Chronic administration of ketamine mimics the perturbed sense of body ownership associated with schizophrenia

Abstract

Rationale

Subanaesthetic ketamine infusion in healthy volunteers induces experiences redolent of early psychosis, including changes in the experience of one’s own body. It is not clear, however, whether repeated self-administration of ketamine has a sustained effect on body representation that is comparable to that found during acute administration.

Objectives

We sought to establish whether chronic ketamine use resulted in disturbances to sense of body ownership.

Methods

Following on from our work on the effects of acute ketamine infusion, we used the rubber hand illusion (RHI) to experimentally manipulate the sense of body ownership in chronic ketamine users, compared to healthy controls.

Results

Chronic ketamine users experienced the RHI more strongly and reported more body-image aberrations, even though they had not recently taken the drug.

Conclusions

These findings suggest that the chronic ketamine model for psychosis models more long-lasting changes in sense of ownership, perhaps more akin to schizophrenia.

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References

  1. Adler CM, Goldberg TE, Malhotra AK, Pickar D, Breier A (1998) Effects of ketamine on thought disorder, working memory, and semantic memory in healthy volunteers. Biol Psychiatry 43:811–816

    Article  CAS  PubMed  Google Scholar 

  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR), 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  3. Başar E (2013) A review of gamma oscillations in healthy subjects and in cognitive impairment. Int J Psychophysiol 90(2):99–117

    Article  PubMed  Google Scholar 

  4. Behrendt RP (2003) Hallucinations: synchronisation of thalamocortical gamma oscillations underconstrained by sensory input. Conscious Cogn 12(3):413–451

    Article  CAS  PubMed  Google Scholar 

  5. Behrendt RP, Young C (2004) Hallucinations in schizophrenia, sensory impairment, and brain disease: a unifying model. Behav Brain Sci 27(6):771–787

    PubMed  Google Scholar 

  6. Bosman CA, Lansink CS, Pennartz CM (2014) Functions of gamma-band synchronization in cognition: from single circuits to functional diversity across cortical and subcortical systems. Eur J Neurosci 39(11):1982–1999

    Article  PubMed  Google Scholar 

  7. Botvinick M, Cohen J (1998) Rubber hands ‘feel’ touch that eyes see. Nature 391:756

    Article  CAS  PubMed  Google Scholar 

  8. Bremner JD, Krystal JH, Putnam FW, Southwick SM, Marmar C, Charney DS, Mazure CM (1998) Measurement of dissociative states with the clinician-administered dissociative states scale (CADSS). J Trauma Stress 11:125–136

    Article  CAS  PubMed  Google Scholar 

  9. Chapman LJ, Chapman JP, Raulin ML (1978) Body-image aberration in Schizophrenia. J Abnorm Psychol 87:399–407

    Article  CAS  PubMed  Google Scholar 

  10. Corlett PR, Honey GD, Fletcher PC (2007) From prediction error to psychosis: ketamine as a pharmacological model of delusions. J Psychopharmacol 21:238–252

    Article  CAS  PubMed  Google Scholar 

  11. Corlett PR, Honey GD, Krystal JH, Fletcher PC (2011) Glutamatergic model psychoses: prediction error, learning, and inference. Neuropsychopharmacology 36:294–315

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Costantini M, Haggard P (2007) The rubber hand illusion: sensitivity and reference frame for body ownership. Conscious Cogn 16:229–240

    Article  PubMed  Google Scholar 

  13. Coull JT, Morgan H, Cambridge VC, Moore JW, Giorlando F, Adapa R, Corlett PR, Fletcher PC (2011) Ketamine perturbs perception of the flow of time in healthy volunteers. Psychopharmacology (Berlin) 218:543–556

    Article  CAS  Google Scholar 

  14. Curran HV, Monaghan L (2001) In and out of the K-hole: a comparison of the acute and residual effects of ketamine in frequent and infrequent ketamine users. Addiction 96:749–760

    Article  CAS  PubMed  Google Scholar 

  15. Curran HV, Morgan C (2000) Cognitive, dissociative and psychotogenic effects of ketamine in recreational users on the night of drug use and 3 days later. Addiction 95:575–590

