Kara A. McRae

Gating of auditory P50 in schizophrenics: Unique effects of clozapine

Schizophrenic patients have a deficit in the ability to filter sensory stimuli, which can be demonstrated in several psychophysiological paradigms. For example, most unmedicated schizophrenic subjects fail to decrement the P50 auditory evoked response to the second of paired stimuli, when the interstimulus interval is 500 msec. This sensory gating deficit persists in schizophrenics treated with typical antipsychotics, even if they show significant clinical improvement. When the interstimulus interval is 100 msec, most schizophrenics exhibit impaired gating while acutely ill, but normalize with treatment. Clozapine, the prototypic atypical antipsychotic medication, is clinically more effective than conventional neuroleptics in a significant proportion of schizophrenics refractory to other drug treatment. Nine schizophrenic subjects who were refractory to conventional neuroleptic treatment were studied while being treated with typical neuroleptics and then restudied after 1 months treatment with clozapine. In the six clozapine responders, there was significant improvement of P50 gating at the 500 msec interval. At the 100 msec interval there was an inverse relationship between sensory gating of P50 and clozapine dose, independent of clinical response. Thus, although this can only be considered preliminary data because of the small number of subjects, it appears that clozapine, compared to typical neuroleptics, has distinct effects on P50 gating.

Auditory P50 in Schizophrenics on Clozapine: Improved Gating Parallels Clinical Improvement and Changes in Plasma 3-Methoxy-4-Hydroxyphenylglycol

Schizophrenic patients have decreased inhibition of the P50 auditory evoked potential response to the second of two paired click stimuli delivered 500 ms apart. This deficit in inhibitory gating does not change during treatment with typical neuroleptics. We recently reported that neuroleptic-resistant schizophrenics had enhanced P50 gating after 1 month of clozapine treatment, if they responded with decreased clinical symptoms. This study reports the outcome of more prolonged treatment. Ten treatment-refractory schizophrenic patients were studied at baseline, after 1 month on clozapine, and again after 15 ± 6.1 (SD) months of clozapine treatment. Eight subjects reached a clinically stable improved state, at which time they had significantly improved P50 auditory gating. One patient had a return of impaired gating after stopping clozapine, as did another during a clinical relapse. Decreasing plasma 3-methoxy-4-hydroxyphenylglycol levels with clozapine treatment were correlated with improved P50 gating and improved Brief Bsychiatric Rating Scale-positive scores. This study provides further evidence that improved P50 gating in schizophrenic patients treated with clozapine coincides with clinical improvement and that this improvement can be sustained for at least 1 year.

114. Ondansetron improves P50 auditory sensory gating in medicated schizophrenic patients

P50 auditory sensory gating is impaired in schizophrenic patients. A schizophrenic patient does not show a decrease in the amplitude of the P50 waveform of the auditory evoked potential to the second of two closely paired click stimuli. In contrast, a normal control has a greatly decreased amplitude of the P50 waveform to the second stimulus. Expressed as a percentage (amplitude to the 2 stimulus/amplitude to the first stimulus 3 100), the P50 ratio is significantly higher in schizophrenic patients. This genetic deficit in inhibitory neuronal processing is mediated by the alpha-7 nicotinic receptor, which is rapidly desensitizing to nicotine. Nicotine briefly ameliorates this deficit in schizophrenic patients, but the effect is usually lost after one hour. Clozapine treatment, but not conventional antipsychotic medication, improves P50 auditory gating. We hypothesized that blockade of the 5HT3 receptor by clozapine may result in release of acetylcholine which then acts directly at the alpha-7 nicotinic receptor to enhance gating. To test this hypothesis, we gave 16 mg of oral ondansetron, a selective 5HT3 receptor antagonist, to 7 stable medicated schizophrenic outpatients in a double-blind placebo design. On two different days, the same subject had baseline auditory evoked responses recorded followed by either oral ondansetron or placebo. ERPs were recorded hourly for the next three hours. Ondansetron, but not placebo, resulted in a significant decrease in P50 ratio in these patients (Repeated measures ANOVA: F 5 21.44, d.f. 5 1, 12, p 5 0.001) that lasted significantly longer than nicotine treatment. These results support a possible role of 5HT3 antagonism in enhancing P50 gating by atypical antipsychotics.