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Wang L, Tseng YT, Schaefke B, Wei P, He S. Reply to 'Fear, anxiety and the functional architecture of the human central extended amygdala'. Nat Rev Neurosci 2024:10.1038/s41583-024-00834-w. [PMID: 38858580 DOI: 10.1038/s41583-024-00834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Affiliation(s)
- Liping Wang
- Key Laboratory of Brain Cognition and Brain-inspired Intelligence Technology, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Yu-Ting Tseng
- Key Laboratory of Brain Cognition and Brain-inspired Intelligence Technology, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bernhard Schaefke
- Key Laboratory of Brain Cognition and Brain-inspired Intelligence Technology, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Pengfei Wei
- Key Laboratory of Brain Cognition and Brain-inspired Intelligence Technology, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Sheng He
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
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Tomasi J, Zai CC, Pouget JG, Tiwari AK, Kennedy JL. Heart rate variability: Evaluating a potential biomarker of anxiety disorders. Psychophysiology 2024; 61:e14481. [PMID: 37990619 DOI: 10.1111/psyp.14481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/19/2023] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
Establishing quantifiable biological markers associated with anxiety will increase the objectivity of phenotyping and enhance genetic research of anxiety disorders. Heart rate variability (HRV) is a physiological measure reflecting the dynamic relationship between the sympathetic and parasympathetic nervous systems, and is a promising target for further investigation. This review summarizes evidence evaluating HRV as a potential physiological biomarker of anxiety disorders by highlighting literature related to anxiety and HRV combined with investigations of endophenotypes, neuroimaging, treatment response, and genetics. Deficient HRV shows promise as an endophenotype of pathological anxiety and may serve as a noninvasive index of prefrontal cortical control over the amygdala, and potentially aid with treatment outcome prediction. We propose that the genetics of HRV can be used to enhance the understanding of the genetics of pathological anxiety for etiological investigations and treatment prediction. Given the anxiety-HRV link, strategies are offered to advance genetic analytical approaches, including the use of polygenic methods, wearable devices, and pharmacogenetic study designs. Overall, HRV shows promising support as a physiological biomarker of pathological anxiety, potentially in a transdiagnostic manner, with the heart-brain entwinement providing a novel approach to advance anxiety treatment development.
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Affiliation(s)
- Julia Tomasi
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Jennie G Pouget
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Maita I, Bazer A, Chae K, Parida A, Mirza M, Sucher J, Phan M, Liu T, Hu P, Soni R, Roepke TA, Samuels BA. Chemogenetic activation of corticotropin-releasing factor-expressing neurons in the anterior bed nucleus of the stria terminalis reduces effortful motivation behaviors. Neuropsychopharmacology 2024; 49:377-385. [PMID: 37452139 PMCID: PMC10724138 DOI: 10.1038/s41386-023-01646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Corticotropin-releasing factor (CRF) in the anterior bed nucleus of the stria terminalis (aBNST) is associated with chronic stress and avoidance behavior. However, CRF + BNST neurons project to reward- and motivation-related brain regions, suggesting a potential role in motivated behavior. We used chemogenetics to selectively activate CRF+ aBNST neurons in male and female CRF-ires-Cre mice during an effort-related choice task and a concurrent choice task. In both tasks, mice were given the option either to exert effort for high value rewards or to choose freely available low value rewards. Acute chemogenetic activation of CRF+ aBNST neurons reduced barrier climbing for a high value reward in the effort-related choice task in both males and females. Furthermore, acute chemogenetic activation of CRF+ aBNST neurons also reduced effortful lever pressing in high-performing males in the concurrent choice task. These data suggest a novel role for CRF+ aBNST neurons in effort-based decision and motivation behaviors.
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Affiliation(s)
- Isabella Maita
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Neuroscience Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Allyson Bazer
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Behavioral and Systems Neuroscience Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Kiyeon Chae
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Amlaan Parida
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Mikyle Mirza
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Jillian Sucher
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Behavioral and Systems Neuroscience Graduate Program, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Mimi Phan
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Tonia Liu
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Pu Hu
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Ria Soni
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Troy A Roepke
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Benjamin Adam Samuels
- Department of Psychology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
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Rodrigues-Ribeiro L, Resende BL, Pinto Dias ML, Lopes MR, de Barros LLM, Moraes MA, Verano-Braga T, Souza BR. Neuroproteomics: Unveiling the Molecular Insights of Psychiatric Disorders with a Focus on Anxiety Disorder and Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1443:103-128. [PMID: 38409418 DOI: 10.1007/978-3-031-50624-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Anxiety and depression are two of the most common mental disorders worldwide, with a lifetime prevalence of up to 30%. These disorders are complex and have a variety of overlapping factors, including genetic, environmental, and behavioral factors. Current pharmacological treatments for anxiety and depression are not perfect. Many patients do not respond to treatment, and those who do often experience side effects. Animal models are crucial for understanding the complex pathophysiology of both disorders. These models have been used to identify potential targets for new treatments, and they have also been used to study the effects of environmental factors on these disorders. Recent proteomic methods and technologies are providing new insights into the molecular mechanisms of anxiety disorder and depression. These methods have been used to identify proteins that are altered in these disorders, and they have also been used to study the effects of pharmacological treatments on protein expression. Together, behavioral and proteomic research will help elucidate the factors involved in anxiety disorder and depression. This knowledge will improve preventive strategies and lead to the development of novel treatments.
