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Taylor WD, Ajilore O, Karim HT, Butters MA, Krafty R, Boyd BD, Banihashemi L, Szymkowicz SM, Ryan C, Hassenstab J, Landman BA, Andreescu C. Assessing depression recurrence, cognitive burden, and neurobiological homeostasis in late life: Design and rationale of the REMBRANDT Study. J Mood Anxiety Disord 2024; 5:100038. [PMID: 38523701 PMCID: PMC10959248 DOI: 10.1016/j.xjmad.2023.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Background Late-life depression is characterized by disability, cognitive impairment and decline, and a high risk of recurrence following remission. Aside from past psychiatric history, prognostic neurobiological and clinical factors influencing recurrence risk are unclear. Moreover, it is unclear if cognitive impairment predisposes to recurrence, or whether recurrent episodes may accelerate brain aging and cognitive decline. The purpose of the REMBRANDT study (Recurrence markers, cognitive burden, and neurobiological homeostasis in late-life depression) is to better elucidate these relationships and identify phenotypic, cognitive, environmental, and neurobiological factors contributing to and predictive of depression recurrence. Methods Across three sites, REMBRANDT will enroll 300 depressed elders who will receive antidepressant treatment. The goal is to enroll 210 remitted depressed participants and 75 participants with no mental health history into a two-year longitudinal phase focusing on depression recurrence. Participants are evaluated every 2 months with deeper assessments occurring every 8 months, including structural and functional neuroimaging, environmental stress assessments, deep symptom phenotyping, and two weeks of 'burst' ecological momentary assessments to elucidate variability in symptoms and cognitive performance. A broad neuropsychological test battery is completed at the beginning and end of the longitudinal study. Significance REMBRANDT will improve our understanding of how alterations in neural circuits and cognition that persist during remission contribute to depression recurrence vulnerability. It will also elucidate how these processes may contribute to cognitive impairment and decline. This project will obtain deep phenotypic data that will help identify vulnerability and resilience factors that can help stratify individual clinical risk.
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Affiliation(s)
- Warren D. Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL
| | - Helmet T. Karim
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Brian D. Boyd
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sarah M. Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Claire Ryan
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Jason Hassenstab
- Departments of Neurology and Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Bennett A. Landman
- Departments of Computer Science, Electrical Engineering, and Biomedical Engineering, Vanderbilt University; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
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Gerlach AR, Karim HT, Lee S, Kolobaric A, Tudorascu DL, Butters MA, Andreescu C. White Noise-Is Anxiety in Late-Life Associated With White Matter Hyperintensity Burden? Am J Geriatr Psychiatry 2024; 32:83-97. [PMID: 37718134 PMCID: PMC10843002 DOI: 10.1016/j.jagp.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety phenotypes (global anxiety, worry, and rumination) and white matter hyperintensities (WMH), with special consideration for the roles of age and executive function (EF). Our hypotheses were 1) anxiety phenotypes would be associated with WMH and 2) EF would moderate this relationship. DESIGN Cross-sectional. SETTING Participants were recruited from the local community (Pittsburgh, PA). PARTICIPANTS We recruited 110 older adults (age ≥ 50) with varying worry severity and clinical comorbidity. INTERVENTIONS Not applicable. MEASUREMENTS Demographics (age, sex, race, education), clinical measures (cumulative illness burden, global anxiety, worry, and rumination), EF, and WMH quantified with magnetic resonance imaging. RESULTS Lower global anxiety and worry severity were significantly correlated with higher WMH volume, though the global anxiety relationship was not significant after controlling for age. Rumination as not associated with WMH burden. EF was not correlated with either global anxiety, worry, rumination, or WMH. However, in those with advanced age and/or greater WMH burden, there was an association between worry and EF as well as EF and WMH. CONCLUSION Longitudinal studies are needed in order to clarify the complex interactions between anxiety phenotypes, WMH, and EF.
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Affiliation(s)
- Andrew R Gerlach
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA
| | - Helmet T Karim
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering (HTK), University of Pittsburgh, Pittsburgh, PA
| | - Soyoung Lee
- Department of Psychiatry (SL), Brigham and Women's Hospital, Boston, MA; Department of Psychiatry (SL), Harvard Medical School, Boston, MA
| | | | - Dana L Tudorascu
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics (DLT), University of Pittsburgh, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA
| | - Carmen Andreescu
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA.
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Wilson JD, Gerlach AR, Karim HT, Aizenstein HJ, Andreescu C. Sex matters: acute functional connectivity changes as markers of remission in late-life depression differ by sex. Mol Psychiatry 2023; 28:5228-5236. [PMID: 37414928 PMCID: PMC10919097 DOI: 10.1038/s41380-023-02158-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
The efficacy of antidepressant treatment in late-life is modest, a problem magnified by an aging population and increased prevalence of depression. Understanding the neurobiological mechanisms of treatment response in late-life depression (LLD) is imperative. Despite established sex differences in depression and neural circuits, sex differences associated with fMRI markers of antidepressant treatment response are underexplored. In this analysis, we assess the role of sex on the relationship of acute functional connectivity changes with treatment response in LLD. Resting state fMRI scans were collected at baseline and day one of SSRI/SNRI treatment for 80 LLD participants. One-day changes in functional connectivity (differential connectivity) were related to remission status after 12 weeks. Sex differences in differential connectivity profiles that distinguished remitters from non-remitters were assessed. A random forest classifier was used to predict the remission status with models containing various combinations of demographic, clinical, symptomatological, and connectivity measures. Model performance was assessed with area under the curve, and variable importance was assessed with permutation importance. The differential connectivity profile associated with remission status differed significantly by sex. We observed evidence for a difference in one-day connectivity changes between remitters and non-remitters in males but not females. Additionally, prediction of remission was significantly improved in male-only and female-only models over pooled models. Predictions of treatment outcome based on early changes in functional connectivity show marked differences between sexes and should be considered in future MR-based treatment decision-making algorithms.
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Affiliation(s)
- James D Wilson
- Department of Mathematics and Statistics, University of San Francisco, San Francisco, CA, USA
| | - Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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Lee DY, Andreescu C, Aizenstein H, Karim H, Mizuno A, Kolobaric A, Yoon S, Kim Y, Lim J, Hwang EJ, Ouh YT, Kim HH, Son SJ, Park RW. Impact of symptomatic menopausal transition on the occurrence of depression, anxiety, and sleep disorders: A real-world multi-site study. Eur Psychiatry 2023; 66:e80. [PMID: 37697662 PMCID: PMC10594314 DOI: 10.1192/j.eurpsy.2023.2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The menopause transition is a vulnerable period that can be associated with changes in mood and cognition. The present study aimed to investigate whether a symptomatic menopausal transition increases the risks of depression, anxiety, and sleep disorders. METHODS This population-based, retrospective cohort study analysed data from five electronic health record databases in South Korea. Women aged 45-64 years with and without symptomatic menopausal transition were matched 1:1 using propensity-score matching. Subgroup analyses were conducted according to age and use of hormone replacement therapy (HRT). A primary analysis of 5-year follow-up data was conducted, and an intention-to-treat analysis was performed to identify different risk windows over 5 or 10 years. The primary outcome was first-time diagnosis of depression, anxiety, and sleep disorder. We used Cox proportional hazard models and a meta-analysis to calculate the summary hazard ratio (HR) estimates across the databases. RESULTS Propensity-score matching resulted in a sample of 17,098 women. Summary HRs for depression (2.10; 95% confidence interval [CI] 1.63-2.71), anxiety (1.64; 95% CI 1.01-2.66), and sleep disorders (1.47; 95% CI 1.16-1.88) were higher in the symptomatic menopausal transition group. In the subgroup analysis, the use of HRT was associated with an increased risk of depression (2.21; 95% CI 1.07-4.55) and sleep disorders (2.51; 95% CI 1.25-5.04) when compared with non-use of HRT. CONCLUSIONS Our findings suggest that women with symptomatic menopausal transition exhibit an increased risk of developing depression, anxiety, and sleep disorders. Therefore, women experiencing a symptomatic menopausal transition should be monitored closely so that interventions can be applied early.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
- Department of Medical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Antonija Kolobaric
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Seokyoung Yoon
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, South Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jaegyun Lim
- Department of Laboratory Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Ein Jeong Hwang
- Institute for IT Convergence, Myongji Hospital, Goyang, South Korea
| | - Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Kangwon National University, Kangwon, South Korea
| | - Hyung Hoi Kim
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
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Kazan J, Gerlach AR, Mizuno A, Andreescu C, Aizenstein HJ, Ward S, Buente KJ, Stahl ST. Depressive symptoms anticipate behavioral and emotional factors among older adults: A prospective cross-lagged panel design. Psychiatry Research Communications 2023; 3. [PMID: 37009251 PMCID: PMC10062444 DOI: 10.1016/j.psycom.2022.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study examined the temporal relationship among depression, anxiety, insomnia, perceived stress, and physical activity in adults aged 60+ years with a history of major depressive disorder. We conducted a longitudinal study with 12 weeks of follow-up. Assessments consisted of phone or video interviews and included questionnaires evaluating depression, anxiety, insomnia, perceived stress, and physical activity. Our analytic approach consisted of a depression-focused cross-lagged panel model (CLPM) to examine week-to-week correlations among the five measures. The depression-focused CLPM identified statistically significant week-to-week self-predictive effects for each of the five measures. Higher depressive symptom burden was a strong predictor of increased stress, greater insomnia, and less physical activity the following week. No other cross-measure predictions were statistically significant. Our analytical approach clarifies the directional relationship among variables that typically co-occur with depression showing that higher depression symptom burden predisposes older adults to poor sleep, a reduced level of daytime activity, and a greater sense of stress. These findings support the need for longitudinal assessments and targeted interventions for reducing symptoms of depression in older adults.
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Affiliation(s)
- Joseph Kazan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew R. Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Ward
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kara J. Buente
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Corresponding author. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA., (S.T. Stahl)
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Andreescu C, Lenze E, Lavretsky H. Is Anxiety in Late Life an Uncharted Territory?-Questioning the USPSTF Draft Recommendation Statement for Anxiety Screening in Older Adults. JAMA Psychiatry 2023; 80:197-198. [PMID: 36652241 PMCID: PMC10485849 DOI: 10.1001/jamapsychiatry.2022.4609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This Viewpoint discusses the updated US Preventive Services Task Force recommendations for anxiety screening in adults.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Eric Lenze
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Helen Lavretsky
- Department of Psychiatry, University of California, Los Angeles
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Jain N, Wang Y, Zhang Y, Jacobsen E, Andreescu C, Snitz BE, Chang CCH, Ganguli M. It goes both ways: The relationship between anxiety and mild cognitive impairment. Int J Geriatr Psychiatry 2023; 38:e5899. [PMID: 36855309 DOI: 10.1002/gps.5899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To investigate the relationship between anxiety and mild cognitive impairment (MCI), and whether it is mediated by perceived stress, at the population level. METHOD AND DESIGN In a longitudinal study of 368 adults aged 65+ from a population-based cohort, we annually assessed anxiety symptoms (GAD-7), perceived stress (PSS-4), and ratings on the Clinical Dementia Rating (CDR®), where CDR = 0.5 was operationalized as MCI. Examining data from three consecutive assessment waves, we first determined the associations between anxiety at the first wave with MCI at the third wave, and vice versa. We then used mediation analyses to determine whether the pathways in both directions were mediated by perceived stress at the second wave, adjusting for demographics and other relevant covariates. RESULTS We confirmed significant bidirectional longitudinal associations between anxiety and MCI. Perceived stress was detected as a significant mediator for both pathways between anxiety and MCI, explaining 37.1% of the total effect (TE) of anxiety on incident MCI while conversely explaining 27.1% of the TE of MCI on anxiety. CONCLUSIONS A bidirectional relationship with a 2-year lag between anxiety and MCI was mediated through perceived stress. Clinicians should be sensitive both to potential consequent anxiety when patients present with cognitive impairment, and to potential incipient MCI when the presenting complaint is anxiety. Managing stress may help mitigate adverse outcomes.
