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Nexha A, Pilz LK, Oliveira MAB, Xavier NB, Borges RB, Frey BN, Hidalgo MPL. Greater within- and between-day instability is associated with worse anxiety and depression symptoms. J Affect Disord 2024; 356:215-223. [PMID: 38582128 DOI: 10.1016/j.jad.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Depression and anxiety affect hundreds of millions of people worldwide, and their prevalence increased during the COVID-19 pandemic as social schedules were disrupted. This study explores the associations between anxiety and depression and within- and between-day instability of affective, somatic, and cognitive symptoms during the early pandemic stages. METHODS Participants (n = 153, ages 18-77, 72 % female) reported daily levels of affective (anxiety/sadness), somatic (appetite/sleepiness), and cognitive (concentration/energy) symptoms for 14-44 days at five timepoints: 0, 3, 6, 9, and 12 h after awakening. At the end of the study, participants completed validated scales for anxiety (GAD-7) and depression (PHQ-9). Symptom instability was assessed using the Absolute Real Variability (ARV) index. Regression models examined within-day instability (WD-I) and between-day instability (BD-I) with GAD-7 and PHQ-9 scores as outcomes. RESULTS Greater instability (both WD-I and BD-I) of affective symptoms correlated with elevated GAD-7 and PHQ-9 scores. For somatic and cognitive symptoms, greater BD-I was associated with higher scores. LIMITATIONS The study used retrospective daily data, which could benefit from real-time assessments for improved accuracy. CONCLUSIONS This study provides empirical evidence of a connection between greater anxiety and depression severity and increased instability in daily mood and physiological symptoms. The findings underscore the importance of consistent symptom monitoring to understand overall mental health trajectories. Additionally, it highlights the role of daily routines in stabilizing the circadian system, potentially regulating physiological and psychological processes and reducing symptom instability.
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Affiliation(s)
- Adile Nexha
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
| | - Luísa K Pilz
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Anesthesiology and Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany; ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Melissa A B Oliveira
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Nicoli B Xavier
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rogério Boff Borges
- Biostatistics Unit - Research Board (DIPE), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Statistics, Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Maria Paz L Hidalgo
- Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Clemente-Suárez VJ, Beltrán-Velasco AI, Redondo-Flórez L, Martín-Rodríguez A, Tornero-Aguilera JF. Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients 2023; 15:2749. [PMID: 37375654 DOI: 10.3390/nu15122749] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
The Western diet is a modern dietary pattern characterized by high intakes of pre-packaged foods, refined grains, red meat, processed meat, high-sugar drinks, candy, sweets, fried foods, conventionally raised animal products, high-fat dairy products, and high-fructose products. The present review aims to describe the effect of the Western pattern diet on the metabolism, inflammation, and antioxidant status; the impact on gut microbiota and mitochondrial fitness; the effect of on cardiovascular health, mental health, and cancer; and the sanitary cost of the Western diet. To achieve this goal, a consensus critical review was conducted using primary sources, such as scientific articles, and secondary sources, including bibliographic indexes, databases, and web pages. Scopus, Embase, Science Direct, Sports Discuss, ResearchGate, and the Web of Science were used to complete the assignment. MeSH-compliant keywords such "Western diet", "inflammation", "metabolic health", "metabolic fitness", "heart disease", "cancer", "oxidative stress", "mental health", and "metabolism" were used. The following exclusion criteria were applied: (i) studies with inappropriate or irrelevant topics, not germane to the review's primary focus; (ii) Ph.D. dissertations, proceedings of conferences, and unpublished studies. This information will allow for a better comprehension of this nutritional behavior and its effect on an individual's metabolism and health, as well as the impact on national sanitary systems. Finally, practical applications derived from this information are made.
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Affiliation(s)
| | | | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, 28670 Villaviciosa de Odón, Spain
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Jegede O, Stefanovics EA, Rhee TG, Rosenheck RA. Multimorbidity and Correlates of Comorbid Depression and Generalized Anxiety Disorder in a Nationally Representative US Sample. J Nerv Ment Dis 2023; 211:355-361. [PMID: 36807207 DOI: 10.1097/nmd.0000000000001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
ABSTRACT Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently occur together, but sociodemographic, behavioral, and diagnostic correlates of this comorbidity have not been comprehensively studied. Data from the nationally representative US sample surveyed in the National Epidemiologic Survey on Alcohol and Related Conditions-III ( N = 36,309) were used to define three groups, individuals with a) both past-year GAD and MDD ( n = 909, 16.9%), b) GAD only ( n = 999, 18.6%), and c) MDD only ( n = 3471, 64.5%). The comorbid group was compared with each single-diagnosis group on sociodemographic, behavioral, and diagnostic characteristics based on effect sizes (risk ratios and Cohen's d ) rather than p values because of the large sample sizes. Multivariable-adjusted logistic regression analyses were used to identify factors independently associated with the comorbid group. Bivariate analysis showed that the comorbid group had more parental and childhood adversities, additional psychiatric disorders, and poorer mental health quality of life than both single-disorder groups. Multivariable-adjusted logistic regression of the comorbid group showed that on two of five factors, additional psychiatric diagnoses were significantly more frequent than in the GAD-only group, and that on three of six factors, additional psychiatric diagnoses were significantly more frequent than in the MDD-only group. There is a significantly higher burden of social adjustment problems, comorbid psychiatric disorders, and poorer mental health-related quality of life among individuals with comorbid GAD-MDD than those with single disorders. The adversities associated with this non-SUD psychiatric comorbidity are comparable to those associated with the more extensively studied comorbidity of psychiatric and substance use disorders and deserve further research and treatment.
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Calhoun CA, Lattouf C, Lewis V, Barrientos H, Donaldson ST. Chronic mild stress induces differential depression-like symptoms and c-Fos and 5HT1A protein levels in high-anxiety female Long Evans rats. Behav Brain Res 2023; 438:114202. [PMID: 36343695 PMCID: PMC9990717 DOI: 10.1016/j.bbr.2022.114202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Depression and anxiety disorders overlap in clinical populations, suggesting common mechanisms that may be further investigated in reliable animal models. We used filial 8 female Long-Evans rats bred for high (HAn; n = 19) and low anxiety (LAn)-like behavior (n = 21) to assess forced swim test mobility strategies and chronic mild stress (CMS)-induced depression-like symptoms. We measured (1) weight, (2) fur piloerection, (3) sweet food consumption, (4) grooming behavior, and (5) circulating estradiol (E2). One month after CMS terminated and following a terminal forced swim test, brains were processed for immunohistochemistry targeting c-Fos and serotonin 1 A receptor (5-HT1AR) protein in the paraventricular nucleus (PVN) of the hypothalamus. HAn female rats showed increased anxiety-like behavior (i.e., lower open to closed arm ratios, increased closed arm entries), more swimming (i.e., mobility), and less floating (i.e., immobility) behavior in the forced swim test. Overall, HAn females weighed less than their LAn counterparts. After chronic mild stress, HAn lines displayed even greater mobility and consumed fewer Froot Loops™. Fur and grooming analyses indicated no significant differences in mean counts across experimental groups. One month after CMS, cycling E2 concentrations (pg/ml) did not differ between HAn and LAn animals. Elevated c-Fos and 5-HT1AR expression were observed in the PVN, where HAn CMS rats expressed the most c-Fos and 5-HT1AR immunoreactivity. In summary, outbred HAn rats show robust anxiety-like behavior, exhibit more mobility in the forced swim test, and are more sensitive to chronic mild stress-induced grooming and decline in palatable food ingestion.
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Affiliation(s)
- Corey A Calhoun
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine Lattouf
- Developmental and Brain Sciences Program, Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Victoria Lewis
- Developmental and Brain Sciences Program, Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Heidi Barrientos
- Developmental and Brain Sciences Program, Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - S Tiffany Donaldson
- Developmental and Brain Sciences Program, Department of Psychology, University of Massachusetts Boston, Boston, MA, USA.
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McGowan OO. Pharmacogenetics of anxiety disorders. Neurosci Lett 2020; 726:134443. [PMID: 31442515 DOI: 10.1016/j.neulet.2019.134443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/25/2019] [Accepted: 08/19/2019] [Indexed: 01/04/2023]
Abstract
Anxiety disorders are common and disabling conditions the treatment of which remains a challenge. While different groups of medication are available for their treatment, a substantial proportion of patients remain refractory to pharmacotherapy. The reason for this variation in the individual response to treatment has yet to be understood; however genetic factors have been shown to play an important role. Up to now there have been limited publications about pharmacogenetics of anxiety disorders, compared to studies in depression. Published studies are focused on pharmacogenetics of antidepressants rather than being disease specific. This review summarizes pharmacogenetic findings related to the anxiolytic treatment response and their possible functional mechanisms. This inevitably focuses on genes involved in the pharmacodynamics of the medications used, along with some genes implicated in the disease process, as well as briefly mentioning genetic factors associated with psychotherapeutic response.
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Affiliation(s)
- O O McGowan
- Leverndale Hospital, 510 Crookston Road, Glasgow G53 7TU, UK.
