Anxiety Disorders: A Review

Stressor-evoked heart rate, perceived physiological arousal, and anxiety symptoms in young adults

BACKGROUND

Acute psychological stress is associated with increases in heart rate (HR) and state anxiety. Stressor-evoked perceived HR changes relate more strongly to state anxiety than actual HR reactivity. However, research has yet to examine these associations in the context of general anxiety symptoms.

METHODS

Participants (N = 160) completed a resting baseline period followed by a standardized acute psychological stress task; HR was recorded throughout. After the stress task, participants rated their perceived stressor-evoked physiological arousal and anxiety intensity. Participants also completed a general anxiety symptoms measure ~17 days later.

RESULTS

The a priori hypothesized model demonstrated a good fit to the data, χ2 (59) = 93.15, p = .003; CFI = 0.94; TLI = 0.91; SRMR = 0.05; RMSEA = 0.06 (90 % CI = 0.04-0.08). After controlling for covariates, perceived physiological arousal was positively related to both cognitive and somatic anxiety. In turn, only somatic anxiety was positively associated with general anxiety symptoms. Perceived physiological arousal was related to general anxiety symptoms through state somatic anxiety. HR reactivity was not statistically significantly associated with either cognitive or somatic anxiety.

LIMITATIONS

The study was correlational, which limits the ability to determine causation.

CONCLUSIONS

Perceived HR, rather than actual HR, is more closely associated with anxiety intensity during acute psychological stress. Stressor-evoked perceived HR and general anxiety symptoms are related indirectly through stressor-evoked somatic anxiety intensity. The findings have implications for elucidating the mechanisms of the stress-anxiety relationship.

SSRI use is not associated with the intensity of romantic love, obsessive thinking about a loved one, commitment, or sexual frequency in a sample of young adults experiencing romantic love

For >15 years, researchers have speculated that selective serotonin reuptake inhibitor (SSRI) use is associated with negative romantic love outcomes. No one has empirically investigated this, however. Drawing on 810 participants from the Romantic Love Survey 2022, we used binary logistic regression to identify differences between young adults experiencing romantic love who were and were not taking SSRIs. Predictor variables were biological sex, mental health problems, intensity of romantic love, obsessive thinking about a loved one, commitment, and frequency of sex. Only biological sex and mental health problems were associated with SSRI use. None of our romantic love variables were associated with SSRI use. This is the first evidence to demonstrate that SSRI use is not associated with some features of romantic love in a sample of young adults experiencing romantic love. The findings have implications for clinical practice and can be used to allay some concerns among individuals considering commencing SSRIs for common mental health problems.

Anxiolytic effects of accelerated continuous theta burst stimulation on mice exposed to chronic restraint stress and the underlying mechanism involving gut microbiota

BACKGROUND

Accelerated continuous theta burst stimulation (acTBS) is a more intensive and rapid protocol than continuous theta burst stimulation (cTBS). However, it remains uncertain whether acTBS exhibits anxiolytic effects. The aim of this study was to investigate the impact of acTBS on anxiety model mice and elucidate the underlying mechanisms involved, in order to provide a more comprehensive understanding of its effects.

METHODS

Chronic restraint stress (CRS) model was employed to observe the anxiolytic effects of acTBS. The study focused on evaluating the impact of acTBS on behavior, neuroinflammation, gut and gut microbiota in mice with anxiety induced by CRS.

RESULTS

The application of acTBS ameliorated anxiety-like behaviors in CRS-induced mice. Notably, it effectively suppressed the activation of microglia and reduced the level pro-inflammatory cytokines in PFC, hippocampus, and amygdala of anxiety mice. Additionally, acTBS alleviated astrocyte activation specifically in hippocampus. The NF-κB signaling pathway involved in the anti-inflammatory effects of acTBS. Furthermore, acTBS ameliorated inflammation and histological damage in colon. 16S rRNA analysis revealed that acTBS significantly enhanced the relative abundance of Lactobacillus, while normalized the dysregulated levels of Coriobacterales, Bacteroides, and Parabacteroides caused by CRS. These changes facilitated chemoheterotrophic and fermentation functions within the microbiota. Importantly, changes in microbiota composition influenced by acTBS was found to be correlated with anxiety-like behaviors and neuroinflammation.

CONCLUSIONS

acTBS exerted anxiolytic effects on mice exposed to CRS, which was associated with the modulation of gut microbiota.

Evidence for a causal link between lipoprotein (a) and mental disorders: A retrospective and Mendelian randomization study

STUDY OBJECTIVES

Lipoprotein (a) [Lp(a)] is a biomarker of atherosclerotic cardiovascular disease, but its role in mental disorders is controversial. Our study aimed to explore the causality between Lp(a) levels and mental disorders by combining retrospective and Mendelian randomization (MR) studies.

METHODS

All genome-wide association study datasets used in the MR study were obtained from UK Biobank, FinnGen, and the Psychiatric Genomics Consortium. The matched case-control study were based on electronic health records from the Second Affiliated Hospital of Nanchang University and NHANES III cohort.

RESULTS

In the MR analysis, Lp(a) had a positive causal effect on the longest period of depression [1.05 (1.02-1.08), P = 0.0001], the number of depressive episodes [1.03 (1.01-1.06), P = 0.009] and a weak negative effect on memory loss [0.84 (0.72-0.99), P = 0.039]. Meanwhile, bipolar and major depressive disorder status was causally associated with significantly lower Lp(a) levels [0.96 (0.93-0.98), P = 0.003]. Retrospective study revealed low Lp(a) levels were associated with a significantly higher risk of depression (n = 670) [1.273 (1.007, 1.609), P = 0.044], anxiety (n = 1284) [1.231 (1.041, 1.456), P = 0.015] and major depression (n = 538) [1.364 (1.012,1.841), P = 0.042].

CONCLUSIONS

This study found there is a causal relationship between the number and longest period of depressive episodes or memory loss and Lp(a), while bipolar disorder and major depressive disorder were associated with a significant causal effect on reduced Lp(a) levels. Future studies should focus on whether a sustained decrease in Lp(a) levels could cause the development of mental disorders, and which target value is suitable for clinical practice.

Perceived stress mediates the longitudinal effect of sleep quality on internalizing symptoms

BACKGROUND

Numerous studies have explored the relationship between sleep quality and internalizing symptoms (i.e., depression and anxiety), but there is uncertainty about their directional pathways. Here, we investigated the longitudinal associations between sleep quality and internalizing symptoms and tested the potential mediation effect of perceived stress.

METHODS

A longitudinal survey of Chinese healthcare students (N = 343) was conducted at three time points: Time 1 (baseline), Time 2 (1 week later), and Time 3 (3 weeks after Time 2). Participants completed the Sleep Quality Questionnaire (SQQ), Perceived Stress Questionnaire-30 (PSQ-30), and the Patient Health Questionnaire-4 (PHQ-4) at each time point, where each asked about participants' experiences over the past week. A higher SQQ score indicated poorer sleep quality, while higher scores on the PHQ-4 and PSQ-30 indicated more severe internalizing symptoms and perceived stress. Using autoregressive cross-lagged panel modeling (CLPM), we examined the bidirectional relationships among sleep quality, internalizing symptoms, and perceived stress.

RESULTS

CLPM revealed that baseline sleep quality negatively predicted subsequent changes in internalizing symptoms, and vice versa. While perceived stress mediated the relationship between sleep quality and internalizing symptoms at the 3-week follow-up (β = 0.017, p = .038), it did not mediate the reverse relationship between internalizing symptoms and sleep quality.

CONCLUSIONS

There was a negative bidirectional relationship between sleep quality and internalizing symptoms. Furthermore, perceived stress mediated the effect of poor sleep quality on internalizing symptoms, suggesting that good-quality sleep may enhance stress resilience and alleviate symptoms of depression and anxiety, thereby improving overall wellbeing.

Treating anxiety comorbidity: Lessons from exposure generalization studies

Comorbidity is a characteristic hallmark of anxiety disorders. Presence of comorbid anxiety and depression is challenging to the diagnosis and treatment. Conventional and transdiagnostic treatment options for anxiety disorders strongly depend on the use of exposure. Recent compelling evidence suggests that the beneficial effects of exposure therapy are transferable across different fear- and anxiety provoking situations and might even affect depressive symptomatology. We provide an overview of findings on existing studies on generalization of exposure effects to untreated stimuli and depression. Potential mechanisms which contribute to generalization of beneficial exposure therapy effects, such as extinction generalization, mastery-related increases in self-efficacy and underlying neural changes are presented and discussed. Understanding and promoting mechanisms related to exposure therapy efficacy and generalization can expedite and enhance the development of more effective transdiagnostic therapy approaches for comorbid anxiety disorders.

Trends in Outpatient Psychotherapy Among Adults in the US

Importance

While access to psychotherapy has recently increased in the US, concern exists that recent gains may be unevenly distributed despite teletherapy expansion.

Objective

To characterize recent trends and patterns in outpatient psychotherapy by US adults.

