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Stein DJ, Nielsen K, Hartford A, Gagné-Julien AM, Glackin S, Friston K, Maj M, Zachar P, Aftab A. Philosophy of psychiatry: theoretical advances and clinical implications. World Psychiatry 2024; 23:215-232. [PMID: 38727058 PMCID: PMC11083904 DOI: 10.1002/wps.21194] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kris Nielsen
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Anna Hartford
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anne-Marie Gagné-Julien
- Centre for Research in Ethics, Canada Research Chair in Epistemic Injustice and Agency, Université du Québec à Montréal, Montreal, Canada
| | - Shane Glackin
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Awais Aftab
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Portnova G, Khayrullina GM, Mikheev IV, Byvsheva SM, Proskurnina EV, Martynova O. The Dynamics of Resting-State EEG and Salivary Trace Elements in Patients with Obsessive-Compulsive Disorder. ACS Chem Neurosci 2024; 15:1415-1423. [PMID: 38499363 DOI: 10.1021/acschemneuro.3c00697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
The study of salivary microelements and their neurophysiological and behavioral correlates in patients with obsessive-compulsive disorder (OCD) is a pressing issue in modern psychiatry, which, however, lacks adequate research at this time. In this study, we tested the dynamics of behavioral parameters, resting-state electroencephalogram (EEG), and salivary iron, copper, manganese, magnesium, and zinc in 30 healthy volunteers and 30 individuals with OCD before and after an emotional antisaccade task. The eye-movement data served as a measure of behavioral performance. Our research revealed consistently higher manganese concentrations in the OCD group compared to healthy volunteers associated with a higher EEG ratio of amplitude transformation and symptom severity. The dynamics of salivary microelements and resting-state EEG, possibly influenced by cognitive and emotional load during the anticsaccade task, differed between groups. In healthy volunteers, there was a decrease in salivary iron level with an increase in high-frequency power spectral density of EEG. The OCD group showed a decrease in salivary copper with an increased Hjorth mobility of EEG.
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Affiliation(s)
- Galina Portnova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova St. 5A, Moscow 117485, Russia
| | - Guzal M Khayrullina
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova St. 5A, Moscow 117485, Russia
- Faculty of Biology and Biotechnology, HSE University, Myasnitskaya 20, Moscow 101000, Russia
| | - Ivan V Mikheev
- Analytical Chemistry Division, Chemistry Department, M.V. Lomonosov Moscow State University, Lenin Hills 1-3, Moscow 119234, Russia
| | - Sofiya M Byvsheva
- Analytical Chemistry Division, Chemistry Department, M.V. Lomonosov Moscow State University, Lenin Hills 1-3, Moscow 119234, Russia
| | - Elena V Proskurnina
- Research Centre for Medical Genetics, ul. Moskvorechye 1, Moscow 115522, Russia
| | - Olga Martynova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova St. 5A, Moscow 117485, Russia
- Faculty of Biology and Biotechnology, HSE University, Myasnitskaya 20, Moscow 101000, Russia
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Girelli F, Rossetti MG, Perlini C, Bellani M. Neural correlates of cognitive behavioral therapy-based interventions for bipolar disorder: A scoping review. J Psychiatr Res 2024; 172:351-359. [PMID: 38447356 DOI: 10.1016/j.jpsychires.2024.02.054] [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] [Received: 08/25/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
Cognitive Behavioral Therapy (CBT) is among the gold-standard psychotherapeutic interventions for the treatment of psychiatric disorders, including bipolar disorder (BD). While the clinical response of CBT in patients with BD has been widely investigated, its neural correlates remain poorly explored. Therefore, this scoping review aimed to discuss neuroimaging studies on CBT-based interventions in bipolar populations. Particular attention has been paid to similarities and differences between studies to inform future research. The literature search was conducted on PubMed, PsycINFO, and Web of Science databases in June 2023, identifying 307 de-duplicated records. Six studies fulfilled the inclusion criteria and were reviewed. All of them analyzed functional brain activity data. Four studies showed that the clinical response to CBT was associated with changes in the functional activity and/or connectivity of prefrontal and posterior cingulate cortices, temporal parietal junction, amygdala, precuneus, and insula. In two additional studies, a peculiar pattern of baseline activations in the prefrontal cortex, hippocampus, amygdala, and insula predicted post-treatment improvements in depressive symptoms, emotion dysregulation, and psychosocial functioning, although CBT-specific effects were not shown. These results suggest, at the very preliminary level, the potential of CBT-based interventions in modulating neural activity and connectivity of patients with BD, especially in regions ascribed to emotional processing. Nonetheless, the discrepancies between studies concerning aims, design, sample characteristics, and CBT and fMRI protocols do not allow conclusions to be drawn. Further research using multimodal imaging techniques, better-characterized BD samples, and standardized CBT-based interventions is needed.
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Affiliation(s)
- Francesca Girelli
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Gloria Rossetti
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Marcella Bellani
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Kabrel M, Tulver K, Aru J. The journey within: mental navigation as a novel framework for understanding psychotherapeutic transformation. BMC Psychiatry 2024; 24:91. [PMID: 38302927 PMCID: PMC10835954 DOI: 10.1186/s12888-024-05522-8] [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] [Received: 09/01/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., "unexplored territory" or "going in circles") serves as a robust marker of mental navigation. METHODS Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation. RESULTS We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play. CONCLUSION Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.
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Affiliation(s)
- Mykyta Kabrel
- Institute of Philosophy and Semiotics, University of Tartu, Tartu, Estonia.
| | - Kadi Tulver
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Jaan Aru
- Institute of Computer Science, University of Tartu, Tartu, Estonia
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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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Zhang X, Zhang L, Yu F, Zhang W. Can Brain Activities of Guided Metaphorical Restructuring Predict Therapeutic Changes? Neuroscience 2023; 531:39-49. [PMID: 37689232 DOI: 10.1016/j.neuroscience.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
The present study examined whether brain activities of metaphorical restructuring could predict improvements in emotion and general self-efficacy (GSES). Sixty-two anxious graduates were randomly assigned to either the metaphor group (n = 31) or the literal group (n = 31). After completing the pretest (T1), the participants were first presented with micro-counseling dialogues (MCD) to guide metaphorical or literal restructuring, and their functional brain activities were simultaneously recorded. They then completed the posttest (T2) and 1 week's follow-up (T3). It was found that (1) compared with the literal group, the metaphor group had more insightful experiences, a greater increase in positive affect and GSES at T2, and a greater decrease in psychological distress at T2 and T3; (2) the metaphor group showed a greater activation in the left inferior frontal gyrus (IFG) and bilateral temporal gyrus, and further activation in the left hippocampus positively predicted T2 GSES scores while that in the IFG and left hippocampus positively predicted the reduction slope of distress over the three time points. One important limitation is that the results should be interpreted with caution when generalizing to clinical anxiety samples due to the participants were graduate students with anxiety symptoms rather than clinical sample. These results indicated that metaphor restructuring produced greater symptom improvements, and activation in the hippocampus and IFG could predict these symptom improvements. This suggests that the activation of the two regions during the restructuring intervention may be a neural marker for symptom improvements.
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Affiliation(s)
- Xiaoyu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China; School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Lu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fei Yu
- Department of Psychology, Hebei Normal University, Shijiazhuang 050010, China
| | - Wencai Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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7
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Khayrullina G, Panfilova E, Martynova O. Increased error rate and delayed response to negative emotional stimuli in antisaccade task in obsessive-compulsive disorder. Int J Psychophysiol 2023; 192:62-71. [PMID: 37604280 DOI: 10.1016/j.ijpsycho.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Ample evidence links impaired inhibitory control, attentional distortions, emotional dysregulation, and obsessive-compulsive disorder (OCD). However, it remains unclear what underlies the deficit that triggers the OCD cycle. The present study used an antisaccade paradigm with emotional valences to compare eye movement patterns reflecting inhibitory control and attention switching in OCD and healthy control groups. Thirty-two patients with OCD and thirty healthy controls performed the antisaccade task with neutral, positive, and negative visual images served as fixation stimuli. Presentation of the fixation stimulus overlapped with target stimuli appearance for 200 ms. The OCD group showed more errors to negative stimuli than the control group and they also performed antisaccades more slowly to negative and neutral stimuli than positive ones. Other patterns, including mean gaze velocity of correct antisaccades did not differ between groups. The mean gaze velocity of correct antisaccades was higher for negative and positive stimuli than for neutral stimuli in both groups. The peak velocity parameter did not show any differences either between groups or between valences. The findings support a hypothesis that an attentional bias toward negative stimuli interferes with inhibitory control in OCD.
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Affiliation(s)
- Guzal Khayrullina
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia; Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Myasnitskaya 20, Moscow 101000, Russia.
| | - Elizaveta Panfilova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia
| | - Olga Martynova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia; Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Myasnitskaya 20, Moscow 101000, Russia
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Kashyap H, Mehta UM, Reddy RP, Bharath RD. Role of Cognitive Control in Psychotherapy: An Integrated Review. Indian J Psychol Med 2023; 45:462-470. [PMID: 37772131 PMCID: PMC10523513 DOI: 10.1177/02537176221128611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Background Cognitive control (CC), including shifting, updating, and inhibiting functions, may play an integral role in various aspects of psychotherapy; however, research on this is limited. This review aims to link the disparate lines of evidence on CC as they relate to psychotherapy processes, techniques, and outcomes. Methods A systematic search of the literature on neuropsychological domains relating to psychotherapy in adults with anxiety/depression yielded 18 eligible studies. The review also uses a narrative format to explore other potential links between CC and psychotherapy that are underinvestigated, and highlights the need for research and application to evidence-based practice of psychotherapy. Results and conclusions Findings suggest that CC may predict psychotherapy outcomes and also improve as a function of psychotherapy. Analog sample studies suggest a possible link between CC and techniques for regulation of cognition and emotion, such as reappraisal, mindfulness, and cognitive restructuring. CC may also play an integral role in the regulation of behavior. Study of CC in the context of psychotherapy may potentially explain individual differences in psychotherapy outcomes and mechanisms of action of various psychotherapy techniques and processes. Such an understanding may have possible implications for "best fit" matching clients to therapies and modifying psychological interventions to account for poorer CC abilities. CC may be enhanced through training and further research is warranted on the impact of such training in facilitating better long-term psychotherapy outcomes.