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Threat-sensitivity in affective disorders: A case-control study. J Affect Disord 2020; 266:595-602. [PMID: 32056932 DOI: 10.1016/j.jad.2020.01.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anxiety disorders are highly comorbid with major depression but differ in their symptom profiles and pharmacological responses. Threat-sensitivity may explain such differences, yet research on its relationship to specific disorders is lacking. METHODS One-hundred patients (71 women) and 35 healthy controls (23 women) were recruited. Thirty-five had Panic Disorder (PD), 32 had Generalized Anxiety Disorder (GAD) and 33 Major Depressive Disorder (MDD). Threat-sensitivity was measured via behaviour (Joystick Operated Runway Task; JORT) and self-report (Fear Survey Schedule; FSS). RESULTS Behavioural sensitivity to simple threat was higher in females compared to males (p = .03). Self-reported sensitivity to simple threat (FSS Tissue Damage Fear) was higher in PD patients compared to other groups (p ≤ .007) and in GAD patients compared to controls (p = .02). Behavioural sensitivity to complex threat was higher in females than males (p = .03) and a group by sex interaction (p = .01) indicated that this difference was largest in PD patients. Self-reported sensitivity to complex threat (FSS Social Fear) was higher in all patients compared to controls (p ≤ .001). Females scored higher than males on FSS Tissue Damage Fear and FSS Social Fear). CONCLUSIONS Our findings oppose the simple/complex threat dichotomy, instead suggesting elevated sensitivity to physical threat differentiates anxiety disorders from MDD, whereas elevated sensitivity to social threat is associated with both anxiety disorders and MDD.
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Alpha 2-adrenergic dysregulation in congenic DxH recombinant inbred mice selectively bred for a high fear-sensitized (H-FSS) startle response. Pharmacol Biochem Behav 2019; 188:172835. [PMID: 31805289 DOI: 10.1016/j.pbb.2019.172835] [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] [Received: 08/21/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022]
Abstract
Patients with anxiety disorders and posttraumatic stress disorder (PTSD) exhibit exaggerated fear responses and noradrenergic dysregulation. Fear-related responses to α2-adrenergic challenge were therefore studied in DxH C3H/HeJ-like recombinant inbred (C3HLRI) mice, which are a DBA/2J-congenic strain selectively bred for a high fear-sensitized startle (H-FSS). C3HLRI mice showed an enhanced acoustic startle response and immobility in the forced swim test compared to DBA/2J controls. The α2-adrenoceptor antagonist yohimbine (Yoh; 5.0 mg/kg) induced an anxiogenic and the α2-adrenoceptor agonist clonidine (Clon; 0.1 mg/kg) an anxiolytic effect in the open field (OF) in C3HLRI but not DBA/2J mice. In auditory fear-conditioning, Yoh (5.0 mg/kg)-treated C3HLRI mice showed higher freezing during fear recall and extinction learning than DBA/2J mice, and a higher ceiling for the Yoh-induced deficit in fear extinction. No strain differences were observed in exploration-related anxiety/spatial learning or the Clon-induced (0.1 mg/kg) corticosterone surge. A global analysis of the behavioral profile of the two mouse strains based on observed and expected numbers of significant behavioral outcomes indicated that C3HLRI mice showed significantly more often fear- and stress-related PTSD-like behaviors than DBA/2J controls. The analysis of the robustness of significant outcomes based on false discovery rate (FDR) thresholds confirmed significant differences for the strain-Yoh-interactions in the OF center and periphery, the Yoh-induced general extinction deficit, strain differences in conditioned fear levels, and at the dose of 5.0 mg/kg for the Yoh-induced ceiling in freezing levels among others. The current findings are consistent with previous observations showing alterations in the central noradrenergic system of C3HLRI mice (Browne et al., 2014, Stress 17:471-83). Based on their behavioral profile and response to α2-adrenergic stimulation, C3HLRI mice are a valuable genetic model for studying adrenergic mechanisms of anxiety disorders and potentially also of PTSD.
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Mellick WH, Mills JA, Kroska EB, Calarge CA, Sharp C, Dindo LN. Experiential Avoidance Predicts Persistence of Major Depressive Disorder and Generalized Anxiety Disorder in Late Adolescence. J Clin Psychiatry 2019; 80:18m12265. [PMID: 31644841 PMCID: PMC6854672 DOI: 10.4088/jcp.18m12265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Experiential avoidance (EA) is a transdiagnostic construct that may underlie the high comorbidity between major depressive disorder (MDD) and generalized anxiety disorder (GAD). This analysis used data from a longitudinal study (conducted September 2010-April 2016) to examine whether adolescent EA varies by MDD and GAD symptomatology trajectory and predicts said trajectories. Longitudinal associations between EA, anxiety, and depression symptoms were also examined. METHODS Adolescents aged 15 to 20 years (N = 183) were followed for 2 years using a comprehensive assessment battery. Symptom trajectory modeling, using weekly symptom ratings, identified 4 MDD and 4 GAD trajectories that were collapsed to form combined MDD/GAD trajectory groups: Persistent (n = 81), High-Decreasing (n = 44), Normal-Increasing (n = 37), and Minimal (n = 21). Group-based trajectory modeling, analyses of covariance, structural equation modeling, and linear regression analyses were performed. DSM-IV-TR criteria were used for MDD and GAD diagnoses. RESULTS The Persistent adolescents had higher EA than other groups (P values ≤ .001), with greater EA stability versus High-Decreasing adolescents (P = .008). EA predicted anxiety and depressive symptoms alike (P values ≤ .005), which in turn did not predict EA (P values ≥ .188). EA, at both time points, predicted combined MDD/GAD trajectories after adjustment for depressive and anxiety symptoms and other confounders (P values < .001). CONCLUSIONS EA appears to be an important predictor of MDD and GAD symptomatology in older adolescents, potentially serving as a treatment target. Findings suggest a possible trait-like nature for EA, perhaps increasing risk for the emergence and persistence of MDD and/or GAD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02147184.
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Affiliation(s)
- William H Mellick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James A Mills
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Emily B Kroska
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Chadi A Calarge
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lilian N Dindo
- Health Services Research and Development, 2002 Holcombe Blvd (152), Houston, TX 77030.
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Varoglu E, Seytanoglu A, Asilmaz E, Taneri B. Neurotransmitter receptor genotypes associated with mental and behavioral disorders. Per Med 2018; 14:327-338. [PMID: 29749833 DOI: 10.2217/pme-2016-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM Investigation of association studies within the field of mental and behavioral disorders is of value given their complex molecular etiology including epistatic interactions of multiple genes with small effects. MATERIALS & METHODS Utilizing biomedical text mining, associations are uncovered for all mental and behavioral conditions listed in Diagnostic and Statistical Manual of Mental Disorders Text Revision. Specifically, a computational pipeline is designed to retrieve neurotransmitter receptor variations from biomedical literature with a text mining approach, where unique polymorphisms are also mined. RESULTS Analyses of 1337 unique neurotransmitter receptors and 465 distinct conditions yield 1568 unique gene-disease associations. CONCLUSION This study takes an unconventional approach to association studies and generates a novel dataset of associations for disorders such as major depression and schizophrenia, which provides a global perspective for their genetic etiology.
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Affiliation(s)
- Ekrem Varoglu
- Department of Computer Engineering, Eastern Mediterranean University, Famagusta, North Cyprus 99628, Turkey
| | - Adil Seytanoglu
- Department of Biological Sciences, Eastern Mediterranean University, Famagusta, North Cyprus 99628, Turkey
| | | | - Bahar Taneri
- Department of Biological Sciences, Eastern Mediterranean University, Famagusta, North Cyprus 99628, Turkey.,Institute for Public Health Genomics, Department of Genetics & Cell Biology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
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Abstract
From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included “pantophobia” and “anxiety neurosis.” Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised DSM-III (DSM-III-R), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from DSM-III up to preparation of DSM-5. Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated “anxious apprehension” that would typically fit into the research domain called “negative valence systems” and the more specific construct termed “potential threat.”
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Sild M, Ruthazer ES, Booij L. Major depressive disorder and anxiety disorders from the glial perspective: Etiological mechanisms, intervention and monitoring. Neurosci Biobehav Rev 2017; 83:474-488. [DOI: 10.1016/j.neubiorev.2017.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/08/2017] [Accepted: 09/11/2017] [Indexed: 12/12/2022]
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Interaction of Depression and Anxiety in the Development of Mixed Anxiety/Depression Disorder. Experimental Studies of the Mechanisms of Comorbidity (review). ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11055-017-0458-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Severity of complicated versus uncomplicated subthreshold depression: New evidence on the "Monotonicity Thesis" from the national comorbidity survey. J Affect Disord 2017; 212:101-109. [PMID: 28157549 DOI: 10.1016/j.jad.2017.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/23/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND "Complicated" subthreshold depression (CsD) includes at least one of six pathosuggestive "complicated" symptoms: >6 months duration, marked role impairment, sense of worthlessness, suicidal ideation, psychotic ideation, and psychomotor retardation. "Uncomplicated" subthreshold depression (UsD) has no complicated features. Whereas studies show that complicated (CMDD) versus uncomplicated (UMDD) major depression differ substantially in severity and prognosis, UsD and CsD severity has not been previously compared. This study evaluates UsD and CsD pathology validator levels and examines whether the complicated/uncomplicated distinction offers incremental concurrent validity over the standard number-of-symptoms dimension as a depression severity measure. METHODS Using nationally representative community data from the National Comorbidity Survey, seven depression lifetime history subgroups were identified: one MDD screener symptom (n=1432); UsD (n=430); CsD (n=611); UMDD (n=182); and CMDD with 5-6 symptoms (n=518), 7 symptoms (n=217), and 8-9 symptoms (n=291). Severity was evaluated using five concurrent pathology validators: suicide attempt, interference with life, help seeking, hospitalization, and generalized anxiety disorder. RESULTS CsD validator levels are substantially higher than both UsD and UMDD levels, and similar to mild CMDD, disconfirming the "monotonicity thesis" that severity increase with symptom number. Complicated/uncomplicated status predicts severity, and when complicatedness is controlled, number of symptoms no longer predicts validator levels. LIMITATIONS Diagnoses were based on respondents' fallible retrospective symptom reports during a lay-administered structured interview, which may not yield diagnoses comparable to clinicians' assessments. CONCLUSION CsD is more severe than UsD and comparable to mild MDD. Complicated status more validly indicates depression severity than the standard number-of-symptoms measure.
