inputs originate from many perceptual processing pathways, but importantly also from those areas that compute the incentive salience of contextual stimuli, including the BLA, mOFC, and extended amygdala (e.g., bed nucleus of the stria terminalis) (Groenewegen et al., 1999a,b; O'Donnell, 1999; Berke and Hyman, 2000; Depue and Morrone-Strupinsky, 2005). The end product of this compression is a contextual ensemble that is encoded for incentive salience or value. That ensemble is further compressed in a cortico-cortical loop, which terminates in the mOFC where the ensemble is associated with an expected outcome (i.e., probability and magnitude of reward; Alexander et al., 1990; O'Donnell, 1999; Amodio and Frith, 2006). It is not surprising then that it is the mOFC that provides the major source of activation of VTA DA neurons when predictive contexts of reward occur (Taber et al., 1995; Carr and Sesack, 2000; Zellner and Ranaldi, 2010). The magnitude of the encoded incentive salience of the mOFC contextual ensemble is thus translated into the magnitude of mOFC-VTA DA activation and, in turn, NAc DA-facilitated incentive motivation.

The acquisition of contextual ensembles is strongly dependent on DA in the NAc. Corticolimbic regions carrying contextual information innervate NAc neurons in close proximity to VTA DA projections to the NAc (O'Donnell, 1999; Depue and Morrone-Strupinsky, 2005; Sesack and Grace, 2010). It is here that DA facilitates the development of long-term potentiated connections of corticolimbic afferents to NAc neurons (Nestler, 2001; Goto and Grace, 2005; Kauer and Malenka, 2007; Shen et al., 2008; Stuber et al., 2008). Presumably, the more DA that is released in the NAc, (a) the greater the strengthening of the connection of contextual afferents on NAc neurons, and (b) the greater the number of afferents thus facilitated. Hence, variation in DA input to the NAc will modulate the strength of the contextual ensemble, and hence the capacity of that ensemble to subsequently elicit incentive motivation, positive affect, and approach behavior (i.e., extraverted behavior).

The importance of this model is that individual differences in VTA DA-NAc reactivity to reward, as found in extraversion, could modify the associative conditioning of unconditioned rewards to neutral contextual cues, and thereby create differences in the strength and breadth of individuals' networks of reward-relevant contexts. Exactly this prediction has been confirmed in animal studies, where a significant correlation between DA functioning and contextual conditioning was demonstrated (Hooks et al., 1992; Cabib, 1993; Jodogne et al., 1994; Wassum et al., 2011). The implication of these findings is that variation in the strength and breadth of reward-predictive contextual networks could play a critical role in the maintenance of individual differences in extraverted behavior over time.

Expanding a small preliminary study on conditioning and extraversion, we more fully investigated these possibilities by studying the acquisition and extinction over seven consecutive days of conditioned contextual facilitation of DA-modulated motor, affective, and cognitive processes in a DA agonist (methylphenidate)-paired context in high and low subgroups of extraverts. We predicted and found that high extraverts who had context paired with methylphenidate showed significantly greater conditioned contextual facilitation across all three processes relative to low extraverts. Indeed, low extraverts showed little, if any, conditioning under these experimental conditions. Moreover, conditioning was verified not only on a conditioning Test day, but also by demonstrating (a) robust conditioned responses on the first day of extinction under placebo in the absence of unconditioned drug effects, and (b) the decay of conditioned responding over a three-day extinction period.

Materials and Methods

Design

A study design with three consecutive phases was used (Figure 2): (i) Association (days 1–3), in which MP or placebo (lactose) is associated with laboratory context for three days. MP and placebo were administered in identical capsules double-blind to drug and extraversion score. On the basis of preliminary studies, three Association days were used; even one day with low doses of DA agonist is adequate in rats to demonstrate acquisition of contextual association to incentive processes (Anagnostaras and Robinson, 1996; Robinson and Berridge, 2000); (ii) Test (day 4), in which degree of contextual facilitation of responding is assessed under MP conditions; and (iii) Extinction (days 5–7), three days of placebo, where the first extinction day (day 5) assessed the presence of conditioned context-facilitated responding in the absence of unconditioned drug effects, which provides direct evidence of a motivational effect of conditioned cues (Anagnostaras and Robinson, 1996; Everitt et al., 2001).

FIGURE 2
www.frontiersin.orgFigure 2. Study design and experimental conditions. See text for details. M, methylphenidate; P, placebo.

Three experimental conditions, each with high and low subgroups of extraverts (i.e., six groups total), paired MP exposure with laboratory context (Paired) or did not (Unpaired and Placebo). On each Association day, all three experimental conditions received MP or placebo in each of two contextually distinct laboratories (Lab A, followed by Lab B—in which participants read emotionally neutral magazines supplied by the experimenter, as they also did in Lab A when not involved in tasks). This procedure equated Paired and Unpaired conditions for MP exposure but within different laboratory contexts (see Figure 2) (Anagnostaras and Robinson, 1996). Following previous research (Anagnostaras and Robinson, 1996; Robinson and Berridge, 2000), the context of Labs A and B differed in physical dimensions, flooring, wall colors and decorations, lighting, furniture, and experimenters. Because psychostimulants, including MP, strongly amplify conditioned-cue activation of behavior via DA release in the NAc (Parkinson et al., 1999; Robinson and Berridge, 2000; Everitt et al., 2001), all conditions received MP on Test day. MP was administered on Test day, because expression of conditioned drug effects are context-dependent. Therefore, despite receiving MP, the control groups above should not express facilitation of responding as should the group that has acquired conditioned facilitation. This allowed an assessment on Test day of the extent to which contextual cues had acquired incentive properties in the Paired condition relative to unconditioned effects of MP in Unpaired and Placebo groups.

Participants

The MPQ (Tellegen and Waller, 2008) extraversion scale was used. It correlates with EPQ extraversion (0.62, P < 0.01), incorporates content of the extraversion scales measured by the NEO-PI (Costa and McCrae, 1992; Church, 1994), is influenced by strong genetic variation (Tellegen et al., 1988), and its positive affect or emotionality interpretation is supported by convergent-discriminant relations to the state dimension of positive affect (Zevon and Tellegen, 1982; Watson and Tellegen, 1985; Tellegen and Waller, 2008). MPQ extraversion scores were obtained from 92% (N = 2997) of Cornell freshmen, which has an MPQ profile equivalent to other university samples and to the general population within the age range of 19–24 years (Tellegen and Waller, 2008). High and low extraversion subgroups were randomly selected from the top and bottom deciles, respectively, of MPQ extraversion scores, and then were randomly assigned to the three experimental conditions. Selected participants were medically and psychiatrically normal and taking no medications, as verified blind to MPQ score by (i) medical interview and physical exam by a physician, and (ii) psychiatric interview using the latest version of the SCID (non-patient version), DSM-IV criteria, and the Personality Disorders Examination (Loranger, 1994) for Axis II disorders. We excluded participants with (a) cardiovascular, immune, or endocrine disorders or who were taking medications for these or other conditions that might interact with MP; (b) Axis I and II disorders because such conditions may affect DA functioning in unpredictable ways; (c) substance abuse or dependence; and (d) a recent (within last two years) smoking history, since nicotine may interact with DA. We have found that frequency of smokers does not differ above or below the MPQ extraversion median. To detect illicit drug use, participants received a confidential drug screen the day prior to each study day. No illicit drug use was detected.

Of the 74 initially selected male participants, 70 (95%) participated. As is expected due to strict decile selection criteria, MPQ extraversion scores did not differ significantly between comparisons of all low subgroup combinations (all P's <0.70) nor between comparisons of all high subgroup combinations (all P's < 0.70) across experimental conditions (Table 1). The 70 participants were also selected on the basis of their falling within the middle six deciles on MPQ Negative Emotionality (Neuroticism) and Constraint (impulsivity scale). Therefore, high and low extraversion participants were equivalent (not significantly different) on these other MPQ traits. Males (Caucasian; age: 19–21 years; weight: 62–88 kg) rather than females were used because DA efficacy markedly varies across the menstrual cycle (Depue et al., 1994). The number in each of the six experimental groups is: Paired High Extraversion: (PH = 15); Paired Low Extraversion: (PL = 15); Unpaired High Extraversion: (UPH = 10); Unpaired Low Extraversion: (UPL = 10); Placebo High Extraversion: (PBH = 10); Placebo Low Extraversion: (PBL = 10). Because the critical comparison in this study is between paired high vs. paired low extraversion, the N for those two groups is higher than for the other groups. Written informed consent was obtained from all participants in a protocol approved by Cornell University's institutional review board.

TABLE 1
www.frontiersin.orgTable 1. MPQ Extraversion scores for low and high extraversion subgroups in each condition.

Methylphenidate (MP)

MP was used because (a) MP exerts its DA-agonist effects by increasing release of DA from presynaptic terminals, thereby activating an array of DA receptor subtypes; (b) MP binds with similar or greater magnitude to the same DA-uptake transporter as cocaine and amphetamine at presynaptic sites in cortex and striatum, especially the NAc; (c) regional distribution of MP binding in human brain is almost identical to cocaine; and (d) MP strongly induces NAc-facilitated incentive motivated behaviors, including (i) rewarding properties in conditioned place preference, (ii) self-administration in primates, and (iii) positive affect, energy, and euphoria in humans at doses of 0.5 mg/kg or less that correlates with its % DA-uptake binding in ventral striatum (Volkow et al., 1995, 1997, 1998, 2001).

MP was also used because of its specificity of action to DA at doses used here. In individual limbic and coritical brain regions, there are varying mixtures of D1, D2, D3, D4, and D5 receptors (Strange, 1993). The control of motor, emotion, and motivation processes by DA in these brain regions will, therefore, be dependent on DA interacting with various combinations of receptor isoforms. With respect to behavioral effects of D1 and D2 and D1/D2 mixed agonists and antagonists in interaction with MP, MP has its behavioral effects via both D1 and D2 receptors in a dose-dependent manner (Koek and Colpaert, 1993; Strange, 1993). Importantly, compounds not directly involving DA receptors, and compounds with antagonist properties at CNS receptors other than DA (including alpha 1 and 2 and beta noradrenergic, and 5HT 2 and 1A receptor antagonists), either did not interact with MP behavioral effects, or did so only at such high doses that extreme behavioral adverse effects occurred (Koek and Colpaert, 1993). Moreover, affinitiy for the 5HT transporter is not only much lower for MP than amphetamine and cocaine, but also affinity for this transporter is not associated with the reinforcing properties of MP (Ritz et al., 1987; Little et al., 1993). Thus, at the relatively low dose used in the current study, MP's major effects appear to be on both D1 and D2 (and perhaps other DA) receptor families. Since DA facilitation of incentive motivation, positive affect, and initiation of locomotion appears to involve at least both D1 and D2 receptors (Depue and Collins, 1999), MP is a better agonist to study extraversion processes than bromocriptine or bupropion (Vassout et al., 1993), which both have mainly D2 receptor effects. MP also appears to have a more specific DA transporter binding affinity, relative to noradrenergic and serotonergic affinities (Weiner, 1972), than amphetamine and to some extent cocaine.

