Anxiety in healthy humans is associated with orbital frontal chemistry

Lactate: a prospective target for therapeutic intervention in psychiatric disease

ABSTRACT

Although antipsychotics that act via monoaminergic neurotransmitter modulation have considerable therapeutic effect, they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorders. This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs. Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitters. Among these candidate neurotransmitters, lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years. Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses; animal experiments have also shown that the supply of exogenous lactate exerts an antidepressant effect. In this review, we have described how medications targeting newer neurotransmitters offer promise in psychiatric diseases; we have also summarized the advances in the use of lactate (and its corresponding signaling pathways) as a signaling molecule. In addition, we have described the alterations in brain lactate levels in depression, anxiety, bipolar disorder, and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.

Long-term cortisol stress response in depression and comorbid anxiety is linked with reduced N-acetylaspartate in the anterior cingulate cortex

OBJECTIVES

Major Depression (MDD) and anxiety disorders are stress-related disorders that share pathophysiological mechanisms. There is evidence for alterations of glutamate-glutamine, N-acetylaspartate (NAA) and GABA in the anterior cingulate cortex (ACC), a stress-sensitive region affected by hypothalamic-pituitary-adrenal axis (HPA). The aim was to investigate metabolic alterations in the ACC and whether hair cortisol, current stress or early life adversity predict them.

METHODS

We investigated 22 patients with MDD and comorbid anxiety disorder and 23 healthy controls. Proton magnetic resonance spectroscopy was performed with voxels placed in pregenual (pg) and dorsal (d) ACC in 3 T. Analysis of hair cortisol was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

The N-acetylaspartate/Creatin ratio (NAA/Cr) was reduced in patients in both pgACC (p = .040) and dACC (p = .016). A significant interactive effect of diagnosis and cortisol on both pg-NAA/Cr (F = 5.00, p = .033) and d-NAA/Cr (F = 7.86, p = .009) was detected, whereby in controls cortisol was positively correlated with d-NAA/Cr (r = 0.61, p = .004).

CONCLUSIONS

Our results suggest a relationship between NAA metabolism in ACC and HPA axis activity as represented by long-term cortisol output.

State and Trait Anxiety Share Common Network Topological Mechanisms of Human Brain

Anxiety is a future-oriented unpleasant and negative mental state induced by distant and potential threats. It could be subdivided into momentary state anxiety and stable trait anxiety, which play a complex and combined role in our mental and physical health. However, no studies have systematically investigated whether these two different dimensions of anxiety share a common or distinct topological mechanism of human brain network. In this study, we used macroscale human brain morphological similarity network and functional connectivity network as well as their spatial and temporal variations to explore the topological properties of state and trait anxiety. Our results showed that state and trait anxiety were both negatively correlated with the coefficient of variation of nodal efficiency in the left frontal eyes field of volume network; state and trait anxiety were both positively correlated with the median and mode of pagerank centrality distribution in the right insula for both static and dynamic functional networks. In summary, our study confirmed that state and trait anxiety shared common human brain network topological mechanisms in the insula and the frontal eyes field, which were involved in preliminary cognitive processing stage of anxiety. Our study also demonstrated that the common brain network topological mechanisms had high spatiotemporal robustness and would enhance our understanding of human brain temporal and spatial organization.

Anomalous static and dynamic functional connectivity of amygdala subregions in individuals with high trait anxiety

BACKGROUND

Trait anxiety is considered a susceptible factor for stress-related disorders, and is characterized by abnormal brain activity and connectivity in the regions related to emotional processing (e.g., the amygdala). However, only a few studies have examined the static and dynamic changes of functional connectivity in trait anxiety.

METHOD

We compared the resting-state static and dynamic functional connectivity (sFC/dFC) in individuals with high trait anxiety (HTA, n = 257) and low trait anxiety (LTA, n = 264) using bilateral amygdala subregions as the seeds, that is, the centromedial amygdala (CMA), basolateral amygdala (BLA), and superficial amygdala (SFA).

RESULTS

The CMA, BLA, and SFA all showed reduced sFC with the executive control network (ECN) and anomalous dFC with the default mode network (DMN) in individuals with HTA. The CMA only showed reduced sFC with the ECN and reduced dFC with the DMN in individuals with HTA. The BLA showed reduced sFC with the salience network (mainly in the anterior and median cingulate), and increased dFC between the BLA and the DMN in individuals with HTA compared to those with LTA. Notably, HTA showed widespread anomalous functional connectivity in the SFA, including the visual network, mainly in the calcarine fissure, limbic system (olfactory cortex), and basal ganglia (putamen).

CONCLUSION

The anomalous sFC and dFC in individuals with HTA may reflect altered mechanisms in prefrontal control, salient stimuli processing, and amygdaloidal responsivity to potential threats, leading to alterations in associative, attentional, interpretative, and regulating processes that sustain a threat-related processing bias in HTA individuals.

Daily and intermittent smoking are associated with low prefrontal volume and low concentrations of prefrontal glutamate, creatine, myo-inositol, and N-acetylaspartate

Cigarette smoking is still the largest contributor to disease and death worldwide. Successful cessation is hindered by decreases in prefrontal glutamate concentrations and gray matter volume due to daily smoking. Because nondaily, intermittent smoking also contributes greatly to disease and death, understanding whether infrequent tobacco use is associated with reductions in prefrontal glutamate concentrations and gray matter volume may aid public health. Eighty-five young participants (41 nonsmokers, 24 intermittent smokers, 20 daily smokers, mean age ~23 years old), underwent ¹ H-magnetic resonance spectroscopy of the medial prefrontal cortex, as well as structural magnetic resonance imaging (MRI) to determine whole-brain gray matter volume. Compared with nonsmokers, both daily and intermittent smokers exhibited lower concentrations of glutamate, creatine, N-acetylaspartate, and myo-inositol in the medial prefrontal cortex, and lower gray matter volume in the right inferior frontal gyrus; these measures of prefrontal metabolites and structure did not differ between daily and intermittent smokers. Finally, medial prefrontal metabolite concentrations and right inferior frontal gray matter volume were positively correlated, but these relationships were not influenced by smoking status. This study provides the first evidence that both daily and intermittent smoking are associated with low concentrations of glutamate, creatine, N-acetylaspartate, and myo-inositol and low gray matter volume in the prefrontal cortex. Future tobacco cessation efforts should not ignore potential deleterious effects of intermittent smoking by considering only daily smokers. Finally, because low glutamate concentrations hinder cessation, treatments that can normalize tonic levels of prefrontal glutamate, such as N-acetylcysteine, may help intermittent and daily smokers to quit.

Connectome-Based Predictive Modeling of Individual Anxiety

Anxiety-related illnesses are highly prevalent in human society. Being able to identify neurobiological markers signaling high trait anxiety could aid the assessment of individuals with high risk for mental illness. Here, we applied connectome-based predictive modeling (CPM) to whole-brain resting-state functional connectivity (rsFC) data to predict the degree of trait anxiety in 76 healthy participants. Using a computational “lesion” approach in CPM, we then examined the weights of the identified main brain areas as well as their connectivity. Results showed that the CPM successfully predicted individual anxiety based on whole-brain rsFC, especially the rsFC between limbic areas and prefrontal cortex. The prediction power of the model significantly decreased from simulated lesions of limbic areas, lesions of the connectivity within limbic areas, and lesions of the connectivity between limbic areas and prefrontal cortex. Importantly, this neural model generalized to an independent large sample (n = 501). These findings highlight important roles of the limbic system and prefrontal cortex in anxiety prediction. Our work provides evidence for the usefulness of connectome-based modeling in predicting individual personality differences and indicates its potential for identifying personality factors at risk for psychopathology.