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de Lijster JM, Dierckx B, Utens EM, Verhulst FC, Zieldorff C, Dieleman GC, Legerstee JS. The Age of Onset of Anxiety Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:237-246. [PMID: 27310233 PMCID: PMC5407545 DOI: 10.1177/0706743716640757] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective was to estimate the age of onset (AOO) for all anxiety disorders and for specific subtypes. Gender differences in the AOO of anxiety disorders were examined, as were the influence of study characteristics on reported AOOs. METHODS Seven electronic databases were searched up to October 2014, with keywords representing anxiety disorder subtypes, AOO, and study design. The inclusion criteria were studies using a general population sample that provided data on the AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV, or ICD-10 criteria. RESULTS There were 1028 titles examined, which yielded 24 studies meeting the inclusion criteria. Eight studies reported the AOO and gender. Meta-analysis found a mean AOO of all anxiety disorders of 21.3 years (95% CI 17.46 to 25.07). Separation anxiety disorder, specific phobia, and social phobia had their mean onset before the age of 15 years, whereas the AOO of agoraphobia, obsessive-compulsive disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder began, on average, between 21.1 and 34.9 years. Meta-analysis revealed no difference in the AOO between genders. A prospective study design and higher developmental level of the study country were associated with an earlier AOO. CONCLUSIONS Results from this meta-analysis indicate that anxiety disorder subtypes differ in the mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards factors associated with the development of anxiety disorder subtypes in the age groups with the greatest vulnerability for developing those disorders.
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Affiliation(s)
- Jasmijn M. de Lijster
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Elisabeth M.W.J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Carola Zieldorff
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Gwen C. Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Jeroen S. Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, the Netherlands
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Qubty W, Gelfand AA. Psychological and Behavioral Issues in the Management of Migraine in Children and Adolescents. Curr Pain Headache Rep 2017; 20:69. [PMID: 27896587 DOI: 10.1007/s11916-016-0597-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW It is sometimes assumed that children and adolescents with migraine have a psychiatric or behavioral comorbidity, a belief that can be stigmatizing. This review will examine the recent literature addressing this area to determine if pediatric and adolescent migraineurs are at increased risk for psychiatric comorbidity and to discuss management strategies. RECENT FINDINGS A large systematic review of pediatric and adolescent studies concluded anxiety and depression were not associated with onset of recurrent headaches. Children with increasing migraine frequency have reduced school attendance. Pediatric migraineurs have mildly lower quality of life (QOL) scores than healthy peers but not abnormally low. Finally, children with higher migraine frequency as well as migraineurs with aura were more likely to report suicidal ideation. Migraine is a primary neurologic disorder. Migraine and psychiatric disorders may be comorbid; however, at this time, it can be difficult to clearly delineate some migraine features from psychiatric diagnoses with the current screening tools available. The majority of pediatric migraineurs do not have behavioral comorbidities; however, when such comorbidities occur, they should be addressed and appropriately managed. We need more accurate ways of delineating psychiatric and behavioral comorbidities from the migraine phenotype.
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Affiliation(s)
- William Qubty
- UCSF Department of Neurology, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA, 94158, USA.
| | - Amy A Gelfand
- UCSF Department of Neurology, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA, 94158, USA
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Kelly KM, Mezuk B. Predictors of remission from generalized anxiety disorder and major depressive disorder. J Affect Disord 2017; 208:467-474. [PMID: 27863710 PMCID: PMC5515235 DOI: 10.1016/j.jad.2016.10.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/06/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The predictors of onset of major depressive disorder (MDD) and generalized anxiety disorder (GAD) are well-characterized. However the factors that predict remission from these conditions are less clear, and the study of this area is further complicated by differing definitions of remission. METHODS Data come from the National Comorbidity Survey - Replication, and analysis was limited to respondents with a lifetime history of GAD (n=621) or MDD (n=1299) assessed by the Composite International Diagnostic Interview. Predictors of remission included demographic factors, adverse childhood events, family history, and clinical characteristics. Multiple definitions of remission were explored to account for residual symptoms. RESULTS Half (54.4%) of respondents with MDD and 41.1% of respondents with GAD experienced full remission. Older age and higher socioeconomic status were positively related to remission in a dose-response manner for both disorders. Adverse childhood experiences and family history of anxious/depressive symptoms were negatively associated with remission from MDD. Comorbid GAD was inversely associated with remission from MDD (Odds ratio (OR): 0.62, 95% Confidence interval (CI): 0.44-0.88), but comorbid MDD did not impact remission from GAD (OR: 0.93, 95% CI: 0.64-1.35). With the exception of the influence of comorbidity, these associations were robust across definitions of remission. LIMITATIONS Cross-sectional analysis and retrospective recall of onset of MDD/GAD. CONCLUSIONS Many individuals with MDD or GAD will experience full remission. Some predictors appear to have a general association with remission from both disorders, while others are uniquely associated with remission from MDD.
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Affiliation(s)
- Kristen M. Kelly
- Corresponding author: One Capitol Plaza, Suite 824, PO Box 980212, Richmond, Virginia 23298. Tel.: +517 703 4718; fax: N/A.
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17
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Cui X, Niu W, Kong L, He M, Jiang K, Chen S, Zhong A, Li W, Lu J, Zhang L. Long noncoding RNAs: New evidence for overlapped pathogenesis between major depressive disorder and generalized anxiety disorder. Indian J Psychiatry 2017; 59:83-87. [PMID: 28529365 PMCID: PMC5419018 DOI: 10.4103/psychiatry.indianjpsychiatry_219_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND About half of patients with major depressive disorder (MDD) have clinically meaningful levels of anxiety. Greater severity of depressive illness and functional impairment has been reported in patients with high levels of anxiety accompanying depression. The pathogenesis for the comorbidity was still unsure. AIM This study aimed to determine whether there would be molecular link for overlapped pathogenesis between MDD and anxiety disorder. MATERIALS AND METHODS Using long noncoding RNA (lncRNA) microarray profiling and reverse transcription polymerase chain reaction, six downregulated lncRNAs and three upregulated lncRNAs had been identified to be the potential biomarkers for MDD and generalized anxiety disorder (GAD), respectively. Then, the lncRNAs were cross-checked in forty MDD patients, forty GAD patients, and forty normal controls. RESULTS Compared with normal controls, six downregulated MDD lncRNAs also had a significantly lower expression in GAD (P < 0.01), and there was no significant difference between GAD and MDD (P > 0.05). In addition, three upregulated GAD lncRNAs had no different expression in MDD (P > 0.05), but there was remarkable difference between MDD and GAD (P < 0.01). CONCLUSIONS These results indicated that lncRNAs in peripheral blood mononuclear cells could be potential molecular link between MDD and GAD, which added new evidence to the overlapped pathogenesis and suggested that anxious depression could be a valid diagnostic subtype of MDD.
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Affiliation(s)
- Xuelian Cui
- Department of Health Care, Changzhou Maternity and Child Health Care Hospital Affiliated with Nanjing Medical University, Changzhou, People's Republic of China
| | - Wei Niu
- Department of Rehabilitation, No. 102 Hospital of Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Lingming Kong
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Mingjun He
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Kunhong Jiang
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Shengdong Chen
- Department of Neurology, No. 102 Hospital of Chinese People's Liberation Army, Changzhou, People's Republic of China
| | - Aifang Zhong
- Department of Clinical Laboratory, No.102 Hospital of Chinese Liberation Army, Changzhou, People's Republic of China
| | - Wanshuai Li
- Gopath Diagnostic Laboratory Co. Ltd., Changzhou, People's Republic of China
| | - Jim Lu
- Gopath Diagnostic Laboratory Co. Ltd., Changzhou, People's Republic of China.,Gopath Laboratories LLC, 1351 Barclay Blvd, Buffalo Grove, USA
| | - Liyi Zhang
- Prevention and Treatment Center for Psychological Diseases, No. 102 Hospital of Chinese People's Liberation Army, Changzhou, People's Republic of China
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18
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Wakefield JC, Lorenzo-Luaces L, Lee JJ. Taking People as They Are: Evolutionary Psychopathology, Uncomplicated Depression, and Distinction between Normal and Disordered Sadness. EVOLUTIONARY PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-60576-0_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:4612953. [PMID: 28044084 PMCID: PMC5156813 DOI: 10.1155/2016/4612953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022]
Abstract
Currently, there are no effective pharmaceutical treatments to reduce cognitive decline or prevent dementia. At the same time, the global population is aging, and rates of dementia and mild cognitive impairment (MCI) are on the rise. As such, there is an increasing interest in complementary and alternative interventions to treat or reduce the risk of cognitive decline. Depression is one potentially modifiable risk factor for cognitive decline and dementia. Notably, exercise and yoga are two interventions known to both reduce symptoms of depression and improve cognitive function. The current review discusses the efficacy of exercise and yoga to ameliorate depression and thereby reduce the risk of cognitive decline and potentially prevent dementia. Potential mechanisms of change, treatment implications, and future directions are discussed.
