1
|
Krause K, Zhang XC, Schneider S. Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care for Youth with Anxiety Disorders. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:181-190. [PMID: 38615662 DOI: 10.1159/000537932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/14/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION This study examined the long-term effectiveness of cognitive behavioral therapy (CBT) (≥ 2 years after the end of therapy) in the routine care of youth (mean 11.95 years; SD = 3.04 years) with primary anxiety disorder (AD). METHODS Two hundred and ten children with any AD as a primary diagnosis and with any comorbidity were included in the "Kids Beating Anxiety (KibA)" clinical trial and received evidence-based CBT. Diagnoses, severity of diagnoses, and further dimensional outcome variables of symptoms and functioning were assessed before (baseline), after the last treatment session (POST), and at two follow-up (FU) assessments in the child and caregiver report: 6 months (6MONTHS-FU) and >2 years (mean 4.31; SD = 1.07 years) after the last treatment session (long-term FU). RESULTS At POST, 61.38% showed total remission of all and any ADs. At long-term FU, the remission rate was 63.64%. Compared to baseline, ratings of severity, anxiety, impairment/burden, and life quality improved significantly after CBT in child and caregiver report. All pre-post/FU improvements and global success ratings were stable in child (Pre-Post: Hedges' g = 3.57; Pre-6MONTHS-FU: Hedges' g = 3.43; Pre-LT-FU: Hedges' g = 2.34) and caregiver report (Pre-Post: Hedges' g = 2.00; Pre-6MONTHS-FU: Hedges' g = 2.31; Pre-LT-FU: Hedges' g = 2.31) across all POST- and FU-assessment points. Some outcomes showed further significant improvement, and no deterioration was found over the course of time. Effect sizes calculated in the present study correspond to, or even exceed, effect sizes reported in previous meta-analysis. CONCLUSIONS Stable long-term effects of "KibA" CBT for youth with ADs, comparable to those results from efficacy studies, were achieved in a routine practice setting by applying treatment manuals tested in randomized controlled trials. These findings are remarkable, as the patient group studied here consisted of an age group within the main risk phase of developing further mental disorders, and therefore an increase in new-onset anxiety and further mental disorders would be expected over the long time span studied here.
Collapse
Affiliation(s)
- Karen Krause
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Bochum, Germany
| |
Collapse
|
2
|
Sapozhnikov Y, Vermilion J. Co-Occurring Anxiety in Youth with Tic Disorders: A Review. J Child Adolesc Psychopharmacol 2023; 33:402-408. [PMID: 37870770 DOI: 10.1089/cap.2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Objective: To review the current state of the literature regarding anxiety symptoms and anxiety disorders in chronic tic disorder (CTD). Results: We conducted a literature search on anxiety and tic disorders. Anxiety symptoms and anxiety disorders are common in youth with CTD, with ∼30%-50% of youth with CTD having at least one co-occurring anxiety disorder. Tics often improve by young adulthood but anxiety symptoms tend to persist, or worsen, over time. Anxiety and tics are closely related, but the exact nature of their relationship is poorly understood. We discuss some potential ways in which anxiety and tics are linked with an emphasis on the underlying brain circuitry involved. The relationship between anxiety and tics may be related to the premonitory urge. In addition, stress hormones may link anxiety and tics. Individuals with CTD have greater activation of their hypothalamic-pituitary-adrenal system in response to acute stress. We also review the impact of anxiety on youth with CTD and approaches to management of anxiety in youth. Conclusions: Anxiety is common in youth with CTD, is associated with more severe CTD, and can adversely affect a child's function. Thus, it is important to identify anxiety disorders in CTD and manage them appropriately.
Collapse
Affiliation(s)
- Yelizaveta Sapozhnikov
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
3
|
Mutluer T, Gorker I, Akdemir D, Ozdemir DF, Ozel OO, Vural P, Tufan AE, Karacetin G, Arman AR, Fis NP, Demirci E, Ozmen S, Hesapcioglu ST, Oztop D, Tural U, Aktepe E, Aksu H, Ardic UA, Basgul S, Bilac O, Coskun M, Celik GG, Demirkaya SK, Dursun OB, Durukan I, Fidan T, Gokcen C, Gormez V, Gundogdu OY, Herguner S, Kandemir H, Kilic BG, Kilincaslan A, Nasiroglu S, Sapmaz SY, Sahin N, Tahiroglu AY, Toros F, Unal F, Yazici IP, Yazici KU, Isik U, Ercan ES. Prevalence, comorbidities and mediators of childhood anxiety disorders in urban Turkey: a national representative epidemiological study. Soc Psychiatry Psychiatr Epidemiol 2022:10.1007/s00127-022-02396-7. [PMID: 36526939 PMCID: PMC9758023 DOI: 10.1007/s00127-022-02396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to evaluate the prevalence of anxiety disorders, its correlation with sociodemographic characteristics, its comorbidities with other psychiatric disorders and its predictors in school-aged children. METHODS This study is part of a representative, multi-centered national study that is planned by the Turkish Association of Child and Adolescent Mental Health to evaluate the prevalence of psychopathology among elementary school students in Turkey between the years 2014-2015. Children are screened via Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version. Impairment is assessed by a 3-point Likert type scale independently by the parent and the teacher. The final sample included 5842 children with the mean age of 8.7 years. RESULTS The prevalence of any anxiety disorder without considering impairment is 16.7% and considering impairment is 5.2% in children according to our study. We found significant differences for comorbid Attention Deficit Hyperactivity Disorder, Disruptive Behavior Disorder, Mood Disorders, Tic Disorders, Obsessive Compulsive Disorder, Enuresis Nocturna, Encopresis, and Intellectual Disability. Having a history of paternal physical disorder, living in the regions of Marmara, Mediterranean and Black Sea were found to be the main predictors of having childhood anxiety disorders according to the logistic regression analysis. CONCLUSION Better understanding of childhood anxiety disorders, comorbid conditions and predictors will result in earlier diagnosis and more appropriate treatment.