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Affiliation(s)
- Lucas Rodrigues-Ribeiro
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bruna Lopes Resende
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Luiza Pinto Dias
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Megan Rodrigues Lopes
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Luppi Monteiro de Barros
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Muiara Aparecida Moraes
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Verano-Braga
- Department of Physiology and Biophysics, National Institute of Science and Technology in Nanobiopharmaceutics (INCT-Nanobiofar), Federal University of Minas Gerais, Belo Horizonte, Brazil.
- Department of Physiology and Biophysics, Proteomics Group (NPF), Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Bruno Rezende Souza
- Department of Physiology and Biophysics, Laboratory of Neurodevelopment and Evolution (NeuroDEv), Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Tseng YT, Schaefke B, Wei P, Wang L. Defensive responses: behaviour, the brain and the body. Nat Rev Neurosci 2023; 24:655-671. [PMID: 37730910 DOI: 10.1038/s41583-023-00736-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/22/2023]
Abstract
Most animals live under constant threat from predators, and predation has been a major selective force in shaping animal behaviour. Nevertheless, defence responses against predatory threats need to be balanced against other adaptive behaviours such as foraging, mating and recovering from infection. This behavioural balance in ethologically relevant contexts requires adequate integration of internal and external signals in a complex interplay between the brain and the body. Despite this complexity, research has often considered defensive behaviour as entirely mediated by the brain processing threat-related information obtained via perception of the external environment. However, accumulating evidence suggests that the endocrine, immune, gastrointestinal and reproductive systems have important roles in modulating behavioural responses to threat. In this Review, we focus on how predatory threat defence responses are shaped by threat imminence and review the circuitry between subcortical brain regions involved in mediating defensive behaviours. Then, we discuss the intersection of peripheral systems involved in internal states related to infection, hunger and mating with the neurocircuits that underlie defence responses against predatory threat. Through this process, we aim to elucidate the interconnections between the brain and body as an integrated network that facilitates appropriate defensive responses to threat and to discuss the implications for future behavioural research.
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Affiliation(s)
- Yu-Ting Tseng
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Guangdong Provincial Key Laboratory of Brain Connectome and Behaviour, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bernhard Schaefke
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Pengfei Wei
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Liping Wang
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
- Guangdong Provincial Key Laboratory of Brain Connectome and Behaviour, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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Wilson KA, MacNamara A. Transdiagnostic Fear and Anxiety: Prospective Prediction Using the No-Threat, Predictable Threat, and Unpredictable Threat Task. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:930-938. [PMID: 37881540 PMCID: PMC10593901 DOI: 10.1016/j.bpsgos.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Fear and anxiety are distinct dimensions of psychopathology that may be characterized by differences in dimensional threat reactivity. Heightened response to predictable threat is hypothesized to underlie fear symptomatology, whereas increased response to unpredictable threat may underlie anxiety. Despite widespread acceptance of this model, these purported associations have rarely been tested, and the prognostic value of predictable and unpredictable threat responding is unclear. Here we examined multilevel indicators of predictable and unpredictable threat response as cross-sectional correlates and prospective predictors of transdiagnostic fear and anxiety. Methods Fifty-two individuals with varying levels of internalizing psychopathology (31 female) performed the no-threat, predictable threat, and unpredictable threat task. Transdiagnostic fear and anxiety were assessed at baseline (time 1) and approximately 1.5 years later (time 2). We used event-related potential, the stimulus-preceding negativity, as a measure of threat anticipation and startle eyeblink as a measure of defensive reactivity during the no-threat, predictable threat, and unpredictable threat task. These probes were assessed as cross-sectional correlates and prospective predictors of fear and anxiety. Results Participants with larger time 1 stimulus-preceding negativities to predictable threat were characterized by greater time 1 fear. Larger time 1 stimulus-preceding negativities to unpredictable threat were associated with greater increases in time 2 anxiety. Heightened time 1 startle to predictable threat predicted larger increases in time 2 fear. Conclusions Results validate predictable and unpredictable threat responding as dimensional correlates of transdiagnostic fear versus anxiety and suggest that psychophysiological measures of predictable and unpredictable threat response hold promise as prospective predictors of trajectories of fear and anxiety.
