Effects of ketamine and midazolam on resting state connectivity and comparison with ENIGMA connectivity deficit patterns in schizophrenia

  • Bhim M. Adhikari
    Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine Baltimore Maryland
  • Juergen Dukart
    F. Hoffmann‐La Roche, Pharma Research Early Development Roche Innovation Centre Basel Basel Switzerland
  • Joerg F. Hipp
    F. Hoffmann‐La Roche, Pharma Research Early Development Roche Innovation Centre Basel Basel Switzerland
  • Anna Forsyth
    School of Pharmacy, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
  • Rebecca McMillan
    School of Pharmacy, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
  • Suresh D. Muthukumaraswamy
    School of Pharmacy, Faculty of Medical and Health Sciences The University of Auckland Auckland New Zealand
  • Meghann C. Ryan
    Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine Baltimore Maryland
  • L. Elliot Hong
    Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine Baltimore Maryland
  • Simon B. Eickhoff
    Institute of Neuroscience and Medicine, Brain & Behaviour (INM‐7) Research Centre Jülich Jülich Germany
  • Neda Jahandshad
    Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine University of Southern California Marina del Rey California
  • Paul M. Thompson
    Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine University of Southern California Marina del Rey California
  • Laura M. Rowland
    Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine Baltimore Maryland
  • Peter Kochunov
    Maryland Psychiatric Research Center, Department of Psychiatry University of Maryland School of Medicine Baltimore Maryland

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<jats:title>Abstract</jats:title><jats:p>Subanesthetic administration of ketamine is a pharmacological model to elicit positive and negative symptoms of psychosis in healthy volunteers. We used resting‐state pharmacological functional MRI (rsPhfMRI) to identify cerebral networks affected by ketamine and compared them to the functional connectivity (FC) in schizophrenia. Ketamine can produce sedation and we contrasted its effects with the effects of the anxiolytic drug midazolam. Thirty healthy male volunteers (age = 19–37 years) underwent a randomized, three‐way, cross‐over study consisting of three imaging sessions, with 48 hr between sessions. A session consisted of a control period followed by infusion of placebo or ketamine or midazolam. The ENIGMA rsfMRI pipeline was used to derive two long‐distance (seed‐based and dual‐regression) and one local (regional homogeneity, ReHo) FC measures. Ketamine induced significant reductions in the connectivity of the salience network (Cohen's <jats:italic>d</jats:italic>: 1.13 ± 0.28, <jats:italic>p</jats:italic> = 4.0 <jats:bold>×</jats:bold> 10<jats:sup>−3</jats:sup>), auditory network (<jats:italic>d</jats:italic>: 0.67 ± 0.26, <jats:italic>p</jats:italic> = .04) and default mode network (DMN, <jats:italic>d</jats:italic>: 0.63 ± 0.26, <jats:italic>p</jats:italic> = .05). Midazolam significantly reduced connectivity in the DMN (<jats:italic>d</jats:italic>: 0.77 ± 0.27, <jats:italic>p</jats:italic> = .03). The effect sizes for ketamine for resting networks showed a positive correlation (<jats:italic>r</jats:italic> = .59, <jats:italic>p</jats:italic> = .07) with the effect sizes for schizophrenia‐related deficits derived from ENIGMA's study of 261 patients and 327 controls. Effect sizes for midazolam were not correlated with the schizophrenia pattern (<jats:italic>r</jats:italic> = −.17, <jats:italic>p</jats:italic> = .65). The subtraction of ketamine and midazolam patterns showed a significant positive correlation with the pattern of schizophrenia deficits (<jats:italic>r</jats:italic> = .68, <jats:italic>p</jats:italic> = .03). RsPhfMRI reliably detected the shared and divergent pharmacological actions of ketamine and midazolam on cerebral networks. The pattern of disconnectivity produced by ketamine was positively correlated with the pattern of connectivity deficits observed in schizophrenia, suggesting a brain functional basis for previously poorly understood effects of the drug.</jats:p>

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