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Dorsal raphe neurons integrate the values of reward amount, delay, and uncertainty in multi-attribute decision-making

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... The neuromodulators dopamine (DA) and serotonin (5-hydroxytryptamine; 5HT) powerfully regulate associative learning [1][2][3][4][5][6][7][8] . Similarities in the activity and connectivity of these neuromodulatory systems have inspired competing models of how DA and 5HT interact to drive the formation of new associations [9][10][11][12][13][14] . However, these hypotheses have not been tested directly because it has not been possible to interrogate and manipulate multiple neuromodulatory systems in a single subject. ...
... Historically, two contradictory hypotheses about the roles of DA and 5HT in associative learning have been debated. The synergy hypothesis posits that DA and 5HT signals carry information about reward expectation on short and long timescales, respectively 9,12,14 , thereby synthesizing theories about the function of DA in temporal-difference learning [21][22][23] and the role of 5HT in regulating mood 24,25 . The opponency hypothesis proposes that DA invigorates 26,27 and 5HT suppresses 28,29 behavioural activation to optimize reward seeking with respect to cognitive flexibility 30 , intertemporal choice trade-offs 29,[31][32][33] or under the threat of punishment 10,11,34,35 , such that imbalances between these processes could lead to compulsion and addiction 36,37 . ...
... This finding is consistent with previous work showing that inhibition of 5HT signalling, both systemically 37 and in the dorsal striatum 36 , potentiates the reinforcing properties of a cocaine reward, and with long-standing studies showing that 5HT-releasing drugs dampen the reinforcing potency of amphetamines 56,57 . Nevertheless, our experiments cannot formally exclude the possibility that slow fluctuations in tonic levels of DA and 5HT may also carry information about reward expectation or value 12,14,26 , as proposed by some synergy theories. ...
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The neuromodulators dopamine (DA) and serotonin (5-hydroxytryptamine; 5HT) powerfully regulate associative learning1, 2, 3, 4, 5, 6, 7–8. Similarities in the activity and connectivity of these neuromodulatory systems have inspired competing models of how DA and 5HT interact to drive the formation of new associations9, 10, 11, 12, 13–14. However, these hypotheses have not been tested directly because it has not been possible to interrogate and manipulate multiple neuromodulatory systems in a single subject. Here we establish a mouse model that enables simultaneous genetic access to the brain’s DA and 5HT neurons. Anterograde tracing revealed the nucleus accumbens (NAc) to be a putative hotspot for the integration of convergent DA and 5HT signals. Simultaneous recording of DA and 5HT axon activity, together with genetically encoded DA and 5HT sensor recordings, revealed that rewards increase DA signalling and decrease 5HT signalling in the NAc. Optogenetically dampening DA or 5HT reward responses individually produced modest behavioural deficits in an appetitive conditioning task, while blunting both signals together profoundly disrupted learning and reinforcement. Optogenetically reproducing DA and 5HT reward responses together was sufficient to drive the acquisition of new associations and supported reinforcement more potently than either manipulation did alone. Together, these results demonstrate that striatal DA and 5HT signals shape learning by exerting opponent control of reinforcement.
... Merging ideas from reinforcement learning theory 6 with recent insights into the filtering properties of the dorsal raphe nucleus 7 , here we find a unifying perspective in a prospective code for value. This biological code for near-future reward explains why serotonin neurons are activated by both rewards and punishments 3,4,[8][9][10][11][12][13] , and why these neurons are more strongly activated by surprising rewards but have no such surprise preference for punishments 3,9 -observations that previous theories have failed to reconcile. Finally, our model quantitatively predicts in vivo population activity better than previous theories. ...
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The in vivo responses of dorsal raphe nucleus serotonin neurons to emotionally salient stimuli are a puzzle¹. Existing theories centring on reward², surprise³, salience⁴ and uncertainty⁵ individually account for some aspects of serotonergic activity but not others. Merging ideas from reinforcement learning theory⁶ with recent insights into the filtering properties of the dorsal raphe nucleus⁷, here we find a unifying perspective in a prospective code for value. This biological code for near-future reward explains why serotonin neurons are activated by both rewards and punishments3,4,8, 9, 10, 11, 12–13, and why these neurons are more strongly activated by surprising rewards but have no such surprise preference for punishments3,9—observations that previous theories have failed to reconcile. Finally, our model quantitatively predicts in vivo population activity better than previous theories. By reconciling previous theories and establishing a precise connection with reinforcement learning, our work represents an important step towards understanding the role of serotonin in learning and behaviour.