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Affiliation(s)
- Neha Jain
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Yueting Wang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Yingjin Zhang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Beth E Snitz
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chung-Chou H Chang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Andreescu C. The Humble Worrier - The Long-Term Impact of Using Yoga to Treat Severe Worry and Anxiety in Older Adults. Am J Geriatr Psychiatry 2022; 30:991-993. [PMID: 35321810 DOI: 10.1016/j.jagp.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
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Gerlach AR, Karim HT, Peciña M, Ajilore O, Taylor WD, Butters MA, Andreescu C. MRI predictors of pharmacotherapy response in major depressive disorder. Neuroimage Clin 2022; 36:103157. [PMID: 36027717 PMCID: PMC9420953 DOI: 10.1016/j.nicl.2022.103157] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
Major depressive disorder is among the most prevalent psychiatric disorders, exacting a substantial personal, social, and economic toll. Antidepressant treatment typically involves an individualized trial and error approach with an inconsistent success rate. Despite a pressing need, no reliable biomarkers for predicting treatment outcome have yet been discovered. Brain MRI measures hold promise in this regard, though clinical translation remains elusive. In this review, we summarize structural MRI and functional MRI (fMRI) measures that have been investigated as predictors of treatment outcome. We broadly divide these into five categories including three structural measures: volumetric, white matter burden, and white matter integrity; and two functional measures: resting state fMRI and task fMRI. Currently, larger hippocampal volume is the most widely replicated predictor of successful treatment. Lower white matter hyperintensity burden has shown robustness in late life depression. However, both have modest discriminative power. Higher fractional anisotropy of the cingulum bundle and frontal white matter, amygdala hypoactivation and anterior cingulate cortex hyperactivation in response to negative emotional stimuli, and hyperconnectivity within the default mode network (DMN) and between the DMN and executive control network also show promise as predictors of successful treatment. Such network-focused measures may ultimately provide a higher-dimensional measure of treatment response with closer ties to the underlying neurobiology.
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Affiliation(s)
- Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marta Peciña
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
| | - Warren D Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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van Voren R, Andreescu C. Ukrainian Mental Health - A Report From the War. Am J Geriatr Psychiatry 2022; 30:940-943. [PMID: 35577655 DOI: 10.1016/j.jagp.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Robert van Voren
- Chief Executive of the Federation Global Initiative on Psychiatry, Honorary Member of the Ukrainian Psychiatric Association and Honorary Fellow of the British Royal College of Psychiatrists (RVV), Vilnius, Lithuania.; Department of Psychiatry (CA), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carmen Andreescu
- Chief Executive of the Federation Global Initiative on Psychiatry, Honorary Member of the Ukrainian Psychiatric Association and Honorary Fellow of the British Royal College of Psychiatrists (RVV), Vilnius, Lithuania.; Department of Psychiatry (CA), University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Kolobaric A, Karim HT, Banihashemi L, Mizuno A, Aizenstein HJ, Andreescu C. Are All Anxieties Created Equal? Stress-related Networks and Anxiety Phenotypes in Old Age. Am J Geriatr Psychiatry 2022; 30:801-812. [PMID: 35000866 PMCID: PMC9177511 DOI: 10.1016/j.jagp.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The dysregulation of stress-related networks due to chronic symptoms such as severe worry and/or rumination is one of the putative pathways linking anxiety in late-life with cognitive decline and increased cardiovascular burden. Symptoms such as severe worry or rumination respond poorly to standard treatment and drive the morbidity associated with anxiety in older adults. We assessed if any of the neural networks anchored in the stress-related regions of interest (ROIs) are associated with distinct anxiety phenotypes (worry, rumination and global anxiety). METHODS We recruited older participants (over 50 years of age) with varying levels of worry (N = 91) to undergo resting state fMRI. We computed seed-based connectivity for each ROI: the bed nucleus of the stria terminalis, the paraventricular nucleus of the hypothalamus, habenula, and amygdala. We limited our connectivity analyses to extracted regions for each seeded ROI-based network based on their canonical networks in 1,000 participants (Neurosynth). Using connectivity and clinical factors, we fit cross-validated elastic net models to predict scores on Penn State Worry Questionnaire, Rumination Subscale Questionnaire, Hamilton Anxiety Rating Scale, and Perceived Stress Scale. RESULTS We identified several distinct connectivity patterns that predict anxiety phenotypes' severity. Greater worry was associated with greater paraventricular nucleus of the hypothalamus -subgenual anterior cingulate cortex, parahippocampal, and olfactory and amygdala-PHC connectivity. Greater global anxiety was associated with lower amygdala-superior temporal gyrus connectivity. Greater perceived stress was associated with lower amygdala-inferior temporal gyrus and amygdala-fusiform gyrus connectivity. CONCLUSION Our study suggests that various late-life anxiety phenotypes (worry, global anxiety, rumination) may be associated with varying functional connectivity related to stress and emotion regulation. This may aid in the development of future targeted interventions.
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Affiliation(s)
| | - Helmet T. Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA,Department of Bioengineering, University of Pittsburgh, Pittsburgh PA
| | | | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA,Department of Bioengineering, University of Pittsburgh, Pittsburgh PA
| | - Carmen Andreescu
- Department of Psychiatry (HTK, LB, AM, HJA, CA), University of Pittsburgh, Pittsburgh PA.
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Mizuno A, Karim HT, Newmark J, Khan F, Rosenblatt MJ, Neppach AM, Lowe M, Aizenstein HJ, Mennin DS, Andreescu C. Thinking of Me or Thinking of You? Behavioral Correlates of Self vs. Other Centered Worry and Reappraisal in Late-Life. Front Psychiatry 2022; 13:780745. [PMID: 35815034 PMCID: PMC9256986 DOI: 10.3389/fpsyt.2022.780745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Psychotherapeutic approaches in late-life anxiety have limited effect on reducing worry severity. The self-referential processing of worry contents (self- vs. other-focused worry) and reappraisal styles (internal vs. external locus of control) are important elements in psychotherapy, but little is known about these processes in late-life. We aimed to characterize severe worry from a self-referential processing perspective. We recruited 104 older adults with various levels of worry and used a personalized task to induce and reappraise worry. We analyzed the association between (1) worry severity/frequency for worry content (self- or other-focused) and (2) for reappraisal style (internal vs. external locus of control) with clinical inventories measuring anxiety, worry, depression, rumination, neuroticism, emotion regulation strategies, perceived stress, and physical illness burden. Higher self-worry severity was associated with higher scores of clinical inventories of worry, depression, perceived stress, and neuroticism, whereas other-worry severity did not show any association. Greater self-worry frequency was associated with higher medical burden. External locus of control in reappraisal statements was associated with lower worry severity in men. Overall, more severe and frequent self-focused worry was associated with a greater psychological and physiological burden. These results are useful in tailoring psychotherapy for older adults with severe worry.
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Affiliation(s)
- Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Helmet Talib Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jordyn Newmark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Faiha Khan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Alyssa M. Neppach
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - MaKayla Lowe
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Howard Jay Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Douglas S. Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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13
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Lee E, Karim H, Andreescu C, Mizuno A, Aizenstein H, Lee H, Lee D, Lee K, Cho SM, Kim D, Park RW, Son SJ, Park B. Network modeling of anxiety and psychological characteristics on suicidal behavior: Cross-sectional study. J Affect Disord 2022; 299:545-552. [PMID: 34952111 DOI: 10.1016/j.jad.2021.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/08/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suicide is influenced by complex interactions among various psychopathological features. We aimed to examine the relationship between suicide risk and psychological risk factors such as defense mechanisms, personality, and anxiety. METHODS We established a psychiatric database by utilizing the Observational Medical Outcomes Partnership Common Data Model. We conducted a 1:1 propensity score matching with age, sex, and depression severity, and identified a sample (n = 258) with two groups: those with suicidal behavior and those with non-suicidal behavior. Using principal component analysis, we extracted nine psychological scales and applied network analysis to compare relationships among psychological factors between the two groups. RESULTS Patients with non-suicidal behaviors showed associations between trait anxiety and defense mechanisms, while those with suicidal behaviors did not. For patients with suicidal ideation there was an association between somatization and trait anxiety. Patients with suicide attempts showed associations between paranoia and dissociation connected to trait anxiety. LIMITATIONS Longitudinal research is required to fully observe transitions from suicidal ideation to attempts and recurrent suicidal events. In addition, these networks may not generalize suicidal behaviors because the group participants are not homogeneous. Lastly, data from self-report questionnaires limits the reliability of responses. CONCLUSIONS We presented important new insights on suicidal behavior by estimating psychological networks. Patients with non-suicidal behavior may exhibit discrete relationships between defense mechanisms and anxiety, compared to those with suicidal behavior. Patients with suicidal ideation and suicide attempts may show distinct associations between anxiety and psychopathological features.
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Affiliation(s)
- Eunyoung Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea; Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea; Department of Medical Sciences, Graduate school of Ajou University, Suwon, Republic of Korea
| | - Helmet Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, United States; Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, United States; Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Heirim Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea; Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Dongyun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea; Department of Medical Sciences, Graduate school of Ajou University, Suwon, Republic of Korea; Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyungmin Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sun-Mi Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Doyeop Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea; Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, United States; Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, Republic of Korea; Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea.