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Affiliation(s)
- Himani Kashyap
- Dept. of Clinical Psychology & Cognite
Clinic, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
| | - Urvakhsh Meherwan Mehta
- Dept. of Psychiatry, National Institute of
Mental Health And Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajakumari P. Reddy
- Dept. of Clinical Psychology & Cognite
Clinic, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
| | - Rose Dawn Bharath
- Dept. of Neuroimaging and Interventional
Radiology, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
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Chen Q, Xu Y, Christiaen E, Wu GR, De Witte S, Vanhove C, Saunders J, Peremans K, Baeken C. Structural connectome alterations in anxious dogs: a DTI-based study. Sci Rep 2023; 13:9946. [PMID: 37337053 DOI: 10.1038/s41598-023-37121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
Anxiety and fear are dysfunctional behaviors commonly observed in domesticated dogs. Although dogs and humans share psychopathological similarities, little is known about how dysfunctional fear behaviors are represented in brain networks in dogs diagnosed with anxiety disorders. A combination of diffusion tensor imaging (DTI) and graph theory was used to investigate the underlying structural connections of dysfunctional anxiety in anxious dogs and compared with healthy dogs with normal behavior. The degree of anxiety was assessed using the Canine Behavioral Assessment & Research Questionnaire (C-BARQ), a widely used, validated questionnaire for abnormal behaviors in dogs. Anxious dogs showed significantly decreased clustering coefficient ([Formula: see text]), decreased global efficiency ([Formula: see text]), and increased small-worldness (σ) when compared with healthy dogs. The nodal parameters that differed between the anxious dogs and healthy dogs were mainly located in the posterior part of the brain, including the occipital lobe, posterior cingulate gyrus, hippocampus, mesencephalon, and cerebellum. Furthermore, the nodal degree ([Formula: see text]) of the left cerebellum was significantly negatively correlated with "excitability" in the C-BARQ of anxious dogs. These findings could contribute to the understanding of a disrupted brain structural connectome underlying the pathological mechanisms of anxiety-related disorders in dogs.
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Affiliation(s)
- Qinyuan Chen
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Yangfeng Xu
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emma Christiaen
- Medical Image and Signal Processing (MEDISIP), Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Sara De Witte
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Neurology and Bru-BRAIN, University Hospital (UZ Brussel), Brussels, Belgium
- Neuroprotection & Neuromodulation Research Group (NEUR), Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Christian Vanhove
- Medical Image and Signal Processing (MEDISIP), Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Jimmy Saunders
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Kathelijne Peremans
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Chris Baeken
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Vrije Universiteit Brussel (VUB), Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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10
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Hong A, Zhou S, Yang C, Liu X, Su S, Wang Z. Impact of childhood trauma on the abnormal functional connectivity of brain regions in the fear network model of panic disorder. J Affect Disord 2023; 329:500-510. [PMID: 36858271 DOI: 10.1016/j.jad.2023.02.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND People who have suffered childhood trauma may be more susceptible to panic disorder (PD). Existing evidence indicates that childhood trauma can significantly impact brain function. Meanwhile, the brain regions involved in the fear network model (FNM) of PD highly overlap with the brain regions affected by childhood trauma. However, it remains unclear whether functional connections between brain regions associated with the FNM in patients with PD are affected by childhood trauma. This study aimed to investigate the effects of childhood trauma on the functional connectivity (FC) of brain regions associated with the FNM in patients with PD. METHOD This study recruited 62 patients with PD, including 21 with a high level of childhood trauma (PD_HCT), 41 with a low level of childhood trauma (PD_LCT), and 40 healthy controls (HCs). The patients underwent magnetic resonance imaging resting-state scanning. The amygdala, anterior cingulate, thalamus, and hippocampus were chosen as regions of interest (ROIs) to examine group differences in ROIs and whole-brain resting-state FC (rsFC). RESULTS Compared with PD_HCT patients, PD_LCT patients exhibited significantly increased rsFC in the right thalamus, right temporo-occipital middle temporal gyrus, left thalamus, and right temporo-occipital middle temporal gyrus. Compared with HCs, PD_LCT patients had increased rsFC between the right thalamus and the right temporo-occipital middle temporal gyrus. CONCLUSION Patients with PD who had suffered high and low levels of childhood trauma were found to exhibit different pathological rsFC alterations in the FNM, suggesting that childhood trauma may be an important risk factor for the development of PD symptoms.
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Affiliation(s)
- Ang Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuangyi Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitong Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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Williams M, Honan C, Skromanis S, Sanderson B, Matthews AJ. Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis. CURRENT PSYCHOLOGY 2023:1-23. [PMID: 37359641 PMCID: PMC10173921 DOI: 10.1007/s12144-023-04695-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 06/28/2023]
Abstract
This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04695-x.
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Affiliation(s)
- Monique Williams
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, TAS 7001 Australia
| | - Cynthia Honan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250 Australia
| | - Sarah Skromanis
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250 Australia
| | - Ben Sanderson
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, TAS 7001 Australia
| | - Allison J. Matthews
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, TAS 7001 Australia
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12
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Cammisuli DM, Castelnuovo G. Neuroscience-based psychotherapy: A position paper. Front Psychol 2023; 14:1101044. [PMID: 36860785 PMCID: PMC9968886 DOI: 10.3389/fpsyg.2023.1101044] [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: 11/17/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
In the recent years, discoveries in neuroscience have greatly impacted upon the need to modify therapeutic practice starting from the evidence showing some cerebral mechanisms capable of coping with mental health crisis and traumatic events of the individual's life history by redesigning the narrative plot and the person's sense of the Self. The emerging dialogue between neuroscience and psychotherapy is increasingly intense and modern psychotherapy cannot ignore the heritage deriving from studies about neuropsychological modification of memory traces, neurobiology of attachment theory, cognitive mechanisms involved in psychopathology, neurophysiology of human empathy, neuroimaging evidence about psychotherapeutic treatment, and somatoform disorders connecting the brain and the body. In the present article, we critically examined sectorial literature and claimed that psychotherapy has to referred to a neuroscience-based approach in order to adopt the most tailored interventions for specific groups of patients or therapy settings. We also provided recommendations for care implementation in clinical practice and illustrated challenges of future research.
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Affiliation(s)
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy,*Correspondence: Gianluca Castelnuovo ✉
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13
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Schrammen E, Roesmann K, Rosenbaum D, Redlich R, Harenbrock J, Dannlowski U, Leehr EJ. Functional neural changes associated with psychotherapy in anxiety disorders - A meta-analysis of longitudinal fMRI studies. Neurosci Biobehav Rev 2022; 142:104895. [PMID: 36179918 DOI: 10.1016/j.neubiorev.2022.104895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/12/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
Successful psychotherapy for anxiety disorders is thought to be linked to functional neural changes in prefrontal control areas and fear-related limbic regions. Thus, discovering such therapy-associated neural changes might point to relevant mechanisms of action. Using AES-SDM, we conducted a coordinate-based meta-analysis of 22 whole-brain datasets (n = 419 anxiety patients) from 18 studies identified by our systematic literature search following PRISMA criteria (preregistration available at OSF: https://osf.io/dgc4p). In these studies, fMRI data was collected in response to negative stimuli during cognitive-emotional tasks before and after psychotherapy. Post-psychotherapy, activation decreased in the right insula, the anterior cingulate cortex, and the dorsolateral prefrontal cortex; no region had increased activation. A subgroup analysis for CBT revealed additional decrease in the supplementary motor area. Reduced activation in limbic and frontal regions might indicate therapy-associated normalization regarding the perception of internal and external threat, subsequent allocation of cognitive resources, and changes in effortful cognitive control. Due to the integration of diverse treatments and experimental tasks, these changes presumably reflect global effects of successful psychotherapy.
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Affiliation(s)
| | - Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen
| | | | - Jana Harenbrock
- Institute for Translational Psychiatry, University of Münster
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster
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14
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Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy. Neurosci Biobehav Rev 2022; 142:104867. [PMID: 36122739 DOI: 10.1016/j.neubiorev.2022.104867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
Mental health disorders and substance use disorders are a leading cause of morbidity and mortality worldwide, and one of the most important challenges for public health systems. While evidence-based psychotherapy is generally pursued to address mental health challenges, psychological change is often hampered by non-adherence to treatments, relapses, and practical barriers (e.g., time, cost). In recent decades, Non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to directly target dysfunctional neural circuitry and promote long-lasting plastic changes. While the therapeutic efficacy of NIBS protocols for mental illnesses has been established, neuromodulatory interventions might also be employed to support the processes activated by psychotherapy. Indeed, combining psychotherapy with NIBS might help tailor the treatment to the patient's unique characteristics and therapeutic goal, and would allow more direct control of the neuronal changes induced by therapy. Herein, we overview emerging evidence on the use of NIBS to enhance the psychotherapeutic effect, while highlighting the next steps in advancing clinical and research methods toward personalized intervention approaches.
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15
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Fumero A, Marrero RJ, Olivares T, Rivero F, Alvarez-Pérez Y, Pitti C, Peñate W. Neuronal Activity during Exposure to Specific Phobia through fMRI: Comparing Therapeutic Components of Cognitive Behavioral Therapy. Life (Basel) 2022; 12:life12081132. [PMID: 36013311 PMCID: PMC9410164 DOI: 10.3390/life12081132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Cognitive behavioral therapy (CBT) packages for anxiety disorders, such as phobias, usually include gradual exposure to anxious contexts, positive self-verbalizations, and relaxation breathing. The objective of this research was to analyze the specific neural activation produced by the self-verbalizations (S) and breathing (B) included in CBT. Thirty participants with clinical levels of a specific phobia to small animals were randomly assigned to three fMRI conditions in which individuals were exposed to phobic stimuli in real images: a group underwent S as a technique to reduce anxiety; a second group underwent B; and a control group underwent exposure only (E). Simple effects showed higher brain activation comparing E > S, E > B, and S > B. In particular, in the E group, compared to the experimental conditions, an activation was observed in sensory-perceptive and prefrontal and in other regions involved in the triggering of emotion (i.e., amygdala, supplementary motor area, and cingulate gyrus) as well as an activation associated with interoceptive sensitivity (i.e., insula and cingulate cortex). According to the specific tool used, discrepancies in the neural changes of CBT efficacy were observed. We discuss the theoretical implications according to the dual model of CBT as a set of therapeutic tools that activate different processes.
