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Maturation of amygdala inputs regulate shifts in social and fear behaviors: A substrate for developmental effects of stress. Neurosci Biobehav Rev 2021; 125:11-25. [PMID: 33581221 DOI: 10.1016/j.neubiorev.2021.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
Stress can negatively impact brain function and behaviors across the lifespan. However, stressors during adolescence have particularly harmful effects on brain maturation, and on fear and social behaviors that extend beyond adolescence. Throughout development, social behaviors are refined and the ability to suppress fear increases, both of which are dependent on amygdala activity. We review rodent literature focusing on developmental changes in social and fear behaviors, cortico-amygdala circuits underlying these changes, and how this circuitry is altered by stress. We first describe changes in fear and social behaviors from adolescence to adulthood and parallel developmental changes in cortico-amygdala circuitry. We propose a framework in which maturation of cortical inputs to the amygdala promote changes in social drive and fear regulation, and the particularly damaging effects of stress during adolescence may occur through lasting changes in this circuit. This framework may explain why anxiety and social pathologies commonly co-occur, adolescents are especially vulnerable to stressors impacting social and fear behaviors, and predisposed towards psychiatric disorders related to abnormal cortico-amygdala circuits.
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Hendriks GJ, van Zelst WH, van Balkom AJ, Uphoff E, Robertson L, Keijsers GPJ, Oude Voshaar RC. Cognitive behavioural therapy and third wave approaches for anxiety and related disorders in older people. Hippokratia 2021. [DOI: 10.1002/14651858.cd007674.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gert-Jan Hendriks
- “Overwaal” Centre of Expertise for Anxiety Disorders, OCD and PTSD; Institute for Integrated Mental Health Care “Pro Persona; Nijmegen Netherlands
- Behavioural Science Institute; Radboud University; Nijmegen Netherlands
- Department of Psychiatry; Radboud University Medical Centre; Nijmegen Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry; University Medical Centre Groningen; Groningen Netherlands
| | - Anton J van Balkom
- Department of Psychiatry and EMGO+ Institute; VU-University Medical Centre and GGZ inGeest; Amsterdam Netherlands
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Lindsay Robertson
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Ger PJ Keijsers
- Behavioural Science Institute; Radboud University; Nijmegen Netherlands
- Department of Clinical Psychological Sciences; Maastricht University; Maastricht Netherlands
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Wong H, Levenga J, LaPlante L, Keller B, Cooper-Sansone A, Borski C, Milstead R, Ehringer M, Hoeffer C. Isoform-specific roles for AKT in affective behavior, spatial memory, and extinction related to psychiatric disorders. eLife 2020; 9:e56630. [PMID: 33325370 PMCID: PMC7787664 DOI: 10.7554/elife.56630] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
AKT is implicated in neurological disorders. AKT has three isoforms, AKT1/AKT2/AKT3, with brain cell type-specific expression that may differentially influence behavior. Therefore, we examined single Akt isoform, conditional brain-specific Akt1, and double Akt1/3 mutant mice in behaviors relevant to neuropsychiatric disorders. Because sex is a determinant of these disorders but poorly understood, sex was an experimental variable in our design. Our studies revealed AKT isoform- and sex-specific effects on anxiety, spatial and contextual memory, and fear extinction. In Akt1 mutant males, viral-mediated AKT1 restoration in the prefrontal cortex rescued extinction phenotypes. We identified a novel role for AKT2 and overlapping roles for AKT1 and AKT3 in long-term memory. Finally, we found that sex-specific behavior effects were not mediated by AKT expression or activation differences between sexes. These results highlight sex as a biological variable and isoform- or cell type-specific AKT signaling as potential targets for improving treatment of neuropsychiatric disorders.
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Affiliation(s)
- Helen Wong
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
| | - Josien Levenga
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
- Linda Crnic Institute, Anschutz Medical Center, Aurora, United States
| | - Lauren LaPlante
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
| | - Bailey Keller
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
| | | | - Curtis Borski
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
| | - Ryan Milstead
- Department of Integrative Physiology, University of Colorado, Boulder, United States
| | - Marissa Ehringer
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
- Department of Integrative Physiology, University of Colorado, Boulder, United States
| | - Charles Hoeffer
- Institute for Behavioral Genetics, University of Colorado, Boulder, United States
- Linda Crnic Institute, Anschutz Medical Center, Aurora, United States
- Department of Integrative Physiology, University of Colorado, Boulder, United States
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Higgins C, Chambers JA, Major K, Durham RC. Healthcare costs and quality of life associated with the long-term outcome of anxiety disorders. ANXIETY STRESS AND COPING 2020; 34:228-241. [PMID: 33108887 DOI: 10.1080/10615806.2020.1839731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Anxiety disorders are costly; however, the relationship with treatment outcome has been neglected. This study examined healthcare costs and quality of life by diagnostic status (treatment outcome and the presence of comorbidity) at long-term follow-up. DESIGN AND METHODS This cohort study comprized 317 patients entering treatment for at least one Axis I anxiety disorder. Four groups were identified based on diagnostic status at follow-up (recovered or disordered) and self-reported degree of interim treatment (high or low). A further grouping was established based on co-morbid diagnostic status at follow-up. Healthcare costs were calculated for the two years prior to treatment entry and the two years prior to follow-up using a repeated measures analysis of variance (ANOVA). Group differences in quality of life were assessed using a univariate ANOVA. RESULTS Over two thirds of the sustained recovery group was treatment-free at follow-up whilst the remainder required adjuvant drug therapy. Over half of those remaining disordered at follow-up incurred substantial healthcare costs and presented with treatment-resistant symptoms and severely impaired quality of life. CONCLUSIONS Despite substantial investment some patients were associated with a clinical anxiety diagnosis at follow-up, and multimorbidity was associated with considerably higher costs.
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Affiliation(s)
- Cassie Higgins
- Division of Neuroscience, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Julie A Chambers
- Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Kirsten Major
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Robert C Durham
- Division of Neuroscience, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
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Jones AL, Cochran SD, Rafferty J, Taylor RJ, Mays VM. Lifetime and Twelve-Month Prevalence, Persistence, and Unmet Treatment Needs of Mood, Anxiety, and Substance Use Disorders in African American and U.S. versus Foreign-Born Caribbean Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7007. [PMID: 32992680 PMCID: PMC7579446 DOI: 10.3390/ijerph17197007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
There is growing diversity within the Black population in the U.S., but limited understanding of ethnic and nativity differences in the mental health treatment needs of Black women. This study examined differences in the prevalence of psychiatric disorders, their persistence, and unmet treatment needs among Black women in the U.S. Data were from the National Survey of American Life, a nationally representative survey that assessed lifetime and twelve-month mood, anxiety, and substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria, and mental health service use among those meeting disorder criteria. One in three African American women met criteria for a lifetime disorder, compared to one in three Caribbean women born within the U.S. and one in five Caribbean women born outside the U.S. About half of African American women with a lifetime disorder had a persistent psychiatric disorder, compared to two in five Caribbean women born within the U.S. and two in three Caribbean women born outside the U.S. African Americans had more persisting dysthymia and panic disorder and less persisting social phobia compared to foreign-born Caribbean women. Of the three groups, Caribbean women born within the U.S. were most likely to seek mental health treatment during their lifetime. These results demonstrate, despite a lower prevalence of psychiatric disorders in Black women, that there is a great likelihood their disorders will be marked by persistence and underscores the need for culturally specific treatment approaches. As Black immigrants in the United States are increasing in number, adequate mental health services are needed.
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Affiliation(s)
- Audrey L. Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Susan D. Cochran
- Departments of Epidemiology and Statistics, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA;
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions (BRITE), Los Angeles, CA 90095, USA;
| | - Jane Rafferty
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA; (J.R.); (R.J.T.)
| | - Robert Joseph Taylor
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA; (J.R.); (R.J.T.)
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vickie M. Mays
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions (BRITE), Los Angeles, CA 90095, USA;
- Departments of Psychology and Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
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Byrd-Bredbenner C, Eck K, Quick V. Psychometric Properties of the Generalized Anxiety Disorder-7 and Generalized Anxiety Disorder-Mini in United States University Students. Front Psychol 2020; 11:550533. [PMID: 33071867 PMCID: PMC7541941 DOI: 10.3389/fpsyg.2020.550533] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Generalized anxiety disorder (GAD) is common in young adults, yet few studies have established the psychometric properties of the GAD-7 screener in college students. Methods: A secondary analysis of three studies was conducted to determine GAD-7 factor structure stability, create a GAD-Mini version using standard procedures, and evaluate the psychometric properties, validity, sensitivity, specificity, and predictive values of both versions in young adults. Results: Exploratory and confirmatory principal components analysis indicated the GAD-7 has a single factor structure with strong loadings, reliability, and stability across data collected in three studies. Data from all studies met criteria indicative of good to excellent model fit. Iterative confirmatory principal components analyses revealed the most parsimonious group of items that maintained scale unidimensionality, strong loadings, and high reliability was two items (not able to stop or control worrying and worried too much). Both the GAD-7 and GAD-Mini exhibited good construct and convergent validity. Specificity, sensitivity, and negative predictive value were high, and positive predictive value was moderate to high for the GAD-Mini. Conclusions: The GAD-Mini is a psychometrically sound tool that can serve as a step toward universal screening in clinical practice and contribute to early treatment and improved health outcomes for GAD.