Design, Setting, and Participants

This is a repeated cross-sectional study of psychotherapy use among adults (ages ≥18 years) in the 2018 to 2021 Medical Expenditure Panel Surveys, which are nationally representative surveys of the civilian noninstitutionalized population. Data were analyzed from March to August 2024.

Main Outcomes and Measures

Age-, sex-, and distress-adjusted differences between 2018 and 2021 in use of any psychotherapy and video-based psychotherapy (teletherapy) in 2021 with tests for trend differences (interactions) across levels of sociodemographic characteristics and distress were assessed. Psychological distress was measured using the Kessler-6 scale, with scores of 13 or higher defining serious psychological distress, 1 to 12 defining mild to moderate distress, and 0 defining no distress.

Results

The analysis involved 89 619 participants (47 838 female [51.5%] and 41 781 male [48.5%]; 22 510 aged 18-34 years [29.0%], 43 371 aged 35-64 years [48.8%], and 23 738 aged ≥65 years [22.2%]). Between 2018 and 2021, psychotherapy use increased significantly faster for females (931/12 270 females [7.7%] to 1207/12 237 females [10.5%]) than males (547/10 741 males [5.2%] to 655/10 544 males [6.3%]), younger (455/6149 individuals [8.0%] to 602/5296 individuals [11.9%] aged 18-34 years) than older (217/5550 individuals [3.6%] to 304/6708 individuals [4.6%] aged ≥65 years) adults, college graduates (503/6456 adults [7.6%] to 810/7277 adults [11.4%]) than those without a high school diploma (193/3824 adults [5.5%] to 200/3593 adults [7.0%]), privately insured (881/14 387 adults [6.1%] to 1154/13 414 adults [8.9%]) than publicly insured (558/6511 adults [8.8%] to 659/7453 adults [8.8%]) individuals, adults at 2 to 4 times the poverty level (370/6670 adults [5.7%] to 488/6370 adults [8.2%]) than those below the poverty level (384/4495 adults [9.7%] to 428/4760 adults [10.0%]), employed persons overall (733/13 358 adults [5.7%] to 1082/12 365 adults [8.9%]) than unemployed persons aged 65 years and younger (547/5138 adults [10.8%] to 519/4905 adults [10.5%]), and urban (1335/20 682 adults [6.5%] to 1729/20 590 adults [8.7%]) than rural (143/2329 adults [6.4%] to 133/2191 adults [5.9%]) residents. In 2021, after controlling for distress level, teletherapy use was significantly higher among younger than middle-aged (aged 35-64 years: difference, -3.7 percentage points; 95% CI, -5.1 to -2.3) or older (aged ≥65 years: difference, -6.5 percentage points (95% CI, -8.0 to -5.0 percentage points) adults, females (difference, 1.9 percentage points; 95% CI, 0.9 to 2.9 percentage points) than males, not married (difference, 2.9 percentage points; 95% CI, 1.6 to 4.2 percentage points) than married persons, college educated adults (difference, 4.9 percentage points; 95% CI, 3.3 to 6.4 percentage points) than those without a high school diploma, people with higher (eg, 400% vs <100% of the federal poverty level: difference, 2.3 percentage points; 95% CI, 1.2 to 3.5 percentage points) than lower incomes, privately than publicly (difference, -2.5 percentage points; 95% CI, -3.4 to -1.5 percentage points) insured persons, and urban (difference, 2.7 percentage points; 95% CI, 1.5 to 3.8 percentage points) than rural residents.

Conclusions

This study found that psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access. These trends and patterns highlight a need for clinical interventions and health care policies to broaden access to psychotherapy including teletherapy.

Property-Based Design of Xanthine Derivatives as Potent and Orally Available TRPC4/5 Inhibitors for Depression and Anxiety

Transient receptor potential canonical channels 4 and 5 (TRPC4/5) are nonselective cation channels involved in emotional regulation, positioning them to be promising targets for treating mental disorders such as anxiety and depression. HC-070, a potent TRPC4/5 inhibitor, exhibits significant anxiolytic and antidepressant effects in animal models, though its drug-like properties require optimization. In this study, we applied a property-based drug design (PBDD) approach to optimize HC-070, leading to the discovery of compound 32, which shows improved LipE and Fsp3 values, reduced hERG blocking activity, enhanced metabolic stability, increased aqueous solubility, and superior oral bioavailability. Oral administration of compound 32 in mouse models demonstrates anxiolytic and antidepressant efficacy comparable to fluoxetine. This study supports the therapeutic potential of TRPC4/5 inhibitors for mental disorders and identifies compound 32 as a promising candidate for further investigation. Furthermore, our work underscores the value of PBDD in optimizing lead compounds during drug discovery process.

Coding principles and mechanisms of serotonergic transmission modes

Serotonin-mediated intercellular communication has been implicated in myriad human behaviors and diseases, yet how serotonin communicates and how the communication is regulated remain unclear due to limitations of available monitoring tools. Here, we report a method multiplexing genetically encoded sensor-based imaging and fast-scan cyclic voltammetry, enabling simultaneous recordings of synaptic, perisynaptic, proximate and distal extrasynaptic serotonergic transmission. Employing this method alongside a genetically encoded sensor-based image analysis program (GESIAP), we discovered that heterogeneous firing patterns of serotonergic neurons create various transmission modes in the mouse raphe nucleus and amygdala, encoding information of firing pulse frequency, number, and synchrony using neurotransmitter quantity, releasing synapse count, and synaptic and/or volume transmission. During tonic and low-frequency phasic activities, serotonin is confined within synaptic clefts due to efficient retrieval by perisynaptic transporters, mediating synaptic transmission modes. Conversely, during high-frequency, especially synchronized phasic activities, or when transporter inhibition, serotonin may surpass transporter capacity, and escape synaptic clefts through 1‒3 outlet channels, leading to volume transmission modes. Our results elucidate a mechanism of how channeled synaptic enclosures, synaptic properties, and transporters collaborate to define the coding principles of activity pattern-dependent serotonergic transmission modes.

Randomized controlled study of a digital data driven intervention for depressive and generalized anxiety symptoms

As mental health disorders like Major Depressive Disorder and Generalized Anxiety Disorder rise globally, effective, scalable, and personalized treatments are urgently needed. This 16-week prospective, decentralized, randomized, waitlist-controlled study investigated the effectiveness of a digital data-driven therapeutic integrating wearable sensor data with a mobile app to deliver personalized CBT-based interventions for individuals with depressive and generalized anxiety symptoms. 200 adults were randomized to intervention or control groups, with 164 completing the study. The intervention group demonstrated significant reductions in depressive (mean change = -5.61, CI = -7.14, -4.08) and anxiety symptoms (mean change = -5.21, CI = -6.66, -3.76), compared to the control group, with medium-to-large effect sizes (r = 0.64 and r = 0.62, P < 0.001). Notably, these improvements were also observed in participants with clinically significant depression and anxiety, further reinforcing the potential of digital therapeutics in targeting more severe cases. These findings, combined with high engagement levels, suggest that data-driven digital health interventions could complement traditional treatments, though further research is needed to assess their long-term impact.

The (neuro)inflammatory system in anxiety disorders and PTSD: Potential treatment targets

Targeting the immune system has recently garnered attention in the treatment of stress- associated psychiatric disorders resistant to existing pharmacotherapeutics. While such approaches have been studied in considerable detail in depression, the role of (neuro)inflammation in anxiety-related disorders, or in anxiety as an important transdiagnostic symptom, is much less clear. In this review we first critically review clinical and in part preclinical evidence of central and peripheral immune dysregulation in anxiety disorders and post-traumatic stress disorder (PTSD) and briefly discuss proposed mechanisms of how inflammation can affect anxiety-related symptoms. We then give an overview of existing and potential future targets in inflammation-associated signal transduction pathways and discuss effects of different immune-modulatory drugs in anxiety-related disorders. Finally, we discuss key gaps in current clinical trials such as the lack of prospective studies involving anxiety patient stratification strategies based on inflammatory biomarkers. Overall, although evidence is rather limited so far, there is data to indicate that increased (neuro)inflammation is present in subgroups of anxiety disorder patients. Although exact identification of such immune subtypes of anxiety disorders and PTSD is still challenging, these patients will likely particularly benefit from therapeutic targeting of aspects of the inflammatory system. Different anti-inflammatory treatment approaches (microglia-directed treatments, pro-inflammatory cytokine inhibitors, COX-inhibitors, phytochemicals and a number of novel anti-inflammatory agents) have indeed shown some efficacy even in non-stratified anxiety patient groups and appear promising as novel alternative or complimentary therapeutic options in specific ("inflammatory") subtypes of anxiety disorder and PTSD patients.