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20
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Prevalence, correlates, comorbidity and severity of generalized anxiety disorder in Singapore. Asian J Psychiatr 2016; 23:32-38. [PMID: 27969075 DOI: 10.1016/j.ajp.2015.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 05/14/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
Abstract
Despite its pervasiveness and associated impairment, generalized anxiety disorder (GAD) remains a poorly recognized disorder. Furthermore, given that GAD has been relatively understudied in Asia, the current study examined the prevalence, correlates and co-morbid conditions of this disorder in a multi-ethnic population of Singapore. Data was utilized from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among the adult population (n=6616) aged 18 years and above. The Composite International Diagnostic Interview version 3.0 (CIDI v3.0) was used to assess co-morbidity as well as the life-time and 12-month prevalence of disorders. Functional impairment and treatment-seeking behavior were also assessed. The life-time (0.9%) and 12-month (0.4%) prevalence estimates in the current study were found to be lower than those reported in Western populations but comparable to the prevalence estimates found in Asian countries. The relatively lower prevalence rate of GAD in this study suggests the possible role of culture in reporting and manifestation of anxiety symptomatology. The failure of a substantial proportion of individuals to seek treatment despite self-reported impairment was also identified as an area of concern.
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21
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Kotliar DM. Depression Narratives in Blogs: A Collaborative Quest for Coherence. QUALITATIVE HEALTH RESEARCH 2016; 26:1203-1215. [PMID: 26531881 DOI: 10.1177/1049732315612715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
People with depression often suffer from severe social seclusion, and the lack of an agreed upon etiology for depression makes it difficult to satisfactorily narrate and "ritually control" it. Focusing on blogs by women with major depression, I delineate the ways in which bloggers publicly express and collaboratively reconstruct their depression narratives. Specifically, using thematic analysis, I argue that depression blogs uniquely bridge between the seclusion that characterizes depression and the exposure offered in blogs, and thus offer people a rare opportunity to publicly share very intimate depression narratives, form communal bonds with their readers, and collaboratively revise their narratives. Depression blogs are also shown to function as "narrative sandboxes"-protected spaces in which bloggers can temporarily and experimentally add or remove different sections from their illness narratives, assess the compatibility of different cultural frameworks, and interchangeably use various metaphors, in an attempt to satisfactorily explain depression.
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Affiliation(s)
- Dan M Kotliar
- The Hebrew University of Jerusalem, Jerusalem, Israel
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22
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Iorfino F, Hickie IB, Lee RSC, Lagopoulos J, Hermens DF. The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: a systematic review. BMC Psychiatry 2016; 16:156. [PMID: 27215830 PMCID: PMC4878058 DOI: 10.1186/s12888-016-0852-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mood and anxiety disorders are leading causes of disability and mortality, due largely to their onset during adolescence and young adulthood and broader impact on functioning. Key factors that are associated with disability and these disorders in young people are social and economic participation (e.g. education, employment), physical health, suicide and self-harm behaviours, and alcohol and substance use. A better understanding of the objective markers (i.e. neurobiological parameters) associated with these factors is important for the development of effective early interventions that reduce the impact of disability and illness persistence. METHODS We systematically reviewed the literature for neurobiological parameters (i.e. neuropsychology, neuroimaging, sleep-wake and circadian biology, neurophysiology and metabolic measures) associated with functional domains in young people (12 to 30 years) with mood and/or anxiety disorders. RESULTS Of the one hundred and thirty-four studies selected, 7.6 % investigated social and economic participation, 2.1 % physical health, 15.3 % suicide and self-harm behaviours, 6.9 % alcohol and substance use, whereas the majority (68.1 %) focussed on clinical syndrome. CONCLUSIONS Despite the predominance of studies that solely examine the clinical syndrome of young people the literature also provides evidence of distinct associations among objective measures (indexing various aspects of brain circuitry) and other functional domains. We suggest that a shift in focus towards characterising the mechanisms that underlie and/or mediate multiple functional domains will optimise personalised interventions and improve illness trajectories.
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Affiliation(s)
- Frank Iorfino
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Ian B Hickie
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Rico S C Lee
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Jim Lagopoulos
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Daniel F Hermens
- Clinical Research Unit, Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia.
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Hettema JM. The nosologic relationship between generalized anxiety disorder and major depression. Depress Anxiety 2016; 25:300-16. [PMID: 18412057 DOI: 10.1002/da.20491] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Generalized anxiety disorder (GAD) has undergone a series of revisions in its diagnostic criteria that has moved it, nosologically, away from its original affiliation with panic disorder (PD) and closer to major depressive disorder (MDD). This, together with its high comorbidity and putative shared genetic risk with MDD, has brought into question its place in future psychiatric nosology, prompting the planners of Diagnostic and Statistical Manual-V (DSM-V) and International Classification of Diseases-11 (ICD-11) to set up a workgroup tasked to better understand the relationship between GAD and MDD. This review attempts to summarize the extant data to compare GAD and MDD on a series of research validators to explore this relationship. Although insufficient data currently exist for GAD in several key validator classes, tentative conclusions can be drawn on the diagnostic status of GAD in relation to MDD. Although GAD possesses substantial overlap with MDD in the areas of genetics, childhood environment, demographics, and personality traits, this tends to hold true for other anxiety disorders (ADs) as well, with the strongest evidence for PD. Data from life events, personality disorders, biology, comorbidity, and pharmacology are mixed, showing some areas of similarity between GAD and MDD but some clear differences, again with a moderate degree of nonspecificity. Thus, although the bulk of evidence supports a close underlying relationship between them, the relatively nonspecific nature of these findings provides little more reason to question the nosologic validity of GAD in relation to MDD than that of some other anxiety disorders.
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Affiliation(s)
- John M Hettema
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
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24
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Yang Y, Ligthart L, Terwindt GM, Boomsma DI, Rodriguez-Acevedo AJ, Nyholt DR. Genetic epidemiology of migraine and depression. Cephalalgia 2016; 36:679-91. [DOI: 10.1177/0333102416638520] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/17/2016] [Indexed: 12/24/2022]
Abstract
Background Migraine and major depressive disorder (commonly referred to as depression) are both common disorders with a significant impact on society. Studies in both clinical and community-based settings have demonstrated a strong relationship between migraine and depression. In addition to complicating the diagnosis, depression that is comorbid with migraine may lower treatment adherence, increase risk of medication overuse and is associated with migraine chronification, thus leading to higher direct and indirect costs and poorer health-related outcomes with increased disability. Aim The aim of this review is to summarise the current knowledge on the genetic epidemiology of migraine and depression and the possible biological mechanisms underlying their comorbidity. Methods We present a narrative review reporting on the current literature. Results and conclusions Epidemiological findings indicate that there is a bidirectional relationship between migraine and depression, with one disorder increasing the risk for the other and vice versa, suggesting shared biological mechanisms. Twin and family studies indicate that this bidirectional relationship can be explained, at least partly, by shared underlying genetically determined disease mechanisms. Although no genes have been robustly associated with the aetiology of both migraine and depression, genes from serotonergic, dopaminergic and GABAergic systems together with variants in the MTHFR and BDNF genes remain strong candidates.
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Affiliation(s)
- Yuanhao Yang
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Lannie Ligthart
- Department of Biological Psychology, VU University, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, VU University, The Netherlands
| | - Astrid J Rodriguez-Acevedo
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Dale R Nyholt
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
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Aberrant Parasympathetic Stress Responsivity in Pure and Co-Occurring Major Depressive Disorder and Generalized Anxiety Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-015-9493-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Seeley SH, Mennin DS, Aldao A, McLaughlin KA, Rottenberg J, Fresco DM. Impact of Comorbid Depressive Disorders on Subjective and Physiological Responses to Emotion in Generalized Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2015; 40:290-303. [PMID: 27660375 DOI: 10.1007/s10608-015-9744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Generalized anxiety disorder (GAD) and unipolar depressive disorders (UDD) have been shown to differ from each other in dimensions of affective functioning despite their high rates of comorbidity. We showed emotional film clips to a community sample (n = 170) with GAD, GAD with secondary UDD, or no diagnosis. Groups had comparable subjective responses to the clips, but the GAD group had significantly lower heart rate variability (HRV) during fear and after sadness, compared to controls. While HRV in the GAD and control groups rose in response to the sadness and happiness clips, it returned to baseline levels afterwards in the GAD group, potentially indicating lesser ability to sustain attention on emotional stimuli. HRV in the GAD + UDD group changed only in response to sadness, but was otherwise unvarying between timepoints. Though preliminary, these findings suggest comorbid UDD as a potential moderator of emotional responding in GAD.