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Affiliation(s)
| | - Kaitlyn Eck
- Department of Nutritional Science, Rutgers University, New Brunswick, NJ, United States
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57
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Graham BM, Weiner S, Li SH. Gender differences in avoidance and repetitive negative thinking following symptom provocation in men and women with spider phobia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:565-577. [PMID: 32955767 DOI: 10.1111/bjc.12267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 08/04/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Women's greater prevalence of anxiety disorders compared to men is widely assumed to be partly due to gender differences in cognitive and behavioural factors that perpetuate anxiety, such as repetitive negative thinking (RNT) and avoidance. However, past studies assessing this assumption have not controlled for gender differences in baseline symptom severity, the type of stressful life experiences against which RNT and avoidance are measured, or emotional reactivity to these experiences. DESIGN Using a two-group design, the present study controlled for these confounds by comparing avoidance and RNT in relation to a controlled symptom provocation task in spider phobic men and women with equivalent spider fear severity on the Fear of Spiders Questionnaire. METHODS Participants engaged in a behavioural approach test (BAT) involving a live spider, during which they were assessed for avoidance (physical proximity to the spider) and subjective distress. Two weeks later, participants reported on their levels of negative affect and RNT experienced during the preceding weeks in relation to the BAT. RESULTS Women exhibited greater avoidance and reported greater RNT than men, despite reporting comparable distress and negative affect. Gender remained a significant predictor of avoidance when accounting for distress and also remained a significant predictor of RNT when accounting for depressive symptoms and negative affect. CONCLUSIONS These results provide in vivo evidence that heightened avoidance and RNT may perpetuate anxiety symptoms in women independently of gender differences in symptom severity, daily experiences, or emotional reactivity. PRACTITIONER POINTS Following symptom provocation, men and women with spider phobia differ in cognitive and behavioural coping responses. Women exhibit greater avoidance and repetitive negative thinking than men, and these differences are not attributable to gender differences in symptom severity or emotional reactivity. These findings provide novel evidence for gender differences in maintaining factors that perpetuate anxiety disorders whilst accounting for confounding factors present in prior research.
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Affiliation(s)
- Bronwyn M Graham
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shelley Weiner
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie H Li
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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58
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Araç S, Dönmezdil S. Investigation of mental health among hospital workers in the COVID-19 pandemic: a cross-sectional study. SAO PAULO MED J 2020; 138:433-440. [PMID: 33053051 PMCID: PMC9673856 DOI: 10.1590/1516-3180.2020.0272.r3.21072020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The rapid spread of the COVID-19 epidemic has led to extraordinary measures taken worldwide, and has led to serious psychological disorders. Healthcare professionals face greater severity of stress burden, due both to their direct contact with patients with the virus and to the isolation dimension of this outbreak. OBJECTIVE To examine psychiatric disorders such as anxiety, depression and sleep disorders among healthcare professionals working in an emergency department and a COVID-19 clinic. DESIGN AND SETTING Cross-sectional study including healthcare professionals in the emergency department and other units serving patients with COVID-19, of a training and research hospital in Turkey. METHODS 210 volunteers, including 105 healthcare professionals in the emergency department and 105 healthcare professionals working in other departments rendering services for COVID-19 patients, were included in this study. A sociodemographic data form and the Hospital Anxiety Depression Scale (HAD), Pittsburg Sleep Quality Index (PSQI), World Health Organization Quality of Life scale (WHOQOL-BREF-TR) and Religious Orientation Scale were applied to the volunteers. RESULTS The perceived stress levels and PSQI subscores were found to be significantly higher among the volunteers working in the emergency department than among those in other departments. The risk of development of anxiety among women was 16.6 times higher than among men. CONCLUSIONS Healthcare professionals on the frontline need systematic regular psychosocial support mechanisms. Anxiety due to fear of infecting family members can be prevented through precautions such as isolation. However, it should be remembered that loneliness and feelings of missing family members consequent to isolation may increase the risk of depression.
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Affiliation(s)
- Songül Araç
- MD. Assistant Professor, Department of Emergency Medicine, University of Health Sciences, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Diyarbakır, Turkey.
| | - Süleyman Dönmezdil
- MD. Assistant Professor, Department of Psychiatry, University of Health Sciences, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Diyarbakır, Turkey.
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59
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Arch JJ, Genung SR, Ferris MC, Kirk A, Slivjak ET, Fishbein JN, Schneider RL, Stanton AL. Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors. Support Care Cancer 2020; 28:4425-4433. [PMID: 31925530 PMCID: PMC7347435 DOI: 10.1007/s00520-020-05297-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite cancer survivors' frequent endorsement of anxiety symptoms, assessing the full range of anxiety disorders (AD), their timing of onset relative to cancer diagnosis, co-morbidity with mood disorder, and predictors of post-cancer onset, is rare or absent to date. This study provides a step toward addressing these gaps. METHODS Cancer survivors at re-entry after primary treatment completion who screened positively for anxiety symptoms (N = 133) and sought care through an intervention trial completed standardized diagnostic interviews, dimensional assessment of disorder severity, and timing of disorder onset relative to cancer diagnosis. We evaluated sociodemographic and medical predictors of developing a first AD after cancer diagnosis. RESULTS Most ADs began after cancer diagnosis (58%); for 68% of affected patients, this represented their first AD episode. The most common was generalized anxiety disorder (GAD; 41%), where "cancer-focused GAD" was distinguished from "typical GAD"; the next most common were specific phobia (14%) and social anxiety disorder (13%). A minority (31%) of ADs were comorbid with major depression. Relative to having no AD, experiencing more lingering treatment side effects predicted developing a first AD after cancer diagnosis. Relative to having an AD that began before cancer diagnosis, reporting a higher cancer stage predicted developing a first AD after diagnosis. CONCLUSIONS Cancer survivors at re-entry seeking care for anxiety symptoms manifested a broad range of ADs which most commonly developed after cancer diagnosis and were prompted by the experience of cancer. Such disorders represent an unusually late-life, cancer-linked etiology that warrants further investigation and clinical attention.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA.
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, 80045, USA.
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Michelle C Ferris
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Alex Kirk
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Joel N Fishbein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Rebecca L Schneider
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, 90095, USA
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60
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Bosman RC, van Balkom AJLM, Rhebergen D, van Hemert AM, Schoevers RA, Penninx BWJH, Batelaan NM. Predicting the course of anxiety disorders: The role of biological parameters. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109924. [PMID: 32179152 DOI: 10.1016/j.pnpbp.2020.109924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Clinical characteristics appear limited in their ability to predict course of anxiety disorders, therefore we explored the predictive value of biological parameters on course of anxiety disorders. METHODS 907 persons with an anxiety (panic, social phobia, generalised anxiety) disorder with a baseline and two-year follow-up measure were selected from the Netherlands Study of Depression and Anxiety (NESDA). Previously, three course trajectories were distinguished which vary in terms of symptom severity and chronicity. Baseline clinical parameters like anxiety severity, anxiety duration, and disability were limited in their ability to predict the two-year course. This study explored whether metabolic syndrome, hypothalamic-pituitary-adrenal-axis functioning, inflammation markers, and neuroplasticity were indicators of two-year course and whether these parameters improved the model containing the most predictive clinical parameters only. RESULTS Baseline diastolic blood pressure of persons with chronic moderate symptoms was significantly higher than of persons with non-chronic mild symptoms (odds ratio [OR] = 1.18, 95% confidence interval [CI95%] 1.01 to 1.38). Baseline high-density lipid cholesterol of persons with severe chronic symptoms was significantly lower than of persons with non-chronic mild symptoms (OR = 0.77, CI95% 0.62 to 0.96). The predictive ability of both parameters was however low with concordance statistics of 0.55 and 0.57 respectively. Addition of biological parameters did not improve the predictive ability of the model containing the clinical parameters. CONCLUSIONS In addition to clinical characteristics, biological parameters did not improve the predictive ability of the model for course trajectory of anxiety disorders. Prediction of course trajectory in anxiety disorders remains difficult and warrants further research.
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Affiliation(s)
- R C Bosman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.
| | - A J L M van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - D Rhebergen
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - R A Schoevers
- University Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University of Groningen, Groningen, the Netherlands
| | - B W J H Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - N M Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
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61
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Korte KJ, Schmidt NB. Transdiagnostic preventative intervention for subclinical anxiety: Development and initial validation. J Psychiatr Res 2020; 126:34-42. [PMID: 32416385 PMCID: PMC7366324 DOI: 10.1016/j.jpsychires.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/25/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Risk factors associated with the development of anxiety disorders have been identified; however, the development of preventive interventions targeting these risk factors is in the nascent stage. To date, preventive interventions have tended to target specific anxiety disorder symptoms (e.g., panic attacks). Although these interventions are effective at reducing risk for the targeted disorder (e.g., panic disorder), the focus of the intervention is narrow, thereby limiting the dissemination of these interventions. One approach that may broaden the scope of our prevention efforts is the development of a transdiagnostic intervention. Currently, transdiagnostic interventions have only been used in those with diagnosed conditions (e.g., anxiety disorders); however, it stands to reason that a transdiagnostic approach may also be helpful for those at-risk for developing anxiety disorders. The present study reported on the development and use of a brief preventative intervention for those with subclinical anxiety (i.e., worry, social anxiety). Participants were randomized into either a transdiagnostic preventative intervention, focused on reduction of safety aids, or a health focused control group. Participants consisted of sixty-nine individuals with subclinical levels of anxiety. Results revealed significant between group differences in the reduction of social anxiety, worry, and levels of impairment with the active intervention group relative to the control group. Further, change in safety aid utilization was a significant mediator in the association between intervention group and social anxiety and worry at Week 1; however, it was not a significant mediator at Month 1. Implications of these results and avenues for future research are discussed.