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Affiliation(s)
- Ascensión Fumero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain
- Correspondence:
| | - Rosario J. Marrero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain
| | - Teresa Olivares
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
| | - Francisco Rivero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, 38300 La Orotava, Tenerife, Spain
| | | | - Carmen Pitti
- Dirección General de Salud Pública, Servicio Canario de la Salud, 38006 Santa Cruz, Tenerife, Spain;
| | - Wenceslao Peñate
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain; (R.J.M.); (T.O.); or (F.R.); (W.P.)
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Tenerife, Spain
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16
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Hao LS, Du Y, Chen L, Jiao YG, Cheng Y. Brain-derived neurotrophic factor as a biomarker for obsessive-compulsive disorder: A meta-analysis. J Psychiatr Res 2022; 151:676-682. [PMID: 35667336 DOI: 10.1016/j.jpsychires.2022.05.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/30/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is a growth factor that plays many critical functions in the central nervous system (CNS) and may be involved in the development of a range of psychopathologies, including depression, dementia, and neurodegenerative disorders. METHODS In the present study, we performed the first systematic review with a meta-analysis to quantitatively compare the peripheral blood BDNF levels between patients with obsessive-compulsive disorder (OCD) and healthy controls (HCs). A systematic search was conducted using PubMed and Web of Science databases to identify the relevant articles. RESULTS Nine studies encompassing 474 adults with OCD and 436 HCs were included in this meta-analysis. A random-effects meta-analysis showed that patients with OCD had significantly decreased peripheral blood levels of Brain-derived neurotrophic factor (BDNF) when compared with the HCs (Hedges' g = -0.722, 95% confidence interval [CI] = -1.152 to -0.292, P = 0.001). Subgroup analyses revealed decreased BDNF levels in plasma of patients (Hedges' g = -1.137, 95% CI = -1.463 to -0.810, P = 0.000) and drug-free patients (Hedges' g = -1.269, 95% CI = -1.974 to -0.564, P = 0.000) as compared to patients on active drug therapy and HCs. Meta-regression analyses showed that age, sex, sample size, Y-BOS total score, and publication year had no moderating effects on the outcome. CONCLUSION Although the relationship between our findings and the pathophysiology of OCD and the role BDNF plays in the development of the disease remains to be determined, the outcomes suggest that BDNF may serve as a potential biomarker of OCD.
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Affiliation(s)
- Lin-Shuai Hao
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, China
| | - Yang Du
- Key Laboratory of Ethnomedicine for Ministry of Education, School of Pharmacy, Minzu University of China, Beijing, China
| | - Lei Chen
- Key Laboratory of Ethnomedicine for Ministry of Education, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yu-Guo Jiao
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, China.
| | - Yong Cheng
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, China.
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17
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Chen J, Tian C, Zhang Q, Xiang H, Wang R, Hu X, Zeng X. Changes in Volume of Subregions Within Basal Ganglia in Obsessive–Compulsive Disorder: A Study With Atlas-Based and VBM Methods. Front Neurosci 2022; 16:890616. [PMID: 35794954 PMCID: PMC9251343 DOI: 10.3389/fnins.2022.890616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe role of basal ganglia in the pathogenesis of obsessive–compulsive disorder (OCD) remains unclear. The studies on volume changes of basal ganglia in OCD commonly use the VBM method; however, the Atlas-based method used in such research has not been reported. Atlas-based method has a lower false positive rate compared with VBM method, thus having advantages partly.ObjectivesThe current study aimed to detect the volume changes of subregions within basal ganglia in OCD using Atlas-based method to further delineate the precise neural circuitry of OCD. What is more, we explored the influence of software used in Atlas-based method on the volumetric analysis of basal ganglia and compared the results of Atlas-based method and regularly used VBM method.MethodsWe analyzed the brain structure images of 37 patients with OCD and 41 healthy controls (HCs) using the VBM method, Atlas-based method based on SPM software, or Freesurfer software to find the areas with significant volumetric variation between the two groups, and calculated the effects size of these areas.ResultsVBM analysis revealed a significantly increased volume of bilateral lenticular nucleus in patients compared to HCs. In contrast, Atlas-based method based on Freesurfer revealed significantly increased volume of left globus pallidus in patients, and the largest effect size of volumetric variation was revealed by Freesurfer analysis.ConclusionsThis study showed that the volume of bilateral lenticular nucleus significantly increased in patients compared to HCs, especially left globus pallidus, which was in accordance with the previous findings. In addition, Freesurfer is better than SPM and a good choice for Atlas-based volumetric analysis of basal ganglia.
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Affiliation(s)
- Jiaxiang Chen
- School of Medicine, Guizhou University, Guiyang, China
| | - Chong Tian
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qun Zhang
- Department of Psychology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Hui Xiang
- Department of Psychology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Rongpin Wang
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- *Correspondence: Xiaofei Hu
| | - Xianchun Zeng
- School of Medicine, Guizhou University, Guiyang, China
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, China
- Xianchun Zeng
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18
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Isagulyan ED, Makashova ES, Myasnikova LK, Sergeenko EV, Aslakhanova KS, Tomskiy AA, Voloshin AG, Kashcheev AA. Psychogenic (nociplastic) pain: Current state of diagnosis, treatment options, and potentials of neurosurgical management. PROGRESS IN BRAIN RESEARCH 2022; 272:105-123. [PMID: 35667797 DOI: 10.1016/bs.pbr.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Classification of pain syndromes is quite multifaceted. However, pathogenetic classification by which chronic pain syndromes are usually divided into nociceptive, neuropathic and psychogenic, is crucial in choosing treatment tactics. In modern classifications, psychogenic pain is distinguished from nociceptive pain (associated with direct tissue injury or damage) and neuropathic pain (in which lesion can only be determined morphologically). Mental disorders play a leading role in psychogenic pain. Here, somatic/neurological disorders, if any, are of no pathogenetic significance in the dynamics of pain syndrome. There are certain algorithms (though not yet fully developed) and even guidelines for diagnosing and treating nociceptive and neuropathic pain, whereas psychogenic pain has been and still is almost out of sight for a long time. Despite its considerable prevalence, attitude towards it is still uncertain. Until now, it has no single classification, nor any strategy with regards to diagnosis, treatment and prevention.
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Affiliation(s)
- Emil D Isagulyan
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.
| | - Elizaveta S Makashova
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | | | - Elizaveta V Sergeenko
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Karina S Aslakhanova
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Alexey A Tomskiy
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Alexey G Voloshin
- Pain Clinic, Center of Endosurgery and Lithotripsy, Moscow, Russian Federation
| | - Alexey A Kashcheev
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russian Federation
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19
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Luciana M, Collins PF. Neuroplasticity, the Prefrontal Cortex, and Psychopathology-Related Deviations in Cognitive Control. Annu Rev Clin Psychol 2022; 18:443-469. [PMID: 35534121 DOI: 10.1146/annurev-clinpsy-081219-111203] [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: 11/09/2022]
Abstract
A basic survival need is the ability to respond to, and persevere in the midst of, experiential challenges. Mechanisms of neuroplasticity permit this responsivity via functional adaptations (flexibility), as well as more substantial structural modifications following chronic stress or injury. This review focuses on prefrontally based flexibility, expressed throughout large-scale neuronal networks through the actions of excitatory and inhibitory neurotransmitters and neuromodulators. With substance use disorders and stress-related internalizing disorders as exemplars, we review human behavioral and neuroimaging data, considering whether executive control, particularly cognitive flexibility, is impaired premorbidly, enduringly compromised with illness progression, or both. We conclude that deviations in control processes are consistently expressed in the context of active illness but operate through different mechanisms and with distinct longitudinal patterns in externalizing versus internalizing conditions.
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Affiliation(s)
- Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
| | - Paul F Collins
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA; ,
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20
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Namkung H, Thomas KL, Hall J, Sawa A. Parsing neural circuits of fear learning and extinction across basic and clinical neuroscience: Towards better translation. Neurosci Biobehav Rev 2022; 134:104502. [PMID: 34921863 DOI: 10.1016/j.neubiorev.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/22/2022]
Abstract
Over the past decades, studies of fear learning and extinction have advanced our understanding of the neurobiology of threat and safety learning. Animal studies can provide mechanistic/causal insights into human brain regions and their functional connectivity involved in fear learning and extinction. Findings in humans, conversely, may further enrich our understanding of neural circuits in animals by providing macroscopic insights at the level of brain-wide networks. Nevertheless, there is still much room for improvement in translation between basic and clinical research on fear learning and extinction. Through the lens of neural circuits, in this article, we aim to review the current knowledge of fear learning and extinction in both animals and humans, and to propose strategies to fill in the current knowledge gap for the purpose of enhancing clinical benefits.
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Affiliation(s)
- Ho Namkung
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Kerrie L Thomas
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK; School of Biosciences, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK; School of Medicine, Cardiff University, Cardiff, UK
| | - Akira Sawa
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21287, USA.