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14
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Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Freitag GF, Harrewijn A, Hilbert K, Jahanshad N, Thomopoulos SI, Thompson PM, Veltman DJ, Winkler AM, Lueken U, Pine DS, Wee NJA, Stein DJ, Agosta F, Åhs F, An I, Alberton BAV, Andreescu C, Asami T, Assaf M, Avery SN, Nicholas L, Balderston, Barber JP, Battaglia M, Bayram A, Beesdo‐Baum K, Benedetti F, Berta R, Björkstrand J, Blackford JU, Blair JR, Karina S, Blair, Boehme S, Brambilla P, Burkhouse K, Cano M, Canu E, Cardinale EM, Cardoner N, Clauss JA, Cividini C, Critchley HD, Udo, Dannlowski, Deckert J, Demiralp T, Diefenbach GJ, Domschke K, Doruyter A, Dresler T, Erhardt A, Fallgatter AJ, Fañanás L, Brandee, Feola, Filippi CA, Filippi M, Fonzo GA, Forbes EE, Fox NA, Fredrikson M, Furmark T, Ge T, Gerber AJ, Gosnell SN, Grabe HJ, Grotegerd D, Gur RE, Gur RC, Harmer CJ, Harper J, Heeren A, Hettema J, Hofmann D, Hofmann SG, Jackowski AP, Andreas, Jansen, Kaczkurkin AN, Kingsley E, Kircher T, Kosti c M, Kreifelts B, Krug A, Larsen B, Lee S, Leehr EJ, Leibenluft E, Lochner C, Maggioni E, Makovac E, Mancini M, Manfro GG, Månsson KNT, Meeten F, Michałowski J, Milrod BL, Mühlberger A, Lilianne R, Mujica‐Parodi, Munjiza A, Mwangi B, Myers M, Igor Nenadi C, Neufang S, Nielsen JA, Oh H, Ottaviani C, Pan PM, Pantazatos SP, Martin P, Paulus, Perez‐Edgar K, Peñate W, Perino MT, Peterburs J, Pfleiderer B, Phan KL, Poletti S, Porta‐Casteràs D, Price RB, Pujol J, Andrea, Reinecke, Rivero F, Roelofs K, Rosso I, Saemann P, Salas R, Salum GA, Satterthwaite TD, Schneier F, Schruers KRJ, Schulz SM, Schwarzmeier H, Seeger FR, Smoller JW, Soares JC, Stark R, Stein MB, Straube B, Straube T, Strawn JR, Suarez‐Jimenez B, Boris, Suchan, Sylvester CM, Talati A, Tamburo E, Tükel R, Heuvel OA, Van der Auwera S, Nieuwenhuizen H, Tol M, van Velzen LS, Bort CV, Vermeiren RRJM, Visser RM, Volman I, Wannemüller A, Wendt J, Werwath KE, Westenberg PM, Wiemer J, Katharina, Wittfeld, Wu M, Yang Y, Zilverstand A, Zugman A, Zwiebel HL. ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders. Hum Brain Mapp 2022; 43:83-112. [PMID: 32618421 PMCID: PMC8805695 DOI: 10.1002/hbm.25100] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.
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Affiliation(s)
- Janna Marie Bas‐Hoogendam
- Department of Developmental and Educational PsychologyLeiden University, Institute of Psychology Leiden The Netherlands
- Department of PsychiatryLeiden University Medical Center Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Mental HealthUniversity of Cape Town Cape Town South Africa
| | - Moji Aghajani
- Department of PsychiatryAmsterdam UMC / VUMC Amsterdam The Netherlands
- Department of Research & InnovationGGZ inGeest Amsterdam The Netherlands
| | - Gabrielle F. Freitag
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Anita Harrewijn
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu Berlin Berlin Germany
| | - Neda Jahanshad
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Sophia I. Thomopoulos
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Paul M. Thompson
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam UMC / VUMC Amsterdam The Netherlands
| | - Anderson M. Winkler
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu Berlin Berlin Germany
| | - Daniel S. Pine
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Nic J. A. Wee
- Department of PsychiatryLeiden University Medical Center Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Mental HealthUniversity of Cape Town Cape Town South Africa
- University of Cape TownSouth African MRC Unit on Risk & Resilience in Mental Disorders Cape Town South Africa
- University of Cape TownNeuroscience Institute Cape Town South Africa
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15
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Zugman A, Harrewijn A, Cardinale EM, Zwiebel H, Freitag GF, Werwath KE, Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Hilbert K, Cardoner N, Porta‐Casteràs D, Gosnell S, Salas R, Blair KS, Blair JR, Hammoud MZ, Milad M, Burkhouse K, Phan KL, Schroeder HK, Strawn JR, Beesdo‐Baum K, Thomopoulos SI, Grabe HJ, Van der Auwera S, Wittfeld K, Nielsen JA, Buckner R, Smoller JW, Mwangi B, Soares JC, Wu M, Zunta‐Soares GB, Jackowski AP, Pan PM, Salum GA, Assaf M, Diefenbach GJ, Brambilla P, Maggioni E, Hofmann D, Straube T, Andreescu C, Berta R, Tamburo E, Price R, Manfro GG, Critchley HD, Makovac E, Mancini M, Meeten F, Ottaviani C, Agosta F, Canu E, Cividini C, Filippi M, Kostić M, Munjiza A, Filippi CA, Leibenluft E, Alberton BAV, Balderston NL, Ernst M, Grillon C, Mujica‐Parodi LR, van Nieuwenhuizen H, Fonzo GA, Paulus MP, Stein MB, Gur RE, Gur RC, Kaczkurkin AN, Larsen B, Satterthwaite TD, Harper J, Myers M, Perino MT, Yu Q, Sylvester CM, Veltman DJ, Lueken U, Van der Wee NJA, Stein DJ, Jahanshad N, Thompson PM, Pine DS, Winkler AM. Mega-analysis methods in ENIGMA: The experience of the generalized anxiety disorder working group. Hum Brain Mapp 2022; 43:255-277. [PMID: 32596977 PMCID: PMC8675407 DOI: 10.1002/hbm.25096] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022] Open
Abstract
The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses.
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Affiliation(s)
- André Zugman
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Anita Harrewijn
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Elise M. Cardinale
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Hannah Zwiebel
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Gabrielle F. Freitag
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Katy E. Werwath
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Janna M. Bas‐Hoogendam
- Leiden University Medical Center, Department of PsychiatryLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
- Leiden University, Institute of Psychology, Developmental and Educational PsychologyLeidenThe Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Moji Aghajani
- Department. of PsychiatryAmsterdam UMC/VUMCAmsterdamThe Netherlands
- GGZ InGeestDepartment of Research & InnovationAmsterdamThe Netherlands
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Narcis Cardoner
- Department of Mental HealthUniversity Hospital Parc Taulí‐I3PTBarcelonaSpain
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud MentalCarlos III Health InstituteMadridSpain
| | - Daniel Porta‐Casteràs
- Department of Mental HealthUniversity Hospital Parc Taulí‐I3PTBarcelonaSpain
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud MentalCarlos III Health InstituteMadridSpain
| | - Savannah Gosnell
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Karina S. Blair
- Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - James R. Blair
- Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Mira Z. Hammoud
- Department of PsychiatryNew York UniversityNew YorkNew YorkUSA
| | - Mohammed Milad
- Department of PsychiatryNew York UniversityNew YorkNew YorkUSA
| | - Katie Burkhouse
- Department of PsychiatryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - K. Luan Phan
- Department of Psychiatry and Behavioral HealthThe Ohio State UniversityColumbusOhioUSA
| | - Heidi K. Schroeder
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOhioUSA
| | - Jeffrey R. Strawn
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOhioUSA
| | - Katja Beesdo‐Baum
- Behavioral EpidemiologyInstitute of Clinical Psychology and Psychotherapy, Technische Universität DresdenDresdenGermany
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Hans J. Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Sandra Van der Auwera
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Jared A. Nielsen
- Department of PsychologyHarvard UniversityCambridgeMassachusettsUSA
- Center for Brain ScienceHarvard UniversityCambridgeMassachusettsUSA
| | - Randy Buckner
- Department of PsychologyHarvard UniversityCambridgeMassachusettsUSA
- Center for Brain ScienceHarvard UniversityCambridgeMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Jordan W. Smoller
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Jair C. Soares
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Mon‐Ju Wu
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Giovana B. Zunta‐Soares
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Andrea P. Jackowski
- LiNC, Department of PsychiatryFederal University of São PauloSão PauloSão PauloBrazil
| | - Pedro M. Pan
- LiNC, Department of PsychiatryFederal University of São PauloSão PauloSão PauloBrazil
| | - Giovanni A. Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do SulPorto AlegreRio Grande do SulBrazil
| | - Michal Assaf
- Olin Neuropsychiatry Research CenterInstitute of Living, Hartford HospitalHartfordConnecticutUSA
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Gretchen J. Diefenbach
- Anxiety Disorders CenterInstitute of Living, Hartford HospitalHartfordConnecticutUSA
- Yale School of MedicineNew HavenConnecticutUSA
| | - Paolo Brambilla
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Eleonora Maggioni
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of MuensterMuensterGermany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of MuensterMuensterGermany
| | - Carmen Andreescu
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rachel Berta
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Erica Tamburo
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rebecca Price
- Department of Psychiatry & PsychologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Gisele G. Manfro
- Anxiety Disorder ProgramHospital de Clínicas de Porto AlegrePorto AlegreRio Grande do SulBrazil
- Department of PsychiatryFederal University of Rio Grande do SulPorto AlegreRio Grande do SulBrazil
| | - Hugo D. Critchley
- Department of NeuroscienceBrighton and Sussex Medical School, University of SussexBrightonUK
| | - Elena Makovac
- Centre for Neuroimaging ScienceKings College LondonLondonUK
| | - Matteo Mancini
- Department of NeuroscienceBrighton and Sussex Medical School, University of SussexBrightonUK
| | | | | | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Camilla Cividini
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
- Neurology and Neurophysiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Milutin Kostić
- Institute of Mental Health, University of BelgradeBelgradeSerbia
- Department of Psychiatry, School of MedicineUniversity of BelgradeBelgradeSerbia
| | - Ana Munjiza
- Institute of Mental Health, University of BelgradeBelgradeSerbia
| | - Courtney A. Filippi
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Ellen Leibenluft
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Bianca A. V. Alberton
- Graduate Program in Electrical and Computer Engineering, Universidade Tecnológica Federal do ParanáCuritibaPuerto RicoBrazil
| | - Nicholas L. Balderston
- Center for Neuromodulation in Depression and StressUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Monique Ernst
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Christian Grillon
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | | | | | - Gregory A. Fonzo
- Department of PsychiatryThe University of Texas at Austin Dell Medical SchoolAustinTexasUSA
| | | | - Murray B. Stein
- Department of Psychiatry & Family Medicine and Public HealthUniversity of CaliforniaLa JollaCaliforniaUSA
| | - Raquel E. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ruben C. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Bart Larsen
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Jennifer Harper
- Department of PsychiatryWashington UniversitySt. LouisMissouriUSA
| | - Michael Myers
- Department of PsychiatryWashington UniversitySt. LouisMissouriUSA
| | | | - Qiongru Yu
- Department of PsychiatryWashington UniversitySt. LouisMissouriUSA
| | | | - Dick J. Veltman
- Department. of PsychiatryAmsterdam UMC/VUMCAmsterdamThe Netherlands
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Nic J. A. Van der Wee
- Leiden University Medical Center, Department of PsychiatryLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- SAMRC Unite on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Daniel S. Pine
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Anderson M. Winkler
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
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16
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Gerlach AR, Karim HT, Kazan J, Aizenstein HJ, Krafty RT, Andreescu C. Networks of worry-towards a connectivity-based signature of late-life worry using higher criticism. Transl Psychiatry 2021; 11:550. [PMID: 34711810 PMCID: PMC8553743 DOI: 10.1038/s41398-021-01648-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 01/14/2023] Open
Abstract
Severe worry is a complex transdiagnostic phenotype independently associated with increased morbidity, including cognitive impairment and cardiovascular diseases. We investigated the neurobiological basis of worry in older adults by analyzing resting state fMRI using a large-scale network-based approach. We collected resting fMRI on 77 participants (>50 years old) with varying worry severity. We computed region-wise connectivity across the default mode network (DMN), anterior salience network, and left executive control network. All 22,366 correlations were regressed on worry severity and adjusted for age, sex, race, education, disease burden, depression, anxiety, rumination, and neuroticism. We employed higher criticism, a second-level method of significance testing for rare and weak features, to reveal the functional connectivity patterns associated with worry. The analysis suggests that worry has a complex, yet distinct signature associated with resting state functional connectivity. Intra-connectivities and inter-connectivities of the DMN comprise the dominant contribution. The anterior cingulate, temporal lobe, and thalamus are heavily represented with overwhelmingly negative association with worry. The prefrontal regions are also strongly represented with a mix of positive and negative associations with worry. Identifying the most salient connections may be useful for targeted interventions for reducing morbidity associated with severe worry in older adults.