    Article  CAS  PubMed  Google Scholar 

  16. D’Souza DC, Ahn K, Bhakta S, Elander J, Singh N, Nadim H, Jatlow P, Suckow RF, Pittman B, Ranganathan M (2012) Nicotine fails to attenuate ketamine-induced cognitive deficits and negative and positive symptoms in humans: implications for schizophrenia. Biol Psychiatry 72(9):785–794

    Article  PubMed  Google Scholar 

  17. Deroza PF, Ghedim FV, Heylmann AS, de Luca RD, Budni J, Souza RP, Quevedo J, Zugno AI (2012) Effect of cigarette smoke exposure in the behavioral changes induced by ketamine. Schizophr Res 141(1):104–105

    Article  PubMed  Google Scholar 

  18. Díez A, Suazo V, Casado P, Martín-Loeches M, Perea MV, Molina V (2014) Frontal gamma noise power and cognitive domains in schizophrenia. Psychiatry Res 221(1):104–113

    Article  PubMed  Google Scholar 

  19. Duncan EJ, Madonick SH, Parwani A, Angrist B, Rajan R, Chakravorty S, Efferen TR, Szilagyi S, Stephanides M, Chappell PB, Gonzenbach S, Ko GN, Rotrosen JP (2001) Clinical and sensorimotor gating effects of ketamine in normals. Neuropsychopharmacology 25:72–83

    Article  CAS  PubMed  Google Scholar 

  20. Eckblad M, Chapman LJ (1983) Magical ideation as an indicator of schizotypy. J Consult Clin Psychol 51:215–225

    Article  CAS  PubMed  Google Scholar 

  21. Foucher JR, Lacambre M, Pham BT, Giersch A, Elliott MA (2007) Low time resolution in schizophrenia lengthened windows of simultaneity for visual, auditory and bimodal stimuli. Schizophr Res 97:118–127

    Article  CAS  PubMed  Google Scholar 

  22. Germine L, Benson TL, Cohen F, Hooker CI (2013) Psychosis-proneness and the rubber hand illusion of body ownership. Psychiatry Res 207:45–52

    Article  PubMed  Google Scholar 

  23. Hipp JF, Engel AK, Siegel M (2011) Oscillatory synchronization in large-scale cortical networks predicts perception. Neuron 69(2):387–396

    Article  CAS  PubMed  Google Scholar 

  24. Honey RA, Turner DC, Honey GD, Sharar SR, Kumaran D, Pomarol-Clotet E, McKenna P, Sahakian BJ, Robbins TW, Fletcher PC (2003) Subdissociative dose ketamine produces a deficit in manipulation but not maintenance of the contents of working memory. Neuropsychopharmacology 28:2037–2044

    Article  CAS  PubMed  Google Scholar 

  25. Honey RA, Honey GD, O’Loughlin C, Sharar SR, Kumaran D, Bullmore ET, Menon DK, Donovan T, Lupson VC, Bisbrown-Chippendale R, Fletcher PC (2004) Acute ketamine administration alters the brain responses to executive demands in a verbal working memory task: an FMRI study. Neuropsychopharmacology 29:1203–1214

    Article  CAS  PubMed  Google Scholar 

  26. Honey GD, Honey RA, Sharar SR, Turner DC, Pomarol-Clotet E, Kumaran D, Simons JS, Hu X, Rugg MD, Bullmore ET, Fletcher PC (2005) Impairment of specific episodic memory processes by sub-psychotic doses of ketamine: the effects of levels of processing at encoding and of the subsequent retrieval task. Psychopharmacology (Berlin) 181:445–457

    Article  CAS  Google Scholar 

  27. Honey GD, O’Loughlin C, Turner DC, Pomarol-Clotet E, Corlett PR, Fletcher PC (2006) The effects of a subpsychotic dose of ketamine on recognition and source memory for agency: implications for pharmacological modelling of core symptoms of schizophrenia. Neuropsychopharmacology 31:413–423