Development of buspirone hydrochloride-loaded long-acting microneedles for management of anxiety disorders

Buspirone hydrochloride (BSP) is an anxiolytic agent approved for the management of anxiety disorders. The current US-FDA approved medications of BSP are administered via the oral route, which is linked to several disadvantages such as low oral bioavailability and low half-life necessitating multiple daily doses. For chronic diseases such as anxiety disorders, where long-term or lifelong management is often required, these factors impact patient compliance and treatment adherence. The present study offers an alternative treatment approach by investigating the feasibility of sustained transdermal delivery of BSP via long-acting microneedles (MNs). Needle-tip-loaded MNs were fabricated via micro-molding technique using various grades of poly-vinyl alcohol (PVA) namely 4-88, 8-88, 18-88, and 26-88. These MNs were compared using characterization techniques such as Parafilm® insertion testing, scanning electron microscopy (SEM), confocal microscopy, Fourier transform infrared spectroscopy (FTIR), and histological evaluation of MNs-treated human skin. The effect of different grades of PVA on the structural and mechanical properties of the fabricated MNs was evaluated. Further, in vitro release and permeation tests were conducted to assess the drug release patterns and transdermal delivery across dermatomed human skin over 7-day study periods. The highest release (5507.37 ± 456.88 µg/cm2) and delivery (4705.42 ± 634.57 µg/cm2) were observed from PVA 4-88, with significant differences among the PVA grades based on their properties. Notably, all four types of the fabricated PVA MNs crossed the daily and weekly therapeutic targets for the systemic delivery of BSP. Overall, this study established the feasibility of sustained delivery of BSP across the skin using PVA MNs for the management of anxiety disorders.

Isolation and evaluation of rhoifolin: an anxiolytic flavonoid from Citrus paradisi Macfayden var. redblush leaves

Citrus species have a history of use in treating neurological conditions like insomnia, anxiety, and nervousness, though these claims lack exhaustive validation. This study evaluated the anxiolytic activity of Citrus paradisi Macfayden var. redblush leaves, aiming to isolate and characterise the bioactive constituent. Four leaf extracts (petroleum ether (60-80 °C), chloroform, methanol and aqueous) were evaluated for anxiolytic activity using elevated plus maze (EPM) in mice. The methanol extract showed anxiolytic activity and was subjected to bioactivity guided isolation using solvent partitioning, column chromatography and preparative HPLC to isolate the anxiolytic compound, CP-1, characterised as rhoifolin (based on spectroscopic analysis). Rhoifolin, at 0.705% w/w in leaves, was confirmed as anxiolytic compound through additional tests (light-dark box and social interaction tests) and holds promise as a potential treatment for anxiety disorders.

The Value of Non-Instrumental Information in Anxiety: Insights from a Resource-Rational Model of Planning

Anxiety is intimately related to the desire for information and, under some accounts, thought to arise from the intolerance of uncertainty. Here, we seek to test this hypothesis by studying the relationship between trait anxiety and the willingness to pay for non-instrumental information (i.e., information that reveals whether an event will happen but cannot be used to change the outcome). We model behavior with a resource-rational model of planning, according to which non-instrumental information is useful for planning ahead, but paying for this information only makes sense if the anticipated benefits of planning outweigh the cognitive and financial costs. We find a bidirectional effect of trait anxiety factors on information seeking behavior: those with high trait somatic anxiety exhibit a stronger preference for non-instrumental information, whereas those with high trait negative affect exhibit a weaker preference. By fitting the resource-rational model, we find that this divergent desire for information arises from the utility of obtaining information for future planning (increased in somatic anxiety, decreased in negative affect). Our findings lend support to the intolerance of uncertainty hypothesis in somatic anxiety and highlight the importance of studying anxiety as a multifactorial construct.

Examining the influence of two emotion regulation strategies on anxiety in Chinese college students: insights from cross-lagged and moderated network models

BACKGROUND

Anxiety, a prevalent and detrimental mental disorder, usually emerges in late adolescence and emerging adulthood. Emotion regulation strategies, namely expressive suppression and cognitive reappraisal, share a close relation with the onset and maintenance of anxiety. Yet the relation between anxiety and emotion regulation strategies remains controversial and warrants further clarification.

METHODS

The generalized anxiety disorder-7 (GAD-7) was used to measure the anxiety disorders and the emotion regulation questionnaire (ERQ) was utilized to assess the use of two emotion regulation strategies. In study 1, a total of 2201 college students completed two measurement waves (females = 1358, 61.70%, Mage = 18.37). The cross-lagged model was conducted to identify the directional relation between two emotion regulation strategies and anxiety. In study 2, 3150 college students (females = 1562, 49.59%, Mage = 19.73) completed the measurements. The moderated network model was utilized to clarify the influence of emotion regulation strategy on anxiety from the symptomatic perspective.

RESULTS

In study 1, the results of the cross-lagged model suggested that the level of anxiety in wave 2 could be negatively predicted by the cognitive reappraisal (b = -0.552, p < .01) but not by expressive suppression (b = 0.035, p = .174) in wave 1. In study 2, the results of the moderated network indicated that cognitive reappraisal could moderate the interaction between "Excessive worry"-"Irritability", "Nervousness" -"Uncontrollable worry", "Trouble relaxing"-"Nervousness" (GAD1) ,and "Restlessness" -"Irritability".

CONCLUSIONS

The current study confirmed cognitive reappraisal could serve as a protective factor for anxiety by diminishing the positive relation between "Excessive worry"-"Irritability" and "Nervousness" -"Uncontrollable worry". This finding may guide clinical workers to develop more targeted interventions using cognitive reappraisal to alleviate anxiety symptoms.

Effects of A Brief Resonance Frequency Breathing Exercise on Heart Rate Variability and Inhibitory Control in the Context of Generalised Anxiety Disorder

Generalised anxiety disorder (GAD) is associated with cognitive and physiological symptoms including uncontrollable worry, inhibitory control deficits, and low heart rate variability (HRV). Literature linking HRV and inhibition in GAD is predominantly correlational. The present experiment investigated whether HRV has a causal role in maintaining inhibitory control. Participants (N = 135, 111 female) aged 18-37 reporting high levels of symptoms associated with GAD (GAD-7 scores ≥ 10; Penn State Worry Questionnaire scores ≥ 56) were assigned to an experimental or active control condition and completed baseline measures of HRV, respiration rate, and inhibitory control. The experimental condition completed resonance frequency breathing (RFB) training, and the control condition practiced breathing at their mean breathing rate before repeating the inhibitory control assessment. Participants also completed the breathing training before a behavioural worry task. The experimental condition was predicted to show increased HRV, alongside improved inhibitory control and better ability to stop worrying as compared to the control condition. HRV increased during the experimental condition, as compared to the control condition. However, there were no significant effects of RFB on inhibitory control or worry, or on HRV during the inhibitory control tasks. In conclusion, RFB can increase HRV in high GAD scorers, but further research is required to determine whether there is a relationship between increased HRV and symptoms of GAD in a single session experiment.

Confronting the anxiety of Generation Z: electroacupuncture therapy regulates oxidative stress and microglia activity in amygdala-basolateral of socially isolated mice

Introduction

Anxiety disorders are prevalent mental health conditions characterized by significant impairments in daily functioning and social interactions. Despite the effectiveness of pharmacological treatments, challenges such as medication resistance, adverse side effects, and the high rate of relapse necessitate the exploration of alternative therapies. Recently, electroacupuncture (EA) has garnered attention as a promising non-pharmacological intervention for anxiety disorders; however, the mechanisms by which EA exerts its anxiolytic effects remain poorly understood. This study aims to elucidate the role of microglial cells in anxiety, specifically examining how EA modulates microglial morphology and function within the basolateral amygdala (BLA) in the context of anxiety induced by social isolation.

Methods

Utilizing a mouse model of social isolation-induced anxiety, we evaluated anxiety-like behaviors through the Elevated Plus Maze (EPM) and Open Field Test (OFT). Additionally, biochemical analyses and immunofluorescence imaging were performed to assess the expression of NADPH oxidase 2 (NOX2), microglial activation markers, and levels of oxidative stress.

Results

Our findings reveal that EA treatment significantly mitigates anxiety-like behaviors in mice, correlating with a reduction in NOX2 expression within BLA microglia and decreased levels of reactive oxygen species (ROS). Furthermore, EA was observed to restore normal microglial morphology, indicating its potential role in modulating microglial activity.

Discussion

The results of this study suggest that EA exerts its anxiolytic effects through the modulation of oxidative stress and the activity of microglia in the BLA. These findings provide new insights into the cellular mechanisms underlying the therapeutic effects of EA, highlighting the potential for non-pharmacological strategies in the management of anxiety disorders and paving the way for future research aimed at improving clinical outcomes for individuals suffering from anxiety.