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Affiliation(s)
- Kristina J. Korte
- Massachusetts General Hospital, Boston, MA,Harvard T.H. Chan School of Public Health, Boston, MA,Harvard Medical School, Boston, MA
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Day TN, Chong LJ, Meyer A. Parental Presence Impacts a Neural Correlate of Anxiety (the Late Positive Potential) in 5-7 Year Old Children: Interactions with Parental Sensitivity to Child Anxiety. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:951-963. [PMID: 32323110 DOI: 10.1007/s10802-020-00648-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Anxiety disorders tend to onset early in development and often result in chronic impairment across the lifespan. Thus, there is substantial interest in identifying early neural markers of anxiety and leveraging these markers to better understand processes leading to anxiety. The late positive potential (i.e., LPP) indexes sustained attention to motivationally relevant stimuli; and the LPP to negative images is increased in individuals with anxiety. In the current study, we examined how parental presence impacts the LPP to threatening images in children (52.6% male) between 5 and 7 years-old (N = 78). Moreover, we explored interactions with parental sensitivity to child anxiety symptoms. Results suggest that when children are in the presence of their parent (compared to the presence of an experimenter), they displayed a larger LPP to threatening images. LPP activity was modulated by parental response to their child's anxiety symptoms, such that children with parents who were overly reactive to their children's anxiety symptoms had the greatest LPP response when viewing threatening stimuli in their parent's presence. Additionally, exploratory analyses indicated that children with clinical and subclinical anxiety were characterized by an increased LPP to negative images, but only when the LPP was measured with parents in the room. Findings are novel and extend previous work by suggesting that parents who react strongly when observing their children's anxiety symptoms in turn increase their child's engagement with threatening stimuli, thereby placing them at greater risk for anxiety.
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Affiliation(s)
- Taylor N Day
- Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL, 32304, USA
| | - Lyndsey J Chong
- Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL, 32304, USA
| | - Alexandria Meyer
- Department of Psychology, Florida State University, 1107 W Call St., Tallahassee, FL, 32304, USA.
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Lawrence PJ, Creswell C, Cooper PJ, Murray L. The role of maternal anxiety disorder subtype, parenting and infant stable temperamental inhibition in child anxiety: a prospective longitudinal study. J Child Psychol Psychiatry 2020; 61:779-788. [PMID: 31916250 DOI: 10.1111/jcpp.13187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) aggregates in families. To elucidate intergenerational transmission of risk, we examined whether childhood SAD and symptoms of anxiety were prospectively predicted by stable infant temperamental inhibition, maternal SAD, maternal generalized anxiety disorder (GAD) and maternal parenting behaviours. METHODS We conducted a longitudinal study beginning prenatally with follow-up at 4, 10, 14 and 58 months postnatally. Mothers were assessed for anxiety disorders prenatally and assigned to one of three groups: SAD (n = 67), GAD (n = 56) and nonanxious controls (n = 94). We assessed infant temperamental inhibition at 4 and 14 months, maternal parenting behaviours at 10 and 58 months, and child anxiety disorders and symptoms at 58 months. RESULTS Child SAD at 58 months was predicted by prenatal maternal SAD (OR = 23.76, 95% CI = 1.15-60.37), but not by prenatal maternal GAD (OR = 7.44, 95% CI = 0.32-124.49), stable temperamental inhibition or maternal behaviours. Child anxiety symptoms at 58 months were predicted specifically by maternal SAD (but not GAD), and also by concurrent maternal intrusiveness. Stable temperamental inhibition moderated the association between 10-month maternal encouragement and 58-month child anxiety symptoms. CONCLUSIONS We found evidence for specificity of risk for child SAD and anxiety symptoms from maternal SAD compared to maternal GAD. Childhood anxiety symptoms were also predicted by an interaction between a lack of maternal encouragement in infancy and stable temperamental inhibition, as well as concurrent maternal intrusiveness. The findings have clinical implications for targeted prevention of child anxiety.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology, University of Southampton, Southampton, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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64
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Abstract
Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.
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Affiliation(s)
- Ayelet Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6018, USA;
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65
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Duong P, Tenkorang MAA, Trieu J, McCuiston C, Rybalchenko N, Cunningham RL. Neuroprotective and neurotoxic outcomes of androgens and estrogens in an oxidative stress environment. Biol Sex Differ 2020; 11:12. [PMID: 32223745 PMCID: PMC7104511 DOI: 10.1186/s13293-020-0283-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The role of sex hormones on cellular function is unclear. Studies show androgens and estrogens are protective in the CNS, whereas other studies found no effects or damaging effects. Furthermore, sex differences have been observed in multiple oxidative stress-associated CNS disorders, such as Alzheimer's disease, depression, and Parkinson's disease. The goal of this study is to examine the relationship between sex hormones (i.e., androgens and estrogens) and oxidative stress on cell viability. METHODS N27 and PC12 neuronal and C6 glial phenotypic cell lines were used. N27 cells are female rat derived, whereas PC12 cells and C6 cells are male rat derived. These cells express estrogen receptors and the membrane-associated androgen receptor variant, AR45, but not the full-length androgen receptor. N27, PC12, and C6 cells were exposed to sex hormones either before or after an oxidative stressor to examine neuroprotective and neurotoxic properties, respectively. Estrogen receptor and androgen receptor inhibitors were used to determine the mechanisms mediating hormone-oxidative stress interactions on cell viability. Since the presence of AR45 in the human brain tissue was unknown, we examined the postmortem brain tissue from men and women for AR45 protein expression. RESULTS Neither androgens nor estrogens were protective against subsequent oxidative stress insults in glial cells. However, these hormones exhibited neuroprotective properties in neuronal N27 and PC12 cells via the estrogen receptor. Interestingly, a window of opportunity exists for sex hormone neuroprotection, wherein temporary hormone deprivation blocked neuroprotection by sex hormones. However, if sex hormones are applied following an oxidative stressor, they exacerbated oxidative stress-induced cell loss in neuronal and glial cells. CONCLUSIONS Sex hormone action on cell viability is dependent on the cellular environment. In healthy neuronal cells, sex hormones are protective against oxidative stress insults via the estrogen receptor, regardless of sex chromosome complement (XX, XY). However, in unhealthy (e.g., high oxidative stress) cells, sex hormones exacerbated oxidative stress-induced cell loss, regardless of cell type or sex chromosome complement. The non-genomic AR45 receptor, which is present in humans, mediated androgen's damaging effects, but it is unknown which receptor mediated estrogen's damaging effects. These differential effects of sex hormones that are dependent on the cellular environment, receptor profile, and cell type may mediate the observed sex differences in oxidative stress-associated CNS disorders.
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Affiliation(s)
- Phong Duong
- Department of Physiology and Anatomy, Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Mavis A A Tenkorang
- Department of Physiology and Anatomy, Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Jenny Trieu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Clayton McCuiston
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Nataliya Rybalchenko
- Department of Physiology and Anatomy, Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Rebecca L Cunningham
- Department of Physiology and Anatomy, Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA. .,Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, 3400 Camp Bowie Boulevard, Fort Worth, TX, 76107, USA.
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66
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Achieving complete mental health despite a history of generalized anxiety disorders: Findings from a large, nationally representative Canadian survey. J Affect Disord 2020; 265:687-694. [PMID: 32090786 DOI: 10.1016/j.jad.2019.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023]
Abstract
Ideally, the clinical goal for individuals with a history of anxiety disorder is not only to remit from the disorder, but also to reach optimal well-being. This broader concept of recovery aligns with Keyes' concept of complete mental health (CMH), including presence of happiness or life satisfaction, and social and psychological well-being, and absence of any past year mental illness including anxiety disorders, depressive disorders, substance dependence and suicidal ideation. This study's aim was to identify factors associated with CMH in a population-based sample of Canadians with a previous diagnosis of Generalized Anxiety Disorder (GAD) (n = =2128), of whom 40% are currently in CMH. Data were from the 2012 Canadian Community Health Survey-Mental Health (response rate=68.9%). The World Health Organization version of the Composite International Diagnostic Interview (WHOCIDI) scales were used to define lifetime and past-year GAD. Factors associated with complete mental health include female gender, older age, being married, reporting good to excellent physical health, being free of chronic insomnia, being able to manage household activities without difficulties, using religion or spirituality to cope, having a confidant, and never having had a major depressive disorder nor substance dependence. Results of this study suggest many with a history of anxiety disorders can achieve CMH and point to factors that appear to facilitate this process.
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67
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Rådmark L, Hanson LM, Montgomery S, Bojner Horwitz E, Osika W. Mind and body exercises (MBE), prescribed antidepressant medication, physical exercise and depressive symptoms - a longitudinal study. J Affect Disord 2020; 265:185-192. [PMID: 32090740 DOI: 10.1016/j.jad.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 01/21/2023]
Abstract
AIMS Earlier studies show that participation in mind and body exercises (MBE) is cross-sectionally associated with high levels of depressive symptoms and antidepressants. This study investigates the longitudinal interrelationship between depressive symptoms, MBE and antidepressants. METHODS 3269 men and 4318 women aged 24-74 years participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Measures of MBE practice and depressive symptoms were drawn from the SLOSH questionnaire, data on prescription drugs were obtained from the Swedish Prescribed Drug Register. Structural Equation Modeling (SEM) was used to analyze temporal relationships. RESULTS Both MBE practice and antidepressants in 2012 was associated with higher levels of depressive symptoms two years later. Depressive symptoms in turn were associated with higher levels of later MBE practice and antidepressants. These relationships seemed to be explained by confounding by indication and were of higher magnitude for antidepressants than for MBE. CONCLUSION Overall, SEM analysis shows that MBE and antidepressant treatment were both bi-directionally associated with depressive symptoms over time. Part of the explanation is likely to be confounding by indication: those with symptoms of depression more likely to undertake treatment, and MBE alone may be more common among those with less severe depression. The results clarify some of our findings from earlier studies and give some important, new information on what people are doing to manage depressive symptoms on a societal level, regarding self-care, medication, and the combination of both.