Collapse
Affiliation(s)
- T. Mutluer
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Koç University School of Medicine, Istanbul, Turkey
| | - I. Gorker
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Trakya University, Edirne, Turkey
| | - D. Akdemir
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey
| | - D. Foto Ozdemir
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey
| | - O. Ozcan Ozel
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Inonu University, Malatya, Turkey
| | - P. Vural
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Uludag University, Bursa, Turkey
| | - A. E. Tufan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University, Bolu, Turkey
| | - G. Karacetin
- Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - A. Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - N. Perdahli Fis
- Department of Child and Adolescent Psychiatry, Marmara University, Pendik Training and Research Hospital, Istanbul, Turkey
| | - E. Demirci
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erciyes University, Kayseri, Turkey
| | - S. Ozmen
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Erciyes University, Kayseri, Turkey
| | - S. Tural Hesapcioglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Karadeniz Technical University, Trabzon, Turkey
| | - D. Oztop
- Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara University, Ankara, Turkey
| | - U. Tural
- Faculty of Medicine, Department of Psychiatry, Kocaeli University, Kocaeli, Turkey
| | - E. Aktepe
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Suleyman Demirel University, Isparta, Turkey
| | - H. Aksu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Adnan Menderes University, Aydin, Turkey
| | - U. Akyol Ardic
- Child and Adolescent Psychiatry, Denizli State Hospital, Denizli, Turkey
| | - S. Basgul
- Department of Psychology, Hasan Kalyoncu University, Istanbul, Turkey
| | - O. Bilac
- Department of Child and Adolescent Psychiatry, Manisa Celal Bayar University, Manisa, Turkey
| | - M. Coskun
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul University, Istanbul, Turkey
| | - G. G. Celik
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Cukurova University, Adana, Turkey
| | | | - O. B. Dursun
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ataturk University, Erzurum, Turkey
| | - I. Durukan
- Gulhane Faculty of Medicine, Department of Child and Adolescent Psychiatry, University of Health Sciences, Ankara, Turkey
| | - T. Fidan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Osmangazi University, Eskisehir, Turkey
| | - C. Gokcen
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Gaziantep University, Gaziantep, Turkey
| | - V. Gormez
- Department of Child and Adolescent Psychiatry, Bezmi Alem University, Istanbul, Turkey
| | - O. Yildiz Gundogdu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Kocaeli University, Kocaeli, Turkey
| | - S. Herguner
- Meram Faculty of Medicine, Department of Child and Adolescent Psychiatry, Necmettin Erbakan University, Konya, Turkey
| | - H. Kandemir
- Medical School, Department of Child and Adolescent Psychiatry, Harran University, Sanliurfa, Turkey
| | - B. Gunay Kilic
- Faculty of Medicine, Child and Adolescent Psychiatry Department, Ankara University, Ankara, Turkey
| | - A. Kilincaslan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Istanbul University, Istanbul, Turkey
| | - S. Nasiroglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Akdeniz University, Antalya, Turkey
| | - S. Yalin Sapmaz
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Celal Bayar University, Manisa, Turkey
| | - N. Sahin
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mugla Sitki Kocman University, Mugla, Turkey
| | - A. Y. Tahiroglu
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Cukurova University, Adana, Turkey
| | - F. Toros
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Mersin University, Mersin, Turkey
| | - F. Unal
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey
| | - I. Percinel Yazici
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Firat University, Elazig, Turkey
| | - K. U. Yazici
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Firat University, Elazig, Turkey
| | - U. Isik
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Suleyman Demirel University, Isparta, Turkey
| | - E. S. Ercan
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ege University, Izmir, Turkey
| |
Collapse
|
4
|
Tangjittiporn T, Sottimanon A, Ularntinon S. Psychometric properties of the Screen for Child Anxiety Related Disorders Thai version. Pediatr Int 2022; 64:e15093. [PMID: 34897896 DOI: 10.1111/ped.15093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders among children. Because of their internalizing nature, anxiety disorders are underdiagnosed and untreated. Therefore, self-report screening tools play an important role in the early identification of these cases. This study aimed to examine the psychometric properties of the Screen for Child Anxiety Related Disorders (SCARED)-Thai version in a clinical population. METHODS One hundred and eight participants were enrolled from patients aged 9-16 years with any psychiatric diagnosis and their parents who visited a child and adolescent psychiatric clinic in Thailand. All the parent-child pairs completed the SCARED and the Strengths and Difficulties Questionnaire (SDQ)-emotional subscale. Clinical diagnosis of an anxiety disorder was endorsed through a standard clinical interview by certified child and adolescent psychiatrists blinded to the results of the SCARED and SDQ. Internal consistency, predictive validity, and convergent validity of the screens were assessed. RESULTS This study found that the SCARED-Thai version had very good reliability, with internal consistency (Cronbach's alpha) of 0.913 for the SCARED-Child form and 0.925 for the SCARED-Parent form. With an optimal cut-off point of 23, the SCARED-Child version significantly distinguished anxious from non-anxious young people in clinical settings with a sensitivity of 0.74 and a specificity of 0.50, while the SCARED-Parent version had a sensitivity of 0.74 and a specificity of 0.67 at the same threshold. The convergent validity between the SCARED-Thai (total) and SDQ (emotional subscale) was at a highly suitable range (r = 0.81). CONCLUSION The SCARED-Thai version exhibited good psychometric quality for identifying young people with comorbid anxiety disorders when used in clinical settings.
Collapse
Affiliation(s)
- Thiraporn Tangjittiporn
- Department of Child and Adolescent Psychiatry, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Arunsiri Sottimanon
- Department of Child and Adolescent Psychiatry, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Sirirat Ularntinon
- Department of Child and Adolescent Psychiatry, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| |
Collapse
|
5
|
Crum KI, Hwang S, Blair KS, Aloi JM, Meffert H, White SF, Tyler PM, Leibenluft E, Pope K, Blair RJR. Interaction of irritability and anxiety on emotional responding and emotion regulation: a functional MRI study. Psychol Med 2021; 51:2778-2788. [PMID: 32584213 PMCID: PMC7759590 DOI: 10.1017/s0033291720001397] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Irritability and anxiety frequently co-occur in pediatric populations. Studies separately looking at the neural correlates of these symptoms have identified engagement of similar neural systems - particularly those implicated in emotional processing. Both irritability and anxiety can be considered negative valence emotional states that might relate to emotion dysregulation. However, previous work has not examined the neural responding during the performance of an emotion regulation task as a function of interaction between irritability and anxiety simultaneously. METHODS This fMRI study involved 155 participants (90 with significant psychopathologies and 92 male) who performed the Affective Stroop Task, designed to engage emotion regulation as a function of task demands. The Affective Reactivity Index (ARI) was used to index irritability and the Screen for Child Anxiety Related Emotional Disorders (SCARED) was used to index anxiety. RESULTS Levels of irritability, but not anxiety, was positively correlated with responses to visual images within the right rostro-medial prefrontal cortex and left anterior cingulate cortex during view trials. The second region of ventral anterior cingulate cortex showed a condition-by-emotion-by-ARI score-by-SCARED score interaction. Specifically, anxiety level was significantly correlated with a decreased differential BOLD response to negative relative to neutral view trials but only in the presence of relatively high irritability. CONCLUSIONS Atypical maintenance of emotional stimuli within the rostro-medial prefrontal cortex may exacerbate the difficulties faced by adolescents with irritability. Moreover, increased anxiety combined with significant irritability may disrupt an automatic emotional conflict-based form of emotion regulation that is particularly associated with the ventral anterior cingulate cortex.