Percent binding of MP to the DA-uptake transporter provides one means of judging the “saturation” effects of an MP dose, and is correlated significantly with induced positive affect in humans (Volkow et al., 1997). We used an oral MP dose of 0.6 mg/kg based on the fact that at this dose (a) % DA transporter binding is ~80% or more (Volkow et al., 1998, 2001); (b) a sufficiently long, stable peak plateau (~90 min) is associated with the positive affect effects of MP (Volkow et al., 1997, 1998), permitting sufficient time for our task administration (~1 h) at peak MP concentrations; (c) no significant negative affect is observed; and (d) clearance is ~10 h, indicating wash-out by the next day (Volkow et al., 2001). In addition, in humans, retest stability for the binding and time-course characteristics of MP (0.5 mg/kg) is very high (Volkow et al., 1995). Finally, in humans, MP has a very low adverse effect profile when orally administered acutely in low dose (0.5 mg/kg or less) (Aoyama, 1994; Wang et al., 1994; Volkow et al., 1995).

Experimental Stimuli

The extent to which MP-induced reward is associated with context in the Paired condition is reflected in facilitation of responding elicited by general contextual features of Lab A. General context-reward association, like conditioned place preference, is an implicit Pavlovian process that is acquired more readily and with greater resistance to extinction than is the pairing of explicit, discrete stimuli with reward (Holland, 1992; Graybiel, 1998). The number of conditioning sessions required for general context vs discrete stimuli in animals is ~1:20 session ratio, respectively. To assess the success of associative conditioning of Lab A to MP, we used five 20-s video clips that differed in their (i) association with laboratory context, (ii) MP drug effects, and (iii) inherent incentive value. The five video clips were presented in Lab A via VCR in randomized order, each separated by a 1-min rest interval, on a 56-inch TV monitor located 12 feet in front of participants.

The content of three of the video clips, shown on Association day 1 and Test day 4, were initially incentive-neutral, but differed in their representation of the Lab A context and in their association with MP drug reward: (i) Library: a moving pan across the front of Cornell's main library, which has no association with Lab A or drug reward; (ii) Labfront: a moving video pan across the front of Lab A, which participants continually faced during the study because they were seated facing the front of the lab; and (iii) Portrait: a large poster of a female portrait in the front of Lab A. The latter two stimuli vary in two other ways: Labfront (i) represents an implicit general contextual stimulus, which is rapidly and strongly conditioned in animals, and (ii) such general contextual stimuli are likely processed in the dorsal visual stream (i.e., via peripheral vision). In contrast, Portrait (i) represents an explicit, discrete stimulus object that is conditioned more slowly in animals and (ii) such discrete stimuli are likely processed in the ventral visual stream (i.e., as object recognition). Differential facilitated responding on Test day 4 is a direct test of an acquired incentive salience for Labfront and Portrait compared to Library.

Two additional previously validated video clips (Morrone et al., 2000; Morrone-Strupinsky and Depue, 2004), also shown on Association day 1 and Test day 4, had no association with drug reward or the general context of Lab A (outside of the 5-minute exposure on day 1). The two clips, however, differed in inherent incentive value and appetitive approach motivation, to which extraverts respond vigorously, but not in calm pleasurable feelings, to which extraverts do not respond vigorously (Morrone et al., 2000; Morrone-Strupinsky and Depue, 2004; Smillie et al., 2012): (iv) Rainforest (low incentive): neutral rainforest scenes, and (v) Football (high incentive and approach motivation, rather than a calm pleasurable emotional state: a triumphant football game sequence (scoring of a touchdown). The rationale for comparing these two clips is to assess whether the Lab A context had acquired facilitatory effects on unfamiliar stimuli that had not been paired with Lab A or with MP. The incentive response elicited by any stimulus is a joint function of both the conditioned incentive value of the context and of the inherent incentive value of the unfamiliar stimulus (Jodogne et al., 1994; Schultz et al., 1997; Robinson and Berridge, 2000). Stimuli with little inherent incentive value, like Rainforest, will not be facilitated substantially by a conditioned context. While the incentive response to the Football clip relative to the Rainforest clip is expected to naturally differ on day 1, whether that incentive response will evidence an enhancement on day 4 relative to day 1 depends on the success of the conditioning procedure in interaction with the natural incentive value of the unfamiliar stimulus. Therefore, if there is an enhanced incentive response to Football on day 4 relative to day 1, but no enhancement for Rainforest, then one may conclude that the enhanced response to Football on day 4 was dependent on contextual conditioning (Robinson and Berridge, 2000).

Preliminary research showed that Library, Rainforest, Labfront, and Portrait were initially rated on both the 10-point positive and negative affect scales used in this study (see below) as neutral in affective state [N = 50 college males; Positve Affect Means (SDs) = 1.1 (0.05), 1.01 (0.03), 1.08 (0.04), 2.03 (0.07), respectively, where a rating of 1 or 2 = neutral affect state]. Football was rated 4.1 (1.2), where 4 = mild positive affect state. Mean negative affect ratings were generally around 1, and did not exceed 2.2 (neutral affect state).

Measures

Three variables, measured only in Lab A, indexed conditioned context facilitation on motor, affective, and working memory processes. All three variables are strongly dependent on VTA DA projections to the NAc or dorsolateral prefrontal cortex (working memory variable). The three variables were assessed only on Association day 1 and on Test day 4 to avoid excessive task repetition, with affective and motor variables being measured (in that order) after each of the video clips. Working memory was measured only once on these two days, immediately after the video clip presentations. During the Extinction phase, only motor and affective responses to video clips were measured—on the first (day 5) and final (day 7) days of extinction. The cognitive task was not assessed in Extinction, because it is subject to repetition effects (Luciana et al., 1992).

Motor velocity

Velocity of motor behavior is (i) specifically related to incentive processes facilitated by DA predominantly in the NAc (Le Moal and Simon, 1991; Depue and Collins, 1999), (ii) activated by drug-associated conditioned cues (Hyman and Malenka, 2001), and (iii) correlates (r = 0.68, P < 0.01) with % DA-uptake binding in human NAc (Volkow et al., 1998). Therefore, velocity of finger tapping was measured as in Volkow et al. (1998). Finger tapping was performed on a laptop computer space bar for 6 s using the dominant hand with palm resting on the laptop base so that taps were performed solely by finger-wrist movement. To control for variation in reaction time (RT), which affects number of taps in the first second, only the last 5 s of tapping were analyzed. Preliminary studies using 20 s of tapping showed that differences between individuals are most marked in the initial 5-s period of tapping (after 1 s correction for RTs).

Positive affect

Positive affect, which reflects a state of positive incentive motivation (Zevon and Tellegen, 1982; Watson and Tellegen, 1985; Watson and Clark, 1997; Depue and Collins, 1999; Tellegen and Waller, 2008), was assessed by a rating scale similar to a previously validated scale described in detail elsewhere (Morrone et al., 2000; Morrone-Strupinsky and Depue, 2004). This and similar scales have excellent internal consistencies, retest reliabilities, and factor homogeneity (Watson and Tellegen, 1985; Watson et al., 1988; Krauss et al., 1992). They are also correlated with (i) % DA-uptake binding specifically in human ventral striatum (Volkow et al., 1997), (ii) DA-agonist challenge and responses to the video material used here (r = 0.57, P < 0.01) (Depue et al., 1994; Volkow et al., 1997; Morrone et al., 2000; Morrone-Strupinsky and Depue, 2004), and (iii) extraversion (r = 0.49, P < 0.01) (Morrone et al., 2000). Intraclass correlation between MP-induced peak affect ratings obtained 2–3 months apart is 0.58 (P < 0.05; N = 20, ranging from top to bottom decile on MPQ extraversion). Negative affect state was also rated at the same times as positive affect, but the former showed little (non-significant) variation from 1 to 2 (neutral mood state), and no significant activation by MP. Therefore, negative ratings are not discussed further.

The positive and negative affect rating scales are visual analog scales ranging from 1 (neutral affect state) to 10. Point 10 was anchored by adjectives found to be most highly correlated with positive and negative affect states (Watson and Tellegen, 1985). The positive adjective anchors were: active, elated, enthusiastic, excited, peppy, strong (where all adjectives were listed under point 10 on the scale). Participants were instructed to rate their emotional response on the scale to each clip.

The positive affect rating scale was displayed on a laptop monitor, and ratings were made directly on computer. For the affect and motor measures, the stimulus–response sequence was: (a) audiovisual prompt on the monitor, preparing the participant for the video clip, (b) video clip, (c) positive affect rating (~3 s), (d) 6 s of tapping, the timing of which started with the first tap and ended with an audio stop-beep produced by the laptop, and (e) 1-min rest interval between video clips. Participants were trained prior to the study on the laptop, tapping procedure, and rating scales.

Visuospatial working memory task

This measure reflected conditioned incentive effects derived from the general laboratory context of Lab A. The task, validated and described previously (Luciana et al., 1992, 1998; Luciana and Collins, 1997), is dependent in primates and humans on VTA DA projections to dorsolateral prefrontal cortex, and is facilitated by MP (Oades and Halliday, 1987; Luciana et al., 1992, 1998; Luciana and Collins, 1997; Devilbiss and Berridge, 2008; McNab et al., 2009; Aart et al., 2011). Briefly, during each trial, participants observed a central fixation point (a black “+”) on a computer monitor for 3 s. Next, a visual cue (a blackened circle against a white background) appeared in peripheral vision within a 360° Circumference for 200 ms (too brief to make a saccadic eye movement), after which the cue and fixation point disappeared and the screen blackened for delay intervals of 0.5 s, 4.0 s, or 8.0 s. After the delay, participants indicated the screen location of the cue with a light pen (FTG Data Systems, Inc.). Twenty-four trials (8 for each delay), with a 2-s inter-trial interval, were completed, with delay intervals randomly interspersed and cue locations randomized over trials. Visual cues were presented randomly at two different locations in each of four quadrants (8 trials) for each delay. Working memory accuracy was computer assessed by use of the hypotenuse of a triangle formed by the actual target location and the vertical and horizontal deviations from the actual target indicated by the participant by use of the light pen. RT was also recorded by computer.