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Affiliation(s)
- L Rådmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
| | | | - S Montgomery
- Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK
| | - E Bojner Horwitz
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Music, Pedagogy and Society, Royal College of Music, Stockholm, Sweden
| | - W Osika
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden.
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68
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Conroy K, Curtiss JE, Barthel AL, Lubin R, Wieman S, Bui E, Simon NM, Hofmann SG. Emotion Regulation Flexibility in Generalized Anxiety Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020; 42:93-100. [PMID: 32661451 DOI: 10.1007/s10862-019-09773-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background People differ in their affective styles, which refers to habitual use of emotion regulation (ER) strategies. Previous research has shown that mental health is associated with an individual's adaptive flexibility of emotion regulation strategies rather than any one particular ER strategy. Methods The present study employed a person-centered approach using latent profile analyses to distinguish patients with generalized anxiety disorder based on their responses on an affective styles measure. Results Results of the latent profile analysis supported a three-class solution. Class 1 (26% of participants) identified individuals with the lowest scores of each affective style; class 2 (10%) included individuals with the highest scores of each style; and class 3 (64%) consisted of individuals who scored in the mid-range of each affective style. Greater ER flexibility was associated with better emotional functioning and quality of life. Conclusions Patients with GAD differ in ER flexibility. The vast majority of patients appear to have only moderate or low ER flexibility. Those individuals with high ER flexibility show a greater quality of life and less emotional distress.
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Affiliation(s)
- Kristina Conroy
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Joshua E Curtiss
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Abigail L Barthel
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Rebecca Lubin
- Department of Psychiatry, New York University Langone Health, New York, New York, USA
| | - Sarah Wieman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Langone Health, New York, New York, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
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69
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Rosellini AJ, Liu S, Anderson GN, Sbi S, Tung E, Knyazhanskaya E. Developing algorithms to predict adult onset internalizing disorders: An ensemble learning approach. J Psychiatr Res 2020; 121:189-196. [PMID: 31864158 PMCID: PMC7027595 DOI: 10.1016/j.jpsychires.2019.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/07/2019] [Accepted: 12/05/2019] [Indexed: 01/17/2023]
Abstract
A growing literature is utilizing machine learning methods to develop psychopathology risk algorithms that can be used to inform preventive intervention. However, efforts to develop algorithms for internalizing disorder onset have been limited. The goal of this study was to utilize prospective survey data and ensemble machine learning to develop algorithms predicting adult onset internalizing disorders. The data were from Waves 1-2 of the National Epidemiological Survey on Alcohol and Related Conditions (n = 34,653). Outcomes were incident occurrence of DSM-IV generalized anxiety, panic, social phobia, depression, and mania between Waves 1-2. In total, 213 risk factors (features) were operationalized based on their presence/occurrence at the time of or before Wave 1. For each of the five internalizing disorder outcomes, super learning was used to generate a composite algorithm from several linear and non-linear classifiers (e.g., random forests, k-nearest neighbors). AUCs achieved by the cross-validated super learner ensembles were in the range of 0.76 (depression) to 0.83 (mania), and were higher than AUCs achieved by the individual algorithms. Individuals in the top 10% of super learner predicted risk accounted for 37.97% (depression) to 53.39% (social anxiety) of all incident cases. Thus, the algorithms achieved acceptable-to-excellent prediction accuracy with a high concentration of incident cases observed among individuals predicted to be highest risk. In parallel with the development of effective preventive interventions, further validation, expansion, and dissemination of algorithms predicting internalizing disorder onset/trajectory could be of great value.
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70
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Björkstrand J, Schiller D, Li J, Davidson P, Rosén J, Mårtensson J, Kirk U. The effect of mindfulness training on extinction retention. Sci Rep 2019; 9:19896. [PMID: 31882606 PMCID: PMC6934560 DOI: 10.1038/s41598-019-56167-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 12/05/2019] [Indexed: 11/09/2022] Open
Abstract
Anxiety and trauma related disorders are highly prevalent, causing suffering and high costs for society. Current treatment strategies, although effective, only show moderate effect-sizes when compared to adequate control groups demonstrating a need to develop new forms of treatment or optimize existing ones. In order to achieve this, an increased understanding of what mechanisms are involved is needed. An emerging literature indicates that mindfulness training (MFT) can be used to treat fear and anxiety related disorders, but the treatment mechanisms are unclear. One hypothesis, largely based on findings from neuroimaging studies, states that MFT may improve extinction retention, but this has not been demonstrated empirically. To investigate this question healthy subjects either completed a 4-week MFT- intervention delivered through a smart-phone app (n = 14) or were assigned to a waitlist (n = 15). Subsequently, subjects participated in a two-day experimental protocol using pavlovian aversive conditioning, evaluating acquisition and extinction of threat-related responses on day 1, and extinction retention on day 2. Results showed that the MFT group displayed reduced spontaneous recovery of threat related arousal responses, as compared to the waitlist control group, on day 2. MFT did not however, have an effect on either the acquisition or extinction of conditioned responses day 1. This clarifies the positive effect of MFT on emotional functioning and could have implications for the treatment of anxiety and trauma related disorders.
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Affiliation(s)
- Johannes Björkstrand
- Department of Psychology, University of Southern Denmark, Odense, Denmark. .,Department of Psychology, Uppsala University, Uppsala, Sweden. .,Department of Psychology, Lund University, Lund, Sweden.
| | - Daniela Schiller
- Departments of Psychiatry and Neuroscience, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jian Li
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Per Davidson
- Department of Psychology, Lund University, Lund, Sweden
| | - Jörgen Rosén
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Ulrich Kirk
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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71
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Multiple extinction contexts modulate the neural correlates of context-dependent extinction learning and retrieval. Neurobiol Learn Mem 2019; 168:107150. [PMID: 31881356 DOI: 10.1016/j.nlm.2019.107150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Exposure therapy is a successful treatment for patients with anxiety and fear-related disorders. Extinction of conditioned fear comprises one important mechanism underlying the effects of exposure therapy. Yet, relapses frequently occur in the long-term, probably related to difficulties in generalizing the extinction of conditioned fear to new contexts, leading to renewal of conditioned fear. Extinction training in multiple extinction contexts depicts a promising opportunity to reduce this renewal of conditioned fear. However, the underlying neural correlates are unknown yet. In this functional magnetic resonance imaging study, 49 healthy men participated in a fear conditioning paradigm with fear acquisition training in context A on a first day, extinction training in a single context (B1) or in four different contexts (B1-B4) one day later, and fear and extinction recall and reinstatement in context B1 and a novel context C on a third day one week later. Multiple extinction contexts led to a stronger differential activation decrease in the hippocampus during extinction learning compared to a single extinction context. One week later, the multiple context group compared with the single context group showed reduced differential amygdala activation during fear renewal in the novel context C compared with the extinction context B1. Furthermore, multiple extinction contexts diminished amygdala activation during a subsequent reinstatement test in context B1. However, there were no significant differences in differential conditioned SCRs. These results indicate that the use of multiple extinction contexts during extinction training leads to reduced conditioned responses in the amygdala-hippocampus complex.
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72
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Kanuri N, Arora P, Talluru S, Colaco B, Dutta R, Rawat A, Taylor BC, Manjula M, Newman MG. Examining the initial usability, acceptability and feasibility of a digital mental health intervention for college students in India. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2019; 55:657-673. [PMID: 31867730 DOI: 10.1002/ijop.12640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022]
Abstract
Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the "Mana Maali Digital Anxiety Program." Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.
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Affiliation(s)
- Nitya Kanuri
- School of Management & School of Public Health, Yale University, New Haven, CT, USA
| | - Prerna Arora
- Department of Health and Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Sai Talluru
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bona Colaco
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Rohan Dutta
- Electrical and Electronics Engineering, BITS Pilani, Goa Campus, Goa, India
| | | | - Barr C Taylor
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry (emeritus), Stanford University, Stanford, CA, USA
| | - M Manjula
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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73
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Clauss J. Extending the neurocircuitry of behavioural inhibition: a role for the bed nucleus of the stria terminalis in risk for anxiety disorders. Gen Psychiatr 2019; 32:e100137. [PMID: 31922088 PMCID: PMC6937153 DOI: 10.1136/gpsych-2019-100137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
Behavioural inhibition is a biologically based risk factor for anxiety disorders. Children with behavioural inhibition are shy, cautious and avoidant of new situations. Much research on behavioural inhibition has focused on the amygdala as an underlying neural substrate and has identified differences in amygdala function and volume; however, amygdala findings have yet to lead to meaningful interventions for prevention or treatment of anxiety disorders. The bed nucleus of the stria terminalis (BNST) is a prime candidate to be a neural substrate of behavioural inhibition, given current evidence of BNST function and development in human research and animal models. Children with behavioural inhibition have an increased startle response to safety cues and an increased cortisol response to social evaluative situations, both of which are mediated by the BNST. In rodents, activation of the BNST underlies contextual fear responses and responses to uncertain and sustained threat. Non-human primates with anxious temperament (the macaque equivalent of behavioural inhibition) have increased BNST activity to ambiguous social situations, and activity of the BNST in anxious temperament is significantly heritable. Importantly, the BNST is sexually dimorphic and continues to develop into adulthood, paralleling the development of anxiety disorders in humans. Together, these findings suggest that further investigation of the BNST in behavioural inhibition is necessary and may lead to new avenues for the prevention and treatment of anxiety disorders.