    Article  CAS  PubMed  Google Scholar 

  28. Hong LE, Summerfelt A, Buchanan RW, O’Donnell P, Thaker GK, Weiler MA, Lahti AC (2010) Gamma and delta neural oscillations and association with clinical symptoms under subanesthetic ketamine. Neuropsychopharmacology 35:632–640

    Article  PubMed Central  PubMed  Google Scholar 

  29. Javitt DC, Zukin SR (1991) Recent advances in the phencyclidine model of schizophrenia. Am J Psychiatry 148:1301–1308

    Article  CAS  PubMed  Google Scholar 

  30. Kanayama N, Sato A, Ohira H (2007) Crossmodal effect with rubber hand illusion and gamma-band activity. Psychophysiology 44:392–402

    Article  PubMed  Google Scholar 

  31. Kanayama N, Sato A, Ohira H (2009) The role of gamma band oscillations and synchrony on rubber hand illusion and crossmodal integration. Brain Cogn 69:19–29

    Article  PubMed  Google Scholar 

  32. Knott V, Shah D, Millar A, McIntosh J, Fisher D, Blais C, Ilivitsky V (2012) Nicotine, auditory sensory memory, and sustained attention in a human ketamine model of schizophrenia: moderating influence of a hallucinatory trait. Front Pharmacol 3:172

    Article  PubMed Central  PubMed  Google Scholar 

  33. Kocsis B, Brown RE, McCarley RW, Hajos M (2013) Impact of ketamine on neuronal network dynamics: translational modeling of schizophrenia-relevant deficits. CNS Neurosci Ther 19(6):437–447

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Krystal JH, Karper LP, Seibyl JP, Freeman GK, Delaney R, Bremner JD, Heninger GR, Bowers MB Jr, Charney DS (1994) Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, in humans. Psychotomimetic, perceptual, cognitive, and neuroendocrine responses. Arch Gen Psychiatry 51:199–214

    Article  CAS  PubMed  Google Scholar 

  35. Krystal JH, Bennett A, Abi-Saab D, Belger A, Karper LP, D’Souza DC, Lipschitz D, Abi-Dargham A, Charney DS (2000) Dissociation of ketamine effects on rule acquisition and rule implementation: possible relevance to NMDA receptor contributions to executive cognitive functions. Biol Psychiatry 47:137–143

    Article  CAS  PubMed  Google Scholar 

  36. Longo MR, Schuur F, Kammers MP, Tsakiris M, Haggard P (2008) What is embodiment? A psychometric approach. Cognition 107:978–998

    Article  PubMed  Google Scholar 

  37. Malhotra AK, Pinals DA, Weingartner H, Sirocco K, Missar CD, Pickar D, Breier A (1996) NMDA receptor function and human cognition: the effects of ketamine in healthy volunteers. Neuropsychopharmacology 14:301–307

    Article  CAS  PubMed  Google Scholar 

  38. Mathalon DH, Ahn KH, Perry EB Jr, Cho HS, Roach BJ, Blais RK, Bhakta S, Ranganathan M, Ford JM, D’Souza DC (2014) Effects of nicotine on the neurophysiological and behavioral effects of ketamine in humans. Front Psychiatry 5:3

    Article  PubMed Central  PubMed  Google Scholar 

  39. Moore JW, Turner DC, Corlett PR, Arana FS, Morgan HL, Absalom AR, Adapa R, de WS, Everitt JC, Gardner JM, Pigott JS, Haggard P, Fletcher PC (2011) Ketamine administration in healthy volunteers reproduces aberrant agency experiences associated with schizophrenia. Cogn Neuropsychiatry 16:364–81

  40. Moore JW, Cambridge VC, Morgan H, Giorlando F, Adapa R, Fletcher PC (2013) Time, action and psychosis: using subjective time to investigate the effects of ketamine on sense of agency. Neuropsychologia 51:377–384

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Moratti S, Méndez-Bértolo C, Del-Pozo F, Strange BA (2014) Dynamic gamma frequency feedback coupling between higher and lower order visual cortices underlies perceptual completion in humans. J Neuroimaging 86:470–479

