ABSTRACT
The use of opioid drugs and related overdose deaths, which rose to epidemic proportions over the past decade, have been exacerbated by the COVID pandemic, a time of great uncertainty and isolation. Much is known about opioid pharmacology and related neural circuits that, combined with novel emerging neurobiological insights, can help guide new treatment strategies. To view this SnapShot, open or download the PDF.
Subject(s)
Neurobiology , Opioid-Related Disorders/pathology , Humans , Nerve Net/pathology , Neurons/pathology , Opioid-Related Disorders/therapyABSTRACT
Dopamine D2 receptors (D2Rs) in the nucleus accumbens (NAc) regulate motivated behavior, but the underlying neurobiological mechanisms remain unresolved. Here, we show that selective upregulation of D2Rs in the indirect pathway of the adult NAc enhances the willingness to work for food. Mechanistic studies in brain slices reveal that D2R upregulation attenuates inhibitory transmission at two main output projections of the indirect pathway, the classical long-range projections to the ventral pallidum (VP), as well as local collaterals to direct pathway medium spiny neurons. In vivo physiology confirms the reduction in indirect pathway inhibitory transmission to the VP, and inhibition of indirect pathway terminals to VP is sufficient to enhance motivation. In contrast, D2R upregulation in the indirect pathway does not disinhibit neuronal activity of the direct pathway in vivo. These data suggest that D2Rs in ventral striatal projection neurons promote motivation by weakening the canonical output to the ventral pallidum.
Subject(s)
Basal Forebrain/metabolism , Motivation/physiology , Nucleus Accumbens/metabolism , Receptors, Dopamine D2/metabolism , Animals , Female , Inhibitory Postsynaptic Potentials , Male , Mice, Inbred C57BL , Neurons/metabolism , Up-RegulationABSTRACT
UNLABELLED: Chronic pain disorder is a challenging presentation for the dental surgeon, and carries considerable impairment for the affected individual. Patients undergo extensive unnecessary investigations and treatments before the correct diagnosis is reached. It is frequently a diagnosis of exclusion. We report the case of a 46-year-old man who experienced persistent severe orofacial pain superimposed upon pain involving other anatomical regions for more than 20 years. He received treatment by eight specialties and at five national centres with increasingly poor outcome. The importance of early recognition of medically unexplained pain will be discussed. CLINICAL RELEVANCE: Dentists should have a high index of suspicion of pain disorder in those with multiple complaints of chronic pain in order to avoid unnecessary investigation and treatment.
Subject(s)
Facial Pain/etiology , Somatoform Disorders/diagnosis , Antidepressive Agents/therapeutic use , Chronic Disease , Cognitive Behavioral Therapy , Depressive Disorder/complications , Depressive Disorder/therapy , Diagnosis, Differential , Facial Pain/therapy , Humans , Male , Middle Aged , Prognosis , Selective Serotonin Reuptake Inhibitors/therapeutic use , Somatoform Disorders/therapyABSTRACT
Over a three-year period we devised, developed, and implemented a simple proforma, validated by a previous audit, to improve the accuracy of data collected on maxillofacial trauma. It covers both sides of an A4 sheet and functions as an aide-memoire for junior staff and prompts the comprehensive recording of all necessary medicolegal details should further documentation be required by the police, judiciary, or compensatory body.
Subject(s)
Dental Records/standards , Maxillofacial Injuries/diagnosis , Medical Records/standards , Checklist , Contusions/diagnosis , Contusions/therapy , Data Collection/standards , Dental Audit , Diagnostic Techniques, Ophthalmological , Documentation/standards , Electronic Health Records/standards , Facial Bones/injuries , Forms and Records Control , Humans , Lacerations/diagnosis , Lacerations/therapy , Maxillofacial Injuries/therapy , Medical Audit , Risk Factors , Skull Fractures/diagnosis , Skull Fractures/therapy , Tooth Injuries/diagnosis , Tooth Injuries/therapy , Treatment OutcomeABSTRACT
There has been a remarkable increase in the popularity of micro-scooters over the past few years. This has brought with it an astonishing rise in the number of associated injuries. Highlighted here is a case report which outlines the dental injuries associated with the use of a micro-scooter.