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Lee AM, Sturm VE, Dawes H, Krystal AD, Chang EF. Human Anterior Insular Cortex Encodes Multiple Electrophysiological Representations of Anxiety-Related Behaviors. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.05.583610. [PMID: 38496459 PMCID: PMC10942279 DOI: 10.1101/2024.03.05.583610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Anxiety is a common symptom across psychiatric disorders, but the neurophysiological underpinnings of these symptoms remain unclear. This knowledge gap has prevented the development of circuit-based treatments that can target the neural substrates underlying anxiety. Here, we conducted an electrophysiological mapping study to identify neurophysiological activity associated with self-reported state anxiety in 17 subjects implanted with intracranial electrodes for seizure localization. Participants had baseline anxiety traits ranging from minimal to severe. Subjects volunteered to participate in an anxiety induction task in which they were temporarily exposed to the threat of unpredictable shock during intracranial recordings. We found that anterior insular beta oscillatory activity was selectively elevated during epochs when unpredictable aversive stimuli were being delivered, and this enhancement in insular beta was correlated with increases in self-reported anxiety. Beta oscillatory activity within the frontoinsular region was also evoked selectively by cues-predictive of threat, but not safety cues. Anterior insular gamma responses were less selective than gamma, strongly evoked by aversive stimuli and had weaker responses to salient threat and safety cues. On longer timescales, this gamma signal also correlated with increased skin conductance, a measure of autonomic state. Lastly, we found that direct electrical stimulation of the anterior insular cortex in a subset of subjects elicited self-reported increases in anxiety that were accompanied by enhanced frontoinsular beta oscillations. Together, these findings suggest that electrophysiologic representations of anxiety- related states and behaviors exist within anterior insular cortex. The findings also suggest the potential of reducing anterior insular beta activity as a therapeutic target for refractory anxiety-spectrum disorders.
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Lopes LM, Reis-Silva LL, Rodrigues B, Crestani CC. Pharmacological Manipulation of Corticotropin-Releasing Factor Receptors in the Anterior and Posterior Subregions of the Insular Cortex Differently Affects Anxiety-Like Behaviors in the Elevated Plus Maze in Rats. BIOMED RESEARCH INTERNATIONAL 2024; 2024:8322844. [PMID: 38327803 PMCID: PMC10849808 DOI: 10.1155/2024/8322844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
Neuroimaging data in humans and neurobiological studies in rodents have suggested an involvement of the insular cortex (IC) in anxiety manifestations. However, the local neurochemical mechanisms involved are still poorly understood. Corticotropin-releasing factor (CRF) neurotransmission has been described as a prominent neurochemical mechanism involved in the expression of anxiety-like behaviors, but the brain sites related are poorly understood. Additionally, several findings indicate that control of physiological and behavioral responses by the IC occurs in a site-specific manner along its rostrocaudal axis. Thus, this study is aimed at evaluating the effect of CRF receptor agonism and antagonism within the anterior and posterior subregions of the IC in controlling anxiety-related behaviors in the elevated plus maze (EPM). For this, independent groups (six groups) of animals received bilateral microinjections of vehicle, the selective CRF1 receptor antagonist CP376395, or CRF into either the anterior or posterior subregions of the IC. Ten minutes later, the behavior in the EPM was evaluated for five minutes. Treatment of the anterior IC with CP376395, but not with CRF, increased the time and number of entries into the open arms of the EPM. CRF, but not the CRF1 receptor antagonist, microinjected into the posterior IC also increased exploration of the EPM open arms. Taken together, these data indicate that CRFergic neurotransmission in the anterior IC is involved in the expression of anxiety-related behaviors in the EPM. This neurochemical mechanism does not seem to be activated within the posterior IC during exposure to the EPM, but the effects caused by CRF microinjection indicate that activation of CRF receptors in this IC subregion might evoke anxiolytic-like effects.
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Affiliation(s)
- Lucas M. Lopes
- Laboratory of Pharmacology, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Lilian L. Reis-Silva
- Laboratory of Pharmacology, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Bruno Rodrigues
- Department of Adapted Physical Activity, Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carlos C. Crestani
- Laboratory of Pharmacology, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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Moraga-Amaro R, Muñoz P, Villalobos T, Linsambarth S, Maldonado F, Meirone V, Femopase B, Stehberg J. Real-world data of non-invasive stimulation of the human insula-prefrontal cortices using deep TMS to treat anxiety for occupational stress and generalized anxiety disorder. Psychiatry Res 2023; 320:115036. [PMID: 36586377 DOI: 10.1016/j.psychres.2022.115036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/13/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022]
Abstract
Activation of the insula is found in all anxiety-related disorders and increased insular-prefrontal cortex (PFC) functional connectivity is associated with reduced anxiety. In this study, the combined stimulation of the insula and PFC using the dTMS H4 (insula+LPFC) and H2 (PFC) coils were used to reduce anxiety in 13 subjects experiencing occupational stress, and 55 participants suffering from generalized anxiety disorder (GAD). The combined HF stimulation of the insula and PFC significantly decreased anxiety scores according to the HARS, CAS, and STAI anxiety scales, leading to a reduction in anxiety according to HARS of 88.7% and 70.7% in participants with occupational stress and the clinical sample of participants diagnosed with GAD, respectively. The findings suggest that the prefrontal-insular axis is critical for the regulation of anxiety and its stimulation can be used for the treatment of anxiety in people suffering from occupational stress and GAD.
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Affiliation(s)
- Rodrigo Moraga-Amaro
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina. Universidad Andres Bello, Santiago, Chile
| | - Paula Muñoz
- Clínica Nova Vita. Del Inca 4446 of. 708. Las Condes, Santiago, Chile
| | - Tomás Villalobos
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina. Universidad Andres Bello, Santiago, Chile
| | | | - Francisco Maldonado
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina. Universidad Andres Bello, Santiago, Chile
| | - Valeria Meirone
- Clínica Nova Vita. Del Inca 4446 of. 708. Las Condes, Santiago, Chile
| | - Bruno Femopase
- Clínica Nova Vita. Del Inca 4446 of. 708. Las Condes, Santiago, Chile
| | - Jimmy Stehberg
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina. Universidad Andres Bello, Santiago, Chile.
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The functional connectivity between left insula and left medial superior frontal gyrus underlying the relationship between rumination and procrastination. Neuroscience 2023; 509:1-9. [PMID: 36427671 DOI: 10.1016/j.neuroscience.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
Procrastination is regarded as a prevalent problematic behavior that impairs people's physical and mental health. Although previous studies have indicated that trait rumination is robustly positively correlated with procrastination, it remains unknown about the neural substrates underlying the relationship between trait rumination and procrastination. To address this issue, we used voxel-based morphometry (VBM) and resting-state functional connectivity (RSFC) approaches to explore the neural basis of the relationship between trait rumination and procrastination. Our behavior results found that trait rumination was significantly positively correlated to procrastination, while the VBM analysis showed that trait rumination was negatively correlated with gray matter volume of the insula. Furthermore, the RSFC results revealed a negative association of the left insula-lmSFG (left medial superior frontal gyrus) functional connectivity with trait rumination. More importantly, the mediation analysis showed that trait rumination could completely mediate the relationship between left insula-lmSFG functional connectivity and procrastination. These results suggest that the left insula-lmSFG functional connectivity involved in emotion regulation modulates the association between trait rumination and procrastination, which provides neural evidence for the relationship between trait rumination and procrastination.
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Jotwani ML, Wu Z, Lunde CE, Sieberg CB. The missing mechanistic link: Improving behavioral treatment efficacy for pediatric chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1022699. [PMID: 36313218 PMCID: PMC9614027 DOI: 10.3389/fpain.2022.1022699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Pediatric chronic pain is a significant global issue, with biopsychosocial factors contributing to the complexity of the condition. Studies have explored behavioral treatments for pediatric chronic pain, but these treatments have mixed efficacy for improving functional and psychological outcomes. Furthermore, the literature lacks an understanding of the biobehavioral mechanisms contributing to pediatric chronic pain treatment response. In this mini review, we focus on how neuroimaging has been used to identify biobehavioral mechanisms of different conditions and how this modality can be used in mechanistic clinical trials to identify markers of treatment response for pediatric chronic pain. We propose that mechanistic clinical trials, utilizing neuroimaging, are warranted to investigate how to optimize the efficacy of behavioral treatments for pediatric chronic pain patients across pain types and ages.
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Affiliation(s)
- Maya L. Jotwani
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Ziyan Wu
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Christine B. Sieberg
- Department of Psychiatry and Behavioral Sciences, Biobehavioral Pain Innovations Lab, Boston Children's Hospital, Boston, MA, United States,Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, Pain Medicine, Boston Children's Hospital, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States,Correspondence: Christine B. Sieberg
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Baumel WT, Lu L, Huang X, Drysdale AT, Sweeny JA, Gong Q, Sylvester CM, Strawn JR. Neurocircuitry of Treatment in Anxiety Disorders. Biomark Neuropsychiatry 2022; 6. [PMID: 35756886 PMCID: PMC9222661 DOI: 10.1016/j.bionps.2022.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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Affiliation(s)
- W. Tommy Baumel
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Correspondence to: University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA. (W.T. Baumel)
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Andrew T. Drysdale
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - John A. Sweeny
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chad M. Sylvester
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - Jeffrey R. Strawn
- Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Simultaneous determination of citalopram and selegiline using an efficient electrochemical sensor based on ZIF-8 decorated with RGO and g-C3N4 in real samples. Anal Chim Acta 2022; 1203:339662. [DOI: 10.1016/j.aca.2022.339662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
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Better living through understanding the insula: Why subregions can make all the difference. Neuropharmacology 2021; 198:108765. [PMID: 34461066 DOI: 10.1016/j.neuropharm.2021.108765] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
Insula function is considered critical for many motivated behaviors, with proposed functions ranging from attention, behavioral control, emotional regulation, goal-directed and aversion-resistant responding. Further, the insula is implicated in many neuropsychiatric conditions including substance abuse. More recently, multiple insula subregions have been distinguished based on anatomy, connectivity, and functional contributions. Generally, posterior insula is thought to encode more somatosensory inputs, which integrate with limbic/emotional information in middle insula, that in turn integrate with cognitive processes in anterior insula. Together, these regions provide rapid interoceptive information about the current or predicted situation, facilitating autonomic recruitment and quick, flexible action. Here, we seek to create a robust foundation from which to understand potential subregion differences, and provide direction for future studies. We address subregion differences across humans and rodents, so that the latter's mechanistic interventions can best mesh with clinical relevance of human conditions. We first consider the insula's suggested roles in humans, then compare subregional studies, and finally describe rodent work. One primary goal is to encourage precision in describing insula subregions, since imprecision (e.g. including both posterior and anterior studies when describing insula work) does a disservice to a larger understanding of insula contributions. Additionally, we note that specific task details can greatly impact recruitment of various subregions, requiring care and nuance in design and interpretation of studies. Nonetheless, the central ethological importance of the insula makes continued research to uncover mechanistic, mood, and behavioral contributions of paramount importance and interest. This article is part of the special Issue on 'Neurocircuitry Modulating Drug and Alcohol Abuse'.