The neurobiology of wellness: 1H-MRS correlates of agency, flexibility and neuroaffective reserves in healthy young adults

Proton magnetic resonance spectroscopy (¹H-MRS) is a noninvasive imaging technique that measures the concentration of metabolites in defined areas of the human brain in vivo. The underlying structure of natural metabolism-emotion relationships is unknown. Further, there is a wide range of between-person differences in metabolite concentration in healthy individuals, but the significance of this variation for understanding emotion in healthy humans is unclear. Here we investigated the relationship of two emotional constructs, agency and flexibility, with the metabolites glutamate and glutamine (Glx), N-acetylaspartate (tNAA), choline (Cho), creatine (tCr), and myo-inositol (Ins) in the right dorsal anterior cingulate cortex (dACC) in medically and psychiatrically healthy volunteers (N = 20, 9 female; mean age = 22.8 years, SD = 3.40). The dACC was selected because this region is an integrative hub involved in multiple brain networks of emotion, cognition and behavior. Emotional traits were assessed using the Multidimensional Personality Questionnaire Brief Form (MPQ-BF), an empirically derived self-report instrument with an orthogonal factor structure. Phenotypes evaluated were positive and negative agency (MPQ-BF Social Potency, Aggression), emotional and behavioral flexibility (MPQ-BF Absorption, Control-reversed), and positive and negative affect (MPQ-BF Social Closeness; Stress Reaction, Alienation). The resting concentration of tNAA in the dACC was robustly positively correlated with Absorption (r = +0.56, unadjusted p = .005), moderately positively correlated with Social Potency (r = +0.42, unadjusted p = .03), and robustly negatively correlated with Aggression (r = −0.59, unadjusted p = .003). Absorption and Aggression accounted for substantial variance in tNAA (R² = 0.31, 0.35; combined R² = 0.50), and survived correction for multiple comparisons (Holm-Bonferroni adjusted p = .032, 0.021, respectively). dACC Glx and Cho had modest relationships with behavioral flexibility and social affiliation that did not survive this multiple correction, providing effect sizes for future work. Principal Component Analysis (PCA) revealed a three-factor orthogonal solution indicating specific relationships between: 1) Glx and behavioral engagement; 2) Cho and affiliative bonding; and 3) tNAA and a novel dimension that we term neuroaffective reserves. Our results inform the neurobiology of agency and flexibility and lay the groundwork for understanding mechanisms of natural emotion using ¹H-MRS.

OFC and its connectivity with amygdala as predictors for future social anxiety in adolescents

Social anxiety is a common problem that usually emerges at puberty, during which great developmental changes occur both in the brain and mental state. However, little is known about the influence of social anxiety on adolescents’ brain and behavior. The present study investigated the neural basis of social anxiety using voxel-based morphometry (VBM) and functional connectivity analysis. Then we investigated whether social anxiety is associated with attention bias. Furthermore, we investigated the neural basis of this association. Finally, longitudinal data was used to test if these biomarkers could predict social anxiety. The results indicated that social anxiety is positively associated with the grey matter volume (GMV) of orbital-frontal cortex (OFC), and the functional connectivity (FC) of OFC-amygdala. Mediation analysis revealed that the relationship between social anxiety and attention avoidance is partly mediated by the FC of OFC-amygdala. Finally, the present study demonstrated a close relationship between FC of the OFC-amygdala, the GMV of the OFC and the individual’s social anxiety one year later. The present study suggested the aberrant structure of OFC and its connectivity with amygdala as the neural underpinning of social anxiety, which might serve as a compensatory mechanism to decrease attention avoidance and promote effective emotion regulation.

Altered relationship between prefrontal glutamate and activation during cognitive control in people with high trait anxiety

Trait anxiety can affect cognitive control resulting in ineffective and/or inefficient task performance. Moreover, previous functional Magnetic Resonance Imaging (fMRI) studies have reported altered dorsolateral prefrontal cortex (DLPFC) activity in anxious cohorts, particularly when executive control is required. Recently, it has been demonstrated that cortical glutamate levels can predict both functional activation during cognitive control, and anxiety levels. In the present study we sought to investigate the relationship between trait anxiety, prefrontal glutamate levels and functional activation in DLPFC during a cognitive control task. Thirty-nine participants assigned to either low trait anxiety (LTA) or high trait anxiety (HTA) groups underwent ¹H-Magnetic Resonance Spectroscopy (¹H-MRS) to measure levels of resting glutamate in the prefrontal cortex (PFC). Participants also completed fMRI during a Stroop task comprising congruent and incongruent colour word trials. The HTA group showed reduced task performance relative to the LTA group. In the LTA group, there was a positive association between PFC Glu levels and DLPFC activation during incongruent trials. This association was absent in the HTA group. Individual differences in trait anxiety affect the relationship between PFC glutamate levels and DLPFC activation, possibly contributing to ineffective task performance when cognitive control is required.

Default mode network alterations in individuals with high-trait-anxiety: An EEG functional connectivity study

BACKGROUND

Although several researches investigated Default Mode Network (DMN) alterations in individuals with anxiety disorders, up to now no studies have investigated DMN functional connectivity in non-clinical individuals with high-trait-anxiety using quantitative electroencephalography (EEG). Here, the main aim was to extend previous findings investigating the association between trait anxiety and DMN EEG functional connectivity.

METHODS

Twenty-three individuals with high-trait-anxiety and twenty-four controls were enrolled. EEG was recorded during 5 min of resting state (RS). EEG analyses were conducted by means of the exact Low-Resolution Electromagnetic Tomography software (eLORETA).

RESULTS

Compared to controls, individuals with high-trait-anxiety showed a decrease of theta connectivity between right medial prefrontal cortex (mPFC) and right posterior cingulate/retrosplenial cortex. A decrease of beta connectivity was also observed between right mPFC and right anterior cingulate cortex. Furthermore, DMN functional connectivity strength was negatively related with STAI-T total score (i.e., lower connectivity was associated with higher trait anxiety), even when controlling for potential confounding variables (i.e., sex, age, and general psychopathology).

LIMITATIONS

Small sample size makes it difficult to draw definitive conclusions. Furthermore, we did not assess state variation of anxiety, which make our interpretation specific to trait anxiety.

CONCLUSIONS

Taken together, our results suggest that high-trait-anxiety individuals fail to synchronize DMN during RS, reflecting a possible top-down cognitive control deficit. These results may help in the understanding of the individual differences in functional brain networks associated with trait anxiety, a crucial aim in the prevention and in the early etiology understanding of clinical anxiety and related sequelae.

Individual differences in trait anxiety are associated with gray matter alterations in hypothalamus: Preliminary neuroanatomical evidence

Trait anxiety is particularly a prone phenotype for the development of anxiety disorders and depression. Studying the neural underpinnings of trait anxiety can further inform our understanding of the etiology of these disorders. To investigate the structural correlates of trait anxiety, high resolution structural images were acquired from 76 right-handed healthy participants and gray matter volumes were extracted from a priori regions of interest (ROIs) that were earlier implicated in anxiety like behaviour (i.e., hippocampus, amygdala, anterior cingulate cortex, thalamus, hypothalamus and prefrontal (dorsolateral, rostrolateral, ventrolateral) cortex. In a partial correlation analysis (with age, gender, and Beck Depression Inventory (BDI) scores as covariates of no interest), trait anxiety was found to be negatively correlated with the gray matter volume of hypothalamus bilaterally and positively correlated with the gray matter volume of left thalamus. In a hierarchical multiple regression analysis, grey matter volume of hypothalamus and left thalamus were found to be the significant predictors of trait anxiety. Our findings thus suggest that a smaller gray matter volume in the hypothalamus and an increase in the gray matter volume of left thalamus is related to a disposition to high anxiety personality trait.

