1
|
Schmalbach I, Witthöft M, Strauß B, Joraschky P, Petrowski K. The predictive value of cortisol in psychodynamic psychotherapy for social anxiety disorder: Extended results of the SOPHONET-Study. Transl Psychiatry 2024; 14:188. [PMID: 38605013 PMCID: PMC11009385 DOI: 10.1038/s41398-024-02882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Psychotherapy is an effective treatment for anxiety disorders (AD), yet a vast majority of patients do not respond to therapy, necessitating the identification of predictors to enhance outcomes. Several studies have explored the relationship between stress response and treatment outcome, as a potential treatment mechanism. However, the latter remains under-researched in patients with social anxiety disorder (SAD). We studied N = 29 patients undergoing psychodynamic psychotherapy (PDT) within the SOPHONET-Study. Stress reactivity (i.e., area under the curve with respect to the increase; AUCi) was induced by a standardized psychosocial stressor (Trier Social Stress Test; TSST) and assessed by means of adrenocorticotropic hormone (ACTH), blood and salivary cortisol samples before (t1) treatment. Samples of these biomarkers were taken -1 min prior stress exposure and six more blood samples were collected post-TSST ( + 1, + 10, + 20, + 30, + 45, + 60 min.). The participants were diagnosed with SAD based on the Structured Clinical Interview for DSM-IV (SCID) and completed the Liebowitz Social Anxiety Scale as well as the Beck Depression Inventory before (t1) and after psychotherapy (t2). Pre-treatment stress reactivity significantly predicted changes in depression (salivary p < 0.001 and blood cortisol p = 0.001), as well as in avoidance behavior (blood cortisol p = 0.001). None of the biomarkers revealed significant results in fear or in the total LSAS-scores, except for ACTH with a trend finding (p = 0.06). Regarding therapy success, symptoms of social anxiety (p = 0.005) and depression (p < 0.001) were significantly reduced from pre (t1) to post-treatment (t2). Our study showed that stress reactivity pre-treatment may serve as a predictor of psychotherapy outcome. In this regard, alterations in stress response relate to changes in symptoms of social anxiety and depression after PDT. This implies that patients with chronic stress might benefit from a targeted interventions during psychotherapy, especially to manage fear in social contexts.
Collapse
Affiliation(s)
- Ileana Schmalbach
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Bernhard Strauß
- Institute for Psychosocial Medicine, Psychotherapy & Psychooncology, University Hospital Jena, Jena, Germany
| | - Peter Joraschky
- University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Dresden University of Technology, Carl Gustav Carus Medical Faculty, Department of General Medicine/MK3, Dresden, Germany
| |
Collapse
|
2
|
Passos GS, Youngstedt SD, Rozales AARC, Ferreira WS, De-Assis DE, De-Assis BP, Santana MG. Insomnia Severity is Associated with Morning Cortisol and Psychological Health. Sleep Sci 2023; 16:92-96. [PMID: 37151768 PMCID: PMC10157827 DOI: 10.1055/s-0043-1767754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/25/2022] [Indexed: 05/09/2023] Open
Abstract
Studies suggest associations between cortisol and sleep, and cortisol shows a profound diurnal rhythm. The evidence about the relationship between chronic insomnia and cortisol is mixed. Chronic insomnia is associated with the risk of mental health disorders. The aim of this study was to evaluate the association of insomnia severity and objective sleep pattern with morning cortisol level and psychological health. The instruments used were the Insomnia Severity Index (ISI), polysomnography, Beck Depression Inventory (BDI), and Profile of Mood States (POMS). Serum cortisol was analyzed by chemiluminescence. The data revealed significant positive correlations of ISI with morning cortisol level (r = 0.37, p = 0.03), BDI score (r = 0.44, p < 0.01), and POMS-tension anxiety (r = 0.39, p = 0.02). Sleep stages N2 and N3 were correlated with POMS-fatigue (r = 0.46, p < 0.01; r = -0.37, p = 0.04). Sleep stage N3 was also negatively correlated with POMS-tension-anxiety (r = -0.36, p = 0.04). Higher insomnia severity was associated with higher morning cortisol, depression, and tension-anxiety. Sleep stage N2 was associated with higher fatigue and N3 was associated with lower tension-anxiety and fatigue.
Collapse
Affiliation(s)
- Giselle Soares Passos
- Universidade Federal de Jataí, Unidade Acadêmica de Ciências da Saúde, Jataí, GO, Brazil
- Address for correspondence Giselle Soares Passos
| | - Shawn D. Youngstedt
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ, United States
| | | | | | - Daniela Elias De-Assis
- Universidade Federal de Jataí, Unidade Acadêmica de Ciências da Saúde, Jataí, GO, Brazil
| | | | | |
Collapse
|
3
|
Bate G, Buscemi J, Greenley RN, Tran S, Miller SA. Salivary cortisol levels and appraisals of daily hassles across dimensions of the tripartite model of anxiety and depression in emerging adults. Biol Psychol 2023; 176:108469. [PMID: 36460125 DOI: 10.1016/j.biopsycho.2022.108469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study was to investigate how cortisol levels and appraisals of daily hassles differ across tripartite dimensions of depression and anxiety in emerging adults. Data collected from a sample of undergraduate students at a large Midwestern university was used to investigate these aims. This included salivary cortisol data collected over four days, scores on a measure of the tripartite model of anxiety and depression, and scores on a measure of daily hassles administered everyday for two weeks. Generalized estimating equations and multilevel modeling techniques were used to analyze data. Elevated cortisol levels during the awakening period and the evening period, lower total levels across the day, steeper diurnal slopes, and elevated levels of negative affect and physiological hyperarousal predicted experiences of daily hassles. Tripartite dimensions were unrelated to cortisol indices. The present study demonstrates the utility of modeling multiple cortisol indices and provides evidence of differential associations between physiological and phenomenological indices of stress.
Collapse
Affiliation(s)
- George Bate
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA.
| | | | - Rachel Neff Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
| | - Susan Tran
- Department of Psychology, DePaul University, USA
| | - Steven A Miller
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
| |
Collapse
|
4
|
Masdrakis VG, Papageorgiou C, Markianos M. Correlations of plasma oxytocin with clinical and hormonal parameters in panic disorder. Nord J Psychiatry 2022; 77:221-226. [PMID: 35714973 DOI: 10.1080/08039488.2022.2083675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS The potential association between oxytocin (OXT) plasma levels and clinical and hormonal parameters in panic disorder (PD) especially in its acute phase - has not been investigated as yet. This was the aim of this article. METHOD Twenty-four consecutively-referred, acutely-ill, medication-free PD patients with (PDA, N = 21) or without agoraphobia, moreover without comorbidities, completed the following clinical measures: Hamilton Anxiety Rating Scale (HARS); Agoraphobic Cognitions Questionnaire (ACQ); Mobility Inventory-Alone subscale (MI-alone); and number of panic attacks during last 21 d (PA21d). Plasma levels of OXT, adrenocorticotropic hormone (ACTH) and cortisol were evaluated. RESULTS OXT levels were significantly, negatively associated with the HARS scores (r= -0.59 p=.002) and weakly, negatively correlated with the ACQ scores (r = -0.403 p=.051). No significant correlations were traced between OXT levels and PA21d, MI-alone, ACTH, and cortisol. CONCLUSION In acutely-ill, medication-free PD patients, OXT plasma levels may be relevant to the severity of their 'general' anxiety symptoms, but not to the 'specific' panic psychopathology.
Collapse
Affiliation(s)
- Vasilios G Masdrakis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Papageorgiou
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Markianos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
5
|
Why Does Psychotherapy Work and for Whom? Hormonal Answers. Biomedicines 2022; 10:biomedicines10061361. [PMID: 35740383 PMCID: PMC9220228 DOI: 10.3390/biomedicines10061361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 12/11/2022] Open
Abstract
The questions of for whom and why psychotherapy is effective have been the focus of five decades of research. Most of this knowledge is based on self-report measures. Following the biopsychosocial model of mental disorders, this article explores the potential of hormones in answering these questions. The literature on cortisol, oxytocin, and oestradiol in psychotherapy was systematically searched, focusing on (a) baseline hormonal predictors of who may benefit from psychotherapy and (b) hormonal changes as indicators of therapeutic change. The search was limited to depression and anxiety disorders. In sum, the findings show that, of all three hormones, the role of cortisol is most established and that both cortisol and oxytocin are implicated in psychotherapy, although a causal role is still waiting to be demonstrated. Moreover, there is a differential role of hormones in the psychotherapy of depression versus anxiety. The directions of research mapped in this article may elucidate how psychotherapy can be selected to match patients’ endocrine states and how hormonal levels can be manipulated to improve outcomes.
Collapse
|
6
|
Marcil MJ, Cyr S, Marin MF, Rosa C, Tardif JC, Guay S, Guertin MC, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel. Psychoneuroendocrinology 2022; 138:105645. [PMID: 35134663 PMCID: PMC8697418 DOI: 10.1016/j.psyneuen.2021.105645] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked. METHODS 467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors. RESULTS As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% (IQR = 3-59%, p < 0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model's predictability. CONCLUSION Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.