    Article  CAS  Google Scholar 

  42. Morgan CJ, Curran HV (2012) Ketamine use: a review. Addiction 107:27–38

    Article  PubMed  Google Scholar 

  43. Morgan CJ, Monaghan L, Curran HV (2004a) Beyond the K-hole: a 3-year longitudinal investigation of the cognitive and subjective effects of ketamine in recreational users who have substantially reduced their use of the drug. Addiction 99:1450–1461

    Article  PubMed  Google Scholar 

  44. Morgan CJ, Riccelli M, Maitland CH, Curran HV (2004b) Long-term effects of ketamine: evidence for a persisting impairment of source memory in recreational users. Drug Alcohol Depend 75:301–308

    Article  CAS  PubMed  Google Scholar 

  45. Morgan CJ, Muetzelfeldt L, Curran HV (2010) Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study. Addiction 105:121–133

    Article  PubMed  Google Scholar 

  46. Morgan HL, Turner DC, Corlett PR, Absalom AR, Adapa R, Arana FS, Pigott J, Gardner J, Everitt J, Haggard P, Fletcher PC (2011) Exploring the impact of ketamine on the experience of illusory body ownership. Biol Psychiatry 69:35–41

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Newcomer JW, Krystal JH (2001) NMDA receptor regulation of memory and behavior in humans. Hippocampus 11:529–542

    Article  CAS  PubMed  Google Scholar 

  48. Overall JE, Klett CJ (1972) Applied multivariate analysis. McGraw Hill, New York

    Google Scholar 

  49. Oye I, Paulsen O, Maurset A (1992) Effects of ketamine on sensory perception: evidence for a role of N-methyl-D-aspartate receptors. J Pharmacol Exp Ther 260:1209–1213

    CAS  PubMed  Google Scholar 

  50. Pavani F, Spence C, Driver J (2000) Visual capture of touch: out-of-the-body experiences with rubber gloves. Psychol Sci 11:353–359

    Article  CAS  PubMed  Google Scholar 

  51. Peled A, Ritsner M, Hirschmann S, Geva AB, Modai I (2000) Touch feel illusion in schizophrenic patients. Biol Psychiatry 48:1105–1108

    Article  CAS  PubMed  Google Scholar 

  52. Peled A, Pressman A, Geva AB, Modai I (2003) Somatosensory evoked potentials during a rubber-hand illusion in schizophrenia. Schizophr Res 64:157–163

    Article  PubMed  Google Scholar 

  53. Perez VB, Roach BJ, Woods SW, Srihari VH, McGlashan TH, Ford JM, Mathalon DH (2013) Early auditory gamma-band responses in patients at clinical high risk for schizophrenia. Suppl Clin Neurophysiol 62:147–162

    Article  PubMed Central  PubMed  Google Scholar 

  54. Peters E, Joseph S, Day S, Garety P (2004) Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). Schizophr Bull 30:1005–1022

    Article  PubMed  Google Scholar 

  55. Pomarol-Clotet E, Honey GD, Murray GK, Corlett PR, Absalom AR, Lee M, McKenna PJ, Bullmore ET, Fletcher PC (2006) Psychological effects of ketamine in healthy volunteers. Phenomenological study. Br J Psychiatry 189:173–179

    Article  CAS  PubMed  Google Scholar 

  56. Rowland LM, Bustillo JR, Mullins PG, Jung RE, Lenroot R, Landgraf E, Barrow R, Yeo R, Lauriello J, Brooks WM (2005) Effects of ketamine on anterior cingulate glutamate metabolism in healthy humans: a 4-T proton MRS study. Am J Psychiatry 162:394–396

    Article  PubMed  Google Scholar 

  57. Stone JM, Pilowsky LS (2006) Psychopathological consequences of ketamine. Br J Psychiatry 189:565–566

    Article  CAS  PubMed  Google Scholar 

  58. Stone JM, Erlandsson K, Arstad E, Bressan RA, Squassante L, Teneggi V, Ell PJ, Pilowsky LS (2006) Ketamine displaces the novel NMDA receptor SPET probe [(123) I] CNS-1261 in humans in vivo. Nucl Med Biol 33:239–243