... The serotonergic system dynamically interacts with the hippocampus to regulate reward-related information processing. DRN 5-HT neurons are responsible for encoding the reward signal by co-releasing 5-HT and glutamate [9,[123][124][125]; these neurons are selectively recruited by emotional stimuli rather than neutral stimuli, and subsequently, they activate the downstream ventral tegmental area but not the hippocampus [126]. Meanwhile, in vivo two-photon imaging has screened two distinct neuronal populations in the MRN that project to the hippocampus: one is associated with reward delivery and the other with locomotion, and stimulation of these hippocampal projection fibers modulates reward-induced behavior [127]. ...
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Subcortical innervation of the hippocampus by the raphe nucleus is essential for emotional and cognitive control. The two major afferents from raphe to hippocampus originate from serotonergic and glutamatergic neurons, of which the serotonergic control of hippocampal inhibitory network, theta activity, and synaptic plasticity have been extensively explored in the growing body of literature, whereas those of glutamatergic circuits have received little attention. Notably, both serotonergic and glutamatergic circuits between raphe and hippocampus are disrupted in Alzheimer’s disease (AD), which may contribute to initiation and progression of behavioral and psychological symptoms of dementia. Thus, deciphering the mechanism underlying abnormal raphe–hippocampal circuits in AD is crucial to prevent dementia-associated emotional and cognitive symptoms. In this review, we summarize the anatomical, neurochemical, and electrophysiological diversity of raphe nuclei as well as the architecture of raphe–hippocampal circuitry. We then elucidate subcortical control of hippocampal activity by raphe nuclei and their role in regulation of emotion and cognition. Additionally, we present an overview of disrupted raphe–hippocampal circuits in AD pathogenesis and analyze the available therapies that can potentially be used clinically to alleviate the neuropsychiatric symptoms and cognitive decline in AD course.
... ;https://doi.org/10.1101https://doi.org/10. /2024 effects reflect the subjective value of the anticipated reward, a signed or unsigned reward prediction error (i.e., discrepancy between expected and actual rewards), or some related quantity (Feng et al. 2024;Jordan 2024). This remains an intriguing question for future research. ...
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Subcortical nuclei of the ascending arousal system play an important role in regulating brain and cognition. However, functional MRI of these nuclei in humans involves unique challenges due to their size and location deep within the brain. Here, we used ultra-high-field MRI and other methodological advances to investigate the activity of six subcortical nuclei during reward anticipation and memory encoding: the locus coeruleus, basal forebrain, median and dorsal raphe nuclei, substantia nigra and ventral tegmental area. Participants performed a monetary incentive delay task, which successfully induced a state of reward anticipation, and a 24-hour delayed surprise memory test. Region-of-interest analyses revealed that activity in all subcortical nuclei increased in anticipation of potential rewards as opposed to neutral outcomes. In contrast, activity in none of the nuclei predicted memory performance 24 hours later. These findings provide new insights into the cognitive functions that are supported by the human ascending arousal system.
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Transient variations in pupil size (PS) under constant luminance are coupled to rapid changes in arousal state,1, 2, 3 which have been interpreted as vigilance,⁴ salience,⁵ or a surprise signal.6, 7, 8 Neural control of such fluctuations presumably involves multiple brain regions⁵,9, 10, 11 and neuromodulatory systems,³,¹²,¹³ but it is often associated with phasic activity of the noradrenergic system.⁹,¹²,¹⁴,¹⁵ Serotonin (5-HT), a neuromodulator also implicated in aspects of arousal¹⁶ such as sleep-wake transitions,¹⁷ motivational state regulation,¹⁸ and signaling of unexpected events,¹⁹ seems to affect PS,20, 21, 22, 23, 24 but these effects have not been investigated in detail. Here we show that phasic 5-HT neuron stimulation causes transient PS changes. We used optogenetic activation of 5-HT neurons in the dorsal raphe nucleus (DRN) of head-fixed mice performing a foraging task. 5-HT-driven modulations of PS were maintained throughout the photostimulation period and sustained for a few seconds after the end of stimulation. We found no evidence that the increase in PS with activation of 5-HT neurons resulted from interactions of photostimulation with behavioral variables, such as locomotion or licking. Furthermore, we observed that the effect of 5-HT on PS depended on the level of environmental uncertainty, consistent with the idea that 5-HT could report a surprise signal.¹⁹ These results advance our understanding of the neuromodulatory control of PS, revealing a tight relationship between phasic activation of 5-HT neurons and changes in PS.