Collapse
Affiliation(s)
- Marie-Joëlle Marcil
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Samuel Cyr
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Pharmacy, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Marie-France Marin
- Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Department of Psychology, UQAM, 100 Sherbrooke Street West, Montréal, H2X 3P2 Québec, Canada,Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Stéphane Guay
- Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada
| | - Christine Genest
- Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada,Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Pavilion, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, P.O. Box 8888, Downtown Branch, Montréal, H3C 3P8 Québec, Canada
| | - Patrick Lavoie
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Pavilion, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Mélanie Labrosse
- Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montréal, H3T 1C5 Québec, Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Shaun Selcer
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, H4H 1R3 Québec, Canada,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University St, Montréal, H3A 2B4 Québec, Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada.
| |
Collapse
|
7
|
Masdrakis VG, Legaki EM, Papageorgiou C, Markianos M. Pituitary-adrenal axis hormones in early-onset versus late-onset panic disorder. Int J Psychiatry Clin Pract 2022; 26:72-78. [PMID: 33043745 DOI: 10.1080/13651501.2020.1828929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE It has been hypothesised that early-onset panic disorder (PD) may constitute a biologically distinct subtype of PD, but the few relevant data are inconclusive. We systematically explored for potential psychopathological and hormonal differences between early-onset (age at onset ≤ 27 years) versus late-onset PD, in consecutively-referred, medication-free, acutely-ill PD outpatients, moreover without comorbid mental disorders except agoraphobia (N = 54; age = 32.3 ± 7.5 years; early-onset = 27; females = 38). METHODS Hormones assessed (plasma levels) included adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEAS). Psychopathological measures included panic attacks' number during last three weeks, the Agoraphobic Cognitions and the Body Sensations Questionnaires and the Hamilton Anxiety Rating Scale. RESULTS Early-onset PD patients - compared to their late-onset counterparts - had longer duration of the disease. The two onset-groups demonstrated similar panic and anxiety symptoms and similar ratios of smokers/never-smokers. However, early-onset patients demonstrated significantly greater ACTH and DHEAS levels and higher (marginally significant) cortisol levels than the late-onset patients. Moreover, in the early-onset patients only, significant positive correlations emerged between ACTH levels and the severity of both panic and anxiety symptomatology. CONCLUSIONS These findings suggest that the two onset-groups demonstrate significant differences in the hypothalamic-pituitary-adrenal axis functioning, at least when acutely-ill.Key pointsEarly-onset panic disorder (EOPD) may differ biologically from late-onset PD (LOPD).EOPD was correlated with greater adrenocorticotropic hormone (ACTH) plasma levels.EOPD was correlated with greater dehydroepiandrosterone sulphate plasma levels.In EOPD only, ACTH levels were positively correlated with panic and anxiety symptoms.
Collapse
Affiliation(s)
- Vasilios G Masdrakis
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospitalm, Athens, Greece
| | - Emilia-Maria Legaki
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospitalm, Athens, Greece
| | - Charalambos Papageorgiou
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospitalm, Athens, Greece
| | - Manolis Markianos
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospitalm, Athens, Greece
| |
Collapse
|
8
|
Karachaliou FH, Karavanaki K, Simatou A, Tsintzou E, Skarakis NS, Kanaka-Gatenbein C. Association of growth hormone deficiency (GHD) with anxiety and depression: experimental data and evidence from GHD children and adolescents. Hormones (Athens) 2021; 20:679-689. [PMID: 34195937 DOI: 10.1007/s42000-021-00306-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022]
Abstract
Anxiety and depression are among the commonest emotional problems in children and young adolescents. They are encountered with even higher prevalence in children and adults with growth hormone deficiency (GHD). Alterations in the somatotropic axis, as observed in both GH/IGF1 deficiency and excess, can produce permanent changes in brain tissue structure. The growth hormone/insulin-like growth factor 1 (GH/IGF1) axis seems to exert a regulatory effect on brain function and neurogenesis, especially in the hippocampus, a brain region associated with mental and emotional disorders, such as depression and anxiety. There is evidence from animal models of the possible interrelationship of the endocrine system with the pathogenesis of emotional disorders. Moreover, clinical data support the association of GHD and mood disorders, which are often reversed by GH replacement therapy. However, the causal relationship and the mechanism underlying this association are to date obscure and remain to be clarified. The present review reports experimental data from animal models regarding the role of GH/IGF1 in emotional disorders and focuses on clinical data on the presence of these disorders in children with GHD and their response to GH therapy.
Collapse
Affiliation(s)
- Fotini-Heleni Karachaliou
- Unit of Pediatric Endocrinology, Diabetes and Metabolism, 3Rd Department of Pediatrics, Attikon University Hospital, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, Department of Pediatrics, University of Athens, A Kyriakou" Children's Hospital, "P &, 2nd, Athens, Greece
| | - Aristofania Simatou
- Unit of Pediatric Endocrinology, Diabetes and Metabolism, 3Rd Department of Pediatrics, Attikon University Hospital, Athens, Greece
| | - Eleni Tsintzou
- Unit of Pediatric Endocrinology, Diabetes and Metabolism, 3Rd Department of Pediatrics, Attikon University Hospital, Athens, Greece
| | - Nikitas S Skarakis
- Unit of Pediatric Endocrinology, Diabetes and Metabolism, 3Rd Department of Pediatrics, Attikon University Hospital, Athens, Greece.
- Third Department of Pediatrics, Endocrinology Unit, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christina Kanaka-Gatenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Agia Sophia Children's Hospital, Athens, Greece
| |
Collapse
|
9
|
García-Moreno JA, Cañadas-Pérez F, García-García J, Roldan-Tapia MD. Cognitive Reserve and Anxiety Interactions Play a Fundamental Role in the Response to the Stress. Front Psychol 2021; 12:673596. [PMID: 34539485 PMCID: PMC8446200 DOI: 10.3389/fpsyg.2021.673596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/03/2021] [Indexed: 12/21/2022] Open
Abstract
The aims of the present study were to assess the possible interaction between Cognitive Reserve (CR) and State Anxiety (SA) on adrenocortical and physiological responses in coping situations. Forty healthy, middle-aged men completed the Cognitive Reserve Scale and the State-Trait Anxiety Inventory. We used an Observational Fear Conditioning (OFC) paradigm in order to assess emotional learning and to induce stress. Electrodermal activity (EDA) and salivary cortisol concentrations were measured throughout the conditions. Our results indicate that those who indicated having higher state anxiety showed a lower capacity for learning the contingency, along with presenting higher salivary cortisol peak response following the observational fear-conditioning paradigm. The most prominent finding was the interaction between cognitive reserve and state anxiety on cortisol response to the post observational fear-conditioning paradigm. Thus, those who showed a high anxiety-state and, at the same time, a high cognitive reserve did not present an increased salivary cortisol response following the observational fear-conditioning paradigm. Given these results, we postulate that the state anxiety reported by participants, reflects emotional activation that hinders the attention needed to process and associate emotional stimuli. However, cognitive reserve has an indirect relation with conditioning, enabling better emotional learning. In this context, cognitive reserve demonstrated a protective effect on hormonal response in coping situations, when reported anxiety or emotional activation were high. These findings suggest that cognitive reserve could be used as a tool to deal with the effects of stressors in life situations, limiting development of the allostatic load.
Collapse
Affiliation(s)
- Jose A García-Moreno
- CERNEP Research Center, University of Almeria, Almería, Spain.,CEINSAUAL Research Center, University of Almeria, Almería, Spain
| | - Fernando Cañadas-Pérez
- CERNEP Research Center, University of Almeria, Almería, Spain.,CEINSAUAL Research Center, University of Almeria, Almería, Spain
| | | | - María D Roldan-Tapia
- CERNEP Research Center, University of Almeria, Almería, Spain.,CEINSAUAL Research Center, University of Almeria, Almería, Spain
| |
Collapse
|
10
|
Begum N, Taylor JR, Brown C, Rajan J, Keevil B, Pye E, Rainey T, Jones A. Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk. Eur J Pain 2021; 26:197-206. [PMID: 34437747 DOI: 10.1002/ejp.1854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development. METHODS We sought to determine differences in morning and evening salivary cortisol levels in FM (n = 19), those at-risk (n = 20) and pain-free controls (n = 17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research. RESULTS Repeated measures ANOVA revealed significant main effects of group (p = 0.003), and time of day (p = 0.002), with no significant interaction. Cortisol levels were higher in FM (p = 0.027) and at-risk (p = 0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p = 0.021) and life events (p = 0.007), but was not significant with anxiety (p = 0.076) or depression (p = 0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p = 0.017). CONCLUSIONS This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain. SIGNIFICANCE This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.