As described previously (Luciana et al., 1992, 1998; Luciana and Collins, 1997), MP drug effects on attentional, arousal, perceptual, and sensorimotor processes involved in a targeted visual search (but not specifically in working memory tasks) were assessed on day 4 by use of (a) a non-mnemonic spatial location task of 16 stimulus trials with no response delay, where accuracy and latency to respond were computer recorded; and (b) a bi-letter cancellation task, where number of omission and commission errors (unmarked target letters and incorrectly marked non-target letters, respectively) were tabulated. Order of these tasks was: non-mnemonic spatial location, working memory task, bi-letter cancellation task. These tasks were given on day 1 and day 4 immediately after all the video clips had been viewed and responded to for affective and motor variables.

Procedure

Participants were habituated to Labs A and B during two pre-study visits to the labs. Participants completed the 2½ h protocol sometime between noon and 6 p.m. for seven consecutive days. MP and placebo were administered with water in Lab A upon arrival, and tasks and measures occurred over a 1-h period beginning 1 h post-drug ingestion. Participants fasted from midnight prior to each study day, and were on a low monoamine diet for three days prior to and during the study.

Results

As recommended by others (Anagnostaras and Robinson, 1996; Volkow et al., 1997, 1998; Robinson and Berridge, 2000), magnitude of conditioning was assessed as % change from Association day 1 to Test day 4 on the three dependent variables: motor velocity (finger tapping), positive affect ratings, and visuospatial working memory accuracy. Within the Placebo (PB) and Unpaired (UP) conditions, the high and low extrovert subgroups showed no significant difference on Association day 1 or in % change from day 1 to Test day 4 for any of the five video clips (alpha adjusted for number of analyses, P < 0.005). Thus, a 4 (subgroups: PBL, PBH, UPL, UPH) × 5 (video clips) ANOVA with repeated measures on the second factor revealed no significant main effects for subgroups [F(3, 144) = 1.45, P = 0.36] or video clips [F(4, 144) = 1.32, P = 0.39] on motor velocity on day 1. A 4 (subgroups) × 5 (video clips) ANOVA with repeated measures on the second factor revealed no significant main effects for subgroups [F(3, 144) = 1.61, P = 0.48] or video clips [F(4, 144) = 1.13, P = 0.59] on positive affect ratings on day 1. Finally, a 4 (subgroups) × 3 (working memory delay intervals) ANOVA with repeated measures on the second factor revealed no significant main effects for subgroups [F(3, 72) = 1.39, P = 0.38] or delay intervals [F(2, 72) = 1.47, P = 0.46] on day 1 for working memory.

A 4 (subgroups) × 5 (video clips) ANOVA with repeated measures on the second factor revealed no significant main effects for subgroups [F(3, 144) = 1.34, P = 0.42] or video clips [F(4, 144) = 1.44, P = 0.51] on % change from Association day 1 to Test day 4 for motor velocity. In addition, a 4 (subgroups) × 5 (video clips) ANOVA with repeated measures on the second factor revealed no significant main effects for subgroups [F(3, 144) = 1.21, P = 0.54] or video clips [F(4, 144) = 1.68, P = 0.33] on % change from Association day 1 to Test day 4 for positive affect ratings. Finally, a 4 (subgroups) × 3 (working memory delay intervals) ANOVA with repeated measures on the second factor revealed no significant main effects for subgroups [F(3, 72) = 1.42, P = 0.35] or delay intervals [F(2, 72) = 1.39, P = 0.42] on % change from Association day 1 to Test day 4 for working memory.

Thus, none of the four extraversion subgroups comprising PB and UP experimental conditions showed evidence on motor velocity, positive affect, or working memory of conditioning (i.e., no significant % change from day 1 to day 4 on any measure), nor did they differ significantly from each other on day 1. Therefore, these low and high extraversion subgroups were combined, leaving the larger PB and UP groups (now each with an N of 20). The low and high subgroups in the paired condition represent the strong test of differential conditioning, so they were of course not combined.

Group Comparisons of Motor Velocity and Positive Affect Ratings

Alpha adjusted for the number of analyses for the following analyses is P < 0.008. A 4 (groups: PB, UP, PL, PH) × 5 (video clips) ANOVA with repeated measures on the second factor revealed no significant main effects for groups [F(3, 272) = 1.48, P = 0.44] nor for video clips [F(4, 272) = 1.51, P = 0.51] on day 1 for motor velocity. A 4 (groups: PB, UP, PL, PH) × 5 (video clips) ANOVA with repeated measures on the second factor revealed significant main effects for groups [F(3, 272) = 19.26, P < 0.001; partial eta squared = 0.10] and for video clips [F(4, 272) = 15.59, P < 0.001; partial eta squared = 0.11] on % change from Association day 1 to Test day 4 for motor velocity. The Groups × Video Clips interaction was also significant [F(12, 272) = 10.43, P < 0.001; partial eta squared = 0.14]. Tukey post-hoc comparisons revealed that PH significantly exceeded all of the other three groups in % change for motor velocity on Labfront, Portrait, and Football video clips (all P's < 0.003), but not on Library and Rainforest (all P's > 0.30) (Table 2; Figures 3A–E). In addition, none of the other three groups (PB, UP, PL) differed significantly from each other for motor velocity on any of video clips for motor velocity (all P's > 0.30). Indeed, PB, UP, and PL groups generally showed a decrease in % change in motor velocity.

TABLE 2
www.frontiersin.orgTable 2. Means (SDs) of motor velocity for association and extinction phases.
FIGURE 3
www.frontiersin.orgFigure 3. Conditioned contextual facilitation of motor velocity during the Association phase for four experimental groups. Shown is the degree of contextual facilitation (% change from Association day 1 to Test day 4) of motor velocity (finger tapping) induced by 5 video clips [Library (A), Rainforest (B), Labfront (C), Portrait (D), Football (E)] in the Association phase. Zero % change indicates no change from day 1 to day 4. PB, placebo; UP, unpaired; PL, paired low extraverts; PH, paired high extraverts.

A 4 (groups: PB, UP, PL, PH) × 5 (video clips) ANOVA with repeated measures on the second factor revealed no significant main effects for groups [F(3, 272) = 1.433, P = 0.49] nor for video clips [F(4, 272) = 1.46, P = 0.45] on day 1 for positive affect ratings. A 4 (groups: PB, UP, PL, PH) × 5 (video clips) ANOVA with repeated measures on the second factor revealed significant main effects for groups [F(3, 272) = 21.37, P < 0.001; partial eta squared = 0.17] and for video clips [F(4, 272) = 16.92, P < 0.001; partial eta squared = 0.15] on % change from Association day 1 to Test day 4 for positive affect ratings. The Groups × Video Clips interaction was also significant [F(12, 272) = 10.28, P < 0.001; partial eta squared = 0.23]. Tukey post-hoc comparisons revealed that PH significantly exceeded all of the other three groups in % change for positive affect on Labfront, Portrait, and Football video clips (all P's < 0.003), but not on Library and Rainforest (all P's > 0.30) (Table 3; Figures 4A–E). In addition, none of the other three groups (PB, UP, PL) differed significantly from each other on any of video clips for positive affect (all P's > 0.30). Indeed, PB, UP, and PL groups generally showed a decrease in % change in positive affect.

TABLE 3
www.frontiersin.orgTable 3. Means (SDs) of positive affect ratings for association and extinction phases.
FIGURE 4
www.frontiersin.orgFigure 4. Conditioned contextual facilitation of positive affect during the Association phase for four experimental groups. Shown is the degree of contextual facilitation (% change from Association day 1 to Test day 4) of positive affect ratings induced by 5 video clips [Library (A), Rainforest (B), Labfront (C), Portrait (D), Football (E)] in the Association phase. Zero % change indicates no change from day 1 to day 4. PB, placebo; UP, unpaired; PL, paired low extraverts; PH, paired high extraverts.

Thus, only PH showed a significant increase in % change from Association day 1 to Test day 4 in both motor velocity and positive affect to the three video clips that were either paired with MP and Lab A context (Labfront, Portrait) or had high inherent incentive value (Football). PH did not evidence increases in % change for video clips that were not paired with MP or Lab A context (Library) or that had low inherent incentive value (Rainforest). The % change increase in motor velocity by PH was substantial, ranging from increases of 19–28%, being greatest for Football. The % change increase in positive affect ratings by PH was particularly substantial, ranging from increases of 105–126%, being greatest for Portrait [note that although the female Portrait may have been more rewarding to the male participants, this analysis was on the change from day 1 to day 4, and hence represents a conditioning effect only]. For PH, within-subject increases in % change in motor x affect variables correlated (Pearson product-moment) significantly for Labfront (r = 0.49, P < 0.05), Portrait (r = 0.52, P < 0.05), and Football (r = 0.50, P < 0.05), indicating a joint conditioned contextual facilitation across two different DA-modulated response systems within participants.

Group Comparisons of Visuospatial Working Memory

Alpha was adjusted to number of analyses at P < 0.03. A 4 (groups: PB, UP, PL, PH) × 3 (delay intervals) ANOVA with repeated measures on the second factor revealed no significant main effects for groups [F(3, 136) = 1.53, P < 0.39] nor for delay intervals [F(2, 136) = 1.49, P < 0.34] on day 1 for visuospatial working memory accuracy. A 4 (groups: PB, UP, PL, PH) × 3 (delay intervals) ANOVA with repeated measures on the second factor revealed significant main effects for groups [F(3, 136) = 18.45, P < 0.001; partial eta squared = 0.18] and for delay intervals [F(2, 136) = 21.72, P < 0.001; partial eta squared = 0.23] on % change from Association day 1 to Test day 4 for visuospatial working memory accuracy. The Groups × Delay interaction was also significant [F(6, 136) = 13.13, P < 0.001; partial eta squared = 0.31] (Table 4; Figure 5). Tukey post-hoc comparisons revealed that the four groups did not differ in % change from day 1 to day 4 in working memory accuracy for the delay interval of 0.5 s (all P's>0.30). However, PH significantly exceeded all of the other three groups in % change for working memory accuracy at delay intervals of 4.0 s and 8.0 s (all P's<0.003). None of the other three groups (PB, UP, PL) differed significantly from each other at any of the delay intervals (all P's >0.30). Indeed, PB, UP, and PL groups showed decreases in % change in working memory accuracy at all delay intervals. Finally, PH showed a significant increase in % change from delay interval 0.5 s to 4.0 s (P < 0.003), as well as a significant increase in % change from delay interval 4.0 s to 8.0 s (P < 0.003) (see Table 4 and Figure 5). The % change increases for PH were substantial, ranging from +29% at delay 4.0 s to +47% at delay 8.0 s, which is in accord with the demands on DA functioning in dorsolateral prefrontal cortex during increasingly long working memory delay periods (Luciana et al., 1992, 1998; Luciana and Collins, 1997).