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Affiliation(s)
- Saren H Seeley
- The University of Arizona, 1503 East University Boulevard, Tucson, AZ 85721, USA
| | - Douglas S Mennin
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, HN742, New York, NY 10065, USA; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, USA
| | - Amelia Aldao
- Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Katie A McLaughlin
- University of Washington, 3939 University Way NE, Seattle, WA 98105, USA
| | | | - David M Fresco
- Kent State University, 226 Kent Hall Annex, Kent, OH 44242, USA
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Functional decline and herpes zoster in older people: an interplay of multiple factors. Aging Clin Exp Res 2015; 27:757-65. [PMID: 26440662 DOI: 10.1007/s40520-015-0450-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/09/2015] [Indexed: 12/17/2022]
Abstract
Herpes zoster is a frequent painful infectious disease whose incidence and severity increase with age. In older people, there is a strong bidirectional link between herpes zoster and functional decline, which refers to a decrement in ability to perform activities of daily living due to ageing and disabilities. However, the exact nature of such link remains poorly established. Based on the opinion from a multidisciplinary group of experts, we here propose a new model to account for the interplay between infection, somatic/psychiatric comorbidity, coping skills, polypharmacy, and age, which may account for the functional decline related to herpes zoster in older patients. This model integrates the risk of decompensation of underlying disease; the risk of pain becoming chronic (e.g. postherpetic neuralgia); the risk of herpes zoster non-pain complications; the detrimental impact of herpes zoster on quality of life, functioning, and mood; the therapeutic difficulties due to multimorbidity, polypharmacy, and ageing; and the role of stressful life events in the infection itself and comorbid depression. This model underlines the importance of early treatment, strengthening coping, and vaccine prevention.
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Jesulola E, Sharpley CF, Bitsika V, Agnew LL, Wilson P. Frontal alpha asymmetry as a pathway to behavioural withdrawal in depression: Research findings and issues. Behav Brain Res 2015; 292:56-67. [DOI: 10.1016/j.bbr.2015.05.058] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 05/21/2015] [Accepted: 05/23/2015] [Indexed: 12/28/2022]
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ACF chromatin-remodeling complex mediates stress-induced depressive-like behavior. Nat Med 2015; 21:1146-53. [PMID: 26390241 PMCID: PMC4598281 DOI: 10.1038/nm.3939] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/11/2015] [Indexed: 02/08/2023]
Abstract
Improved treatment for major depressive disorder (MDD) remains elusive because of the limited understanding of its underlying biological mechanisms. It is likely that stress-induced maladaptive transcriptional regulation in limbic neural circuits contributes to the development of MDD, possibly through epigenetic factors that regulate chromatin structure. We establish that persistent upregulation of the ACF (ATP-utilizing chromatin assembly and remodeling factor) ATP-dependent chromatin-remodeling complex, occurring in the nucleus accumbens of stress-susceptible mice and depressed humans, is necessary for stress-induced depressive-like behaviors. We found that altered ACF binding after chronic stress was correlated with altered nucleosome positioning, particularly around the transcription start sites of affected genes. These alterations in ACF binding and nucleosome positioning were associated with repressed expression of genes implicated in susceptibility to stress. Together, our findings identify the ACF chromatin-remodeling complex as a critical component in the development of susceptibility to depression and in regulating stress-related behaviors.
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Shorey RC, Elmquist J, Anderson S, Stuart GL. The Relationship Between Early Maladaptive Schemas, Depression, and Generalized Anxiety among Adults Seeking Residential Treatment for Substance Use Disorders. J Psychoactive Drugs 2015; 47:230-8. [PMID: 26099037 PMCID: PMC4697940 DOI: 10.1080/02791072.2015.1050133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous research has shown that early maladaptive schemas (EMS) play an important role in substance use, depression, and anxiety. However, few studies have examined the role of EMS within the context of all three concurrently. The goal of this study was to determine the role of EMS in predicting symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) among adults in residential treatment for substance dependence. We used pre-existing patient records of adults diagnosed with a substance use disorder from a residential substance use treatment facility (N=122). The EMS domains of disconnection and rejection and impaired limits were associated with symptoms of MDD and the domain of impaired autonomy and performance was associated with symptoms of GAD, even after controlling for age, gender, years of education, alcohol use, drug use, and symptoms of MDD (when predicting GAD) and GAD (when predicting MDD). Findings suggest that EMS may play an important role in comorbid mental health problems among men and women in residential substance use treatment. Continued treatment outcome research is needed to examine whether modification of EMS results in improved mental health and substance use outcomes.
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Affiliation(s)
- Ryan C Shorey
- a Assistant Professor, Department of Psychology , Ohio University , Athens , OH
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Anxiety Assessment: Psychometric Properties of the Spanish Version of the Burns Anxiety Inventory. THE SPANISH JOURNAL OF PSYCHOLOGY 2015; 18:E44. [PMID: 26096128 DOI: 10.1017/sjp.2015.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The main purpose of this study was to analyze the psychometric properties of the Spanish version of the Burns Anxiety Inventory (Burns-A: Burns, 1993). The sample consisted of 417 participants, 387 (29.71% male) healthy participants (control group: M = 35.5 years; SD = 8.40) and 30 (36.66% female) patients (clinical group: M = 35.8 years; SD = 12.94). The internal consistency evaluated through Cronbach' Alpha was 0.95 for the Total Score in both subsamples. The test-retest reliability (two weeks) for Total Score was 0.86 (F = 13.2, p ≤ .001) for the non-clinical subsample, and 0.95 (F = 36.5, p ≤ .001) for the clinical subsample. Confirmatory factor analyses supported the initial three-factor model. However, modifications to the initial three-factor model improved the goodness-of-fit indices. Results showed statistically significant differences in the mean scores of the Burns-A between the clinical and control groups. This study supports the Spanish version of the Burns-A as a brief and useful tool for the screening of anxiety symptoms in adult populations. Future studies should investigate measurement invariance across cultures.
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32
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Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial. Internet Interv 2015. [DOI: 10.1016/j.invent.2014.12.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Carpenter KLH, Angold A, Chen NK, Copeland WE, Gaur P, Pelphrey K, Song AW, Egger HL. Preschool anxiety disorders predict different patterns of amygdala-prefrontal connectivity at school-age. PLoS One 2015; 10:e0116854. [PMID: 25625285 PMCID: PMC4308069 DOI: 10.1371/journal.pone.0116854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022] Open
Abstract
Objective In this prospective, longitudinal study of young children, we examined whether a history of preschool generalized anxiety, separation anxiety, and/or social phobia is associated with amygdala-prefrontal dysregulation at school-age. As an exploratory analysis, we investigated whether distinct anxiety disorders differ in the patterns of this amygdala-prefrontal dysregulation. Methods Participants were children taking part in a 5-year study of early childhood brain development and anxiety disorders. Preschool symptoms of generalized anxiety, separation anxiety, and social phobia were assessed with the Preschool Age Psychiatric Assessment (PAPA) in the first wave of the study when the children were between 2 and 5 years old. The PAPA was repeated at age 6. We conducted functional MRIs when the children were 5.5 to 9.5 year old to assess neural responses to viewing of angry and fearful faces. Results A history of preschool social phobia predicted less school-age functional connectivity between the amygdala and the ventral prefrontal cortices to angry faces. Preschool generalized anxiety predicted less functional connectivity between the amygdala and dorsal prefrontal cortices in response to fearful faces. Finally, a history of preschool separation anxiety predicted less school-age functional connectivity between the amygdala and the ventral prefrontal cortices to angry faces and greater school-age functional connectivity between the amygdala and dorsal prefrontal cortices to angry faces. Conclusions Our results suggest that there are enduring neurobiological effects associated with a history of preschool anxiety, which occur over-and-above the effect of subsequent emotional symptoms. Our results also provide preliminary evidence for the neurobiological differentiation of specific preschool anxiety disorders.