Collapse
Affiliation(s)
- Nayab Begum
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Jason R Taylor
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Christopher Brown
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jonathan Rajan
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Brian Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Emily Pye
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Timothy Rainey
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Anthony Jones
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| |
Collapse
|
11
|
Moriishi C, Maeda S, Ogishima H, Shimada H. Effects of cortisol on retrieval of extinction memory in individuals with social anxiety. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 7:100060. [PMID: 35757066 PMCID: PMC9216654 DOI: 10.1016/j.cpnec.2021.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/20/2021] [Accepted: 05/20/2021] [Indexed: 10/27/2022] Open
|
12
|
Steudte-Schmiedgen S, Fay E, Capitao L, Kirschbaum C, Reinecke A. Hydrocortisone as an adjunct to brief cognitive-behavioural therapy for specific fear: Endocrine and cognitive biomarkers as predictors of symptom improvement. J Psychopharmacol 2021; 35:641-651. [PMID: 33908295 PMCID: PMC8278554 DOI: 10.1177/02698811211001087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glucocorticoid (GC) administration prior to exposure-based cognitive-behavioural therapy (CBT) has emerged as a promising approach to facilitate treatment outcome in anxiety disorders. Further components relevant for improved CBT efficacy include raised endogenous GCs and reductions in information-processing biases to threat. AIMS To investigate hydrocortisone as an adjunct to CBT for spider fear and the modulating role of threat bias change and endogenous short-term and long-term GCs for treatment response. METHODS Spider-fearful individuals were randomized to receiving either 20 mg of hydrocortisone (n = 17) or placebo (n = 16) one hour prior to single-session predominantly computerised exposure-based CBT. Spider fear was assessed using self-report and behavioural approach measures at baseline, 1-day and 1-month follow-up. Threat processing was assessed at baseline and 1-day follow-up. Cortisol and cortisone were analysed from hair and saliva samples at baseline. RESULTS/OUTCOMES Self-report, behavioural and threat processing indices improved following CBT. Hydrocortisone augmentation resulted in greater improvement of self-report spider fear and stronger increase in speed when approaching a spider, but not on threat bias. Neither threat bias nor endogenous GCs predicted symptom change, and no interactive effects with hydrocortisone emerged. Preliminary evidence indicated higher hair cortisone as predictor of a stronger threat bias reduction. CONCLUSIONS/INTERPRETATION Our data extend earlier findings by suggesting that GC administration boosts the success of exposure therapy for specific fear even with a low-level therapist involvement. Future studies corroborating our result of a predictive hair GC relationship with threat bias change in larger clinical samples are needed.
Collapse
Affiliation(s)
- Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany,Department of Psychiatry, University of Oxford, Oxford, UK,Susann Steudte-Schmiedgen, Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, Dresden 01062, Germany.
| | - Emily Fay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Liliana Capitao
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Health NHS Trust, Oxford, UK
| | | | | |
Collapse
|
13
|
Hair cortisol concentration in anxiety disorders: exploration of relationships with symptom severity and inflammatory markers. Acta Neuropsychiatr 2021; 33:104-110. [PMID: 33054873 DOI: 10.1017/neu.2020.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hair cortisol concentration (HCC) can be used to periodically assess hypothalamic-pituitary-adrenal (HPA) axis function, and appears correlated with prolonged exposure to stress. METHODS Serial assessment (at Baseline, Week 6 and Week 12) of participants (n = 35) with anxiety disorders by psychopathological rating scales, with assays of HCC and levels of peripheral anti- and pro-inflammatory cytokines. Patients underwent antidepressant treatment for an initial 6 weeks, followed by cyclo-oxygenase inhibitor-2 (COX-2) inhibitor (celecoxib) augmentation or 'treatment as usual' for a further 6 weeks. RESULTS At Baseline (n = 35), HCC was elevated in patients with single-episode but not recurrent-episode anxiety disorders, mean IL-12p70 levels were low, and mean TNF-α levels were elevated. Following 6 weeks of antidepressant treatment (n = 33), mean HCC was within the normal range but mean IL-2 level was low. Celecoxib augmentation (n = 18) was associated with a reduction in anxiety symptoms and normalisation of mean IL-2 levels. LIMITATIONS Small sample size. Not all participants were assessed at all time points. CONCLUSION Serial assessment of HCC is practicable in patients with anxiety disorders. These preliminary findings warrant further investigation in larger samples.
Collapse
|
14
|
Kische H, Ollmann TM, Voss C, Hoyer J, Rückert F, Pieper L, Kirschbaum C, Beesdo-Baum K. Associations of saliva cortisol and hair cortisol with generalized anxiety, social anxiety, and major depressive disorder: An epidemiological cohort study in adolescents and young adults. Psychoneuroendocrinology 2021; 126:105167. [PMID: 33592366 DOI: 10.1016/j.psyneuen.2021.105167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Most of the observed associations of generalized anxiety disorder (GAD), social anxiety disorder (SAD) and major depressive disorder (MDD) with cortisol concentrations came from clinical and adult study samples, with inconsistent findings, partly due to method variance. We examined cross-sectional and longitudinal associations between GAD, SAD and MDD with saliva and hair cortisol as well as hair cortisol change in a population-based sample of adolescents and young adults, considering relevant co-factors. DESIGN Epidemiological cohort study in Dresden, Germany. Data of 1050 individuals (mean age: 17.2 years) assessed at baseline (11/2015-12/2016) and of 605 individuals assessed at 1-year follow-up (FU1) are used. METHODS Multivariable regression models were implemented to assess cross-sectional and longitudinal associations of DSM-5 defined 12-month diagnoses of GAD, SAD, and MDD, with short-term (saliva cortisol: cortisol awakening response (CAR) and area under the curve (AUC) as total cortisol) and long-term (hair cortisol) cortisol indices. Multivariable models were adjusted for age or "tanner" stage, waist circumference, tobacco and alcohol consumption, physical inactivity, and hair cortisol dependent confounder. Sex-specific analyses were additionally conducted. RESULTS Cross-sectional analyses revealed positive associations between SAD and baseline saliva cortisol in multivariable models (CAR: β-coefficient: 0.12; 95% CI: 0.01; 0.23) but could not be confirmed after adjusting for "tanner" stage or comorbid depression. Cross-sectional analyses concerning GAD and MDD in the full baseline sample yielded no significant associations. Sex-specific linear models revealed a significant inverse cross-sectional association between MDD (β-coefficient: - 2.21; 95% CI: - 3.64; - 0.79) as well as SAD (β-coefficient: - 2.21; 95% CI: - 4.03; - 0.38) with baseline hair cortisol in males, but not in females. In longitudinal analyses, no significant associations were found in the fully adjusted model, except for a positive association between hair cortisol change between baseline and FU1 and FU1-SAD (OR: 1.07; 95% CI: 1.02; 1.12). CONCLUSIONS Results confirmed sex-specificity and the role of pubertal development in the association between cortisol with SAD and MDD, while no association emerged regarding cortisol and GAD. Future research in adolescents focusing on the role of cortisol in the pathogenesis of anxiety and depressive disorders would benefit from considering factors like sex-specificity and puberty development as well as comorbidity.
Collapse
Affiliation(s)
- Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Theresa Magdalena Ollmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jana Hoyer
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Centre for Obesity, Städtisches Klinikum Dresden, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Department of Biopsychology, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
15
|
Lopresti AL, Smith SJ, Drummond PD. Modulation of the hypothalamic-pituitary-adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials. Nutr Neurosci 2021; 25:1704-1730. [PMID: 33650944 DOI: 10.1080/1028415x.2021.1892253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in the stress response. Plants, herbs, spices, and plant-based nutrients may influence HPA-axis activity. OBJECTIVE To evaluate randomised controlled, human trials assessing the effects of single plants or phytonutrients on HPA-axis related hormones. METHODS A systematic review of PubMed, Cochrane library, and the Cumulative Index to Nursing and Allied Health Literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria comprised of human, randomised controlled studies with a control intervention examining the effects of a single herb, spice, plant, or extract on pre- and post-changes in blood, saliva, urine, or hair concentrations of cortisol, cortisone, corticotrophin-releasing hormone, or adrenocorticotropic hormone. Databases were searched from inception until October 2020. RESULTS Fifty-two studies were identified examining the effects of ashwagandha, Korean ginseng, St John's Wort, cannabidiol, Rhodiola rosea, curcumin, cherry juice, asparagus, Jiaogulan, Black cohosh, Siberian ginseng, Bacopa monnieri, blueberries, green tea, Caralluma fimbriata, cashew apple juice, melon, American ginseng, Ginkgo biloba, grape juice, grapefruit juice, rosella, hops, mangosteen, holy basil, and pomegranate juice. Due to significant variability in study designs, the effect of phytonutrients on HPA-axis activity in humans was unclear. The most consistent finding was a morning, cortisol-lowering effect from ashwagandha supplementation. CONCLUSION For most phytonutrients, the effects of supplementation on HPA-axis activity in humans is unclear. Before more definitive conclusions about the effects of phytonutrients on the HPA-axis can be made, further research is required.