Collapse
Affiliation(s)
- Kathleen I. Crum
- Medical University of South Carolina, Charleston, South Carolina, USA
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Soonjo Hwang
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Karina S. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | | | | | - Stuart F. White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Patrick M. Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Kayla Pope
- Medical College of Wisconsin, Northeastern Wisconsin Psychiatry Training Program, Winnebago, Wisconsin, USA
| | - R. J. R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebraska, USA
| |
Collapse
|
6
|
Jaka O, Iturria I, van der Toorn M, Hurtado de Mendoza J, Latino DARS, Alzualde A, Peitsch MC, Hoeng J, Koshibu K. Effects of Natural Monoamine Oxidase Inhibitors on Anxiety-Like Behavior in Zebrafish. Front Pharmacol 2021; 12:669370. [PMID: 34079463 PMCID: PMC8165606 DOI: 10.3389/fphar.2021.669370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/28/2021] [Indexed: 01/28/2023] Open
Abstract
Monoamine oxidases (MAO) are a valuable class of mitochondrial enzymes with a critical role in neuromodulation. In this study, we investigated the effect of natural MAO inhibitors on novel environment-induced anxiety by using the zebrafish novel tank test (NTT). Because zebrafish spend more time at the bottom of the tank when they are anxious, anxiolytic compounds increase the time zebrafish spend at the top of the tank and vice versa. Using this paradigm, we found that harmane, norharmane, and 1,2,3,4-tetrahydroisoquinoline (TIQ) induce anxiolytic-like effects in zebrafish, causing them to spend more time at the top of the test tank and less time at the bottom. 2,3,6-trimethyl-1,4-naphtoquinone (TMN) induced an interesting mix of both anxiolytic- and anxiogenic-like effects during the first and second halves of the test, respectively. TIQ was unique in having no observable effect on general movement. Similarly, a reference MAO inhibitor clorgyline—but not pargyline—increased the time spent at the top in a concentration-dependent manner. We also demonstrated that the brain bioavailability of these compounds are high based on the ex vivo bioavailability assay and in silico prediction models, which support the notion that the observed effects on anxiety-like behavior in zebrafish were most likely due to the direct effect of these compounds in the brain. This study is the first investigation to demonstrate the anxiolytic-like effects of MAO inhibitors on novel environment-induced anxiety in zebrafish.
Collapse
Affiliation(s)
- Oihane Jaka
- Biobide, Gipuzkoa Scientific and Technological Park, San Sebastian, Spain
| | - Iñaki Iturria
- Biobide, Gipuzkoa Scientific and Technological Park, San Sebastian, Spain
| | - Marco van der Toorn
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel, Switzerland
| | | | - Diogo A R S Latino
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel, Switzerland
| | - Ainhoa Alzualde
- Biobide, Gipuzkoa Scientific and Technological Park, San Sebastian, Spain
| | - Manuel C Peitsch
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel, Switzerland
| | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel, Switzerland
| | - Kyoko Koshibu
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel, Switzerland
| |
Collapse
|
7
|
Brain and Behavior Correlates of Risk Taking in Pediatric Anxiety Disorders. Biol Psychiatry 2021; 89:707-715. [PMID: 33451676 PMCID: PMC9037066 DOI: 10.1016/j.biopsych.2020.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
Avoidant behavior is a defining feature of pediatric anxiety disorders. Although prior research has examined it from the perspective of early information processing events, there has been relatively less consideration of the processes by which anxious youth make avoidant decisions and how these choices are reinforced over time. Studies of risk taking are valuable in this regard because they consider how individuals identify the pros and cons of their choices, how they weigh potential gains and losses and estimate their respective probabilities, and how they tolerate the uncertainty intrinsic to any decision. In this review, we place risk taking within existing models of information processing in pediatric anxiety disorders and highlight the particular value of this construct for informing models of developmental psychopathology and individual differences in outcome over time. We review existing behavioral and neurobiological studies of risk taking in anxious youth and conclude by identifying directions for future research.
Collapse
|
8
|
Bertagna NB, Dos Santos PGC, Queiroz RM, Fernandes GJD, Cruz FC, Miguel TT. Involvement of the ventral, but not dorsal, hippocampus in anxiety-like behaviors in mice exposed to the elevated plus maze: participation of CRF1 receptor and PKA pathway. Pharmacol Rep 2020; 73:57-72. [PMID: 33175366 DOI: 10.1007/s43440-020-00182-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The hippocampus is a limbic structure involved in anxiety-like behaviors. We aimed to evaluate the role of the dorsal (DH) and ventral (VH) hippocampus in anxiety-like behaviors in the elevated plus maze (EPM). METHODS We inhibited these brain regions using cobalt chloride (CoCl2: 1.0 nmol) microinjections. We also investigated the involvement of corticotropin-releasing factor (CRF) action and protein kinase A (PKA) pathway using intra-DH and intra-VH microinjections of the CRF1 receptor antagonist CP376395 (0, 3.0, or 6.0 nmol) and the PKA inhibitor H-89 (0, 2.5, or 5.0 nmol). RESULTS The results indicated that intra-VH CoCl2 microinjection increased the percentage of time spent and entries in the open arms. The mice also exhibited fewer stretch attend postures in the protected area and increased percentage of open arm entries. Further, intra-VH injection of 3.0 nmol CP376395 increased time spent in the open arms. Intra-DH injection of 6.0 nmol CP376395 increased the frequency of unprotected head dipping, whereas intra-VH injection of 6 nmol CP376395 increased the frequency of protected head dipping. Intra-VH, but not intra-DH, microinjection of 2.5 nmol H-89 increased the percentages of open arm entries and time spent in the open arms. Microinjection of 2.5 and 5.0 nmol H-89 reduced the frequency of protected head dipping behavior. CONCLUSIONS This study demonstrated that VH modulates anxiety-like behaviors in EPM. Moreover, CRF and the cAMP/PKA pathway seem to modulate these effects.