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Individuals often assess past decisions by comparing what was gained with what would have been gained had they acted differently. Thoughts of past alternatives that counter what actually happened are called "counterfactuals." Recent theories emphasize the role of the prefrontal cortex in processing counterfactual outcomes in decision-making, although how subcortical regions contribute to this process remains to be elucidated. Here we report a clear distinction among the roles of the orbitofrontal cortex, ventral striatum and midbrain dopamine neurons in processing counterfactual outcomes in monkeys. Our findings suggest that actually gained and counterfactual outcome signals are both processed in the cortico-subcortical network constituted by these regions but in distinct manners and integrated only in the orbitofrontal cortex in a way to compare these outcomes. This study extends the prefrontal theory of counterfactual thinking and provides key insights regarding how the prefrontal cortex cooperates with subcortical regions to make decisions using counterfactual information.
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Background The nature of cognitive flexibility deficits in obsessive-compulsive disorder (OCD), which historically have been tested with probabilistic reversal learning tasks, remains elusive. Here, a novel deterministic reversal task and inclusion of unmedicated patients in the study sample illuminated the role of fixed versus uncertain rules/contingencies and of serotonergic medication. Additionally, our understanding of probabilistic reversal was enhanced through theoretical computational modeling of cognitive flexibility in OCD. Methods We recruited 49 patients with OCD, 21 of whom were unmedicated, and 43 healthy control participants matched for age, IQ, and gender. Participants were tested on 2 tasks: a novel visuomotor deterministic reversal learning task with 3 reversals (feedback rewarding/punishing/neutral) measuring accuracy/perseveration and a 2-choice visual probabilistic reversal learning task with uncertain feedback and a single reversal measuring win-stay and lose-shift. Bayesian computational modeling provided measures of learning rate, reinforcement sensitivity, and stimulus stickiness. Results Unmedicated patients with OCD were impaired on the deterministic reversal task under punishment only at the first and third reversals compared with both control participants and medicated patients with OCD, who had no deficit. Perseverative errors were correlated with OCD severity. On the probabilistic reversal task, unmedicated patients were only impaired at reversal, whereas medicated patients were impaired at both the learning and reversal stages. Computational modeling showed that the overall change was reduced feedback sensitivity in both OCD groups. Conclusions Both perseveration and increased shifting can be observed in OCD, depending on test conditions including the predictability of reinforcement. Perseveration was related to clinical severity and remediated by serotonergic medication.
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Realistic, everyday rewards contain multiple components, such as taste and size. However, our reward valuations and the associated neural reward signals are single dimensional (vector to scalar transformation). Here, we present a protocol to identify these single-dimensional neural responses for multi-component choice options in humans and monkeys using concept-based behavioral choice experiments. We describe the use of stringent economic concepts to develop and implement behavioral tasks. We detail regional neuroimaging in humans and fine-grained neurophysiology in monkeys and describe approaches for data analysis. For complete details on the use and execution of this protocol, please refer to our work on humans Seak et al.¹ and Pastor-Bernier et al.² and monkeys Pastor-Bernier et al. ³, Pastor-Bernier et al.⁴, and Pastor-Bernier et al.⁵.
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Serotonin influences many aspects of animal behavior. But how serotonin acts on its diverse receptors across the brain to modulate global activity and behavior is unknown. Here, we examine how serotonin release in C. elegans alters brain-wide activity to induce foraging behaviors, like slow locomotion and increased feeding. Comprehensive genetic analyses identify three core serotonin receptors (MOD-1, SER-4, and LGC-50) that induce slow locomotion upon serotonin release and others (SER-1, SER-5, and SER-7) that interact with them to modulate this behavior. SER-4 induces behavioral responses to sudden increases in serotonin release, whereas MOD-1 induces responses to persistent release. Whole-brain imaging reveals widespread serotonin-associated brain dynamics, spanning many behavioral networks. We map all sites of serotonin receptor expression in the connectome, which, together with synaptic connectivity, helps predict which neurons show serotonin-associated activity. These results reveal how serotonin acts at defined sites across a connectome to modulate brain-wide activity and behavior.