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Affiliation(s)
- Kayla A. Wilson
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Annmarie MacNamara
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
- Institute for Neuroscience, Texas A&M University, College Station, Texas
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van de Poll Y, Cras Y, Ellender TJ. The neurophysiological basis of stress and anxiety - comparing neuronal diversity in the bed nucleus of the stria terminalis (BNST) across species. Front Cell Neurosci 2023; 17:1225758. [PMID: 37711509 PMCID: PMC10499361 DOI: 10.3389/fncel.2023.1225758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/03/2023] [Indexed: 09/16/2023] Open
Abstract
The bed nucleus of the stria terminalis (BNST), as part of the extended amygdala, has become a region of increasing interest regarding its role in numerous human stress-related psychiatric diseases, including post-traumatic stress disorder and generalized anxiety disorder amongst others. The BNST is a sexually dimorphic and highly complex structure as already evident by its anatomy consisting of 11 to 18 distinct sub-nuclei in rodents. Located in the ventral forebrain, the BNST is anatomically and functionally connected to many other limbic structures, including the amygdala, hypothalamic nuclei, basal ganglia, and hippocampus. Given this extensive connectivity, the BNST is thought to play a central and critical role in the integration of information on hedonic-valence, mood, arousal states, processing emotional information, and in general shape motivated and stress/anxiety-related behavior. Regarding its role in regulating stress and anxiety behavior the anterolateral group of the BNST (BNSTALG) has been extensively studied and contains a wide variety of neurons that differ in their electrophysiological properties, morphology, spatial organization, neuropeptidergic content and input and output synaptic organization which shape their activity and function. In addition to this great diversity, further species-specific differences are evident on multiple levels. For example, classic studies performed in adult rat brain identified three distinct neuron types (Type I-III) based on their electrophysiological properties and ion channel expression. Whilst similar neurons have been identified in other animal species, such as mice and non-human primates such as macaques, cross-species comparisons have revealed intriguing differences such as their comparative prevalence in the BNSTALG as well as their electrophysiological and morphological properties, amongst other differences. Given this tremendous complexity on multiple levels, the comprehensive elucidation of the BNSTALG circuitry and its role in regulating stress/anxiety-related behavior is a major challenge. In the present Review we bring together and highlight the key differences in BNSTALG structure, functional connectivity, the electrophysiological and morphological properties, and neuropeptidergic profiles of BNSTALG neurons between species with the aim to facilitate future studies of this important nucleus in relation to human disease.
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Affiliation(s)
- Yana van de Poll
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Yasmin Cras
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Tommas J. Ellender
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
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Dabrowska J. From recent advances in underlying neurocircuitry of fear and anxiety to promising pharmacotherapies for PTSD: The saga of heart, sex and the developing brain. Neuropharmacology 2023; 232:109529. [PMID: 37004751 PMCID: PMC11017858 DOI: 10.1016/j.neuropharm.2023.109529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Available pharmacotherapies for anxiety disorders and post-traumatic stress-disorder (PTSD) have limited efficacy, but no new anxiolytic drug has been approved for treatment since the 1980s. In this issue of Neuropharmacology on "Fear, anxiety and PTSD: from cellular mechanisms to translational approaches", we review the currently recommended pharmacotherapy for PTSD and discuss promising pharmacotherapies being revisited or newly developed. Novel strategies for pharmaceuticals in PTSD treatment include the use of serotonergic psychedelics as low-dose adjunct therapies combined with psychotherapy. We also discuss the use of glucocorticoids targeting the temporal window shortly following trauma exposure to interfere with fear memory consolidation. Although many factors have impeded progress in pharmacotherapy development for anxiety disorders and PTSD, we highlight three: (1) the sparsity of preclinical studies investigating the neurobiology of fear processing in female animal models despite the higher prevalence of anxiety disorders in women, (2) the poor implementation of the knowledge of how stress affects fear circuitry development across the lifetime into clinical practice, and (3) our paucity of knowledge of canonical fear circuitry in adaptive vs. maladaptive fear processing. Finally, we emphasize the functional link between interoceptive signals and emotion regulation and discuss how these interoceptive signals may be an inroad into PTSD treatment, which is often accompanied by cardiovascular dysregulation. A better understanding of the neurobiological underpinnings of adaptive and maladaptive fear processing is critical for identifying risk factors that will spur the development of sex- and developmental trauma-specific interventions, ushering in a new era of precision medicine for anxiety disorders and PTSD.
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Affiliation(s)
- Joanna Dabrowska
- Center for the Neurobiology of Stress Resilience and Psychiatric Disorders, Discipline of Cellular and Molecular Pharmacology, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, USA.