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Acute Citalopram administration modulates anxiety in response to the context associated with a robotic stimulus in zebrafish. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110172. [PMID: 33188831 PMCID: PMC8026524 DOI: 10.1016/j.pnpbp.2020.110172] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anxiety represents one of the most urgent health challenges in Western Countries, where it is associated with major medical and societal costs. A common therapeutic approach is the use of selective serotonin reuptake inhibitors, such as Citalopram. However, this treatment of choice is characterized by incomplete efficacy and potential side effects. Preclinical research is needed to detail the mechanisms underlying therapeutic efficacy of available treatments. METHODS Zebrafish, a rapidly emerging model species, constitutes an excellent candidate for high-throughput studies in behavioral pharmacology. Here, we present a robotics-based experimental paradigm to investigate the effects of acute Citalopram administration on conditioned place aversion. We trained adult subjects in a three-partitioned tank, consisting of one central and two lateral compartments: the latter were associated either with a fear eliciting robotic stimulus or with an empty environment. Following training, we implemented an automated three-dimensional tracking system to assess the spatial association and detail individual phenotype in a stimulus-free test session. RESULTS We observed a linear dose-response profile with respect to geotaxis, with increasing Citalopram concentrations reducing the tendency to swim near the bottom of the tank. Although control subjects failed to exhibit the predicted conditioned aversion, we found preliminary evidence that Citalopram may affect sexes differentially, with male subjects showing increased conditioned aversion at low Citalopram concentration. CONCLUSIONS Experimental paradigms based on robotics and three-dimensional tracking can contribute methodological advancements in zebrafish behavioral psychopharmacology.
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Zhu Y, Zhao X, Yin H, Zhang M. Functional connectivity density abnormalities and anxiety in primary insomnia patients. Brain Imaging Behav 2021; 15:114-121. [PMID: 32043233 DOI: 10.1007/s11682-019-00238-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary insomnia (PI) is strongly associated with emotional dysregulation. However, the neurobiological pathology of the association between PI and emotional dysregulation is limited. Previous studies have indicated an impact of PI on the emotional regulatory system, but the specificity of this finding remains to be confirmed. A sample of 27 primary insomnia patients (PIs) and 32 matched healthy controls (HCs) was recruited for this study. The functional connectivity density (FCD) was used to assess the spontaneous functional brain organization in PIs. Then, we identified whether the local (lFCD) and global FCD (gFCD) abnormalities can be the potential biomarker for emotion level in PIs. Our findings suggested that PIs exhibited higher levels of anxiety and depression, and the levels of anxiety and depression is associated with the insomnia severity. We also found that PIs showed both lower lFCD and gFCD in several regions (i.e. thalamus, anterior cingulate cortex (ACC), insula). Furthermore, the lower gFCD values of left ACC and right insula were associated with their anxiety level in PIs, which demonstrated their potential biomarker for anxiety in PIs. Our results demonstrated that the relationship between the insomnia severity and the anxiety level could be partially mediated by gFCD of the ACC and insula. The current study improved our understanding of the anxiety in PIs and provided helpful information for future therapeutic development for PIs.
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Affiliation(s)
- Yifei Zhu
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China. .,Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China. .,Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China.
| | - Xumeng Zhao
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Hua Yin
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.
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11
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Flook EA, Luchsinger JR, Silveri MM, Winder DG, Benningfield MM, Blackford JU. Anxiety during abstinence from alcohol: A systematic review of rodent and human evidence for the anterior insula's role in the abstinence network. Addict Biol 2021; 26:e12861. [PMID: 31991531 DOI: 10.1111/adb.12861] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 12/30/2022]
Abstract
Alcohol Use Disorder (AUD) is a chronic, relapsing disease that impacts almost a third of Americans. Despite effective treatments for attaining sobriety, the majority of patients relapse within a year, making relapse a substantial barrier to long-term treatment success. A major factor contributing to relapse is heightened negative affect that results from the combination of abstinence-related increases in stress-reactivity and decreases in reward sensitivity. Substantial research has contributed to the understanding of reward-related changes in AUD. However, less is known about anxiety during abstinence, a critical component of understanding addiction as anxiety during abstinence can trigger relapse. Most of what we know about abstinence-related negative affect comes from rodent studies which have identified key brain regions responsible for abstinence-related behaviors. This abstinence network is composed of brain regions that make up the extended amygdala: the nucleus accumbens (NAcc), the central nucleus of the amygdala (CeA), and the bed nucleus of the stria terminalis (BNST). More recently, emerging evidence from rodent and human studies suggests a fourth brain region, the anterior insula, might be part of the abstinence network. Here, we review current rodent and human literature on the extended amygdala's role in alcohol abstinence and anxiety, present evidence for the anterior insula's role in the abstinence network, and provide future directions for research to further elucidate the neural underpinnings of abstinence in humans. A better understanding of the abstinence network is critical toward understanding and possibly preventing relapse in AUD.
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Affiliation(s)
- Elizabeth A. Flook
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
| | - Joseph R. Luchsinger
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
| | - Marisa M. Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, Brain Imaging Center, McLean Hospital Belmont MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Danny G. Winder
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
- Department of Molecular Physiology and Biophysics Vanderbilt University School of Medicine Nashville TN USA
| | - Margaret M. Benningfield
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
| | - Jennifer Urbano Blackford
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
- Research Health Scientist, Research and Development, Department of Veterans Affairs Medical Center Nashville TN USA
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Wang M, Cao L, Li H, Xiao H, Ma Y, Liu S, Zhu H, Yuan M, Qiu C, Huang X. Dysfunction of Resting-State Functional Connectivity of Amygdala Subregions in Drug-Naïve Patients With Generalized Anxiety Disorder. Front Psychiatry 2021; 12:758978. [PMID: 34721119 PMCID: PMC8548605 DOI: 10.3389/fpsyt.2021.758978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: Although previous studies have reported on disrupted amygdala subregional functional connectivity in generalized anxiety disorder (GAD), most of these studies were conducted in GAD patients with comorbidities or with drug treatment. Besides, whether/how the amygdala subregional functional networks were associated with state and trait anxiety is still largely unknown. Methods: Resting-state functional connectivity of amygdala subregions, including basolateral amygdala (BLA) and centromedial amygdala (CMA) as seed, were mapped and compared between 37 drug-naïve, non-comorbidity GAD patients and 31 age- and sex-matched healthy controls (HCs). Relationships between amygdala subregional network dysfunctions and state/trait anxiety were examined using partial correlation analyses. Results: Relative to HCs, GAD patients showed weaker functional connectivity of the left BLA with anterior cingulate/medial prefrontal cortices. Significantly increased functional connectivity of right BLA and CMA with superior temporal gyrus and insula were also identified in GAD patients. Furthermore, these functional connectivities showed correlations with state and trait anxiety scores. Conclusions: These findings revealed abnormal functional coupling of amygdala subregions in GAD patients with regions involved in fear processing and emotion regulation, including anterior cingulate/medial prefrontal cortex and superior temporal gyrus, which provide the unique biological markers for GAD and facilitating the future accurate clinical diagnosis and target treatment.
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Affiliation(s)
- Mei Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Lingxiao Cao
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Hongqi Xiao
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Yao Ma
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Shiyu Liu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Hongru Zhu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, China
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13
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Lai C, Ciacchella C, Pellicano GR, Altavilla D, Sambucini D, Paolucci T, Sorgi ML, Di Franco M, Saggini R, Aceto P. Different Electrophysiological Responses to Pain-Related Visual Stimuli Between Fibromyalgia and Chronic low Back Pain Women: A Pilot Case-Control Study. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:24705470211046881. [PMID: 34988344 PMCID: PMC8723168 DOI: 10.1177/24705470211046881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fibromyalgia is a chronic pain syndrome which occurs in the absence of an organic damage, whom causes is still unclear. Aims of this pilot study were to investigate the neural correlates of fibromyalgia in response to pain-related visual stimuli and explore the psychological differences among fibromyalgia, chronic low back pain (CLBP) and healthy conditions. METHODS After a clinical assessment, electrophysiological responses to pain-related visual stimuli were recorded using a 256-Hydrocel Geodesic-Sensor-Net. Event-related potentials (ERPs), standardised low-resolution electromagnetic tomography (sLORETA), and psychological (Symptom Checklist-90-Revised) data were analysed for a total sample of 23 women (5 healthy volunteers, 12 fibromyalgia patients, 6 CLBP patients). RESULTS The main finding was that fibromyalgia women reported a different brain response to pain-related visual stimuli on the frontal montage compared to women with CLBP (p = .028). Moreover, fibromyalgia women showed an increased activity mainly on the hippocampus (p = .003) and the posterior cingulate cortex (p ≤ .001) in response to algic stimuli compared to not algic ones. Lastly, these women presented higher scores on the somatization (p = .002), obsession-compulsion (p = .045), depression (p = .043) and positive symptom distress (p = .023) dimensions compared to the healthy women. CONCLUSIONS These preliminary results suggest that although the painful symptoms are similar, the central elaboration of pain could be different between women with fibromyalgia and those with CLBP. Moreover, these findings provide preliminary evidences about the great alert and the central sensitivity to pain-related information regarding fibromyalgia patients.