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Affiliation(s)
- Jacqueline Clauss
- Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Child and Adolescent Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
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74
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Hohls JK, König HH, Heider D, Brenner H, Böhlen F, Matschinger H, Saum KU, Schöttker B, Haefeli WE, Hajek A, Wild B. Longitudinal association between panic disorder and health care costs in older adults. Depress Anxiety 2019; 36:1135-1142. [PMID: 31609044 DOI: 10.1002/da.22959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/16/2019] [Accepted: 09/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze whether probable panic disorder (PD) is associated with health care costs in older age over time. METHODS Data regarding individuals aged 65 and over were derived from two waves of the ESTHER cohort study (nt1 = 2,348, nt2 = 2,090). Probable PD was assessed using the panic screening module from the Patient Health Questionnaire. Health care costs were obtained through monetary valuation of self-reported health care use data. Fixed effects regressions analyzed the association between transitions in probable PD status and change in health care costs, while adjusting for potential confounders. RESULTS On a descriptive level, study participants with a positive PD screening displayed higher three-month health care costs compared to those without (incremental costs: € 259 for t1 , € 1,544 for t2 ). Transitions in probable PD were associated with an approximate increase of 65% in outpatient health care costs (β = 0.50, p < .05). There was no significant association between probable PD transition and change in any other cost category. CONCLUSIONS Using longitudinal data, our results highlight the economic consequences of probable PD in older adults. Future research should address whether reducing PD in older adults may reduce the associated economic burden and analyze underlying mechanisms.
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Affiliation(s)
- Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Friederike Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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75
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Hirsch CR, Beale S, Grey N, Liness S. Approaching Cognitive Behavior Therapy For Generalized Anxiety Disorder From A Cognitive Process Perspective. Front Psychiatry 2019; 10:796. [PMID: 31780964 PMCID: PMC6852150 DOI: 10.3389/fpsyt.2019.00796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022] Open
Abstract
Generalized anxiety disorder (GAD), with uncontrollable worry at its core, is a common psychological disorder with considerable individual and societal costs. Cognitive behavior therapy (CBT) is recommended as the first-line treatment for GAD; however, further investigation into its effectiveness in routine clinical care is indicated and improvement is required in treatment outcomes for worry. Improvements to CBT need to be guided by experimental research that identifies key mechanisms maintaining core aspects of the disorder. This paper summarizes how theory-driven experimental research guided selection and refinements of CBT techniques originally developed by Borkovec and Costello, to target key cognitive processes that maintain worry in GAD. Hirsch and Mathews' model specifies three key research-supported processes that maintain uncontrollable worry in GAD: implicit cognitive biases such as negative interpretation bias and attention bias, generalized verbal thinking style, and impaired ability to re-direct attentional control away from worry. Specific CBT techniques outlined in this paper aim to target these key processes. Clinical data from clients treated using our refined CBT protocol for GAD in a routine clinical care service with a special interest in anxiety disorders were collected as part of service procedures. Large pre-to-posttreatment effect sizes were obtained for anxiety (GAD-7), depression (PHQ-9), and worry (PSWQ) (d=.90-2.54), and a moderate effect size was obtained for quality of life (WASA; d=.74). Recovery was indicated for 74% of cases for anxiety, 78% for depression, and 53% for worry. These findings exceeded most previous effectiveness studies in routine care and were in-line with GAD efficacy trials. This paper also outlines the application of specific clinical techniques selected, adapted or developed to target key cognitive mechanisms which maintain worry in GAD.
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Affiliation(s)
- Colette R. Hirsch
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sarah Beale
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Sheena Liness
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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76
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Moreno-Rius J. The cerebellum under stress. Front Neuroendocrinol 2019; 54:100774. [PMID: 31348932 DOI: 10.1016/j.yfrne.2019.100774] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 12/22/2022]
Abstract
Stress-related psychiatric conditions are one of the main causes of disability in developed countries. They account for a large portion of resource investment in stress-related disorders, become chronic, and remain difficult to treat. Research on the neurobehavioral effects of stress reveals how changes in certain brain areas, mediated by a number of neurochemical messengers, markedly alter behavior. The cerebellum is connected with stress-related brain areas and expresses the machinery required to process stress-related neurochemical mediators. Surprisingly, it is not regarded as a substrate of stress-related behavioral alterations, despite numerous studies that show cerebellar responsivity to stress. Therefore, this review compiles those studies and proposes a hypothesis for cerebellar function in stressful conditions, relating it to stress-induced psychopathologies. It aims to provide a clearer picture of stress-related neural circuitry and stimulate cerebellum-stress research. Consequently, it might contribute to the development of improved treatment strategies for stress-related disorders.
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77
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Zainal NH, Newman MG. Relation between cognitive and behavioral strategies and future change in common mental health problems across 18 years. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:295-304. [PMID: 31045412 PMCID: PMC6707366 DOI: 10.1037/abn0000428] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD), constitute common mental disorders that may have chronic and disabling courses. Cognitive and behavioral theories posit that lack of engagement in certain strategies (goal persistence, self-mastery, positive reappraisal) increases vulnerability toward these disorders. Further, scar effect theories assert that experiencing more of these disorders may diminish engagement in such strategies within individuals across time. However, dynamic longitudinal associations between cognitive-behavioral strategies (CBS) and disorder counts across adulthood are not well understood. Using bivariate latent difference score models, this study aimed to test the dynamic trajectories between disorder counts and each CBS across 18 years. Participants were 3,294 community-dwelling adults ages 45.62 years (SD = 11.41, range = 20-74; 54.61% female) who took part in 3 waves of measurement spaced 9 years apart. Self-mastery, disorder counts, and their change were not significantly related. However, higher within-subject increase in goal persistence (but not self-mastery or positive reappraisal) led to greater future decline in disorder counts, but not vice versa. Last, within individuals, greater prior levels of goal persistence and positive reappraisal predicted larger subsequent reduction in disorder counts, and vice versa. The reciprocal, bidirectional associations between specific CBS (goal persistence, positive reappraisal) and disorder counts support both vulnerability and scar models of depression and anxiety. Treatments for MDD, GAD, and PD should attempt to enhance perseverance and optimism. Theoretical and clinical implications are further discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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78
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Kalmbach DA, Abelson JL, Arnedt JT, Zhao Z, Schubert JR, Sen S. Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns. Sleep Med 2019; 55:40-47. [PMID: 30763868 PMCID: PMC7045299 DOI: 10.1016/j.sleep.2018.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVES While anxiety rates are alarmingly high in short sleeping insomniacs, the relationship between insomnia and anxiety symptoms has not been extensively studied, especially in comparison to the relationship between insomnia and depressive symptoms. Using residency training as a naturalistic stress exposure, we prospectively assessed the role of sleep disturbance and duration on anxiety-risk in response to stress. METHODS Web-based survey data from 1336 first-year training physicians (interns) prior to and then quarterly across medical internship. Using mixed effects modeling, we examined how pre-internship sleep disturbance and internship sleep duration predicted symptoms of anxiety, using an established tool for quantifying symptom severity in generalized anxiety disorder (GAD). RESULTS Pre-internship poor sleepers are at more than twice the odds of having short sleep (≤6 h) during internship as good sleepers (OR = 2.38, 95% CI = 1.61, 3.57). Poor sleepers were also at twice the odds for screening positive for probable GAD diagnosis (OR = 2.08, 95% CI = 1.26, 3.45). Notably, sleep onset insomnia strongly predicted anxiety development under stress (OR = 3.55, 95% CI = 1.49, 8.45). During internship, short sleep associated with concurrent anxiety symptoms (b = -0.26, 95% CI = -0.38, -0.14) and predicted future anxiety symptoms even more strongly (b = -0.39, 95% CI = -0.76, -0.03). CONCLUSIONS Poor sleepers, particularly those with sleep onset insomnia symptoms, are vulnerable to short sleep and GAD anxiety and worry during chronic stress.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Novi, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Todd Arnedt
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zhuo Zhao
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jessica R Schubert
- Department of Behavioral Health, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
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79
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Sex differences and the neurobiology of affective disorders. Neuropsychopharmacology 2019; 44:111-128. [PMID: 30061743 PMCID: PMC6235863 DOI: 10.1038/s41386-018-0148-z] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 12/11/2022]
Abstract
Observations of the disproportionate incidence of depression in women compared with men have long preceded the recent explosion of interest in sex differences. Nonetheless, the source and implications of this epidemiologic sex difference remain unclear, as does the practical significance of the multitude of sex differences that have been reported in brain structure and function. In this article, we attempt to provide a framework for thinking about how sex and reproductive hormones (particularly estradiol as an example) might contribute to affective illness. After briefly reviewing some observed sex differences in depression, we discuss how sex might alter brain function through hormonal effects (both organizational (programmed) and activational (acute)), sex chromosome effects, and the interaction of sex with the environment. We next review sex differences in the brain at the structural, cellular, and network levels. We then focus on how sex and reproductive hormones regulate systems implicated in the pathophysiology of depression, including neuroplasticity, genetic and neural networks, the stress axis, and immune function. Finally, we suggest several models that might explain a sex-dependent differential regulation of affect and susceptibility to affective illness. As a disclaimer, the studies cited in this review are not intended to be comprehensive but rather serve as examples of the multitude of levels at which sex and reproductive hormones regulate brain structure and function. As such and despite our current ignorance regarding both the ontogeny of affective illness and the impact of sex on that ontogeny, sex differences may provide a lens through which we may better view the mechanisms underlying affective regulation and dysfunction.