TABLE 4
www.frontiersin.orgTable 4. Means (SDs) for % change in visuospatial working memory in the association phase.
FIGURE 5
www.frontiersin.orgFigure 5. Conditioned contextual facilitation of visuospatial working memory during the Association phase for four experimental groups. Shown is the degree of contextual facilitation (% change from Association day 1 to Test day 4) of visuospatial working memory induced by the general context of Lab A in the Association phase. PB, placebo; UP, unpaired; PL, paired low extraverts; PH, paired high extraverts.

For PH participants, the % change increase at 8.0 s delay correlated significantly with the % change increase in motor velocity (r = 0.49, P < 0.05) and positive affect (r = 0.57, P < 0.05) to the Football video clip, again indicating a joint conditioned contextual within-subject facilitation across three different DA-modulated response systems within participants. [Affective responses to the Football clip were used here to correlate with the other dependent variables, because it had the strongest affective induction of positive affect].

Finally, MP drug effects on attentional, arousal, perceptual, and sensorimotor processes involved in a targeted visual search (but not specifically in working memory) were assessed by use of a non-mnemonic spatial location task of 16 stimulus trials with no response delay (0.0 s) on day 4, where accuracy was computer recorded. Adjusted alpha was P < 0.007. There was no significant main effect for One-Way ANOVA's comparing accuracy [F(3, 64) = 1.23, P = 0.45] or RT [F(3, 64) = 1.51, P = 0.48] of the four groups at a delay of 0.0 s. In addition, a bi-letter cancellation task was also used to assess MP drug effects on attentional, arousal, perceptual, and sensorimotor processes on day 4, where number of omission + commission errors (unmarked target letters + incorrectly marked non-target letters, respectively) were tabulated. There were no significant main effects for the four groups in a One-Way ANOVA in bi-letter accuracy scores [F(3, 64) = 1.43, P = 0.42]. Taken together, these findings indicate that MP effects on attentional, arousal, perceptual, and sensorimotor processes do not account for group differences in the working memory results.

Motor Velocity and Positive Affect in the Extinction Phase

Extinction-phase data represent % change in motor velocity and positive affect from day 1 to each of days 4, 5, and 7 (% change in days 1 to 4 is used as the conditioning baseline for assessing extinction effects). Because only PH demonstrated significant conditioning (all other groups showed a level line across days 4–7; Tables 2, 3), only the PH Extinction data are analyzed for the three video clips that evidenced conditioning: Labfront, Portrait, and Football (Table 4; Figures 6A,B). Alpha was adjusted for number of analyses at P < 0.13. A 3 (video clips) × 3 (days 4, 5, 7) ANOVA with repeated measures on both factors revealed a significant main effect for days [F(2, 84) = 14.37, P < 0.001; partial eta squared = 0.15], but no significant main effect for video clips [F(2, 84) = 1.92, P = 0.43], on % change in motor velocity (Figure 6A) from Association day 1 to day 4, 5, and 7. Tukey post-hoc tests showed that % change on Test day 4 vs. first extinction day 5 was not significant for any of the three video clips (all P's > 0.30), indicating that conditioned contextual facilitation occurred on day 5 in the absence of unconditioned MP drug effects. Comparison of % change on day 5 vs. day 7 showed that day 5 significantly exceeded day 7 for all three video clips (all P's < 0.003). As seen in Figure 6A, by day 7 motor responding was at or near the level of day 1 (indicated by the 0% change dashed line) on all three video clips.

FIGURE 6
www.frontiersin.orgFigure 6. Extinction (placebo during days 5, 6, and 7) of conditioned contextual facilitation of motor velocity (A) and positive affect (B) to successfully conditioned video clips (Labfront, Portrait, and Football) in PH participants (who were the only participants to condition). Degree of extinction of conditioned contextual facilitation is indexed as % change (change from day 1) in responding on Test day 4, day 5, and day 7. Responding on day 5 is a strong index of conditioning in that facilitated responding (degree of similarity to facilitated responding on Test day 4) occurs only to context, because the unconditioned effects of methylphenidate are absent. PH, paired high extraverts.

A 3 (video clips) × 3 (days 4, 5, 7) ANOVA with repeated measures on both factors revealed a significant main effect for days [F(2, 84) = 19.42, P < 0.001; partial eta squared = 0.28], but no significant main effect for video clips [F(2, 84) = 1.62, P = 0.38], on % change in positive affect (Figure 6B) from Association day 1 to day 4, 5, and 7. Tukey post-hoc tests showed that % change on day 4 vs. day 5 was not significant for any of the three video clips (all P's > 0.30), indicating that conditioned contextual facilitation occurred on day 5 in the absence of unconditioned MP drug effects. Comparison of % change on day 5 vs. day 7 showed that day 5 significantly exceeded day 7 for all three video clips (all P's < 0.003). As seen in Figure 6B, by day 7 positive affect ratings were at or below the level of day 1 (indicated by the 0 % change dashed line) on all three video clips.

Discussion

The current findings suggest that extraversion is positively related to brain processes that associate contexts with reward. The robustness of this conclusion is indicated by five findings:

(a) There was a significant acquired contextual facilitation of responding in PH but little-to-none in PL across Association day 1 to Test day 4 in motor velocity, positive affect, and working memory. In fact, PL generally showed decreased levels of responding from day 1 to day 4 on all measures. In contrast, enhanced responding by PH on Test day 4 relative to Association day 1 was substantial, ranging across variables from increases of 19–21% for motor velocity, 105–126% for positive affect, and 29 and 47% for working memory in delays of 4.0 s and 8.0 s, respectively. No such facilitation was found in PH with stimuli that had not been associated with MP (i.e., Library and Rainforest) or had no inherent incentive value (Rainforest).

(b) Breadth of acquired contextual facilitation across motor, affective, and cognitive processes occurred in PH but not PL. Moreover, conditioned facilitation in PH was also found equally for visual stimuli that differ in their ease and strength of conditioning (Holland, 1992; Graybiel, 1998) [implicit, contextual stimuli (Labfront) vs. explicit, discrete stimuli (Portrait)], and that are likely processed along different brain pathways [i.e., ventral (Portrait) and dorsal (Labfront) visual streams]. Thus, broad conditioned contextual facilitation was observed across different domains (motor, affective, and cognitive) and for different types of stimuli (general context and a discrete object stimulus) for PH participants.

(c) There were significant correlations within participants across combinations of all three domains (motor, affective, cognitive), ranging from 0.46 to 0.52.

(d) There was robust conditioned contextual facilitation by PH on the first day of Extinction (day 5), despite the absence of unconditioned effects of MP.

(e) Non-specific, general contextual stimuli (i.e., Lab A) elicited enhanced facilitation of responding on day 4 relative to day 1 in PH participants to visual stimuli that are naturally of high incentive salience (Football), but not to stimuli of little incentive salience (Rainforest) (Jodogne et al., 1994; Schultz et al., 1997; Robinson and Berridge, 2000). Therefore, according to the rationale described in the Materials and Methods section, one may conclude that the enhanced response to Football on day 4 was dependent on contextual conditioning in PH participants only (Robinson and Berridge, 2000).

Thus, high extraverts that had context paired with MP in Lab A during the Association phase of the study (i.e., PH) manifested broad conditioned contextual facilitation across motor, affective, and cognitive processes, where the three processes correlated in magnitude of facilitation within participants, and which persisted into the first day of Extinction when no unconditioned effects of MP were present. These conditioned effects were not observed in high or low extraverts who had no exposure to MP in Lab A (i.e., PB and UP), or who had been exposed to MP but in a different lab context (i.e., UP in Lab B). Indeed, PB and UP groups generally showed a moderate loss of contextual facilitation on Test day 4 relative to Association day 1, apparently due to having found repeated presentation of the Lab A context to be absent of incentive value without MP exposure.

Most importantly, low extraverts exposed to MP in Lab A (i.e., PL) apparently experienced little or no rewarding effects from the MP dose used in this study, since they manifested no significant conditioned contextual facilitation on Test day 4 relative to Association day 1. This suggests that PH participants are more sensitive than PL participants to the MP-induced reward generated by the dose used here. This would support the notion that extraversion is characterized by individual differences in reactivity to reward or incentive stimuli, and that these differences have implications for contextual conditioning (Depue et al., 1994; Gray, 1994; Depue and Collins, 1999).

Several lines of evidence suggest that DA modulation contributes to the relation between extraversion and the magnitude of conditioned contextual facilitation of responding. First, DA functioning in the NAc in animals is strongly correlated with (a) the acquisition of reward-induced conditioned contextual responding (Hooks et al., 1992; Cabib, 1993; Jodogne et al., 1994; Wassum et al., 2011), (b) the magnitude of incentive attributed to context (Hooks et al., 1992; Cabib, 1993; Jodogne et al., 1994; Robinson and Berridge, 2000), and (c) the efficacy of drug-associated cues to markedly enhance DA release and gene expression in the NAc (Berke and Hyman, 2000; Everitt et al., 2001). Second, as reviewed above, MP is a potent DA agonist and inducer of feelings of reward in humans. It was the pairing of MP with context in our study that was critical to demonstrating contextual facilitation in PH participants in that equivalently high extraverts in conditions that did not pair MP with context (i.e., PB and UP participants) did not acquire such conditioned facilitation. Third, the presence of conditioned facilitation in PH participants on the first day of Extinction (where no unconditioned MP effects were present) is also consistent with cue-induced NAc DA activity (Ranaldi et al., 1999; Devilbiss and Berridge, 2008). Fourth, as discussed above, the dependence of facilitation of motor velocity, positive affect, and visuospatial working memory processes on VTA DA projections to the NAc and dorsolateral prefrontal cortex, respectively, is well established in animals and humans (Luciana et al., 1992, 1998; Luciana and Collins, 1997; Depue and Collins, 1999; Devilbiss and Berridge, 2008; McNab et al., 2009; Aart et al., 2011). Fifth, the increasing efficacy of contextual facilitation of working memory with longer response delays found here, when demands on DA facilitation are increasing, is also consistent with a role for DA (Luciana et al., 1992, 1998; Luciana and Collins, 1997). And sixth, that only PH but not PL participants acquired a context-incentive reward association may reflect the positive relation between DA functioning and extraversion reviewed above.

VTA DA neural subgroups positioned more laterally in midbrain project to the NAc, where DA release enhances incentive facilitation of locomotor activity and positive affect (Depue and Collins, 1999; Olson et al., 2005; Fields et al., 2007). In contrast, more medially located VTA DA neural subgroups project to cortical regions, such as the dorsolateral prefrontal cortex, and facilitate working memory processes (Goldman-Rakic, 1987; Luciana et al., 1992, 1998; Fields et al., 2007). The fact that incentive motivational processes reflected by motor and affective variables, as well as cognitive processes indexed by visuospatial working memory, similarly evidenced conditioned contextual facilitation, and that these three variables correlated in % change with each other within participants, suggests that afferents from corticolimbic regions carrying contextual information to the VTA have broad excitatory effects across distinct VTA DA nuclear subgroups (Oades and Halliday, 1987; Taber et al., 1995; Luciana et al., 1998; Groenewegen et al., 1999b; Berke and Hyman, 2000; Carr and Sesack, 2000). Thus, contexts that have been associated with reward appear to facilitate not only incentive motivational processes that activate approach to reward (Berke and Hyman, 2000; Hyman and Malenka, 2001), but also cognitive processes that mediate behavioral strategies and outcome expectancies that guide goal-oriented decisions and behaviors (Everitt et al., 2001; Hyman and Malenka, 2001). This perspective suggests that extraversion involves both affective and cognitive components in engaging with rewarding goals (Gray and Braver, 2002; Depue and Fu, 2012).