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Affiliation(s)
- Andrew R. Gerlach
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Helmet T. Karim
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Joseph Kazan
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Howard J. Aizenstein
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Robert T. Krafty
- grid.189967.80000 0001 0941 6502Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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17
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Harrewijn A, Cardinale EM, Groenewold NA, Bas-Hoogendam JM, Aghajani M, Hilbert K, Cardoner N, Porta-Casteràs D, Gosnell S, Salas R, Jackowski AP, Pan PM, Salum GA, Blair KS, Blair JR, Hammoud MZ, Milad MR, Burkhouse KL, Phan KL, Schroeder HK, Strawn JR, Beesdo-Baum K, Jahanshad N, Thomopoulos SI, Buckner R, Nielsen JA, Smoller JW, Soares JC, Mwangi B, Wu MJ, Zunta-Soares GB, Assaf M, Diefenbach GJ, Brambilla P, Maggioni E, Hofmann D, Straube T, Andreescu C, Berta R, Tamburo E, Price RB, Manfro GG, Agosta F, Canu E, Cividini C, Filippi M, Kostić M, Munjiza Jovanovic A, Alberton BAV, Benson B, Freitag GF, Filippi CA, Gold AL, Leibenluft E, Ringlein GV, Werwath KE, Zwiebel H, Zugman A, Grabe HJ, Van der Auwera S, Wittfeld K, Völzke H, Bülow R, Balderston NL, Ernst M, Grillon C, Mujica-Parodi LR, van Nieuwenhuizen H, Critchley HD, Makovac E, Mancini M, Meeten F, Ottaviani C, Ball TM, Fonzo GA, Paulus MP, Stein MB, Gur RE, Gur RC, Kaczkurkin AN, Larsen B, Satterthwaite TD, Harper J, Myers M, Perino MT, Sylvester CM, Yu Q, Lueken U, Veltman DJ, Thompson PM, Stein DJ, Van der Wee NJA, Winkler AM, Pine DS. Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group. Transl Psychiatry 2021; 11:502. [PMID: 34599145 PMCID: PMC8486763 DOI: 10.1038/s41398-021-01622-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.
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Affiliation(s)
- Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA.
| | - Elise M Cardinale
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Nynke A Groenewold
- Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Janna Marie Bas-Hoogendam
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ InGeest, Amsterdam, The Netherlands
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Narcis Cardoner
- Department of Mental Health, University Hospital Parc Taulí-I3PT, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Daniel Porta-Casteràs
- Department of Mental Health, University Hospital Parc Taulí-I3PT, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Savannah Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrea P Jackowski
- LiNC, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Pedro M Pan
- LiNC, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Giovanni A Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Mira Z Hammoud
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, USA
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Heidi K Schroeder
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey R Strawn
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Randy Buckner
- Center for Brain Science & Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jared A Nielsen
- Center for Brain Science & Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychology Department & Neuroscience Center, Brigham Young University, Provo, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jair C Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mon-Ju Wu
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Giovana B Zunta-Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Gretchen J Diefenbach
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Berta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica Tamburo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gisele G Manfro
- Anxiety Disorder Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Cividini
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Milutin Kostić
- Institute of Mental Health, University of Belgrade, Belgrade, Serbia
- Department of Psychiatry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Bianca A V Alberton
- Graduate Program in Electrical and Computer Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Puerto Rico, Brazil
| | - Brenda Benson
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Gabrielle F Freitag
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Courtney A Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Andrea L Gold
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Grace V Ringlein
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathryn E Werwath
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Hannah Zwiebel
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - André Zugman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | | | | | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK
| | - Matteo Mancini
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Frances Meeten
- School of Psychology, University of Sussex, Brighton, UK
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Tali M Ball
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | - Murray B Stein
- Department of Psychiatry, School of Medicine and Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bart Larsen
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jennifer Harper
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Michael Myers
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Michael T Perino
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Qiongru Yu
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nic J A Van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Anderson M Winkler
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Ross LP, Andreescu C, Inagaki TK. Relationships Between Early Maternal Warmth and Social Connection: A Randomized Clinical Trial With Naltrexone. Psychosom Med 2021; 83:924-931. [PMID: 34292204 PMCID: PMC8687105 DOI: 10.1097/psy.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Early experiences of having received maternal warmth predict responses to opportunities to connect with others later in life. However, the understanding of neurochemical mechanisms by which such relationships emerge remains incomplete. Endogenous opioids, involved in social connection in both animals and humans, may contribute to this link. Therefore, the current study examined a) relationships between early maternal warmth and brain and self-report responses to novel social targets (i.e., outcomes that may promote social connection) and b) the effect of the opioid antagonist, naltrexone, on such relationships. METHODS Eighty-two adult participants completed a retrospective report of early maternal warmth. On a second visit, participants were randomized to 50 mg of oral naltrexone (n = 42) or placebo (n = 40), followed by a magnetic resonance imaging scan where functional brain activity in response to images of novel social targets (strangers) was assessed. Approximately 24 hours later, participants reported on their feelings of social connection since leaving the scanner. RESULTS In the placebo condition, greater early maternal warmth was associated with less dorsal anterior cingulate cortex, anterior insula, ventral striatum, and amygdala activity in response to images of novel social targets (r values ≥ -0.360, p values ≤ .031), and greater feelings of social connection (r = 0.524, p < .001) outside of the laboratory. The same relationships, however, were not present in the naltrexone condition. CONCLUSIONS Results highlight relationships between early maternal warmth and responses to the social world at large and suggest that opioids might contribute to social connection by supporting the buffering effects of warm early life experiences on social connection later in life.Trial Registration: Clinical Trials NCT02818036.
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Affiliation(s)
- Lauren P. Ross
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - Carmen Andreescu
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Tristen K. Inagaki
- San Diego State University, Department of Psychology, San Diego, CA, USA
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Karim HT, Ly M, Yu G, Krafty R, Tudorascu DL, Aizenstein HJ, Andreescu C. Aging faster: worry and rumination in late life are associated with greater brain age. Neurobiol Aging 2021; 101:13-21. [PMID: 33561786 PMCID: PMC8122027 DOI: 10.1016/j.neurobiolaging.2021.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 01/07/2023]
Abstract
Older adults with anxiety have lower gray matter brain volume-a component of accelerated aging. We have previously validated a machine learning model to predict brain age, an estimate of an individual's age based on voxel-wise gray matter images. We investigated associations between brain age and anxiety, depression, stress, and emotion regulation. We recruited 78 participants (≥50 years) along a wide range of worry severity. We collected imaging data and computed voxel-wise gray matter images, which were input into an existing machine learning model to estimate brain age. We conducted a multivariable linear regression between brain age and age, sex, race, education, worry, anxiety, depression, rumination, neuroticism, stress, reappraisal, and suppression. We found that greater brain age was significantly associated with greater age, male sex, greater worry, greater rumination, and lower suppression. Male sex, worry, and rumination are associated with accelerated aging in late life and expressive suppression may have a protective effect. These results provide evidence for the transdiagnostic model of negative repetitive thoughts, which are associated with cognitive decline, amyloid, and tau.
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Affiliation(s)
- Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Ly
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gary Yu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Krafty
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana L Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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20
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Andreescu C. The "Late-Life" Snag in Late-Life Anxious Depression. Am J Geriatr Psychiatry 2021; 29:348-351. [PMID: 33546981 DOI: 10.1016/j.jagp.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Carmen Andreescu
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA.
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21
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Andreescu C. The Scientific Autobiography of a Traveler. Am J Geriatr Psychiatry 2021; 29:405-408. [PMID: 33563521 DOI: 10.1016/j.jagp.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/25/2022]
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22
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Lee DY, Cho J, You SC, Park RW, Kim CS, Lee EY, Aizenstein H, Andreescu C, Karim H, Hong CH, Rho HW, Park B, Son SJ. Risk of Mortality in Elderly Coronavirus Disease 2019 Patients With Mental Health Disorders: A Nationwide Retrospective Study in South Korea. Am J Geriatr Psychiatry 2020; 28:1308-1316. [PMID: 33023798 PMCID: PMC7521355 DOI: 10.1016/j.jagp.2020.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the different clinical characteristics among elderly coronavirus disease 2019 (COVID-19) patients with and without mental disorders in South Korea and determine if these characteristics have an association with underlying mental disorders causing mortality. METHOD A population-based comparative cohort study was conducted using the national claims database. Individuals aged ≥65 years with confirmed COVID-19 between January 1, 2020 and April 10, 2020 were assessed. The endpoints for evaluating mortality for all participants were death, 21 days after diagnosis, or April 10, 2020. The risk of mortality associated with mental disorders was estimated using Cox hazards regression. RESULTS We identified 814 elderly COVID-19 patients (255 [31.3%] with mental disorder and 559 [68.7%] with nonmental disorder). Individuals with mental disorders were found more likely to be older, taking antithrombotic agents, and had diabetes, hypertension, chronic obstructive lung disease, and urinary tract infections than those without mental disorders. After propensity score stratification, our study included 781 patients in each group (236 [30.2%] with mental disorder and 545 [69.8%] with nonmental disorder). The mental disorder group showed higher mortality rates than the nonmental disorder group (12.7% [30/236] versus 6.8% [37/545]). However, compared to patients without mental disorders, the hazard ratio (HR) for mortality in elderly COVID-19 patients with mental disorders was not statistically significant (HR: 1.57, 95%CI: 0.95-2.56). CONCLUSION Although the association between mental disorders in elderly individuals and mortality in COVID-19 is unclear, this study suggests that elderly patients with comorbid conditions and those taking psychiatric medications might be at a higher risk of COVID-19.
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Affiliation(s)
- Dong Yun Lee
- Department of Psychiatry, Ajou University School of Medicine (DYL, CHH, HWR, SJS), Suwon, South Korea
| | - Jaehyeong Cho
- Department of Biomedical Sciences, Graduate School of Ajou University (JC, RWP, CSK), Suwon, South Korea
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine (SCY, RWP, EYL, BP), Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Graduate School of Ajou University (JC, RWP, CSK), Suwon, South Korea,Department of Biomedical Informatics, Ajou University School of Medicine (SCY, RWP, EYL, BP), Suwon, South Korea
| | - Chung Soo Kim
- Department of Biomedical Sciences, Graduate School of Ajou University (JC, RWP, CSK), Suwon, South Korea
| | - Eun Young Lee
- Department of Biomedical Informatics, Ajou University School of Medicine (SCY, RWP, EYL, BP), Suwon, South Korea,Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center (EYL, BP), Suwon, South Korea
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine (HA, CA, HK), PA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine (HA, CA, HK), PA
| | - Helmet Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine (HA, CA, HK), PA
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine (DYL, CHH, HWR, SJS), Suwon, South Korea
| | - Hyun Woong Rho
- Department of Psychiatry, Ajou University School of Medicine (DYL, CHH, HWR, SJS), Suwon, South Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine (SCY, RWP, EYL, BP), Suwon, South Korea; Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center (EYL, BP), Suwon, South Korea.