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Affiliation(s)
- Carlo Lai
- Department of Dynamic and Clinical
Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Chiara Ciacchella
- Department of Dynamic and Clinical
Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Gaia Romana Pellicano
- Department of Dynamic and Clinical
Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Daniela Altavilla
- Department of Philosophy, Communication
and Performing Arts, “Roma Tre” University, Rome, Italy
| | - Daniela Sambucini
- Department of Dynamic and Clinical
Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Teresa Paolucci
- Department of Oral and Biotechnological
Biomedical Sciences, Physical Medicine and Rehabilitation, University of G.
D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Maria Laura Sorgi
- Department of Clinical and Molecular
Medicine, Sant' Andrea University Hospital, Sapienza University
of, Rome, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Medicine and Medical
Specialties, Sapienza University of Rome, Italy
| | - Raoul Saggini
- Department of Oral and Biotechnological
Biomedical Sciences, Physical Medicine and Rehabilitation, University of G.
D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Paola Aceto
- Department of Emergency,
anesthesiological and reanimation sciences, Fondazione Policlinico
Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Basic Biotechnological
Sciences, Intensive Care and Perioperative Clinics, University of Sacred
Heart, Rome, Italy
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14
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Won E, Kim YK. Neuroinflammation-Associated Alterations of the Brain as Potential Neural Biomarkers in Anxiety Disorders. Int J Mol Sci 2020; 21:ijms21186546. [PMID: 32906843 PMCID: PMC7555994 DOI: 10.3390/ijms21186546] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
Stress-induced changes in the immune system, which lead to neuroinflammation and consequent brain alterations, have been suggested as possible neurobiological substrates of anxiety disorders, with previous literature predominantly focusing on panic disorder, agoraphobia, and generalized anxiety disorder, among the anxiety disorders. Anxiety disorders have frequently been associated with chronic stress, with chronically stressful situations being reported to precipitate the onset of anxiety disorders. Also, chronic stress has been reported to lead to hypothalamic–pituitary–adrenal axis and autonomic nervous system disruption, which may in turn induce systemic proinflammatory conditions. Preliminary evidence suggests anxiety disorders are also associated with increased inflammation. Systemic inflammation can access the brain, and enhance pro-inflammatory cytokine levels that have been shown to precipitate direct and indirect neurotoxic effects. Prefrontal and limbic structures are widely reported to be influenced by neuroinflammatory conditions. In concordance with these findings, various imaging studies on panic disorder, agoraphobia, and generalized anxiety disorder have reported alterations in structure, function, and connectivity of prefrontal and limbic structures. Further research is needed on the use of inflammatory markers and brain imaging in the early diagnosis of anxiety disorders, along with the possible efficacy of anti-inflammatory interventions on the prevention and treatment of anxiety disorders.
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Affiliation(s)
- Eunsoo Won
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea;
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
- Correspondence: ; Tel.: +82-31-412-5140; Fax: +82-31-412-5144
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15
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Progressive brain structural alterations assessed via causal analysis in patients with generalized anxiety disorder. Neuropsychopharmacology 2020; 45:1689-1697. [PMID: 32396920 PMCID: PMC7419314 DOI: 10.1038/s41386-020-0704-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Abstract
Accumulating neuroimaging studies implicate widespread brain structural alterations in patients with generalized anxiety disorder (GAD), but little is known regarding the temporal information of these changes and their causal relationships. In this study, a morphometric analysis was performed on T1-weighted structural images, and the progressive changes in the gray matter volume (GMV) in GAD were simulated by dividing the patients into different groups from low illness duration to high illness duration. The duration was defined as the interval between the onset of GAD and the time for magnetic resonance imaging collection. Then, a causal structural covariance network analysis was conducted to describe the causal relationships of the brain structural alterations in GAD. With increased illness duration, the GMV reduction in GAD originated from the subgenual anterior cingulate cortex (sgACC) and propagated to the bilateral ventromedial prefrontal cortex, right dorsomedial prefrontal cortex, left inferior temporal gyrus, and right insula. Intriguingly, the sgACC and the right insula had positive causal effects on each other. Moreover, both sgACC and right insula exhibited positive causal effects on the parietal cortex and negative effects on the posterior cingulate cortex, dorsolateral prefrontal cortex, visual cortex, and temporal lobe. The opposite causal effects were noted on the somatosensory and the ventrolateral prefrontal cortices. In conclusion, patients with GAD show gradual GMV reduction with increasing ilness duration. Furthermore, the causal effects of the sgACC and the right insula GMV reduction with shifts of duration may provide an important new avenue for understanding the pathological anomalies in GAD.
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16
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Kuzucu Y, Şimşek ÖF, Koşe-Demiray Ç. Language and the Symptoms of Mental Illness Connection via Abstract Representations of the Self and the World. THE JOURNAL OF PSYCHOLOGY 2020; 154:214-232. [PMID: 31910131 DOI: 10.1080/00223980.2019.1703098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The aim of the present study is to provide additional knowledge about the mediatory processes through which language contributes to the symptoms of mental illness. Although recent studies have provided insight about the relationship between language and the indicators of mental illness, the role of intervening variables in this connection has been ignored. The present investigation tested a structural equation model in which the need for the absolute truth about self and worry mediated the relationship of the gap between inner psychological experience and language with anxiety and depression. The results have provided support for the model and showed that the gap predicts both the need for absolute truth and worry which, in turn, predict the levels of anxiety and depression. The results have been discussed in the light of previous research, and implications for future research have also been considered.
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17
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Tomasi J, Lisoway AJ, Zai CC, Harripaul R, Müller DJ, Zai GCM, McCabe RE, Richter MA, Kennedy JL, Tiwari AK. Towards precision medicine in generalized anxiety disorder: Review of genetics and pharmaco(epi)genetics. J Psychiatr Res 2019; 119:33-47. [PMID: 31563039 DOI: 10.1016/j.jpsychires.2019.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
Generalized anxiety disorder (GAD) is a prevalent and chronic mental disorder that elicits widespread functional impairment. Given the high degree of non-response/partial response among patients with GAD to available pharmacological treatments, there is a strong need for novel approaches that can optimize outcomes, and lead to medications that are safer and more effective. Although investigations have identified interesting targets predicting treatment response through pharmacogenetics (PGx), pharmaco-epigenetics, and neuroimaging methods, these studies are often solitary, not replicated, and carry several limitations. This review provides an overview of the current status of GAD genetics and PGx and presents potential strategies to improve treatment response by combining better phenotyping with PGx and improved analytical methods. These strategies carry the dual benefit of delivering data on biomarkers of treatment response as well as pointing to disease mechanisms through the biology of the markers associated with response. Overall, these efforts can serve to identify clinical, genetic, and epigenetic factors that can be incorporated into a pharmaco(epi)genetic test that may ultimately improve treatment response and reduce the socioeconomic burden of GAD.
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Affiliation(s)
- Julia Tomasi
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Amanda J Lisoway
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ricardo Harripaul
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Molecular Neuropsychiatry & Development (MiND) Lab, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel J Müller
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gwyneth C M Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Randi E McCabe
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Margaret A Richter
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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18
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Salvi SS, Pati S, Chaudhari PR, Tiwari P, Banerjee T, Vaidya VA. Acute Chemogenetic Activation of CamKIIα-Positive Forebrain Excitatory Neurons Regulates Anxiety-Like Behaviour in Mice. Front Behav Neurosci 2019; 13:249. [PMID: 31736725 PMCID: PMC6828652 DOI: 10.3389/fnbeh.2019.00249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/14/2019] [Indexed: 01/12/2023] Open
Abstract
Anxiety disorders are amongst the most prevalent mental health disorders. Several lines of evidence have implicated cortical regions such as the medial prefrontal cortex, orbitofrontal cortex, and insular cortex along with the hippocampus in the top–down modulation of anxiety-like behaviour in animal models. Both rodent models of anxiety, as well as treatment with anxiolytic drugs, result in the concomitant activation of multiple forebrain regions. Here, we sought to examine the effects of chemogenetic activation or inhibition of forebrain principal neurons on anxiety and despair-like behaviour. We acutely activated or inhibited Ca2+/calmodulin-dependent protein kinase II α (CamKIIα)-positive forebrain excitatory neurons using the hM3Dq or the hM4Di Designer Receptor Exclusively Activated by Designer Drug (DREADD) respectively. Circuit activation was confirmed via an increase in expression of the immediate early gene, c-Fos, within both the hippocampus and the neocortex. We then examined the influence of DREADD-mediated activation of forebrain excitatory neurons on behavioural tests for anxiety and despair-like behaviour. Our results indicate that acute hM3Dq DREADD activation of forebrain excitatory neurons resulted in a significant decline in anxiety-like behaviour on the open field, light–dark avoidance, and the elevated plus maze test. In contrast, hM3Dq DREADD activation of forebrain excitatory neurons did not alter despair-like behaviour on either the tail suspension or forced swim tests. Acute hM4Di DREADD inhibition of CamKIIα-positive forebrain excitatory neurons did not modify either anxiety or despair-like behaviour. Taken together, our results demonstrate that chemogenetic activation of excitatory neurons in the forebrain decreases anxiety-like behaviour in mice.
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Affiliation(s)
- Sonali S Salvi
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Sthitapranjya Pati
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Pratik R Chaudhari
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Praachi Tiwari
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Toshali Banerjee
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Vidita A Vaidya
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
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19
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Abstract
BACKGROUND Excessive worry is a defining feature of generalized anxiety disorder and is present in a wide range of other psychiatric conditions. Therefore, individualized predictions of worry propensity could be highly relevant in clinical practice, with respect to the assessment of worry symptom severity at the individual level. METHODS We applied a multivariate machine learning approach to predict dispositional worry based on microstructural integrity of white matter (WM) tracts. RESULTS We demonstrated that the machine learning model was able to decode individual dispositional worry scores from microstructural properties in widely distributed WM tracts (mean absolute error = 10.46, p < 0.001; root mean squared error = 12.82, p < 0.001; prediction R2 = 0.17, p < 0.001). WM tracts that contributed to worry prediction included the posterior limb of internal capsule, anterior corona radiate, and cerebral peduncle, as well as the corticolimbic pathways (e.g. uncinate fasciculus, cingulum, and fornix) already known to be critical for emotion processing and regulation. CONCLUSIONS The current work thus elucidates potential neuromarkers for clinical assessment of worry symptoms across a wide range of psychiatric disorders. In addition, the identification of widely distributed pathways underlying worry propensity serves to better improve the understanding of the neurobiological mechanisms associated with worry.