Anxiolytic activity of paraoxon is associated with alterations in rat brain glutamatergic system

Exposure to organophosphate (OP) compounds leads to behavioral alterations. To determine whether paraoxon has effects on anxiety, anxiety-like behaviors were assessed in paraoxon-exposed rats. Protein expression of glutamate transporters has also been measured in hippocampus and prefrontal cortex. Three doses of paraoxon (0.3, 0.7, or 1 mg/kg) or corn oil (vehicle) were intraperitoneally injected to adult male rats. At 14 or 28 days after exposure, behavioral tests were done using elevated plus-maze (EPM) or open field tests. Thereafter, animals were sacrificed and both hippocampi and prefrontal cortices were extracted for cholinesterase assay and western blotting. Animals treated with convulsive doses of paraoxon (0.7 and 1 mg/kg) showed an increase in percentage of time spent in open arms and percentage of open arm entries in the EPM. In the open field test, an increase in the time spent in central area was observed in rats treated with the same doses of paraoxon. These effects of paraoxon were independent of any changes in locomotor activity. There was an increase in both astrocytic glutamate transporter proteins (GLAST and GLT-1) in the hippocampus of animals treated with 0.7 and 1 mg/kg of paraoxon. In the prefrontal cortex, protein levels of the GLAST and GLT-1 increased in 0.7 and decreased in 1 mg/kg groups. Only a significant decrease in EAAC1 protein was observed in the prefrontal cortex at 14 days following exposure to 1 mg/kg of paraoxon. Collectively, this study showed that exposure to convulsive doses of paraoxon induced anxiolytic-like behaviors in both behavioral tests. This effect may be attributed to alterations of glutamate transporter proteins in the rat hippocampus and prefrontal cortex.

Spontaneous activity in medial orbitofrontal cortex correlates with trait anxiety in healthy male adults

Medial orbitofrontal cortex (mOFC) abnormalities have been observed in various anxiety disorders. However, the relationship between mOFC activity and anxiety among the healthy population has not been fully examined. Here, we conducted a resting state functional magnetic resonance imaging (R-fMRI) study with 56 healthy male adults from the Nathan Kline Institute/Rockland Sample (NKI-RS) to examine the relationship between the fractional amplitude of low-frequency fluctuation (fALFF) signals and trait anxiety across the whole brain. A Louvain method for module detection based on graph theory was further employed in the automated functional subdivision to explore subregional correlates of trait anxiety. The results showed that trait anxiety was related to fALFF in the mOFC. Additionally, the resting-state functional connectivity (RSFC) between the right subregions of the mOFC and the precuneus was correlated with trait anxiety. These findings provided evidence about the involvement of the mOFC in anxiety processing among the healthy population.

The role of mid-insula in the relationship between cardiac interoceptive attention and anxiety: evidence from an fMRI study

Interoception refers to the perception of the internal bodily states. Recent accounts highlight the role of the insula in both interoception and the subjective experience of anxiety. The current study aimed to delve deeper into the neural correlates of cardiac interoception; more specifically, the relationship between interoception-related insular activity, interoceptive accuracy, and anxiety. This was done using functional magnetic resonance imaging (fMRI) in an experimental design in which 40 healthy volunteers focused on their heartbeat and anxious events. Interoceptive accuracy and anxiety levels were measured using the Heartbeat Perception Task and State Trait Anxiety Inventory, respectively. The results showed posterior, mid and anterior insular activity during cardiac interoception, whereas anxiety-related activation showed only anterior insular activity. Activation of the anterior insula when focused on cardiac interoception was positively correlated to state and trait anxiety levels, respectively. Moreover, the mid-insular activity during the cardiac attention condition not only related to individuals’ interoceptive accuracy but also to their levels of state and trait anxiety, respectively. These findings confirm that there are distinct neural representations of heartbeat attention and anxious experience across the insular regions, and suggest the mid-insula as a crucial link between cardiac interoception and anxiety.

Brain metabolite abnormalities in ventromedial prefrontal cortex are related to duration of hypercortisolism and anxiety in patients with Cushing's syndrome

Chronic exposure to excessive glucocorticoid (GC) concentration in Cushing's syndrome (CS) can affect the brain structurally and functionally; ventromedial prefrontal cortex (vmPFC) is rich in GC receptors and therefore particularly vulnerable to excessive GC concentration. Proton magnetic resonance spectroscopy ((1)H-MRS) is a sensitive, non-invasive imaging technique that provides information on brain metabolites in vivo. Our aim was to investigate metabolite concentrations in vmPFC of CS patients and their relationship with clinical outcome. Twenty-two right-handed CS patients (7 active/15 in remission, 19 females, 41.6 ± 12.3 years) and 22 right-handed healthy controls (14 females, 41.7 ± 11 years) underwent brain MRI and (1)H-MRS exams at 3 Tesla. Concentrations of glutamate (Glu), glutamate + glutamine (Glx), creatine (Cr), N-Acetyl-aspartate (NAA), N-Acetyl-aspartate + N-acetylaspartylglutamate (total NAA), choline-containing compounds (Cho) and myoinositol (MI) were determined. Moreover, anxiety and depressive symptoms were evaluated with the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II) test, respectively. CS patients had lower concentrations of glutamate and total NAA in the vmPFC than healthy controls (8.6 ± 1.2 vs. 9.3 ± 0.7 mmol/L, and 6.4 ± 0.8 vs. 6.8 ± 0.4 mmol/L, respectively; p < 0.05). Duration of hypercortisolism was negatively correlated with total NAA (r = -0.488, p < 0.05). Moreover, the concentration of total NAA was negatively correlated with anxiety state (r = -0.359, p < 0.05). Brain metabolites are abnormal in the vmPFC of patients with CS. Decreased total NAA and glutamate concentrations indicate neuronal dysfunction that appear to be related with duration of hypercortisolism and anxiety.

Aberrant regional neural fluctuations and functional connectivity in generalized anxiety disorder revealed by resting-state functional magnetic resonance imaging

The purpose of this study was to investigate the neural activity and functional connectivity in generalized anxiety disorder (GAD) during resting state, and how these alterations correlate to patients' symptoms. Twenty-eight GAD patients and 28 matched healthy controls underwent resting-state functional magnetic resonance (fMRI) scans. Amplitude of low-frequency fluctuation (ALFF) and seed-based resting-state functional connectivity (RSFC) were computed to explore regional activity and functional integration, and were compared between the two groups using the voxel-based two-sample t test. Pearson's correlation analyses were performed to examine the neural relationships with demographics and clinical symptoms scores. Compared to controls, GAD patients showed functional abnormalities: higher ALFF in the bilateral dorsomedial prefrontal cortex, bilateral dorsolateral prefrontal cortex and left precuneus/posterior cingulate cortex; lower connectivity in prefrontal gyrus; lower in prefrontal-limbic and cingulate RSFC and higher prefrontal-hippocampus RSFC were correlated with clinical symptoms severity, but these associations were unable to withstand correction for multiple testing. These findings may help facilitate further understanding of the potential neural substrate of GAD.

Aberrant functional connectivity of resting state networks associated with trait anxiety

Trait anxiety, a personality dimension, has been characterized by functional consequences such as increased distractibility, attentional bias in favor of threat-related information and hyper-responsive amygdala. However, literature on the association between resting state brain functional connectivity, as studied using resting state functional magnetic resonance imaging (rs-fMRI), and reported anxiety levels in the sub-clinical population is limited. In the present study, we employed rs-fMRI to investigate the possible alterations in the functional integrity of Resting State Networks (RSNs) associated with trait anxiety of the healthy subjects (15 high anxious and 14 low anxious). The rs-fMRI data was analyzed using independent component analysis and a dual regression approach that was applied on 12 RSNs that were identified using FSL. High anxious subjects showed significantly reduced functional connectivity in regions of the default mode network (posterior cingulate gyrus, middle and superior temporal gyrus, planum polare, supramarginal gyrus, temporal pole, angular gyrus and lateral occipital gyrus) which has been suggested to be involved in episodic memory, theory of mind, self-evaluation, and introspection, and perceptual systems including medial visual network, auditory network and another network involving temporal, parieto-occipital and frontal regions. Reduction in resting state connectivity in regions of the perceptual networks might underlie the perceptual, attentional and working memory deficits associated with trait anxiety. To our knowledge, this is the first study to relate trait anxiety to resting state connectivity using independent component analysis.