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21
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Kenwood MM, Kalin NH, Barbas H. The prefrontal cortex, pathological anxiety, and anxiety disorders. Neuropsychopharmacology 2022; 47:260-275. [PMID: 34400783 PMCID: PMC8617307 DOI: 10.1038/s41386-021-01109-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
Abstract
Anxiety is experienced in response to threats that are distal or uncertain, involving changes in one's subjective state, autonomic responses, and behavior. Defensive and physiologic responses to threats that involve the amygdala and brainstem are conserved across species. While anxiety responses typically serve an adaptive purpose, when excessive, unregulated, and generalized, they can become maladaptive, leading to distress and avoidance of potentially threatening situations. In primates, anxiety can be regulated by the prefrontal cortex (PFC), which has expanded in evolution. This prefrontal expansion is thought to underlie primates' increased capacity to engage high-level regulatory strategies aimed at coping with and modifying the experience of anxiety. The specialized primate lateral, medial, and orbital PFC sectors are connected with association and limbic cortices, the latter of which are connected with the amygdala and brainstem autonomic structures that underlie emotional and physiological arousal. PFC pathways that interface with distinct inhibitory systems within the cortex, the amygdala, or the thalamus can regulate responses by modulating neuronal output. Within the PFC, pathways connecting cortical regions are poised to reduce noise and enhance signals for cognitive operations that regulate anxiety processing and autonomic drive. Specialized PFC pathways to the inhibitory thalamic reticular nucleus suggest a mechanism to allow passage of relevant signals from thalamus to cortex, and in the amygdala to modulate the output to autonomic structures. Disruption of specific nodes within the PFC that interface with inhibitory systems can affect the negative bias, failure to regulate autonomic arousal, and avoidance that characterize anxiety disorders.
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Affiliation(s)
- Margaux M Kenwood
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Neuroscience Training Program at University of Wisconsin-Madison, Madison, USA
| | - Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Neuroscience Training Program at University of Wisconsin-Madison, Madison, USA
- Wisconsin National Primate Center, Madison, WI, USA
| | - Helen Barbas
- Neural Systems Laboratory, Department of Health Sciences, Boston University, Boston, MA, USA.
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
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22
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Carhart-Harris RL, Wagner AC, Agrawal M, Kettner H, Rosenbaum JF, Gazzaley A, Nutt DJ, Erritzoe D. Can pragmatic research, real-world data and digital technologies aid the development of psychedelic medicine? J Psychopharmacol 2022; 36:6-11. [PMID: 33888025 PMCID: PMC8801625 DOI: 10.1177/02698811211008567] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Favourable regulatory assessments, liberal policy changes, new research centres and substantial commercial investment signal that psychedelic therapy is making a major comeback. Positive findings from modern trials are catalysing developments, but it is questionable whether current confirmatory trials are sufficient for advancing our understanding of safety and best practice. Here we suggest supplementing traditional confirmatory trials with pragmatic trials, real-world data initiatives and digital health solutions to better support the discovery of optimal and personalised treatment protocols and parameters. These recommendations are intended to help support the development of safe, effective and cost-efficient psychedelic therapy, which, given its history, is vulnerable to excesses of hype and regulation.
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Affiliation(s)
- Robin L Carhart-Harris
- Centre for Psychedelic Research, Imperial College London, London, UK,Robin L Carhart-Harris, Centre for Psychedelic Research, Imperial College London, Burlington Danes Building, London W12 0NN, UK.
| | - Anne C Wagner
- Remedy, Toronto, Canada,Department of Psychology, Ryerson University, Toronto, Canada
| | - Manish Agrawal
- Maryland Oncology and Hematology, Rockville, USA,Aquilino Cancer Center, Rockville, USA
| | - Hannes Kettner
- Centre for Psychedelic Research, Imperial College London, London, UK
| | | | - Adam Gazzaley
- Neuroscape, Department of Neurology, Physiology and Psychiatry, University of California San Francisco, San Francisco, USA
| | - David J Nutt
- Centre for Psychedelic Research, Imperial College London, London, UK
| | - David Erritzoe
- Centre for Psychedelic Research, Imperial College London, London, UK
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23
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Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Sci Rep 2021; 11:19267. [PMID: 34588511 PMCID: PMC8481564 DOI: 10.1038/s41598-021-98736-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/13/2021] [Indexed: 12/04/2022] Open
Abstract
Anxiety is recognized as a major health issue and is quite prevalent among older adults. An efficient way to manage anxiety is abdominal breathing. Breathing exercises seem to reduce anxiety and to increase parasympathetic activity assessed by HRV indexes. Yet, the effect of abdominal breathing on physiological stress (HRV) and anxiety in older adults remains poorly understood. Therefore, the aim of this study is to test the effects of deep and slow breathing (DSB, low inhale/exhale ratio) on physiological stress and anxiety in older adults (n = 22) in comparison with younger ones (n = 25). DSB increased significantly HFpower and reduced state anxiety in both younger and older adults. Interestingly, the increased in HF power was significantly higher among older adults than younger ones. As expected, the ratio inhale/exhale being not equal, RMSSD did not increase following DSB. Thus, we provide evidence suggesting that DSB is more beneficial to older adults than younger ones to restore vagal outflow. Despite future work being required, those results provide relevant clinical application leads to manage state anxiety among older adults and to promote successfull aging.
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24
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Xie S, Zhang X, Cheng W, Yang Z. Adolescent anxiety disorders and the developing brain: comparing neuroimaging findings in adolescents and adults. Gen Psychiatr 2021; 34:e100411. [PMID: 34423252 PMCID: PMC8340272 DOI: 10.1136/gpsych-2020-100411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
Adolescence is the peak period for the incidence of anxiety disorders. Recent findings have revealed the immaturity of neural networks underlying emotional regulation in this population. Brain vulnerability to anxiety in adolescence is related to the unsynchronised development of anxiety-relevant brain functional systems. However, our current knowledge on brain deficits in adolescent anxiety is mainly borrowed from studies on adults. Understanding adolescent-specific brain deficits is essential for developing biomarkers and brain-based therapies targeting adolescent anxiety. This article reviews and compares recent neuroimaging literature on anxiety-related brain structural and functional deficits between adolescent and adult populations, and proposes a model highlighting the differences between adolescence and adulthood in anxiety-related brain networks. This model emphasises that in adolescence the emotional control system tends to be hypoactivated, the fear conditioning system is immature, and the reward and stress response systems are hypersensitive. Furthermore, the striatum’s functional links to the amygdala and the prefrontal cortex are strengthened, while the link between the prefrontal cortex and the amygdala is weakened in adolescence. This model helps to explain why adolescents are vulnerable to anxiety disorders and provides insights into potential brain-based approaches to intervene in adolescent anxiety disorders.
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Affiliation(s)
- Shuqi Xie
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Zhang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhong Cheng
- Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychological Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Yang
- Laboratory of Psychological Health and Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychological and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, China
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Wong B, Lucente D, Krivensky S, Krahn E, Karlawish J, Dickerson BC. Knowledge assessment and psychological impact of genetic counseling in people at risk for familial FTD. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12225. [PMID: 34337135 PMCID: PMC8319661 DOI: 10.1002/dad2.12225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The decision to undergo genetic testing for familial frontotemporal dementia (fFTD) is challenging and complex. When counseling individuals, clinicians need to know what individuals understand about the type of fFTD for which they may be at elevated risk. Unfortunately, no tools to measure understanding of fFTD exist, and no study has investigated knowledge gain from fFTD genetic counseling. METHODS Before and after genetic counseling, 42 asymptomatic individuals from fFTD families completed the newly developed fFTD Knowledge Assessment and Psychological Impact Questionnaire (fFTD KAPI-Q), along with affect and mood questionnaires. RESULTS Genetic counseling resulted in substantial knowledge gain on the fFTD KAPI-Q (average gain = 40%); those with lower pre-counseling scores gained the most. Negative affect diminished by 11%. Individuals who gained the greatest knowledge demonstrated the greatest reduction in negative affect. CONCLUSIONS Genetic counseling was effective regardless of level of baseline knowledge and has an immediate ameliorative impact on negative affect.
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Affiliation(s)
- Bonnie Wong
- Departments of Neurology and PsychiatryFrontotemporal Disorders Unit and Alzheimer's Disease Research CenterBostonMassachusettsUSA
| | - Diane Lucente
- Departments of Neurology and PsychiatryFrontotemporal Disorders Unit and Alzheimer's Disease Research CenterBostonMassachusettsUSA
- Center for Genomic MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Samantha Krivensky
- Departments of Neurology and PsychiatryFrontotemporal Disorders Unit and Alzheimer's Disease Research CenterBostonMassachusettsUSA
| | - Erin Krahn
- Departments of Neurology and PsychiatryFrontotemporal Disorders Unit and Alzheimer's Disease Research CenterBostonMassachusettsUSA
| | - Jason Karlawish
- Penn Memory Center & Division of GeriatricsDepartments of MedicineMedical Ethics and Health Policyand NeurologyPerelman School of MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Bradford C. Dickerson
- Departments of Neurology and PsychiatryFrontotemporal Disorders Unit and Alzheimer's Disease Research CenterBostonMassachusettsUSA
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Baroni M, Frumento S, Cesari V, Gemignani A, Menicucci D, Rutigliano G. Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 128:136-151. [PMID: 34139247 DOI: 10.1016/j.neubiorev.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
Attentional biases to threat exist in panic disorder (PD), probably related to altered subliminal processing. We systematically reviewed studies investigating subliminal processing in PD. Studies were retrieved from MEDLINE and Scopus®. We meta-analytically compared PD (n = 167) and healthy controls (HC, n = 165) for processing of masked panic-related and neutral words. We also compared subliminal and supraliminal presentations of panic-related words relative to neutral words within PD subjects and HC. We found a significantly enhanced Stroop interference to masked panic-related words in PD vs HC (Hedges' g = 0.60, p = 0.03; Q = 14.83, I2 = 66.3 %, p = 0.01). While both PD subjects and HC tended to be slower to respond to supraliminal threat words than to neutral words, PD subjects only showed a marginally significant slower response to subliminal panic-related words vs neutral words. Findings remain inconclusive regarding comparison to other mental disorders, neural correlates, and the effect of psychotherapy. Even if possibly flawed by methodological weaknesses, our findings support the existence of a sensitivity to subliminal threat cues in PD, which could be targeted to improve treatment.