The conditioned contextual effects found in PH are specific to the trait of extraversion. This is because we used selection criteria that limited our participants to the middle six deciles on the two major higher-order traits of neuroticism and constraint (impulsivity). While this selection method helps to assure specificity of results to extraversion, it also creates study participants that do not represent the full range of combinations of extraversion with other higher-order traits. Such combinations (e.g., high extraversion and low constraint) may modify conditioning effects (Depue and Fu, 2012). Future studies will need to assess the effects of interactions of traits on the conditioning process.

At a broader level, the current findings shed further light on the nature of extraversion. Two points are worth emphasizing about extraversion. First, as much research in genetics, pharmacology, psychology, and neuroscience now suggests, a major contributor to variation in extraverted behavior is individual differences in the functional properties of the VTA DA-NAc/cortical pathways. Second, variation in DA functioning is manifested by the eliciting effects of environmental incentive stimuli, which as our study suggests can be conditioned incentives as well. Therefore, as shown in Figure 7, the expression of extraverted behavior can be illustrated by a threshold model that represents a central nervous system weighting of the external and internal factors that contribute to initiation of behavior (Stricker and Zigmond, 1986; White, 1986; Depue and Collins, 1999). In the case of extraversion, the threshold would be weighted most strongly by the joint function of two main variables: (i) the magnitude of incentive stimuli, which ultimately is mainly a function of the magnitude of reward induced by an unconditioned or conditioned incentive stimulus, and (ii) level of DA postsynaptic receptor activation. The interaction of these two variables creates a trade-off function in Figure 7, where pairs of values (of incentive stimulus magnitude and DA activation) specify a diagonal representing the minimum threshold value for activation of incentive reward processes that manifest as extraverted behavior. Because the two input variables are interactive, independent variation in either one not only modifies the probability of behavior, but it also simultaneously modifies the value of the other variable that is required to reach a minimum threshold of reward and extraverted behavior.

FIGURE 7
www.frontiersin.orgFigure 7. A minimum threshold for facilitation of feelings of reward and extraverted behavior is illustrated as a trade-off function between incentive stimulus magnitude (left vertical axis) and dopamine (DA) postsynaptic receptor activation (horizontal axis). Range of effective (facilitating) incentive stimuli is illustrated on the right vertical axis as a function of level of DA activation. Two hypothetical individuals with low and high trait DA postsynaptic receptor activation (demarcated on the horizontal axis as A and B, respectively) are shown to have narrow (A) and broad (B) ranges of effective incentive stimuli, respectively.

A threshold model allows behavioral predictions that have implications for conceptualizing the nature of extraversion. A trait dimension of DA postsynaptic receptor activation is represented on the horizontal axis of Figure 7, where two individuals with divergent trait levels are demarcated: A (low trait level) and B (high trait level). These two divergent individuals may be used to illustrate the effects of trait differences in DA receptor activation on both acquisition and maintenance of extraverted behavior.

First, as Figure 7 indicates, for any given incentive stimulus, the degree of DA response will on average be larger in individual B vs. A. Because the degree of DA activity is correlated with the magnitude of positive affect that is naturally elicited by incentive stimuli [e.g., increased enthusiasm, activity, desire, wanting, optimism], this positive emotional experience is also predicted to be more enhanced in B vs. A.

Second, trait differences in incentive activation may have marked effects on the range of effective (i.e., reward- and behavior-inducing) incentive stimuli. This is illustrated in Figure 7, where the right vertical axis represents the range of effective affiliative stimuli. Increasing trait levels of DA activation (horizontal axis) are associated with an increasing efficacy of weaker incentive stimuli and, thus, with an increasing range of effective incentive stimuli. In Figure 7 individuals A and B have a narrow vs broad range, respectively. Significantly, the broader range for individual B suggests that on average B will experience more frequent elicitation of positive emotional experiences associated with reward.

Third, if individual B experiences more frequent and more enhanced reward to incentive sitmuli, animal research suggests that this experience is associated with the quantity of DA release in the NAc and with a graded increase in the frequency and duration of VTA DA neuronal activity (White, 1986; Nishino et al., 1987; Blackburn et al., 1989; Schultz et al., 1995). Thus, variation in DA activation by incentive stimuli may not only influence the level of experienced reward, but also may lead to variation in the strength of DA-facilitated associative processes that link neutral stimuli with reward (Phillips et al., 2003; Simmons and Neill, 2009; Wassum et al., 2011). The outcome of these interactions may be the acquisition of a more elaborate associative network linking reward to incentive stimuli in individual B. The findings of the current study support such a proposition.

Finally, the maintenance of individual differences in extraversion may relate to the very factors that promote variation in the acquisition of conditioned incentive stimuli. The latter would be expected to result in variation in the strength and breadth of the encoded memory network of conditioned positive incentives (i.e., a contextual ensemble) that represents the general context and specific features associated with subsequent reward. Such differences in reward-encoding of memory representations of salient contexts could have marked effects on the maintenance of extraverted behavior through the operation of cognitive processes of working memory integrated in prefrontal cortical regions. In prefrontal regions, symbolic central representations of the salient context associated with reward can be held on-line as a means of (a) “reliving” and predicting the expected reward from engagement with a salient context, and (b) guiding motivated approach to the goal (Goldman-Rakic, 1987; Waterhouse et al., 1996; Damasio, 1999; Rolls, 2000). Thus, individuals A and B may develop differences in their capacity to facilitate over time subjective reward and extraverted behavior due to differentially encoded central representations of salient contexts and their expected outcome (most likely held in mOFC (Depue and Collins, 1999). Put differently, individual differences in extraversion may be maintained by activation of differentially encoded central representations of incentive contexts that predict reward. The implications of the current study are that, in high extraverts, who are predicted to have a lower threshold of behavioral facilitation, this process will involve: (i) more frequent activation of incentive; (ii) by a broader network of conditioned contexts that; (iii) elicit more strongly encoded central representations of related rewarding events and their expected outcomes.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

This work was supported by grant R01 MH 55347 (Richard A. Depue) from the National Institute of Mental Health.

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Keywords: dopamine, extraversion, conditioning, cognition, motor velocity, positive affect

 

Citation: Depue RA and Fu Y (2013) On the nature of extraversion: variation in conditioned contextual activation of dopamine-facilitated affective, cognitive, and motor processes. Front. Hum. Neurosci. 7:288. doi: 10.3389/fnhum.2013.00288

 

Received: 30 March 2013; Paper pending published: 19 April 2013;
Accepted: 02 June 2013; Published online: 13 June 2013.

 

Edited by:

Jan Wacker, Philipps-Universität Marburg, Germany

 

Reviewed by:

Charles S. Carver, University of Miami, USA
Luke D. Smillie, The University of Melbourne, Australia
Juergen Hennig, Justus-Liebig-University Giessen, Germany

 

Copyright © 2013 Depue and Fu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.

 

*Correspondence: Richard A. Depue, Human Development, Laboratory of Neurobiology of Personality, 243 MVR Hall, Cornell University, Ithaca, NY 14853, USA e-mail: rad5@cornell.edu

Prediction of detached personality in healthy subjects by low dopamine transporter binding (2000)

Am J Psychiatry. 2000 Feb;157(2):290-2.

Laakso A, Vilkman H, Kajander J, Bergman J, paranta M, Solin O, Hietala J.

Source

Department of Pharmacology and Clinical Pharmacology, University of Turku, Finland. akilaa@utu.fi

Abstract

OBJECTIVE:

Low striatal dopamine D(2) receptor binding in healthy human subjects has been associated with detached personality in studies using positron emission tomography (PET) and the Karolinska Scales of Personality questionnaire. The authors investigated whether a similar correlation exists between striatal dopamine transporter binding and detached personality

METHOD:

Eighteen healthy volunteers participated in a PET study with the specific dopamine transporter ligand [(18)F]CFT ([(18)F]WIN 35,428) and completed the Karolinska Scales of Personality questionnaire form.

RESULTS:

Age-corrected dopamine transporter binding in the putamen, but not in the caudate, correlated negatively with detachment personality scores, especially in the right hemisphere.

CONCLUSIONS:

This finding supports the hypothesis that low dopaminergic neurotransmission is associated with detached personality. Furthermore, since [(18)F]CFT binding is thought to reflect the density of dopaminergic nerve terminals in the brain, the authors suggest that the neurodevelopmental formation of the brain dopaminergic system may influence adult personality traits.

Remarks on the paper "Dopamine and social anxiety disorder" by Robinson et al. (2007)

Rev Bras Psiquiatr. 2007 Mar;29(1):89-90.

Corchs F, Bernik M.

Comment on - Dopamine and social anxiety disorder. [Rev Bras Psiquiatr. 2006]

Dear Editor,

The role of neurotransmitters other than serotonin in phobic-avoidance disorders has been clarified as neural science progresses.1Among those, dopamine, both directly and by its interactions with other systems, is an excellent candidate for investigation. In agreement with the author's hypothesis are also some important clinical correlates of the development of phobias and lack of motivational drive, and the parallel drawn between social anxiety disorder (SAnD) and studies of subordinated monkeys.

There is another dimension on the role of dopamine in SAnD and anxiety disorders as a whole. Such hypothesis is founded on the idea of anxiety as a condition in which there is a conflict between appetitive/positively reinforced behaviors, closely related to dopaminergic systems,2 and escape/avoidance behaviors, related to serotonergic systems.3

Other authors have already addressed the importance of those two systems in anxiety, describing the conflict between the behavioral approach system and the fight/flight/freeze system.4 In this way, it would be logical to speculate that while serotonergic drugs would inhibit inborn fight or flight responses to proximal danger through its action in the dorsal periaqueductal gray matter,3 while dopaminergic drugs would increase motivation/appetitive behaviors through its actions in the mesolimbic system,2 augmenting thus the effect of serotonergic drugs.

It is unlikely that DA could have an "anxiolitic" property by itself. Drugs enhancing dopaminergic bioavailability, such as bupropion, have little or inconsistent effects on anxiety disorders. On the other hand, augmented DA could have an impact upon treatment response.