Seseli foliosum (Somm. et Levier) Manden.-A Comprehensive Phytochemical and Biological Evaluation

The genus Seseli L. (Apiaceae family) is widespread across Europe and Asia, with ten species identified in Georgia. Among these, Seseli foliosum (Somm. et Levier) Manden., is notable for its unique pharmacological properties. To our knowledge, comprehensive phytochemical and biological investigations have not yet been conducted. The primary aim of this research is to explore the chemical and biological properties of S. foliosum, thereby enhancing its potential applications in medicine and related fields. Different chromatographic techniques were utilized to isolate individual compounds and to identify the chemical composition of S. foliosum MeOH and Et2O extracts from seeds and roots. A battery of biological assays (antimicrobial, antioxidant, enzymatic, anxiolytic, and cytotoxic) were employed to assess the pharmacological properties of the extracts. The results from gas chromatography with mass spectrometry (GC/MS) revealed that both MeOH and Et2O extracts contain a diverse array of compounds, including monoterpenoids, sesquiterpenoids, and phenolic compounds. Furanocoumarin edultin was isolated from the MeOH extract by liquid-liquid separation (LLS). The MeOH extracts exhibited important antioxidant, enzyme inhibitory, and antimicrobial activities with notable efficacy against Staphylococcus aureus (MIC 125 µg/mL) and Candida glabrata (MIC 62.5 µg/mL). Underground Et2O extracts showed advanced cytotoxic activity, particularly against hypopharyngeal carcinoma cells (CC50 22.33 µg/mL and 27.16 µg/mL, respectively). The study provides a wide-range analysis of the phytochemical composition and biological activities of S. foliosum, highlighting its potential as a source of bioactive compounds. These findings contribute to the understanding of the therapeutic potential of S. foliosum and lay the groundwork for further pharmacological and clinical research.

Chronotype, sleep hygiene, and sleep characteristics among athletes of different disciplines

The objective of the study was to assess chronotype, sleep hygiene, and sleep characteristics of Italian athletes in order to identify differences among sport disciplines (team- vs individual-sports), level of competition (Elite vs Non-Elite) and sexes. Moreover, correlations between chronotype, sleep hygiene and sleep quality were evaluated. Two hundred eighty Italian athletes (Females:113; Males:167) participated in the study. They completed the Pittsburgh Sleep Quality Index (PSQI), the Sleep Hygiene Index (SHI) and the MorningnessEveningness Questionnaire (MEQ). Among the athletes, 66.4% were intermediate-type, 21.8% were morning-type and 11.8% were evening-type. 55.4% of the sample was classified as good sleeper (PSQI<5), while 16.1% had poor sleep hygiene (SHI≥35). Females had higher total sleep time (p=0.022) than males. Individual-sports showed more morning-oriented score (p=0.001) and lower PSQI (p=0.006) and SHI (p<0.001) scores, with earlier timing of sleep (bedtime:p<0.001; wake-up time:p<0.001) compared to teamsports. Elite athletes exhibited greater sleep efficiency (p=0.009), and lower sleep latency (p=0.018) and wake after sleep onset (p=0.043) than Non-Elite athletes. Additionally, significant correlations were found between PSQI and SHI (r=0.43, p<0.001), and between MEQ and SHI (r=-0.35, p<0.001). This study yields crucial insights into the sleep behaviors of Italian athletes, revealing that nearly half of the sample were bad sleepers.

Evidence and Mechanism of Bile Acid-Mediated Gut-Brain Axis in Anxiety and Depression

Bidirectional communication between the brain and gastrointestinal tract, called the gut-brain axis, is linked with our emotions. Intestinal lipids, hormones, and molecules, such as bile acids (BAs), impact our mood, motivation, and emotions via the gut-brain axis. BAs are synthesized from cholesterol in the liver and serve as a regulator of lipid metabolism and hormonal secretion in the intestine. Human studies have indicated that the alteration of plasma BA levels is associated with depression and anxiety. Several possible mechanisms, such as BA receptor-dependent and receptor-independent mechanisms, have been reported for emotional control. Animal studies have indicated that the deletion of BA receptors shows behavioral abnormalities. BAs regulate gut hormones, glucagon-like peptide-1 secretion, bioactive lipids, oleoylethanolamide, and the immune system function, which influences neural activities. Thus, BAs act as an emotional regulator. This review aims to summarize the following: clinical evidence of BA concentration linked to mental disorders, including depression and anxiety; and animal studies of BA-related signaling correlated with its neurobehavioral effect supporting its mechanism. We will also discuss future research required for further neurobehavioral treatment.

Association between non-carious cervical lesions, dentin hypersensitivity and anxiety in young adults: A cross-sectional study

OBJECTIVES

To investigate the prevalence and factors associated with dentin hypersensitivity (DH) and non-carious cervical lesions (NCCLs).

METHODS

The analytical cross-sectional study included 157 participants aged between 18 and 45 years, who were clinically examined and answered a questionnaire related to their lifestyle and daily habits (diet, parafunctional habits, temporomandibular disorders, general and oral health) and the Beck Anxiety Inventory. A descriptive analysis of the prevalence of DH and NCCL was performed, both at the individual level and considering the distribution among the teeth. Poisson regression models were used to investigate factors associated with hypersensitivity.

RESULTS

The prevalence of DH and NCCL was 84.7 % and 49.7 %, respectively. The use of whitening toothpaste and brushing teeth immediately after meals were related to the presence of at least one tooth with DH, while the NCCL and anxiety factors were related to the presence of DH in both at least one tooth and more than four teeth per individual. On the other hand, individuals who used soft and extra soft toothbrushes, as well as those who had knowledge about oral health, had a lower prevalence of DH.

CONCLUSIONS

DH and NCCL have a high prevalence in the population and are associated with each other and with the individual's lifestyle and habits.

CLINICAL SIGNIFICANCE

Individuals with signs of anxiety had a higher prevalence of DH, while individuals with knowledge about the etiological factors had a lower prevalence of the disease.

Dimensional early life adversity and anxiety symptoms: A network analysis and longitudinal study

BACKGROUND

Accumulating literature has found a close relation between early life adversity (ELA) and anxiety. However, previous studies did not rule out the high co-occurrence of different types of ELA when exploring the association of ELA and anxiety. In the present study, we carried out network analysis based on a cross-sectional sample and longitudinal sample to investigate the relationship between ELA and anxiety symptoms in non-clinical populations over time.

METHODS

Online advertisement was carried out to recruit participants. The cross-sectional sample included 871 Chinese participants (Mage = 19.11, SDage = 1.57), and the longitudinal sample involved 440 Chinese participants (Mage = 18.93, SDage = 0.75). Three dimensions of ELA were assessed. The Threat/Harm dimension was assessed by subscales of physical abuse, emotional abuse, and sexual abuse of Childhood Trauma Questionnaire (CTQ). The Deprivation dimension of ELA was measured by subscales of physical neglect, and emotional neglect of CTQ. The Unpredictability dimension of ELA was evaluated by the Childhood Unpredictability scale. Anxiety symptoms were captured by the Generalized Anxiety Disorder-7 (GAD-7). Regularized partial correlation networks were constructed, and the expected influence (EI) as well as predictability of each node were calculated. Stability within the network was tested and the network comparison test was conducted to examine the difference between the cross-sectional network and the longitudinal network.

RESULTS

The cross-sectional network was relatively tight, and nodes within the dimension of ELA clustered together. Childhood unpredictability and emotional abuse revealed stronger associations with anxiety symptoms than other ELAs. Emotional abuse showed the highest EI in the network. These findings were replicated in the longitudinal network. The network comparison test indicated no significant difference between the cross-sectional network and the longitudinal network.

CONCLUSION

Childhood unpredictability and emotional abuse were strong predictors of anxiety symptoms, and the prediction was reliable and persistent. Reduce the experience of childhood emotional abuse can serve as a target to prevent anxiety.

Protective effects of wogonin in the treatment of central nervous system and degenerative diseases

Wogonin, an O-methylated flavonoid extracted from Scutellaria baicalensis, has demonstrated profound neuroprotective effects in a range of central nervous system (CNS) diseases. This review elucidates the pharmacological mechanisms underlying the protective effects of wogonin in CNS diseases, including ischemic stroke, hemorrhagic stroke, traumatic brain injury, epilepsy, anxiety, neurodegenerative diseases, and CNS infections. Wogonin modulates key signaling pathways, such as the MAPK, NF-κB, and ROS pathways, contributing to its anti-inflammatory, antioxidant, and antiapoptotic properties. In ischemic stroke models, wogonin reduces infarct size and enhances neurological outcomes by mitigating inflammation and oxidative stress. For patients with hemorrhagic stroke and traumatic brain injury, it accelerates hematoma regression, mitigates secondary brain damage, and promotes neurogenesis, making it an entirely new treatment option for patients with limited access to this type of therapy. Its anticonvulsant and anxiolytic effects are mediated through GABA-A receptor modulation. Moreover, wogonin shows promise in treating neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease by promoting autophagy and reducing neuroinflammation. Additionally, it exhibits antiviral properties, offering potential benefits against CNS infections. Despite extensive preclinical evidence, further clinical studies are warranted to confirm its efficacy and safety in humans. This review highlights the great therapeutic potential of wogonin in terms of CNS protection. However, despite the substantial preclinical evidence, further large-scale clinical studies are necessary. Future researchers need to further explore the long-term efficacy and safety of wogonin in clinical trials and translate it for early application in the clinical treatment of true CNS disorders.