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine (DYL, CHH, HWR, SJS), Suwon, South Korea.
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Inagaki TK, Hazlett LI, Andreescu C. Opioids and social bonding: Effect of naltrexone on feelings of social connection and ventral striatum activity to close others. J Exp Psychol Gen 2020; 149:732-745. [PMID: 31414860 PMCID: PMC7021584 DOI: 10.1037/xge0000674] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Close social bonds are critical to immediate and long-term well-being. However, the neurochemical mechanisms by which we remain connected to our closest loved ones are not well understood. Opioids have long been theorized to contribute to social bonding via their actions on the brain. But feelings of social connection toward one's own close others and direct comparisons of ventral striatum (VS) activity in response to close others and strangers, a neural correlate of social bonding, have not been explored. Therefore, the current clinical trial examined whether opioids causally affect neural and experiential signatures of social bonding. Eighty participants were administered naltrexone (n = 40), an opioid antagonist that blocks natural opioid processing, or placebo (n = 40) before completing a functional MRI scan where they viewed images of their close others and individuals they had not seen before (i.e., strangers). Feelings of social connection to the close others and physical symptoms commonly experienced when taking naltrexone were also collected. In support of hypotheses, naltrexone (vs. placebo) reduced feelings of social connection toward the close others (e.g., family, friends, romantic partners). Furthermore, naltrexone (vs. placebo) reduced left VS activity in response to images of the same close others, but did not alter left VS activity to strangers. Finally, the positive correlation between feelings of connection and VS activity to close others present in the placebo condition was erased by naltrexone. Effects remained after adjusting for physical symptoms. Together, results lend support to theories suggesting that opioids contribute to social bonding, especially with our closest loved ones. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | - Carmen Andreescu
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
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Sullivan KJ, Liu A, Dodge HH, Andreescu C, Chang CCH, Ganguli M. Depression Symptoms Declining Among Older Adults: Birth Cohort Analyses From the Rust Belt. Am J Geriatr Psychiatry 2020; 28:99-107. [PMID: 31300193 PMCID: PMC6898763 DOI: 10.1016/j.jagp.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate potential birth cohort effects in depression symptoms in older adults. DESIGN Population-based prospective cohort. SETTING Small-town communities in Pennsylvania. PARTICIPANTS Three thousand two hundred and twenty seven older adults (average baseline age = 71.6) born between 1902 and 1941. MEASUREMENTS Four decade-long birth cohorts were the primary predictors in this study: 1902-1911, 1912-1921, 1922-1931, and 1932-1941. The outcome was symptoms of depression assessed at baseline and follow-up study visits using a modified Center for Epidemiologic Studies Depression Scale (mCES-D). The depression outcome was operationalized as: 1). A binary outcome of having greater than equal to 5 depression symptoms on the total mCES-D at any study visit, and 2). A continuous outcome of four factor-analyzed component scores of the mCES-D including depressed mood, anergia/hopelessness, withdrawal, and poor self-esteem. All analyses were jointly modeled with attrition and adjusted for age, sex, education, Mini Mental State Examination score, antidepressant medications, and total prescription medications. RESULTS Participants from more recently born cohorts were significantly less likely to have a study visit in which they reported greater than or equal to 5 depression symptoms, controlling for attrition. Specifically, in comparison to the 1902-1911 referent cohort, the 1912-1921 birth cohort was 43% less likely (odds ratio [OR] = 0.566, 95% confidence interval [CI]: 0.341-0.939), the 1922-1931 birth cohort was 63% less likely (OR = 0.0369, 95% CI: 0.215-0.632), and the 1932-1941 cohort was 79% less likely (OR = 0.205, 95% CI: 0.106-0.399). The cohort effect was most evident in the depressed mood and anergia/hopelessness symptom composites. CONCLUSION Reduced rates of depression symptoms observed in successive birth cohorts of older adults may reflect compression of morbidity or other secular trends.
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Affiliation(s)
- Kevin J Sullivan
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
| | - Anran Liu
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Hiroko H Dodge
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor, MI,Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Chung-Chou H Chang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mary Ganguli
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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25
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Andreescu C, Ajilore O, Aizenstein HJ, Albert K, Butters MA, Landman BA, Karim HT, Krafty R, Taylor WD. Disruption of Neural Homeostasis as a Model of Relapse and Recurrence in Late-Life Depression. Am J Geriatr Psychiatry 2019; 27:1316-1330. [PMID: 31477459 PMCID: PMC6842700 DOI: 10.1016/j.jagp.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/26/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
The significant public health burden associated with late-life depression (LLD) is magnified by the high rates of recurrence. In this manuscript, we review what is known about recurrence risk factors, conceptualize recurrence within a model of homeostatic disequilibrium, and discuss the potential significance and challenges of new research into LLD recurrence. The proposed model is anchored in the allostatic load theory of stress. We review the allostatic response characterized by neural changes in network function and connectivity and physiologic changes in the hypothalamic-pituitary-adrenal axis, autonomic nervous system, immune system, and circadian rhythm. We discuss the role of neural networks' instability following treatment response as a source of downstream disequilibrium, triggering and/or amplifying abnormal stress response, cognitive dysfunction and behavioral changes, ultimately precipitating a full-blown recurrent episode of depression. We propose strategies to identify and capture early change points that signal recurrence risk through mobile technology to collect ecologically measured symptoms, accompanied by automated algorithms that monitor for state shifts (persistent worsening) and variance shifts (increased variability) relative to a patient's baseline. Identifying such change points in relevant sensor data could potentially provide an automated tool that could alert clinicians to at-risk individuals or relevant symptom changes even in a large practice.
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Affiliation(s)
| | | | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh,Department of Bioengineering, University of Pittsburgh
| | - Kimberly Albert
- The Center for Cognitive Medicine, the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | | | - Bennett A. Landman
- Departments of Computer Science, Electrical Engineering, and Biomedical Engineering, Vanderbilt University; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | | | - Robert Krafty
- Department of Biostatistics, University of Pittsburgh
| | - Warren D. Taylor
- The Center for Cognitive Medicine, the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center,Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System
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26
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Wu M, Mennin DS, Ly M, Karim HT, Banihashemi L, Tudorascu DL, Aizenstein HJ, Andreescu C. When worry may be good for you: Worry severity and limbic-prefrontal functional connectivity in late-life generalized anxiety disorder. J Affect Disord 2019; 257:650-657. [PMID: 31357162 PMCID: PMC6711791 DOI: 10.1016/j.jad.2019.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/31/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late-life generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older adults. However, its neural markers have received relatively little attention. In this study, we explored the association between worry severity and limbic-prefrontal connectivity during emotional reactivity in late-life GAD. METHODS We recruited 16 anxious (GAD) and 20 non-anxious (HC) older adults to perform the faces/shapes emotional reactivity task during functional magnetic resonance imaging (fMRI). We investigated the functional connectivity of both the amygdala and the bed nucleus of stria terminalis (BNST) with the prefrontal cortex (PFC) using generalized psychophysiological interaction (gPPI) analysis. We tested for (1) group differences in connectivity, (2) association between worry severity and connectivity, and (3) interaction between group and worry severity and its association with connectivity. RESULTS Amygdala-PFC and BNST-PFC functional connectivity were associated with worry severity in an inverse U-shape, and was independent of depression severity, global anxiety, neuroticism, and general cognitive function. LIMITATIONS Our limitations include slightly skewed PSWQ distributions, lack of non-anxious individuals with high worry, small sample size, and low depression comorbidity in a sample of late-life GAD that may not generalize to GAD in younger populations. CONCLUSIONS This suggests that moderate worry is associated with maximum engagement of the limbic-PFC connectivity, while severe worry is associated with failure of the limbic-PFC emotional regulation circuit. This may explain the aberrant and exaggerated responses to negative stimuli observed in participants with pathological worry.
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Affiliation(s)
- M Wu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DS Mennin
- Teachers college, Columbia University, New York City, NY
| | - M Ly
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - HT Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - L Banihashemi
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DL Tudorascu
- Department of Internal Medicine, Graduate School of Public health, Pittsburgh, PA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
| | - HJ Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - C Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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27
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Inagaki TK, Hazlett LI, Andreescu C. Naltrexone alters responses to social and physical warmth: implications for social bonding. Soc Cogn Affect Neurosci 2019; 14:471-479. [PMID: 30976797 PMCID: PMC6545530 DOI: 10.1093/scan/nsz026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 01/12/2023] Open
Abstract
Socially warm experiences, when one feels connected to others, have been linked with physical warmth. Opioids, hypothesized to support social bonding with close others and, separately, physical warmth, may underlie both experiences. In order to test this hypothesis, 80 participants were randomly assigned to the opioid antagonist, naltrexone or placebo before neural and emotional responses to social and physical warmth were collected. Social and physical warmth led to similar increases in ventral striatum (VS) and middle-insula (MI) activity. Further, feelings of social connection were positively related to neural activity to social warmth. However, naltrexone (vs placebo) disrupted these effects by (i) reducing VS and MI activity to social and physical warmth, (ii) erasing the subjective experience-brain association to social warmth and (iii) disrupting the neural overlap between social and physical warmth. Results provide additional support for the theory that social and physical warmth share neurobiological, opioid receptor-dependent mechanisms and suggest multiple routes by which social connections may be maintained.
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Affiliation(s)
- Tristen K Inagaki
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura I Hazlett
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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28
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Wei W, Karim HT, Lin C, Mizuno A, Andreescu C, Karp JF, Reynolds CF, Aizenstein HJ. Trajectories in Cerebral Blood Flow Following Antidepressant Treatment in Late-Life Depression: Support for the Vascular Depression Hypothesis. J Clin Psychiatry 2018; 79:18m12106. [PMID: 30358242 PMCID: PMC6419103 DOI: 10.4088/jcp.18m12106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/28/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Studies have identified longitudinally that there exists an association between depression, cerebral blood flow (CBF), and white matter hyperintensities that are thought to be due to vascular pathologies in the brain. However, the changes in CBF, a measure that reflects cerebrovascular integrity, following pharmacotherapy are not well understood. In this study, we investigated the dynamic CBF changes over the course of antidepressant treatment and the association of these changes with depressive symptoms. METHODS We used pseudocontinuous arterial spin labeling to investigate CBF changes in a sample of older patients (≥ 50 years of age; N = 46; 29 female) with a DSM-IV diagnosis of major depressive disorder. Participants had 5 magnetic resonance imaging scans (at baseline, the day after receiving a placebo, the day after receiving a first dose of venlafaxine, a week after starting venlafaxine treatment, and at the end of trial [12 weeks]). Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity and treatment outcome. We investigated the association between changes in depression severity with changes in voxel-wise CBF while adjusting for potential confounding factors. RESULTS Increased CBF in the middle and posterior cingulate between baseline and end of treatment was significantly associated with percent decrease in MADRS score, independent of sex and Mini-Mental State Examination score (5,000 permutations, cluster forming threshold P < .005, family-wise error P < .05). No significant effects were detected between baseline and other scans (ie, placebo, acute [single dose], or subacute [after a week]). CONCLUSIONS Regional CBF increases were associated with decreases in depressive symptoms. This observation is consistent with the vascular depression hypothesis in late-life depression. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00892047 and NCT01124188.