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Affiliation(s)
- Marina Baroni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy; Institute of Clinical Physiology (IFC), National Research Council, via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Sergio Frumento
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy.
| | - Grazia Rutigliano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
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Altered resting-state functional connectivity of the default mode and central executive networks following cognitive processing therapy for PTSD. Behav Brain Res 2021; 409:113312. [PMID: 33895228 DOI: 10.1016/j.bbr.2021.113312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
Psychotherapy research is increasingly targeting both psychological and neurobiological mechanisms of therapeutic change. This trend is evident in and applicable to post-traumatic stress disorder (PTSD) treatment research given the high nonresponse rate of individuals with PTSD who undergo cognitive-behavioral therapy (CBT). Functional connectivity analyses investigating disrupted brain networks across mental disorders have been employed to understand both mental disorder symptoms and therapeutic mechanisms. However, few studies have examined pre-post CBT brain changes in PTSD using functional connectivity analyses. The current study investigated a) whether brain networks commonly implicated in psychopathology (e.g., default mode network [DMN], central executive network [CEN], and salience network [SN]) changed following Cognitive Processing Therapy (CPT) for PTSD and b) whether change in these networks was associated with PTSD and/or transdiagnostic symptom change. Independent components analysis was implemented to investigate resting-state functional connectivity in DMN, CEN, and SN in 42 women with PTSD and 18 trauma-exposed controls (TEC). Results indicated decreased CEN-cerebellum connectivity in PTSD participants versus TEC prior to CPT and decreased DMN connectivity in PTSD participants after CPT. Additionally, DMN and SN connectivity was related to change in positive and negative affectivity, while exploratory analyses at a cluster threshold of pFDR < .10 indicated DMN and SN connectivity was also related to change in PTSD symptoms and rumination. These findings provide evidence for normalization of CEN connectivity with treatment and implicate the DMN and SN in clinical symptom change following CPT.
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Fitzgerald KD, Schroder HS, Marsh R. Cognitive Control in Pediatric Obsessive-Compulsive and Anxiety Disorders: Brain-Behavioral Targets for Early Intervention. Biol Psychiatry 2021; 89:697-706. [PMID: 33454049 PMCID: PMC8353584 DOI: 10.1016/j.biopsych.2020.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
The DSM provides distinct criteria for obsessive-compulsive disorder (OCD) and various types of anxiety disorders, but phenomenological overlap, high rates of comorbidity, and early onset suggest common underlying mechanisms. This notion is further supported by use of the same treatments-cognitive behavioral therapy and serotonin reuptake inhibitor medication-for managing both OCD and non-OCD anxiety disorders in clinical settings. While early intervention with these gold standard treatments is recommended for pediatric OCD and anxiety disorders, young patients often remain symptomatic even after treatment. To guide the development of novel, mechanistically targeted treatments to better resolve OCD and anxiety symptoms, the identification of neural circuits underlying psychological constructs with relevance across disorders has been recommended. One construct that may be relevant for understanding pediatric OCD and anxiety disorders is cognitive control, given the difficulty that young patients experience in dismissing obsessions, compulsions, and worry despite recognition that these symptoms are excessive and unreasonable. In this review, we examine findings from a growing body of literature implicating brain-behavioral markers of cognitive control in pediatric OCD and anxiety disorders, including before and after treatment. We conclude by suggesting that interventions designed to enhance the functioning of the task control circuits underlying cognitive control may facilitate brain maturation to help affected youth overcome symptoms.
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Affiliation(s)
- Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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La Buissonniere-Ariza V, Fitzgerald K, Meoded A, Williams LL, Liu G, Goodman WK, Storch EA. Neural correlates of cognitive behavioral therapy response in youth with negative valence disorders: A systematic review of the literature. J Affect Disord 2021; 282:1288-1307. [PMID: 33601708 DOI: 10.1016/j.jad.2020.12.182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/25/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning. METHODS We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response. RESULTS A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently. LIMITATIONS The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature. CONCLUSIONS Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.
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Affiliation(s)
- Valerie La Buissonniere-Ariza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Laurel L Williams
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Gary Liu
- Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
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Wang X, Cheng B, Wang S, Lu F, Luo Y, Long X, Kong D. Distinct grey matter volume alterations in adult patients with panic disorder and social anxiety disorder: A systematic review and voxel-based morphometry meta-analysis. J Affect Disord 2021; 281:805-823. [PMID: 33243552 DOI: 10.1016/j.jad.2020.11.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/18/2020] [Accepted: 11/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The paradox of similar diagnostic criteria but potentially different neuropathologies in panic disorder (PD) and social anxiety disorder (SAD) needs to be clarified. METHODS We performed a qualitative systematic review and a quantitative whole-brain voxel-based morphometry (VBM) meta-analysis with an anisotropic effect-size version of seed-based D mapping (AES-SDM) to explore whether the alterations of grey matter volume (GMV) in PD are similar to or different from those in SAD, together with potential confounding factors. RESULTS A total of thirty-one studies were eligible for inclusion, eighteen of which were included in the meta-analysis. Compared to the respective healthy controls (HC), qualitative and quantitative analyses revealed smaller cortical-subcortical GMVs in PD patients in brain areas including the prefrontal and temporal-parietal cortices, striatum, thalamus and brainstem, predominantly right-lateralized regions, and larger GMVs in the prefrontal and temporal-parietal-occipital cortices, and smaller striatum and thalamus in SAD patients. Quantitatively, the right inferior frontal gyrus (IFG) deficit was specifically implicated in PD patients, whereas left striatum-thalamus deficits were specific to SAD patients, without shared GMV alterations in both disorders. Sex, the severity of clinical symptoms, psychiatric comorbidity, and concomitant medication use were negatively correlated with smaller regional GMV alterations in PD patients. CONCLUSION PD and SAD may represent different anxiety sub-entities at the neuroanatomical phenotypes level, with different specific neurostructural deficits in the right IFG of PD patients, and the left striatum and thalamus of SAD patients. This combination of differences and specificities can potentially be used to guide the development of diagnostic biomarkers for these disorders.
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Affiliation(s)
- Xiuli Wang
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China.
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu 610041, China
| | - Song Wang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Fengmei Lu
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China
| | - Ya Luo
- Mental Health Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Di Kong
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China
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Schweda A, Weismüller B, Bäuerle A, Dörrie N, Musche V, Fink M, Kohler H, Teufel M, Skoda EM. Phenotyping mental health: Age, community size, and depression differently modulate COVID-19-related fear and generalized anxiety. Compr Psychiatry 2021; 104:152218. [PMID: 33232827 DOI: 10.1016/j.comppsych.2020.152218] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION When the first COVID-19 infections were reported in Germany, fear and anxiety spread faster than the pandemic itself. While moderate amounts of fear of a COVID-19 infection may be functional, generalized anxiety and the potentially resulting distress and psychopathology may possibly be detrimental to people's health. Authorities need to avoid a countrywide panic, on the one hand, but foster a realistic awareness of the actual threat, on the other hand. OBJECTIVES The current cross-sectional study aimed to investigate psychological reactions in response to the real or perceived infection threats. In particular, the analysis should reveal whether COVID-19-related fear and generalized anxiety in times of COVID-19 have distinct correlates. METHODS A nationwide study was conducted from March 10th to May 4th 2020 in Germany (n = 15,308; 10,824 women, 4433 men, 51 other). Generalized anxiety was assessed using the GAD-7, while COVID-19-related fear was measured using a self-generated item. Both outcome variables were entered into linear regression models. Demographic information, depressive symptoms, trust in governmental interventions, subjective level of information regarding COVID-19 and media use were used to predict generalized anxiety and COVID-19-related fear. RESULTS The data revealed distinct correlates of COVID-19-related fear and generalized anxiety. Although COVID-19-related fear and generalized anxiety had overlapping predictors, such as neuroticism, they most prominently differed in age distribution and direction of an urban-rural disparity: generalized anxiety decreases with age, but COVID-19-related fear is most pronounced in elderly participants. Generalized anxiety is also more prevalent in rural communities, but COVID-19-related fear is elevated in metropoles. Furthermore, the presence of a risk disease increases COVID-19-related fear, but not generalized anxiety. CONCLUSION These results suggest that COVID-19-related fear is often justified considering the individual risk of infection or complication due to infection. Some of the characteristics that predict COVID-19-related fear leave generalized anxiety unaffected or show divergent predictive directions. The present findings hint toward two related, but discriminant constructs.
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Affiliation(s)
- Adam Schweda
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany.
| | - Benjamin Weismüller
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Alexander Bäuerle
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Nora Dörrie
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Venja Musche
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Madeleine Fink
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Hannah Kohler
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Martin Teufel
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
| | - Eva-Maria Skoda
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, Essen, Germany
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ADORA2A variation and adenosine A 1 receptor availability in the human brain with a focus on anxiety-related brain regions: modulation by ADORA1 variation. Transl Psychiatry 2020; 10:406. [PMID: 33235193 PMCID: PMC7686488 DOI: 10.1038/s41398-020-01085-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Adenosine, its interacting A1 and A2A receptors, and particularly the variant rs5751876 in the A2A gene ADORA2A have been shown to modulate anxiety, arousal, and sleep. In a pilot positron emission tomography (PET) study in healthy male subjects, we suggested an effect of rs5751876 on in vivo brain A1 receptor (A1AR) availability. As female sex and adenosinergic/dopaminergic interaction partners might have an impact on this rs5751876 effect on A1AR availability, we aimed to (1) further investigate the pilot male-based findings in an independent, newly recruited cohort including women and (2) analyze potential modulation of this rs5751876 effect by additional adenosinergic/dopaminergic gene variation. Healthy volunteers (32/11 males/females) underwent phenotypic characterization including self-reported sleep and A1AR-specific quantitative PET. Rs5751876 and 31 gene variants of adenosine A1, A2A, A2B, and A3 receptors, adenosine deaminase, and dopamine D2 receptor were genotyped. Multivariate analysis revealed an rs5751876 effect on A1AR availability (P = 0.047), post hoc confirmed in 30 of 31 brain regions (false discovery rate (FDR) corrected P values < 0.05), but statistically stronger in anxiety-related regions (e.g., amygdala, hippocampus). Additional effects of ADORA1 rs1874142 were identified; under its influence rs5751876 and rs5751876 × sleep had strengthened effects on A1AR availability (Pboth < 0.02; post hoc FDR-corrected Ps < 0.05 for 29/30 regions, respectively). Our results support the relationship between rs5751876 and A1AR availability. Additional impact of rs1874142, together with rs5751876 and sleep, might be involved in regulating arousal and thus the development of mental disorders like anxiety disorders. The interplay of further detected suggestive ADORA2A × DRD2 interaction, however, necessitates larger future samples more comparable to magnetic resonance imaging (MRI)-based samples.