Collapse
Affiliation(s)
- Adrian L Lopresti
- Clinical Research Australia, Perth, Australia.,College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Stephen J Smith
- Clinical Research Australia, Perth, Australia.,College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Peter D Drummond
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| |
Collapse
|
16
|
Conde A, Costa R, Figueiredo B. Anxiety and depressive symptoms effects on cortisol trajectories from pregnancy to postpartum: Differences and similarities between women and men. Horm Behav 2021; 128:104917. [PMID: 33387466 DOI: 10.1016/j.yhbeh.2020.104917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023]
Abstract
Anxiety and depressive symptoms may influence cortisol trajectories in women and men during pregnancy and the postpartum period. Using a multilevel approach, anxiety and depressive symptoms effects on 24-hour urinary free cortisol trajectories from the 2nd trimester to 3-months postpartum were examined in a sample of 66 women and 65 men with no known psychosocial or medical risk (N = 131; 33 (50%) of them were couples that participated in the same assessment waves). Results showed that both anxiety and depressive symptoms influence women's and men's cortisol trajectories from mid-pregnancy to 3-months postpartum. Women with high depressive symptoms and men with high anxiety or high depressive symptoms exhibited less accentuated variations in the 24-hour urinary free cortisol trajectories compared with women with low depressive symptoms and men with low anxiety or depressive symptoms, respectively. These effects were significant for women's cortisol trajectories from the 2nd to the 3rd pregnancy trimester and for men's cortisol trajectories throughout the entire period. The effect of anxiety and depressive symptoms on HPA axis functioning and cortisol production during pregnancy and postpartum, seems to be sex-specific. Reproductive-related alterations (associated with gestation, parturition and lactation) in women's HPA axis functioning may explain these sex-specific effects.
Collapse
Affiliation(s)
- Ana Conde
- INPP - Portucalense Institute for Human Development, Portucalense University, Porto, Portugal; Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal.
| | - Raquel Costa
- Universidade Europeia, Lisboa, Portugal; EPIUnit, ISPUP - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Bárbara Figueiredo
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| |
Collapse
|
17
|
Abstract
Of all mental disorders, anxiety disorders are currently the strongest contributors to the global burden of disease, with 7.3% of the general population affected worldwide. The hypothalamus is crucial hub of a network of neural structures modulating fear conditioning and extinction and, as such, highly relevant to the pathophysiology of these conditions. Three hypothalamic systems have emerged as particularly relevant in this context. First, the oxytocin system is highly likely to be involved anxiety disorders and in particular in the cognitive and behavioral deficits pertaining to social anxiety disorder. Second, peripheral markers of the hypothalamic-pituitary-adrenal axis appear altered in patients with panic disorder and generalized anxiety disorder, which may denote aberrant functioning of their central corticotropin-releasing hormone system. Furthermore, cortisol seems to augment the effects of exposure therapy in patients with specific phobia. Third, the integrity of the hypothalamic-pituitary-thyroid axis is likely compromised in panic disorder. Further, cross-disciplinary research efforts are required to shed more light on how, exactly, these hypothalamic systems interact with the neural structures involved in fear conditioning and extinction, which should ultimately open up new avenues for the prevention and treatment of anxiety disorders.
Collapse
|
18
|
Kitamura Y, Ushio S, Sumiyoshi Y, Wada Y, Miyazaki I, Asanuma M, Sendo T. N-Acetylcysteine Attenuates the Anxiety-Like Behavior and Spatial Cognition Impairment Induced by Doxorubicin and Cyclophosphamide Combination Treatment in Rats. Pharmacology 2020; 106:286-293. [PMID: 33352577 DOI: 10.1159/000512117] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cancer patients can suffer from psychological and cognitive disorders after chemotherapy, which influence quality of life. OBJECTIVE Oxidative stress may contribute to the psychological and cognitive disorders induced in rats by chemotherapy. In the present study, we examined the effects of N-acetylcysteine, an anti-oxidant, on anxiety-like behavior and cognitive impairment in rats treated with a combination of doxorubicin and cyclophosphamide. METHODS Rats were intraperitoneally injected with doxorubicin and cyclophosphamide once a week for 2 weeks. The light-dark test and the novel location recognition test were used to assess anxiety-like behavior and spatial cognition, respectively. The rats' hippocampal levels of glutathione (GSH) and glutathione disulfide (GSSG) were measured using a GSSG/GSH quantification kit. RESULTS Combined treatment with doxorubicin and cyclophosphamide produced anxiety-like behavior and cognitive impairment in rats. N-acetylcysteine reversed the anxiety-like behavior and inhibition of novel location recognition induced by the combination treatment. Furthermore, the combination of doxorubicin and cyclophosphamide significantly reduced the rats' hippocampal GSH/GSSG ratios. N-acetylcysteine reversed the reduction in the GSH/GSSG ratio seen in the doxorubicin and cyclophosphamide-treated rats. CONCLUSION These results suggest that N-acetylcysteine inhibits doxorubicin and cyclophosphamide-induced anxiety-like behavior and cognitive impairment by reducing oxidative stress in the hippocampus.
Collapse
Affiliation(s)
- Yoshihisa Kitamura
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan,
- School of Pharmacy, Shujitsu University, Okayama, Japan,
| | - Soichiro Ushio
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Yusuke Sumiyoshi
- Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yudai Wada
- Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Ikuko Miyazaki
- Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masato Asanuma
- Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiaki Sendo
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
- Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
19
|
The roles of comorbidity and trauma exposure and its timing in shaping HPA axis patterns in depression. Psychoneuroendocrinology 2020; 120:104776. [PMID: 32593866 PMCID: PMC7502500 DOI: 10.1016/j.psyneuen.2020.104776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Much work has documented hypothalamic pituitary adrenal (HPA) axis abnormalities in major depressive disorder (MDD), but inconsistencies leave this system's role in the illness unclear. Comparisons across studies are complicated by variation in co-morbidity (Posttraumatic Stress Disorder-PTSD, anxiety disorders), exposure to trauma, and timing of trauma (child vs. adult). Here, we examined the impact of these factors on HPA axis profiles in depression. METHODS We recruited 5 groups of participants: MDD (n = 14), comorbid MDD + PTSD following adulthood trauma (MDD + PTSD-Adult; n = 12), comorbid MDD + PTSD following childhood trauma (MDD + PTSD-Child; n = 18), comorbid MDD + social anxiety disorder (MDD + SAD; n = 12), and non-depressed control participants who were sex and age matched to patients (combined total n = 36). HPA axis function was assessed using three challenges: stress reactivity via the Trier Social Stress Test (TSST), feedback sensitivity via a dexamethasone suppression test (DST), and central drive via a metyrapone challenge (MET). We compared hormonal responses between patient groups and their respective non-depressed controls. RESULTS MDD + PTSD-Child showed low cortisol levels at baseline, and reduced adrenocorticotropic hormone (ACTH) levels at baseline and throughout the TSST. MDD-only, MDD + PTSD-Adult, and MDD + SAD did not differ from non-depressed controls in HPA axis responses to the TSST. Controlling for childhood trauma severity, the reduced baseline levels in MDD + PTSD-Child were no longer significant and significantly reduced baseline cortisol levels emerged for MDD + PTSD-Adult. No diagnostic group effects were detected with DST and MET. Childhood maltreatment subtypes were associated with unique HPA axis responses to TSST and MET. CONCLUSION Comorbidity and trauma exposure, as well as their timing and type, contribute to inconsistencies in the depression literature and must be included in efforts to clarify the role of the HPA axis in MDD.
Collapse
|
20
|
Paltian JJ, Dos Reis AS, de Oliveira RL, da Fonseca CAR, Domingues WB, Dellagostin EN, Campos VF, Kruger R, Alves D, Luchese C, Wilhelm EA. The anxiolytic effect of a promising quinoline containing selenium with the contribution of the serotonergic and GABAergic pathways: Modulation of parameters associated with anxiety in mice. Behav Brain Res 2020; 393:112797. [PMID: 32649976 DOI: 10.1016/j.bbr.2020.112797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
Recently, we demonstrated the promising anxiolytic action of 7-chloro-4-(phenylselanyl) quinoline (4-PSQ) in mice. For this reason, the objective of this study was to expand our previous findings by investigating the contribution of serotoninergic and GABAergic systems to the anxiolytic action of this compound. Pretreatment with different serotoninergic antagonists (pindolol, WAY100635 and ketanserin) blocked the anxiolytic effect caused by 4-PSQ (50 mg/kg, per oral) in the elevated plus maze (EPM) test. The contribution of the GABAergic system was investigated by pretreatment with pentylenetetrazole (a GABAA receptor antagonist) (PTZ). 4-PSQ diminished the PTZ-induced anxiety, and did not modify the locomotor, exploratory and motor activities of mice. Later, this group of animals was euthanized and the blood was removed to determine the levels of corticosterone, and cerebral cortex and hippocampus to determine the mRNA expression levels of cAMP response element binding protein (CREB), brain derived neurotrophic factor (BDNF) and nuclear factor kappa B (NF-κB), as well as the Na+, K+ ATPase activity and reactive species (RS) levels. 4-PSQ was able to significantly reverse the increase in RS and corticosterone levels, as well as the decrease of CREB and BDNF expression in the cerebral structures and increase of NF-κB expression in the hippocampus. Finally, 4-PSQ restored the Na+, K+ ATPase activity in the cerebral structures evaluated. Here, we showed that the modulation of serotonergic and GABAergic systems, factors related to neurogenesis, oxidative status and Na+, K+ ATPase activity contributes to the anxiolytic effect of 4-PSQ and reinforces the therapeutical potential of this compound for the treatment of anxiety.