Examining the Feasibility and Acceptability of Identifying Signs of Social Anxiety, in University Students Aged 18-25, While Watching 360° Immersive Films

Timely, accurate assessment and treatment for social anxiety disorder (SAD) in young people is crucial. There is potential for the adoption of tailored virtual reality interventions for a complementary diagnostic tool using heart rate monitoring as a response indicator. This study examined the feasibility and acceptability of this concept by exposing healthy individuals, aged 18-25, to developed 360° immersive films while collecting heart rate sensor data. Two immersive scenarios were designed with a participatory advisory youth group. A clinical consultant nurse mapped scenario events against validated routine assessment subscales in child and adolescent services. The films were shown to seven participants through a VR headset while monitoring heart rate. They provided qualitative feedback on their quality, acceptability and usability. The study indicated that this approach has the potential to enhance assessments in child and adolescent mental health services. The study has several limitations which are discussed with recommendations for consideration if this concept is taken further. The intervention could act as a potential portable, user-friendly complementary diagnostic tool for clinicians in practice. However, further research is needed to examine its validity.

Dysfunction in neuro-mesenchymal units impairs the development of bone marrow B cells in mice with anxiety

The reduction in B lymphocytes observed in individuals with anxiety disorders may compromise antiviral responses, yet the precise mechanisms behind this decline remain unclear. While elevated glucocorticoid levels have been suggested as contributing factors, anxiety disorders are associated with diminished glucocorticoid signaling. Given that autonomic nervous system dysfunction is a hallmark of anxiety disorders, we established an anxiety-related behavior mouse model by stimulating C1 neurons in the rostral ventrolateral medulla. Using this model, we confirmed that sustained activation of sympathetic nerves can disrupt adaptive immunity, particularly affecting the development of B cells. The underlying mechanism involves the control of B cell development through neuro-mesenchymal units within the bone marrow, with mesenchyme-derived CXCL12 playing a pivotal role in this regulatory process. Intriguingly, targeting these neuro-mesenchymal units not only restored B cell development but also alleviated anxiety-like behavior in the mice. Our study provides compelling evidence regarding the regulatory role of neuro-mesenchymal units in the development of B cells within the bone marrow. Additionally, our findings suggest that anxiety disorders can create a vicious cycle, perpetuating ongoing mental and immunological damage and ultimately leading to irreversible harm. To break this cycle, it is essential to focus on the dysfunction of immune cells and strive to restore immune homeostasis in individuals suffering from anxiety disorders.

Proteomics of neuropsychiatric disorders

The pathogenesis of neuropsychiatric disorders (NDs) remains largely unclear, hence there is a lack of objective and reliable biomarkers. Proteomics, as a powerful tool for disease biomarkers research, has been largely ignored in the field of NDs. This review summarizes recent research on the application of mass spectrometry-based proteomics in NDs. Proteins associated with NDs have been identified in various sample sources, including blood, urine, saliva, tear, cerebrospinal fluid, and brain tissue. These studies have preliminarily demonstrated the potential of proteomics in NDs and require comprehensive validation in multi-center, large-scale clinical cohorts. We also discuss the challenges and prospects of proteomics in the research of early diagnostic biomarkers for NDs. These findings may provide a foundation for developing proteomic-based diagnostics and advancing precision medicine in NDs.

Clinical characteristics and potential pathology of Moyamoya disease combined with psychiatric disorders in Chinese population - A cross-sectional study

OBJECTIVE

This study aims to identify the clinical characteristics of Moyamoya disease (MMD) combined with psychiatric disorders and explore the potential pathogenesis.

MATERIAL AND METHODS

Psychiatric disorders between 88 MMD patients and 72 health controls were investigated using psychological testing scales. We subsequently analyzed the clinical features of 72 MMD patients with psychiatric comorbidities retrospectively. Finally, neurotransmitters analysis was conducted to further explore the pathogenesis.

RESULTS

Results of self-testing scales revealed a significantly higher susceptibility of psychiatric disorders in MMD patients. Compared with MMD group, clinical features of combined group demonstrated significant differences in age (51.3 ± 9.6 vs. 40.9 ± 10.4, p = 0.000), gender of female (68.1 % vs. 51.3 %, p = 0.018), duration time (33.3 ± 44.6mon vs. 8.1 ± 15.3mon, p = 0.000), cerebral infarction (55.2 % vs. 70.8 %, p = 0.025), initial type, Suzuki stage and mRS scores (p < 0.05). The perfusion results revealed significantly decreased time to peak in frontal parietal lobe (1854.14 ± 238.62 vs. 1242.79 ± 115.99, p = 0.025), temporal occipital lobe (1721.55 ± 245.15 vs. 1165.71 ± 111.55, p = 0.040), lateral ventricle (1840.03 ± 256.88 vs. 1221.95 ± 115.53, p = 0.028), and the cerebral blood volume of temporal occipital lobe was found significantly decreased (300.36 ± 34.93 vs. 403.23 ± 19.70, p = 0.026), and remarkable lower incidence of hyperperfusion syndrome and subdural effusion were demonstrated. Differential neurotransmitters of decreased 3-htdroxybutyric acid expression and increased sarcosine, tyrosine, betaine aldehyde chloride, kynurenic acid, glycine, succinic acid and lysine were identified in combined group.

CONCLUSIONS

Patients of MMD combined with psychiatric disorders presented unique clinical characteristics. Neurotransmitters disorder may be involved in the pathogenesis. These results provided novel clinical management evidence and new insights in pathologic mechanism of MMD combined with psychiatric disorders.

Photopsias are associated with greater levels of depression and anxiety

CLINICAL RELEVANCE

Vitreous floaters have been associated with depressive and anxiety symptoms. However, there is a scarcity in the literature regarding the possible impact of vitreous flashes on the psychological status of the patients.

BACKGROUND

Photopsias and vitreous floaters frequently co-exist. Floaters have been accompanied by exacerbated levels of depression and anxiety. The aim of this study was to examine whether the presence of photopsias in patients suffering from vitreous floaters is accompanied by exacerbated levels of anxiety and depression.

METHODS

One hundred and four patients complaining of floaters were included in the study; 51 experienced also photopsias and 53 did not. A comprehensive ocular examination, including funduscopy and optical coherence tomography scans was performed to every patient, while their clinical and demographic data were also assessed. Every participant completed the PHQ-9, the Zung SDS, and the HADS anxiety and depression questionnaires.

RESULTS

The clinical and demographic data did not differ significantly between the study groups (p > 0.05).The scores of every questionnaire were significantly higher among the patients with vitreous flashes (p < 0.05 for all). After adjustment for several confounders, the values remained significantly impaired.

CONCLUSION

Photopsias negatively affect the psychological and mental well-being of the patients, by the terms of amplified levels of depression and anxiety. These findings underscore the necessity for a more holistic approach to managing patients presenting with vitreous flashes.

Caregiving responsibility and psychological distress among community-dwelling cancer survivors in the United States

PURPOSE

There are over 18 million cancer survivors in the U.S., with a projected increase of 24.4% over the next decade. Currently, little is known about the relationship between a cancer survivor's caregiving responsibility and their psychological distress. This study examines whether cancer survivors who assume the role of informal caregivers (surviving caregivers) experience greater psychological distress than cancer survivors without caregiving responsibilities.

METHODS

Data were drawn from the National Cancer Institute's Health Information National Trends Survey (HINTS5, Cycles 1 through 4, 2017-2020). The analytical sample included 2,579 U.S. cancer survivors. Caregiving responsibility was self-reported, and psychological distress was assessed through the Patient Health Questionnaire-4 (PHQ-4). Accounting for the complex design features of HINTS and jackknife replicate weights, a multivariable multinomial logistic regression model was fit to compute adjusted odds ratios (aORs) and their associated 95% confidence intervals (CIs).

RESULTS

Overall, 19.3% of cancer survivors had mild psychological distress, and 10.9% had moderate to severe psychological distress. Approximately 19.1% of the cancer survivors self-reported caregiving responsibilities. Compared to cancer survivors with no caregiving responsibilities, surviving caregivers had more than twofold greater odds of experiencing mild (aOR = 2.25; 95% CI: 1.17, 4.29) and moderate to severe (aOR = 2.18; 95% CI: 1.07, 4.46) psychological distress. Other factors associated with greater psychological distress among cancer survivors included female sex, lower perceived health status, and having one or more chronic diseases.

CONCLUSIONS

Our findings indicate that caregiving among cancer survivors has a substantial adverse impact on their mental and emotional well-being. Cancer surviving caregivers are a distinct subgroup that navigates both survivorship and caregiving burdens at the same time. There is a need to identify and develop tailored interventions, programs, and resources for this vulnerable group of cancer survivors.