Collapse
Affiliation(s)
- Natalia Bonetti Bertagna
- Pharmacology Laboratory, Pharmacology Department, Biomedical Sciences Institute, Federal University of Uberlândia (UFU), Av. Pará, 1720, Bloco 2A, Uberlândia, MG, 38405-320, Brazil
| | - Paulla Giovanna Cabral Dos Santos
- Pharmacology Laboratory, Pharmacology Department, Biomedical Sciences Institute, Federal University of Uberlândia (UFU), Av. Pará, 1720, Bloco 2A, Uberlândia, MG, 38405-320, Brazil
| | - Rafaella Misael Queiroz
- Pharmacology Laboratory, Pharmacology Department, Biomedical Sciences Institute, Federal University of Uberlândia (UFU), Av. Pará, 1720, Bloco 2A, Uberlândia, MG, 38405-320, Brazil
| | - Gustavo Juliate Damaceno Fernandes
- Pharmacology Laboratory, Pharmacology Department, Biomedical Sciences Institute, Federal University of Uberlândia (UFU), Av. Pará, 1720, Bloco 2A, Uberlândia, MG, 38405-320, Brazil
| | - Fabio Cardoso Cruz
- Psychopharmacology Laboratory, Pharmacology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Tarciso Tadeu Miguel
- Pharmacology Laboratory, Pharmacology Department, Biomedical Sciences Institute, Federal University of Uberlândia (UFU), Av. Pará, 1720, Bloco 2A, Uberlândia, MG, 38405-320, Brazil.
| |
Collapse
|
9
|
Kaajalaakso K, Lempinen L, Ristkari T, Huttunen J, Luntamo T, Sourander A. Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) among elementary school children in Finland. Scand J Psychol 2020; 62:34-40. [PMID: 32776566 DOI: 10.1111/sjop.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/17/2020] [Indexed: 12/01/2022]
Abstract
Anxiety disorders are the most common mental disorders in children and youth. Effective screening methods are needed to identify children in need of treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire is a widely used tool to assess childhood anxiety. We aim toevaluate the psychometric properties of the SCARED questionnaire, test the SCARED factor structure, and evaluate the prevalence of anxiety symptoms in a community sample of Finnish elementary school children, based on both a child and parent report. The sample included all pupils (n = 1,165) in grades 2 through 6 (ages 8-13) in four elementary schools in the city of Turku, Finland. Children completed a Finnish translation of the SCARED questionnaire at school, with one parent report questionnaire per child completed at home. In total, 663 child-parent dyads (56.9%) completed the questionnaire. Internal consistency was high for both child and parent reports on all subscales (0.71-0.92), except for school avoidance (0.57 child, 0.63 parent report). Inter-rater reliability ranged from poor to fair across subscales (intraclass correlation 0.27-0.47). Self-reported anxiety scores were higher than the parent reported scores. Females had significantly higher total scores than males based on the child reports (p = 0.003), but not the parent reports. In the confirmatory factor analysis, hypothesized models did not have a good fit with the data, and modification was needed. The Finnish SCARED questionnaire has good internal consistency. Low child-parent agreement calls for the importance of including both child and parental reports in the assessment of anxiety symptoms.
Collapse
Affiliation(s)
- Katri Kaajalaakso
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Lotta Lempinen
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Terja Ristkari
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Jukka Huttunen
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Terhi Luntamo
- Child psychiatry, University of Turku and Turku University Hospital, Finland
| | - Andre Sourander
- Child psychiatry, University of Turku and Turku University Hospital, Finland.,INVEST Research Flagship, University of Turku, Finland
| |
Collapse
|
10
|
Woodgate RL, Tailor K, Tennent P, Wener P, Altman G. The experience of the self in Canadian youth living with anxiety: A qualitative study. PLoS One 2020; 15:e0228193. [PMID: 32004336 PMCID: PMC6993971 DOI: 10.1371/journal.pone.0228193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anxiety can create serious disruption in the life and mind of youth who are affected. Youth living with anxiety suffer a wealth of physical and psychological challenges, yet little is known about how anxiety influences the sense of the self. The purpose of this research was to explore the experience of the self in a sample of Canadian youth living with anxiety. MATERIALS AND METHODS The qualitative research approach of hermeneutic phenomenology was used. The sample consisted of 58 Canadian youth with anxiety, 44 females and 14 males between the ages of 10 and 22. Youth took part in open-ended interviewing, ecomaps, and photovoice. Data analysis followed a staged process, informed by Max van Manen. All sources of data were included in the analysis to form thematic statements. RESULTS Entering into the lifeworld of youth revealed that they suffered deeply. A fractured sense of self underlined their experience, setting up for a great deal of self-scrutiny and a lack of self-compassion. They experienced a profound sense of responsibility for others at the loss of being-there-for-oneself. Navigating their social sphere presented an additional challenge. However, youth were genuinely interested in self-discovery through awareness and reflection. CONCLUSIONS The phenomenological accounts by youth on living with anxiety reinforce the challenges they experienced within themselves that give rise to a great deal of inner turmoil. Care and support to youth with anxiety requires an understanding of the ways in which the self may be fractured by their experiences with anxiety. Providing young people with an opportunity to share with others who had similar lived experiences can serve to contribute to a sense of healing for youth, while also providing a safe space in which young people can let down their guard and openly acknowledge or share their experiences without fear of stigmatization.