Collapse
Affiliation(s)
- Jaini J Paltian
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Angélica S Dos Reis
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Renata L de Oliveira
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Caren A R da Fonseca
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - William B Domingues
- Programa de Pós-graduação em Biotecnologia, Laboratório de Genômica Estrutural, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Eduardo N Dellagostin
- Programa de Pós-graduação em Biotecnologia, Laboratório de Genômica Estrutural, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Vinícius F Campos
- Programa de Pós-graduação em Biotecnologia, Laboratório de Genômica Estrutural, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Roberta Kruger
- Programa de Pós-graduação em Química, Laboratório de Síntese Orgânica Limpa (LaSOL), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Diego Alves
- Programa de Pós-graduação em Química, Laboratório de Síntese Orgânica Limpa (LaSOL), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Cristiane Luchese
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | - Ethel A Wilhelm
- Programa de Pós-graduação em Bioquímica e Bioprospecção, Laboratório de Pesquisa em Farmacologia Bioquímica (LaFarBio), Centro de Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| |
Collapse
|
21
|
Cui Y, Yu H, Meng F, Liu J, Yang F. Prospective study of pregnancy outcome between perceived stress and stress-related hormones. J Obstet Gynaecol Res 2020; 46:1355-1363. [PMID: 32500644 DOI: 10.1111/jog.14278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/06/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the relationship between physiological and psychological stress on pregnancy outcome in women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment. METHODS Women undergoing the first IVF cycle were enrolled to complete the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Their blood samples were collected on the 3rd day of the menstrual cycle to measure 5-hydroxytryptamine, renin, norepinephrine, angiotensin II and cortisol. Salivary amylase was obtained on the embryo transfer day. RESULTS Compared with normal women who came to the hospital for regular physical examination, the incidence of anxiety and depression was higher in women seeking for IVF treatment. After psychological intervention, the condition got improved and the incidence of anxiety and depression was 6.25% and 7.81% separately in these women. There were no significant differences between the anxiety scores in women with and without pregnancy. The depression scores did show some statistically differences, with higher scores in the nonpregnancy group. The level of 5-hydroxytryptamine, renin, norepinephrine and cortisol were not significantly different between the two groups, while angiotensin II and salivary amylase seemed to be negatively correlated with pregnancy outcome. Simultaneously, a positive correlation was found between angiotensin II and anxiety and depression scores. CONCLUSION Depression during IVF has a negative impact on pregnancy outcome. The measurement of angiotensin II and salivary amylase might be reference index for the psychological status of patients during IVF-ET.
Collapse
Affiliation(s)
- Yuqian Cui
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo college of Medicine, Shandong University, Jinan, China
| | - Hongling Yu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo college of Medicine, Shandong University, Jinan, China
| | - Fanwei Meng
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo college of Medicine, Shandong University, Jinan, China
| | - Jin Liu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo college of Medicine, Shandong University, Jinan, China
| | - Fang Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo college of Medicine, Shandong University, Jinan, China
| |
Collapse
|
22
|
Pittenger C, Pushkarskaya H, Gruner P. Animal models of OCD-relevant processes: an RDoC perspective. J Obsessive Compuls Relat Disord 2019; 23:100433. [PMID: 32322462 PMCID: PMC7176322 DOI: 10.1016/j.jocrd.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Animal models have been invaluable tools in deciphering pathophysiology in many branches of medicine. Their application in the study of complex neuropsychiatric conditions such as obsessive-compulsive disorder (OCD), however, raises vexing interpretative challenges. The Research Domain Criteria (RDoC) approach of identifying dimensions of function and dysfunction that cut across syndromic diagnoses provides one potential path forward. We review some of the domains in the current RDoC matrix that may inform our understanding of patients with obsessions and compulsions, and how work in animal model systems is helping us to understand them. We focus on three specific RDoC constructs that may be particularly informative for our understanding of OCD: potential threat, habit, and cognitive control. In each case we review selected recent studies in animal models and their potential contribution to our understanding of OCD, and suggest directions for future research, informed by the animal studies. Such mechanistic work in animal models, in parallel with clinical studies refining our understanding of the relationship between these dimensional constructs and the symptomatology of particular groups of patients, may over time help us to generate a more comprehensive understanding of the pathogenesis and complexity of obsessions and compulsions.
Collapse
Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine
- Child Study Center, Yale University School of Medicine
- Interdepartmental Neuroscience Program, Yale University School of Medicine
| | | | - Patricia Gruner
- Department of Psychiatry, Yale University School of Medicine
| |
Collapse
|
23
|
Fiksdal A, Hanlin L, Kuras Y, Gianferante D, Chen X, Thoma MV, Rohleder N. Associations between symptoms of depression and anxiety and cortisol responses to and recovery from acute stress. Psychoneuroendocrinology 2019; 102:44-52. [PMID: 30513499 PMCID: PMC6420396 DOI: 10.1016/j.psyneuen.2018.11.035] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/25/2018] [Accepted: 11/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anxiety disorders and major depressive disorder (MDD) have been associated with increased and blunted HPA axis reactivity to social stress. However, research focusing on associations between HPA axis responses to stress and symptoms of anxiety and depression among individuals without a diagnosis remains an understudied area of research. METHODS One hundred forty-three adults (52% female) completed the Trier Social Stress Test (TSST). Symptoms of depression and anxiety were assessed prior to the TSST using the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS). HPA axis responses were assessed by measuring salivary cortisol at baseline and following the TSST. Reactivity to and recovery from stress were assessed using multilevel growth modeling controlling for age, BMI, and sex among the full sample and a subset of cortisol responders (n = 72). RESULTS Anxiety symptoms were positively associated with flatter recovery slopes among the full sample (t(122.3) = 2.082, p = .039). Among cortisol responders, depression symptoms were associated with steeper reactivity (t(63.32) = 2.53, p = .026) and recovery (t(58.75)=-2.20, p = .03). Anxiety symptoms were associated with marginally flatter reactivity (t(64.00)=-1.97, p = .053) and significantly flatter recovery (t(59.22) = 2.29, p = .025). CONCLUSION Symptoms of anxiety and depression among individuals without a psychiatric diagnosis are associated with blunted and exaggerated cortisol responses to and recovery from stress. Such patterns could indicate increased risk for unhealthy HPA axis dysregulation, allostatic load, and disease.
Collapse
Affiliation(s)
- Alexander Fiksdal
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Luke Hanlin
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Yuliya Kuras
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Danielle Gianferante
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Xuejie Chen
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Myriam V. Thoma
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Nicolas Rohleder
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States; Chair of Health Psychology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
| |
Collapse
|
24
|
Gerritsen L, Staufenbiel SM, Penninx BWJH, van Hemert AM, Noppe G, de Rijke YB, van Rossum EFC. Long-term glucocorticoid levels measured in hair in patients with depressive and anxiety disorders. Psychoneuroendocrinology 2019; 101:246-252. [PMID: 30472466 DOI: 10.1016/j.psyneuen.2018.11.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Depressive and anxiety disorders have been linked to a dysregulated hypothalamus-pituitary-adrenal (HPA)-axis. Hair cortisol levels (HairF) reflect integrated long-term cortisol regulation and are therefore promising endocrine markers of chronic (psychological and physical) stress. Our aim was to assess hair cortisol levels in persons with a depressive and/or anxiety disorder and to compare their levels with that of persons in remission and healthy controls. METHODS Data from 1166 participants of the Netherlands Study of Depression and Anxiety (NESDA) were used, including 266 participants with a recent (1-month) diagnosis of a depressive and/or anxiety disorder, 655 participants with a diagnosis in remission, and 245 healthy controls. HairF was measured in the proximal three cm of scalp hair, using LC-MS/MS. RESULTS Compared to the healthy controls no differences on HairF or HairE levels were found for depressive and anxiety disorders alone. However the presence of a comorbid depressive and anxiety disorder was significantly associated with increased HairF levels (β = 0.07; p = .031), as was the severity of depressive symptoms (β = 0.06; p = .029), but no differences were found on HairE nor the HairF:HairE ratio. CONCLUSIONS Persons with current diagnosis of comorbid depression and anxiety show moderately higher levels of cortisol than patients with only depression or anxiety, or patients in remission and healthy controls, which may be indicative of a chronic state of hyperactivation of the HPA axis.