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80
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Anxiety as a Risk Factor for Cognitive Decline: A 12-Year Follow-Up Cohort Study. Am J Geriatr Psychiatry 2019; 27:42-52. [PMID: 30409551 DOI: 10.1016/j.jagp.2018.09.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Anxiety might be a risk factor for cognitive decline, but previous studies had short follow-up or small sample sizes or studied general or single cognitive domain functioning. METHODS Anxiety symptoms were assessed with the Symptom Checklist-90 in 918 participants of the Maastricht Aging Study aged 50 years or older. Anxiety was analyzed both dichotomously (highest versus lower quartiles as a group) and continuously. Neuropsychological tests measured executive function, memory, speed of information processing, and verbal fluency. Linear mixed models were conducted with anxiety symptoms as predictor and change in cognitive scores as outcome. Differences of associations by age and gender were studied with three-way interactions. RESULTS Higher anxiety symptoms were significantly associated with more decline in verbal memory in those aged 65 years and older (delayed recall: χ2 = 9.30, df = 2, p = 0.01; immediate recall: χ2 = 11.81, df = 2, p = 0.003). There were sex differences in executive function (χ2 = 6.63, df = 2, p = 0.036), fluency (χ2 = 6.89, df = 2, p = 0.032), and processing speed (χ2 = 8.83, df = 2, p = 0.012), with lower performance in women over time. CONCLUSION In participants without cognitive impairments at baseline, anxiety symptoms were associated with a decline in verbal memory in older adults and with poorer performance in nonamnestic domains in women. Adequate treatment of anxiety symptoms could have a beneficial influence on the risk of developing neurodegenerative diseases. Further research is needed to elucidate whether this association is causal.
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81
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Goode TD, Maren S. Common neurocircuitry mediating drug and fear relapse in preclinical models. Psychopharmacology (Berl) 2019; 236:415-437. [PMID: 30255379 PMCID: PMC6373193 DOI: 10.1007/s00213-018-5024-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Comorbidity of anxiety disorders, stressor- and trauma-related disorders, and substance use disorders is extremely common. Moreover, therapies that reduce pathological fear and anxiety on the one hand, and drug-seeking on the other, often prove short-lived and are susceptible to relapse. Considerable advances have been made in the study of the neurobiology of both aversive and appetitive extinction, and this work reveals shared neural circuits that contribute to both the suppression and relapse of conditioned responses associated with trauma or drug use. OBJECTIVES The goal of this review is to identify common neural circuits and mechanisms underlying relapse across domains of addiction biology and aversive learning in preclinical animal models. We focus primarily on neural circuits engaged during the expression of relapse. KEY FINDINGS After extinction, brain circuits involving the medial prefrontal cortex and hippocampus come to regulate the expression of conditioned responses by the amygdala, bed nucleus of the stria terminalis, and nucleus accumbens. During relapse, hippocampal projections to the prefrontal cortex inhibit the retrieval of extinction memories resulting in a loss of inhibitory control over fear- and drug-associated conditional responding. CONCLUSIONS The overlapping brain systems for both fear and drug memories may explain the co-occurrence of fear and drug-seeking behaviors.
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Affiliation(s)
- Travis D Goode
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, 301 Old Main Dr., College Station, TX, 77843-3474, USA
| | - Stephen Maren
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, 301 Old Main Dr., College Station, TX, 77843-3474, USA.
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82
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Ahn JK, Kim Y, Choi KH. The Psychometric Properties and Clinical Utility of the Korean Version of GAD-7 and GAD-2. Front Psychiatry 2019; 10:127. [PMID: 30936840 PMCID: PMC6431620 DOI: 10.3389/fpsyt.2019.00127] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/21/2019] [Indexed: 01/26/2023] Open
Abstract
Generalized anxiety disorder (GAD) is a common but serious form of anxiety disorder. Despite this, the rate of GAD recognition in primary care remains low in both Western and Eastern countries. The GAD-7 and GAD-2 were developed to efficiently identify people with GAD, and their reliability and validity have been well-documented in Western countries. The GAD-7 and GAD-2 have also been widely utilized to screen for other anxiety disorders; however, their diagnostic utility has not been fully justified with empirical support, especially in East Asian samples. In this study, we examined the diagnostic sensitivity and specificity of these screening tools for identifying individuals with GAD or other anxiety disorders, and recommended screening cutoff scores for GAD and other anxiety disorders for use in Korea. Based on the rigorous standard suggested by the Quality Assessment of Diagnostic Accuracy Studies-2, a total of 1,157 participants randomly recruited from the community completed the GAD-7, GAD-2, and other anxiety and depression measures in a counter-balanced order. All participants were assessed, and their psychiatric diagnosis confirmed through a structured clinical interview conducted by independent clinicians blinded to the results of the self-report questionnaires. The GAD-7 and GAD-2 both showed excellent reliability and validity. Notably, both the GAD-7 and GAD-2 demonstrated acceptable diagnostic accuracy in detecting GAD with similar recommended cut-off scores as those reported in Western countries, but unacceptable diagnostic accuracy for other anxiety disorders. We conclude that given their brevity, the GAD-7 and GAD-2 can be well-utilized to identify people with GAD for preventative evaluation and treatment in Korea. Use of the GAD-7 and GAD-2 for screening other anxiety disorders should be cautioned.
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Affiliation(s)
- Jung-Kwang Ahn
- Department of Psychology, Korea University Mind Health Institute, Korea University, Seoul, South Korea
| | - Yeseul Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University Mind Health Institute, Korea University, Seoul, South Korea.,Department of Psychology, Korea University, Seoul, South Korea
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83
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Richardson GB, Blount TN, Hanson-Cook BS. Life History Theory and Recovery From Substance Use Disorder. REVIEW OF GENERAL PSYCHOLOGY 2018. [DOI: 10.1037/gpr0000173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recovery has emerged as an important paradigm in addictions treatment but the field has yet to achieve consensus on how it should be defined and measured. The recovery construct has been extended beyond sustained reductions in use or abstinence to enhancements in global health/well-being and also prosocial community reintegration. However, few studies have included these broader domains in their measurement of recovery and few scientific theories have been advanced to explain why reductions in substance use occasion these broader life changes. This article applies life history theory to recovery for the first time to help define recovery, advance recovery measurement, and explain why broad change across multiple life domains should facilitate sustained recovery progress. We conclude with a discussion of future directions and challenges for future research informed by our life history framework for recovery.
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Affiliation(s)
- George B. Richardson
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati
| | - Taheera N. Blount
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati
| | - Blair S. Hanson-Cook
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati
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84
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Asami T, Yoshida H, Takaishi M, Nakamura R, Yoshimi A, Whitford TJ, Hirayasu Y. Thalamic shape and volume abnormalities in female patients with panic disorder. PLoS One 2018; 13:e0208152. [PMID: 30566534 PMCID: PMC6300210 DOI: 10.1371/journal.pone.0208152] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022] Open
Abstract
The thalamus is believed to play crucial role in processing viscero-sensory information, and regulating the activity of amygdala in patients with panic disorder (PD). Previous functional neuroimaging studies have detected abnormal activation in the thalamus in patients with PD compared with healthy control subjects (HC). Very few studies, however, have investigated for volumetric abnormalities in the thalamus in patients with PD. Furthermore, to the best of our knowledge, no previous study has investigated for shape abnormalities in the thalamus in patients with PD. Twenty-five patients with PD and 25 HC participants (all female) were recruited for the study. A voxel-wise volume comparison analysis and a vertex-wise shape analysis were conducted to evaluate structural abnormalities in the PD patients compared to HC. The patients with PD demonstrated significant gray matter volume reductions in the thalamus bilaterally, relative to the HC. The shape analysis detected significant inward deformation in some thalamic regions in the PD patients, including the anterior nucleus, mediodorsal nucleus, and pulvinar nucleus. PD patients showed shape deformations in key thalamic regions that are believed to play a role in regulating emotional and cognitive functions.
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Affiliation(s)
- Takeshi Asami
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Haruhisa Yoshida
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masao Takaishi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Ryota Nakamura
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Asuka Yoshimi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Thomas J. Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Yoshio Hirayasu
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Heian Hospital, Urazoe, Japan
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85
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Hennemann S, Farnsteiner S, Sander L. Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research. Internet Interv 2018; 14:1-17. [PMID: 30510909 PMCID: PMC6205252 DOI: 10.1016/j.invent.2018.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/17/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mental disorders are characterized by a high likelihood of recurrence. Thus, aftercare and follow-up interventions aim to maintain treatment gains and to prevent relapse. Internet- and mobile-based interventions (IMIs) may represent promising instruments in tertiary prevention. This systematic review summarizes and evaluates the research on the efficacy of IMIs as aftercare or follow-up interventions for adults with mental health issues. METHODS A systematic database search (PsycInfo, MEDLINE, CENTRAL) was conducted and studies selected according to predefined eligibility criteria (RCTs, adult population, clinical symptoms/disorder, assessed with validated instruments, clinical-psychological intervention rationale, aftercare/follow-up intervention, web-/mobile-based, minimum follow-up measurement of three months, inclusion of a control group). Inspected outcomes were symptom severity, recurrence- and rehospitalization rates, functioning, quality of life and adherence to primary treatment.Systematic review registration: PROSPERO CRD42017055289. RESULTS Sixteen RCTs met the inclusion criteria, covering trials on depression (n = 5), eating disorders (n = 4) and transdiagnostic interventions (n = 7). The majority of the interventions were based on Cognitive Behavioral Therapy (CBT) principles and were web-based (n = 11). Methodological quality of included studies was suboptimal. Limitations included attrition bias and non-specification of routine care co-interventions. IMIs yielded small to medium post-treatment effects for symptom severity (d = -0.08 - d = -0.45) in comparison to control groups. Best evidence base was found for symptom severity of depression and anxiety. Study results regarding recurrence and rehospitalization were inconsistent. DISCUSSION There is some evidence, that IMIs are feasible instruments for maintaining treatment gains for some mental disorders. However, further high quality, large-scale trials are needed to expand research fields, improve adherence to and uptake of IMIs and facilitate implementation of effective interventions into routine care.