    Article  CAS  PubMed  Google Scholar 

  59. Tan HR, Lana L, Uhlhaas PJ (2013) High-frequency neural oscillations and visual processing deficits in schizophrenia. Front Psychol 4:621

    Article  PubMed Central  PubMed  Google Scholar 

  60. Thakkar KN, Nichols HS, McIntosh LG, Park S (2011) Disturbances in body ownership in schizophrenia: evidence from the rubber hand illusion and case study of a spontaneous out-of-body experience. PLoS One 6:e27089

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Tsakiris M (2010) My body in the brain: a neurocognitive model of body-ownership. Neuropsychologia 48:703–712

    Article  PubMed  Google Scholar 

  62. Tsakiris M, Haggard P (2005) The rubber hand illusion revisited: visuotactile integration and self-attribution. J Exp Psychol Hum Percept Perform 31:80–91

    Article  PubMed  Google Scholar 

  63. Uhlhaas PJ, Millard I, Muetzelfeldt L, Curran HV, Morgan CJ (2007) Perceptual organization in ketamine users: preliminary evidence of deficits on night of drug use but not 3 days later. J Psychopharmacol 21:347–352

    Article  CAS  PubMed  Google Scholar 

  64. Vollenweider FX, Leenders KL, Oye I, Hell D, Angst J (1997a) Differential psychopathology and patterns of cerebral glucose utilisation produced by (S)- and (R)-ketamine in healthy volunteers using positron emission tomography (PET). Eur Neuropsychopharmacol 7:25–38

    Article  CAS  PubMed  Google Scholar 

  65. Vollenweider FX, Leenders KL, Scharfetter C, Antonini A, Maguire P, Missimer J, Angst J (1997b) Metabolic hyperfrontality and psychopathology in the ketamine model of psychosis using positron emission tomography (PET) and [18 F] fluorodeoxyglucose (FDG). Eur Neuropsychopharmacol 7:9–24

    Article  CAS  PubMed  Google Scholar 

  66. Wilkins LK, Girard TA, Cheyne JA (2011) Ketamine as a primary predictor of out-of-body experiences associated with multiple substance use. Conscious Cogn 20:943–950

    Article  PubMed  Google Scholar 

  67. Wilkins LK, Girard TA, Cheyne JA (2012) Anomalous bodily-self experiences among recreational ketamine users. Cogn Neuropsychiatry 17:415–430

    Article  PubMed  Google Scholar 

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Financial disclosures

This study was supported by the Natural Science Foundation of China (Grant No. 30900486 and 81371480 to J.T., 81100996 to Y.L., 81471361 and 81271484 to X.C., 81271499 to Y.T., 81130020 to W.H.), the National Key Basic Research and Development Program (973) (Grant No. 2012CB517904 to X.C., 2009CB522007 to W.H.), Doctoral Fund of the Ministry of Education of China (20100162110046 to W.H.). Philip Corlett reports receiving research support from Astra Zeneca Pharmaceuticals, LP, and consulting for Pfizer Pharmaceuticals and Janssen Pharmaceuticals. His contribution was made possible by the Connecticut Mental Health Center as well as the Department of Mental Health and Addiction Services. He is supported by CTSA Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Science (NCATS), components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Paul Fletcher was funded by the Wellcome Trust and the Bernard Wolfe Health Neuroscience Fund. Paul Fletcher reports receiving consultancy fees from GlaxoSmithKline and an honorarium for a lecture from Astra Zeneca. However, the funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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The authors declare no conflict of interest.

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Correspondence to Paul C. Fletcher or Xiaogang Chen.

Additional information

Jinsong Tang and Hannah L. Morgan contributed equally to this work.

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Tang, J., Morgan, H.L., Liao, Y. et al. Chronic administration of ketamine mimics the perturbed sense of body ownership associated with schizophrenia. Psychopharmacology 232, 1515–1526 (2015). https://doi.org/10.1007/s00213-014-3782-0

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Keywords

  • N-methyl-d-aspartate (NMDA)
  • Body ownership
  • Rubber hand illusion
  • Ketamine
  • Psychosis