Collapse
Affiliation(s)
- Roberta L. Woodgate
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ketan Tailor
- Counseling and Psychological Services, University of Kansas, Lawrence, Kansas, United States of America
| | - Pauline Tennent
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Wener
- Department of Occupational Therapy, Rady Faculty of Health Sciences, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gary Altman
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba and PsycHealth Centre, Winnipeg, Manitoba, Canada
| |
Collapse
|
11
|
Philippot A, Meerschaut A, Danneaux L, Smal G, Bleyenheuft Y, De Volder AG. Impact of Physical Exercise on Symptoms of Depression and Anxiety in Pre-adolescents: A Pilot Randomized Trial. Front Psychol 2019; 10:1820. [PMID: 31440186 PMCID: PMC6694801 DOI: 10.3389/fpsyg.2019.01820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Abstract
Aim The intensity of the most appropriate exercise to use in depressed youth is unclear due to differences in methodology and the lack of evidence documenting the effect of physical activity in children. Therefore, the authors of this study attempted to document the effectiveness of different training intensities to reduce symptoms of depression and anxiety in pre-teens. Methods The study included twenty-seven, randomly selected pre-adolescents (aged between 9–11 years of age) all of whom had Primary education. The participants were enrolled and, over a 5-week period, were subject to either intensive or low-to-moderate exercise programs four times a week. Psychological self-reports, as well as physical examinations, were conducted before and after such programs in blinded assessments. Psychological effects were considered the primary outcome, whilst physical condition was secondary. Results Four subjects were lost and twenty-three were analyzed. General linear model with 2 criteria revealed significant changes (p = 0.05) in trait anxiety symptoms over time in the low-to-moderate intensity group (LMIG). Within group changes followed a significant decrease in levels of anxiety (38.82 ± 2.20 to 33.36 ± 2.83, p = 0.004) and depression (10.36 ± 2.83 to 6.73 ± 1.88, p = 0.006) related symptoms amongst those in the LMIG. Interpretation This study indicated that depression and anxiety symptoms were reduced amongst a non-clinical sample of Primary educated pre-adolescents when they were subject to a low-to-moderate exercise program. The program focused on associating movement with pleasure, encouraged positive and non-competitive interactions between participants. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02970825, autumn 2016, updated May 7, 2018 (https://clinicaltrials.gov/ct2/show/NCT02970825).
Collapse
Affiliation(s)
- Arnaud Philippot
- MSL-In Laboratory, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Psychiatric Hospital, AREA+, Epsylon ASBL, Brussels, Belgium
| | - Alexandre Meerschaut
- MSL-In Laboratory, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Laura Danneaux
- MSL-In Laboratory, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Gauthier Smal
- MSL-In Laboratory, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Yannick Bleyenheuft
- MSL-In Laboratory, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Anne G De Volder
- MSL-In Laboratory, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Pediatric Neurology Service, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
12
|
Prevalence and Predictors of Anxiety Disorders in Adolescent and Adult Males with Autism Spectrum Disorder and Fragile X Syndrome. J Autism Dev Disord 2019; 49:1131-1141. [PMID: 30430320 DOI: 10.1007/s10803-018-3804-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety disorders affect ~ 15-20% of youths without neurodevelopmental disorders, with persons having autism spectrum disorder (ASD) and fragile X syndrome (FXS) at elevated risk for anxiety disorders. Few studies have compared rates and predictors of anxiety disorders in adolescents with FXS or ASD. This study directly compares rates, predictors, and medication of anxiety disorders between age-matched, male adolescents with FXS (n = 31) or ASD (n = 20). Results indicate that 51.6% of FXS and 50.0% of ASD adolescents met criteria for an anxiety disorder. Cognitive scores and ASD severity did not predict anxiety. Of those with anxiety, ~ 40% of the FXS and 20% of the ASD participants were prescribed medications for anxiety.
Collapse
|
13
|
Potter LA, Scholze DA, Biag HMB, Schneider A, Chen Y, Nguyen DV, Rajaratnam A, Rivera SM, Dwyer PS, Tassone F, Al Olaby RR, Choudhary NS, Salcedo-Arellano MJ, Hagerman RJ. A Randomized Controlled Trial of Sertraline in Young Children With Autism Spectrum Disorder. Front Psychiatry 2019; 10:810. [PMID: 31780970 PMCID: PMC6851992 DOI: 10.3389/fpsyt.2019.00810] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/14/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: Selective serotonin reuptake inhibitors like sertraline have been shown in observational studies and anecdotal reports to improve language development in young children with fragile X syndrome (FXS). A previous controlled trial of sertraline in young children with FXS found significant improvement in expressive language development as measured by the Mullen Scales of Early Learning (MSEL) among those with comorbid autism spectrum disorder (ASD) in post hoc analysis, prompting the authors to probe whether sertraline is also indicated in nonsyndromic ASD. Methods: The authors evaluated the efficacy of 6 months of treatment with low-dose sertraline in a randomized, double-blind, placebo-controlled trial in 58 children with ASD aged 24 to 72 months. Results: 179 subjects were screened for eligibility, and 58 were randomized to sertraline (32) or placebo (26). Eight subjects from the sertraline arm and five from the placebo arm discontinued. Intent-to-treat analysis showed no significant difference from placebo on the primary outcomes (MSEL expressive language raw score and age equivalent combined score) or secondary outcomes. Sertraline was well tolerated, with no difference in side effects between sertraline and placebo groups. No serious adverse events possibly related to study treatment occurred. Conclusion: This randomized controlled trial of sertraline treatment showed no benefit with respect to primary or secondary outcome measures. For the 6-month period, treatment in young children with ASD appears safe, although the long-term side effects of low-dose sertraline in early childhood are unknown. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02385799.
Collapse
Affiliation(s)
- Laura A Potter
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States
| | - Danielle A Scholze
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Hazel Maridith B Biag
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States.,Department of Pediatrics, UC Davis Health, Sacramento, CA, United States.,College of Psychology, California Northstate University, Elk Grove, CA, United States
| | - Yanjun Chen
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
| | - Danh V Nguyen
- Department of Medicine, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Akash Rajaratnam
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Susan M Rivera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA, United States
| | - Patrick S Dwyer
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States.,Department of Biochemistry and Molecular Medicine, UC Davis Health, Sacramento, CA, United States
| | - Reem R Al Olaby
- College of Health Sciences, California Northstate University, Rancho Cordova, CA, United States
| | - Nimrah S Choudhary
- Department of Biochemistry and Molecular Medicine, UC Davis Health, Sacramento, CA, United States
| | - Maria J Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis Health, Sacramento, CA, United States.,Department of Pediatrics, UC Davis Health, Sacramento, CA, United States
| |
Collapse
|
14
|
Salum GA, Petersen CS, Jarros RB, Toazza R, DeSousa D, Borba LN, Castro S, Gallegos J, Barrett P, Abend R, Bar-Haim Y, Pine DS, Koller SH, Manfro GG. Group Cognitive Behavioral Therapy and Attention Bias Modification for Childhood Anxiety Disorders: A Factorial Randomized Trial of Efficacy. J Child Adolesc Psychopharmacol 2018; 28:620-630. [PMID: 29969293 PMCID: PMC6421990 DOI: 10.1089/cap.2018.0022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. METHODS A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). RESULTS There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] -0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI -3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. CONCLUSIONS We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.