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Affiliation(s)
- Chunliang Feng
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- College of Information Science and Technology, Beijing Normal University, Beijing 100875, China
| | - Zaixu Cui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104, USA
| | - Dazhi Cheng
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ruolei Gu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
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20
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Neufang S, Geiger MJ, Homola GA, Mahr M, Schiele MA, Gehrmann A, Schmidt B, Gajewska A, Nowak J, Meisenzahl-Lechner E, Pham M, Romanos M, Akhrif A, Domschke K. Cognitive-behavioral therapy effects on alerting network activity and effective connectivity in panic disorder. Eur Arch Psychiatry Clin Neurosci 2019; 269:587-598. [PMID: 30288559 DOI: 10.1007/s00406-018-0945-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
Given the particular relevance of arousal and alerting in panic disorder (PD), here the alerting network was investigated (1) contrasting patients with PD and healthy controls, (2) as a function of anxiety sensitivity constituting a dimensional measure of panic-related anxiety, and (3) as a possible correlate of treatment response. Using functional magnetic resonance imaging (fMRI), 45 out-patients with PD (f = 34) and 51 matched healthy controls were investigated for brain activation patterns and effective connectivity (Dynamic Causal Modeling, DCM) while performing the Attention Network Task (ANT). Anxiety sensitivity was ascertained by the Anxiety Sensitivity Index (ASI). Forty patients and 48 controls were re-scanned after a 6 weeks cognitive-behavioral treatment (CBT) or an equivalent waiting time, respectively. In the alerting condition, patients showed decreased activation in fronto-parietal pathways including the middle frontal gyrus and the superior parietal lobule (MFG, SPL). In addition, ASI scores were negatively correlated with connectivity emerging from the SPL, the SFB and the LC and going to the MFG in patients but not in healthy controls. CBT resulted in an increase in middle frontal and parietal activation along with increased connectivity going from the MFG to the SPL. This change in connectivity was positively correlated with reduction in ASI scores. There were no changes in controls. The present findings point to a pathological disintegration of the MFG in a fronto-parietal pathway in the alerting network in PD which was observed to be reversible by a successful CBT intervention.
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Affiliation(s)
- Susanne Neufang
- Center of Mental Health, Department of Child and Adolescent Psychiatry, University of Wuerzburg, 97080, Wuerzburg, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40204, Duesseldorf, Germany.
| | - Maximilian J Geiger
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
- Epilepsy Center, Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - György A Homola
- Institute for Diagnostical and Interventional Neuroradiology, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Marina Mahr
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Miriam A Schiele
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Centre, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany
| | - Andrea Gehrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Brigitte Schmidt
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Agnieszka Gajewska
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Johannes Nowak
- Institute for Diagnostical and Interventional Radiology, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Eva Meisenzahl-Lechner
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40204, Duesseldorf, Germany
| | - Mirko Pham
- Institute for Diagnostical and Interventional Neuroradiology, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Atae Akhrif
- Center of Mental Health, Department of Child and Adolescent Psychiatry, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Katharina Domschke
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Centre, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany
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21
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Madonna D, Delvecchio G, Soares JC, Brambilla P. Structural and functional neuroimaging studies in generalized anxiety disorder: a systematic review. ACTA ACUST UNITED AC 2019; 41:336-362. [PMID: 31116259 PMCID: PMC6804309 DOI: 10.1590/1516-4446-2018-0108] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/16/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Brain imaging studies carried out in patients suffering from generalized anxiety disorder (GAD) have contributed to better characterize the pathophysiological mechanisms underlying this disorder. The present study reviews the available functional and structural brain imaging evidence on GAD, and suggests further strategies for investigations in this field. METHODS A systematic literature review was performed in PubMed, PsycINFO, and Google Scholar, aiming to identify original research evaluating GAD patients with the use of structural and functional magnetic resonance imaging as well as diffusion tensor imaging. RESULTS The available studies have shown impairments in ventrolateral and dorsolateral prefrontal cortex, anterior cingulate, posterior parietal regions, and amygdala in both pediatric and adult GAD patients, mostly in the right hemisphere. However, the literature is often tentative, given that most studies have employed small samples and included patients with comorbidities or in current use of various medications. Finally, different methodological aspects, such as the type of imaging equipment used, also complicate the generalizability of the findings. CONCLUSIONS Longitudinal neuroimaging studies with larger samples of both juvenile and adult GAD patients, as well as at risk individuals and unaffected relatives, should be carried out in order to shed light on the specific biological signature of GAD.
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Affiliation(s)
- Domenico Madonna
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá di Milano, Milano, Italy.,Dipartimento di Neuroscienze e Salute Mentale, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuseppe Delvecchio
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá di Milano, Milano, Italy
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Paolo Brambilla
- Dipartimento di Neuroscienze e Salute Mentale, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, USA
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22
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Makovac E, Fagioli S, Watson DR, Meeten F, Smallwood J, Critchley HD, Ottaviani C. Response time as a proxy of ongoing mental state: A combined fMRI and pupillometry study in Generalized Anxiety Disorder. Neuroimage 2019; 191:380-391. [DOI: 10.1016/j.neuroimage.2019.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/27/2023] Open
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23
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De Luca R, Manuli A, De Domenico C, Lo Voi E, Buda A, Maresca G, Bramanti A, Calabrò RS. Improving neuropsychiatric symptoms following stroke using virtual reality: A case report. Medicine (Baltimore) 2019; 98:e15236. [PMID: 31083155 PMCID: PMC6531176 DOI: 10.1097/md.0000000000015236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Post-stroke cognitive impairment occurs frequently in patients with stroke, with a 20% to 80% prevalence. Anxiety is common after stroke, and is associated with a poorer quality of life. The use of standard relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation have shown some positive effects, whereas virtual reality seems to have a role in the treatment of anxiety disorders, especially when associated to neurological damage. PATIENTS CONCERNS A 50-year-old woman, smokers, affected by hypertension and right ischemic stroke in the chronic phase (i.e., after 12 months by cerebrovascular event), came to our observation for a severe anxiety state and a mild cognitive deficit, mainly involving attention and visuo-executive processes, besides a mild left hemiparesis. DIAGNOSIS Anxiety in a patient with ischemic stroke. INTERVENTIONS Standard relaxation techniques alone in a common clinical setting or the same psychological approach in an immersive virtual environment (i.e., Computer Assisted Rehabilitation Environment - CAREN). OUTCOMES The patient's cognitive and psychological profile, with regard to attention processes, mood, anxiety, and coping strategies, were evaluated before and after the 2 different trainings. A significant improvement in the functional and behavioral outcomes were observed only at the end of the combined approach. LESSONS The immersive virtual reality environment CAREN might be useful to improve cognitive and psychological status, with regard to anxiety symptoms, in post-stroke individuals.
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Méndez-Ruette M, Linsambarth S, Moraga-Amaro R, Quintana-Donoso D, Méndez L, Tamburini G, Cornejo F, Torres RF, Stehberg J. The Role of the Rodent Insula in Anxiety. Front Physiol 2019; 10:330. [PMID: 30984021 PMCID: PMC6450210 DOI: 10.3389/fphys.2019.00330] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/11/2019] [Indexed: 01/21/2023] Open
Abstract
The human insula has been consistently reported to be overactivated in all anxiety disorders, activation which has been suggested to be proportional to the level of anxiety and shown to decrease with effective anxiolytic treatment. Nonetheless, studies evaluating the direct role of the insula in anxiety are lacking. Here, we set out to investigate the role of the rodent insula in anxiety by either inactivating different insular regions via microinjections of glutamatergic AMPA receptor antagonist CNQX or activating them by microinjection of GABA receptor antagonist bicuculline in rats, before measuring anxiety-like behavior using the elevated plus maze. Inactivation of caudal and medial insular regions induced anxiogenic effects, while their activation induced anxiolytic effects. In contrast, inactivation of more rostral areas induced anxiolytic effects and their activation, anxiogenic effects. These results suggest that the insula in the rat has a role in the modulation of anxiety-like behavior in rats, showing regional differences; rostral regions have an anxiogenic role, while medial and caudal regions have an anxiolytic role, with a transition area around bregma +0.5. The present study suggests that the insula has a direct role in anxiety.
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Affiliation(s)
- Maxs Méndez-Ruette
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Sergio Linsambarth
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Rodrigo Moraga-Amaro
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Daisy Quintana-Donoso
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Luis Méndez
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Giovanni Tamburini
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Francisca Cornejo
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Rodrigo F Torres
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Jimmy Stehberg
- Laboratorio de Neurobiología, Instituto de Ciencias Biomédicas, Facultad de Medicina y Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
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Ma H, Wang N, Wang X, Jia M, Li Y, Cui C. Wnt7a in Mouse Insular Cortex Contributes to Anxiety-like Behavior During Protracted Abstinence from Morphine. Neuroscience 2018; 394:164-176. [PMID: 30367944 DOI: 10.1016/j.neuroscience.2018.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 01/05/2023]
Abstract
Anxiety is considered an important protracted abstinence symptom that can aggravate craving and relapse risk in opioid addicts. Although the insular cortex (IC) has been reported to be a key brain region in mediating emotional and motivational alterations induced by drug consumption and withdrawal, the role of IC in anxiety related to protracted abstinence remains elusive. In this study, we found that: (1) anxiety-like behavior in morphine-dependent mice became significant after 28 days of withdrawal, while their physical symptoms became undetectable. (2) Activated glutamatergic neurons in the medial IC, but not the anterior or posterior IC were significantly increased after 28 days of withdrawal. Bilateral lesion of the medial IC, but not the anterior or posterior IC with ibotenic acid (IBO) alleviated the anxiety-like behavior. (3) Expression of Wnt7a in the medial IC was significantly increased after 28 days of withdrawal, and specific down-regulation of Wnt7a with AAV-shWnt7a also alleviated the anxiety-like behavior. The findings reveal the medial IC is involved in mediating anxiety-like behavior related to morphine protracted abstinence, in which Wnt7a plays a critical role.
