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Abstract
It is well established that migraine is a multifactorial disorder. A deep understanding of migraine should be based upon both the underlying traits and the current states affected by different physiological, psychological, and environmental factors. At this point, there is no framework fully meeting these criteria. Here, we describe a broader view of the migraine disorder defined as a dysfunctional brain state and trait interaction. In this model, we consider events that may enhance or diminish migraine responsivity based on an individual's trait and state. This could provide an expanded view for considering how migraine attacks are sometimes precipitated by "triggers" and sometimes not, how these factors only lead to migraine attacks in migraine patients, or how individuals with an increased risk for migraine do not show any symptoms at all. Summarizing recent studies and evidence that support the concept of migraine as a brain state-trait interaction can also contribute to improving patient care by highlighting the importance of precision medicine and applying measures that are able to capture how different traits and states work together to determine migraine.
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Abstract
PURPOSE OF REVIEW The review focused on associations between temperament dimensions and clinical features in different anxiety disorders, likewise in obsessive-compulsive disorder in clinical samples of adults. A literature search was conducted in the Medline and PsycINFO databases covering the years 2010-2016. A systematic review and grading of the level of evidence for an association between temperament dimension scores and clinical features in each disorder were performed. RECENT FINDINGS Twenty papers reporting 18 different studies were included. Five of the papers focused on panic disorder (PD), five on social anxiety disorder (SAD), three on post-traumatic stress disorder (PTSD), one on generalized anxiety disorder (GAD), three on obsessive-compulsive disorder (OCD), and an additional three papers on several anxiety disorders. The review consolidates the finding that trait anxiety, especially as assessed by Cloninger's model or the five-factor model, is a phenomenon common to all anxiety disorders and OCD. More follow-up studies including large samples are needed to differentiate the dimensional profiles of trait anxiety in specific disorders.
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Affiliation(s)
- Olli Kampman
- Faculty of Medicine and Life Sciences, University of Tampere, PO Box 100, 33014, Tampere, FI, Finland. .,Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland.
| | - Merja Viikki
- Faculty of Medicine and Life Sciences, University of Tampere, PO Box 100, 33014, Tampere, FI, Finland.,Tampere City Mental Health Center, Tampere, Finland
| | - Esa Leinonen
- Faculty of Medicine and Life Sciences, University of Tampere, PO Box 100, 33014, Tampere, FI, Finland.,Department of Psychiatry, Tampere University Hospital, Tampere, Finland
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3
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Abstract
Overactive bladder (OAB) is a ubiquitous syndrome that is defined by urinary urgency with, or without urinary incontinence. OAB is observed in all parts of the world, with a prevalence of 5-12% in children (5-10 years of age) and a prevalence of 0.5% in older adolescents (16-18 years of age). Published data indicate that around a third of children with OAB are likely to become adults with similar complaints. Studies in children and in adults with OAB indicate that these individuals are more likely to also have anxiety, depression and attention deficit problems, and that appropriate treatment of these comorbidities can often improve the patient's OAB symptoms. Furthermore, data from twin studies and familial surveys seem to indicate a genetic component of OAB. Pharmacological treatments of OAB in children have improved in the past 5 years, moving beyond anticholinergic agents and including the off-label use of α-blockers, β3-agonists and intravesical botulinum toxin. Use of several different electrical stimulation techniques is also effective, both as first-line treatments, and for patients with treatment-refractory symptoms. Overall the outlook of children with OAB seems to be improving, with a greater understanding of the pathophysiology of this syndrome. Treatment modalities that target the source of the underlying problem, especially in children, are likely to provide the best patient outcomes.