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Research in computational psychiatry is dominated by models of behavior. Subjective experience during behavioral tasks is not well understood, even though it should be relevant to understanding the symptoms of psychiatric disorders. Here, we bridge this gap and review recent progress in computational models for subjective feelings. For example, happiness reflects not how well people are doing, but whether they are doing better than expected. This dependence on recent reward prediction errors is intact in major depression, although depressive symptoms lower happiness during tasks. Uncertainty predicts subjective feelings of stress in volatile environments. Social prediction errors influence feelings of self-worth more in individuals with low self-esteem despite a reduced willingness to change beliefs due to social feedback. Measuring affective state during behavioral tasks provides a tool for understanding psychiatric symptoms that can be dissociable from behavior. When smartphone tasks are collected longitudinally, subjective feelings provide a potential means to bridge the gap between lab-based behavioral tasks and real-life behavior, emotion, and psychiatric symptoms.
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Psychedelics are serotonin 2A receptor agonists that can lead to profound changes in perception, cognition and mood. In this review, we focus on the basic neurobiology underlying the action of psychedelic drugs. We first discuss chemistry, highlighting the diversity of psychoactive molecules and the principles that govern their potency and pharmacokinetics. We describe the roles of serotonin receptors and their downstream molecular signaling pathways, emphasizing key elements for drug discovery. We consider the impact of psychedelics on neuronal spiking dynamics in several cortical and subcortical regions, along with transcriptional changes and sustained effects on structural plasticity. Finally, we summarize neuroimaging results that pinpoint effects on association cortices and thalamocortical functional connectivity, which inform current theories of psychedelic action. By synthesizing knowledge across the chemical, molecular, neuronal, and network levels, we hope to provide an integrative perspective on the neural mechanisms responsible for the acute and enduring effects of psychedelics on behavior. Psychedelics are serotonergic drugs that have therapeutic potential. This Review article provides an integrative perspective on the basic neurobiology underlying the actions of psychedelics and highlights open questions in the field.
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Depressive symptoms are associated with altered pupillary responses during learning and reward prediction as well as with changes in neurometabolite levels, including brain concentrations of choline, glutamate and gamma-aminobutyric acid (GABA). However, the full link between depressive symptoms, reward-learning-related pupillary responses and neurometabolites is yet to be established as these constructs have not been assessed in the same individuals. The present pilot study, investigated these relations in a sample of 24 adolescents aged 13 years. Participants completed the Revised Child Anxiety and Depression Scale (RCADS) and underwent a reward learning task while measuring pupil dilation and a single voxel dorsal anterior cingulate cortex (dACC) MEGA-PRESS magnetic resonance spectroscopy scan assessing choline, glutamate and GABA concentrations. Pupil dilation was related to prediction errors (PE) during learning, which was captured by a prediction error-weighted pupil dilation response index (PE-PDR) for each individual. Higher PE-PDR scores, indicating larger pupil dilations to negative prediction errors, were related to lower depressive symptoms and lower dACC choline concentrations. Dorsal ACC choline was positively associated with depressive symptoms, whereas glutamate and GABA were not related to PE-PDR or depressive symptoms. The findings support notions of cholinergic involvement in depressive symptoms and cholinergic influence on reward-related pupillary response, suggesting that pupillary responses to negative prediction errors may hold promise as a biomarker of depressive states.
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The serotonin system modulates a wide variety of emotional behaviors and states, including reward processing, anxiety, and social interaction. To reveal the underlying patterns of neural activity, we visualized serotonergic neurons in the dorsal raphe nucleus (DRN5-HT) of mice using miniaturized microscopy during diverse emotional behaviors. We discovered ensembles of cells with highly correlated activity and found that DRN5-HT neurons are preferentially recruited by emotionally salient stimuli as opposed to neutral stimuli. Individual DRN5-HT neurons responded to diverse combinations of salient stimuli, with some preference for valence and sensory modality. Anatomically defined subpopulations projecting to either a reward-related structure (the ventral tegmental area) or an anxiety-related structure (the bed nucleus of the stria terminalis) contained all response types but were enriched in reward- and anxiety-responsive cells, respectively. Our results suggest that the DRN serotonin system responds to emotional salience using ensembles with mixed selectivity and biases in downstream connectivity.