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Affiliation(s)
- Hui Ma
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Key Laboratory for Neuroscience of the Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Na Wang
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Key Laboratory for Neuroscience of the Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Xinjuan Wang
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Key Laboratory for Neuroscience of the Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Meng Jia
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Key Laboratory for Neuroscience of the Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Yijing Li
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Key Laboratory for Neuroscience of the Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China
| | - Cailian Cui
- Department of Neurobiology, School of Basic Medical Sciences, Neuroscience Research Institute, Key Laboratory for Neuroscience of the Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China.
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Marques DR, Gomes AA, Clemente V, dos Santos JM, Duarte IC, Caetano G, Castelo-Branco M. Self-Referential Dysfunction and Default-Mode Hyperactivation in Psychophysiological Insomnia Patients. J PSYCHOPHYSIOL 2018. [DOI: 10.1027/0269-8803/a000194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Psychophysiological insomnia (PI) is one of the most frequent sleep disorders. In this study we tested whether differences in terms of neural activation are present between a group of PI patients and a healthy-control group while they are exposed to idiosyncratic ruminations and worries, evoked visually by words, so as to explore their hypothetical link with default-mode network (DMN) dysfunction in PI. We recruited five PI patients diagnosed according to the International Classification of Sleep Disorders, version 2 (ICSD-2) of American Academy of Sleep Medicine (AASM) and five age- and sex-matched healthy controls. Patients were recruited at the outpatient Sleep Medicine Centre of the Coimbra University Hospital Centre. We used a functional magnetic resonance imaging (fMRI) block-design paradigm where the participants visualized lists of words related to past/present and future concerns and also emotionally neutral words. The results suggested that the PI patients showed a failure of the DMN to deactivate. Moreover, when these patients were exposed to words concerning both past/present ruminations and future worries, there was a pronounced and significant over-recruitment of brain areas related to DMN and self-referential processing when they were compared to healthy volunteers. The differences between the patient and control groups were also evident in self-report measures. In sum, despite the relatively small sample size, our study clearly suggests that in PI there is a dysfunction in brain regions pertaining to self-referential processing, which is corroborated by an overall pattern of hyperarousal in brain regions comprising the DMN. These data may be useful in the improvement of pathophysiological models, diagnostic and therapeutic interventions for insomnia.
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Affiliation(s)
- Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Portugal
- Institute for Biomedical Imaging and Life Sciences (IBILI), Coimbra, Portugal
| | - Ana Allen Gomes
- Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
- CINEICC – Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo-Comportamental/Research & Development Unit (FCT): Cognitive and Behavioural Center for Research and Intervention, Coimbra, Portugal
| | - Vanda Clemente
- Sleep Medicine Centre, Coimbra University Hospital Centre (CHUC), Portugal
| | | | | | - Gina Caetano
- Institute for Biomedical Imaging and Life Sciences (IBILI), Coimbra, Portugal
- Brain Imaging Network, ICNAS, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Institute for Biomedical Imaging and Life Sciences (IBILI), Coimbra, Portugal
- Brain Imaging Network, ICNAS, Coimbra, Portugal
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27
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Kim GW, Yoon W, Jeong GW. Whole-brain volume alteration and its correlation with anxiety severity in patients with obsessive-compulsive disorder and generalized anxiety disorder. Clin Imaging 2018; 50:164-170. [PMID: 29567629 DOI: 10.1016/j.clinimag.2018.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/25/2018] [Accepted: 03/09/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the differential gray matter (GM) and white matter volume alterations between healthy controls and patients with obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD) using voxel-based morphometry (VBM). METHOD Patients with OCD and GAD, and healthy controls underwent MR. RESULTS Patients with GAD showed significantly decreased GM volume in the medial prefrontal cortex (mPFC) compared with patients with OCD (p < 0.001). The GM volumes of the mPFC in patients with GAD were negatively correlated with Hamilton Anxiety Rating Scales. CONCLUSION Our findings indicate that the mPFC volume abnormality may be associated with anxiety disorder in patients with GAD rather than OCD.
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Affiliation(s)
- Gwang-Won Kim
- Advanced Institute of Aging Science, Chonnam National University, Gwangju, Republic of Korea
| | - Woong Yoon
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Gwang-Woo Jeong
- Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
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28
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Buff C, Schmidt C, Brinkmann L, Gathmann B, Tupak S, Straube T. Directed threat imagery in generalized anxiety disorder. Psychol Med 2018; 48:617-628. [PMID: 28735579 DOI: 10.1017/s0033291717001957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Worrying has been suggested to prevent emotional and elaborative processing of fears. In cognitive-behavioral therapy (CBT), generalized anxiety disorder (GAD) patients are exposed to their fears during the method of directed threat imagery by inducing emotional reactivity. However, studies investigating neural correlates of directed threat imagery and emotional reactivity in GAD patients are lacking. The present functional magnetic resonance imaging (fMRI) study aimed at delineating neural correlates of directed threat imagery in GAD patients. METHOD Nineteen GAD patients and 19 healthy controls (HC) were exposed to narrative scripts of either disorder-related or neutral content and were encouraged to imagine it as vividly as possible. RESULTS Rating results showed that GAD patients experienced disorder-related scripts as more anxiety inducing and arousing than HC. These results were also reflected in fMRI data: Disorder-related v. neutral scripts elicited elevated activity in the amygdala, dorsomedial prefrontal cortex, ventrolateral prefrontal cortex and the thalamus as well as reduced activity in the ventromedial prefrontal cortex/subgenual anterior cingulate cortex in GAD patients relative to HC. CONCLUSION The present study presents the first behavioral and neural evidence for emotional reactivity during directed threat imagery in GAD. The brain activity pattern suggests an involvement of a fear processing network as a neural correlate of initial exposure during directed imagery in CBT in GAD.
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Affiliation(s)
- C Buff
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - C Schmidt
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - B Gathmann
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - S Tupak
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience,University of Muenster,Von-Esmarch-Str. 52, 48149 Muenster,Germany
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Abstract
Generalized anxiety disorder (GAD) is a prevalent and highly disabling mental health condition; however, there is still much to learn with regard to pertinent biomarkers, as well as diagnosis, made more difficult by the marked and common overlap of GAD with affective and anxiety disorders. Recently, intensive research efforts have focused on GAD, applying neuroimaging, genetic, and blood-based approaches toward discovery of pathogenetic and treatment-related biomarkers. In this paper, we review the large amount of available data, and we focus in particular on evidence from neuroimaging, genetic, and neurochemical measurements in GAD in order to better understand potential biomarkers involved in its etiology and treatment. Overall, the majority of these studies have produced results that are solitary findings, sometimes inconsistent and not clearly replicable. For these reasons, they have not yet been translated into clinical practice. Therefore, further research efforts are needed to distinguish GAD from other mental disorders and to provide new biological insights into its pathogenesis and treatment.
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Affiliation(s)
- Eduard Maron
- Faculty of Medicine, Department of Medicine, Center for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK ; Department of Psychiatry, University of Tartu, Tartu, Estonia ; North Estonia Medical Center, Department of Psychiatry, Tallinn, Estonia
| | - David Nutt
- Faculty of Medicine, Department of Medicine, Center for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
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Abstract
Anxiety disorders are among the most prevalent psychological issues worldwide, displaying the youngest age of onset and greatest chronicity of any mood or substance abuse disorder. Given the high social and economic cost imposed by these disorders, developing effective treatments is of the utmost importance. Anxiety disorders manifest in a variety of symptomatic phenotypes and are highly comorbid with other psychological diseases such as depression. These facts have made unraveling the complex underlying neural circuity an ever-present challenge for researchers. We offer a brief review on the neuroanatomy of anxiety disorders and discuss several currently available therapeutic options.
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Affiliation(s)
| | - Shehzad Khalid
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
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31
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Maron E, Lan CC, Nutt D. Imaging and Genetic Approaches to Inform Biomarkers for Anxiety Disorders, Obsessive-Compulsive Disorders, and PSTD. Curr Top Behav Neurosci 2018; 40:219-292. [PMID: 29796838 DOI: 10.1007/7854_2018_49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Anxiety disorders are the most common mental health problem in the world and also claim the highest health care cost among various neuropsychiatric disorders. Anxiety disorders have a chronic and recurrent course and cause significantly negative impacts on patients' social, personal, and occupational functioning as well as quality of life. Despite their high prevalence rates, anxiety disorders have often been under-diagnosed or misdiagnosed, and consequently under-treated. Even with the correct diagnosis, anxiety disorders are known to be difficult to treat successfully. In order to implement better strategies in diagnosis, prognosis, treatment decision, and early prevention for anxiety disorders, tremendous efforts have been put into studies using genetic and neuroimaging techniques to advance our understandings of the underlying biological mechanisms. In addition to anxiety disorders including panic disorder, generalised anxiety disorder (GAD), specific phobias, social anxiety disorders (SAD), due to overlapping symptom dimensions, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) (which were removed from the anxiety disorder category in DSM-5 to become separate categories) are also included for review of relevant genetic and neuroimaging findings. Although the number of genetic or neuroimaging studies focusing on anxiety disorders is relatively small compare to other psychiatric disorders such as psychotic disorders or mood disorders, various structural abnormalities in the grey or white matter, functional alterations of activity during resting-state or task conditions, molecular changes of neurotransmitter receptors or transporters, and genetic associations have all been reported. With continuing effort, further genetic and neuroimaging research may potentially lead to clinically useful biomarkers for the prevention, diagnosis, and management of these disorders.
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Affiliation(s)
- Eduard Maron
- Neuropsychopharmacology Unit, Centre for Academic Psychiatry, Division of Brain Sciences, Imperial College London, London, UK.
- Department of Psychiatry, University of Tartu, Tartu, Estonia.