Neuroanatomical correlates of individual differences in social anxiety in a non-clinical population

Socially anxious individuals are characterized as those with distorted negative self-beliefs (NSBs), which are thought to enhance reactions of social distress (emotional reactivity) and social avoidance (social functioning). However, it remains unclear whether individual differences in social distress and social avoidance are represented by differences in brain morphometry. To probe into these neural correlates, we analyzed magnetic resonance images of a sample of 130 healthy subjects and used the Connectome Computation System (CCS) to evaluate these factors. The results showed that social distress was correlated with the cortical volume of the right orbitofrontal cortex (OFC) and the subcortical volume of the left amygdala, while social avoidance was correlated with the cortical volume of the right dorsolateral prefrontal cortex (DLPFC). Additionally, loneliness might mediate the relationship between the amygdala volume and the social distress score. Our results demonstrated that social distress and social avoidance were represented by segregated cortical regions in the healthy individuals. These findings might provide a valuable basis for understanding the stable brain structures underlying individual differences in social anxiety.

Glutamate level in anterior cingulate predicts anxiety in healthy humans: a magnetic resonance spectroscopy study

Anxiety, a personality dimension in healthy humans, has been found to be associated with many functional consequences such as increased distractibility and attentional bias in favour of threat-related information, along with morphological and microstructural changes in the brain. The associated metabolic/neurochemical alterations are sparsely studied. In the present magnetic resonance spectroscopy (MRS) study, we investigated the possible relationship between regional brain chemistry within anterior cingulate cortex (4-cm(3) voxel) and hippocampus (2.5-cm(3) voxel) and anxiety (measured by State-Trait Anxiety Inventory) in our subject group. In the anterior cingulate cortex, multivariate analysis of covariance showed an increase in myo-inositol and combined glutamate and glutamine levels in the high anxiety subject group as compared with the low anxiety group. In the partial correlation analysis between neurochemicals and anxiety, glutamate and combined glutamate and glutamine also showed a predictive value for anxiety. On analysing the trait anxiety sub-score separately, we found glutamate, inositol and combined glutamate and glutamine levels to be increased in the high trait anxiety group as compared with the low trait anxiety group. All three resonances also had a predictive value for trait anxiety. In the hippocampus, none of the neurochemicals showed significant difference between high and low anxiety groups. The study provides a first account of alterations in anterior cingulate cortex neurochemistry in relation to anxiety in healthy subjects. The study thus contributes to the limited literature available on altered metabolism and neural mechanisms underlying sub-clinical anxiety.

A pilot study of anterior cingulate cortex neurochemistry in adolescents with generalized anxiety disorder

BACKGROUND/AIMS

This study used proton magnetic resonance spectroscopy (¹H MRS) to evaluate the neurochemistry of the anterior cingulate cortex (ACC) in adolescents with generalized anxiety disorder (GAD).

METHODS

Adolescents with GAD (n = 10) and healthy subjects (n = 10) underwent a ¹H MRS scan at 4 T. Glutamate (Glu), N-acetyl aspartate, creatine (Cr) and myo-inositol concentrations were measured in the ACC and were compared between untreated adolescents with GAD and age- and sex-matched healthy subjects.

RESULTS

Glu/Cr ratios in the ACC correlated with the severity of both generalized anxiety symptoms on the Pediatric Anxiety Rating Scale and with total anxiety symptom severity as measured by the Hamilton Anxiety Rating Scale, but did not differ between adolescents with GAD and healthy subjects. In addition, no differences in N-acetyl aspartate, Cr, or myo-inositol were detected between groups.

CONCLUSION

These findings suggest that Glu/Cr in untreated adolescents with GAD may relate to the severity of anxiety symptoms and raise the possibility that dysregulation of Glu within the ACC may be linked to the pathophysiology of pediatric GAD.

Cortical thinning of the right anterior cingulate cortex in spider phobia: a magnetic resonance imaging and spectroscopy study

There a lack of consistent neuroimaging data on specific phobia (SP) and a need to assess volumetric and metabolic differences in structures implicated in this condition. The aim of this study is investigate possible metabolic (via (1)H MRS) and cortical thickness abnormalities in spider-phobic patients compared to healthy volunteers. Participants were recruited via public advertisement and underwent clinical evaluations and MRI scans. The study started in 2010 and the investigators involved were not blind in respect to patient groupings. The study was conducted at the Ribeirão Preto Medical School University Hospital of the University of São Paulo, Brazil. Patients with spider phobia (n=19) were matched to 17 healthy volunteers with respect to age, education and socio-economic status. The spider SP group fulfilled the diagnostic criteria for spider phobia according to the Structured Clinical Interview for DSM-IV. None of the participants had a history of neurological, psychiatric or other relevant organic diseases, use of prescribed psychotropic medication or substance abuse. All imaging and spectroscopy data were collected with a 3 T MRI scanner equipped with 25 mT gradient coils in 30-minute scans. The Freesurfer image analysis package and LC Model software were used to analyze data. The hypothesis being tested was formulated before the data collection (neural correlates of SP would include the amygdala, insula, anterior cingulate gyrus and others). The results indicated the absence of metabolic alterations, but thinning of the right anterior cingulate cortex (ACC) in the SP group when compared to the healthy control group (mean cortical thickness±SD: SP=2.11±0.45 mm; HC=2.16±0.42 mm; t (34)=3.19, p=0.001 [-35.45, 71.00, -23.82]). In spectroscopy, the ratios between N-acetylaspartate and creatine and choline levels were measured. No significant effect or correlation was found between MRS metabolites and scores in the Spider Phobia Questionnaire and Beck Anxiety Inventory (p>0.05). The ACC is known to be related to the cognitive processing of fear and anxiety and to be linked with the conditioning circuit. The MRS findings are preliminary and need more studies. The finding of reduced ACC thickness in SP is in agreement with evidence from previous functional neuroimaging studies and highlights the importance of this brain area in the pathophysiology of SP.

Time-dependent analysis of nociception and anxiety-like behavior in rats submitted to persistent inflammation of the temporomandibular joint

Temporomandibular disorder (TMD) is prevalent in dental clinics and can involve problems with the masticatory muscles or the temporomandibular joints (TMJ). The pain of TMD is frequently associated with inflammation in the TMJs, but it's etiology is considered to be multifactorial and includes biologic, behavioral, environmental, social, emotional and cognitive factors. The purpose of this investigation was to evaluate the anxiety-like behavior in rats exposed to temporomandibular inflammation via injection of Freund's Adjuvant (CFA) with the elevated plus maze (EPM) and light/dark box (LDB) tests and to evaluate nociceptive behavior with the von Frey test at different periods. Moreover, this study measured TMJ inflammation using plasma extravasation (Evans blue test) and the intraarticular infiltration of polymorphonuclear neutrophils (myeloperoxidase quantification). The results showed that rats that were submitted to TMJ inflammation exhibited a decreased number of entries into the open arms of the EPM and a decrease in the time spent in the light compartment and in the number of transitions in the LDB. Additionally, the number of entries in closed arms in the EPM, used as indicator of locomotor activity, did not alter between treatments. Furthermore, increases in mechanical sensitivity and increases in plasma extravasation in the joint tissue occurred throughout the inflammation process, along with an increase in myeloperoxidase in the synovial fluid of TMJ. Our results suggest that the temporomandibular inflammation induced by CFA produced anxiety-like behaviors in rats and induced nociceptive behavior across different periods of inflammation.