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Affiliation(s)
- Kimberly L. H. Carpenter
- Duke University Medical Center, Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, United States of America
- * E-mail:
| | - Adrian Angold
- Duke University Medical Center, Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, United States of America
| | - Nan-Kuei Chen
- Duke University Medical Center, Brain Imaging and Analysis Center, Durham, North Carolina, United States of America
| | - William E. Copeland
- Duke University Medical Center, Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, United States of America
| | - Pooja Gaur
- Vanderbilt University School of Medicine, Chemical and Physical Biology, Nashville, Tennessee, United States of America
| | - Kevin Pelphrey
- Yale University, Yale Child Study Center, New Haven, Connecticut, United States of America
| | - Allen W. Song
- Duke University Medical Center, Brain Imaging and Analysis Center, Durham, North Carolina, United States of America
| | - Helen L. Egger
- Duke University Medical Center, Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, United States of America
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Kaladjian A, Adida M, Belzeaux R, Azorin JM. [Affective disorders and anxiety comorbidities]. Encephale 2015; 40 Suppl 3:S18-22. [PMID: 25550234 DOI: 10.1016/s0013-7006(14)70126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Anxiety disorders are frequently associated with affective disorders and represent one of the most important comorbidity in patients with bipolar disorder. Their prevalence is high, whatever the anxiety disorder, with nevertheless higher rates for generalized anxiety disorder (18.4 to 19.9% for lifetime prevalence). Such high frequencies raise essential questions about the link between these groups of disorders, and if it is necessary to distinguish them or to consider their phenomenological overlap as resulting of common disease processes. The existence of comorbid anxiety disorder in bipolar disorder significantly worsens its evolution, inducing more severe episodes, shortening remission periods, favoring relapses and suicide as well as substance use, and reducing quality of life in comparison to bipolar patients without anxiety. The mechanisms that link the anxious symptomatology to mood dysregulation are still poorly understood, although it is likely that genetic factors play a key role, combined with other factors of vulnerability, including those involved in coping strategy to address ongoing distress. Despite the high impact of anxiety on the severity of bipolar disorder course, few randomized controlled trials examined treatments of comorbid anxiety disorders and only recent recommendations offer useful therapeutic perspectives. In this context, it seems necessary to better understand the features associated with the occurence of anxiety disorders in affective disorders, in order to better identify the mechanisms underlying such comorbidity, together with working to develop therapeutics that efficiently target them.
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Affiliation(s)
- A Kaladjian
- Pôle de Psychiatrie des Adultes, CHU Robert Debré, Avenue du Général Koenig, 51092 Reims cedex, France.
| | - M Adida
- Pôle Universitaire de Psychiatrie, Hôpital Sainte Marguerite, 270 boulevard Sainte Marguerite, 13274 Marseille cedex 09, France
| | - R Belzeaux
- Pôle Universitaire de Psychiatrie, Hôpital Sainte Marguerite, 270 boulevard Sainte Marguerite, 13274 Marseille cedex 09, France
| | - J M Azorin
- Pôle Universitaire de Psychiatrie, Hôpital Sainte Marguerite, 270 boulevard Sainte Marguerite, 13274 Marseille cedex 09, France
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Reid KM. The Relationship Between Parents’ Poor Emotional Health Status and Childhood Mood and Anxiety Disorder in Florida Children, National Survey of Children’s Health, 2011–2012. Matern Child Health J 2014; 19:1071-7. [DOI: 10.1007/s10995-014-1607-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Albert PR, Vahid-Ansari F, Luckhart C. Serotonin-prefrontal cortical circuitry in anxiety and depression phenotypes: pivotal role of pre- and post-synaptic 5-HT1A receptor expression. Front Behav Neurosci 2014; 8:199. [PMID: 24936175 PMCID: PMC4047678 DOI: 10.3389/fnbeh.2014.00199] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/16/2014] [Indexed: 01/03/2023] Open
Abstract
Decreased serotonergic activity has been implicated in anxiety and major depression, and antidepressants directly or indirectly increase the long-term activity of the serotonin system. A key component of serotonin circuitry is the 5-HT1A autoreceptor, which functions as the major somatodendritic autoreceptor to negatively regulate the "gain" of the serotonin system. In addition, 5-HT1A heteroreceptors are abundantly expressed post-synaptically in the prefrontal cortex (PFC), amygdala, and hippocampus to mediate serotonin actions on fear, anxiety, stress, and cognition. Importantly, in the PFC 5-HT1A heteroreceptors are expressed on at least two antagonist neuronal populations: excitatory pyramidal neurons and inhibitory interneurons. Rodent models implicate the 5-HT1A receptor in anxiety- and depression-like phenotypes with distinct roles for pre- and post-synaptic 5-HT1A receptors. In this review, we present a model of serotonin-PFC circuitry that integrates evidence from mouse genetic models of anxiety and depression involving knockout, suppression, over-expression, or mutation of genes of the serotonin system including 5-HT1A receptors. The model postulates that behavioral phenotype shifts as serotonin activity increases from none (depressed/aggressive not anxious) to low (anxious/depressed) to high (anxious, not depressed). We identify a set of conserved transcription factors including Deaf1, Freud-1/CC2D1A, Freud-2/CC2D1B and glucocorticoid receptors that may confer deleterious regional changes in 5-HT1A receptors in depression, and how future treatments could target these mechanisms. Further studies to specifically test the roles and regulation of pyramidal vs. interneuronal populations of 5-HT receptors are needed better understand the role of serotonin in anxiety and depression and to devise more effective targeted therapeutic approaches.
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Affiliation(s)
- Paul R Albert
- Neuroscience, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada
| | - Faranak Vahid-Ansari
- Neuroscience, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada ; Department of Cellular and Molecular Medicine, University of Ottawa Ottawa ON, Canada
| | - Christine Luckhart
- Neuroscience, Ottawa Hospital Research Institute, University of Ottawa Ottawa, ON, Canada ; Department of Cellular and Molecular Medicine, University of Ottawa Ottawa ON, Canada
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Bredemeier K, Beevers CG, McGeary JE. Serotonin transporter and BDNF polymorphisms interact to predict trait worry. ANXIETY STRESS AND COPING 2014; 27:712-21. [PMID: 24679122 DOI: 10.1080/10615806.2014.909928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Excessive worry is associated with a range of psychological disorders. While previous studies have examined genes associated with a range of different anxiety phenotypes, none have explored genes specifically associated with the general tendency to worry. DESIGN The present study tested associations between trait worry and functional polymorphisms of three candidate genes: the serotonin transporter-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene, the Val66Met region of the brain-derived neurotrophic factor (BDNF) gene, and the Val158Met region of the catechol-O-methyltransferase (COMT) gene. METHODS A heterogeneous sample of adult participants (n=173) completed the Penn State Worry Questionnaire (PSWQ) and provided DNA samples for genotyping. RESULTS Results revealed a significant interaction between 5-HTTLPR and BDNF genotypes predicting levels of worry. Specifically, there was a significant positive association between 5-HTTLPR short alleles and PSWQ scores, but only in BDNF met allele carriers. COMT genotype was not significantly associated levels of worry, nor did COMT interact with 5-HTTLPR or BDNF genotypes to predict PSWQ scores. CONCLUSIONS These findings provide preliminary evidence about the putative genetic etiology of worrying. Key limitations of the present study and corresponding directions for future research on this topic are discussed.
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Affiliation(s)
- Keith Bredemeier
- a Providence Veterans Affairs Medical Center , Providence , RI , USA
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Sala R, Strober MA, Axelson DA, Gill MK, Castro-Fornieles J, Goldstein TR, Goldstein BI, Ha W, Liao F, Iyengar S, Yen S, Hower H, Hunt J, Dickstein DP, Ryan ND, Keller MB, Birmaher B. Effects of comorbid anxiety disorders on the longitudinal course of pediatric bipolar disorders. J Am Acad Child Adolesc Psychiatry 2014; 53:72-81. [PMID: 24342387 PMCID: PMC3868011 DOI: 10.1016/j.jaac.2013.09.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 09/04/2013] [Accepted: 10/14/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the longitudinal effects of comorbid anxiety disorders in youth with bipolar spectrum disorder (BP). METHOD As part of the Course and Outcome of Bipolar Youth study, 413 youth, who were 7 through 17 years or age and who met criteria for DSM-IV BP-I (n = 244), BP-II (n = 28), and operationally defined bipolar disorder not otherwise specified (BP-NOS) (n = 141) were included. Subjects were followed on average 5 years using the Longitudinal Interval Follow-up Evaluation. Effects of anxiety on the time to mood recovery and recurrence and percentage of time with syndromal and subsyndromal mood symptomatology during the follow-up period were analyzed. RESULTS At intake and during the follow-up, 62% of youth with BP met criteria for at least 1 anxiety disorder. About 50% of the BP youth with anxiety had ≥2 anxiety disorders. Compared to BP youth without anxiety, those with anxiety had significantly more depressive recurrences and significantly longer median time to recovery. The effects of anxiety on recovery disappeared when the severity of depression at intake was taken into account. After adjusting for confounding factors, BP youth with anxiety, particularly those with ≥2 anxiety disorders, spent significantly less follow-up time asymptomatic and more time with syndromal mixed/cycling and subsyndromal depressive symptomatology compared to those without anxiety. CONCLUSIONS Anxiety disorders are common and adversely affect the course of BP in youth, as characterized by more mood recurrences, longer time to recovery, less time euthymic, and more time in mixed/cycling and depressive episodes. Prompt recognition and the development of treatments for BP youth with anxiety are warranted.