 In our group, we have found a close relation of Cloninger's5 Self Directedness dimension and remission following behavioral treatment in SAnD. This trait may be linked to DA activity and be associated with better treatment responses.

 

Felipe Corchs, Márcio Bernik

Anxiety Clinic, Institute and Department of Psychiatry,

School of Medicine, Universidade de São Paulo (USP),

São Paulo (SP), Brazil

 

References

 

1. Robinson HM, Hood S, Bell C, Nutt D. Dopamine and social anxiety disorder. Rev Bras Psiquiatr. 2006;28(4):263-4.

 

2. Wise RA. Dopamine, learning and motivation. Nat Rev Neurosci. 2004;5:483-94.

 

3. Deakin JF, Graeff FG. 5-HT and mechanism of defense. J Psychopharmacol. 1991;5:305-15.

 

4. Grey JA, McNaughton N. The neuropsychology of anxiety: an enquiry into the functions of septo-hippocampal system. 2nd ed. Oxford: Oxford University Press; 2000.

 

5. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993;50(12):975-90.

 

 

 

School avoidance and social phobia triggered by haloperidol in patients with Tourettes disorder.(1988)

Am J Psychiatry. 1981 Dec;138(12):1572-6.

Mikkelsen EJ, Detlor J, Cohen DJ.

Abstract

Fifteen patients with Tourette's disorder developed school and work avoidance syndromes when treated with low doses (mean 2.5 mg/day) of haloperidol for short periods of time (mean, 8 weeks). The phobic syndromes disappeared completely with discontinuation or reduction of the haloperidol dose. Haloperidol's effects on dopaminergic functioning support a role for catecholamines in the pathogenesis of phobic syndromes. It is not known whether phobias are precipitated by haloperidol only in patients with Tourette's disorder as a consequence of the specific metabolic alterations in this disorder or are a medication side effect in other psychiatric disorders as well.

Social Phobia Linked To High Levels Of Serotonin In The Amygdala.

Jun 17, 2015 11:40 AM By Susan Scutti

Levels of the neurotransmitter serotonin in people with social anxiety disorder may be too high, not too low, as previously believed. Lili Vieira de Carvalho

Anxiety disorders affect more than 25 million Americans. In particular, those with social phobia feel embarrassed, inferior, and uncomfortable when they are in public situations. A new study from Uppsala University gets to the root of this mental disorder. The researchers say that levels of serotonin, a neurotransmitter, in people with social anxiety disorder are not too low as previously believed — instead, these anxious people produce too much serotonin. And, the higher the level of this neurotransmitter, the more anxious they feel.

"Our study provides better insight as to how serotonin contributes to anxiety," Dr. Tomas Furmark, a psychology professor at Sweden’s Uppsala University, told Medical Daily in an email, further noting the importance of understanding the etiology of anxiety disorders.

A very recent small-scale study of social anxiety found more than three quarters of sufferers first developed their symptoms before the age of 18. Compared to those whose symptoms first appeared later in life, the early-onset group had higher scores on anxiety and depression tests, and lower scores on global functioning tests. For those with early anxiety, their depression and other symptoms are more severe and so more difficult to treat.

Commonly, psychiatrists treat social phobia with medications known as selective serotonin reuptake inhibitors or SSRIs, a type of drug which changes the amount of the neurotransmitter serotonin in the brain.

Furmark and Dr. Mats Fredrikson, another professor of psychology at Uppsala University, questioned the underlying hypothesis of treating patients with SSRIs: What molecular role, exactly, does serotonin play in social phobia?

Overly-Sensitive to Fear

To discover the truth, they used brain scanning technology, PET scans, to measure serotonin in the brains of volunteers with social phobia. Essentially, then, they tracked the chemical signals transferred between cells in the brain.

Communication within the brain works like this: Nerve cells release serotonin into the space between nerve cells. Then, serotonin attaches itself to receptor cells. Following this, serotonin is released from the receptor and returns to the original cell.

The researchers discovered patients with social phobia were producing too much serotonin in the amygdala. This brain region, tucked deep inside our skulls, is the seat of our most primitive emotions, including fear. The more serotonin produced in this area, then, the more anxious people feel in social situations.

This new finding does not entirely challenge past research. Previous scientific studies proved people with social phobia have higher nerve activity in the amygdala — for anxious people, the fear center of the brain is overly sensitive. This new research fleshes out the prior work with its suggestion that a surplus of serotonin may be (at least part of) the underlying reason for this.

Serotonin, then, does not decrease anxiety as previously assumed, it increases it. Further research into the underlying chemical processes of anxiety should help scientists investigate familiar treatments and possibly develop new ones for what amounts to a debilitating condition for some people.

"We may have to rethink how anxiety-reducing drugs, like serotonin reuptake inhibitors (SSRIs), actually exert their beneficial effects in anxiety disordered patients," Furmark said.

Source: Frick A, Åhs F, Engman J, et al. Serotonin Synthesis and Reuptake in Social Anxiety Disorder: A Positron Emission Tomography Study. JAMA Psychiatry. 2015.

Quotes from Dr. Furmark were added in following the original posting of this article.

 

Social anxiety disorder and generalized anxiety disorder serotonergic and dopaminergic neurocircuitry (2002)

J Clin Psychiatry. 2002;63 Suppl 6:12-9.

Stein DJ, Westenberg HG, Liebowitz MR.

Source

Medical Research Council Unit on Anxiety Disorders, the University of Stellenbosch, Tygerberg, Cape Town, South Africa. djs2@sun.ac.za

Abstract

Awareness that an amygdala-based fear circuit plays a crucial role in mediating fear conditioning as well as anxiety symptoms is growing. The efficacy of selective serotonin reuptake inhibitors in certain anxiety disorders has been argued to reflect their ability to modulate this circuit. Whether additional neurocircuits play a differentiating role in specific anxiety disorders, such as social anxiety disorder and generalized anxiety disorder (GAD), is an ongoing subject of investigation. A review of the literature suggests that in social anxiety disorder, dopaminergically mediated striatal circuits may also be important, while in GAD, there may be abnormalities of prefrontal areas. Future work will undoubtedly clarify how genetic and environmental factors interact to fashion the neurocircuitry that mediates anxiety symptoms.

Striatal dopamine D2 receptor availability in OCD with and without comorbid social anxiety disorder: preliminary findings. (2008)

COMMENTS: Study found low D2 receptors in the striatum of patients with OCD combined with social anxiety disorder. The "striatum" is where D2 receptors decline during addiction..

Depress Anxiety. 2008;25(1):1-7.

Schneier FR, Martinez D, Abi-Dargham A, Zea-Ponce Y, Simpson HB, Liebowitz MR, Laruelle M.

Source

Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY 10032, USA. frs1@columbia.edu

Abstract

Dopamine D(2) receptor availability in the striatum has been reported to be low in generalized social anxiety disorder (GSAD) and obsessive-compulsive disorder (OCD), but it has not been studied in persons with comorbid OCD and GSAD (OCD+GSAD).

D(2) receptor availability was assessed in 7 subjects with OCD+GSAD, 8 with OCD, and 7 matched healthy comparison (HC) subjects, all unmedicated adults. D(2) receptor availability was assessed with single-photon emission computerized tomography (SPECT) to measure binding potential (BP) of the D(2) receptor radiotracer [(123)I] iodobenzamide ([(123)I]IBZM). Mean striatal [(123)I]IBZM BP was significantly lower in the OCD+GSAD group (72.58 mL/g, SD=18.17) than in the HC group (118.41 mL/g, SD=45.40; P=.025). Mean BP in the OCD group (93.08 mL/g, SD=36.90) did not differ significantly from the HC group (P=.247).

Trait detachment, as measured by the Detachment subscale of the Karolinska Scales of Personality, was negatively correlated with D(2) availability across all subjects (r(s)= -.55, P=.013). Comorbid GSAD and OCD may be associated with decreased availability of D(2) receptors in the striatum, consistent with prior findings in GSAD. Prior findings of decreased D(2) receptor availability in noncomorbid OCD were not confirmed. Decreased D(2) receptor availability was also associated with trait detachment, supporting prior findings in samples of healthy subjects.

http://www.ncbi.nlm.nih.gov/pubmed/17252580

Striatal function in generalized social phobia a functional magnetic resonance imaging study.(2007)

Biol Psychiatry. 2007 Feb 1;61(3):396-404. Epub 2006 Nov 9.

Sareen J, Campbell DW, Leslie WD, Malisza KL, Stein MB, Paulus MP, Kravetsky LB, Kjernisted KD, Walker JR, Reiss JP.

Source

Department of Psychiatry, University of Manitoba, Winnipeg, Canada. sareen@cc.umanitoba.ca

Abstract

BACKGROUND:

Although evidence suggests the involvement of the amygdala in generalized social phobia (GSP), few studies have examined other neural regions. Clinical, preclinical, and dopamine receptor imaging studies demonstrating altered dopaminergic functioning in GSP suggest an association with striatal dysfunction. This is the first functional magnetic resonance imaging (fMRI) study to use a cognitive task known to involve the striatum to examine the neural correlates of GSP. We examined whether subjects with GSP had differential activation in striatal regions compared with healthy control subjects while engaged in a cognitive task that has been shown to activate striatal regions reliably.

METHODS:

Ten adult, unmedicated subjects with a primary DSM-IV diagnosis of GSP and 10 age-, gender-, and education-matched healthy comparison subjects underwent fMRI while performing the implicit sequence learning task.

RESULTS:

The GSP and healthy comparison subjects did not differ significantly on the behavioral performance of the task. Subjects with GSP, however, had significantly reduced neural activation related to implicit learning compared with healthy comparison subjects in the left caudate head, left inferior parietal lobe, and bilateral insula.

CONCLUSIONS:

These findings support the hypothesis that GSP is associated with striatal dysfunction and further the neurobiological understanding of this complex anxiety disorder.

Superiority illusion arises from resting-state brain networks modulated by dopamine (2013)

Proc Natl Acad Sci U S A. 2013 Feb 25.

Yamada M, Uddin LQ, Takahashi H, Kimura Y, Takahata K, Kousa R, Ikoma Y, Eguchi Y, Takano H, Ito H, Higuchi M, Suhara T.

Source

Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba 263-8555, Japan.

Abstract

The majority of individuals evaluate themselves as superior to average. This is a cognitive bias known as the "superiority illusion." This illusion helps us to have hope for the future and is deep-rooted in the process of human evolution. In this study, we examined the default states of neural and molecular systems that generate this illusion, using resting-state functional MRI and PET. Resting-state functional connectivity between the frontal cortex and striatum regulated by inhibitory dopaminergic neurotransmission determines individual levels of the superiority illusion. Our findings help elucidate how this key aspect of the human mind is biologically determined, and identify potential molecular and neural targets for treatment for depressive realism.