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Affiliation(s)
- Severin Hennemann
- University of Mainz, Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany
| | - Sylvia Farnsteiner
- University of Mainz, Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany
| | - Lasse Sander
- University of Freiburg, Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Engelbergerstraße 41, 79085 Freiburg, Germany
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86
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Shah R, Zanarini MC. Comorbidity of Borderline Personality Disorder: Current Status and Future Directions. Psychiatr Clin North Am 2018; 41:583-593. [PMID: 30447726 DOI: 10.1016/j.psc.2018.07.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with borderline personality disorder have high rates of comorbid mood, anxiety, substance use, and eating disorders. The longitudinal studies conducted on borderline patients over 10 years of prospective follow-up suggest that patients with borderline personality disorder experienced declining rates of Axis I disorders over time, but the rates of these disorders remained high compared with those with other personality disorders. In addition, patients whose borderline personality disorder remitted over time experienced a substantial decline in all comorbid Axis I disorders, but those whose borderline personality disorder did not remit over time, reported stable rates of comorbid disorders.
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Affiliation(s)
- Ravi Shah
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA.
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87
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Sado M, Park S, Ninomiya A, Sato Y, Fujisawa D, Shirahase J, Mimura M. Feasibility study of mindfulness-based cognitive therapy for anxiety disorders in a Japanese setting. BMC Res Notes 2018; 11:653. [PMID: 30189900 PMCID: PMC6127937 DOI: 10.1186/s13104-018-3744-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/28/2018] [Indexed: 12/05/2022] Open
Abstract
Objective Mindfulness-based cognitive therapy (MBCT) could be a treatment option for anxiety disorders. Although its effectiveness under conditions of low pharmacotherapy rates has been demonstrated, its effectiveness under condition of high pharmacotherapy rate is still unknown. The aim of the study was to evaluate effectiveness of MBCT under the context of high pharmacotherapy rates. Results A single arm with pre-post comparison design was adopted. Those who had any diagnosis of anxiety disorders, between the ages of 20 and 74, were included. Participants attended 8 weekly 2-hour-long sessions followed by 2 monthly boosters. Evaluation was conducted at baseline, in the middle, at end of the intervention, and at follow-up. The State-Trait Anxiety Inventory (STAI)-state was set as the primary outcome. Pre-post analyses with mixed-effect models repeated measures were conducted. Fourteen patients were involved. The mean age was 45.0, and 71.4% were female. The mean change in the STAI-state at every point showed statistically significant improvement. The STAI-trait also showed improvement at a high significance level from the very early stages. The participants showed significant improvement at least one point in some other secondary outcomes. Trial registration Retrospectively registered at the University Hospital Medical Information Network on 1st August 2013 (ID: UMIN000011347)
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Affiliation(s)
- Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. .,Center for Stress Research, Keio University, Tokyo, Japan.
| | - Sunre Park
- Faculty of Nursing and Medicine Care, Keio University, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Akira Ninomiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
| | - Yasuko Sato
- Department of Nursing, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Daisuke Fujisawa
- Palliative Care Center, Keio University Hospital, Tokyo, Japan.,Division of Patient Safety, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Joichiro Shirahase
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Stress Research, Keio University, Tokyo, Japan
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88
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Kang S, Vervliet B, Engelhard IM, van Dis EA, Hagenaars MA. Reduced return of threat expectancy after counterconditioning versus extinction. Behav Res Ther 2018; 108:78-84. [DOI: 10.1016/j.brat.2018.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/10/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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89
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Bosman RC, Waumans RC, Jacobs GE, Oude Voshaar RC, Muntingh AD, Batelaan NM, van Balkom AJ. Failure to Respond after Reinstatement of Antidepressant Medication: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:268-275. [PMID: 30041180 PMCID: PMC6191880 DOI: 10.1159/000491550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/23/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Following remission of an anxiety disorder or a depressive disorder, antidepressants are frequently discontinued and in the case of symptom occurrence reinstated. Reinstatement of antidepressants seems less effective in some patients, but an overview is lacking. This systematic review aimed to provide insight into the magnitude and risk factors of response failure after reinstatement of antidepressants in patients with anxiety disorders, depressive disorders, obsessive-compulsive disorder (OCD), or posttraumatic stress disorder (PTSD). METHOD PubMed, Embase, and trial registers were systematically searched for studies in which patients: (1) had an anxiety disorder, a depressive disorder, OCD, or PTSD and (2) experienced failure to respond after reinstatement of a previously effective antidepressant. RESULTS Ten studies reported failure to respond following antidepressant reinstatement. The phenomenon was observed in 16.5% of patients with a depressive disorder, OCD, and social phobia and occurred in all common classes of antidepressants. The range of response failure was broad, varying between 3.8 and 42.9% across studies. No risk factors for failure to respond were investigated. The overall study quality was limited. CONCLUSION Research investigating response failure is scarce and the study quality limited. Response failure occurred in a substantial minority of patients. Contributors to the relevance of this phenomenon are the prevalence of the investigated disorders, the number of patients being treated with antidepressants, and the occurrence of response failure for all common classes of antidepressants. This systematic review highlights the need for studies systematically investigating this phenomenon and associated risk factors.
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Affiliation(s)
- Renske C. Bosman
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,GGZ inGeest, Amsterdam, the Netherlands,*Renske C. Bosman, Department of Psychiatry, VU University Medical Center Amsterdam, Oldenaller 1, NL–1081 HL Amsterdam (The Netherlands), E-Mail
| | - Ruth C. Waumans
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,GGZ inGeest, Amsterdam, the Netherlands
| | - Gabriel E. Jacobs
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands,Centre for Human Drug Research, Leiden, the Netherlands
| | - Richard C. Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Anna D.T. Muntingh
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,GGZ inGeest, Amsterdam, the Netherlands
| | - Neeltje M. Batelaan
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,GGZ inGeest, Amsterdam, the Netherlands
| | - Anton J.L.M. van Balkom
- Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,GGZ inGeest, Amsterdam, the Netherlands
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90
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Cândea DM, Szentagotai-Tătar A. Shame-proneness, guilt-proneness and anxiety symptoms: A meta-analysis. J Anxiety Disord 2018; 58:78-106. [PMID: 30075356 DOI: 10.1016/j.janxdis.2018.07.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Abstract
There is a growing body of investigations showing that shame and guilt are important features of various psychological problems including anxiety disorders. This study quantitatively summarized the magnitude of the associations of shame and guilt with anxiety symptoms. We looked both at the associations with broader categories of anxiety symptoms (i.e., undifferentiated anxiety symptoms, trait and state anxiety), but also with symptoms specific to individual anxiety disorders. In most cases, shame was more strongly associated with anxiety symptoms (in general medium effect sizes) than guilt (in general small effect sizes). When controlling for the shared variance of shame and guilt, in most cases only shame remained significantly associated with anxiety symptoms. Moderation analyses testing for the effect of subtype of shame/guilt, type of measurement, clinical status, age and gender were conducted. Two types of guilt seem to be equally maladaptive as shame, generalized guilt (involving a free-floating guilt separated from specific contexts) and contextual-maladaptive guilt (involving an inappropriate or exaggerated feeling of responsibility). External shame (perceived negative evaluations of others) seems to be more strongly associated with social anxiety symptoms than internal shame (negative self-evaluations). Results for other moderators and implications are discussed in light of the existing theoretical and empirical data.
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Affiliation(s)
- Diana-Mirela Cândea
- Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, 37 Republicii Street 400015, Cluj-Napoca, Romania; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, 37 Republicii Street 400015, Cluj-Napoca, Romania
| | - Aurora Szentagotai-Tătar
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, 37 Republicii Street 400015, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania.
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91
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Moreno-Rius J. The cerebellum in fear and anxiety-related disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 85:23-32. [PMID: 29627508 DOI: 10.1016/j.pnpbp.2018.04.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 01/06/2023]
Abstract
Fear and anxiety-related disorders are highly prevalent psychiatric conditions characterized by avoidant and fearful reactions towards specific stimuli or situations, which are disproportionate given the real threat such stimuli entail. These conditions comprise the most common mental disorder group. There are a high proportion of patients who fail to achieve remission and the presence of high relapse rates indicate the therapeutic options available are far from being fully efficient. Despite an increased understanding the neural circuits underlying fear and anxiety-related behaviors in the last decades, a factor that could be partially contributing to the lack of adequate therapies may be an insufficient understanding of the core features of the disorders and their associated neurobiology. Interestingly, the cerebellum shows connections with fear and anxiety-related brain areas and functional involvement in such processes, but explanations for its role in anxiety disorders are lacking. Therefore, the aims of this review are to provide an overview of the neural circuitry of fear and anxiety and its connections to the cerebellum, and of the animal studies that directly assess an involvement of the cerebellum in these processes. Then, the studies performed in patients suffering from anxiety disorders that explore the cerebellum will be discussed. Finally, we'll propose a function for the cerebellum in these disorders, which could guide future experimental approaches to the topic and lead to a better understanding of the neurobiology of anxiety-related disorders, ultimately helping to develop more effective treatments for these conditions.