Collapse
Affiliation(s)
- Giovanni A. Salum
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Address correspondence to: Giovanni A. Salum, MD, PhD Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2350-room 2202, Porto Alegre 90035-003, Brazil
| | - Circe S. Petersen
- Center of Psychological Studies on at Risk Populations, Institute of Psychology, Porto Alegre, Brazil
| | - Rafaela B. Jarros
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rudineia Toazza
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Diogo DeSousa
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Center of Psychological Studies on at Risk Populations, Institute of Psychology, Porto Alegre, Brazil
| | - Lidiane Nunes Borba
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Stela Castro
- Institute of Mathematics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Julia Gallegos
- Department of Psychology, University of Monterrey, Monterrey, Mexico
| | - Paula Barrett
- Faculty of Social and Behavioral Sciences, School of Education, The University of Queensland, Brisbane, Australia
| | - Rany Abend
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S. Pine
- Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
| | - Silvia H. Koller
- Center of Psychological Studies on at Risk Populations, Institute of Psychology, Porto Alegre, Brazil
| | - Gisele G. Manfro
- Child and Adolescent Anxiety Program, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
15
|
Bortoluzzi A, Salum GA, da Rosa ED, Chagas VDS, Castro MAA, Manfro GG. DNA methylation in adolescents with anxiety disorder: a longitudinal study. Sci Rep 2018; 8:13800. [PMID: 30218003 PMCID: PMC6138655 DOI: 10.1038/s41598-018-32090-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/29/2018] [Indexed: 12/18/2022] Open
Abstract
Anxiety disorders (AD) typically manifest in children and adolescents and might persist into adulthood. However, there are still few data concerning epigenetic mechanisms associated with onset, persistence or remission of AD over time. We investigated a cohort of adolescents and young adults at baseline (age; 13.19 ± 2.38) and after 5 years and classified them according to the AD diagnosis and their longitudinal trajectories into 4 groups: (1) Typically Developing Comparisons (TDC; control group, n = 14); (2) Incident (AD in the second evaluation only, n = 11); (3) Persistent (AD in both evaluations, n = 14) and (4) Remittent (AD in the first evaluation only, n = 8). DNA methylation was evaluated with the Infinium HumanMethylation450 BeadChip from saliva samples collected at both evaluations. Gene set enrichment analysis was applied to consider biological pathways. We found decreased DNA methylation in TDC group while the chronic cases of AD presented hypermethylation in central nervous system development pathways. Moreover, we showed that this persistent group also presented hypermethylation while the other three groups were associated with hypomethylation in nervous system development pathway. Incidence and remission groups were associated with increased and decreased methylation in neuron development pathways, respectively. Larger studies are likely to detect specific genes relevant to AD.
Collapse
Affiliation(s)
- Andressa Bortoluzzi
- Anxiety Disorders Outpatient Program for Children and Adolescents, Universidade Federal do Rio Grande do Sul, UFRGS/Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Brazil.
- Post Graduate Program in Neuroscience, Institute of Basic Sciences/Health, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.
- Basic Research and Advanced Investigations in Neurosciences, BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Brazil.
| | - Giovanni Abrahão Salum
- Anxiety Disorders Outpatient Program for Children and Adolescents, Universidade Federal do Rio Grande do Sul, UFRGS/Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
| | - Eduarda Dias da Rosa
- Basic Research and Advanced Investigations in Neurosciences, BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | | | - Gisele Gus Manfro
- Anxiety Disorders Outpatient Program for Children and Adolescents, Universidade Federal do Rio Grande do Sul, UFRGS/Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Brazil
- Post Graduate Program in Neuroscience, Institute of Basic Sciences/Health, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
- Basic Research and Advanced Investigations in Neurosciences, BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| |
Collapse
|
16
|
Gibby BA, Casline EP, Ginsburg GS. Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review. Clin Child Fam Psychol Rev 2018; 20:201-225. [PMID: 28181040 DOI: 10.1007/s10567-017-0222-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.
Collapse
Affiliation(s)
- Brittany A Gibby
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32303, USA
| | - Elizabeth P Casline
- University of Connecticut Health, 65 Kane Street, West Hartford, CT, 06119, USA
| | - Golda S Ginsburg
- University of Connecticut Health, 65 Kane Street, West Hartford, CT, 06119, USA.
| |
Collapse
|
17
|
Ege S, Reinholdt-Dunne ML. Improving Treatment Response for Paediatric Anxiety Disorders: An Information-Processing Perspective. Clin Child Fam Psychol Rev 2018; 19:392-402. [PMID: 27585811 DOI: 10.1007/s10567-016-0211-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying psychopathology of paediatric anxiety disorders indicate possibilities for improving treatment response. Using a critical review of recent theoretical, empirical and academic literature, the paper examines the role of information-processing biases in paediatric anxiety disorders, the extent to which CBT targets information-processing biases, and possibilities for improving treatment response. The literature reviewed indicates a role for attentional and interpretational biases in anxious psychopathology. While there is theoretical grounding and limited empirical evidence to indicate that CBT ameliorates interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby in improving treatment response. The integration of novel interventions into an existing evidence-based protocol is a complex issue and faces important challenges with regard to determining the optimal treatment package. Novel interventions targeting information-processing biases may hold potential in improving response to CBT for paediatric anxiety disorders. Many important questions remain to be answered.