The Social Anxiety Spectrum (2002)

Psychiatr Clin North Am 2002 Dec;25(4):757-74

by Schneier FR, Blanco C, Antia SX, Liebowitz MR.

Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY 10032, USA.

Social anxiety disorder is well suited to the spectrum concept because it has trait-like qualities of early onset, chronicity, and no empirically derived threshold that demarcates normal from clinically significant trait social anxiety. Social anxiety disorder has been shown to respond to relatively specific pharmacologic and cognitive-behavioral therapies, which makes identification of other conditions that may lie on the social anxiety disorder spectrum important because of possible treatment implications. Biologic markers associated with social anxiety disorder also may be shared by similar but nonidentical traits, such as behavioral inhibition and detachment. Clarification of the trait spectrums associated with specific biologic systems offers an opportunity for improving the understanding of the origin of these conditions. Strong evidence exists that at least some forms of shyness, avoidant personality disorder, and selective mutism lie on a social anxiety disorder spectrum. For several other disorders that share a prominent focus on social comparison, significant subgroups of patients seem to have features of social anxiety disorder. These disorders include major depression (especially the atypical subtype), body dysmorphic disorder, and eating disorders. Several other disorders marked by social dysfunction or inhibition, including substance use disorders (especially alcoholism), paranoid disorder, bipolar disorder, autism, and Asperger's disorder, also may show some overlap with social anxiety disorder features (e.g., social anxiety as a cause or complication of substance abuse, social avoidance in paranoid disorder, social disinhibiton in bipolar disorder, and social communication deficits in autism and Asperger's disorder). Social anxiety disorder also is associated with other anxiety disorders in general and other phobias in particular.

In respect to traits, a growing body of evidence links behavioral inhibition to the unfamiliar to a social anxiety disorder spectrum with some specificity. Biologic measures of dopamine system hypoactivity have been linked to social anxiety disorder, trait detachment, and general deficits in reward and incentive function. It remains to be clarified, however, whether this brain system function is best characterized by a social anxiety disorder spectrum or some variant that incorporates social reward deficits or social avoidance behavior. Social anxiety disorder, shyness, and behavioral inhibition all seem to have a genetic component, but more research is needed to attempt to identify a more specifically heritable temperament associated with these conditions.

Finally, the emergent concept of a social anxiety spectrum needs maturation. Although the notion of a single social anxiety disorder spectrum currently has some clinical use, the authors believe that exclusive focus on the notion of a single continuum with two extremes--from social disinhibition in mania to the most severe form of social anxiety, avoidant personality disorder--is premature and limiting in respect to etiologic research. An alternative approach is to conceptualize multiple, probably overlapping spectra in this area of social psychopathology. Individual dimensions might be based on various core phenomenologic, cognitive, or biologic characteristics. A bottom-up biologic approach holds promise for identifying spectra with a common etiology that might respond to specific treatments. Taking a pluralistic view of the concept of spectrum at this stage may help accelerate our understanding of social anxiety and related disorders.

Increased dopamine transporter density in Parkinson's disease patients with Social Anxiety Disorder (2011)

J Neurol Sci. 2011 Nov 15;310(1-2):53-7. Epub 2011 Jul 23.

Moriyama TS, Felicio AC, Chagas MH, Tardelli VS, Ferraz HB, Tumas V, Amaro-Junior E, Andrade LA, Crippa JA, Bressan RA.

Source

Instituto do Cérebro, Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, Sao Paulo, Brazil. taismoriyama@gmail.com

Abstract

Social Anxiety Disorder (SAD) is more common among PD patients than in the general population. This association may be explained by psychosocial mechanisms but it is also possible that neurobiological mechanism underlying PD can predispose to SAD.

The aim of this study was to investigate a possible dopaminergic mechanism involved in PD patients with SAD, by correlating striatal dopamine transporter binding potential (DAT-BP) with intensity of social anxiety symptoms in PD patients using SPECT with TRODAT-1 as the radiopharmaceutical. Eleven PD patients with generalized SAD and 21 PD patients without SAD were included in this study; groups were matched for age, gender, disease duration and disease severity. SAD diagnosis was determined according to DSM IV criteria assessed with SCID-I and social anxiety symptom severity with the Brief Social Phobia Scale (BSPS). Demographic and clinical data were also collected.

DAT-BP was significantly correlated to scores on BSPS for right putamen (r=0.37, p=0.04), left putamen (r=0.43, p=0.02) and left caudate (r=0.39, p=0.03). No significant correlation was found for the right caudate (r=0.23, p=0.21). This finding may reinforce the hypothesis that dopaminergic dysfunction might be implicated in the pathogenesis of social anxiety in PD.

The emergence of social phobia during clozapine treatment and its response to fluoxetine augmentation (1999)

Clozapine has complex effects, but is considered a dopamine antagonist.

J Clin Psychiatry. 1999 Dec;60(12):819-23.

Pallanti S, Quercioli L, Rossi A, Pazzagli A.

Source

Istituto di Neuroscienze, University of Florence Medical School, Italy. s.pallanti@agora.stm.it

Abstract

BACKGROUND:

The underlying neurochemical basis of social phobia has yet to be fully explained, but there are suggestions of serotonergic and dopaminergic dysfunction. The atypical neuroleptic clozapine has been reported to induce anxiety symptoms, probably owing to its effect on serotonergic pathways. We report 12 cases of schizophrenic patients who developed social phobia during clozapine treatment.

METHOD:

Patients were assessed using the Structured Clinical Interview for DSM-III-R, Patient Version, Scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, the Liebowitz Social Phobia Scale, and the Brief Psychiatric Rating Scale. They were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine.

RESULTS:

In 8 of the 12 cases, symptoms responded (> or = 35% reduction in Liebowitz Social Phobia Scale score) with an adjunctive regimen of fluoxetine.

CONCLUSION:

Data are discussed in light of neurochemical mechanisms and cognitive adaptations that could explain the onset of anxiety spectrum disorders (such as social phobia) in clozapine-treated schizophrenic subjects during remission of psychotic symptoms.

(L) ADHD Brain Chemistry Clue Found: Dopamine Receptors and Transporters (2009)

Concentration problems are often associated with porn addictionComments: Many heavy porn users complain of ADD/ADHD like symptoms. Many see an improvement in their symptoms as they get off porn. Porn addiction probably leads to a temporary decline in dopamine (D2) receptors, as was found in those diagnosed with ADHD. Note: I am not saying that the majority of ADHD is caused by porn use.

Story from BBC NEWS:

US researchers have pinned down new differences in the brain chemistry of people with attention deficit hyperactivity disorder (ADHD).

They found ADHD patients lack key proteins which allow them to experience a sense of reward and motivation.

The Brookhaven National Laboratory study appears in the Journal of the American Medical Association.

It is hoped it could help in the design of new ways to combat the condition.

“ For far too long there has been an assumption that children with ADHD are deliberately willful ” Andrea Bilbow ADDISS

Previous research looking at the brains of people with ADHD had uncovered differences in areas controlling attention and hyperactivity.

But this study suggests ADHD has a profound impact elsewhere in the brain too.

Researcher Dr Nora Volkow said: "These deficits in the brain's reward system may help explain clinical symptoms of ADHD, including inattention and reduced motivation, as well as the propensity for complications such as drug abuse and obesity among ADHD patients."

The researchers compared brain scans of 53 adult ADHD patients who had never received treatment with those from 44 people who did not have the condition.

All of the participants had been carefully screened to eliminate factors which could potentially skew the results.

Dopamine pathway

Using a sophisticated form of scan called positron emission tomography (PET), the researchers focused on how the participants' brains handled the chemical dopamine, a key regulator of mood.

In particular they measured levels of two proteins - dopamine receptors and transporters - without which dopamine cannot function effectively to influence mood.

ADHD patients had lower levels of both proteins in two areas of the brain known as the nucleus accumbens and midbrain.

Both form part of the limbic system, responsible for the emotions, and sensations such as motivation and reward.

Patients with more pronounced ADHD symptoms had the lowest levels of the proteins in these areas.

“ It suggests that teachers need to make sure that school tasks are interesting and exciting, so that children with ADHD are motivated to remain interested ” Professor Katya Rubia

Dr Volkow said the findings supported the use of stimulant medications to treat ADHD by raising dopamine levels.

The findings also support the theory that people with ADHD may be more prone to drug abuse and obesity because they are unconsciously attempting to compensate for a deficient reward system.

Andrea Bilbow, of the ADHD charity ADDISS, said the study might help convince people who argue that ADHD is more to do with bad parenting than any concrete medical difference.

She said: "The findings of this new research will go a long way to helping us understand the presentation of symptoms but more importantly it may give teachers more of an idea of what interventions should be used in the classroom in order to accommodate children with ADHD.

"For far too long there has been an assumption that children with ADHD are deliberately wilful which has led to mismanagement and ultimately permanent exclusions from school."

Professor Katya Rubia, of London's Institute of Psychiatry, said: "This study widens our horizons. It shows that ADHD is not just about abnormalities in the attention systems of the brain, but also abnormalities in the motivation and emotion centres.

"It suggests that teachers need to make sure that school tasks are interesting and exciting, so that children with ADHD are motivated to remain interested."

THE STUDY

TUESDAY, Sept. 8 (HealthDay News) -- Rewards-motivation deficits reported in people with attention-deficit/hyperactivity disorder (ADHD) may be associated with a disruption in the mesoaccumbens dopamine reward pathway evidenced by reduced dopamine synaptic markers seen in positron emission tomography (PET) imaging of the brain, according to a study in the Sept. 9 issue of the Journal of the American Medical Association.

Nora D. Volkow, M.D., of the National Institute on Drug Abuse in Bethesda, Md., and colleagues performed PET imaging on 53 subjects with ADHD who were not on medication, along with 44 healthy subjects, to study activity in the brain's mesoaccumbens dopamine reward pathway, which is believed to be involved in rewards-motivation behavior. Specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) were measured using [11C]cocaine and for D2/D3 receptors.

The researchers found lowered specific binding for both ligands in the left-side brain regions involved in the dopamine reward pathway in the subjects with ADHD. The mean for DAT in the nucleus accumbens was 0.63 for the ADHD subjects and 0.71 for controls, and in the midbrain was 0.09 for the ADHD subjects and 0.16 for controls. For the D2/D3 receptors, the median in the accumbens for the ADHD subjects was 2.68 and 2.85 for controls, and in the midbrain was 0.18 for the ADHD subjects and 0.28 for controls.

"In conclusion, these findings show a reduction in dopamine synaptic markers in the dopamine reward pathway midbrain and accumbens region of participants with ADHD that were associated with measures of attention," the authors write.

Several of the study authors reported receiving research support and consulting fees from pharmaceutical companies.