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Affiliation(s)
- Wenjing Wei
- The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Helmet T. Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jordan F. Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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29
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Karim HT, Wang M, Andreescu C, Tudorascu D, Butters MA, Karp JF, Reynolds CF, Aizenstein HJ. Acute trajectories of neural activation predict remission to pharmacotherapy in late-life depression. Neuroimage Clin 2018; 19:831-839. [PMID: 30013927 PMCID: PMC6024196 DOI: 10.1016/j.nicl.2018.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 12/02/2022]
Abstract
Pharmacological treatment of major depressive disorder (MDD) typically involves a lengthy trial and error process to identify an effective intervention. This lengthy period prolongs suffering and worsens all-cause mortality, including from suicide, and is typically longer in late-life depression (LLD). Our group has recently demonstrated that during an open-label venlafaxine (serotonin-norepinephrine reuptake inhibitor) trial, significant changes in functional resting state connectivity occurred following a single dose of treatment, which persisted until the end of the trial. In this work, we propose an analysis framework to translate these perturbations in functional networks into predictors of clinical remission. Participants with LLD (N = 49) completed 12-weeks of treatment with venlafaxine and underwent functional magnetic resonance imaging (fMRI) at baseline and a day following a single dose of venlafaxine. Data was collected at rest as well as during an emotion reactivity task and an emotion regulation task. Remission was defined as a Montgomery-Asberg Depression Rating Scale (MADRS) ≤10 for two weeks. We computed eigenvector centrality (whole brain connectivity) and activation during the emotion regulation and emotion reactivity tasks. We employed principal components analysis, Tikhonov-regularized logistic classification, and least angle regression feature selection to predict remission by the end of the 12-week trial. We utilized ten-fold cross-validation and Receiver Operator Curves (ROC) curve analysis. To determine task-region pairs that significantly contributed to the algorithm's ability to predict remission, we used permutation testing. Using the fMRI data at both baseline and after the first dose of treatment yielded a sensitivity of 72% and a specificity of 68% (AUC = 0.77), a 15% increase in accuracy over baseline MADRS. In general, the accuracy at baseline was further improved by using the change in activation following a single dose. Activation of the frontal cortex, hippocampus, parahippocampus, caudate, thalamus, medial temporal cortex, middle cingulate, and visual cortex predicted treatment remission. Acute, dynamic trajectories of functional imaging metrics in response to a pharmacological intervention are a valuable tool for predicting treatment response in late-life depression and elucidating the mechanism of pharmacological therapies in the context of the brain's functional architecture. Neural activation changes after a single dose of antidepressants have been observed. Patients with late-life depression were treated with an antidepressant for 12 weeks. Neuroimaging data was recorded pre-treatment and after a single dose. Pre-treatment neuroimaging predicted remission at the end of the trial. Neuroimaging after a single dose improved prediction and may guide treatment.
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Affiliation(s)
- Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Maxwell Wang
- Medical Scientist Training Program, University of Pittsburgh School of Medicine and Carnegie Mellon University, University of Pittsburgh, Pittsburgh, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Dana Tudorascu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, USA; Department of Internal Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | | | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA.
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Abstract
PURPOSE OF REVIEW Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders. RECENT FINDINGS In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through "personalized pharmacotherapy" or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation. This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.
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Affiliation(s)
- Maria Ly
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA.
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31
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Andreescu C, Tudorascu D, Sheu LK, Rangarajan A, Butters MA, Walker S, Berta R, Desmidt T, Aizenstein H. Brain structural changes in late-life generalized anxiety disorder. Psychiatry Res 2017; 268:15-21. [PMID: 28837828 PMCID: PMC5593792 DOI: 10.1016/j.pscychresns.2017.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/09/2017] [Accepted: 08/12/2017] [Indexed: 02/05/2023]
Abstract
Late-life Generalized Anxiety Disorder (GAD) is relatively understudied and the underlying structural and functional neuroanatomy has received little attention. In this study, we compare the brain structural characteristics in white and gray matter in 31 non-anxious older adults and 28 late-life GAD participants. Gray matter indices (cortical thickness and volume) were measured using FreeSurfer parcellation and segmentation, and mean diffusivity was obtained through Diffusion Tensor Imaging (DTI). We assessed both macroscopic white matter changes [using white matter hyperintensity (WMH) burden] and microscopic white matter integrity [using fractional anisotropy (FA)]. No differences in macro- or microscopic white matter integrity were found between GAD and non-anxious controls (HC). GAD participants had lower cortical thickness in the orbitofrontal cortex (OFC), inferior frontal gyrus, and pregenual anterior cingulate cortex (ACC). Higher worry severity was associated with gray matter changes in OFC, ACC and the putamen. The results did not survive the multiple comparison correction, but the effect sizes indicate a moderate effect. The study suggests that late-life GAD is associated with gray matter changes in areas involved in emotion regulation, more so than with white matter changes. We conclude that anxiety-related chronic hypercortisolemia may have a dissociative effect on gray and white matter integrity.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Dana Tudorascu
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Biostatistics Department, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lei K Sheu
- Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Anusha Rangarajan
- Bioengineering Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rachel Berta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Thomas Desmidt
- CHU de Tours & INSERM U930 Imagerie et Cerveau, Université François-Rabelais de Tours, Tours, France
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Bioengineering Department, University of Pittsburgh, Pittsburgh, PA, United States
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32
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Karim HT, Tudorascu DL, Butters MA, Walker S, Aizenstein HJ, Andreescu C. In the grip of worry: cerebral blood flow changes during worry induction and reappraisal in late-life generalized anxiety disorder. Transl Psychiatry 2017; 7:e1204. [PMID: 28809854 PMCID: PMC5611745 DOI: 10.1038/tp.2017.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/16/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
Severe worry includes a complex blend of maladaptive affective and cognitive processes. Contrary to other forms of anxiety, there is no consensus in the field regarding the neural basis of worry. To date, no study has looked at neural patterns associated specifically with in-scanner induction and reappraisal of worry. In this study, we attempt to describe distinct components of the 'neural phenomenology' of worry: induction, maintenance, severity and reappraisal, by using a personalized, in-scanner worry script. Twenty older, non-anxious participants and twenty late-life generalized anxiety disorder (GAD) participants were included. Whole-brain axial pseudo-continuous arterial spin-labeling scans were collected. We used a voxel-wise two-way ANOVA to test the group-by-block interaction. Worry induction was associated with greater cerebral blood flow (CBF) in the visual cortex, thalamus, caudate and medial frontal cortex compared with the rest. Reappraisal was associated with greater CBF in similar regions, whereas the orbital frontal gyrus showed lower CBF relative to rest. Relative to non-anxious participants, GAD had greater CBF in multiple regions during worry induction (visual and parietal cortex, middle and superior frontal) and lower CBF during reappraisal in the supplemental motor area, middle cingulate gyrus, insula and putamen. Except for the thalamus, there was no change in CBF throughout the five blocks of worry induction and reappraisal. Severe worry is distinctly associated with increased CBF in several neocortical regulatory regions. We present new data supporting the view of worry as a complex process, engaging multiple regions in the initiation, maintenance and reappraisal of worry.
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Affiliation(s)
- H T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - D L Tudorascu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA, USA
| | - M A Butters
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S Walker
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - H J Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA. E-mail:
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Karim HT, Andreescu C, Tudorascu D, Smagula SF, Butters MA, Karp JF, Reynolds C, Aizenstein HJ. Intrinsic functional connectivity in late-life depression: trajectories over the course of pharmacotherapy in remitters and non-remitters. Mol Psychiatry 2017; 22:450-457. [PMID: 27090303 PMCID: PMC5322273 DOI: 10.1038/mp.2016.55] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/18/2016] [Accepted: 03/02/2016] [Indexed: 01/29/2023]
Abstract
Previous studies in late-life depression (LLD) have found that patients have altered intrinsic functional connectivity in the dorsal default mode network (DMN) and executive control network (ECN). We aimed to detect connectivity differences across a treatment trial among LLD patients as a function of remission status. LLD patients (N=37) were enrolled into a 12-week trial of venlafaxine and underwent five functional magnetic resonance imaging resting state scans during treatment. Patients had no history of drug abuse, psychosis, dementia/neurodegenerative diseases or medical conditions with known effects on mood. We investigated whether there were differences in three networks: DMN, ECN and anterior salience network connectivity, as well as a whole brain centrality measure (eigenvector centrality). We found that remitters showed increases in ECN connectivity in the right precentral gyrus and decreases in DMN connectivity in the right inferior frontal gyrus and supramarginal gyrus. The ECN and DMN had regions (middle temporal gyrus and bilateral middle/inferior temporal/fusiform gyrus, respectively) that showed reversed effects (decreased ECN and increased DMN, respectively). Early changes in functional connectivity can occur after initial medication exposure. This study offers new data, indicating that functional connectivity changes differ depending on treatment response and can occur shortly after exposure to antidepressant medication.
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Affiliation(s)
- H T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D Tudorascu
- Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA, USA
| | - S F Smagula
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M A Butters
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J F Karp
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - H J Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. E-mail:
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Karim H, Tudorascu DL, Aizenstein H, Walker S, Good R, Andreescu C. Emotion Reactivity and Cerebrovascular Burden in Late-Life GAD: A Neuroimaging Study. Am J Geriatr Psychiatry 2016; 24:1040-1050. [PMID: 27633897 PMCID: PMC5914171 DOI: 10.1016/j.jagp.2016.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) in older adults is associated with persistent deficits in emotion reactivity (ER) and regulation, yet the neural basis of these deficits has not been explored. This study focuses on the neural basis of ER deficits in late-life GAD and the association with cerebrovascular burden. METHODS Twenty elderly nonanxious participants and 17 late-life GAD participants were included. The faces-shapes functional magnetic resonance imaging task was used to assess ER; the Hamilton Anxiety Rating Scale and the Penn State Worry Questionnaire to measure global anxiety and worry, respectively; linear regression models to examine the association between ER and global anxiety severity and between ER and worry severity; and mediation analysis to explore the effect of ER on the relationship between global anxiety/worry severity and cerebrovascular burden. RESULTS A positive association was found between ER and global anxiety in the left parahippocampus, left and right precuneus, and right superior occipital gyrus. A negative association was found between ER and worry severity in the left and right precuneus. The association between cerebrovascular burden and anxiety/worry severity was indirectly mediated by increased ER in limbic and paralimbic areas and by decreased ER in prefrontal regulatory regions. CONCLUSION These results indicate that ER is associated with different neural activation patterns for worry and global anxiety and that ER-related functional connectivity indirectly mediates the relationship between cerebrovascular burden and late-life GAD. This latter result supports a yet-unexplored cerebrovascular pathway involved in the pathophysiology of late-life anxiety.