Collapse
Affiliation(s)
- Lotte Gerritsen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Sabine M Staufenbiel
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard Noppe
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yolanda B de Rijke
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
25
|
Akaltun İ, Çayır A, Kara T, Ayaydın H. Is growth hormone deficiency associated with anxiety disorder and depressive symptoms in children and adolescents?: A case-control study. Growth Horm IGF Res 2018; 41:23-27. [PMID: 29886327 DOI: 10.1016/j.ghir.2018.06.001] [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: 10/26/2017] [Revised: 05/18/2018] [Accepted: 06/03/2018] [Indexed: 11/19/2022]
Abstract
AIM Children with growth hormone deficiency (GHD) are reported to experience failure in psychological maturation, and to have a lack of self-confidence in social life, and depressive symptoms. The purpose of this study was to investigate the relation between GHD and anxiety disorders and depression in children and adolescents. METHOD 122 children and adolescents aged 7-17, 87 receiving GHD therapy and 35 before treatment, and 122 healthy volunteers were included in the study. All participants were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version-Turkish Version (K-SADS-PL-T). Diagnoses falling outside this semi-structured interview were made with clinical evaluation based on DSM-V diagnostic criteria. Participants were also assessed using an information form, the State-Trait Anxiety Inventory for Children (STAI-C), the Social Anxiety Scale for Children-Revised (SASC-R), and the Children's Depression Inventory (CDI), and the results were subjected to statistical analysis. RESULTS Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) were significantly more common in children with GHD compared to the control group (p ≤0.001 and p = 0.033, respectively). Receipt of treatment significantly reduced GAD and SAD rates in the group diagnosed with GHD (p = 0.012, and p = 0.014). Being in receipt of GH therapy also caused a significant decrease in STAIC (State) (p ≤0.001), STAIC (Trait) (p ≤0.001), SASC-R (p ≤0.001), and CDI (p ≤0.001) scale scores. Untreated subjects had more adverse scale scores than treated subjects, and treated subjects had more adverse scale scores than the control group. An increase was observed in all scale scores in the form of control group < treated group < pre-treatment group. IGF and GH-PEAK exhibited moderate negative correlation with STAIC-TRAIT, STAIC-STATE, and SASC-R, and weak negative, significant correlation with CDI (Spearman's rho p ≤0.05). CONCLUSION Having GHD and being in receipt of treatment resulted in lower scale scores. Children with GHD had higher GAD and SAD burdens compared to the healthy controls. The etiology of these children's existing psychiatric diseased now requires identification using more variables in psychosocial and hormonal terms.
Collapse
Affiliation(s)
- İsmail Akaltun
- Department of Child and Adolescent Psychiatry, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Atilla Çayır
- Department of Pediatric Endocrinology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Tayfun Kara
- University of Health Sciences, Department of Child and Adolescent Psychiatry, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Hamza Ayaydın
- Harran University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Şanlıurfa, Turkey
| |
Collapse
|
26
|
Amos GA, Byrne G, Chouinard PA, Godber T. Autism Traits, Sensory Over-Responsivity, Anxiety, and Stress: A Test of Explanatory Models. J Autism Dev Disord 2018; 49:98-112. [DOI: 10.1007/s10803-018-3695-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
27
|
Abstract
PURPOSE OF REVIEW Stress has long been suspected to be interrelated to (abdominal) obesity. However, interindividual differences in this complex relationship exist. We suggest that the extent of glucocorticoid action partly explains these interindividual differences. We provide latest insights with respect to multiple types of stressors. RECENT FINDINGS Increased long-term cortisol levels, as measured in scalp hair, are strongly related to abdominal obesity and to specific mental disorders. However, not all obese patients have elevated cortisol levels. Possibly, the interindividual variation in glucocorticoid sensitivity, which is partly genetically determined, may lead to higher vulnerability to mental or physical stressors. Other evidence for the important role for increased glucocorticoid action is provided by recent studies investigating associations between body composition and local and systemic corticosteroids. Stress may play a major role in the development and maintenance of obesity in individuals who have an increased glucocorticoid exposure or sensitivity. These insights may lead to more effective and individualized obesity treatment strategies.
Collapse
Affiliation(s)
- Eline S van der Valk
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Room D-428, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mesut Savas
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Room D-428, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Room D-428, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
28
|
Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev 2018; 63:25-40. [PMID: 29879564 DOI: 10.1016/j.cpr.2018.05.006] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/05/2018] [Accepted: 05/26/2018] [Indexed: 11/27/2022]
Abstract
There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.
Collapse
Affiliation(s)
- Matthew J Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - John A Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia; Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA.
| |
Collapse
|
29
|
Fischer S, Ehlert U. Hypothalamic-pituitary-thyroid (HPT) axis functioning in anxiety disorders. A systematic review. Depress Anxiety 2018; 35:98-110. [PMID: 29064607 DOI: 10.1002/da.22692] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 12/26/2022] Open
Abstract
Depression has repeatedly been linked to subclinical hypothyroidism, and thyroid hormones have successfully been used to augment antidepressant treatment. By contrast, the extent of thyroid dysfunction in anxiety disorders remains less clear. This is surprising, given that anxiety-related symptoms (e.g., nervousness, palpitations, increased perspiration) are highly prevalent in hyperthyroidism. The present study was undertaken to synthesize the literature on hypothalamic-pituitary-thyroid (HPT) axis functioning in anxiety disorders. The PubMed and PsycINFO databases were systematically searched. Three types of studies were included: (1) "comorbidity studies" assessing the prevalence of thyroid disorders in individuals with anxiety disorders, (2) "case-control studies" comparing HPT parameters between patients and controls, and (3) "correlational studies" assessing self-reported anxiety levels and HPT parameters. Risk of bias was assessed via a standardized quality rating. Twenty studies were eligible. Nearly all found the comorbidity between anxiety and thyroid disorders was significant. Half of the studies additionally supported the notion of subtle thyroid dysfunction in that thyroid-stimulating hormone (TSH) responses to the administration of thyrotropin-releasing hormone (TRH) were blunted and an inverse relationship was observed between self-reported anxiety levels and TSH. Overall, HPT assessments were well conducted, but several studies failed to adjust their analyses for smoking, body mass index (BMI), and depression. The findings resonate well with clinical recommendations to routinely screen for thyroid disorders in patients with anxiety disorders, and with what is known from basic research about thyroid-brain interactions. The results of the risk of bias assessment underscore the importance of further high-quality experimental and longitudinal epidemiological research.
Collapse
Affiliation(s)
- Susanne Fischer
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
30
|
Keefe JR, Guo W, Li QS, Amsterdam JD, Mao JJ. An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder. J Psychiatr Res 2018; 96:189-195. [PMID: 29080520 PMCID: PMC5710842 DOI: 10.1016/j.jpsychires.2017.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/22/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Dysfunctions in stress biology are hypothesized to contribute to anxiety disorders, and to be ameliorated during successful treatment, but limited clinical data exist to support this hypothesis. We evaluated whether increases in morning cortisol and the diurnal cortisol slope, markers of stress biology, are associated with clinical response to chamomile therapy among subjects with generalized anxiety disorder (GAD). METHODS Among 45 subjects with DSM-IV diagnosed GAD in an open-label clinical trial of chamomile, salivary cortisol was assessed for three days each pre- and post-treatment, at 8am, 12pm, 4pm, and 8pm. Mixed model analyses assessed whether GAD symptom change predicted the degree to which cortisol levels changed during treatment. RESULTS Symptom improvement during treatment was significantly associated with pre-to-post treatment changes in cortisol. Subjects who experienced more symptomatic improvement experienced significant increases in their morning salivary cortisol (β = 0.48, p < 0.001), and a greater decrease in cortisol from morning to the rest of the day (β = 0.55, p < 0.001). In addition, at baseline a lower cortisol level (β = -0.24, p = 0.023) and a lesser decrease in cortisol after morning (β = 0.30, p = 0.003) were associated with greater symptomatic improvement. CONCLUSION Increases in morning salivary cortisol and the diurnal cortisol slope are associated with symptom improvement in chamomile treatment of GAD. Response to treatment for GAD could partially stem from normalization of stress biology dysfunction, but further work involving establishing abnormalities within-sample, ruling out of confounds (e.g., sleep), and a placebo control is necessary to conclude an amelioration effect. REGISTRATION CODE NCT01072344. URL: https://clinicaltrials.gov/ct2/show/NCT01072344.
Collapse
Affiliation(s)
| | - Wensheng Guo
- Perelman School of Medicine at the University of Pennsylvania
| | | | | | | |
Collapse
|
31
|
Vogel SWN, Bijlenga D, Verduijn J, Bron TI, Beekman ATF, Kooij JJS, Penninx BWJH. Attention-deficit/hyperactivity disorder symptoms and stress-related biomarkers. Psychoneuroendocrinology 2017; 79:31-39. [PMID: 28249186 DOI: 10.1016/j.psyneuen.2017.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/29/2017] [Accepted: 02/09/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The current study examined whether (a) Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms were associated with dysregulation of stress-related mechanisms, and (b) whether ADHD symptoms interact with affective disorders in their association with dysregulated stress-related mechanisms. METHODS Data were obtained from 2307 subjects participating in the Netherlands Study of Depression and Anxiety. Stress-related mechanisms were reflected by the following biomarkers: (1) hypothalamic-pituitary-adrenal axis indicators (salivary cortisol awakening curve, evening cortisol, cortisol suppression after a 0.5mg dexamethasone suppression test (DST)); (2) autonomic nervous system measures (heart rate, pre-ejection period, respiratory sinus arrhythmia); (3) inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha); (4) brain-derived neurotrophic factor. ADHD symptoms were measured using Conners' Adult ADHD Rating Scale and used both dichotomous (High ADHD symptoms (yes/no)) and continuous (Inattentive symptoms, Hyperactive/Impulsive symptoms, and the ADHD index). RESULTS Regression analyses showed associations between High ADHD symptoms, Inattentive symptoms, the ADHD index and a higher cortisol awakening curve, between Hyperactive/Impulsive symptoms and less cortisol suppression after DST, and between Inattentive symptoms and a longer pre-ejection period. However, the associations with the cortisol awakening curve disappeared after adjustment for depressive and anxiety disorders. No associations were observed between ADHD symptoms and inflammatory markers or BDNF. ADHD symptoms did not interact with affective disorders in dysregulation of stress-related mechanisms. CONCLUSION Some associations were observed between ADHD symptoms, the HPA-axis, and the pre-ejection period, but these were mostly driven by depressive and anxiety disorders. This study found no evidence that ADHD symptomatology was associated with dysregulations in inflammatory markers and BDNF. Consequently, ADHD symptoms did not confer an added risk to the disturbances of stress-related mechanisms in an - already at-risk - population with affective disorders.