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Affiliation(s)
- Regina Sala
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine; Institute of Psychiatry, King's College London.
| | - Michael A Strober
- David Geffen School of Medicine, University of California at Los Angeles
| | - David A. Axelson
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Mary Kay Gill
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | | | - Tina R. Goldstein
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | | | - Wonho Ha
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Fangzi Liao
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | | | - Shirley Yen
- Butler Hospital, Brown University School of Medicine
| | - Heather Hower
- Butler Hospital, Brown University School of Medicine
| | - Jeffrey Hunt
- Butler Hospital, Brown University School of Medicine
| | | | - Neal D. Ryan
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
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Mehta NS, Wang L, Redei EE. Sex differences in depressive, anxious behaviors and hippocampal transcript levels in a genetic rat model. GENES BRAIN AND BEHAVIOR 2013; 12:695-704. [PMID: 23876038 DOI: 10.1111/gbb.12063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/30/2013] [Accepted: 07/18/2013] [Indexed: 01/10/2023]
Abstract
Major depressive disorder (MDD) is a common, debilitating illness with high prevalence of comorbid anxiety. The incidence of depression and of comorbid anxiety is much higher in women than in men. These gender biases appear after puberty and their etiology is mostly unknown. Selective breeding of the Wistar Kyoto (WKY) rat strain, an accepted model of adult and adolescent depression, resulted in two fully inbred substrains. Adult WKY more immobile (WMI) rats of both sexes consistently show increased depression-like behavior in the forced swim test when compared with the control WKY less immobile (WLI) strain. In contrast, here we show that while adult female WMIs and WLIs both display high anxiety-like behaviors, only WLI males, but not WMI males, show this behavior. Moreover, the behavioral profile of WMI males is consistent from early adolescence to adulthood, but the high depression- and anxiety-like behaviors of the female WMIs appear only in adulthood. These sex-specific behavioral patterns are paralleled by marked sex differences in hippocampal gene expression differences established by genome-wide transcriptional analyses of 13th generation WMIs and WLIs. Moreover, sex- and age-specific differences in transcript levels of selected genes are present in the hippocampus of the current, fully inbred WMIs and WLIs. Thus, the contribution of specific genes and/or the influence of the gonadal hormonal environment to depression- and anxiety-like behaviors may differ between male and female WMIs, resulting in their distinct behavioral and transcriptomic profiles despite shared sequences of the somatic chromosomes.
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Affiliation(s)
- N S Mehta
- Department of Psychiatry and Behavioral Sciences; The Norman and Helen Asher Center for the Study of Depressive Disorders
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40
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Cooper AJ, Rickels K, Lohoff FW. Association analysis between the A118G polymorphism in the OPRM1 gene and treatment response to venlafaxine XR in generalized anxiety disorder. Hum Psychopharmacol 2013; 28:258-62. [PMID: 23658070 DOI: 10.1002/hup.2317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 03/20/2013] [Indexed: 12/20/2022]
Abstract
Patients diagnosed with generalized anxiety disorder (GAD) exhibit differential responses to standard antidepressant pharmacotherapy. Mounting evidence demonstrates that genetic differences may be implicated in treatment response in disorders like GAD. In this study, we examined whether the OPRM1 gene, which has been implicated in antidepressant treatment response in major depressive disorder, also has an effect in GAD. In our study, 156 patients diagnosed with GAD received venlafaxine XR treatment as part of an 18-month relapse prevention study. Genotypes were obtained for the OPRM1 functional variant A118G for the entire sample (n = 151); however, only the European American population was considered (n = 108) for pharmacogenetic analysis. We found no significant association between A118G and antidepressant treatment response in our GAD population. Future studies that include different single nucleotide polymorphisms of the OPRM1 gene as well as larger populations will need to be conducted to further elucidate the pharmacogenetic role of the endogenous opioid system in anxiety disorders.
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Affiliation(s)
- Alissa J Cooper
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Barfield ET, Moser VA, Hand A, Grisel JE. β-endorphin modulates the effect of stress on novelty-suppressed feeding. Front Behav Neurosci 2013; 7:19. [PMID: 23503677 PMCID: PMC3596765 DOI: 10.3389/fnbeh.2013.00019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
Although stress is implicated in the pathophysiology of mood and anxiety disorders, not all individuals who suffer stressful life events develop psychopathology. Differential susceptibility to stress may be influenced by genetically mediated differences in hypothalamic-pituitary-adrenal (HPA) axis activity and moderation of the stress response by the opioid peptide β-endorphin (β-E). The present study investigated genetic contributions to coping behavior by examining anxious behavior of transgenic mice with varying capacities to synthesize β-E [B6.129S2-Pomctm1Low/J; regulated by insertion of a premature stop codon into one or both copies of the proopiomelanocortin (POMC) gene], both under normal conditions and following 3 min of forced swim (FS). Ten minutes after this stress exposure or a control manipulation, acutely food-deprived female and male transgenic mice were subjected to a novelty-suppressed feeding (NSF) test, during which their interaction with an almond slice located in the center of an open field box was measured. There was an interaction between genotype and stress for latency to approach the almond and whether or not the almond was approached, such that mice with low or absent β-E displayed a stronger aversion to novelty-feeding after stress exposure than did mice with normal levels. These data provide evidence for a moderating effect of β-E on the behavioral response to stress. Genotypic differences in anxious behavior emerged when mice were stressed prior to behavioral assessment, suggesting that β-E plays a role in coping behavior. These findings indicate that genetic variability in sensitivity of the β-E system to stress may contribute, at least in part, to heritable differences in stress reactivity as well as vulnerability to stress-related psychopathology.
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Zbozinek TD, Rose RD, Wolitzky-Taylor KB, Sherbourne C, Sullivan G, Stein MB, Roy-Byrne PP, Craske MG. Diagnostic overlap of generalized anxiety disorder and major depressive disorder in a primary care sample. Depress Anxiety 2012; 29:1065-71. [PMID: 23184657 PMCID: PMC3629816 DOI: 10.1002/da.22026] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 09/28/2012] [Accepted: 10/18/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are highly comorbid. A possible explanation is that they share four symptoms according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR). The present study addressed the symptom overlap of people meeting DSM-IV-TR diagnostic criteria for GAD, MDD, or both to investigate whether comorbidity might be explained by overlapping diagnostic criteria. METHODS Participants (N = 1,218) were enrolled in the Coordinated Anxiety Learning and Management study (a randomized effectiveness clinical trial in primary care). Hypotheses were (1) the comorbid GAD/MDD group endorses the overlapping symptoms more than the nonoverlapping symptoms, and (2) the comorbid GAD/MDD group endorses the overlapping symptoms more than GAD only or MDD only groups, whereas differences would not occur for nonoverlapping symptoms. RESULTS The overlapping GAD/MDD symptoms were endorsed more by the comorbid group than the MDD group but not the GAD group when covarying for total symptom endorsement. Similarly, the comorbid group endorsed the overlapping symptoms more than the nonoverlapping symptoms and did not endorse the nonoverlapping symptoms more than the GAD or MDD groups when covarying for total symptom endorsement. CONCLUSIONS The results suggest that comorbidity of GAD and MDD is strongly influenced by diagnostic overlap. Results are discussed in terms of errors of diagnostic criteria, as well as models of shared psychopathology that account for diagnostic criteria overlap.
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Affiliation(s)
- Tomislav D Zbozinek
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
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The 1-month prevalence of generalized anxiety disorder according to DSM-IV, DSM-V, and ICD-10 among nondemented 75-year-olds in Gothenburg, Sweden. Am J Geriatr Psychiatry 2012; 20:963-72. [PMID: 22549369 DOI: 10.1097/jgp.0b013e318252e749] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the 1-month prevalence of generalized anxiety disorder (GAD) according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Diagnostic and Statistical Manual of Mental, Fifth Edition (DSM-V), and International Classification of Diseases, Tenth Revision (ICD-10), and the overlap between these criteria, in a population sample of 75-year-olds. We also aimed to examine comorbidity between GAD and other psychiatric diagnoses, such as depression. METHOD During 2005-2006, a comprehensive semistructured psychiatric interview was conducted by trained nurses in a representative population sample of 75-year-olds without dementia in Gothenburg, Sweden (N = 777; 299 men and 478 women). All psychiatric diagnoses were made according to DSM-IV. GAD was also diagnosed according to ICD-10 and DSM-V. RESULTS The 1-month prevalence of GAD was 4.1% (N = 32) according to DSM-IV, 4.5% (N = 35) according to DSM-V, and 3.7% (N = 29) according to ICD-10. Only 46.9% of those with DSM-IV GAD fulfilled ICD-10 criteria, and only 51.7% and 44.8% of those with ICD-10 GAD fulfilled DSM-IV/V criteria. Instead, 84.4% and 74.3% of those with DSM-IV/V GAD and 89.7% of those with ICD-10 GAD had depression. Also other psychiatric diagnoses were common in those with ICD-10 and DSM-IV GAD. Only a small minority with GAD, irrespective of criteria, had no other comorbid psychiatric disorder. ICD-10 GAD was related to an increased mortality rate. CONCLUSIONS While GAD was common in 75-year-olds, DSM-IV/V and ICD-10 captured different individuals. Current definitions of GAD may comprise two different expressions of the disease. There was greater congruence between GAD in either classification system and depression than between DSM-IV/V GAD and ICD-10 GAD, emphasizing the close link between these entities.