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Nervous systems evolved to effectively navigate the dynamics of the environment to achieve their goals. One framework used to study this fundamental problem arose in the study of learning and decision-making. In this framework, the demands of effective behavior require slow dynamics—on the scale of seconds to minutes—of networks of neurons. Here, we review the phenomena and mechanisms involved. Using vignettes from a few species and areas of the nervous system, we view neuromodulators as key substrates for temporal scaling of neuronal dynamics. Expected final online publication date for the Annual Review of Neuroscience, Volume 45 is July 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Logistic regressions were developed in economics to model individual choice behavior. In recent years, they have become an important tool in decision neuroscience. Here, I describe and discuss different logistic models, emphasizing the underlying assumptions and possible interpretations. Logistic models may be used to quantify a variety of behavioral traits, including the relative subjective value of different goods, the choice accuracy, risk attitudes, and choice biases. More complex logistic models can be used for choices between good bundles, in cases of nonlinear value functions, and for choices between multiple options. Finally, logistic models can quantify the explanatory power of neuronal activity on choices, thus providing a valid alternative to receiver operating characteristic (ROC) analyses.
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Regulating how fast to learn is critical for flexible behavior. Learning about the consequences of actions should be slow in stable environments, but accelerate when that environment changes. Recognizing stability and detecting change are difficult in environments with noisy relationships between actions and outcomes. Under these conditions, theories propose that uncertainty can be used to modulate learning rates (“meta-learning”). We show that mice behaving in a dynamic foraging task exhibit choice behavior that varied as a function of two forms of uncertainty estimated from a meta-learning model. The activity of dorsal raphe serotonin neurons tracked both types of uncertainty in the foraging task as well as in a dynamic Pavlovian task. Reversible inhibition of serotonin neurons in the foraging task reproduced changes in learning predicted by a simulated lesion of meta-learning in the model. We thus provide a quantitative link between serotonin neuron activity, learning, and decision making.
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Energy balance is orchestrated by an extended network of highly interconnected nuclei across the central nervous system. While much is known about the hypothalamic circuits regulating energy homeostasis, the ‘extra-hypothalamic’ circuits involved are relatively poorly understood. In this review, we focus on the brainstem’s dorsal raphe nucleus (DRN), integrating decades of research linking this structure to the physiologic and behavioral responses that maintain proper energy stores. DRN neurons sense and respond to interoceptive and exteroceptive cues related to energy imbalance and in turn induce appropriate alterations in energy intake and expenditure. The DRN is also molecularly differentiable, with different populations playing distinct and often opposing roles in controlling energy balance. These populations are integrated into the extended circuit known to regulate energy balance. Overall, this review summarizes the key evidence demonstrating an important role for the DRN in regulating energy balance.
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Hypotheses and beliefs guide credit assignment – the process of determining which previous events or actions caused an outcome. Adaptive hypothesis formation and testing are crucial in uncertain and changing environments in which associations and meanings are volatile. Despite primates’ abilities to form and test hypotheses, establishing what is causally responsible for the occurrence of particular outcomes remains a fundamental challenge for credit assignment and learning. Hypotheses about what surprises are due to stochasticity inherent in an environment as opposed to real, systematic changes are necessary for identifying the environment’s predictive features, but are often hard to test. We review evidence that two highly interconnected frontal cortical regions, anterior cingulate cortex and ventrolateral prefrontal area 47/12o, provide a biological substrate for linking two crucial components of hypothesis-formation and testing: the control of information seeking and credit assignment. Neuroimaging, targeted disruptions, and neurophysiological studies link an anterior cingulate – 47/12o circuit to generation of exploratory behaviour, non-instrumental information seeking, and interpretation of subsequent feedback in the service of credit assignment. Our observations support the idea that information seeking and credit assignment are linked at the level of neural circuits and explain why this circuit is important for ensuring behaviour is flexible and adaptive.
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Humans and animals can be strongly motivated to seek information to resolve uncertainty about rewards and punishments. In particular, despite its clinical and societal relevance, very little is known about information seeking about punishments. We show that attitudes toward information about punishments and rewards are distinct and separable at both behavioral and neuronal levels. We demonstrate the existence of prefrontal neuronal populations that anticipate opportunities to gain information in a relatively valence-specific manner, separately anticipating information about either punishments or rewards. These neurons are located in anatomically interconnected subregions of anterior cingulate cortex (ACC) and ventrolateral prefrontal cortex (vlPFC) in area 12o/47. Unlike ACC, vlPFC also contains a population of neurons that integrate attitudes toward both reward and punishment information, to encode the overall preference for information in a bivalent manner. This cortical network is well suited to mediate information seeking by integrating the desire to resolve uncertainty about multiple, distinct motivational outcomes.