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Affiliation(s)
- Helmet Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Dana Larisa Tudorascu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Biostatistics Department, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Howard Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rachel Good
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Khalaf A, Karim H, Berkout OV, Andreescu C, Tudorascu D, Reynolds CF, Aizenstein H. Altered Functional Magnetic Resonance Imaging Markers of Affective Processing During Treatment of Late-Life Depression. Am J Geriatr Psychiatry 2016; 24:791-801. [PMID: 27364483 PMCID: PMC5026904 DOI: 10.1016/j.jagp.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study investigated neural substrate changes in affective processing among late-life depression (LLD) patients undergoing antidepressant treatment and determined if these changes correlated with remission status. METHODS Thirty-three LLD patients were enrolled in a 12-week venlafaxine treatment course. During treatment functional magnetic resonance imaging (fMRI) scans, paired with an affective task that assessed emotional reactivity and regulation, were performed on days 1, 2, 3, and 7 and at week 12. Following treatment patients were classified as remitters or non-remitters. A voxel-wise two-way repeated-measures ANOVA was performed to assess the fMRI data at a significance level of α = 0.05, corrected. RESULTS The emotional reactivity contrast demonstrated a significant interaction between remission status and scan time in the right middle temporal gyrus (MTG) (F = 24.1, df = 1,112, k = 102). Further analysis showed increased emotional reactivity-induced activity among non-remitters, and decreased activity among remitters, which significantly differed from baseline at day 7 (95% CI: 0.027, 0.540; Cohen's d = -1.35) and week 12 (95% CI: -0.171, -0.052; Cohen's d = 0.68), respectively. No significant interaction was observed with the emotional regulation contrast, but multiple regions had significant main effects of scan time, including the cuneus, occipital lobe, insula, lingual gyrus, posterior cingulate cortex, and MTG. CONCLUSIONS During treatment of LLD patients, affective processing-induced activity in the right MTG shows changes based on remission status. This alteration becomes evident early during the course of treatment, suggesting that antidepressant pharmacotherapy may acutely affect the neural basis of emotional reactivity in a differential manner that is relevant to illness remission.
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Karim HT, Andreescu C, MacCloud RL, Butters MA, Reynolds CF, Aizenstein HJ, Tudorascu DL. The effects of white matter disease on the accuracy of automated segmentation. Psychiatry Res 2016; 253:7-14. [PMID: 27254085 PMCID: PMC5746872 DOI: 10.1016/j.pscychresns.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/14/2016] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Abstract
Automated segmentation of the brain is challenging in the presence of brain pathologies such as white matter hyperintensities (WMH). A late-life depression population was used to demonstrate the effect of WMH on brain segmentation and normalization. We used an automated algorithm to detect WMH, and either filled them with normal-appearing white-matter (NAWM) intensities or performed a multi-spectral segmentation, and finally compared the standard approach to the WMH filling or multi-spectral segmentation approach using intra-class correlation coefficients (ICC). The presence of WMH affected segmentations for both approaches suggesting that studies investigating structural differences in populations with high WMH should account for WMH. We also investigated how functional data contrasts are affected using normalization between the standard compared to fill and multi-spectral approach. We found that the functional data was not affected. While replication with a larger sample is needed, this study shows that WMH can significantly affect the results of segmentation and these areas are not limited to those affected by WMH. It is clear that to study gray matter differences that some correction should be made to account for WMH. Future studies should investigate which methods for accounting for WMH are most effective.
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Affiliation(s)
- Helmet T Karim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca L MacCloud
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dana L Tudorascu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA, USA.
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Rosnick CB, Wetherell JL, White KS, Andreescu C, Dixon D, Lenze EJ. Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial. J Consult Clin Psychol 2016; 84:345-52. [PMID: 26881447 DOI: 10.1037/a0040113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are both effective treatments for generalized anxiety disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD. METHODS The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized estimating equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 min after waking). RESULTS Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at posttreatment compared to the group who received escitalopram without CBT augmentation. CONCLUSIONS CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders.
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Affiliation(s)
| | | | - Kamila S White
- Department of Psychology, University of Missouri-St. Louis
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - David Dixon
- Department of Psychiatry, Washington University School of Medicine
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Andreescu C, Aizenstein HJ. New Findings on the Neurobiology of Dementia and Dementia Risk. Am J Geriatr Psychiatry 2016; 24:105-6. [PMID: 26825577 DOI: 10.1016/j.jagp.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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40
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Khalaf A, Edelman K, Tudorascu D, Andreescu C, Reynolds CF, Aizenstein H. White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression. Neuropsychopharmacology 2015; 40:3027-35. [PMID: 26058663 PMCID: PMC4864637 DOI: 10.1038/npp.2015.158] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/26/2015] [Accepted: 05/30/2015] [Indexed: 12/19/2022]
Abstract
White matter hyperintensities (WMHs) have been shown to be associated with the development of late-life depression (LLD) and eventual treatment outcomes. This study sought to investigate longitudinal WMH changes in patients with LLD during a 12-week antidepressant treatment course. Forty-seven depressed elderly patients were included in this analysis. All depressed subjects started pharmacological treatment for depression shortly after a baseline magnetic resonance imaging (MRI) scan. At 12 weeks, patients underwent a follow-up MRI scan, and were categorized as either treatment remitters (n=23) or non-remitters (n=24). Among all patients, there was as a significant increase in WMHs over 12 weeks (t(46)=2.36, P=0.02). When patients were stratified by remission status, non-remitters demonstrated a significant increase in WMHs (t(23)=2.17, P=0.04), but this was not observed in remitters (t(22)=1.09, P=0.29). Other markers of brain integrity were also investigated including whole brain gray matter volume, hippocampal volume, and fractional anisotropy. No significant differences were observed in any of these markers during treatment, including when patients were stratified based on remission status. These results add to existing literature showing the association between WMH accumulation and LLD treatment outcomes. Moreover, this is the first study to demonstrate similar findings over a short interval (ie 12 weeks), which corresponds to the typical length of an antidepressant trial. These findings serve to highlight the acute interplay of cerebrovascular ischemic disease and LLD.
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Affiliation(s)
- Alexander Khalaf
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn Edelman
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana Tudorascu
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles F Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard Aizenstein
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Room 459, Pittsburgh, PA 15213, USA, Tel: +1 412 246 5464, Fax: + 1 412 586 9111, E-mail:
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41
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Andreescu C, Mennin D, Tudorascu D, Sheu LK, Walker S, Banihashemi L, Aizenstein H. The many faces of anxiety-neurobiological correlates of anxiety phenotypes. Psychiatry Res 2015; 234:96-105. [PMID: 26347412 PMCID: PMC4651749 DOI: 10.1016/j.pscychresns.2015.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/25/2015] [Accepted: 08/27/2015] [Indexed: 01/13/2023]
Abstract
Anxiety is an all-inclusive concept incorporating somatic symptoms (palpitations, dizziness, dyspnea), emotional and cognitive elements (negative affect, fear, worry, rumination) and behavioral components (e.g., avoidance). The aim of this study was to examine the specific neural correlates associated with anxiety phenotypes (worry, rumination, somatic anxiety) and negative affect (neuroticism). Twenty-nine anxious participants and 30 healthy controls were included in the study. We analyzed seed-based intrinsic connectivity and used correlation maps in a multivariable regression model to describe the specific effect of each anxiety phenotype independently of the effects of age and the other measures of anxiety. Worry severity was uniquely correlated with increased intrinsic connectivity between right anterior insula (RAI) and the precuneus. Global and somatic anxiety were associated with the limbic and paralimbic structures (increased connectivity between the amygdala, PVN, and hippocampus), while neuroticism was correlated with increased connectivity between limbic and prefrontal structures. Rumination severity did not correlate significantly with any measures of functional connectivity once we controlled for other clinical measures of anxiety. Measures of worry, global anxiety, somatic anxiety, and neuroticism have distinct 'neural signatures'. These results advocate for a fine-grain approach when analyzing the neural substrates of clinical samples with various anxiety disorders.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811, O'Hara Street, Pittsburgh, PA 15213, United States.
| | - Douglas Mennin
- Department of Psychology, Hunter College, City University of New York
| | - Dana Tudorascu
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Internal Medicine, University of Pittsburgh School of Medicine,Biostatistics Department, University of Pittsburgh School of Medicine
| | - Lei K Sheu
- Department of Psychology, University of Pittsburgh
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine,Bioengineering Department, University of Pittsburgh
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Patel MJ, Andreescu C, Price JC, Edelman KL, Reynolds CF, Aizenstein HJ. Machine learning approaches for integrating clinical and imaging features in late-life depression classification and response prediction. Int J Geriatr Psychiatry 2015; 30:1056-67. [PMID: 25689482 PMCID: PMC4683603 DOI: 10.1002/gps.4262] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/19/2014] [Accepted: 01/05/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Currently, depression diagnosis relies primarily on behavioral symptoms and signs, and treatment is guided by trial and error instead of evaluating associated underlying brain characteristics. Unlike past studies, we attempted to estimate accurate prediction models for late-life depression diagnosis and treatment response using multiple machine learning methods with inputs of multi-modal imaging and non-imaging whole brain and network-based features. METHODS Late-life depression patients (medicated post-recruitment) (n = 33) and older non-depressed individuals (n = 35) were recruited. Their demographics and cognitive ability scores were recorded, and brain characteristics were acquired using multi-modal magnetic resonance imaging pretreatment. Linear and nonlinear learning methods were tested for estimating accurate prediction models. RESULTS A learning method called alternating decision trees estimated the most accurate prediction models for late-life depression diagnosis (87.27% accuracy) and treatment response (89.47% accuracy). The diagnosis model included measures of age, Mini-mental state examination score, and structural imaging (e.g. whole brain atrophy and global white mater hyperintensity burden). The treatment response model included measures of structural and functional connectivity. CONCLUSIONS Combinations of multi-modal imaging and/or non-imaging measures may help better predict late-life depression diagnosis and treatment response. As a preliminary observation, we speculate that the results may also suggest that different underlying brain characteristics defined by multi-modal imaging measures-rather than region-based differences-are associated with depression versus depression recovery because to our knowledge this is the first depression study to accurately predict both using the same approach. These findings may help better understand late-life depression and identify preliminary steps toward personalized late-life depression treatment.