Collapse
Affiliation(s)
- S W N Vogel
- PsyQ Expertise Center Adult ADHD, The Hague, The Netherlands.
| | - D Bijlenga
- PsyQ Expertise Center Adult ADHD, The Hague, The Netherlands
| | - J Verduijn
- Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - T I Bron
- PsyQ Expertise Center Adult ADHD, The Hague, The Netherlands
| | - A T F Beekman
- Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - J J S Kooij
- PsyQ Expertise Center Adult ADHD, The Hague, The Netherlands; Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Bandelow B, Baldwin D, Abelli M, Bolea-Alamanac B, Bourin M, Chamberlain SR, Cinosi E, Davies S, Domschke K, Fineberg N, Grünblatt E, Jarema M, Kim YK, Maron E, Masdrakis V, Mikova O, Nutt D, Pallanti S, Pini S, Ströhle A, Thibaut F, Vaghix MM, Won E, Wedekind D, Wichniak A, Woolley J, Zwanzger P, Riederer P. Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. World J Biol Psychiatry 2017; 18:162-214. [PMID: 27419272 PMCID: PMC5341771 DOI: 10.1080/15622975.2016.1190867] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). METHODS Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network. RESULTS The present article (Part II) summarises findings on potential biomarkers in neurochemistry (neurotransmitters such as serotonin, norepinephrine, dopamine or GABA, neuropeptides such as cholecystokinin, neurokinins, atrial natriuretic peptide, or oxytocin, the HPA axis, neurotrophic factors such as NGF and BDNF, immunology and CO2 hypersensitivity), neurophysiology (EEG, heart rate variability) and neurocognition. The accompanying paper (Part I) focuses on neuroimaging and genetics. CONCLUSIONS Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.
Collapse
Affiliation(s)
- Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - David Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marianna Abelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Blanca Bolea-Alamanac
- School of Social and Community Medicine, Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Michel Bourin
- Neurobiology of Anxiety and Mood Disorders, University of Nantes, Nantes, France
| | - Samuel R. Chamberlain
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Parkway, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eduardo Cinosi
- Department of Neuroscience Imaging and Clinical Sciences, Gabriele D’Annunzio University, Chieti, Italy
| | - Simon Davies
- Centre for Addiction and Mental Health, Geriatric Psychiatry Division, University of Toronto, Toronto, Canada
- School of Social and Community Medicine, Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Katharina Domschke
- Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Parkway, UK
| | - Edna Grünblatt
- Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Marek Jarema
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warszawa, Poland
| | - Yong-Ku Kim
- Department of Psychiatry College of Medicine, Korea University, Seoul, Republic of Korea
| | - Eduard Maron
- Department of Psychiatry, North Estonia Medical Centre, Tallinn, Estonia
- Department of Psychiatry, University of Tartu, Estonia
- Faculty of Medicine Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, UK
| | - Vasileios Masdrakis
- Athens University Medical School, First Department of Psychiatry, Eginition Hospital, Athens, Greece
| | - Olya Mikova
- Foundation Biological Psychiatry, Sofia, Bulgaria
| | - David Nutt
- Faculty of Medicine Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, UK
| | - Stefano Pallanti
- UC Davis Department of Psychiatry and Behavioural Sciences, Sacramento, CA, USA
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité – University Medica Center Berlin, Berlin, Germany
| | - Florence Thibaut
- Faculty of Medicine Paris Descartes, University Hospital Cochin, Paris, France
| | - Matilde M. Vaghix
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Eunsoo Won
- Department of Psychiatry College of Medicine, Korea University, Seoul, Republic of Korea
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warszawa, Poland
| | - Jade Woolley
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Peter Zwanzger
- kbo-Inn-Salzach-Klinikum Wasserburg am Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Peter Riederer
- Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
33
|
Fischer S, Cleare AJ. Cortisol as a predictor of psychological therapy response in anxiety disorders-Systematic review and meta-analysis. J Anxiety Disord 2017; 47:60-68. [PMID: 28273494 DOI: 10.1016/j.janxdis.2017.02.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although psychotherapy generally is effective in anxiety disorders, many patients are treatment-resistant. At the same time, some patients with anxiety disorders show alterations in the hypothalamic-pituitary-adrenal (HPA) axis, one of the major stress-responsive systems. Since raised levels of the end product of the HPA axis, cortisol, adversely affect cognition, we hypothesised that more pronounced alterations in cortisol levels would be associated with a less favourable response to psychotherapy. More specifically, the higher patients' basal levels and the lower their levels during exposure, the less likely we expected them to profit from treatment. METHODS We systematically searched the Cochrane Library, EMBASE, MEDLINE, and PsycINFO to review the literature and perform a meta-analysis on the relationship between pre-treatment cortisol and psychotherapy response. Records were included if they studied patients with any anxiety disorder undergoing psychotherapy, with a pre-treatment cortisol and a post-treatment symptom measure. Correlation coefficients were extracted for meta-analyses. RESULTS We identified six studies (N=274). No relationship between patients' basal cortisol and post-treatment symptoms was found (p=0.981). The systematic review showed higher cortisol during exposure sessions to predict better outcomes. Meta-analysis did not confirm this (p=0.603). CONCLUSIONS Basal cortisol did not seem to predict psychological therapy responses in patients with anxiety disorders. By contrast, the current state of research is equivocal in terms of whether higher cortisol concentrations during exposure sessions are linked with better treatment outcomes, and more research is needed to investigate this.
Collapse
Affiliation(s)
- Susanne Fischer
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, United Kingdom.
| | - Anthony J Cleare
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, United Kingdom
| |
Collapse
|
34
|
de Quervain D, Schwabe L, Roozendaal B. Stress, glucocorticoids and memory: implications for treating fear-related disorders. Nat Rev Neurosci 2016; 18:7-19. [PMID: 27881856 DOI: 10.1038/nrn.2016.155] [Citation(s) in RCA: 319] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Glucocorticoid stress hormones are crucially involved in modulating mnemonic processing of emotionally arousing experiences. They enhance the consolidation of new memories, including those that extinguish older memories, but impair the retrieval of information stored in long-term memory. As strong aversive memories lie at the core of several fear-related disorders, including post-traumatic stress disorder and phobias, the memory-modulating properties of glucocorticoids have recently become of considerable translational interest. Clinical trials have provided the first evidence that glucocorticoid-based pharmacotherapies aimed at attenuating aversive memories might be helpful in the treatment of fear-related disorders. Here, we review important advances in the understanding of how glucocorticoids mediate stress effects on memory processes, and discuss the translational potential of these new conceptual insights.
Collapse
Affiliation(s)
- Dominique de Quervain
- Transfaculty Research Platform, University of Basel, CH-4055, Basel, Switzerland.,Division of Cognitive Neuroscience, Department of Psychology, University of Basel, CH-4055, Basel, Switzerland.,University Psychiatric Clinics, University of Basel, CH-4012, Basel, Switzerland
| | - Lars Schwabe
- Department of Cognitive Psychology, Institute of Psychology, University of Hamburg, 20146 Hamburg, Germany
| | - Benno Roozendaal
- Department of Cognitive Neuroscience, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 EN Nijmegen, The Netherlands
| |
Collapse
|
35
|
Pietrzak RH, Laws SM, Lim YY, Bender SJ, Porter T, Doecke J, Ames D, Fowler C, Masters CL, Milicic L, Rainey-Smith S, Villemagne VL, Rowe CC, Martins RN, Maruff P. Plasma Cortisol, Brain Amyloid-β, and Cognitive Decline in Preclinical Alzheimer's Disease: A 6-Year Prospective Cohort Study. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 2:45-52. [PMID: 29560886 DOI: 10.1016/j.bpsc.2016.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/17/2016] [Accepted: 08/29/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal axis dysregulation, which is typically assessed by measuring cortisol levels, is associated with cognitive dysfunction, hippocampal atrophy, and increased risk for mild cognitive impairment and Alzheimer's disease (AD). However, little is known about the role of hypothalamic-pituitary-adrenal axis dysregulation in moderating the effect of high levels of amyloid-β (Aβ+) on cognitive decline in the preclinical phase of AD, which is often protracted, and thus offers opportunities for prevention and early intervention. METHODS Using data from a 6-year multicenter prospective cohort study, we evaluated the relation between Aβ level, plasma cortisol level, and cognitive decline in 416 cognitively normal older adults. RESULTS Results revealed that Aβ+ older adults experienced faster decline than Aβ- older adults in all cognitive domains (Cohen's d at 6-year assessment = 0.37-0.65). They further indicated a significant interaction between Aβ and cortisol levels for global cognition (d = 0.32), episodic memory (d = 0.50), and executive function (d = 0.59) scores, with Aβ+ older adults with high cortisol levels having significantly faster decline in these domains compared with Aβ+ older adults with low cortisol levels. These effects were independent of age, sex, APOE genotype, anxiety symptoms, and radiotracer type. CONCLUSIONS In cognitively healthy older adults, Aβ+ is associated with greater cognitive decline and high plasma cortisol levels may accelerate the effect of Aβ+ on decline in global cognition, episodic memory, and executive function. These results suggest that therapies targeted toward lowering plasma cortisol and Aβ levels may be helpful in mitigating cognitive decline in the preclinical phase of AD.