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Jiao X, Beck KD, Myers CE, Servatius RJ, Pang KCH. Altered activity of the medial prefrontal cortex and amygdala during acquisition and extinction of an active avoidance task. Front Behav Neurosci 2015; 9:249. [PMID: 26441578 PMCID: PMC4569748 DOI: 10.3389/fnbeh.2015.00249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022] Open
Abstract
Altered medial prefrontal cortex (mPFC) and amygdala function is associated with anxiety-related disorders. While the mPFC-amygdala pathway has a clear role in fear conditioning, these structures are also involved in active avoidance. Given that avoidance perseveration represents a core symptom of anxiety disorders, the neural substrate of avoidance, especially its extinction, requires better understanding. The present study was designed to investigate the activity, particularly, inhibitory neuronal activity in mPFC and amygdala during acquisition and extinction of lever-press avoidance in rats. Neural activity was examined in the mPFC, intercalated cell clusters (ITCs) lateral (LA), basal (BA) and central (CeA) amygdala, at various time points during acquisition and extinction, using induction of the immediate early gene product, c-Fos. Neural activity was greater in the mPFC, LA, BA, and ITC during the extinction phase as compared to the acquisition phase. In contrast, the CeA was the only region that was more activated during acquisition than during extinction. Our results indicate inhibitory neurons are more activated during late phase of acquisition and extinction in the mPFC and LA, suggesting the dynamic involvement of inhibitory circuits in the development and extinction of avoidance response. Together, these data start to identify the key brain regions important in active avoidance behavior, areas that could be associated with avoidance perseveration in anxiety disorders.
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Affiliation(s)
- Xilu Jiao
- Neurobehavioral Laboratory, Veterans Bio-Medical Research Institute (VBRI) East Orange, NJ, USA
| | - Kevin D Beck
- Neurobehavioral Research Laboratory, Department of Veterans Affairs, New Jersey Health Care System East Orange, NJ, USA ; Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences Newark, NJ, USA
| | - Catherine E Myers
- Neurobehavioral Research Laboratory, Department of Veterans Affairs, New Jersey Health Care System East Orange, NJ, USA ; Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences Newark, NJ, USA
| | - Richard J Servatius
- Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences Newark, NJ, USA ; Syracuse VA Medical Center, Department of Veterans Affairs Syracuse, NY, USA
| | - Kevin C H Pang
- Neurobehavioral Research Laboratory, Department of Veterans Affairs, New Jersey Health Care System East Orange, NJ, USA ; Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences Newark, NJ, USA
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5
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Abstract
Individual differences in temperament emerge in the first months of life. Some infants display a heightened sensitivity to novelty and uncertainty in the world around them, leading a subset to fearfully withdraw from the social environment. Extreme forms of this temperament, Behavioral Inhibition (BI), are associated with increased risk for social anxiety disorder. Indeed, the link is so strong that some suggest that BI is not simply a risk factor for anxiety, but rather a milder form of the disorder. The current overview describes the literature linking BI and anxiety, highlighting the unique biobehavioral profiles evident in each construct. It then highlights specific evidence that may help distinguish the form and function of BI and anxiety. Finally, we briefly discuss unresolved issues that may help inform future work aimed at improving our understanding of individual development and shape therapeutic interventions directed at specific mechanisms of disorder.
