Mesocortical pathway

As with many neurons (e.g. NA) there are presynaptic autoreceptors on the terminals of dopamine neurons whose activation attenuate DA release. Although most of these receptors appear to be of the D2 type, as found postsynaptically, D3 receptors are also found. It is possible that in addition to the short-term control of transmitter release they may also be linked directly to the control of the synthesising enzyme tyrosine hydroxylase. It seems that autoreceptors are more common on the terminals of nerves in the nigrostriatal (and possibly mesolimbic) than mesocortical pathway. 

Initiation of behaviour Mesolimbic pathway to nucleus accumbens from VTA (AIO) Mesocortical pathways to prefrontal cortex from VTA (AIO) Animals Increases locomotor activity and intracranial self-stimulation Humans Hallucinations, psychoses (reward, reinforcement) Animals Decreases activity and self-stimulation Humans Reduces positive symptoms of schizophrenia D2 ... 

The mechanism by which 5-HT2 antagonism could ameliorate schizophrenic symptoms and what effect 5-HT has on mesolimbic and mesocortical pathways through A10 neurons is even less certain. It is more likely that 5-HT s action occurs postsynaptically in the limbic system or PFC. The probability that neuroleptics benefit from a particular balance of DA and 5-HT2A antagonism is developed later. 

In this regard, considerable evidence shows that PCP increases dopaminergic transmission in the striatum (Johnson 1983) and, more recently, evidence indicates that DA function is increased in the mesolimbic and mesocortical pathways as well. For example, PCP administration has been shown to inhibit the firing of cells found in the ventral tegmental area (Freeman and Bunney 1984) similar to that observed in the substantia nigra (Raja and Guyenet 1980). 

In contrast, it is often hypothesized that the negative symptoms of schizophrenia are a result of decreased activity of the mesocortical dopamine pathway. Unfortunately, dopamine blocking by typical antipsychotics in the mesocortical pathway does not improve the negative symptoms, and may even worsen them. 

The Four Dopamine Pathways. There are four major dopamine circuits in the mammalian brain. They are known as the mesolimbic, mesocortical, tuberoinfun-dibnlar, and nigroneostriatal pathways. The mesolimbic pathway arises in the midbrain and projects to the so-called limbic structures. The mesocortical pathway arises in the midbrain and projects to frontal and temporal areas of the brain s cerebral cortex. 

Underactivity of dopamine in mesocortical pathways, specifically those projecting to the frontal lobes, may account for the negative symptoms of schizophrenia (e.g., anergia, apathy, lack of spontaneity) (Davis et al. 1991 Goff and Evins 1998). In addition, this underactivity in the frontal lobes may serve to disinhibit mesolimbic dopamine activity via a corticolimbic feedback loop. Overactivity of mesolimbic dopamine is the result, which manifests as the positive symptoms of schizophrenia (e.g., hallucinations, delusions). 

Dopaminergic neuromodulatory system. The neurons that synthesize dopamine (structural formula in box) are found in the midbrain, from which they project to the limbic system (the mesolimbic pathway), the cerebral cortex (the mesocortical pathway), as well as to the extrapyramidal motor system (the nigrostriatal pathway). 

The Mesocortical Pathway and the Pharmacology of Improved Negative Symptoms... 

There are four main neuronal systems in the brain in which dopamine is a transmitter the basal nuclei the hypothalamic-pituitary pathway and the mesolimbic and mesocortical pathways (see Figure 11.3). 

The mesolimbic and mesocortical pathways are dopamine-containing neurones that run from an area in the midbrain called the ventral tegmentum to the limbic system and the prefrontal area of the cerebral cortex respectively. These are areas of the brain that are normally involved in behavioural and emotional functions. 

It is thought that there is an abnormality of dopamine receptors or increased release of dopamine in the mesolimbic and mesocortical pathways in schizophrenics. However, no reproducible changes in dopaminergic systems have been found in schizophrenia and the abnormality may be in another system that is somehow linked to dopaminergic neurones. More recently, it has been suggested that schizophrenia may be a developmental disorder of the prefrontal cortex where there is actually a deficiency of dopamine, which leaves dopamine activity in the mesolimbic pathway unbalanced. 

Schizophrenia is the most common psychotic disorder. It may be due to an abnormality of dopamine receptors or increased release of dopamine in particular regions of the brain, the mesolimbic and mesocortical pathways. In addition, there may be an abnormality of serotonin pathways that interact with dopamine. Most drugs effective in the treatment of schizophrenia block dopamine receptors and some of the newer ones block serotonin receptors. Adverse effects of antipsychotics can be severe and are largely due to the blocking of dopamine receptors in other parts of the brain. For example Parkinsonism and tardive dyskinesia are the result of dopamine receptor blocking in the basal nuclei. 

Decreased dopaminergic transmission is the mesocortical pathway (from the VTA to the prefrontal cortex)... 

Mesolimbic and mesocortical. These are dopaminergic neurons that project from the ventral tegmental area (VTA) to frontal and other cortical areas (mesocortical pathway) and to limbic structures such as the nucleus accumbens, the amygdala, and the olfactory tubercle (mesolimbic pathway). It is assumed that in schizophrenia, there is increased dopaminergic neurotransmission in the mesolimbic pathway and decreased transmission in the mesocortical region (see Section 4.1 for details). 

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