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Affiliation(s)
- Josep Moreno-Rius
- Department of Pharmacology and Toxicology, University of Innsbruck, Innsbruck, Austria.
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92
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King G, Graham BM, Richardson R. Effects of d-cycloserine on individual differences in relapse of fear. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:115-121. [PMID: 29432876 DOI: 10.1016/j.pnpbp.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/31/2018] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Abstract
The major weakness of psychological and pharmacological interventions for anxiety disorders is that the fear often returns. We examined whether DCS, which has attracted considerable attention as a potential pharmacological adjunct to therapy, reduces relapse, and whether individual differences in the rate of extinction modulates its effectiveness in reducing relapse. Experimentally-naïve adult male rats received pairings of a white noise CS with a shock US, extinction to a criterion immediately followed by an injection of DCS or Saline, and then were tested for relapse of fear (renewal, spontaneous recovery, or reinstatement; in four separate experiments). The number of blocks to reach criteria in extinction was used to classify animals as "Fast" or "Slow" Extinguishers. We consistently found that while DCS reduced relapse in Fast Extinguishers, it had minimal effects on relapse in Slow Extinguishers. Importantly, the differences in the effect of DCS on Fast and Slow Extinguishers was not due to Fast Extinguishers being less susceptible to relapse as animals in both groups exhibited similar amounts of relapse when injected with saline. Relapse, of all three types tested, was consistently reduced by DCS, but only in the Fast Extinguishers. Such findings contribute to a growing literature identifying factors that could influence the efficacy of pharmacological adjuncts to exposure therapy. These results have important implications for the development of personalized treatment approaches, which recognize, and are tailored to, individual differences.
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Affiliation(s)
- Gabrielle King
- School of Psychology, The University of New South Wales, Australia.
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales, Australia
| | - Rick Richardson
- School of Psychology, The University of New South Wales, Australia
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93
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Mays VM, Jones AL, Cochran SD, Taylor RJ, Rafferty J, Jackson JS. Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences. Healthcare (Basel) 2018; 6:E53. [PMID: 29882853 PMCID: PMC6023328 DOI: 10.3390/healthcare6020053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 11/16/2022] Open
Abstract
This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men.
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Affiliation(s)
- Vickie M Mays
- Departments of Psychology and Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA 90095, USA.
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Veteran Affairs Salt Lake City Health Care System, Salt Lake City, UT 84148, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | - Susan D Cochran
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
- Departments of Epidemiology and Statistics, University of California, Los Angele Fielding School of Public Health, Los Angeles, CA 90095, USA.
| | - Robert Joseph Taylor
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA.
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA.
| | - Jane Rafferty
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA.
| | - James S Jackson
- Program for Research on Black Americans, Institute of Social Research, Ann Arbor, MI 48106, USA.
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA.
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94
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Abstract
Relapses represent a major limitation to the long-term remission of pathological fear and anxiety. Stress modulates the acquisition and expression of fear memories and appears to promote fear recovery in patients with anxiety disorders. However, the neural correlates underlying stress hormone effects on the return of fear in humans remain unexplored. Likewise, little is known about the interactions between sex and stress hormones on return of fear phenomena. In this functional magnetic resonance imaging study, 32 men and 32 women were exposed to a fear renewal paradigm with fear acquisition in context A and extinction in context B. On the following day, participants received either cortisol or placebo 40 min before return of fear was tested in both contexts in a renewal and reinstatement test. Cortisol increased differential conditioned skin conductance responses in the extinction context B following reinstatement in men but not in women. On the neural level, this effect was characterized by enhanced fear-related activation in the right amygdala in men, while an activation decrement in this region was observed after cortisol treatment in women. Our results revealed that cortisol promotes the return of fear in men by strengthening a key node of the fear network - the amygdala. We thereby provide novel insights into a sex-specific mechanism mediating stress-induced fear recovery which may translate into different relapse risks and treatment strategies for men and women.
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Affiliation(s)
- Valerie L Kinner
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr-Universität Bochum, Universitätsstraße 150, 44780 Bochum, Germany.
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr-Universität Bochum, Universitätsstraße 150, 44780 Bochum, Germany.
| | - Christian J Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr-Universität Bochum, Universitätsstraße 150, 44780 Bochum, Germany.
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95
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Asher M, Aderka IM. Gender differences in social anxiety disorder. J Clin Psychol 2018; 74:1730-1741. [DOI: 10.1002/jclp.22624] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/26/2018] [Accepted: 03/19/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Maya Asher
- Department of Psychology; University of Haifa
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96
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Carlier IVE, Andree Wiltens DH, van Rood YR, van Veen T, Dekker J, van Hemert AM. Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care. Clin Psychol Psychother 2018; 25:550-564. [PMID: 29573030 DOI: 10.1002/cpp.2191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/27/2022]
Abstract
AIM Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. METHOD The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini-International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery-Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC). RESULTS The study population generally showed high co-morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36). CONCLUSION Secondary psychiatric care outpatients with somatoform disorders showed high co-morbidity with anxiety and mood disorders, and an unfavourable 6-month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co-morbidity in somatoform disorders.
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Affiliation(s)
- I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - T van Veen
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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97
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Gillett CB, Bilek EL, Hanna GL, Fitzgerald KD. Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clin Psychol Rev 2018; 60:100-108. [DOI: 10.1016/j.cpr.2018.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/12/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
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98
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Offspring of depressed and anxious patients: Help-seeking after first onset of a mood and/or anxiety disorder. J Affect Disord 2018; 227:618-626. [PMID: 29172055 DOI: 10.1016/j.jad.2017.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Offspring of patients with depressive and/or anxiety disorders are at high risk of developing a similar disorder themselves. Early recognition and treatment may have substantial effects on prognosis. The main aim of this study was to examine the time to initial help-seeking and its determinants in offspring after the first onset of a mood and/or anxiety disorder. METHODS Data are presented of 215 offspring with a mood and/or anxiety disorder participating in a cohort study with 10 year follow-up. We determined age of disorder onset and age of initial help-seeking. Offspring characteristics (gender, IQ, age of onset, disorder type, suicidal ideation) and family characteristics (socioeconomic status, family functioning) were investigated as potential predictors of the time to initial help-seeking. RESULTS The estimated overall proportion of offspring of depressed/anxious patients who eventually seek help after onset of a mood and/or anxiety disorder was 91.9%. The time to initial help-seeking was more than two years in 39.6% of the offspring. Being female, having a mood disorder or comorbid mood and anxiety disorder (relative to anxiety) and a disorder onset in adolescence or adulthood (relative to childhood) predicted a shorter time to initial help-seeking. LIMITATIONS Baseline information relied on retrospective reports. Age of onsets and age of initial help-seeking may therefore be subject to recall bias. CONCLUSION Although most offspring eventually seek help after onset of a mood/anxiety disorder, delays in help-seeking were common, especially in specific subgroups of patients. This information may help to develop targeted strategies to reduce help-seeking delays.
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99
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Aktar E, Nikolić M, Bögels SM. Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 28867938 PMCID: PMC5573558 DOI: 10.31887/dcns.2017.19.2/eaktar] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Generalized anxiety disorder (GAD) runs in families. Building on recent theoretical approaches, this review focuses on potential environmental pathways for parent-to-child transmission of GAD. First, we address child acquisition of a generalized pattern of fearful/anxious and avoidant responding to potential threat from parents via verbal information and via modeling. Next, we address how parenting behaviors may contribute to maintenance of fearful/anxious and avoidant reactions in children. Finally, we consider intergenerational transmission of worries as a way of coping with experiential avoidance of strong negative emotions and with intolerance of uncertainty. We conclude that parents with GAD may bias their children's processing of potential threats in the environment by conveying the message that the world is not safe, that uncertainty is intolerable, that strong emotions should be avoided, and that worry helps to cope with uncertainty, thereby transmitting cognitive styles that characterize GAD. Our review highlights the need for research on specific pathways for parent-to-child transmission of GAD.
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Affiliation(s)
- Evin Aktar
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands; Clinical Psychology Unit, Leiden University, the Netherlands
| | - Milica Nikolić
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
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100
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Ojserkis R, Boisseau CL, Reddy MK, Mancebo MC, Eisen JL, Rasmussen SA. The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD. Psychiatry Res 2017; 258:78-82. [PMID: 28988123 PMCID: PMC5681424 DOI: 10.1016/j.psychres.2017.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 02/06/2023]
Abstract
Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective analyses, or small sample sizes. The current study extended this research by comparing the clinical characteristics of individuals with OCD with and without a lifetime PTSD diagnosis in a large, naturalistic, longitudinal sample over the course of seven years. At baseline, individuals with comorbid lifetime PTSD reported significantly more severe symptoms of OCD (including symptom levels and insight), lower quality of life, and higher rates of comorbid lifetime mood and substance use disorders than participants without lifetime PTSD. Further, individuals with comorbid OCD and lifetime PTSD reported significantly more severe OCD symptoms over the course of seven years than those without lifetime PTSD. These results are largely consistent with the existing literature and support the need to consider PTSD symptoms in the assessment and treatment of OCD.
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Affiliation(s)
- Rachel Ojserkis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA.
| | - Christina L Boisseau
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Madhavi K Reddy
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; McGovern Medical School, The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, USA
| | - Maria C Mancebo
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Jane L Eisen
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Mount Sinai St. Luke's/Mount Sinai West, Department of Psychiatry, 1090 Amsterdam Avenue, New York, NY 10025, USA
| | - Steven A Rasmussen
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA
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