PET imaging of dopamine receptors in human basal ganglia: relevance to mental illness.

The development of PET and in vivo ligand-binding techniques over the past decade has allowed the analysis of dopamine receptor functions in the basal ganglia of human subjects. Using ligands selective for the different subtypes of dopamine receptors, their gross distribution, total number of binding sites and affinity have been determined in the caudate-putamen of the living human brain. Recent studies in young, drug-naive schizophrenic patients failed to demonstrate a consistent alteration in the densities or affinities of D2 dopamine receptors in the basal ganglia of these subjects, contradicting the view that elevated densities of D2 dopamine receptors are a major pathophysiological mechanism in this disorder. PET measurements of D2 dopamine receptor occupancy in relation to clinical antipsychotic drug treatment demonstrated that all chemically different categories of antipsychotic drugs induced a marked occupancy of D2 dopamine receptors. This effect was dose-dependent and fully reversible. It appeared earlier than the antipsychotic effect and was also present in neuroleptic-resistant patients. Resistance to neuroleptic drugs is in all probability related to heterogeneity of biological factors causing schizophrenia. Some, but not all, antipsychotic drugs also induced a significant D1 dopamine receptor occupancy. This effect was most marked for the unconventional drug clozapine, which showed about the same degree of D1 as D2 dopamine receptor blockade when given in clinical doses.