- Department of Psychiatry, North Estonia Medical Centre, Tallinn, Estonia.
| | - Chen-Chia Lan
- Neuropsychopharmacology Unit, Centre for Academic Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - David Nutt
- Neuropsychopharmacology Unit, Centre for Academic Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
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32
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Kainate receptor mediated presynaptic LTP in agranular insular cortex contributes to fear and anxiety in mice. Neuropharmacology 2018; 128:388-400. [DOI: 10.1016/j.neuropharm.2017.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/24/2017] [Accepted: 10/28/2017] [Indexed: 11/23/2022]
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33
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Zhang Z, Liao M, Yao Z, Hu B, Xie Y, Zheng W, Hu T, Zhao Y, Yang F, Zhang Y, Su L, Li L, Gutknecht J, Majoe D. Frequency-Specific Functional Connectivity Density as an Effective Biomarker for Adolescent Generalized Anxiety Disorder. Front Hum Neurosci 2017; 11:549. [PMID: 29259549 PMCID: PMC5723402 DOI: 10.3389/fnhum.2017.00549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022] Open
Abstract
Several neuropsychiatric diseases have been found to influence the frequency-specific spontaneous functional brain organization (SFBO) in resting state, demonstrating that the abnormal brain activities of different frequency bands are associated with various physiological and psychological dysfunctions. However, little is known about the frequency specificities of SFBO in adolescent generalized anxiety disorder (GAD). Here, a novel complete ensemble empirical mode decomposition with adaptive noise method was applied to decompose the time series of each voxel across all participants (31 adolescent patients with GAD and 28 matched healthy controls; HCs) into four frequency-specific bands with distinct intrinsic oscillation. The functional connectivity density (FCD) of different scales (short-range and long-range) was calculated to quantify the SFBO changes related to GAD within each above frequency-specific band and the conventional frequency band (0.01–0.08 Hz). Support vector machine classifier was further used to examine the discriminative ability of the frequency-specific FCD values. The results showed that adolescent GAD patients exhibited abnormal alterations of both short-range and long-range FCD (S-FCD and L-FCD) in widespread brain regions across three frequency-specific bands. Positive correlation between the State Anxiety Inventory (SAI) score and increased L-FCD in the fusiform gyrus in the conventional frequency band was found in adolescents with GAD. Both S-FCD and L-FCD in the insula in the lower frequency band (0.02–0.036 Hz) had the highest classification performance compared to all other brain regions with inter-group difference. Furthermore, a satisfactory classification performance was achieved by combining the discrepant S-FCD and L-FCD values in all frequency bands, with the area under the curve (AUC) value of 0.9414 and the corresponding sensitivity, specificity, and accuracy of 87.15, 92.92, and 89.83%, respectively. This study indicates that the alterations of SFBO in adolescent GAD are frequency dependence and the frequency-specific FCD can potentially serve as a valuable biomarker in discriminating GAD patients from HCs. These findings may provide new insights into the pathophysiological mechanisms of adolescent GAD.
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Affiliation(s)
- Zhe Zhang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Mei Liao
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yuanwei Xie
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Weihao Zheng
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Tao Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Yu Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Fan Yang
- Guangdong Mental Health Center, Guangdong General Hospital, Guangzhou, China
| | - Yan Zhang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Linyan Su
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
| | - Jürg Gutknecht
- Computer Systems Institute, ETH Zürich, Zürich, Switzerland
| | - Dennis Majoe
- Computer Systems Institute, ETH Zürich, Zürich, Switzerland
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Kalsi N, Altavilla D, Tambelli R, Aceto P, Trentini C, Di Giorgio C, Lai C. Neural Correlates of Outcome of the Psychotherapy Compared to Antidepressant Therapy in Anxiety and Depression Disorders: A Meta-Analysis. Front Psychol 2017. [PMID: 28638359 PMCID: PMC5461356 DOI: 10.3389/fpsyg.2017.00927] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The most prevalent mental disorders, anxiety and depression, are commonly associated with structural and functional changes in the fronto-limbic brain areas. The clinical trials investigating patients with affective disorders showed different outcome to different treatments such as psychotherapy or pharmacotherapy. It is, however, still unexplored how these interventions approach affect the functional brain. This meta-analysis aims to compare the effects of psychotherapy compared to antidepressant therapy on functional brain activity in anxiety and depression disorders. Twenty-one samples with psychotherapy and seventeen samples with antidepressant therapy were included. The main finding showed an inverse effect of the two treatments on the right paracingulate activity. The patients undergoing psychotherapy showed an increase in the right paracingulate activity while pharmacological treatment led to a decrease of activation of this area. This finding seems to support the recent studies that hypothesize how psychotherapy, through the self-knowledge and the meaning processing, involves a top-down emotional regulation.
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Affiliation(s)
- Navkiran Kalsi
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Daniela Altavilla
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Università Cattolica del Sacro CuoreRome, Italy
| | - Cristina Trentini
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Chiara Di Giorgio
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
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Mohlman J, Eldreth DA, Price RB, Staples AM, Hanson C. Prefrontal-limbic connectivity during worry in older adults with generalized anxiety disorder. Aging Ment Health 2017; 21:426-438. [PMID: 26566020 DOI: 10.1080/13607863.2015.1109058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders in older adults, very little is known about the neurobiology of worry, the hallmark symptom of GAD in adults over the age of 60. This study investigated the neurobiology and neural circuitry of worry in older GAD patients and controls. METHOD Twenty older GAD patients and 16 age-matched controls (mean age = 67.88) were compared on clinical measures and neural activity during worry using functional magnetic resonance imaging. RESULTS As expected, worry elicited activation in frontal regions, amygdala, and insula within the GAD group, with a similar but less prominent frontal pattern was observed in controls. Effective connectivity analyses revealed a positive directional circuit in the GAD group extending from ventromedial through dorsolateral prefrontal cortices, converging on the amygdala. A less complex circuit was observed in controls with only dorsolateral prefrontal regions converging on the amygdala; however, a separate circuit passing through the orbitofrontal cortex converged on the insula. CONCLUSION Results elucidate a different neurobiology of pathological versus normal worry in later life. A limited resource model is implicated wherein worry in GAD competes for the same neural resources (e.g. prefrontal cortical areas) that are involved in the adaptive regulation of emotion through cognitive and behavioral strategies.
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Affiliation(s)
- Jan Mohlman
- a William Paterson University , Wayne , NJ , USA
| | - Dana A Eldreth
- b Rutgers, the State University of New Jersey , Newark , NJ , USA
| | - Rebecca B Price
- c University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | | | - Catherine Hanson
- b Rutgers, the State University of New Jersey , Newark , NJ , USA
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36
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Duquette P. Increasing Our Insular World View: Interoception and Psychopathology for Psychotherapists. Front Neurosci 2017; 11:135. [PMID: 28377690 PMCID: PMC5359279 DOI: 10.3389/fnins.2017.00135] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022] Open
Abstract
Interoception has been determined to be an elemental aspect of the neural foundations of physiological homeostasis, subjective experience, and motivated behavior. This paper reviews current neuroscience research regarding interoception and forms of interoceptive dysfunction that may result in psychopathology, focusing on depression, and anxiety, in a manner conducive to psychotherapists engaging with it to consider clinical applications. Pertinent aspects of interoceptive system processes in relation to psychopathology are addressed: Functional interoceptive ability and the forms of its expression, the difficulty of accurate measurement of such within an individual or group, interoceptive inference processes and perturbations. Predictive coding, considered in this context as interoceptive inference, a process that integrates bottom-up and top down lines of neural information emerging from the multitude of bidirectional, anatomically hierarchical connections the insular cortex makes with other cortical, and subcortical structures, will be addressed regarding its place in psychopathological formulations. Clinical vignettes will elucidate how interoceptive disturbances might present in the therapeutic relationship, supporting the evaluation and application of scientific theory, and research findings by psychotherapists. The clinical implications of this neuroscientific research have received little attention in the psychotherapeutic setting. Increasing the knowledge base of psychotherapists and furthering awareness of the functional interactions of body and brain toward the creation of healthy and psychopathological experience benefits the patient. There is immediate need for the translational expression of scientific findings into the psychological evaluation of patients, therapeutic process, and treatment. While it may seem distant and unrelated to the affective processes that occur within the psychotherapeutic exchange, neuroscience adds a unique perspective from which to observe and live such experience for the therapist and patient. With the therapeutic relationship as the backdrop, a scientific perspective will support psychotherapists' comprehension of their patients' experience and the process of change, either through direct information, or the development of different perspectives from which to observe and interact with their patients. This paper will serve not only as a guide for psychotherapists concerning this expanding knowledge base, but also a source for neuroscience researchers intent on formulating research protocols that could produce clinical benefit.
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37
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Schulz SM. Neural correlates of heart-focused interoception: a functional magnetic resonance imaging meta-analysis. Philos Trans R Soc Lond B Biol Sci 2016; 371:rstb.2016.0018. [PMID: 28080975 DOI: 10.1098/rstb.2016.0018] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 01/22/2023] Open
Abstract
Interoception is the ability to perceive one's internal body state including visceral sensations. Heart-focused interoception has received particular attention, in part due to a readily available task for behavioural assessment, but also due to accumulating evidence for a significant role in emotional experience, decision-making and clinical disorders such as anxiety and depression. Improved understanding of the underlying neural correlates is important to promote development of anatomical-functional models and suitable intervention strategies. In the present meta-analysis, nine studies reporting neural activity associated with interoceptive attentiveness (i.e. focused attention to a particular interoceptive signal for a given time interval) to one's heartbeat were submitted to a multilevel kernel density analysis. The findings corroborated an extended network associated with heart-focused interoceptive attentiveness including the posterior right and left insula, right claustrum, precentral gyrus and medial frontal gyrus. Right-hemispheric dominance emphasizes non-verbal information processing with the posterior insula presumably serving as the major gateway for cardioception. Prefrontal neural activity may reflect both top-down attention deployment and processing of feed-forward cardioceptive information, possibly orchestrated via the claustrum.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.