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Dedoncker J, Baeken C, De Raedt R, Vanderhasselt MA. Combined transcranial direct current stimulation and psychological interventions: State of the art and promising perspectives for clinical psychology. Biol Psychol 2020; 158:107991. [PMID: 33232800 DOI: 10.1016/j.biopsycho.2020.107991] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/14/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
Recent literature shows great heterogeneity in the reported efficacy of transcranial direct current stimulation (tDCS) as a stand-alone psychiatric treatment. Aiming to increase its efficacy, tDCS has been combined with psychological interventions. Our state-of-the-art overview of such combined treatment trials indicates, however, that these usually do not elicit synergistic clinical effects. We therefore explored more basic mechanisms related to the brain state-dependency of tDCS. Importantly, based on our overview, the efficacy of combined interventions may depend on whether individual patients present with endophenotypes that are implicated in the development and maintenance of psychopathology, such as prefrontal-mediated cognitive dysfunction. We discuss how future studies may contribute to the development of personally-tailored dual active treatments by adhering to the Research Domain Criteria (RDoC) framework. RDoC-based mechanistic research may reveal alternative neural circuits that should be functionally targeted by both tDCS and psychological interventions, with promising avenues for clinical psychological science and practice.
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Affiliation(s)
- Josefien Dedoncker
- Department of Head and Skin - Psychiatry and Medical Psychology, Ghent University Hospital, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Chris Baeken
- Department of Head and Skin - Psychiatry and Medical Psychology, Ghent University Hospital, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Psychiatry, University Hospital UZBrussel, Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin - Psychiatry and Medical Psychology, Ghent University Hospital, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Ferreira S, Pêgo JM, Morgado P. A Systematic Review of Behavioral, Physiological, and Neurobiological Cognitive Regulation Alterations in Obsessive-Compulsive Disorder. Brain Sci 2020; 10:E797. [PMID: 33138023 PMCID: PMC7692269 DOI: 10.3390/brainsci10110797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 01/20/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is characterized by cognitive regulation deficits. However, the current literature has focused on executive functioning and emotional response impairments in this disorder. Herein, we conducted a systematic review of studies assessing the behavioral, physiological, and neurobiological alterations in cognitive regulation in obsessive-compulsive patients using the PubMed database. Most of the studies included explored behavioral (distress, arousal, and frequency of intrusive thoughts) and neurobiological measures (brain activity and functional connectivity) using affective cognitive regulation paradigms. Our results pointed to the advantageous use of reappraisal and acceptance strategies in contrast to suppression to reduce distress and frequency of intrusive thoughts. Moreover, we observed alterations in frontoparietal network activity during cognitive regulation. Our conclusions are limited by the inclusion of underpowered studies with treated patients. Nonetheless, our findings support the OCD impairments in cognitive regulation of emotion and might help to improve current guidelines for cognitive therapy.
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Affiliation(s)
- Sónia Ferreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center-Braga (2CA), 4710-243 Braga, Portugal
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Penberthy JK, Russell G, Phillips J, Banaji M, Mann N, Dameron E. Medical Stress and Fear of Death and Dying in a Medical Patient Population. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:255-270. [PMID: 33086904 DOI: 10.1177/0030222820966926] [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: 11/16/2022]
Abstract
We explored the relationship between medical illness-related stress and fear of death and dying in a population of individuals with self-reported medical illnesses. Medically ill participants identified their level of stress related to their medical condition, their level of fear of death and dying, and what treatments they would most prefer for addressing any fear of death and dying as well as their medical illness-related stress. Participants' medical illness-related stress levels were high with an average endorsed score of 7.23 out of 10 (most extreme stress). The majority (70%) of participants endorsed "some," "a little," or "no fear" of death and dying. Overall, reported medical illness-related stress was not significantly correlated with fear of death and dying. Seventy-five percent of participants reported preferring psychotherapy or mindfulness interventions for addressing their stress. Psychotherapy, anti-anxiety medications, and meditation were the top three choices for addressing fear of death and dying.
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Affiliation(s)
- Jennifer Kim Penberthy
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, United States
| | - Genevieve Russell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, United States
| | - Jackson Phillips
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, United States
| | - Medhaa Banaji
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, United States
| | - Nicholas Mann
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, United States
| | - Elizabeth Dameron
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, United States
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Lindquist DH. Emotion in motion: A three-stage model of aversive classical conditioning. Neurosci Biobehav Rev 2020; 115:363-377. [DOI: 10.1016/j.neubiorev.2020.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 01/12/2023]
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Bomyea J, Ball TM, Simmons AN, Campbell-Sills L, Paulus MP, Stein MB. Change in neural response during emotion regulation is associated with symptom reduction in cognitive behavioral therapy for anxiety disorders. J Affect Disord 2020; 271:207-214. [PMID: 32479318 PMCID: PMC7304745 DOI: 10.1016/j.jad.2020.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anxiety disorders are debilitating conditions that can be treated with cognitive behavioral therapy (CBT). Increased understanding of the neurobiological correlates of CBT may inform treatment improvements and personalization. Prior neuroimaging studies point to treatment-related changes in anterior cingulate, insula, and other prefrontal regions during emotional processing, yet to date the impact of CBT on neural substrates of "top down" emotion regulation remains understudied. We examined the relationship between symptom changes assessed over the course of CBT treatment sessions and pre- to post-treatment neural change during an emotion regulation task. METHOD In the current study, a sample of 30 participants with panic disorder or generalized anxiety disorder completed a reappraisal-based emotion regulation task while undergoing fMRI before and after completing CBT. RESULTS Reduced activation in the parahippocampal gyrus was observed from pre- to post-treatment during periods of reducing versus maintaining emotion. Parahippocampal activation was associated with change in symptoms over the course of treatment and post-treatment responder status. Results suggest that, from pre- to post-CBT, participants demonstrated downregulation of neural responses during effortful cognitive emotion regulation. LIMITATIONS Effects were not observed in frontoparietal systems as would be hypothesized based on prior literature, suggesting that treatment-related change could occur outside of fronto-parietal and limbic regions that are central to most models of neural functioning in anxiety disorders. CONCLUSIONS Continued work is needed to better understand how CBT affects cognitive control and memory processes that are hypothesized to support reappraisal as a strategy for emotion regulation.
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Affiliation(s)
- J. Bomyea
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health,University of California, San Diego, Department of Psychiatry,, 9500 Gilman Dr. MC 0855, La Jolla, CA 92131
| | - T. M. Ball
- Stanford University, Department of Psychiatry and Behavioral Sciences
| | - A. N. Simmons
- VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health,University of California, San Diego, Department of Psychiatry
| | | | - M. P. Paulus
- University of California, San Diego, Department of Psychiatry,Laureate Institute for Brain Research
| | - M. B. Stein
- University of California, San Diego, Department of Psychiatry,University of California, San Diego, Department of Family Medicine and Public Health
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Kozhemiako N, Nunes AS, Vakorin V, Iarocci G, Ribary U, Doesburg SM. Alterations in Local Connectivity and Their Developmental Trajectories in Autism Spectrum Disorder: Does Being Female Matter? Cereb Cortex 2020; 30:5166-5179. [PMID: 32368779 DOI: 10.1093/cercor/bhaa109] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/31/2020] [Accepted: 04/05/2020] [Indexed: 01/10/2023] Open
Abstract
Autism spectrum disorder (ASD) is diagnosed more often in males with a ratio of 1:4 females/males. This bias is even stronger in neuroimaging studies. There is a growing evidence suggesting that local connectivity and its developmental trajectory is altered in ASD. Here, we aim to investigate how local connectivity and its age-related trajectories vary with ASD in both males and females. We used resting-state fMRI data from the ABIDE I and II repository: males (n = 102) and females (n = 92) with ASD, and typically developing males (n = 104) and females (n = 92) aged between 6 and 26. Local connectivity was quantified as regional homogeneity. We found increases in local connectivity in participants with ASD in the somatomotor and limbic networks and decreased local connectivity within the default mode network. These alterations were more pronounced in females with ASD. In addition, the association between local connectivity and ASD symptoms was more robust in females. Females with ASD had the most distinct developmental trajectories of local connectivity compared with other groups. Overall, our findings of more pronounced local connectivity alterations in females with ASD could indicate a greater etiological load for an ASD diagnosis in this group congruent with the female protective effect hypothesis.
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Affiliation(s)
- Nataliia Kozhemiako
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Adonay S Nunes
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Vasily Vakorin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.,Behavioural and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.,Fraser Health, British Columbia Health Authority, Surrey, BC V3T 5X3, Canada
| | - Grace Iarocci
- Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Urs Ribary
- Behavioural and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.,Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.,Department of Pediatrics and Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Sam M Doesburg
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.,Behavioural and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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Rosenbaum D, Leehr EJ, Rubel J, Maier MJ, Pagliaro V, Deutsch K, Hudak J, Metzger FG, Fallgatter AJ, Ehlis AC. Cortical oxygenation during exposure therapy - in situ fNIRS measurements in arachnophobia. NEUROIMAGE-CLINICAL 2020; 26:102219. [PMID: 32135488 PMCID: PMC7052440 DOI: 10.1016/j.nicl.2020.102219] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
This is the first study that assessed cortical hemodynamic reactions during exposure therapy in situ. During exposure patients showed increased activity in the cognitive control network (CCN) compared to a control condition. CCN activity deceased during the session. Further, CCN activity was associated with fear ratings at the beginning of the session and this relationship decreased from session to session.