Acute shift in glutamate concentrations following experimentally induced panic with cholecystokinin tetrapeptide--a 3T-MRS study in healthy subjects

According to preclinical studies, glutamate has been implicated in the pathogenesis of anxiety. In order to elucidate the role of glutamate in anxiety and panic in humans, brain glutamate+glutamine (Glx) levels were measured during cholecystokinin-tetrapeptide (CCK-4)-induced panic using magnetic resonance spectroscopy (MRS). Eighteen healthy subjects underwent a CCK-4 challenge. MR spectra were obtained from the anterior cingulate cortex (ACC) using a single voxel point-resolved spectroscopy method and analyzed using LCModel. A combined fitting of Glx was performed. Panic was assessed using the Acute Panic Inventory (API) and Panic Symptom Scale (PSS) scores. Moreover, hypothalamic-pituitary-adrenal axis stimulation was monitored throughout the challenge. There was a significant panic response following CCK-4 as revealed by a marked increase in both the panic scores (API: F(1,17)=149.41; p<0.0001; PSS: F(1,17)=88.03; p<0.0001) and heart rate (HR: F(1,17)=72.79; p<0.0001). MRS measures showed a significant increase of brain Glx/creatine (Glx/Cr) levels peaking at 2-10 min after challenge (F(1,17)=15.94; p=0.001). There was also a significant increase in CCK-4-related cortisol release (F(6,11)=8.68; p=0.002). Finally, significant positive correlations were found between baseline Glx/Cr and both APImax (r=0.598; p=0.009) and maximum heart rate (HR(max)) during challenge (r=0.519; p=0.027). Our results suggest that CCK-4-induced panic is accompanied by a significant glutamate increase in the bilateral ACC. The results add to the hypothesis of a disturbance of the inhibitory-excitatory equilibrium and suggest that apart from static alterations rapid and dynamic neurochemical changes might also be relevant for the neural control of panic attacks.

Glutamate-based anxiolytic ligands in clinical trials

INTRODUCTION

With regard to anxiety, the role of the balance between glutamatergic and GABAergic systems was pursued for many years. The majority of drugs used presently as effective anxiolytics enhance the GABAergic system activity, thus increasing inhibition within the central nervous system (CNS). On the other hand, decreasing the activity of glutamatergic neurotransmission may attenuate excitation in the CNS, thus resulting in anxiolysis.

AREAS COVERED

The present review focuses on clinical data of well-known and recently discovered glutamatergic and, to a lesser extent, GABAergic agents, which reached at least the Phase II criteria.

EXPERT OPINION

A variety of glutamatergic agents active at both N-acetylo-D-asparaginian and metabotropic glutamate (mGlu) receptors have been tested in humans to examine their potential anxiolytic activity. Many compounds acting on the glutamatergic system and approved for the treatment of other disorders than anxiety were shown to exert anxiolytic effects in clinical trials. Those are mainly voltage-dependent ion channel ligands as well as d-cycloserin and memantine. Also, ligands active at mGlu receptors, such as fenobam and LY354740, exhibited activity in controlled clinical trials. However, relatively few trials are found on the agents that are focused on GABAergic neurotransmission. Therefore, it seems that glutamatergic system may become a novel target for modern and effective anxiolytics.

The patient's anxiety before seeing a doctor and her/his hospital choice behavior in China

Background

The patient’s anxiety before seeing a doctor may influence her/his hospital choice behavior through various ways. In order to explore why high level hospitals were overused by patients and why low level hospitals were not fully used by patients in China, this study was set up to test whether and to what extent the patient’s anxiety before seeing a doctor influenced her/his hospital choice behavior in China.

Methods

This study commissioned a large-scale 2009–2010 national resident household survey (N=4,853) in China, and in this survey the Self-Rating Anxiety Scale (SAS) was employed to help patients assess their anxiety before seeing a doctor. Specified ordered probit models were established to analyze the survey dataset.

Results

When the patient had high level of anxiety before seeing a doctor, her/his level of anxiety could not only predict that she/he was more likely to choose the high level hospital, but also accurately predict which level of hospital she/he would choose; when the patient had low level of anxiety before seeing a doctor, her/his level of anxiety could only predict that she/he was more likely to choose the low level hospital, but it couldn’t clearly predict which level of hospital she/he would choose.

Conclusion

The patient with high level of anxiety had the strong consistent bias when she/he chose a hospital (she/he always preferred the high level hospital), while the patient with low level of anxiety didn’t have such consistent bias.

Interactions between age, sex, and hormones in experimental ischemic stroke

Age, sex, and gonadal hormones have profound effects on ischemic stroke outcomes, although how these factors impact basic stroke pathophysiology remains unclear. There is a plethora of inconsistent data reported throughout the literature, primarily due to differences in the species examined, the timing and methods used to evaluate injury, the models used, and confusion regarding differences in stroke incidence as seen in clinical populations vs. effects on acute neuroprotection or neurorepair in experimental stroke models. Sex and gonadal hormone exposure have considerable independent impact on stroke outcome, but these factors also interact with each other, and the contribution of each differs throughout the lifespan. The contribution of sex and hormones to experimental stroke will be the focus of this review. Recent advances and our current understanding of age, sex, and hormone interactions in ischemic stroke with a focus on inflammation will be discussed.

Relevance of orbitofrontal neurochemistry for the outcome of cognitive-behavioural therapy in patients with obsessive-compulsive disorder

Since the advent of non-invasive methods such as proton magnetic resonance spectroscopy ((1)H-MRS), obsessive-compulsive disorder (OCD) has been increasingly associated with an altered composition of neurometabolites and neurotransmitters in several brain areas. Particularly, Inositol has not only been implicated in OCD pathophysiology, but also shown effective in pilot studies in therapy-refractory OCD patients. However, the relevance of regional brain neurochemistry for therapy outcome has not yet been investigated. Whereas numerous neuroimaging findings support a dysfunction of the orbitofrontal cortex (OFC) in OCD, MR-spectroscopic investigations of this region are missing. (1)H-MRS and psychometric measurements were obtained from twenty unmedicated patients with OCD, subsequently enrolled in a 3-month structured inpatient cognitive-behavioural therapy programme, and from eleven matched control subjects. Multiple regression of symptom score changes (Y-BOCS) on (myo-)inositol concentrations in three areas (right orbitofrontal cortex (OFC), right striatum and anterior cingulate cortex) was performed. The concentration of (myo-)inositol in the OFC only predicted the outcome of subsequent CBT regarding Y-BOCS score reduction (Spearman's r(s) = .81, P < 0.003, corrected). The (myo-)inositol concentration did not differ between OCD patients and healthy controls and did not change during therapy. We provide preliminary evidence for a neurochemical marker that may prove informative about a patient's future benefit from behaviour therapy. Inositol, a metabolite involved in cellular signal transduction and a spectroscopic marker of glial activity, predicted the response to CBT selectively in the OFC, adding to the evidence for OFC involvement in OCD and highlighting neurobiological underpinnings of psychotherapy.

Individual variations in maternal care early in life correlate with later life decision-making and c-fos expression in prefrontal subregions of rats

Early life adversity affects hypothalamus-pituitary-adrenal axis activity, alters cognitive functioning and in humans is thought to increase the vulnerability to psychopathology--e.g. depression, anxiety and schizophrenia--later in life. Here we investigated whether subtle natural variations among individual rat pups in the amount of maternal care received, i.e. differences in the amount of licking and grooming (LG), correlate with anxiety and prefrontal cortex-dependent behavior in young adulthood. Therefore, we examined the correlation between LG received during the first postnatal week and later behavior in the elevated plus maze and in decision-making processes using a rodent version of the Iowa Gambling Task (rIGT). In our cohort of male and female animals a high degree of LG correlated with less anxiety in the elevated plus maze and more advantageous choices during the last 10 trials of the rIGT. In tissue collected 2 hrs after completion of the task, the correlation between LG and c-fos expression (a marker of neuronal activity) was established in structures important for IGT performance. Negative correlations existed between rIGT performance and c-fos expression in the lateral orbitofrontal cortex, prelimbic cortex, infralimbic cortex and insular cortex. The insular cortex correlations between c-fos expression and decision-making performance depended on LG background; this was also true for the lateral orbitofrontal cortex in female rats. Dendritic complexity of insular or infralimbic pyramidal neurons did not or weakly correlate with LG background. We conclude that natural variations in maternal care received by pups may significantly contribute to later-life decision-making and activity of underlying brain structures.

Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety

Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes.

Transient inactivation of the medial prefrontal cortex affects both anxiety and decision-making in male wistar rats

In both humans and rats high levels of anxiety impair decision-making in the Iowa gambling task (IGT) in male subjects. Expression of the immediate early gene c-fos as marker of neural activity in rat studies indicated a role of the medial prefrontal cortex (prelimbic and infralimbic region; mPFC) in mediating the relationship between anxiety and decision-making. To delineate this relationship further and assess the underlying neurobiology in more detail, we inactivated in the present study the mPFC in male rats using a mixture of the GABA-receptor agonists muscimol and baclofen. Rats were exposed to the elevated plus maze (EPM) to measure effects on anxiety and to the rodent version of the IGT (r-IGT). Inactivation led to increased levels of anxiety on the EPM, while not affecting general activity. The effect in the r-IGT (trials 61–120) was dependent on levels of performance prior to inactivation (trial 41–60): inactivation of the mPFC hampered task performance in rats, which already showed a preference for the advantageous option, but not in rats which were still choosing in a random manner. These data suggest that the mPFC becomes more strongly involved as rats have learned task-contingencies, i.e., choose for the best long-term option. Furthermore they suggest, along with the data of our earlier study, that both anxiety and decision-making in rats are mediated through a neural circuitry including at least the mPFC. The data are discussed in relation to recent data of rodent studies on the neural circuitry underlying decision-making.

Decision-making performance is related to levels of anxiety and differential recruitment of frontostriatal areas in male rats

In humans, high levels of anxiety are associated with poor performance in the Iowa Gambling Task (IGT). The IGT measures decision-making under conditions of uncertainty. In this study, we investigated the association between anxiety and decision-making in rats. Rats were screened for anxiety on the elevated plus maze (EPM) and subsequently tested in a rat analogue of the IGT (r-IGT). We explored the role of frontostriatal areas related to r-IGT performance using c-fos immunohistochemistry following the last training-session. High levels of anxiety were associated with poor r-IGT performance: high anxious rats made fewer choices for the advantageous option and collected fewer sucrose pellets in the r-IGT than low anxious rats. Analysis of win-stay/lose-shift behaviour of choices for the advantageous option revealed that good performing-low anxious subjects showed an increase in win-stays and a decrease in lose-shifts across trial blocks while poor performing-high anxious subjects did not. Furthermore, decision-making performance and, indirectly, anxiety levels were related to neural activity in parts of the medial prefrontal cortex, that is prelimbic and infralimbic cortex, and in parts of the striatum, that is nucleus accumbens shell and core. These data suggest a similar frontostriatal circuitry underlying affective decision-making in humans and rats.

Increased N-Acetylaspartate/creatine ratio in the medial prefrontal cortex among unmedicated obsessive-compulsive disorder patients

AIMS

Changes in the fronto-striato-thalamo-cortical-circuit loop have been suggested in the pathogenesis of obsessive-compulsive disorder (OCD), and have been studied using (1)H magnetic resonance spectroscopy ((1)H MRS) with interesting findings. However, whether neural metabolites are abnormal in the medial prefrontal cortex in patients with OCD is unknown. The purpose of the present study was to investigate neural metabolites in this brain region in a sample of patients with OCD.

METHODS

Subjects were 21 unmedicated OCD patients, including 10 who were drug-naïve, and 19 healthy controls. Single-voxel (1)H MRS was used to study the medial prefrontal cortex for each subject. Levels of N-acetylaspartate (NAA), choline-containing compounds and myoinositol were measured in terms of their ratios with creatine (Cr).

RESULTS

The NAA/Cr ratio was significantly higher among OCD patients than among healthy controls (F = 4.76, P = 0.037). However, it did not correlate with patients' symptoms or with their illness durations. The NAA/Cr ratio also did not differ between drug-naïve and previously medicated patients. No significant group differences were found between OCD patients and normal controls for the choline-containing compounds/Cr or myoinositol/Cr ratios. In addition, a significant correlation between the NAA/Cr ratio and trait anxiety scores on the State-Trait Anxiety Inventory was found among the controls (r = 0.639, P = 0.010).

CONCLUSIONS

The N-Acetylaspartate level relative to creatine in the medial prefrontal cortex was increased among unmedicated OCD patients. This cannot be attributed to the effect of medications. The possible significance of this finding in the pathophysiology of OCD is discussed.

MRI-related anxiety levels change within and between repeated scanning sessions

Magnetic resonance imaging (MRI) scans frequently trigger state anxiety in individuals being scanned. It is not known, however, whether levels of MRI-related anxiety change over the course of a single scan or across repeated scanning experiences. Since changes in state anxiety are known to affect regional brain activity in healthy volunteers, systematic changes in levels of MRI-related anxiety could confound findings from neuroimaging studies. We assessed anxiety levels in eleven healthy male volunteers during a control period and during two MRI scanning sessions. Anxiety levels were highest during the first MRI scan, dropping to control levels or below by the second scan. In addition, anxiety fluctuated within scanning sessions, particularly during the first scan, with levels high at the beginning of the session, decreasing during mid-scan and then increasing again toward the end of the session. These results suggest that habituation in an MRI simulator before participating in a neuroimaging study could help to decrease fluctuations in MRI-related anxiety. Moreover, in studies that address several experimental questions within a single scanning session, experimental designs could be adapted to avoid potential confounds from within-scan variation in scanner-related anxiety.

Trait anxiety affects decision-making differently in healthy men and women: towards gender-specific endophenotypes of anxiety

Excessive levels of trait anxiety are a risk factor for psychiatric conditions, including anxiety disorders and substance abuse. High trait anxiety has been associated with altered cognitive functioning, in particular with an attentional bias towards aversive stimuli. Decision-making is a crucial aspect of cognitive functioning that relies on the correct processing and control of emotional stimuli. Interestingly, anxiety and decision-making share underlying neural substrates, involving cortico-limbic pathways, including the amygdala, striatum and medial and dorsolateral prefrontal cortices. In the present study, we investigated the relationship between trait anxiety, measured by the State-Trait Anxiety Inventory, and complex decision-making, measured by the Iowa Gambling Task, in healthy male and female volunteers. The main focus of this study was the inclusion of gender as a discriminative factor. Indeed, we found distinct gender-specific effects of trait anxiety: in men, both low and high anxiety groups showed impaired decision-making compared to medium anxiety individuals, whereas in women only high anxiety individuals performed poorly. Furthermore, anxiety affected decision-making in men early in the task, i.e. the exploration phase, as opposed to an effect on performance in women during the second part of the test, i.e. the exploitation phase. These findings were related to different profiles of trait anxiety in men and women, and were independent of performance in the Wisconsin Card Sorting Test and cortisol levels. Our data show gender-specific effects of trait anxiety on emotional decision-making. We suggest gender-specific endophenotypes of anxiety to exist, that differentially affect cognitive functioning.