Collapse
Affiliation(s)
- Sarah Ege
- Sørlandet Sykehus HF, Kristiansand, Norway
| | | |
Collapse
|
18
|
Adolescents' Daily Perception of Internalizing Emotional States by Means of Smartphone-based Ecological Momentary Assessment. SPANISH JOURNAL OF PSYCHOLOGY 2017; 20:E71. [PMID: 29198232 DOI: 10.1017/sjp.2017.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study uses ecological momentary assessment (EMA) with smartphone devices to examine community adolescents' perceptions regarding both the intensity of and variability in their daily sadness/depression, anxiety, and somatic problems over the period of one week. Participants were 90 high-school students (M age = 14.61, SD = 1.64; range 12-18). The sample was divided according to gender (61.1% girls), migratory status (68.5% Spanish nationals and 31.5% Latin American immigrants), and level of psychological symptoms (17% risk group). Sadness/depression, anxiety, and somatic problems were examined using a smartphone app, five times per day, semi-randomly, for seven days (35 possible moments). A high proportion of adolescents did not report feelings of sadness (80.0%) or worry (79.3%) or physical symptoms on a daily basis (84.9%). Girls and the risk group reported greater intensity levels for the three analyzed problems than did boys and the normal group, respectively (p .05 in all cases). Day-to-day fluctuations in mood during the week were statistically significant but not meaningful (b = 0.0004, 95% CI [0.0001, 0.0008], p = .001).
Collapse
|
19
|
Funke R, Eichler A, Distler J, Golub Y, Kratz O, Moll GH. Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression. Stress Health 2017; 33:518-529. [PMID: 27982510 DOI: 10.1002/smi.2736] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 12/19/2022]
Abstract
Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus-pituitary-adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n = 26) with comorbid depression and a healthy comparison group (n = 26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA-axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in-patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.
Collapse
Affiliation(s)
- R Funke
- Department of Child and Adolescent Mental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Eichler
- Department of Child and Adolescent Mental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Distler
- Department of Child and Adolescent Mental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Y Golub
- Department of Child and Adolescent Mental Health, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JW Goethe University Hospital, Frankfurt am Main, Germany
| | - O Kratz
- Department of Child and Adolescent Mental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | - G H Moll
- Department of Child and Adolescent Mental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
20
|
Differential susceptibility effects of oxytocin gene (OXT) polymorphisms and perceived parenting on social anxiety among adolescents. Dev Psychopathol 2017; 30:449-459. [DOI: 10.1017/s0954579417000967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractSocial anxiety is one of the most commonly reported mental health problems among adolescents, and it has been suggested that parenting style influences an adolescent's level of anxiety. A context-dependent effect of oxytocin on human social behavior has been proposed; however, research on the oxytocin gene (OXT) has mostly been reported without considering contextual factors. This study investigated the interactions between parenting style and polymorphic variations in the OXT gene in association with social anxiety symptoms in a community sample of adolescents (n = 1,359). Two single nucleotide polymorphisms linked to OXT, rs4813625 and rs2770378, were genotyped. Social anxiety and perceived parenting style were assessed by behavioral questionnaires. In interaction models adjusted for sex, significant interaction effects with parenting style were observed for both variants in relation to social anxiety. The nature of the interactions was in line with the differential susceptibility framework for rs4813625, whereas for rs2770378 the results indicated a diathesis–stress type of interaction. The findings may be interpreted from the perspective of the social salience hypothesis of oxytocin, with rs4813625 affecting social anxiety levels along a perceived unsafe–safe social context dimension.
Collapse
|
21
|
Laporte PP, Pan PM, Hoffmann MS, Wakschlag LS, Rohde LA, Miguel EC, Pine DS, Manfro GG, Salum GA. Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias. BRAZILIAN JOURNAL OF PSYCHIATRY 2017; 39:118-125. [PMID: 28300935 PMCID: PMC7111439 DOI: 10.1590/1516-4446-2016-2064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022]
Abstract
Objective: To distinguish normative fears from problematic fears and phobias. Methods: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. Results: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. Conclusion: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears.
Collapse
Affiliation(s)
- Paola P Laporte
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Pedro M Pan
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Mauricio S Hoffmann
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Luis A Rohde
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Euripedes C Miguel
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Daniel S Pine
- Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Gisele G Manfro
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Instituto Nacional de Psiquiatria do Desenvolvimento para Crianças e Adolescentes (INPD), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|
22
|
Hansen BH, Oerbeck B, Skirbekk B, Kristensen H. Non-obsessive-compulsive anxiety disorders in child and adolescent mental health services--Are they underdiagnosed, and how accurate is referral information? Nord J Psychiatry 2016; 70:133-9. [PMID: 26179992 DOI: 10.3109/08039488.2015.1061053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have reported low prevalence of non-obsessive-compulsive (OCD) anxiety disorders in child and adolescent mental health services (CAMHSs), suggesting that these disorders may go unrecognized. Possible reasons may be lack of routinely used standardized diagnostic instruments, and/or an under-reporting of anxiety symptoms in the referral information. AIMS To examine the frequency of non-OCD anxiety disorders in referred children based on a standardized diagnostic interview, to compare the results with data from the Norwegian Patient Register (NPR), and to explore the correspondence between anxiety as a referral symptom and anxiety as a diagnosis, and the influence of heterotypic co-morbidity on this correspondence. METHODS Parents of 407 consecutive referrals to CAMHS aged 7-13 years were interviewed with the semi-structured diagnostic interview Kiddie-SADS-PL at the time of admittance. Referral symptoms were collected from national referral forms. RESULTS A total of 133 referred children (32.7%) met the criteria for a non-OCD anxiety disorder compared with about 5% in the NPR. Half of those who met diagnostic criteria for an anxiety disorder did not have anxiety as a referral symptom. Co-morbid ADHD or disruptive disorder was significantly associated with a lower probability of having anxiety as a referral symptom. CONCLUSIONS The use of a standardized diagnostic interview in consecutively referred children yielded significantly higher rates of anxiety disorders than the NPR prevalence rates. Co-morbid ADHD or disruptive disorder may contribute to the underdiagnosing of anxiety disorders. Diagnostic instruments covering the whole range of child psychiatric symptoms should be implemented routinely in CAMHS.