Exposure therapy is a well-studied and highly efficacious treatment for phobic disorders. Although the neurobiological model of fear is well underpinned by various studies, the mechanisms of exposure therapy are still under discussion. Partly, this is due to the fact that most neurophysiological methods like fMRI are not able to be used in the natural therapeutic settings. The current study used in situ measurements of cortical blood oxygenation (O2Hb) during exposure therapy by means of functional near-infrared spectroscopy. 37 subjects (N = 30 completers) underwent exposure therapy during 5 adapted sessions in which subjects were exposed to Tegenaria Domestica (domestic house spider – experimental condition) and Dendrobaena Veneta/ Eisenaia hortensis (red earthworm – control condition). Compared to the control condition, patients showed higher O2Hb levels in the anticipation and exposure phase of spider exposure in areas of the cognitive control network (CCN). Further, significant decreases in O2Hb were observed during the session accompanied by reductions in fear related symptoms. However, while symptoms decreased in a linear quadratic manner, with higher reductions in the beginning of the session, CCN activity decreased linearly. Further, higher anxiety at the beginning of session one was associated with increased O2Hb in the CCN. This association decreased within the following sessions. The current study sheds light on the neuronal mechanisms of exposure therapy. The results are discussed in light of a phase model of exposure therapy that posits a role of cognitive control in the beginning and routine learning at the end of the therapy session.
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Affiliation(s)
- David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany.
| | | | - Julian Rubel
- Psychotherapy Research Lab, Psychology and Sport Sciences, Justus-Liebig-University Giessen, Giessen, Germany
| | - Moritz J Maier
- Fraunhofer IAO
- Center for Responsible Research and Innovation, Berlin, Germany
| | - Valeria Pagliaro
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Kira Deutsch
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Justin Hudak
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT 84112, United States
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany; LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
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Burkhouse KL, Jagan Jimmy, Defelice N, Klumpp H, Ajilore O, Hosseini B, Fitzgerald KD, Monk CS, Phan KL. Nucleus accumbens volume as a predictor of anxiety symptom improvement following CBT and SSRI treatment in two independent samples. Neuropsychopharmacology 2020; 45:561-569. [PMID: 31756730 PMCID: PMC6969163 DOI: 10.1038/s41386-019-0575-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022]
Abstract
Structural variations of neural regions implicated in fear responses have been well documented in the pathophysiology of anxiety and may play an important role in treatment response. We examined whether gray matter volume of three neural regions supporting fear and avoidance responses [bilateral amygdala, nucleus accumbens (NAcc), and ventromedial prefrontal cortex (PFC)] predicted cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) treatment outcome in two independent samples of patients with anxiety disorders. Study 1 consisted of 81 adults with anxiety disorders and Study 2 included 55 children and adolescents with anxiety disorders. In both studies, patients completed baseline structural MRI scans and received either CBT or SSRI treatment. Clinician-rated interviews of anxiety symptoms were assessed at baseline and posttreatment. Among the adult sample, greater pre-treatment bilateral NAcc volume was associated with a greater reduction in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment. Greater left NAcc volume also predicted greater decreases in clinician-rated anxiety symptoms pre-to-post CBT and SSRI treatment among youth with current anxiety. Across studies, results were similar across treatments, and findings were maintained when adjusting for patient's age, sex, and total intracranial brain volume. We found no evidence for baseline amygdala or ventromedial PFC volume serving as treatment predictors across the two samples. Together, these findings provide promising support for the role of NAcc volume as an objective marker of anxiety treatment improvement that spans across development. Future studies should clarify the specific mechanisms through which NAcc volume exerts its therapeutic effects.
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Affiliation(s)
- Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jagan Jimmy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas Defelice
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Bobby Hosseini
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Christopher S Monk
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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41
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Goode TD, Acca GM, Maren S. Threat imminence dictates the role of the bed nucleus of the stria terminalis in contextual fear. Neurobiol Learn Mem 2020; 167:107116. [PMID: 31740383 PMCID: PMC6980749 DOI: 10.1016/j.nlm.2019.107116] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/09/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022]
Abstract
Recent work indicates that the bed nucleus of the stria terminalis (BNST) is critically involved in the regulation of conditioned fear responses to unpredictable threats. Here we examined whether the involvement of the BNST in contextual fear conditioning in male rats depends on the imminence of shock after placement in the conditioning chamber. Specifically, we hypothesized that the BNST supports contextual freezing after conditioning with delayed, but not imminent, footshock (relative to placement in the context). Rats were implanted with cannulae targeting the BNST and underwent a contextual fear conditioning procedure in which a single footshock unconditioned stimulus (US) was delivered either 1 min or 9 min after the rat was placed in the context; the rats received a total of four identical conditioning sessions over two days, all with equivalent exposure to the context. Contexts associated with either imminent or delayed US onsets produced distinct patterns of freezing and shock-induced activity but freezing in each case was context-dependent. Reversible inactivation of the BNST reduced the expression of contextual freezing in the context paired with delayed (9 min), but not imminent (1 min), footshock onset. Implications of these data are discussed in the light of recent conceptualizations of BNST function, as well as for anxiety behaviors.
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Affiliation(s)
- Travis D Goode
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, USA
| | - Gillian M Acca
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, USA
| | - Stephen Maren
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, USA.
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Sartori SB, Singewald N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacol Ther 2019; 204:107402. [PMID: 31470029 DOI: 10.1016/j.pharmthera.2019.107402] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Current medication for anxiety disorders is suboptimal in terms of efficiency and tolerability, highlighting the need for improved drug treatments. In this review an overview of drugs being studied in different phases of clinical trials for their potential in the treatment of fear-, anxiety- and trauma-related disorders is presented. One strategy followed in drug development is refining and improving compounds interacting with existing anxiolytic drug targets, such as serotonergic and prototypical GABAergic benzodiazepines. A more innovative approach involves the search for compounds with novel mechanisms of anxiolytic action using the growing knowledge base concerning the relevant neurocircuitries and neurobiological mechanisms underlying pathological fear and anxiety. The target systems evaluated in clinical trials include glutamate, endocannabinoid and neuropeptide systems, as well as ion channels and targets derived from phytochemicals. Examples of promising novel candidates currently in clinical development for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder or post-traumatic stress disorder include ketamine, riluzole, xenon with one common pharmacological action of modulation of glutamatergic neurotransmission, as well as the neurosteroid aloradine. Finally, compounds such as D-cycloserine, MDMA, L-DOPA and cannabinoids have shown efficacy in enhancing fear-extinction learning in humans. They are thus investigated in clinical trials as an augmentative strategy for speeding up and enhancing the long-term effectiveness of exposure-based psychotherapy, which could render chronic anxiolytic drug treatment dispensable for many patients. These efforts are indicative of a rekindled interest and renewed optimism in the anxiety drug discovery field, after decades of relative stagnation.
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Affiliation(s)
- Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
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Abstract
PURPOSE OF REVIEW This article reviews current knowledge regarding diagnosis, pathophysiology, and treatment trends in obsessive-compulsive disorder (OCD), a severe, underrecognized, and chronic condition frequently encountered in neurologic practice. RECENT FINDINGS With a lifetime prevalence estimated at 2.5%, OCD is a common condition that can also present comorbidly with neurologic disease. The core symptoms of OCD are obsessions and compulsions. Obsessions are intrusive repetitive thoughts, urges, images, or impulses that trigger anxiety and that the individual is not able to suppress. Compulsions are repetitive behaviors or mental acts occurring in response to an obsession with the intention of reducing the distress caused by obsessions. Neuroimaging, neuropsychological, and pharmacologic studies suggest that the expression of OCD symptoms is associated with dysfunction in a cortico-striato-thalamo-cortical circuit. Evidence-based treatments for OCD comprise pharmacotherapy and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs recommended for OCD, but significant differences exist in their use for OCD compared to their use for other mood and anxiety conditions, including the need for higher dosage, longer trials necessitated by a longer lag for therapeutic response, and typically lower response rates. Cognitive-behavioral therapy, based on the principles of exposure and response prevention, shows results superior to pharmacologic treatments with lower relapse rates on long-term follow-up and thus should be considered in the treatment plan of every patient with OCD. SUMMARY OCD and obsessive-compulsive symptoms are frequently encountered in the neurologic clinic setting and require a high index of suspicion to effectively screen for them and an illness-specific therapeutic approach.
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Brain mechanisms impacted by psychological therapies for pain: identifying targets for optimization of treatment effects. Pain Rep 2019; 4:e767. [PMID: 31579858 PMCID: PMC6727993 DOI: 10.1097/pr9.0000000000000767] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/02/2019] [Accepted: 05/25/2019] [Indexed: 12/13/2022] Open
Abstract
Psychological therapies, such as cognitive behavioral therapy, are widely used multifaceted approaches that have been shown to improve pain-related functioning. A small but growing number of studies have used brain imaging to support the use of psychological therapies for pain. Although these studies have led to an increased understanding of how therapies may engage neural systems, there are multiple technical and conceptual challenges to consider. Based on the current literature, several components of effective psychological therapies for pain may be supported by changes in neural circuitry, which are most consistently represented by diminished activation and/or reduced hyperconnectivity in brain regions related to pain processing, emotion, and cognitive control. Findings may vary based on methodological approaches used and may also differ depending on targets of treatment. To provide a nuanced understanding of the current literature, specific targets and components of effective treatments for which a neural basis has been investigated are reviewed. These treatment components include catastrophic thinking about pain, increasing self-efficacy, mindfulness, anxiety symptom reduction, and exposure-based approaches. In general, such strategies have the potential to normalize regional hyperactivations and reduce hyperconnectivity in brain regions associated with nociceptive processing, cognition, and emotion, although additional research is needed. By determining if there are indeed distinct brain mechanisms engaged by different components of psychological therapy and evidence for specific changes in neural function after these interventions, future therapies may be more optimally tailored for individuals afflicted with chronic pain.