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Affiliation(s)
- Meenal J Patel
- Department of Bioengineering, University of Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Julie C Price
- Department of Radiology, University of Pittsburgh Medical Center, PA, USA
| | - Kathryn L Edelman
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
- Department of Neurology, University of Pittsburgh, PA, USA
- Department of Neuroscience, University of Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Bioengineering, University of Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
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Andreescu C, Sheu LK, Tudorascu D, Gross JJ, Walker S, Banihashemi L, Aizenstein H. Emotion reactivity and regulation in late-life generalized anxiety disorder: functional connectivity at baseline and post-treatment. Am J Geriatr Psychiatry 2015; 23:200-14. [PMID: 24996397 PMCID: PMC4234701 DOI: 10.1016/j.jagp.2014.05.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Generalized anxiety disorder (GAD) is one of the most prevalent mental disorders in the elderly, but its functional neuroanatomy is not well understood. Given the role of emotion dysregulation in GAD, we sought to describe the neural bases of emotion regulation in late-life GAD by analyzing the functional connectivity (FC) in the Salience Network and the Executive Control Network during worry induction and worry reappraisal. METHODS The study included 28 elderly GAD and 31 non-anxious comparison participants. Twelve elderly GAD completed a 12-week pharmacotherapy trial. We used an in-scanner worry script that alternates blocks of worry induction and reappraisal. We assessed network FC, using the following seeds: anterior insula (AI), dorsolateral prefrontal cortex (dlPFC), the bed nucleus of stria terminalis (BNST), and the paraventricular nucleus (PVN). RESULTS GAD participants exhibited greater FC during worry induction between the left AI and the right orbitofrontal cortex, and between the BNST and the subgenual cingulate. During worry reappraisal, the non-anxious participants had greater FC between the left dlPFC and the medial PFC, as well as between the left AI and the medial PFC, and elderly GAD patients had greater FC between the PVN and the amygdala. Following 12 weeks of pharmacotherapy, GAD participants had greater connectivity between the dlPFC and several prefrontal regions during worry reappraisal. CONCLUSION FC during worry induction and reappraisal points toward abnormalities in both worry generation and worry reappraisal. Following successful pharmacologic treatment, we observed greater connectivity in the prefrontal nodes of the Executive Control Network during reappraisal of worry.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Lei K Sheu
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Dana Tudorascu
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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Andreescu C, Sheu LK, Tudorascu D, Walker S, Aizenstein H. The ages of anxiety--differences across the lifespan in the default mode network functional connectivity in generalized anxiety disorder. Int J Geriatr Psychiatry 2014; 29:704-12. [PMID: 24254806 PMCID: PMC4028428 DOI: 10.1002/gps.4051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/24/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders, but its neural basis is relatively understudied. This study aims to characterize the functional connectivity in the default mode network (DMN) in GAD across the lifespan. DESIGN AND SETTINGS Functional and structural magnetic resonance imaging data were collected with subjects at rest. We analyzed the resting state functional connectivity patterns in the DMN for 27 GAD participants and 39 non-anxious comparison participants. Using a two-way analysis of variance, we explored the interaction between age and GAD status on functional connectivity. In GAD participants, we analyzed the correlation of functional connectivity indices with the duration of illness and worry severity. RESULTS The age-by-anxiety interaction showed a greater anxiety effect on the functional connectivity between the posterior cingulate seed and the medial prefrontal cortex for the older group relative to the younger participants. Longer duration of illness was positively correlated with greater functional connectivity between the posterior cingulate cortex and the insula. Worry severity was inversely correlated with the functional connectivity between the posterior cingulate cortex seed and the medial prefrontal cortex. CONCLUSION The presence of GAD, longer duration of illness, and more severe worry exacerbate the effects of age on the functional connectivity in the DMN. These results support the need for tailored research and interventions in late-life anxiety.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Lei K. Sheu
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Dana Tudorascu
- Department of Medicine, University of Pittsburgh School of Medicine,Department of Biostatistics, Graduate School of Public Health
| | - Sarah Walker
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine,Bioengineering Department, University of Pittsburgh
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Abstract
In older adults, depression not only results in more years lived with disability than any other disease but it also carries additional risks of suicide, medical comorbidities, and family caregiving burden. Because it can take many months to identify an effective treatment regimen, it is of utmost importance to shorten the window of time and identify early on what medications and dosages will work effectively for individuals having depression. Late-life depression (LLD) has been associated with greater burden of age-related changes (eg, atrophy, white matter ischemic changes, and functional connectivity). Depression in midlife has been shown to alter affective reactivity and regulation, and functional magnetic resonance imaging (fMRI) studies in LLD have replicated the same abnormalities. Effective treatment can normalize these alterations. This article provides a review of the current literature using structural and functional neuroimaging to identify MRI predictors of treatment response in LLD. The majority of the literature on structural MRI has focused on the vascular depression hypothesis, and studies support the view that loss of brain volume and white matter integrity was associated with poorer treatment outcomes. Studies using fMRI have reported that lower task-based activity in the prefrontal cortex and limbic regions was associated with poorer outcome. These imaging markers may be integrated into clinical decision making to attain better treatment outcomes in the future.
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Affiliation(s)
- Howard J. Aizenstein
- University of Pittsburgh, Department of Psychiatry.,Geriatric Psychiatry Neuroimaging Lab, University of Pittsburgh
| | | | - Sarah E. Walker
- Geriatric Psychiatry Neuroimaging Lab, University of Pittsburgh
| | - Carmen Andreescu
- University of Pittsburgh, Department of Psychiatry.,Geriatric Psychiatry Neuroimaging Lab, University of Pittsburgh
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Andreescu C, Teverovsky E, Fu B, Hughes TF, Chang CCH, Ganguli M. Old worries and new anxieties: behavioral symptoms and mild cognitive impairment in a population study. Am J Geriatr Psychiatry 2014; 22:274-84. [PMID: 23759435 PMCID: PMC3783616 DOI: 10.1016/j.jagp.2012.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/07/2012] [Accepted: 09/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To disentangle the complex associations of depression and anxiety with mild cognitive impairment (MCI) at the population level. We examined subgroups of anxiety symptoms and depression symptom profiles in relation to MCI, which we defined using both cognitive and functional approaches. METHODS We used an epidemiologic, cross-sectional study with an age-stratified, random, population-based sample of 1,982 individuals aged 65 years and over. Three definitions of MCI were used: 1) a purely cognitive classification into amnestic and nonamnestic MCI, 2) a combined cognitive-functional definition by International Working Group (IWG) criteria, and 3) a purely functional definition by the Clinical Dementia Rating (CDR) of 0.5. Three depression profiles were identified by factor analysis of the modified Center for Epidemiological Studies-Depression Scale: core mood, self-esteem/interpersonal, and apathy/neurovegetative profiles. Three anxiety groups, chronic mild worry, chronic severe anxiety, and recent-onset anxiety, were based on screening questions. RESULTS Recent-onset anxiety was associated with MCI by nonamnestic and IWG criteria, chronic severe anxiety was associated with MCI by all definitions, and chronic mild worry was associated with none. Of the depression profiles, the core mood profile was associated with CDR-defined MCI, the apathy/neurovegetative profile was associated with MCI by amnestic, IWG, and CDR definitions, and the self-esteem/interpersonal profile was associated with none. CONCLUSION In this population-based sample, subgroups with different anxiety and depression profiles had different relationships with cognitive and functional definitions of MCI. Anxiety, depression, and MCI are all multidimensional entities, interacting in complex ways that may shed light on underlying neural mechanisms.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Esther Teverovsky
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Bo Fu
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health
| | - Tiffany F. Hughes
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Chung-Chou H. Chang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health,Department of Medicine, University of Pittsburgh School of Medicine
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Neurology, University of Pittsburgh School of Medicine,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
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Andreescu C, Tudorascu DL, Butters MA, Tamburo E, Patel M, Price J, Karp JF, Reynolds CF, Aizenstein H. Resting state functional connectivity and treatment response in late-life depression. Psychiatry Res 2013; 214:313-21. [PMID: 24144505 PMCID: PMC3865521 DOI: 10.1016/j.pscychresns.2013.08.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 06/07/2013] [Accepted: 08/13/2013] [Indexed: 02/07/2023]
Abstract
Indices of functional connectivity in the default mode network (DMN) are promising neural markers of treatment response in late-life depression. We examined the differences in DMN functional connectivity between treatment-responsive and treatment-resistant depressed older adults. Forty-seven depressed older adults underwent MRI scanning pre- and post-pharmacotherapy. Forty-six never depressed older adults underwent MR scanning as comparison subjects. Treatment response was defined as achieving a Hamilton Depression Rating Scale of 10 or less post-treatment. We analyzed resting state functional connectivity using the posterior cingulate cortex as the seed region-of-interest. The resulting correlation maps were employed to investigate between-group differences. Additionally we examined the association between white matter hyperintensity burden and functional connectivity results. Comparison of pre- and post-treatment scans of depressed participants revealed greater post-treatment functional connectivity in the frontal precentral gyrus. Relative to treatment-responsive participants, treatment-resistant participants had increased functional connectivity in the left striatum. When adjusting for white matter hyperintensity burden, the observed differences lost significance for the PCC-prefrontal functional connectivity, but not for the PCC-striatum functional connectivity. The post-treatment "frontalization" of the DMN connectivity suggests a normalizing effect of antidepressant treatment. Moreover, our study confirms the central role of white matter lesions in disrupting brain functional connectivity.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Dana L. Tudorascu
- Department of Internal Medicine, University of Pittsburgh School of Medicine Pittsburgh, PA, USA,Biostatistics Department, University of Pittsburgh School of Medicine Pittsburgh, PA, USA
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erica Tamburo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Meenal Patel
- Bioengineering Department, University of Pittsburgh Pittsburgh, PA, USA
| | - Julie Price
- Department of Radiology, University of Pittsburgh Pittsburgh, PA, USA
| | - Jordan F. Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Bioengineering Department, University of Pittsburgh Pittsburgh, PA, USA
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Wetherell JL, Petkus AJ, White KS, Nguyen H, Kornblith S, Andreescu C, Zisook S, Lenze EJ. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. Am J Psychiatry 2013; 170:782-9. [PMID: 23680817 PMCID: PMC4090227 DOI: 10.1176/appi.ajp.2013.12081104] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.
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Vata A, Nicolau C, Ghibu L, Manciuc D, Prisacariu L, Strat A, Andreescu C, Dorobat C. Latero-cervical actinomycosys in an HIV infected patient - case presentation. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lenze EJ, Dixon D, Mantella RC, Dore PM, Andreescu C, Reynolds CF, Newcomer JW, Butters MA. Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder. Int J Geriatr Psychiatry 2012; 27:454-62. [PMID: 21681817 PMCID: PMC4601802 DOI: 10.1002/gps.2732] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/14/2011] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Older adults with anxiety disorders are burdened by impairment in neurocognition, which may be mediated by elevated circulating cortisol levels. In a randomized controlled trial of acute serotonin-reuptake inhibitor treatment for late-life anxiety disorder, we examined whether change in salivary cortisol concentrations during treatment predicted improvements in measures of memory and executive function. METHODS We examined 60 adults aged 60 years and older, who took part in a 12-week trial of escitalopram versus placebo for generalized anxiety disorder. All subjects had pre-treatment and post-treatment assessments that included monitoring of peak and total daily cortisol and a comprehensive neuropsychological evaluation. RESULTS Salivary cortisol changes during treatment showed significant associations with changes in immediate and delayed memory but no association with executive tasks (measures of working memory and set shifting). Analyses suggested that a decrease in cortisol due to serotonin-reuptake inhibitor treatment was responsible for the memory changes: memory improvement was seen with cortisol reduction among patients receiving escitalopram but not among patients receiving placebo. CONCLUSION Serotonin-reuptake inhibitor-induced alteration in circulating cortisol during treatment of generalized anxiety disorder predicted changes in immediate and delayed memory. This finding suggests a novel treatment strategy in late-life anxiety disorders: targeting hypothalamic-pituitary- adrenal axis dysfunction to improve memory.
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Affiliation(s)
- Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
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