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Affiliation(s)
- Koraly E Pérez-Edgar
- Department of Psychology, Child Study Center, The Pennsylvania State University, University Park
| | - Amanda E Guyer
- Department of Human Ecology, Center for Mind and Brain, University of California, Davis
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Methodological challenges of moving beyond DSM categories: transdiagnostic studies of frontolimbic connectivity changes in vulnerable individuals. Biol Psychiatry 2013; 74:240-1. [PMID: 23885753 DOI: 10.1016/j.biopsych.2013.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/24/2022]
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Hardee JE, Benson BE, Bar-Haim Y, Mogg K, Bradley BP, Chen G, Britton JC, Ernst M, Fox NA, Pine DS, Pérez-Edgar K. Patterns of neural connectivity during an attention bias task moderate associations between early childhood temperament and internalizing symptoms in young adulthood. Biol Psychiatry 2013; 74:273-9. [PMID: 23489415 PMCID: PMC3725217 DOI: 10.1016/j.biopsych.2013.01.036] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/02/2013] [Accepted: 01/25/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Biased attention to threat is found in both individuals with anxiety symptoms and children with the childhood temperament of behavioral inhibition (BI). Although perturbed fronto-amygdala function is implicated in biased attention among anxious individuals, no work has examined the neural correlates of attention biases in BI. Work in this area might clarify underlying mechanisms for anxiety in a sample at risk for internalizing disorders. We examined the relations among early childhood BI, fronto-amygdala connectivity during an attention bias task in young adulthood, and internalizing symptoms, assessed in young adulthood. METHODS Children were assessed for BI at multiple age points from infancy through age seven. On the basis of a composite of observational and maternal report data, we selected 21 young adults classified as having a history of BI and 23 classified as non-BI for this study (n = 44). Participants completed an event-related functional magnetic resonance imaging attention-bias task involving threat (angry faces) and neutral trials. Internalizing symptoms were assessed by self-report and diagnostic interviews. RESULTS The young adults characterized in childhood with BI exhibited greater strength in threat-related connectivity than non-behaviorally inhibited young adults. Between-group differences manifested in connections between the amygdala and two frontal regions: dorsolateral prefrontal cortex and anterior insula. Amygdala-insula connectivity also interacted with childhood BI to predict young adult internalizing symptoms. CONCLUSIONS Behavioral inhibition during early childhood predicts differences as young adults in threat and attention-related fronto-amygdala connectivity. Connectivity strength, in turn, moderated the relations between early BI and later psychopathology.
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Affiliation(s)
- Jillian E. Hardee
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Brenda E. Benson
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Science, Tel Aviv University, Tel Aviv, Israel
| | - Karin Mogg
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Brendan P Bradley
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Gang Chen
- Scientific and Statistical Computing Core, National Institute of Mental Health, Bethesda, MD, USA
| | | | - Monique Ernst
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Nathan A. Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Koraly Pérez-Edgar
- Department of Psychology and Child Study Center, The Pennsylvania State University, University Park, PA, USA,Corresponding author and reprint requests: Koraly Pérez-Edgar, Department of Psychology, The Pennsylvania State University, 111 Moore Building, University Park, PA, 16802-3106;
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Pérez-Edgar K, Hardee JE, Guyer AE, Benson BE, Nelson EE, Gorodetsky E, Goldman D, Fox NA, Pine DS, Ernst M. DRD4 and striatal modulation of the link between childhood behavioral inhibition and adolescent anxiety. Soc Cogn Affect Neurosci 2013; 9:445-53. [PMID: 23314010 DOI: 10.1093/scan/nst001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Behavioral inhibition (BI), a temperament characterized by vigilance to novelty, sensitivity to approach-withdrawal cues and social reticence in childhood, is associated with risk for anxiety in adolescence. Independent studies link reward hyper-responsivity to BI, adolescent anxiety and dopamine gene variants. This exploratory study extends these observations by examining the impact of DRD4 genotype and reward hyper-responsivity on the BI-anxiety link. Adolescents (N = 78) completed a monetary incentive delay task in the fMRI environment. Participants were characterized based on a continuous score of BI and the 7-repeat allele (7R+) of the DRD4 functional polymorphism. Parent-report and self-report measures of anxiety were also collected. Across the entire sample, striatal activation increased systematically with increases in the magnitude of anticipated monetary gains and losses. DRD4 status moderated the relation between BI and activation in the caudate nucleus. Childhood BI was associated with parent report of adolescent anxiety among 7R+ participants with elevated levels of striatal response to incentive cues. DRD4 genotype influenced the relations among neural response to incentives, early childhood BI and anxiety. The findings help refine our understanding of the role reward-related brain systems play in the emergence of anxiety in temperamentally at-risk individuals, building a foundation for future larger scale studies.
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Affiliation(s)
- Koraly Pérez-Edgar
- Department of Psychology, Child Study Center, USB I, The Pennsylvania State University, University Park, PA 16802, USA. Tel: +1 814 865 9272; Fax: +1 814 863 7002.