(L) Are Anxiety Disorders All In The Mind - Dopamine

Are Anxiety Disorders All In The Mind?

ScienceDaily (May 12, 2008) — Using single-photon emission computed tomography (SPECT), researchers in The Netherlands were able to detect biochemical differences in the brains of individuals with generalized social anxiety disorder (also known as social phobia), providing evidence of a long-suspected biological cause for the dysfunction.

The study compared densities of elements of the serotonin and dopamine neurotransmitter systems in the brains of 12 people diagnosed with social anxiety disorder, but who had not taken medication to treat it, and a control group of 12 healthy people who were matched by sex and age.

Both groups were injected with a radioactive compound that binds with elements of the brain's serotonin and dopamine systems. Once administered, the radiotracer revealed functional alterations in these systems by measuring the radioactive binding in the thalamus, midbrain and pons (known to be acted upon by serotonin) and in the striatum (known to be acted upon by dopamine). The altered uptake activity in these regions indicated a greater level of disordered function.

"Our study provides direct evidence for the involvement of the brain's dopaminergic system in social anxiety disorder in patients who had no prior exposure to medication," said Dr. van der Wee, M.D., Ph.D., at the department of psychiatry and the Leiden Institute for Brain and Cognition at the Leiden University Medical Center, Leiden (and previously at the Rudolf Magnus Institute of Neuroscience, University Medical Center in Utrecht, The Netherlands). "It demonstrates that social anxiety has a physical, brain dependent component."

Serotonin and dopamine (neurotransmitters, or substances responsible for transferring signals from one neuron to another) act upon receptors in the brain. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts to normal social situations, leading to anxiety.

Other neuroimaging studies have shown abnormalities in glucose and oxygen consumption in the brain, according to van der Wee, who also points to causality as an additional issue. "Most of the people involved in these earlier studies were known to be already suffering from the disorder, so we do not know if the abnormalities were present before the onset of the disorder," he said.

Based on earlier studies, some researchers have suggested that social anxiety disorder is a result of the interplay between a genetic or acquired biological vulnerability and environment. More recent research has indicated that social anxiety disorder might be related to an imbalance of the neurotransmitter serotonin. This is the first time the brain's dopaminergic system was examined directly.

"Although there are no direct implications for treatment as a result of this study yet, it is another piece of evidence showing biological abnormalities, which may lead to new therapeutic approaches and insight into the origins of the disorder," said Dr. van der Wee.

According to the National Institute of Mental Health, social anxiety disorder affects approximately 15 million American adults and is the third most common mental disorder in the United States, after depression and alcohol dependence. The essential feature of the disorder is the fear of being evaluated by others, with the expectation that such an assessment will be negative and embarrassing. It tends to run a chronic and unremitting course and often leads to the development of alcoholism and depression. The disorder most often surfaces in adolescence or early adulthood, but it can occur at any time, including childhood.

Co-authors of the study include J. Frederieke van Veen, Irene M. van Vliet, Herman G. Westenberg, Department of Psychiatry; and Henk Stevens, Peter P. van Rijk, Department of Nuclear Medicine, all from the Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.

________________________________________

Journal Reference:

1. N. J. van der Wee, J. F. van Veen, H. Stevens, I. M. van Vliet, P. P. van Rijk, H. G. Westenberg. Increased Serotonin and Dopamine Transporter Binding in Psychotropic Medication-Naive Patients with Generalized Social Anxiety Disorder Shown by 123I- -(4-Iodophenyl)-Tropane SPECT. Journal of Nuclear Medicine, 2008; 49 (5): 757 DOI: 10.2967/jnumed.107.045518

(L) Extroverts have more sensitive brain-reward system (2013)

Extroverts may be more outgoing and cheerful in part because of their brain chemistry, reports a study by Cornell neuroscientists.

People’s brains respond differently to rewards, say the neuroscientists. Some people’s brains release more of the neurotransmitter dopamine, which ultimately gives them more reasons to be excited and engaged with the world, says Richard Depue, professor of human development in the College of Human Ecology, who co-authored the study with graduate student Yu Fu.

Their study, published in Frontiers in Human Neuroscience (Vol. 7) in June, sheds new light on how differences in the way the brain responds to reward translate into extraverted behavior, the authors say.

“Rewards like food, sex and social interactions as well as more abstract goals such as money or getting a degree trigger the release of dopamine in the brain, producing positive emotions and feelings of desire that motivate us to work toward obtaining those goals. In extroverts, this dopamine response to rewards is more robust so they experience more frequent activation of strong positive emotions,” Depue says.

“Dopamine also facilitates memory for circumstances that are associated with the reward. Our findings suggest this plays a significant role in sustaining extroverted behavior,” Depue adds. “The extroverts in our study showed greater association of context with reward than introverts, which means that over time, extroverts will acquire a more extensive network of reward-context memories that activate their brain’s reward system.”

Over a week, the researchers engaged 70 young adult males – a mix of introverts and extroverts according to a standard personality test – in a set of laboratory tasks that included viewing brief video clips of several aspects of the lab environment. On the first four days, some participants received a low dose of the stimulant methylphenidate (MP), also known as Ritalin, which triggers the release of dopamine in the brain; the others received either a placebo or MP in a different lab location. The team tested how strongly participants associated contextual cues in the lab (presented in video clips) with reward (the dopamine rush induced by MP) by assessing changes in their working memory, motor speed at a finger-tapping task and positive emotions (all known to be influenced by dopamine).

Participants who had unconsciously associated contextual cues in the lab with the reward were expected to have greater dopamine release/reward system activation on day 4 compared with day 1 when shown the same video clips. This so-called “associative conditioning” response is exactly what the team found in the extroverts. The extroverts strongly associated the lab context with reward feelings, whereas the introverts showed little to no evidence of associative conditioning.

 “At a broader level, the study begins to illuminate how individual differences in brain functioning interact with environmental influences to create behavioral variation. This knowledge may someday help us to understand how such interactions create more extreme forms of emotional behavior, such as personality disorders,” says Depue.

The study, “On the Nature of Extraversion: Variation in Conditioned Contextual Activation of Dopamine-Facilitated Affective, Cognitive and Motor Processes,” was funded in part by the National Institute of Mental Health.

Karene Booker is extension support specialist in the Department of Human Development.

(L) Sticks and stones: Brain releases natural painkillers during social rejection (2013)

Sticks and stones: Brain releases natural painkillers during social rejection

This is a brain image showing in orange/red one area of the brain where the natural painkiller (opioid) system was highly active in research volunteers who are experiencing social rejection. This region, called the amygdala, was one of …more

"Sticks and stones may break my bones, but words will never hurt me," goes the playground rhyme that's supposed to help children endure taunts from classmates. But a new study suggests that there's more going on inside our brains when someone snubs us – and that the brain may have its own way of easing social pain.

The findings, recently published in Molecular Psychiatry by a University of Michigan Medical School team, show that the brain's natural painkiller system responds to social rejection – not just physical injury.

What's more, people who score high on a personality trait called resilience – the ability to adjust to environmental change – had the highest amount of natural painkiller activation.

The team, based at U-M's Molecular and Behavioral Neuroscience Institute, used an innovative approach to make its findings. They combined advanced brain scanning that can track chemical release in the brain with a model of social rejection based on online dating. The work was funded by the U-M Depression Center, the Michigan Institute for Clinical and Health Research, the Brain & Behavior Research Foundation, the Phil F Jenkins Foundation, and the National Institutes of Health.

They focused on the mu-opioid receptor system in the brain – the same system that the team has studied for years in relation to response to physical pain. Over more than a decade, U-M work has shown that when a person feels physical pain, their brains release chemicals called opioids into the space between neurons, dampening pain signals.

David T. Hsu, Ph.D., the lead author of the new paper, says the new research on social rejection grew out of recent studies by others, which suggests that the brain pathways that are activated during physical pain and social pain are similar.

"This is the first study to peer into the human brain to show that the opioid system is activated during social rejection," says Hsu, a research assistant professor of psychiatry. "In general, opioids have been known to be released during social distress and isolation in animals, but where this occurs in the human brain has not been shown until now."

The study involved 18 adults who were asked to view photos and fictitious personal profiles of hundreds of other adults. Each selected some who they might be most interested in romantically – a setup similar to online dating.

But then, when the participants were lying in a brain imaging machine called a PET scanner, they were informed that the individuals they found attractive and interesting were not interested in them.

Brain scans made during these moments showed opioid release, measured by looking at the availability of mu-opioid receptors on brain cells. The effect was largest in the brain regions called the ventral striatum, amygdala, midline thalamus, and periaqueductal gray – areas that are also known to be involved in physical pain.

The researchers had actually made sure the participants understood ahead of time that the "dating" profiles were not real, and neither was the "rejection." But nonetheless, the simulated social rejection was enough to cause both an emotional and opioid response.

Suffering slings and arrows differently

Hsu notes that the underlying personality of the participants appeared to play a role in how much of a response their opioid systems made.

"Individuals who scored high for the resiliency trait on a personality questionnaire tended to be capable of more opioid release during social rejection, especially in the amygdala," a region of the brain involved in emotional processing, Hsu says. "This suggests that opioid release in this structure during social rejection may be protective or adaptive."

The more opioid release during social rejection in another brain area called the pregenual cingulate cortex, the less the participants reported being put in a bad mood by the news that they'd been snubbed.

The researchers also examined what happens when the participants were told that someone they'd expressed interest in had expressed interest in them – social acceptance. In this case, some brain regions also had more opioid release. "The opioid system is known to play a role in both reducing pain and promoting pleasure, and our study shows that it also does this in the social environment," says Hsu.

The new research holds more importance than just pure discovery, note the authors, who also include senior author Jon-Kar Zubieta, M.D., Ph.D., a longtime opioid researcher. Specifically, they are pursuing further research on how those who are vulnerable to, or currently suffering from depression or social anxiety have an abnormal opioid response to social rejection and/or acceptance. "It is possible that those with depression or social anxiety are less capable of releasing opioids during times of social distress, and therefore do not recover as quickly or fully from a negative social experience. Similarly, these individuals may also have less opioid release during positive social interactions, and therefore may not gain as much from social support," Hsu theorizes.

Hsu also notes that perhaps new opioid medications without addictive potential may be an effective treatment for depression and social anxiety. Although such medications are not yet available, he adds, "increasing evidence for the neural overlap of physical and social pain suggests a significant opportunity to bridge research in the treatment of chronic pain with the treatment of psychiatric disorders."

If nothing else, perhaps knowing that our response to a social snub isn't "all in our heads" can help some people understand their responses and cope better, Hsu says. "The knowledge that there are chemicals in our brains working to help us feel better after being rejected is comforting."

Explore further: Following bariatric surgery, use of opioids increases among chronic opioid users

More information: Molecular Psychiatry, DOI: 10.1038/mp.2013.96