Central nervous system active medication use in Medicare enrollees receiving home health care: association with chronic pain and anxiety level

ABSTRACT

No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. Three sets of linear regression difference-in-reduction analyses assessed the association of pain or anxiety reduction with number of drugs; drug type; and drug combinations in those with daily pain and daily anxiety. Logistic regression analysis assessed the effect of medication number and class on less-than-daily pain or anxiety at HH discharge. A sensitivity analysis using multinomial regression was conducted with a three-level improvement to further determine clinical significance. Of 85,403 HH patients, 43% received opioids, 27% benzodiazepines, 26% gabapentinoids, 32% selective serotonin reuptake inhibitors, and 8% serotonin and norepinephrine reuptake inhibitors (SNRI). Furthermore, 75% had depression, 40% had substance use disorder diagnoses, and 6.9% had PTSD diagnoses. At HH admission, 83%, 35%, and 30% of patients reported daily pain, daily anxiety, and both, respectively. Central nervous system polypharmacy was associated with worse pain control and had no significant effect on anxiety. For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.

Functional Connectivity to the Amygdala in the Neonate Is Impacted by the Maternal Anxiety Level During Pregnancy

BACKGROUND AND PURPOSE

Anxiety during pregnancy is common, and exposure to heightened anxiety during pregnancy may influence children's brain development and functioning. However, it is unclear if exposure to low levels of anxiety in utero would also impact the developing brain. The current prospective and longitudinal study included 40 healthy pregnant women without pregnancy complications or previous diagnosis of anxiety disorders.

METHODS

Pregnant women's anxiety symptoms were measured at 12, 24, and 36 weeks of gestation. Their healthy, full-term offspring underwent a brain MRI scan without sedation, including resting-state functional MRI, at 2 weeks postnatal age. The associations between neonatal brain cortical functional connectivity originating from the amygdala and maternal prenatal anxiety symptom scores were examined using correlational analyses.

RESULTS

Significant correlations were identified after controlling for child sex, postmenstrual age at MRI, and mother's depression symptom scores. Higher maternal anxiety during pregnancy was related to alterations in offspring's functional connectivity between the amygdala and other brain regions involved in fear learning. Specifically, higher maternal prenatal anxiety during the first trimester of pregnancy was associated with lower connectivity between the amygdala and fusiform gyrus and higher connectivity between the amygdala and thalamus. Higher maternal prenatal anxiety during the third trimester was also associated with lower connectivity between the amygdala and fusiform gyrus.

CONCLUSIONS

The findings from this study indicate that exposure to low levels of anxiety in utero may also impact offspring brain development and functioning, particularly brain regions that are important for threat detection.

Metabolomics in Depression: What We Learn from Preclinical and Clinical Evidences

Depression is one of the predominant common mental illnesses that affects millions of people of all ages worldwide. Random mood changes, loss of interest in routine activities, and prevalent unpleasant senses often characterize this common depreciated mental illness. Subjects with depressive disorders have a likelihood of developing cardiovascular complications, diabesity, and stroke. The exact genesis and pathogenesis of this disease are still questionable. A significant proportion of subjects with clinical depression display inadequate response to antidepressant therapies. Hence, clinicians often face challenges in predicting the treatment response. Emerging reports have indicated the association of depression with metabolic alterations. Metabolomics is one of the promising approaches that can offer fresh perspectives into the diagnosis, treatment, and prognosis of depression at the metabolic level. Despite numerous studies exploring metabolite profiles post-pharmacological interventions, a quantitative understanding of consistently altered metabolites is not yet established. The article gives a brief discussion on different biomarkers in depression and the degree to which biomarkers can improve treatment outcomes. In this review article, we have systemically reviewed the role of metabolomics in depression along with current challenges and future perspectives.

Spinosin improves anxiety disorders in mice with chronic restraint stress via the ERK1/2-CREB-BDNF pathway

Anxiety disorders, a prevalent mental health condition often stemming from chronic stress, are characterized by uncontrollable emotional responses, heightened psychological stress, and cognitive impairment. Ziziphi Spinosae Semen, a traditional Chinese medicine (TCM), is widely used for its calming effects. Among its flavonoid components, spinosin serves as a primary bioactive compound, playing a significant role in treating psychiatric disorders. However, the mechanisms underlying the anxiolytic effects of spinosin are not fully elucidated. This study explores the protective effects of spinosin against anxiety in mice subjected to chronic restraint stress (CRS). Male C57BL/6J mice were subjected to restraint stress modeling for 10 consecutive days, and the treatment groups were gavaged with spinosin at doses of 1.25 mg/kg, 2.5 mg/kg, and 5 mg/kg, respectively. Behavioral experiments including the elevated plus maze test (EPM), open field test (OFT), and novelty suppressed feeding test (NSF) were conducted to confirm the successful establishment of the CRS model and the anxiolytic effect of spinosin. Additionally, spinosin normalized neurotransmitter levels and mitigated inflammation and neuronal damage in the hippocampus (HPC) and prefrontal cortex (PFC). Mechanistically, spinosin treatment significantly modulated the extracellular signal-regulated kinase 1/2 (ERK1/2)/cyclic adenosine monophosphate response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling pathway, a key axis in anxiety regulation. The upregulation of ERK1/2, p-CREB, and BDNF proteins significantly alleviated anxiety, suggesting that spinosin plays a pivotal role in treating CRS-induced anxiety disorders. Our findings indicate that spinosin treatment can ameliorate anxiety and that it verifies a previously unrecognized mechanism, providing crucial evidence for future research on anti-anxiety medications.

Neuropsychiatric symptoms as early indicators of brain tumors

Brain tumors, despite the high mortality and morbidity, they are a rare type of heterogenous tumors that are highly dependent on sex, age, race, level of education, and socioeconomic status. Due to their high mortality rates, it is important to identify as many potential biomarkers for early detection as the earlier the tumor is discovered, the better the prognosis. One such early biomarker we propose in the current paper is the assessment of anxiety, depression, and cognitive changes. In most cancer patients, a certain degree of anxiety and depression is expected upon receiving the diagnosis as it triggers fears regarding the prognosis, possible side effects of the treatment, and even the possibility of the treatment failing. In this paper we analyzed the way anxiety, depression, and cognitive changes present themselves in the case of several types of tumors and whether these could be used as early markers. We have observed that most of the cognitive changes present are due to the location, size, and type of the tumor with some highly connected to anxiety and depression. Moreover, in the case of certain tumors, the removal of the mass has not improved the mood or cognitive function.

Increased levels of Escherichia-Shigella and Klebsiella in the gut contribute to the responsivity of placebo analgesia

Placebo analgesia is observed in both humans and animals. Given the complexity of placebo analgesia involving a variety of neurobiological, psychological, and psychosocial processes, further investigation into its underlying mechanisms is essential. Gut microbiota has been implicated in the responsivity of placebo analgesia, but its precise role remains unknown and warrants further investigations. Here, we conducted a conditioning training model with chronic inflammatory pain induced by complete Freund's adjuvant (CFA) in mice, associating parecoxib with different cues. Hierarchical clustering analysis of placebo analgesia behaviors was employed to classify mice into responders and non-responders phenotypes. Approximately 40% of CFA mice undergoing conditioning training exhibited placebo analgesia. Notably, placebo analgesia responders displayed reduced anxiety-like behaviors. 16S rRNA results revealed a distinct composition of gut microbiota composition among the control, placebo analgesia non-responders and responders groups. Notably, levels of Escherichia Shigella and Klebsiella in the gut were increased considerably in the placebo analgesia responders as compared to both control and non-responders groups. In conclusion, placebo analgesia responders demonstrated marked analgesia, reduced anxiety-like behaviors, and increased levels of Escherichia-Shigella and Klebsiella, implying a potential linkage between gut microbiota and placebo analgesia.

Within-Person Relationships Among Self-Compassion, Emotion Regulation Difficulties, and Anxiety Symptoms: Testing an Emotion Regulation Model of Self-Compassion

Anxiety symptoms is prevalent among college students and is associated with a range of detrimental consequences. Self-compassion and emotion regulation difficulties are important factors affecting anxiety symptoms, but their functional mechanism and longitudinal correlation are still unclear. This three-year longitudinal study (baseline: n = 5785, 48.2% of female, Mage = 18.63 years, SD = 0.88; T1 to T5: n = range from 4312 to 5497) aimed to validate the emotion regulation model of self-compassion by examining the associations between self-compassion, emotion regulation difficulties, and anxiety symptoms. Random intercept cross-lagged panel models (RI-CLPMs) was used to distinguish within-person variations overtime from stable between-person differences. The results obtained from the RI-CLPMs indicated that there is a bidirectional effect between self-compassion and anxiety symptoms at the within-person level. Emotional regulation difficulties played a longitudinal mediating role in the prediction from self-compassion to anxiety symptoms at the within-person level, validating the emotion regulation model of self-compassion. The current study indicates that cultivating self-compassion in college students is crucial as it can improve their emotion regulation skills and alleviate anxiety symptoms.

Effects of volcanic eruptions on the mental health of exposed populations: a systematic review

Introduction

Millions of people living in volcanic environments are at risk of experiencing volcanic eruptions, a natural disaster. This systematic review aimed to collect empirical evidence of the effects of volcanic eruptions on the mental health of the exposed populations.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted systematic searches on Scopus, PubMed, PsycINFO, Medline, and Web of Science (WoS) databases.

