The primary objective of this study is: • To determine the effects of ketamine, which blocks the ion-channel gated by the NMDA receptor, on performance of cognitive tasks and the extent to which these effects can be reversed by the dopamine receptor antagonist, risperidone. The secondary objectives of this study are: * To establish whether patients with schizophrenia are able to reliably complete the biomarker test battery and to assess whether their responses are similar to healthy volunteers treated with ketamine. * To establish a multi-site recruitment and assessment capacity based on shared Standard Operating Procedures across three study centres.
This study is a continuation from a previous study (P1V-SCH-CT01-07). The overall aim of the 2 studies is to identify and validate potential biomarker tasks that may be used to provide early indications into the use of new treatments for schizophrenia. The studies are considering two potential models for schizophrenia in healthy volunteers, the first model looks at high versus average schizotypy, schizotypy being a personality trait. The second model, explored in this study, is a ketamine infusion. Healthy volunteers will be identified through advertising and will initially be asked to complete an online questionnaire.Suitability for the next stage of the study will be based on the responses to the online questionnaire. Telephone interviews will then be conducted to assess suitability for screening.Screening visits will then be carried out in which a full medical and lab screening is undertaken. participants will also complete a number of psychiatric questionnaires and interviews. If participants remain suitable they will be invited to an assessment day in which they will be randomised to one of four study medication arms. Participants will then complete the biomarker tasks followed by questionnaires, rating scales and interviews. Patients with schizophrenia will form the 5th study arm and will not receive medication. They will complete the biomarkers in the same way as healthy volunteers.87 participants are planned, 72 healthy volunteers, 15 patients with schizophrenia. This study does not test any investigational medicinal product (IMP) so any ethical issues that are associated with introducing a participant to a study drug are not applicable in this study. Ketamine is already a widely used anaesthetic agent but when given at sub-anaesthetic doses is a useful tool for modelling schizophrenia psychosis. The current study aims to assess the sensitivity of a battery of biomarker tasks (biomarkers are measures of processes that go wrong in illnesses and that contribute to symptoms) to the cognitive deficits induced by ketamine. It may in future be possible to evaluate the effects of novel treatment for schizophrenia in healthy volunteers using this model, which would then potentially provide a rapid indication of the potential efficacy of candidate compounds at an early phase of drug development . The study will provide information about the sensitivity of the biomarker tasks in detecting the effects of the pharmacological treatments for schizophrenia in healthy volunteers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
QUADRUPLE
Enrollment
87
ketamine infusion to achieve plasma concentrations of 100 ng/mL. Duration approximately 3 hours
risperidone (2 mg) capsule. One dosing of 2 mg.
saline infusion. Duration approximately 3 hours
placebo capsule to match risperidone 2 mg capsule
Institute of Psychiatry, King's College London
London, Greater London, United Kingdom
University of Manchester (Dept of Neuropyschiatry)
Manchester, Manchester, United Kingdom
School of Psychology, University of Cardiff
Cardiff, United Kingdom
Biconditional learning task
Accuracy (% correct) for simple and biconditional learning trials, averaged over 8 blocks
Time frame: 6 months
Eye movement task
1. Antisaccade error rate. 2. Antisaccade correction rate. 3. Antisaccade latency. 4. Antisaccade amplitude gain. 5. Antisaccade peak velocity. 6. Prosaccade error rate. 7. Prosaccade correction rate. 8. Prosaccade latency. 9. Prosaccade amplitude gain. 10. Prosaccade peak velocity. 11. Smooth pursuit gain at three different target speeds. 12. Smooth pursuit saccadic frequency at three different target speeds.
Time frame: 6 months
Salience Attribution task
1. Implicit aberrant salience (ms). 2. i. Overall reaction time b.ii. Implicit adaptive salience (ms). c. Explicit adaptive salience (mm). d. Explicit aberrant salience (mm). e. Commission errors. f. Omission errors.
Time frame: 6 months
Signal detection task
1. d׳ value 2. Hits, when participants respond positively and a voice is present. 3. False alarm rate. 4. β value.
Time frame: 6 months
N-Back
1. Correct responses across three levels of difficulty. 2. Percentage of overall responses that was correct. 3. Errors of omission. 4. Errors of commission.
Time frame: 6 months
Spatial working memory
1. Between search error rate - errors due to a participant returning to a treasure chest which had previously contained some treasure on an earlier trial within the same block. 2. Within search error rate - errors due to a participant returning to the same treasure chest more than once within a trial. 3. Average time to complete each difficulty level
Time frame: 6 months
Verbal Fluency
1. Number of words generated. 2. Number of repetition errors: When the same word is repeated more than once within the letter or category. 3. Number of set loss errors: These are: i.) Words that start with a letter which do not fit the trial; ii.) Words which are names of people or places or numbers; iii.) Grammatical variants of an already stated word; and iv.) Non-words.
Time frame: 6 months
Event-related potentials (Manchester EEG pilot study only)
1. Amplitude and latencies of the positive peak in the 80-160 ms range (P1) and the negative peak in the 160 - 250 ms range (N1) for the Kanitsa and non-Kanitsa conditions. 2. Evoked gamma (30-100 Hz) and beta (14-30 Hz) oscillations in the 30 - 350 ms range to the Kanitsa condition. 3. Evoked alpha (8-12 Hz) and theta (4-8 Hz) oscillations in the 30-500 ms range to both conditions. 4. Coherence within and between frontal and occipital electrodes in the 100 - 400 ms range
Time frame: 6 months
Questionnaires and assessment scale scores
1. CADSS. 2. BPRS. 3. Effects of Drug Rating Scale.
Time frame: 6 months
Pharmacogenomic analysis
An exploratory genetic analysis aiming to correlate any genetic polymorphisms associated with schizotypy, schizophrenia or brain development with study outcomes.
Time frame: 12 months
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