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Affiliation(s)
- Stefan M Schulz
- Department of Psychology I, University of Würzburg, Marcusstrasse 9-11, 97070 Würzburg, Germany .,Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Straubmühlweg 2a, 97078 Würzburg, Germany
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Buff C, Brinkmann L, Neumeister P, Feldker K, Heitmann C, Gathmann B, Andor T, Straube T. Specifically altered brain responses to threat in generalized anxiety disorder relative to social anxiety disorder and panic disorder. NEUROIMAGE-CLINICAL 2016; 12:698-706. [PMID: 27761400 PMCID: PMC5065042 DOI: 10.1016/j.nicl.2016.09.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/14/2016] [Accepted: 09/30/2016] [Indexed: 11/23/2022]
Abstract
Background Despite considerable effort, the neurobiological underpinnings of hyper-responsive threat processing specific to patients suffering from generalized anxiety disorder (GAD) remain poorly understood. The current functional magnetic resonance imaging (fMRI) study aims to delineate GAD-specific brain activity during immediate threat processing by comparing GAD patients to healthy controls (HC), to social anxiety disorder (SAD) and to panic disorder (PD) patients. Method Brain activation and functional connectivity patterns to threat vs. neutral pictures were investigated using event-related fMRI. The sample consisted of 21 GAD, 21 PD, 21 SAD and 21 HC. Results GAD-specific elevated activity to threat vs. neutral pictures was found in cingulate cortex, dorsal anterior insula/frontal operculum (daI/FO) and posterior dorsolateral prefrontal cortex (dlPFC). Defining these effects as seed regions, we detected GAD-specific increased functional connectivity to threat vs. neutral pictures between posterior dlPFC and ventrolateral prefrontal cortex, between cingulate cortex and amygdala, between cingulate cortex and anterior insula, as well as decreased functional connectivity between daI/FO and mid-dlPFC. Conclusion The findings present the first evidence for GAD-specific neural correlates of hyper-responsive threat processing, possibly reflecting exaggerated threat sensitivity, maladaptive appraisal and attention-allocation processes. Threat processing investigation across multiple anxiety disorders First neural evidence of GAD-specific threat-related alterations GAD-specific alterations primarily located in prefrontal cortex Alterations are suggestive of exaggerated threat sensitivity
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Affiliation(s)
- Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
- Corresponding author.
| | - Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Katharina Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Carina Heitmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Tanja Andor
- Institute of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
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Vasey MW, Chriki L, Toh GY. Cognitive Control and Anxious Arousal in Worry and Generalized Anxiety: An Initial Test of an Integrative Model. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9809-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Diefenbach GJ, Bragdon LB, Zertuche L, Hyatt CJ, Hallion LS, Tolin DF, Goethe JW, Assaf M. Repetitive transcranial magnetic stimulation for generalised anxiety disorder: a pilot randomised, double-blind, sham-controlled trial. Br J Psychiatry 2016; 209:222-8. [PMID: 27198484 DOI: 10.1192/bjp.bp.115.168203] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating generalised anxiety disorder (GAD) but has only been studied in uncontrolled research. AIMS This is the first randomised controlled trial (clinicaltrials.gov: NCT01659736) to investigate the efficacy and neural correlates of rTMS in GAD. METHOD Twenty five participants (active n = 13; sham, n = 12) enrolled. rTMS was targeted at the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 90% resting motor threshold). RESULTS Response and remission rates were higher in the active v. sham groups and there were significant group × time interactions for anxiety, worry and depressive symptoms, favouring active v. sham. In addition, right DLPFC activation during a decision-making gambling task increased at post-treatment for active rTMS only, and changes in neuroactivation correlated significantly with changes in worry symptoms. CONCLUSIONS Findings provide preliminary evidence that rTMS may improve GAD symptoms in association with modifying neural activity in the stimulation site.
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Affiliation(s)
- Gretchen J Diefenbach
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - Laura B Bragdon
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - Luis Zertuche
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher J Hyatt
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lauren S Hallion
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - David F Tolin
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - John W Goethe
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michal Assaf
- Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA
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Ottaviani C, Watson DR, Meeten F, Makovac E, Garfinkel SN, Critchley HD. Neurobiological substrates of cognitive rigidity and autonomic inflexibility in generalized anxiety disorder. Biol Psychol 2016; 119:31-41. [DOI: 10.1016/j.biopsycho.2016.06.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
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Bandelow B, Baldwin D, Abelli M, Altamura C, Dell'Osso B, Domschke K, Fineberg NA, Grünblatt E, Jarema M, Maron E, Nutt D, Pini S, Vaghi MM, Wichniak A, Zai G, Riederer P. Biological markers for anxiety disorders, OCD and PTSD - a consensus statement. Part I: Neuroimaging and genetics. World J Biol Psychiatry 2016; 17:321-65. [PMID: 27403679 DOI: 10.1080/15622975.2016.1181783] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). METHODS Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network. RESULTS The present article (Part I) summarises findings on potential biomarkers in neuroimaging studies, including structural brain morphology, functional magnetic resonance imaging and techniques for measuring metabolic changes, including positron emission tomography and others. Furthermore, this review reports on the clinical and molecular genetic findings of family, twin, linkage, association and genome-wide association studies. Part II of the review focuses on neurochemistry, neurophysiology and neurocognition. CONCLUSIONS Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high-quality research has accumulated that will improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.
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Affiliation(s)
- Borwin Bandelow
- a Department of Psychiatry and Psychotherapy , University of Göttingen , Germany
| | - David Baldwin
- b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Marianna Abelli
- c Department of Clinical and Experimental Medicine , Section of Psychiatry, University of Pisa , Italy
| | - Carlo Altamura
- d Department of Psychiatry , University of Milan; Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Bernardo Dell'Osso
- d Department of Psychiatry , University of Milan; Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico , Milan , Italy
| | - Katharina Domschke
- e Department of Psychiatry, Psychosomatics and Psychotherapy , University of Wuerzburg , Germany
| | - Naomi A Fineberg
- f Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire , Rosanne House, Parkway , Welwyn Garden City , UK
| | - Edna Grünblatt
- e Department of Psychiatry, Psychosomatics and Psychotherapy , University of Wuerzburg , Germany ;,g Neuroscience Center Zurich , University of Zurich and the ETH Zurich , Zürich , Switzerland ;,h Department of Child and Adolescent Psychiatry and Psychotherapy , Psychiatric Hospital, University of Zurich , Zürich , Switzerland ;,i Zurich Center for Integrative Human Physiology , University of Zurich , Switzerland
| | - Marek Jarema
- j Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warszawa , Poland
| | - Eduard Maron
- k North Estonia Medical Centre, Department of Psychiatry , Tallinn , Estonia ;,l Department of Psychiatry , University of Tartu , Estonia ;,m Faculty of Medicine, Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences , Imperial College London , UK
| | - David Nutt
- m Faculty of Medicine, Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences , Imperial College London , UK
| | - Stefano Pini
- c Department of Clinical and Experimental Medicine , Section of Psychiatry, University of Pisa , Italy
| | - Matilde M Vaghi
- n Department of Psychology and Behavioural and Clinical Neuroscience Institute , University of Cambridge , UK
| | - Adam Wichniak
- j Third Department of Psychiatry , Institute of Psychiatry and Neurology , Warszawa , Poland
| | - Gwyneth Zai
- n Department of Psychology and Behavioural and Clinical Neuroscience Institute , University of Cambridge , UK ;,o Neurogenetics Section, Centre for Addiction & Mental Health , Toronto , Canada ;,p Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre , Toronto , Canada ;,q Institute of Medical Science and Department of Psychiatry, University of Toronto , Toronto , Canada
| | - Peter Riederer
- e Department of Psychiatry, Psychosomatics and Psychotherapy , University of Wuerzburg , Germany ;,g Neuroscience Center Zurich , University of Zurich and the ETH Zurich , Zürich , Switzerland ;,h Department of Child and Adolescent Psychiatry and Psychotherapy , Psychiatric Hospital, University of Zurich , Zürich , Switzerland
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Makovac E, Watson DR, Meeten F, Garfinkel SN, Cercignani M, Critchley HD, Ottaviani C. Amygdala functional connectivity as a longitudinal biomarker of symptom changes in generalized anxiety. Soc Cogn Affect Neurosci 2016; 11:1719-1728. [PMID: 27369066 PMCID: PMC5091683 DOI: 10.1093/scan/nsw091] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022] Open
Abstract
Generalized anxiety disorder (GAD) is characterized by excessive worry, autonomic dysregulation and functional amygdala dysconnectivity, yet these illness markers have rarely been considered together, nor their interrelationship tested longitudinally. We hypothesized that an individual’s capacity for emotion regulation predicts longer-term changes in amygdala functional connectivity, supporting the modification of GAD core symptoms. Sixteen patients with GAD (14 women) and individually matched controls were studied at two time points separated by 1 year. Resting-state fMRI data and concurrent measurement of vagally mediated heart rate variability were obtained before and after the induction of perseverative cognition. A greater rise in levels of worry following the induction predicted a stronger reduction in connectivity between right amygdala and ventromedial prefrontal cortex, and enhanced coupling between left amygdala and ventral tegmental area at follow-up. Similarly, amplified physiological responses to the induction predicted increased connectivity between right amygdala and thalamus. Longitudinal shifts in a distinct set of functional connectivity scores were associated with concomitant changes in GAD symptomatology over the course of the year. Results highlight the prognostic value of indices of emotional dysregulation and emphasize the integral role of the amygdala as a critical hub in functional neural circuitry underlying the progression of GAD symptomatology.
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Affiliation(s)
- Elena Makovac
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.,Psychiatry, Division of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - David R Watson
- Psychiatry, Division of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Frances Meeten
- Psychiatry, Division of Medicine, Brighton and Sussex Medical School, Brighton, UK.,Kings College London, London, UK.,Sussex Partnership NHS Foundation Trust Sussex, Sussex UK
| | - Sarah N Garfinkel
- Psychiatry, Division of Medicine, Brighton and Sussex Medical School, Brighton, UK.,Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
| | - Mara Cercignani
- Psychiatry, Division of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Hugo D Critchley
- Psychiatry, Division of Medicine, Brighton and Sussex Medical School, Brighton, UK.,Sussex Partnership NHS Foundation Trust Sussex, Sussex UK.,Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
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Brosschot JF, Verkuil B, Thayer JF. The default response to uncertainty and the importance of perceived safety in anxiety and stress: An evolution-theoretical perspective. J Anxiety Disord 2016; 41:22-34. [PMID: 27259803 DOI: 10.1016/j.janxdis.2016.04.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/13/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
Abstract
From a combined neurobiological and evolution-theoretical perspective, the stress response is a subcortically subserved response to uncertainty that is not 'generated' but 'default': the stress response is 'always there' but as long as safety is perceived, the stress response is under tonic prefrontal inhibition, reflected by high vagally mediated heart rate variability. Uncertainty of safety leads to disinhibiting the default stress response, even in the absence of threat. Due to the stress response's survival value, this 'erring on the side of caution' is passed to us via our genes. Thus, intolerance of uncertainty is not acquired during the life cycle, but is a given property of all living organisms, only to be alleviated in situations of which the safety is learned. When the latter is deficient, generalized unsafety ensues, which underlies chronic anxiety and stress and their somatic health risks, as well as other highly prevalent conditions carrying such risks, including loneliness, obesity, aerobic unfitness and old age.