Collapse
Affiliation(s)
- Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
| | - Simon M Laws
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia; Co-operative Research Centre for Mental Health
| | - Yen Ying Lim
- The Florey Institute, The University of Melbourne, Parkville, Victoria
| | - Sophie J Bender
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia
| | - Tenielle Porter
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia; Co-operative Research Centre for Mental Health
| | - James Doecke
- The Commonwealth Scientific and Industrial Research Organization, Canberra
| | - David Ames
- Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, The University of Melbourne, Kew; National Ageing Research Institute, Parkville, Victoria
| | | | - Colin L Masters
- The Florey Institute, The University of Melbourne, Parkville, Victoria
| | - Lidija Milicic
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia
| | - Stephanie Rainey-Smith
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia
| | - Victor L Villemagne
- The Florey Institute, The University of Melbourne, Parkville, Victoria; Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia; Department of Nuclear Medicine and Centre for PET, Austin Health
| | - Christopher C Rowe
- Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia; Department of Nuclear Medicine and Centre for PET, Austin Health
| | - Ralph N Martins
- Centre of Excellence for Alzheimer's Disease Research and Care, Edith Cowan University, Joondalup, Western Australia; Sir James McCusker Alzheimer's Disease Research Unit, Hollywood Private Hospital, Perth, Western Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, Victoria; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg; Cogstate Ltd., Melbourne, Victoria, Australia
| | | |
Collapse
|
36
|
Crişan LG, Vulturar R, Miclea M, Miu AC. Reactivity to Social Stress in Subclinical Social Anxiety: Emotional Experience, Cognitive Appraisals, Behavior, and Physiology. Front Psychiatry 2016; 7:5. [PMID: 26858658 PMCID: PMC4728202 DOI: 10.3389/fpsyt.2016.00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 01/11/2016] [Indexed: 11/17/2022] Open
Abstract
Recent research indicates that subclinical social anxiety is associated with dysfunctions at multiple psychological and biological levels, in a manner that seems reminiscent of social anxiety disorder (SAD). This study aimed to describe multidimensional responses to laboratory-induced social stress in an analog sample selected for social anxiety symptoms. State anxiety, cognitive biases related to negative social evaluation, speech anxiety behaviors, and cortisol reactivity were assessed in the Trier Social Stress Test (TSST). Results showed that social anxiety symptoms were associated with increased state anxiety, biased appraisals related to the probability and cost of negative social evaluations, behavioral changes in facial expression that were consistent with speech anxiety, and lower cortisol reactivity. In addition, multiple interrelations between responses in the TSST were found, with positive associations between subjective experience, cognitive appraisals, and observable behavior, as well as negative associations between each of the former two types of response and cortisol reactivity. These results show that in response to social stressors, subclinical social anxiety is associated with significant changes in emotional experience, cognitive appraisals, behaviors, and physiology that could parallel those previously found in SAD samples.
Collapse
Affiliation(s)
- Liviu G Crişan
- Department of Psychology, Babeş-Bolyai University , Cluj-Napoca , Romania
| | - Romana Vulturar
- Department of Cell and Molecular Biology, "Iuliu Haţieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Mircea Miclea
- Department of Psychology, Babeş-Bolyai University , Cluj-Napoca , Romania
| | - Andrei C Miu
- Department of Psychology, Babeş-Bolyai University , Cluj-Napoca , Romania
| |
Collapse
|
37
|
Jakuszkowiak-Wojten K, Landowski J, Wiglusz MS, Cubała WJ. Cortisol awakening response in drug-naïve panic disorder. Neuropsychiatr Dis Treat 2016; 12:1581-5. [PMID: 27390521 PMCID: PMC4930225 DOI: 10.2147/ndt.s107547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is unclear whether hypothalamic-pituitary-adrenal axis is involved in the pathophysiology of panic disorder (PD). The findings remain inconsistent. Cortisol awakening response (CAR) is a noninvasive biomarker of stress system activity. We designed the study to assess CAR in drug-naïve PD patients. MATERIALS AND METHODS We assessed CAR in 14 psychotropic drug-naïve outpatients with PD and 14 healthy controls. The severity of PD was assessed with Panic and Agoraphobia Scale. The severity of anxiety and depression was screened with Hospital Anxiety and Depression Scale. RESULTS No significant difference in CAR between PD patients and control group was found. No correlations were observed between CAR and anxiety severity measures in PD patients and controls. LIMITATIONS The number of participating subjects was relatively small, and the study results apply to nonsuicidal drug-naïve PD patients without agoraphobia and with short-illness duration. There was a lack of control on subjects' compliance with the sampling instructions. CONCLUSION The study provides no support for elevated CAR levels in drug-naïve PD patients without agoraphobia.
Collapse
Affiliation(s)
| | - Jerzy Landowski
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariusz S Wiglusz
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Poland
| | | |
Collapse
|
38
|
Harris A, Endresen Reme S, Tangen T, Hansen ÅM, Helene Garde A, Eriksen HR. Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy? Psychiatry Res 2015; 228:209-15. [PMID: 26001959 DOI: 10.1016/j.psychres.2015.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/01/2014] [Accepted: 04/05/2015] [Indexed: 11/30/2022]
Abstract
Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric disorders/symptoms measured with different instruments, and cortisol in a population with LBP. Participants (n=305) sick-listed 2-10 months due to non-specific LBP were included in the study. The screening instruments were the MINI-interview, HADS and HSCL-25. Saliva cortisol were measured on 2 consecutive days; at awakening, 30min later, at 15:00h and 22:00h. Results showed no associations between any of the main diagnostic categories from the MINI-interview, or anxiety/depression measured with HADS or HSCL-25 and cortisol. However, significant associations were found between low cortisol awakening response, low cortisol slope during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall asleep, headache). The results indicate that cortisol, may not be directly associated with psychopathology, such as anxiety and depression, but instead are associated with one dimension of the psychopathology, namely lack of energy. This could help explain the inconsistency in the literature, and it should be explored further.
Collapse
Affiliation(s)
- Anette Harris
- Department of Health Promotion and Development, University of Bergen, Norway.
| | - Silje Endresen Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway; Uni Research Health, Bergen, Norway.
| | - Tone Tangen
- Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway.
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark.
| | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark.
| | - Hege Randi Eriksen
- Department of Health Promotion and Development, University of Bergen, Norway; Uni Research Health, Bergen, Norway.
| |
Collapse
|
39
|
White SW, Mazefsky CA, Dichter GS, Chiu PH, Richey JA, Ollendick TH. Social-cognitive, physiological, and neural mechanisms underlying emotion regulation impairments: understanding anxiety in autism spectrum disorder. Int J Dev Neurosci 2014; 39:22-36. [PMID: 24951837 PMCID: PMC4180783 DOI: 10.1016/j.ijdevneu.2014.05.012] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 12/28/2022] Open
Abstract
Anxiety is one of the most common clinical problems among children, adolescents, and adults with autism spectrum disorder (ASD), yet we know little about its etiology in the context of ASD. We posit that emotion regulation (ER) impairments are a risk factor for anxiety in ASD. Specifically, we propose that one reason why anxiety disorders are so frequently comorbid with ASD is because ER impairments are ubiquitous to ASD, stemming from socio-cognitive, physiological, and neurological processes related to impaired cognitive control, regulatory processes, and arousal. In this review, we offer a developmental model of how ER impairments may arise in ASD, and when (moderating influences) and how (meditational mechanisms) they result in anxiety.
Collapse
Affiliation(s)
- Susan W White
- Department of Psychology, Virginia Tech, United States.
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
| | - Gabriel S Dichter
- Department of Psychiatry, University of North Carolina, United States; Department of Psychology, University of North Carolina, United States
| | - Pearl H Chiu
- Virginia Tech Carilion Research Institute and Department of Psychology, Virginia Tech, United States
| | - John A Richey
- Department of Psychology, Virginia Tech, United States
| | | |
Collapse
|