Results

A total of 17,044 articles were screened. Of these, 24 articles met the inclusion criteria and data were extracted. Twenty-one articles investigated psychological disorders, two articles studied emotions and their relationships with certain environmental factors, and one article explored cognitive functions in the exposed populations. These studies showed that highly exposed populations were more vulnerable to develop long-lasting psychological disorders than less exposed populations.

Conclusion

The negative influence of experiencing volcanic activity on mental health was confirmed. Clearly, there is a need for more research to improve the mental health of the populations highly exposed to volcanic eruptions. Recommendations for future research are also included.

Mechanisms of microbiota-gut-brain axis communication in anxiety disorders

Anxiety disorders, prevalent mental health conditions, receive significant attention globally due to their intricate etiology and the suboptimal effectiveness of existing therapies. Research is increasingly recognizing that the genesis of anxiety involves not only neurochemical brain alterations but also changes in gut microbiota. The microbiota-gut-brain axis (MGBA), serving as a bidirectional communication pathway between the gut microbiota and the central nervous system (CNS), is at the forefront of novel approaches to deciphering the complex pathophysiology of anxiety disorders. This review scrutinizes the role and recent advancements in the MGBA concerning anxiety disorders through a review of the literature, emphasizing mechanisms via neural signals, endocrine pathways, and immune responses. The evidence robustly supports the critical influence of MGBA in both the development and progression of these disorders. Furthermore, this discussion explores potential therapeutic avenues stemming from these insights, alongside the challenges and issues present in this realm. Collectively, our findings aim to enhance understanding of the pathological mechanisms and foster improved preventative and therapeutic strategies for anxiety disorders.

Anxiety and the brain: Neuropeptides as emerging factors

Anxiety disorders are characterized by intense feelings of worry and fear, which can significantly interfere with daily functioning. Current treatment options primarily include selective serotonin reuptake inhibitors, benzodiazepines, non-benzodiazepine anxiolytics, gabapentinoids, and beta-blockers. Neuropeptides have shown an important role in the regulation of complex behaviours, such as psychopathology and anxiety-related reactions. Neuropeptides have a great deal of promise to advance our understanding of and ability to help people with anxiety disorders. This review focuses on the expanding role of neuropeptides in anxiety management, particularly examining the impact of substance P, neuropeptide Y, corticotropin-releasing hormone, arginine-vasopressin, pituitary adenylate cyclase-activating polypeptide, and cholecystokinin. Furthermore, the paper discusses the neuropeptides that are becoming more and more recognized for their impact on anxiety-related reactions and their potential as therapeutic targets.

The relationship between dietary sugar consumption and anxiety disorders: A systematic review

High-sugar intake is a risk factor for chronic diseases such as cardiovascular disease and type 2 diabetes, but less is known about its role in anxiety disorders. This systematic review aimed to systematically synthesise and assess the existing evidence regarding the association between dietary sugars intake and anxiety disorders. Following PRISMA guidelines, a systematic search of PubMed, MEDLINE, Embase, APA PsycArticles and APA PsycINFO was conducted up to 19th August 2022. Study quality was assessed by the Newcastle-Ottawa scale (NOS) and the Cochrane risk of bias tool. Eleven studies (10 cross-sectional and 1 randomised controlled trial [RCT]) were included. Seven cross-sectional studies had very good quality or good quality, and the quality of the RCT was at low risk of bias. These studies examined sugar-sweetened beverages (n = 7), sugar-sweetened foods (n = 4) and/or added sugar (n = 5). The findings suggest a possible positive relationship of added sugar consumption with anxiety disorders, with age as a potential moderator in such association. No conclusions can be drawn on the associations between sugar-sweetened beverages, sugar-sweetened foods consumption and anxiety disorders. Due to the included studies being mostly cross-sectional, the conclusions drawn from the existing evidence should be interpreted with caution. The longitudinal design is warranted to investigate any causal relationship and the potential mechanisms underlying these heterogeneous results. The potential difference in effect at different ages observed in this review should be further examined.

Reproductive Toxicity Induced by Serotonin-Norepinephrine Reuptake Inhibitors: A Pharmacovigilance Analysis From 2004 to 2023 Based on the FAERS Database

AIM

Serotonin-norepinephrine reuptake inhibitors (SNRIs) have been extensively utilized for the treatment of depression and anxiety disorders. Clinical trials and real-world data suggest that SNRIs may cause reproductive toxicity. To comprehensively assess this association, we conducted a pharmacovigilance study.

METHODS

We utilized various disproportionality analysis algorithms, including reporting odds ratio (ROR), proportional reporting ratio (PRR), bayesian confidence propagation neural network (BCPNN), and multi-item gamma poisson shrinker (MGPS), to assess the significance of reproductive toxicity-related adverse events (AEs) reported to FDA Adverse Event Reporting System (FAERS) from January 2004 to December 2023, with subgroup analysis conducted by sex and age.

RESULTS

Duloxetine and venlafaxine were associated with 14 and 25 AE signals related to reproductive toxicity, respectively, with erectile dysfunction (ED) and retrograde ejaculation identified as shared important medical events (IMEs). ED had the highest reporting frequency, strongest in venlafaxine-treated patients under 45 years (ROR 4.34, PRR 4.33, IC 2.09, EBGM 4.25). Retrograde ejaculation was newly identified. With decreasing incidence, venlafaxine's median ED onset was 122.5 days and duloxetine's 38 days.

CONCLUSION

Our study provides evidence through an extensive analysis of the large-scale real-world FAERS database, aiding healthcare professionals in mitigating, and prioritizing SNRI-related reproductive toxicity AEs.

Climate change anxiety and its association with somatic symptom distress and idiopathic environmental intolerances: A cross-sectional study

CONTEXT

Individuals need greater climate change awareness in order to mitigate and adapt to climate changes but this awareness can lead to negative health outcomes including climate change anxiety.

OBJECTIVE

To explore the associations between climate change anxiety, idiopathic environmental intolerances and somatic symptom distress, after accounting for modern health worries, anxiety and depression.

METHODS

A non-representative sample of healthy volunteers completed a cross-sectional online survey that included the Climate Change Anxiety scale (CCA-13), single questions about idiopathic intolerance to five environmental agents, the Somatic Symptoms scale (SSS-8), the Modern Health Worries scale (MHW-12), and the Patient Health Questionnaire for symptoms of anxiety and depression (PHQ-4). Participants also reported their sex, age and subjective socioeconomic status. Bivariate analyses investigated associations between variables and path analyses explored potential mediating factors.

RESULTS

432 participants completed the questionnaire, 421 of whom were included in analyses (67 % women, mean age: 32.7 standard deviation: 12.4). Climate change anxiety, idiopathic environmental intolerances, somatic symptom distress, modern health worries, and symptoms of anxiety and depression were positively correlated in bivariate analyses (Pearson's ranging from 0.22 to 0.57, all p < 0.001). In path analyses, modern health worries (R2 = 9.9 %) partially mediated the relation between climate change anxiety (R2 = 20.3 %) and two correlated outcome variables, idiopathic environmental intolerances (R2 = 36.8 %) and somatic symptom distress (R2 = 32.4 %).

CONCLUSIONS

Climate change anxiety may negatively affect perceived physical health. Stakeholders should aim at promoting climate change awareness while addressing modern health worries to avoid negative health outcomes.

Disentangling the Neural Circuits of Arousal and Anxiety-Like Behavior

Anxiety disorders are prevalent and debilitating conditions characterized by excessive concern and fear, affecting thoughts, behaviors, and sensations. A critical component of anxiety is arousal, a complex process involving alertness regulation and stimulus salience modulation. While arousal is adaptive in normal circumstances, dysregulation can lead to hypoarousal or hyperarousal, affecting response selection and threat perception. This chapter reviews challenges in studying arousal in preclinical anxiety models, emphasizing the need for multicomponent measurement and analysis. Novel methodologies integrating physiological measurement with activity tracking of neurons with single-cell resolution in awake animals are discussed, with emphasis in current challenges. Understanding these mechanisms is crucial for developing effective treatments for anxiety disorders.

Intranasal dantrolene nanoparticles inhibit lipopolysaccharide-induced depression and anxiety behavior in mice

This study investigates the therapeutic effectiveness of intranasal dantrolene nanoparticles pretreatment to inhibit lipopolysaccharide (LPS)-induced pathological inflammation and synapse destruction and depressive and anxiety behavior in mice. Both wild-type (WT) B6SJLF1/J and 5XFAD adult mice (5-10 months old) were pretreated with intranasal dantrolene nanoparticles (dantrolene: 5mg/kg), daily, Monday to Friday, 5 days per week, for 4 weeks. Then, mice were treated with intraperitoneal injection of LPS (5mg/kg) for one time. Behavioral tests for depression, anxiety and side effects were performed 24 hours after a one-time LPS injection. Biomarkers for pyroptosis-related inflammation cytokines (IL-1β and IL-18) in blood and brains were measured using enzyme-linked immunosorbent assay (ELISA) and immunoblotting, respectively. The changes of primary proteins activation inflammatory pyroptosis (NLRP3: NLR family pyrin domain containing 3, Caspase-1, N-GSDMD: N terminal protein gasdermin D) and synapse proteins (PSD-95 and synpatin-1) in brains were measured using immunoblotting. Intranasal dantrolene nanoparticles robustly inhibited LPS-induced depression and anxiety behavior in both WT and 5XFAD mice, without obvious side effects. Intranasal dantrolene nanoparticles significantly inhibited LPS-induced pathological elevation of IL-1β and IL-18 in the blood and synapse loss in the brain. Intranasal dantrolene nanoparticles trended to inhibit LPS-induced elevation of IL1β and IL-18 and the pyroptosis activation proteins in the brain in both type of mice. In conclusion, intranasal dantrolene nanoparticles demonstrated neuroprotection against inflammation mediated depression and anxiety behaviors and should be studied furthermore as a future effective drug treatment of major depression disorder or anxiety psychiatric disorder, especially in AD patients.