Collapse
Affiliation(s)
- Berit Hjelde Hansen
- a Berit Hjelde Hansen, Division of Mental Health Services , Akershus University Hospital , Lørenskog , Norway
| | - Beate Oerbeck
- b Beate Oerbeck, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway
| | - Benedicte Skirbekk
- c Benedicte Skirbekk, Nic Waals Institute, Lovisenberg Diakonale Hospital , Oslo , Norway
| | - Hanne Kristensen
- d Hanne Kristensen, Center for Child and Adolescent Mental Health, Eastern and Southern Norway , Oslo , Norway
| |
Collapse
|
23
|
Bortoluzzi A, Blaya C, Rosa EDD, Paim M, Rosa V, Leistner-Segal S, Manfro GG. What can HPA axis-linked genes tell us about anxiety disorders in adolescents? TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015; 37:232-7. [DOI: 10.1590/2237-6089-2015-0035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/31/2015] [Indexed: 11/21/2022]
Abstract
Introduction: Anxiety disorders (AD) share features of both anxiety and fear linked to stress response. The hypothalamic-pituitary-adrenal (HPA) axis is considered the core biological pathway of the stress system and it is known that an inappropriate response to environmental stimuli may be related to individual genetic vulnerability in HPA-linked genes. Despite the biological plausibility of a relationship between the HPA axis and AD, few studies have investigated associations between genetic polymorphisms linked to the HPA axis and this complex disorder. Objective: To investigate whether AD are associated with genetic polymorphisms in HPA-linked genes in adolescents. Methods: Our study consisted of a cross-sectional evaluation of a community sample comprising a total of 228 adolescents (131 cases of AD). We extracted DNA from saliva and genotyped polymorphisms in HPA-linked genes (FKBP5: rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916; NR3C1: rs6198; CRHR1: rs878886; and SERPINA6: rs746530) with real time polymerase chain reaction (PCR). The instruments used to diagnose and assess the severity of AD were the Schedule for Affective Disorder and Schizophrenia for School-Age Children - Present and Lifetime (K-SADS-PL) and the Screen for Child and Anxiety related Emotional Disorders (SCARED). Results: We failed to detect any associations between AD and genetic polymorphisms in HPA-linked genes (p > 0.05). Conclusion: To our knowledge, this is the first study evaluating these specific polymorphisms in relation to AD in adolescents, which encourages us to design further research on the subject.
Collapse
Affiliation(s)
| | - Carolina Blaya
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | - Mariana Paim
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Virgínia Rosa
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | | |
Collapse
|
24
|
Zhang J, Yang X, Yang Q. Neuropsychological dysfunction in adults with early-onset obsessive-compulsive disorder: the search for a cognitive endophenotype. REVISTA BRASILEIRA DE PSIQUIATRIA 2015; 37:126-32. [PMID: 25806473 DOI: 10.1590/1516-4446-2014-1518] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/14/2014] [Indexed: 11/22/2022]
|
25
|
Association between internalizing disorders and day-to-day activities of low energetic expenditure. Child Psychiatry Hum Dev 2015; 46:67-74. [PMID: 24570170 DOI: 10.1007/s10578-014-0450-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study is to compare energetic expenditure in day-to-day activities among subjects with internalizing disorders (depression and anxiety), externalizing disorders (attention deficit/hyperactivity disorder and oppositional defiant disorder) and healthy children and adolescents without any psychiatric diagnosis. One hundred and five (n = 105) students from a community sample were evaluated throughout a structured psychiatric interview and categorized into three groups: internalizing (n = 54), externalizing (n = 12) and typically developing controls (TDC, n = 39). Energetic expenditure was evaluated using 3-day physical activity record. Subjects with internalizing disorders performed activities with lower energetic expenditure as compared to those with externalizing disorders and TDC. Participants with externalizing disorders had more energetic expenditure variability. Our study suggests that internalizing disorders are associated with activities of low energetic expenditure in day-to-day activities, extending previous findings with physical exercise. These findings may further contribute to the understanding of the associated morbidity previously described in patients with internalizing disorders.
Collapse
|
26
|
Hamm LL, Jacobs RH, Johnson MW, Fitzgerald DA, Fitzgerald KD, Langenecker SA, Monk CS, Phan KL. Aberrant amygdala functional connectivity at rest in pediatric anxiety disorders. BIOLOGY OF MOOD & ANXIETY DISORDERS 2014; 4:15. [PMID: 25530842 PMCID: PMC4272798 DOI: 10.1186/s13587-014-0015-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/28/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Childhood onset of anxiety disorders is associated with greater functional impairment and burden across the lifespan. Recent work suggests that generalized anxiety disorder (GAD) is characterized by dysfunctional connectivity in amygdala-based circuits at rest in adolescents, consistent with adults. However, neural mechanisms underlying a broad spectrum of often-comorbid anxiety disorders in children remains unclear and understudied. The current study examines amygdala functional connectivity at rest in children and adolescents across comorbid anxiety disorders (ADs) including youth with primary diagnoses of GAD and social phobia (SP). RESULTS Compared with healthy controls (HCs), AD youth exhibited hyperconnectivity between the right amygdala and the insula and hypoconnectivity between the left amygdala and the ventromedial prefrontal cortex (vmPFC) and posterior cingulate cortex (PCC). Within the AD group, connectivity was not correlated with anxiety severity and only the amygdala-PCC connectivity was positively correlated with age. CONCLUSIONS Our findings indicate that youth with comorbid ADs demonstrate aberrant connectivity in the anterior limbic network (ALN) as well as the PCC at rest. This extends upon previous work suggesting alterations in amygdala circuits underlying fear learning, emotion regulation, and the processing of interoceptive states. Presence of these findings within this young, comorbid sample points to underlying common mechanisms across ADs and illuminates future targets for prevention and intervention in childhood.
Collapse
Affiliation(s)
- Lisa L Hamm
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Rm. 244, Chicago, IL 60608 USA
| | - Rachel H Jacobs
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Rm. 244, Chicago, IL 60608 USA
| | - Meghan W Johnson
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Rm. 244, Chicago, IL 60608 USA
| | - Daniel A Fitzgerald
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Rm. 244, Chicago, IL 60608 USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Rm. 244, Chicago, IL 60608 USA
| | - Christopher S Monk
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA ; Department of Psychology, University of Michigan, Ann Arbor, Michigan USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, 1747 W. Roosevelt Road, IJR/WROB Rm. 244, Chicago, IL 60608 USA ; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA ; Department of Psychology, University of Illinois at Chicago, Chicago, Illinois USA ; Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois USA
| |
Collapse
|
27
|
Schott AL, Zimmerberg B. Effects of Neurokinin-1 Receptor Inhibition on Anxiety Behavior in Neonatal Rats Selectively Bred for an Infantile Affective Trait. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/pp.2014.59096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|