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Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:222-8. [PMID: 18615162 DOI: 10.4088/pcc.v10n0307] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 11/13/2007] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review the literature on the co-occurrence of anxiety with depressive disorders and the rationale for and use of combination treatment with benzodiazepines and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs) for treating comorbid anxiety and depression. DATA SOURCES PubMed and PsycINFO were searched using terms identified as relevant based on existing practice guidelines. The primary search terms were anxiety, anxiety disorders, depression, depressive disorders, comorbidity, epidemiology, benzodiazepines, antidepressants, pharmacology, clinical trials, and pharmacotherapy. Reference lists of identified articles were also reviewed to ensure capture of relevant literature. STUDY SELECTION Publications were selected for inclusion in the review if they applied to adult populations and specifically addressed the comorbidity of anxiety and depression, their epidemiology, or their management. Case reports and case series were not considered for inclusion. DATA EXTRACTION Each author assessed the publications independently for content related to the review topics. Findings considered relevant to the clinical understanding and management of comorbid anxiety and depression were incorporated into the review. DATA SYNTHESIS Comorbidity is very common among patients with anxiety and depressive disorders, and, even when full criteria for 2 separate disorders are not met, subsyndromal symptoms are often present. Little controlled research has explored how benzodiazepines and SSRIs/SNRIs may be usefully combined, yet their combination is frequently employed in clinical practice. Patients with comorbidities are likely to have poorer treatment outcomes and have greater utilization of health care resources. Currently SSRIs/SNRIs are considered first-line therapy and are effective in both anxiety and depressive states. Nevertheless, many patients have only a partial response or have difficulty tolerating efficacious doses of antidepressant monotherapy. Benzodiazepines appear to improve treatment outcomes when an anxiety disorder co-occurs with depression or for depression characterized by anxious features. Specifically, they may provide benefits both in terms of speed of response and overall response. CONCLUSIONS Long-term management plans for anxiety disorder with or without comorbid depression should include strategies for acute or short-term care, long-term maintenance, and episodic or breakthrough symptoms. Combination therapy with benzodiazepines and antide-pressants in appropriate clinical settings may improve outcomes over monotherapy in some patients.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University, School of Medicine, Atlanta, Ga, USA.
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Li Y, Shi S, Yang F, Gao J, Li Y, Tao M, Wang G, Zhang K, Gao C, Liu L, Li K, Li K, Liu Y, Wang X, Zhang J, Lv L, Wang X, Chen Q, Hu J, Sun L, Shi J, Chen Y, Xie D, Flint J, Kendler KS, Zhang Z. Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression. Psychol Med 2012; 42:1239-1248. [PMID: 22126712 PMCID: PMC3339636 DOI: 10.1017/s003329171100273x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 10/17/2011] [Accepted: 10/31/2011] [Indexed: 12/03/2022]
Abstract
BACKGROUND Studies conducted in Europe and the USA have shown that co-morbidity between major depressive disorder (MDD) and anxiety disorders is associated with various MDD-related features, including clinical symptoms, degree of familial aggregation and socio-economic status. However, few studies have investigated whether these patterns of association vary across different co-morbid anxiety disorders. Here, using a large cohort of Chinese women with recurrent MDD, we examine the prevalence and associated clinical features of co-morbid anxiety disorders. METHOD A total of 1970 female Chinese MDD patients with or without seven co-morbid anxiety disorders [including generalized anxiety disorder (GAD), panic disorder, and five phobia subtypes] were ascertained in the CONVERGE study. Generalized linear models were used to model association between co-morbid anxiety disorders and various MDD features. RESULTS The lifetime prevalence rate for any type of co-morbid anxiety disorder is 60.2%. Panic and social phobia significantly predict an increased family history of MDD. GAD and animal phobia predict an earlier onset of MDD and a higher number of MDD episodes, respectively. Panic and GAD predict a higher number of DSM-IV diagnostic criteria. GAD and blood-injury phobia are both significantly associated with suicidal attempt with opposite effects. All seven co-morbid anxiety disorders predict higher neuroticism. CONCLUSIONS Patterns of co-morbidity between MDD and anxiety are consistent with findings from the US and European studies; the seven co-morbid anxiety disorders are heterogeneous when tested for association with various MDD features.
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Affiliation(s)
- Y. Li
- Wellcome Trust Center for Human Genetics, Roosevelt Drive, Oxford, UK
| | - S. Shi
- Fudan University Affiliated Huashan Hospital, Shanghai, People's Republic of China
- Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - F. Yang
- Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - J. Gao
- Zhejiang Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Youhui Li
- No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - M. Tao
- Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - G. Wang
- Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - K. Zhang
- No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - C. Gao
- No. 1 Hospital of Medical College of Xian Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - L. Liu
- Shandong Mental Health Center, Jinan, Shandong, People's Republic of China
| | - Kan Li
- Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, People's Republic of China
| | - Keqing Li
- Hebei Mental Health Center, Baoding, Hebei, People's Republic of China
| | - Y. Liu
- The First Hospital of China Medical University, He Ping District, Shenyang, Liaoning, People's Republic of China
| | - Xumei Wang
- ShengJing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - J. Zhang
- No. 3 Affiliated Hospital of Sun Yat-sen University, Tian He District, Guangzhou, Guangdong, People's Republic of China
| | - L. Lv
- Psychiatric Hospital of Henan Province, No. 388 Jian She Zhong Lu, Xinxiang, Henan, 453002, People's Republic of China
| | - Xueyi Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Q. Chen
- Dalian No. 7 People's Hospital and Dalian Mental Health Center, Gan Jing Zi District, Dalian, Liaoning, People's Republic of China
| | - J. Hu
- No. 1 Mental Health Center Affiliated Harbin Medical University, Nangang District, Harbin, Heilongjiang, People's Republic of China
| | - L. Sun
- Jilin Brain Hospital, Siping, Jilin, People's Republic of China
| | - J. Shi
- Xi'an Mental Health Center, Qujiang Xin District, Xi'an, Shaanxi, People's Republic of China
| | - Y. Chen
- Clinical Trial Service Unit, Richard Doll Building, Roosevelt Drive, Oxford, UK
| | - D. Xie
- Wellcome Trust Center for Human Genetics, Roosevelt Drive, Oxford, UK
| | - J. Flint
- Wellcome Trust Center for Human Genetics, Roosevelt Drive, Oxford, UK
| | - K. S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics of Virginia Commonwealth University, Richmond, VA, USA
| | - Z. Zhang
- No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China
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Pharmacogenetic investigation of response to duloxetine treatment in generalized anxiety disorder. THE PHARMACOGENOMICS JOURNAL 2012; 13:280-5. [PMID: 22249355 DOI: 10.1038/tpj.2011.62] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Versini A, LeGauffre C, Romo L, Adès J, Gorwood P. Frequency of Gambling Problems among Parents of Pathological, versus Nonpathological, Casino Gamblers Using Slot Machines. Am J Addict 2011; 21:86-95. [DOI: 10.1111/j.1521-0391.2011.00190.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Navarrett S, Collier L, Cardozo C, Dracheva S. Alterations of serotonin 2C and 2A receptors in response to T10 spinal cord transection in rats. Neurosci Lett 2011; 506:74-8. [PMID: 22056918 DOI: 10.1016/j.neulet.2011.10.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 09/30/2011] [Accepted: 10/20/2011] [Indexed: 12/14/2022]
Abstract
Recent studies reported that a recovery of motoneurons after spinal cord transection at the sacrocaudal level may depend on adaptive alterations of the serotonin 2C (5-HT(2C)R) and 2A (5-HT(2C)R) receptor function via changes in mRNA editing or protein expression, respectively. It has been suggested that depletion of serotonergic input may drive these adaptations. Here, mRNA editing and/or expression of 5-HT(2C)R and 5-HT(2A)R was evaluated in rats that sustained a complete transection at the thoracic (T10) level. While 5-HT(2A)R mRNA expression was upregulated below the site of spinal cord injury (SCI), no changes in 5-HT(2C)R mRNA editing or expression were detected. These findings argue against the hypothesis that 5-HT(2C)R editing is regulated by extracellular serotonin levels. Rather, it appears that the editing process is just one of the ways in which excitability of motor neurons can be restored following SCI. To this end, the influence of excitatory locomotor circuits on motor neurons in the thoracic spinal cord of rats requires further exploration.
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Affiliation(s)
- Scott Navarrett
- James J Peters Veterans Affairs Medical Center, Bronx, NY, United States
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Narasimhan S, Aquino TD, Hodge R, Rickels K, Lohoff FW. Association analysis between the Val66Met polymorphism in the brain-derived neurotrophic factor (BDNF) gene and treatment response to venlafaxine XR in generalized anxiety disorder. Neurosci Lett 2011; 503:200-2. [DOI: 10.1016/j.neulet.2011.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
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Contextual conditioning in rats as an animal model for generalized anxiety disorder. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2011; 11:228-44. [PMID: 21302154 DOI: 10.3758/s13415-011-0021-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Animal models of psychiatric disorders are important translational tools for exploring new treatment options and gaining more insight into the disease. Thus far, there is no systematically validated animal model for generalized anxiety disorder (GAD), a severely impairing and difficult-to-treat disease. In this review, we propose contextual conditioning (CC) as an animal model for GAD. We argue that this model has sufficient face validity (there are several symptom similarities), predictive validity (it responds to clinically effective treatments), and construct validity (the underlying mechanisms are comparable). Although the refinement and validation of an animal model is a never-ending process, we want to give a concise overview of the currently available evidence. We suggest that the CC model might be a valuable preclinical tool to enhance the development of new treatment strategies and our understanding of GAD.
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