Analyzing the effect of sleep duration, chronotype, and social jet lag on anxiety disorders and health-related quality of life: A cross-sectional study

BACKGROUND

Anxiety disorders significantly impair the quality of life (QOL). Studies on the effect of sleep duration, chronotype, and social jet lag on anxiety disorders are limited. This study aimed to elucidate the contributions of sleep duration, chronotype, and social jet lag to the prevalence and severity of anxiety disorders in Koreans.

METHODS

This study used data of 9,874 Korean adults from the Korea National Health and Nutrition Examination Survey 2021-2022. Anxiety was assessed using the Generalized Anxiety Disorder-7 scale, and health-related QOL was measured using the Health-Related Quality of Life Instrument with 8-Items. Complex sample logistic regression models were used to evaluate the associations between sleep duration, chronotype, and social jet lag and anxiety disorders, with analyses stratified by sex.

RESULTS

Sleep duration of <6 h, evening chronotype, and social jet lag of >2 h were significantly associated with a high prevalence of anxiety disorders in women; however, in men, only sleep duration of <6 h was associated with anxiety disorders. Sleep duration of <6 h and evening chronotype were associated with low QOL in women but not in men.

CONCLUSION

This study highlights the importance of adequate sleep and circadian alignment for mental health, particularly in women. Public health initiatives should focus on promoting healthy sleep habits to improve mental health and QOL. Further research is required to understand the causal pathways and sex-specific mechanisms underlying these associations.

Development of a Symptom Validity Index for the Beck Anxiety Inventory

Objective: Anxiety disorders are the most prevalent psychiatric disorders experienced by individuals in the United States, and anxiety is often assessed with anxiety symptom inventories. At present, though, there are no anxiety symptom inventories that include symptom validity indices. The present study sought to develop a symptom validity index for the most commonly used anxiety symptom inventory in neuropsychological practice, the Beck Anxiety Inventory (BAI). Method: A sample of 244 veterans seeking outpatient neuropsychological assessments were included in the study. Participants were divided into valid and invalid groups based on external criterion symptom validity tests. The valid participants were then divided into clinical subgroups (Current Anxiety, Lifetime Anxiety, and No Anxiety). A validity index derived from the BAI total score was examined for the total sample and all subgroups. Results: A cutoff of ≥ 29 was identified when utilizing the Valid Full Sample, which resulted in a 0.91 specificity rate and 0.54 sensitivity rate. However, cutoffs had to be adjusted when applied to the clinical subgroups. The Valid Current Anxiety subgroup required the largest cutoff increase (i.e. ≥ 36), which resulted in a 0.91 specificity rate and a 0.42 sensitivity rate. Conclusions: This is the first published article to develop a symptom validity index for the BAI. To minimize false positive errors, a BAI total score of ≥ 36 is recommended.

Differentiating anxiety profiles in medical students: a latent profile analysis

Previous studies have confirmed a high prevalence of anxiety among medical students. The present study aimed to identify distinct medical student anxiety profiles to develop targeted interventions. A cross-sectional study was conducted with 735 medical students (346 males and 389 females) recruited voluntarily from mainland China. Latent profile analysis (LPA) was applied to explore profiles of various types of anxiety, including test anxiety, academic anxiety, social anxiety, career choice anxiety, general anxiety, and trait anxiety. The results showed that LPA yielded four profiles, comprising 17.14, 20.82, 21.50, and 40.54% of the sample respectively. Specifically, Class 1 (17.14%) showed the highest levels of multiple types of anxiety, particularly the highest level of general anxiety. Class 2 (20.82%) and Class 3 (21.50%) showed moderate levels of anxiety, but they displayed different patterns across various types of anxiety except for social anxiety. Class 4 (40.54%) displayed the lowest levels of anxiety across all types. These profiles differed in academic status and depression. Further, the multinomial logistic regression analysis showed that the high-anxiety group (Class 1) was more likely to be elder students, with lower sports frequency and a higher degree of self-handicapping. These results call for the need to move beyond linear relations among global constructs to address the complexity of anxiety coping and highlight the importance of customized intervention for these heterogeneous groups.

GPR17 modulates anxiety-like behaviors via basolateral amygdala to ventral hippocampal CA1 glutamatergic projection

Anxiety disorders are one of the most epidemic and chronic psychiatric disorders. An incomplete understanding of anxiety pathophysiology has limited the development of highly effective drugs against these disorders. GPR17 has been shown to be involved in multiple sclerosis and some acute brain injury disorders. However, no study has investigated the role of GPR17 in psychiatric disorders. In a well-established chronic restraint stress (CRS) mouse model, using a combination of pharmacological and molecular biology techniques, viral tracing, in vitro electrophysiology recordings, in vivo fiber photometry, chemogenetic manipulations and behavioral tests, we demonstrated that CRS induced anxiety-like behaviors and increased the expression of GPR17 in basolateral amygdala (BLA) glutamatergic neurons. Inhibition of GPR17 by cangrelor or knockdown of GPR17 by adeno-associated virus in BLA glutamatergic neurons effectively improved anxiety-like behaviors. Overexpression of GPR17 in BLA glutamatergic neurons increased the susceptibility to anxiety-like behaviors. What's more, BLA glutamatergic neuronal activity was required for anxiolytic-like effects of GPR17 antagonist and GPR17 modulated anxiety-like behaviors via BLA to ventral hippocampal CA1 glutamatergic projection. Our study finds for the first and highlights the new role of GPR17 in regulating anxiety-like behaviors and it might be a novel potential target for therapy of anxiety disorders.

Keeping an Eye Out for Change: Anxiety Disrupts Adaptive Resolution of Policy Uncertainty

BACKGROUND

Human learning unfolds under uncertainty. Uncertainty is heterogeneous with different forms exerting distinct influences on learning. While one can be uncertain about what to do to maximize rewarding outcomes, known as policy uncertainty, one can also be uncertain about general world knowledge, known as epistemic uncertainty (EU). In complex and naturalistic environments such as the social world, adaptive learning may hinge on striking a balance between attending to and resolving each type of uncertainty. Prior work illustrates that people with anxiety-those with increased threat and uncertainty sensitivity-learn less from aversive outcomes, particularly as outcomes become more uncertain. How does a learner adaptively trade-off between attending to these distinct sources of uncertainty to successfully learn about their social environment?

METHODS

We developed a novel eye-tracking method to capture highly granular estimates of policy uncertainty and EU based on gaze patterns and pupil diameter (a physiological estimate of arousal).

RESULTS

These empirically derived uncertainty measures revealed that humans (N = 94) flexibly switched between resolving policy uncertainty and EU to adaptively learn about which individuals can be trusted and which should be avoided. However, those with increased anxiety (n = 49) did not flexibly switch between resolving policy uncertainty and EU and instead expressed less uncertainty overall.

CONCLUSIONS

Combining modeling and eye-tracking techniques, we show that altered learning in people with anxiety emerged from an insensitivity to policy uncertainty and rigid choice policies, leading to maladaptive behaviors with untrustworthy people.

The Effect of Aromatherapy on Anxiety and Pain in Patients Undergoing Oculoplastic Surgery

PURPOSE

To determine the effect of aromatherapy on postoperative anxiety and pain in patients undergoing oculoplastic surgery.

METHODS

A randomized controlled study of 60 patients who underwent monitored anesthesia care sedation for oculoplastic procedures from August 2018 to November 2020. Patients were randomized to an aromatherapy (n = 32) or placebo (n = 28) condition. Anxiety was measured with State-Trait Anxiety Inventory and visual analog scale for anxiety. Pain was measured with a visual analog scale for pain.

RESULTS

Compared with control patients, aromatherapy patients had significantly lower postoperative State-Trait Anxiety Inventory state anxiety (24.1 vs. 29.1; p = 0.05) and visual analog scale pain scores (1.9 vs. 3.2; p = 0.05). Aromatherapy patients also had shorter stays in the postanesthesia care unit than control patients (57.7 vs. 79.4 minutes; p = 0.03).

CONCLUSIONS

Patients who received aromatherapy reported lower postoperative anxiety and pain. Aromatherapy may be a useful adjuvant analgesic and/or anxiolytic for patients undergoing oculoplastic procedures with monitored anesthesia care sedation.