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Social Anxiety Disorder: Recent Developments in Psychological Approaches to Conceptualization and Treatment. Aust N Z J Psychiatry 2009. [DOI: 10.1080/00048670903179111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of the present study was to identify and synthesize recent research findings in the aetiology and psychological treatment of social anxiety disorder and consider how these might improve outcome through more effective intervention. The electronic databases Medline, EMBASE and PsychInfo were searched for January 2000–December 2008. Publications of interest referred to in relevant articles were also reviewed. Case reports and publications not in English were excluded. The greatest variance in social anxiety disorder is accounted for by temperamental and personality factors and these may be associated with significant heritability. The environmental contribution is smaller and mainly due to non-shared factors, with a small contribution from shared environmental factors. Epidemiological research confirms that social anxiety disorder is chronic, and among the anxiety disorders has the lowest rates of treatment seeking, receipt of evidence-based treatments and recovery. Effective psychological treatments have been available for some time, and the research emphasis is on increasing the efficacy of treatments through innovations in programme content and delivery. Cognitive science research has contributed a better understanding of cognitive factors that maintain social anxiety disorder and informed enhancement of the cognitive elements of therapy. Internet-based programmes show promise as a novel way to deliver and improve access to effective therapy. Genetic, personality and temperamental factors contribute to the risk for social anxiety disorder. Given the associated comorbidity and disability, energy needs to be directed towards early recognition and treatment, and to increasing engagement and retention in effective therapy. Ongoing professional education is required to ensure that the disorder is recognized and evidence-based treatments received by patients who do seek help. Current cognitive behavioural treatments are being enhanced as the results of cognitive science research are being applied, and novel forms of treatment delivery show promise in increasing access.
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Affiliation(s)
- J Cottraux
- Psychiatre des Hôpitaux, Chargé de cours à l'Université Lyon 1, Unité de Traitement de l'Anxiété, Hôpital Neurologique
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Abstract
Recently, multidisciplinary research teams have come together to assess the emergence, course, and treatment of anxiety disorders in young children and adolescents. A number of researchers have suggested that early temperament traits may play a significant role in the causes and maintenance of early anxiety. This article reviews the current understanding of temperament and anxiety as separate constructs and then attempts to examine the developmental links between the two constructs. The authors examine the outstanding issues that must be addressed before the benefits of bridging these traditionally independent fields of study can be fully exploited.
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Johnstone T, Somerville LH, Alexander AL, Oakes TR, Davidson RJ, Kalin NH, Whalen PJ. Stability of amygdala BOLD response to fearful faces over multiple scan sessions. Neuroimage 2005; 25:1112-23. [PMID: 15850729 DOI: 10.1016/j.neuroimage.2004.12.016] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 12/01/2004] [Accepted: 12/06/2004] [Indexed: 11/16/2022] Open
Abstract
We used fMRI to examine amygdala activation in response to fearful facial expressions, measured over multiple scanning sessions. 15 human subjects underwent three scanning sessions, at 0, 2 and 8 weeks. During each session, functional brain images centered about the amygdala were acquired continuously while participants were shown alternating blocks of fearful, neutral and happy facial expressions. Intraclass correlation coefficients calculated across the sessions indicated stability of response in left amygdala to fearful faces (as a change from baseline), but considerably less left amygdala stability in responses to neutral expressions and for fear versus neutral contrasts. The results demonstrate that the measurement of fMRI BOLD responses in amygdala to fearful facial expressions might be usefully employed as an index of amygdala reactivity over extended periods. While signal change to fearful facial expressions appears robust, the experimental design employed here has yielded variable responsivity within baseline or comparison conditions. Future studies might manipulate the experimental design to either amplify or attenuate this variability, according to the goals of the research.
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Affiliation(s)
- Tom Johnstone
- W.M. Keck Laboratory for Functional Brain Imaging and Behavior, University of Wisconsin, WI 53705, USA.
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