Research design issues for the use of magnetic resonance imaging machines in brain studies of psychological/psychiatric variables

The magnetic resonance imaging (MRI) machine itself has an impact on the likelihood of obtaining successful measurements of brain size in certain groups of subjects. The differential selection and attrition in both cross-sectional and longitudinal designs, therefore, indicate that the MRI coincidentally serves as a screen for the anatomical structure of the brains that are successfully scanned. This screening effect introduces confounds in experiments whose very hypotheses are focused on comparing anatomical differences in subjects who differ, for example, in their reactions to anxiety-inducing situations. Here, behavioral interventions and possible statistical models are presented in order to reduce attrition and other effects of the confounds introduced by the MRI measurement process in research. Child and adolescent research-particularly in the attention-deficit/hyperactivity disorder research area-is used as an example to clarify and delineate the general research principles presented in the present article.

The use of proton magnetic resonance spectroscopy in PTSD research--meta-analyses of findings and methodological review

Different neuroimaging techniques provided evidence for structural and functional brain alterations in posttraumatic stress disorder (PTSD). Due to technical improvements, especially concerning localization techniques and more reliable analysis methods, one technique, proton magnetic resonance spectroscopy ((1)H-MRS), has increasingly become of interest because it allows further insight into metabolic mechanisms that may contribute to these alterations. The aim of this article is, therefore, to review recent studies utilizing (1)H-MRS of the hippocampus and other brain structures in PTSD. Using meta-analytic methods, we attempted to answer the question if PTSD, as compared to different types of control samples, is accompanied by altered neurometabolite ratios and concentrations in the tissue of different brain regions. A second intent was to review methodological aspects to advise on a minimal standard for reliable results with respect to the application of (1)H-MRS in PTSD. Finally, we discussed the implications of the findings with respect to current PTSD models and future research.

Mechanisms of the blunting of the sympatho-adrenal response: a theory

Development of therapeutic measures to reduce the risk of potentially fatal episodes of hypoglycaemia and thus to achieve the full benefits of intensive insulin therapy in diabetic patients requires a complete understanding of the multi-factorial mechanisms for repeated hypoglycaemia-induced blunting of the sympatho-adrenal response (BSAR). After critical analysis of the hypotheses, this review paper suggests a heuristic theory. This theory suggests two mechanisms for the BSAR, each involving a critical role for the central brain noradrenergic system. Furthermore, this theory also suggests that the lateral hypothalamus (LH) plays an important role in this phenomenon. Within the framework of this theory, explanations for 1) sexual dimorphism in the adrenomedullary response (AR), 2) dissociation in the blunting of the AR and the sympathetic response (SR) and 3) antecedent exercise-induced blunting of the AR are provided. In addition, habituation of orexin-A neurons is suggested to cause defective awakening. Moreover, potential therapeutics measures have been also suggested that will reduce or prevent severe episodes of hypoglycaemia.

Distinguishing expected negative outcomes from preparatory control in the human orbitofrontal cortex

The human orbitofrontal cortex (OFC) plays a critical role in adapting behavior according to the context provided by expected outcomes of actions. However, several aspects of this function are still poorly understood. In particular, it is unclear to what degree any subdivisions of the OFC are specifically engaged when negatively valenced outcomes are expected, and to what extent such areas might be involved in preparatory active control of behavior. We examined these issues in two complementary functional magnetic resonance imaging (fMRI) studies in which we simultaneously and independently manipulated monetary incentives for correct performance, and demands for active preparation of cognitive control. In both experiments, preparation for performance was associated with lateral PFC activity in response to high incentives, regardless of their valence, as well as in response to increased task demands. In contrast, areas of the OFC centered around the lateral orbital sulcus responded maximally to negatively perceived prospects, even when such prospects were associated with decreases in preparatory cognitive control. These results provide direct support for theoretical models which posit that the OFC contributes to behavioral regulation by representing the value of anticipated outcomes, but does not implement active control aimed at avoiding or pursuing outcomes. Furthermore, they provide additional converging evidence that the lateral OFC is involved in representing specifically the affective impact of anticipated negative outcomes.

Hippocampal N-acetylaspartate concentration and response to riluzole in generalized anxiety disorder

BACKGROUND

Previous research has suggested the therapeutic potential of glutamate-modulating agents for severe mood and anxiety disorders, potentially resulting from enhancement of neuroplasticity. We used proton magnetic resonance spectroscopic imaging ((1)H MRSI) to examine the acute and chronic effects of the glutamate-release inhibitor riluzole on hippocampal N-acetylaspartate (NAA), a neuronal marker, in patients with generalized anxiety disorder (GAD) and examined the relationship between changes in NAA and clinical outcome.

METHODS

Fourteen medication-free GAD patients were administered open-label riluzole and then evaluated by (1)H MRSI before drug administration, and 24 hours and 8 weeks following treatment. Patients were identified as responders (n = 9) or nonresponders (n = 5). Seven untreated, medically healthy volunteers, comparable in age, sex, IQ, and body mass index to the patients, received scans at the same time intervals. Molar NAA concentrations in bilateral hippocampus, and change in anxiety ratings were the primary outcome measures.

RESULTS

A group-by-time interaction was found, with riluzole responders showing mean increases in hippocampal NAA across the three time points, whereas nonresponders had decreases over time. In GAD patients at Week 8, hippocampal NAA concentration and proportional increase in NAA from baseline both were positively associated with improvements in worry and clinician-rated anxiety.

CONCLUSIONS

These preliminary data support a specific association between hippocampal NAA and symptom alleviation following riluzole treatment in GAD. Placebo-controlled investigations that examine hippocampal NAA as a viable surrogate endpoint for clinical trials of neuroprotective and plasticity-enhancing agents are warranted.

Role of GABA in anxiety and depression

This review assesses the parallel data on the role of gamma-aminobutyric acid (GABA) in depression and anxiety. We review historical and new data from both animal and human experimentation which have helped define the key role for this transmitter in both these mental pathologies. By exploring the overlap in these conditions in terms of GABAergic neurochemistry, neurogenetics, brain circuitry, and pharmacology, we develop a theory that the two conditions are intrinsically interrelated. The role of GABAergic agents in demonstrating this interrelationship and in pointing the way to future research is discussed.

The human dimension: how the prefrontal cortex modulates the subcortical fear response

Numerous studies suggest that the amygdala is critical for the acquisition and expression of fear. Conditioned fear in animals has been considered a good model for human anxiety disorders, but animal models of anxiety have several limitations. Conditioned fear in animals can be directed to a specific stressor and is easily extinguished. Furthermore, animals do not seem to be able to develop the capacity to worry excessively about the future. While animal models are useful and can demonstrate psychiatric illnesses, they do not completely mimic the complex cognitive processes that occur in anxious humans. Thus, we hypothesize that human anxiety disorders are caused at least in part by differential activity in the prefrontal cortex, the brain region that most separates us from our nearest genetic neighbors. The human prefrontal cortex has not only been shown to be more developed than that of other mammals, but it also has unique morphology and gene expression. Neuroimaging studies repeatedly show abnormalities in the prefrontal cortex in anxious individuals. Thus, we suggest that the very same cortical complexity that allows us to produce a vibrant culture is also the seat of anxiety disorders. Interestingly, preclinical studies have shown that the prefrontal cortex inhibits the amygdala. There appears to be a distinction between two classes of anxiety disorders. Those disorders involving intense fear and panic--panic disorder, post-traumatic stress disorder, and phobias--seem to be characterized by an underactivity of the prefrontal cortex, thus disinhibiting the amygdala. Disorders such as generalized anxiety disorder and obsessive-compulsive disorder, which involve worry and rumination, on the other hand, seem to be characterized by an overactivity of the prefrontal cortex. Studies of prefrontal cortical function in psychiatric illness should be a fruitful method for identifying effective treatment approaches.