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Adapting to changing environmental conditions requires a prospective inference of future actions and their consequences, a strategy also known as model-based decision making.1, 2, 3 In stable environments, extensive experience of actions and their consequences leads to a shift from a model-based to a model-free strategy, whereby behavioral selection is primarily governed by retrospective experiences of positive and negative outcomes. Human and animal studies, where subjects are required to speculate about implicit information and adjust behavioral responses over multiple sessions, point to a role for the central serotonergic system in model-based decision making.4, 5, 6, 7, 8 However, to directly test a causal relationship between serotonergic activity and model-based decision making, phase-specific manipulation of serotonergic activity is needed in a one-shot test, where learning by trial and error is neutralized. Moreover, the serotonergic origin responsible for this effect is yet to be determined. Herein, we demonstrate that optogenetic silencing of serotonin neurons in the dorsal raphe nucleus, but not in the median raphe nucleus, disrupts model-based decision making in lithium-induced outcome devaluation tasks.9, 10, 11 Our data indicate that the serotonergic behavioral effects are not due to increased locomotor activity, anxiolytic effects, or working memory deficits. Our findings provide insights into the neural mechanisms underlying neural weighting between model-free and model-based strategies.
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Serotonin is a neuromodulator that is implicated in awake-sleep cycle, motor behaviors, reward, motivation, and mood. Recent molecular tools for cell-type-specific activity recording and manipulation with fine temporal and spatial resolutions are providing unprecedentedly detailed data about serotonergic neuromodulation. These newly gained information show substantial differences in the signaling and effect of serotonergic neuromodulation depending on the projection targets. To find the common denominator for this diversity, we conjecture that the evolution of serotonergic neuromodulation originates from signaling the time and resource available for action, learning, and development.
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Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat psychiatric disorders with affective biases such as depression and anxiety. How SSRIs exert a beneficial action on emotions associated with life events is still unknown. Here we ask whether and how the effectiveness of the SSRI fluoxetine is underpinned by neural mechanisms in the ventral striatum. To address these issues, we studied the spiking activity of neurons in the ventral striatum of monkeys during an approach-avoidance task in which the valence assigned to sensory stimuli was manipulated. Neural responses to positive and negative events were measured before and during a 4-week treatment with fluoxetine. We conducted PET scans to confirm that fluoxetine binds within the ventral striatum at a therapeutic dose. In our monkeys, fluoxetine facilitated approach of rewards and avoidance of punishments. These beneficial effects were associated with changes in tonic and phasic activities of striatal neurons. Fluoxetine increased the spontaneous firing rate of striatal neurons and amplified the number of cells responding to rewards versus punishments, reflecting a drug-induced positive shift in the processing of emotionally valenced information. These findings reveal how SSRI treatment affects ventral striatum neurons encoding positive and negative valence and striatal signaling of emotional information. In addition to a key role in appetitive processing, our results shed light on the involvement of the ventral striatum in aversive processing. Together, the ventral striatum appears to play a central role in the action of SSRIs on emotion processing biases commonly observed in psychiatric disorders.
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Cognitive inflexibility is suggested by the hallmark symptoms of obsessive-compulsive disorder (OCD), namely the occurrence of repetitive thoughts and/or behaviours that persist despite being functionally impairing and egodystonic to the individual. As well as being implied by the top-level symptoms, cognitive inflexibility in OCD, and some related conditions, has also been objectively quantified in case-control studies using computerised cognitive tasks. This chapter begins by considering the objective measurement of different aspects of cognitive flexibility using neuropsychological paradigms, with a focus on neural and neurochemical substrates. It moves on to conduct a systematic review and meta-analysis of findings from a widely deployed flexibility task: the Intra-Dimensional/Extra-Dimensional Set-Shift Task (IDED). By pooling data from 11 studies (335 OCD patients and 311 controls), we show that Extra-Dimensional (ED) shift deficits are a robust and reproducible finding (effect size medium-large) in OCD across the literature, and that this deficit is not attributable to group differences in age or IQ. The OCD ED deficit is then discussed in terms of dysfunction of fronto-striatal pathways (as exemplified, for example, by functional connectivity data), and the putative role of different neurotransmitters. We consider evidence that impaired ED shifting constitutes a candidate vulnerability marker (or 'endophenotype') for OCD. The available literature is then surveyed as to ED findings in other obsessive-compulsive (OC) related disorders (e.g. hoarding, body-dysmorphic disorder, and trichotillomania), as well as in non-OC disorders (schizophrenia and anxiety symptoms in general). Lastly, we consider more recent, emerging developments in the quantification of compulsivity using cognitive tasks and questionnaires, as well as key directions for future research, including the need to refine compulsivity and its composite cognitive processes.