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Gorka SM, Young CB, Klumpp H, Kennedy AE, Francis J, Ajilore O, Langenecker SA, Shankman SA, Craske MG, Stein MB, Phan KL. Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression: a randomized trial. Neuropsychopharmacology 2019; 44:1639-1648. [PMID: 31060042 PMCID: PMC6785075 DOI: 10.1038/s41386-019-0407-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
Mechanisms and predictors for the successful treatment of anxiety and depression have been elusive, limiting the effectiveness of existing treatments and curtailing the development of new interventions. In this study, we evaluated the utility of three widely used neural probes of emotion (experience, regulation, and perception) in their ability to predict symptom improvement and correlate with symptom change following two first-line treatments-selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Fifty-five treatment-seeking adults with anxiety and/or depression were randomized to 12 weeks of SSRI or CBT treatment (ClinicalTrials.gov identifier: NCT01903447). Functional magnetic resonance imaging (fMRI) was used to examine frontolimbic brain function during emotion experience, regulation, and perception, as probed by the Emotion Regulation Task (ERT; emotion experience and regulation) and emotional face assessment task (EFAT; emotion perception). Brain function was then related to anxiety and depression symptom change. Results showed that both SSRI and CBT treatments similarly attenuated insula and amygdala activity during emotion perception, and greater treatment-related decrease in insula and amygdala activity was correlated with greater reduction in anxiety symptoms. Both treatments also reduced amygdala activity during emotion experience but brain change did not correlate with symptom change. Lastly, greater pre-treatment insula and amygdala activity during emotion perception predicted greater anxiety and depression symptom improvement. Thus, limbic activity during emotion perception is reduced by both SSRI and CBT treatments, and predicts anxiety and depression symptom improvement. Critically, neural reactivity during emotion perception may be a non-treatment-specific mechanism for symptom improvement.
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Affiliation(s)
- Stephanie M. Gorka
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Christina B. Young
- 0000000419368956grid.168010.eDepartment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Heide Klumpp
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA ,0000 0001 2175 0319grid.185648.6Department of Psychology, University of Illinois at Chicago, Chicago, IL USA
| | - Amy E. Kennedy
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Jennifer Francis
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Olusola Ajilore
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Scott A. Langenecker
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA ,0000 0001 2175 0319grid.185648.6Department of Psychology, University of Illinois at Chicago, Chicago, IL USA
| | - Stewart A. Shankman
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA ,0000 0001 2175 0319grid.185648.6Department of Psychology, University of Illinois at Chicago, Chicago, IL USA
| | - Michelle G. Craske
- 0000 0000 9632 6718grid.19006.3eDepartment of Psychology, University of California-Los Angeles, Los Angeles, CA USA
| | - Murray B. Stein
- 0000 0004 0627 2787grid.217200.6Departments of Psychiatry and Family Medicine and Public Health, University of California-San Diego, La Jolla, CA USA
| | - K. Luan Phan
- 0000 0001 2175 0319grid.185648.6Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA ,0000 0001 2175 0319grid.185648.6Department of Psychology, University of Illinois at Chicago, Chicago, IL USA ,Mental Health Service Line, Jesse Brown Medical Center, Chicago, IL USA
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Sadana D, Gupta RK, Jain S, Kumaran SS, G S R, Thennarasu K, Rajeswaran J. Neurocognitive profile of patients with Bipolar Affective Disorder in the euthymic phase. Asian J Psychiatr 2019; 44:121-126. [PMID: 31369947 DOI: 10.1016/j.ajp.2019.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 07/20/2019] [Accepted: 07/23/2019] [Indexed: 01/16/2023]
Abstract
UNLABELLED Bipolar disorder is a chronic psychiatric condition characterized by episodes of elevated/irritable and depressed moods resulting in the loss of more disability-adjusted life years (DALYs) than other major conditions. The neurocognitive impairments in these patients interfere with sustained goal-directed performance and achievement even during the euthymic phase of the illness. METHODOLOGY The study aimed to explore the neurocognitive profile of patients in their euthymic phase. We matched 30 patients diagnosed with Bipolar Affective Disorder (BD) in the age range of 20-40 years with 30 healthy controls (with no axis I or II diagnosis, assessed on MINI) matched on age, gender, and education. The neurocognitive profile was assessed using NIMHANS Neuropsychology Battery. RESULTS Euthymic phase patients with bipolar disorder had statistically significant low scores on the speed of processing information as compared to healthy controls. Although impaired in BD group, no statistically significant difference was found between the two groups on executive functions and memory. CONCLUSION The findings of the study suggest that cognitive retraining aimed at ameliorating these deficits can be a used as an essential intervention in rehabilitation programs to successfully reintegrate patients with the bipolar affective disorder into the society. The research also indicates that despite the symptomatic recovery between the episodes, impairments in the speed of processing information continue to disrupt performance in patients with Bipolar Disorder.
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Affiliation(s)
- Divya Sadana
- Mazumdar Shaw Center, Narayana Health City, Bengaluru, India
| | - Rajnish Kumar Gupta
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - S Senthil Kumaran
- Department of NMR & MRI Facility, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ravi G S
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
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Abstract
Psychogenic pain is one of the urgent problems of medicine. To date, pathogenetic mechanisms of development of pain syndrome are unclear, there is no uniform classification. Pain, developing in patients with a mental disorder without an organic damage to the nervous system, and pain, which is a complication of an already existing pain syndrome of neuropathic or nociceptive nature, should be considered separately. Treatment of psychogenic pain syndromes should be integrated with the mandatory use of methods aimed at modifying the patient's lifestyle and attitude towards the illness.
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Affiliation(s)
- A B Danilov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E D Isagilyan
- Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - E S Mackaschova
- Sechenov First Moscow State Medical University, Moscow, Russia
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Cristea IA, Karyotaki E, Hollon SD, Cuijpers P, Gentili C. Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis. Neurosci Biobehav Rev 2019; 101:32-44. [DOI: 10.1016/j.neubiorev.2019.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 12/15/2022]
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49
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Wu X, Shi L, Wei D, Qiu J. Brain connection pattern under interoceptive attention state predict interoceptive intensity and subjective anxiety feeling. Hum Brain Mapp 2019; 40:1760-1773. [PMID: 30536788 PMCID: PMC6865411 DOI: 10.1002/hbm.24488] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/13/2018] [Accepted: 10/31/2018] [Indexed: 01/04/2023] Open
Abstract
Interoception involves the processing of a variety of different types of information ascending from the body. Accumulating evidence has indicated that interoception plays a fundamental role in cognitive and emotional processes, such as anxiety, but how different functional connectivity patterns contribute to emotions and visceral feelings during an interoceptive attention state is still unclear. In the present study, an interoceptive attention task was performed during functional magnetic resonance imaging of healthy subjects, and the participants' subjective ratings of the intensity of interoception and feelings of anxiety were recorded. Several network nodes were selected, based on previous studies, to construct task-dependent functional connectivity patterns, which were processed by support vector regression to predict the corresponding feeling scores. The results showed that for interoception, the cingulo-opercular task control network provided the greatest contribution, whereas the most important feature for anxiety was the connections between the sensorimotor area (SSM) and the salience network (SN). There existed four overlapping connections between the two predictions: two negative connections between the default mode network (DMN) and the SSM, one negative connection between the DMN and the SN, and one positive connection between the ventral attention network and the SN; this overlap might suggest common bodily attention processing that is involved in both interoception and anxiety. This study remediates the lack of network-level biomarkers of interoception and provides a reference at the level of the brain for further understanding anxiety from an interoceptive perspective.
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Affiliation(s)
- Xinran Wu
- Key Laboratory of Cognition and Personality (SWU)Ministry of EducationChongqingChina
- School of PsychologySouthwest University (SWU)ChongqingChina
| | - Liang Shi
- Key Laboratory of Cognition and Personality (SWU)Ministry of EducationChongqingChina
- School of PsychologySouthwest University (SWU)ChongqingChina
| | - Dongtao Wei
- Key Laboratory of Cognition and Personality (SWU)Ministry of EducationChongqingChina
- School of PsychologySouthwest University (SWU)ChongqingChina
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (SWU)Ministry of EducationChongqingChina
- School of PsychologySouthwest University (SWU)ChongqingChina
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Abdallah CG, Averill CL, Ramage AE, Averill LA, Alkin E, Nemati S, Krystal JH, Roache JD, Resick P, Young-McCaughan S, Peterson AL, Fox P. Reduced Salience and Enhanced Central Executive Connectivity Following PTSD Treatment. CHRONIC STRESS 2019; 3. [PMID: 31008419 PMCID: PMC6469713 DOI: 10.1177/2470547019838971] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background In soldiers with posttraumatic stress disorder, symptom provocation was found
to induce increased connectivity within the salience network, as measured by
functional magnetic resonance imaging and global brain connectivity with
global signal regression (GBCr). However, it is unknown whether these GBCr
disturbances would normalize following effective posttraumatic stress
disorder treatment. Methods Sixty-nine US Army soldiers with (n = 42) and without posttraumatic stress
disorder (n = 27) completed functional magnetic resonance imaging at rest
and during symptom provocation using subject-specific script imagery. Then,
participants with posttraumatic stress disorder received six weeks (12
sessions) of group cognitive processing therapy or present-centered therapy.
At week 8, all participants repeated the functional magnetic resonance
imaging scans. The primary analysis used a region-of-interest approach to
determine the effect of treatment on salience GBCr. A secondary analysis was
conducted to explore the pattern of GBCr alterations posttreatment in
posttraumatic stress disorder participants compared to controls. Results Over the treatment period, present-centered therapy significantly reduced
salience GBCr (p = .02). Compared to controls, salience
GBCr was high pretreatment (present-centered therapy,
p = .01; cognitive processing therapy,
p = .03) and normalized post-present-centered therapy
(p = .53) but not postcognitive processing therapy
(p = .006). Whole-brain secondary analysis found high
GBCr within the central executive network in posttraumatic stress disorder
participants compared to controls. Post hoc exploratory analyses showed
significant increases in executive GBCr following cognitive processing
therapy treatment (p = .01). Conclusion The results support previous models relating cognitive processing therapy to
central executive network and enhanced cognitive control while unraveling a
previously unknown neurobiological mechanism of present-centered therapy
treatment, demonstrating treatment-specific reduction in salience
connectivity during trauma recollection.
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Affiliation(s)
- Chadi G Abdallah
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher L Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Amy E Ramage
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, New Hampshire
| | - Lynnette A Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Evelyn Alkin
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Samaneh Nemati
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Patricia Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Peter Fox
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas.,Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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