Corticotropin releasing hormone receptor alterations elicited by acute and chronic unpredictable stressor challenges in stressor-susceptible and resilient strains of mice

Stressors increase corticotropin releasing hormone (CRH) functioning in hypothalamic and frontal cortical brain regions, and thus may contribute to the provocation of anxiety and depressive disorder. As the effects of stressors on these behavioral changes are more pronounced in some strains of mice (e.g., BALB/cByJ) than in others (e.g., C57BL/6ByJ), the present investigation assessed whether acute and chronic stressors would differentially influence CRH receptor immunoreactivity (ir-CRHr) and CRH receptor mRNA expression (CRH(1) and CRH(2)) in the orbital frontal cortex (OFC) of these strains. An acute noise stressor, and to a greater extent a chronic, variable stressor regimen reduced ir-CRHr in BALB/cByJ mice. In contrast, in the hardier C57BL/6ByJ mice the acute stressor increased ir-CRHr in portions of the OFC, whereas a chronic stressor tended to reduce ir-CRHr. However, whereas the acute stressor did not influence CRH(1) mRNA expression, the chronic stressor increased CRH(1) mRNA expression in both mouse strains. The CRH(2) expression appeared in low abundance in both strains and was unaltered by the stressor. In addition to the OFC variations, quantitative immunohistochemistry indicated that the chronic stressor treatment increased CRH immunoreactivity in the median eminence of C57BL/6ByJ mice, but co-expression of CRH and arginine vasopressin (AVP) immunoreactivity was not provoked by the stressors. The data support the view that stressors provoke marked variations of ir-CRHr in the OFC that might contribute to the differential anxiety/depression-like profiles ordinarily apparent in the stressor-vulnerable and -resilient mouse strains.

Gender-Common and -Specific Neuroanatomical Basis of Human Anxiety-Related Personality Traits

Exploration of the relationships between regional brain volume and anxiety-related personality traits is important for understanding preexisting vulnerability to depressive and anxiety disorders. However, previous studies on this topic have employed relatively limited sample sizes and/or image processing methodology, and they have not clarified possible gender differences. In the present study, 183 (male/female: 117/66) right-handed healthy individuals in the third and fourth decades of life underwent structural magnetic resonance imaging scans and Temperament and Character Inventory. Neuroanatomical correlates of individual differences in the score of harm avoidance (HA) were examined throughout the entire brain using voxel-based morphometry. We found that higher scores on HA were associated with smaller regional gray matter volume in the right hippocampus, which was common to both genders. In contrast, female-specific correlation was found between higher anxiety-related personality traits and smaller regional brain volume in the left anterior prefrontal cortex. The present findings suggest that smaller right hippocampal volume underlies the basis for higher anxiety-related traits common to both genders, whereas anterior prefrontal volume contributes only in females. The results may have implications for why susceptibility to stress-related disorders such as anxiety disorders and depression shows gender and/or individual differences.

MR spectroscopy: its potential role for drug development for the treatment of psychiatric diseases

Magnetic resonance spectroscopy (MRS) is likely in the near future to play a key role in the process of drug discovery and evaluation. As the pharmaceutical industry seeks biochemical markers of drug delivery, efficacy and toxicity, this non-invasive technique offers numerous ways to study adults and children repeatedly and without ionizing radiation. In this article, we survey an array of the information that MRS offers about neurochemistry in general and psychiatric disorders and their treatment in particular. We also present growing evidence of glial abnormalities in neuropsychiatric disorders and discuss what MRS is contributing to that line of investigation. The third major direction of this article is the discussion of where MRS techniques are headed and how those new techniques can contribute to studies of mechanisms of psychiatric disease and drug discovery.

Decreased choline and creatine concentrations in centrum semiovale in patients with generalized anxiety disorder: relationship to IQ and early trauma

We have demonstrated, using proton magnetic resonance spectroscopy imaging ((1)H-MRSI), elevations of N-acetyl-aspartate/creatine (NAA/CR) in right dorsolateral prefrontal cortex (DLPFC) in patients with generalized anxiety disorder (GAD) in comparison to healthy volunteers. A recent study indicates that the volume of prefrontal cortical white matter may be disproportionately increased in man in comparison to other primate species, with evolutionary implications. We therefore re-analyzed the identical scans with a specific focus on the centrum semiovale (CSO) as a representative region of interest of cerebral white matter. The central hypothesis was, in accordance with our gray matter findings, that patients with GAD, in comparison to healthy controls, would exhibit either an increase in NAA in CSO, or alternatively demonstrate reductions in concentrations of choline (CHO)-containing compounds and/or creatine+phosphocreatine (CR). MRSI scans that were obtained from an earlier [Mathew, S.J., Mao, X., Coplan, J.D., Smith, E.L., Sackeim, H.A., Gorman, J.M., Shungu, D.C., 2004. Dorsolateral prefrontal cortical pathology in generalized anxiety disorder: a proton magnetic resonance spectroscopic imaging study. American Journal of Psychiatry 161, 1119-1121] sample of 15 patients with GAD [6 with early trauma (ET)] and 15 healthy age- and sex-matched volunteers were analyzed further for CSO metabolite alterations. Self-reported worry was scored using the Penn State Worry Questionnaire (PSWQ) and intelligence was assessed using the Wechsler Abbreviated Scale of Intelligence (WASI). Serial multislice/multivoxel MRSI scans had been performed on a 1.5-T MRI. Using absolute quantification methods for metabolite concentrations, we examined NAA, CHO and CR. GAD patients without ET exhibited bilaterally decreased concentrations of CHO and CR in CSO in comparison to healthy volunteers, whereas GAD patients with ET were indistinguishable from controls. In patients with GAD, high IQ was paired with greater worry, whereas in healthy volunteers, high IQ was associated with less worry. In all subjects, IQ inversely predicted left and right CSO CHO concentrations, independent of age, sex, group assignment and PSWQ scores. The CSO may therefore represent a neural substrate that exhibits reductions in CHO and CR metabolite concentrations that are inversely associated with GAD symptomatology and, in the case of CHO, with intelligence. These conclusions are deemed preliminary due to small sample size, with further study of cerebral WM in anxiety disorders suggested.

On the importance of inhibition: central and peripheral manifestations of nonlinear inhibitory processes in neural systems

Inhibitory processes provide for the sculpting of neural action at all levels of the neuraxis. Importantly, it appears that this inhibitory function may be decidedly nonlinear in nature such that a little inhibition goes a long way in guiding the behavior of neural systems. The neural control of the heart is used as a model system to illustrate the nature of this nonlinear inhibitory control. Similar inhibitory processes function in the prefrontal cortex, in the amygdala, and between the prefrontal cortex and the amygdala in the service of organism flexibility, adaptability, and health. It is suggested that a dynamical systems perspective of neural regulation involving nonlinear inhibitory processes may be a useful framework within which to investigate the complex behavior associated with health and disease.

Magnetic resonance spectroscopy detects biochemical changes in the brain associated with chronic low back pain: a preliminary report

Magnetic resonance (MR) spectroscopy is a noninvasive technique that can be used to detect and measure the concentration of metabolites and neurotransmitters in the brain and other organs. We used in vivo (1)H MR spectroscopy in subjects with low back pain compared with control subjects to detect alterations in biochemistry in three brain regions associated with pain processing. A pattern recognition approach was used to determine whether it was possible to discriminate accurately subjects with low back pain from control subjects based on MR spectroscopy. MR spectra were obtained from the prefrontal cortex, anterior cingulate cortex, and thalamus of 32 subjects with low back pain and 33 control subjects without pain. Spectra were analyzed and compared between groups using a pattern recognition method (Statistical Classification Strategy). Using this approach, it was possible to discriminate between subjects with low back pain and control subjects with accuracies of 100%, 99%, and 97% using spectra obtained from the anterior cingulate cortex, thalamus, and prefrontal cortex, respectively. These results demonstrate that MR spectroscopy, in combination with an appropriate pattern recognition approach, is able to detect brain biochemical changes associated with chronic pain with a high degree of accuracy.