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Affiliation(s)
- Jos F Brosschot
- Institute of Psychology, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands.
| | - Bart Verkuil
- Institute of Psychology, Leiden University, P.O. Box 9555, 2300 RB Leiden, The Netherlands.
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
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Wang W, Hou J, Qian S, Liu K, Li B, Li M, Peng Z, Xin K, Sun G. Aberrant regional neural fluctuations and functional connectivity in generalized anxiety disorder revealed by resting-state functional magnetic resonance imaging. Neurosci Lett 2016; 624:78-84. [PMID: 27163197 DOI: 10.1016/j.neulet.2016.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to investigate the neural activity and functional connectivity in generalized anxiety disorder (GAD) during resting state, and how these alterations correlate to patients' symptoms. Twenty-eight GAD patients and 28 matched healthy controls underwent resting-state functional magnetic resonance (fMRI) scans. Amplitude of low-frequency fluctuation (ALFF) and seed-based resting-state functional connectivity (RSFC) were computed to explore regional activity and functional integration, and were compared between the two groups using the voxel-based two-sample t test. Pearson's correlation analyses were performed to examine the neural relationships with demographics and clinical symptoms scores. Compared to controls, GAD patients showed functional abnormalities: higher ALFF in the bilateral dorsomedial prefrontal cortex, bilateral dorsolateral prefrontal cortex and left precuneus/posterior cingulate cortex; lower connectivity in prefrontal gyrus; lower in prefrontal-limbic and cingulate RSFC and higher prefrontal-hippocampus RSFC were correlated with clinical symptoms severity, but these associations were unable to withstand correction for multiple testing. These findings may help facilitate further understanding of the potential neural substrate of GAD.
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Affiliation(s)
- Wei Wang
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China; 71702 Hospital, Luoyang 471000, China
| | - Jingming Hou
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Shaowen Qian
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China
| | - Kai Liu
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China
| | - Bo Li
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China
| | - Min Li
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China
| | - Zhaohui Peng
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China
| | - Kuolin Xin
- Department of Medical Psychology, Jinan Military General Hospital, Shandong 250000, China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, Shandong 250000, China.
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Farb DH, Ratner MH. Targeting the modulation of neural circuitry for the treatment of anxiety disorders. Pharmacol Rev 2015; 66:1002-32. [PMID: 25237115 DOI: 10.1124/pr.114.009126] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anxiety disorders are a major public health concern. Here, we examine the familiar area of anxiolysis in the context of a systems-level understanding that will hopefully lead to revealing an underlying pharmacological connectome. The introduction of benzodiazepines nearly half a century ago markedly improved the treatment of anxiety disorders. These agents reduce anxiety rapidly by allosterically enhancing the postsynaptic actions of GABA at inhibitory type A GABA receptors but side effects limit their use in chronic anxiety disorders. Selective serotonin reuptake inhibitors and serotonin/norepinephrine reuptake inhibitors have emerged as an effective first-line alternative treatment of such anxiety disorders. However, many individuals are not responsive and side effects can be limiting. Research into a relatively new class of agents known as neurosteroids has revealed novel modulatory sites and mechanisms of action that are providing insights into the pathophysiology of certain anxiety disorders, potentially bridging the gap between the GABAergic and serotonergic circuits underlying anxiety. However, translating the pharmacological activity of compounds targeted to specific receptor subtypes in rodent models of anxiety to effective therapeutics in human anxiety has not been entirely successful. Since modulating any one of several broad classes of receptor targets can produce anxiolysis, we posit that a systems-level discovery platform combined with an individualized medicine approach based on noninvasive brain imaging would substantially advance the development of more effective therapeutics.
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Affiliation(s)
- David H Farb
- Laboratory of Molecular Neurobiology, Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
| | - Marcia H Ratner
- Laboratory of Molecular Neurobiology, Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts
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Brown GG, Ostrowitzki S, Stein MB, von Kienlin M, Liu TT, Simmons A, Wierenga C, Stein OY, Bruns A, Bischoff-Grethe A, Paulus M. Temporal profile of brain response to alprazolam in patients with generalized anxiety disorder. Psychiatry Res 2015. [PMID: 26211623 DOI: 10.1016/j.pscychresns.2015.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigated the temporal pattern of brain response to emotional stimuli during 28 days of alprazolam treatment among patients with generalized anxiety disorder (GAD) randomized 2:1 to drug or placebo in a double-blind design. Functional magnetic resonance imaging scans obtained during an emotion face matching task (EFMT) and an affective stimulus expectancy task (STIMEX) were performed at baseline, one hour after initial drug administration and 28 days later. Alprazolam significantly reduced scores on the Hamilton Anxiety Scale and the Penn State Worry Questionnaire after one week and 28 days of treatment. Brain activation in the amygdala during the EFMT and in the insula during the STIMEX was reduced one hour after alprazolam administration but returned to baseline levels at Day 28. Exploratory analyses revealed significant treatment differences in brain activity during the STIMEX on Day 28 in frontal lobe, caudate nucleus, middle temporal gyrus, secondary visual cortex, and supramarginal gyrus. These results are consistent with the notion that the neural mechanisms supporting sustained treatment effects of benzodiazepines in GAD differ from those underlying their acute effects.
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Affiliation(s)
- Gregory G Brown
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
| | - Susanne Ostrowitzki
- Neuroscience, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Markus von Kienlin
- Neuroscience, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Thomas T Liu
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Alan Simmons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Christina Wierenga
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Orah Y Stein
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Andreas Bruns
- Neuroscience, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Martin Paulus
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Laureate Institute for Brain Research, Tulsa, OK, USA
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Fallon N, Li X, Chiu Y, Nurmikko T, Stancak A. Altered Cortical Processing of Observed Pain in Patients With Fibromyalgia Syndrome. THE JOURNAL OF PAIN 2015; 16:717-26. [DOI: 10.1016/j.jpain.2015.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/10/2015] [Accepted: 04/20/2015] [Indexed: 12/30/2022]
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49
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Mochcovitch MD, da Rocha Freire RC, Garcia RF, Nardi AE. A systematic review of fMRI studies in generalized anxiety disorder: evaluating its neural and cognitive basis. J Affect Disord 2015; 167:336-42. [PMID: 25020268 DOI: 10.1016/j.jad.2014.06.041] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a prevalent anxiety disorder, but its neurobiological basis has been poorly studied. A few cognitive models have been proposed for understanding GAD development and maintenance. The aim of this study is to review functional Magnetic Resonance Image (fMRI) studies conducted with GAD patients and evaluate if they support and underpin the theoretical cognitive models proposed for this anxiety disorder. METHODS A literature systematic review was undertaken in PubMed and ISI databases with no time limits. RESULTS From the studies included in this review, 10 explored the "emotional dysregulation model", showing, prefrontal cortex (PFC) and anterior cingulate cortex (ACC) hypofunction and deficient top-down control system during emotion regulation tasks, despite conflicting techniques and results. Only one study explored the "conditioned fear overgeneralization theory", other the "intolerance of uncertainty model" and two studies were unspecific (worry induction tasks). Between those, there were 4 studies evaluating pre- and post-treatment with antidepressants or "mindfulness". LIMITATIONS The studies׳ methodologies differ between one another making it difficult to identify a common finding. CONCLUSION Emotion dysregulation seems to be an important cognitive dysfunction in GAD patients and fMRI studies suggest that it is related to PFC and ACC hypofunction as well as a deficient cortex-amygdala functional connectivity.
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Affiliation(s)
| | | | | | - Antonio E Nardi
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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50
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Rifkin-Graboi A, Meaney MJ, Chen H, Bai J, Hameed WB, Tint MT, Broekman BFP, Chong YS, Gluckman PD, Fortier MV, Qiu A. Antenatal maternal anxiety predicts variations in neural structures implicated in anxiety disorders in newborns. J Am Acad Child Adolesc Psychiatry 2015; 54:313-21.e2. [PMID: 25791148 DOI: 10.1016/j.jaac.2015.01.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/19/2014] [Accepted: 01/28/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Antenatal maternal anxiety predicts offspring neurodevelopment and psychopathology, although the degree to which these associations reflect postnatal influences is unclear. To limit this possibility, we assessed newborn neuronal microstructures using diffusion tensor imaging (DTI) and assessed neonatal microstructure variation in relation to antenatal anxiety and in prediction of infant socio-emotional behavior at age 1 year. METHOD Dyads were drawn from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort, and included mothers who completed the Speilberger State-Trait Anxiety Inventory (STAI) at 26 weeks gestation (scoring >90, n = 20; scoring <70, n = 34) and their neonates (5-17 days postnatal) who took part in DTI. RESULTS Antenatal anxiety predicted variation in fractional anisotropy (FA) of regions important to cognitive-emotional responses to stress (i.e., the right insula and dorsolateral prefrontal cortex), sensory processing (e.g., right middle occipital), and socio-emotional function (e.g., the right angular gyrus, uncinate fasciculus, posterior cingulate, and parahippocampus). In a subset of infants with Infant Toddler Socio-Emotional Assessment (ITSEA) data, some of these right lateralized clusters predicted infant internalizing (e.g., insula: β = 0.511, p = .03) but not externalizing behavior 1 year later, although these analyses failed to withstand the correction for multiple comparisons. CONCLUSION These findings suggest the need for larger-scale investigations of the role that corticolimbic structures play in regulating cognitive-emotional responses to threat, and potentially in mediating the cross-generational transmission of anxiety, as well as in underscoring the importance of early mother-infant intervention programs.
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Affiliation(s)
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute and Sackler Program for Epigenetics and Psychobiology, McGill University, Montreal
| | - Helen Chen
- KK Women's and Children's Hospital, Singapore
| | - Jordan Bai
- Clinical Imaging Research Centre, National University of Singapore
| | | | | | - Birit F P Broekman
- Singapore Institute for Clinical Sciences; Yong Loo Lin School of Medicine, National University of Singapore, and National University Health System, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences; Yong Loo Lin School of Medicine
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences; Liggins Institute, University of Auckland, New Zealand
| | | | - Anqi Qiu
- Singapore Institute for Clinical Sciences; National University of Singapore.
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