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Maita I, Roepke TA, Samuels BA. Chronic stress-induced synaptic changes to corticotropin-releasing factor-signaling in the bed nucleus of the stria terminalis. Front Behav Neurosci 2022; 16:903782. [PMID: 35983475 PMCID: PMC9378865 DOI: 10.3389/fnbeh.2022.903782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
The sexually dimorphic bed nucleus of the stria terminalis (BNST) is comprised of several distinct regions, some of which act as a hub for stress-induced changes in neural circuitry and behavior. In rodents, the anterodorsal BNST is especially affected by chronic exposure to stress, which results in alterations to the corticotropin-releasing factor (CRF)-signaling pathway, including CRF receptors and upstream regulators. Stress increases cellular excitability in BNST CRF+ neurons by potentiating miniature excitatory postsynaptic current (mEPSC) amplitude, altering the resting membrane potential, and diminishing M-currents (a voltage-gated K+ current that stabilizes membrane potential). Rodent anterodorsal and anterolateral BNST neurons are also critical regulators of behavior, including avoidance of aversive contexts and fear learning (especially that of sustained threats). These rodent behaviors are historically associated with anxiety. Furthermore, BNST is implicated in stress-related mood disorders, including anxiety and Post-Traumatic Stress Disorders in humans, and may be linked to sex differences found in mood disorders.
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Affiliation(s)
- Isabella Maita
- Samuels Laboratory, Department of Psychology, Behavioral and Systems Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, United States,Neuroscience Graduate Program, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Troy A. Roepke
- Roepke Laboratory, Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Benjamin A. Samuels
- Samuels Laboratory, Department of Psychology, Behavioral and Systems Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, United States,*Correspondence: Benjamin A. Samuels,
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Flanigan ME, Kash TL. Coordination of social behaviors by the bed nucleus of the stria terminalis. Eur J Neurosci 2022; 55:2404-2420. [PMID: 33006806 PMCID: PMC9906816 DOI: 10.1111/ejn.14991] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
The bed nucleus of the stria terminalis (BNST) is a sexually dimorphic, neuropeptide-rich node of the extended amygdala that has been implicated in responses to stress, drugs of abuse, and natural rewards. Its function is dysregulated in neuropsychiatric disorders that are characterized by stress- or drug-induced alterations in mood, arousal, motivation, and social behavior. However, compared to the BNST's role in mood, arousal, and motivation, its role in social behavior has remained relatively understudied. Moreover, the precise cell types and circuits underlying the BNST's role in social behavior have only recently begun to be explored using modern neuroscience techniques. Here, we systematically review the existing literature investigating the neurobiological substrates within the BNST that contribute to the coordination of various sex-dependent and sex-independent social behavioral repertoires, focusing largely on pharmacological and circuit-based behavioral studies in rodents. We suggest that the BNST coordinates social behavior by promoting appropriate assessment of social contexts to select relevant behavioral outputs and that disruption of socially relevant BNST systems by stress and drugs of abuse may be an important factor in the development of social dysfunction in neuropsychiatric disorders.
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Affiliation(s)
- Meghan E. Flanigan
- Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Thomas L. Kash
- Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC,Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC,Correspondence: Thomas L. Kash, John R. Andrews Distinguished Professor, Bowles Center for Alcohol Studies, Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA, , (919) 843-7867
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FKBP51 in the Oval Bed Nucleus of the Stria Terminalis Regulates Anxiety-Like Behavior. eNeuro 2021; 8:ENEURO.0425-21.2021. [PMID: 34872938 PMCID: PMC8687485 DOI: 10.1523/eneuro.0425-21.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022] Open
Abstract
The cochaperone FKBP51, encoded by the Fkbp5 gene, has been identified as central risk factor for anxiety-related disorders and stress system dysregulation. In the brain, the oval bed nucleus of the stria terminalis (ovBNST) has been implicated in stress-induced anxiety. However, the role of Fkbp5 in the ovBNST and its impact on anxiety-like behavior have remained unknown. Here, we show in mice that Fkbp5 in the ovBNST is reactive to acute stress and coexpressed with the stress-regulated neuropeptides Tac2 and Crh Subsequently, results obtained from viral-mediated manipulation indicate that Fkbp5 overexpression (OE) in the ovBNST results in an anxiolytic-like tendency regarding behavior and endocrinology, whereas a Fkbp5 knock-out (KO) exposed a clear anxiogenic phenotype, indicating that native ovBNST expression and regulation is necessary for normal anxiety-related behavior. Notably, our data suggests that a stress-induced increase of Fkbp5 in the ovBNST may in fact have a protective role, leading to a transient decrease in anxiety and suppression of a future stress-induced hypothalamic-pituitary-adrenal (HPA) axis activation. Together, our findings provide a first insight into the previously unknown relationship and effects of Fkbp5 and the ovBNST on anxiety-like behavior and HPA axis functioning.
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Bruzsik B, Biro L, Sarosdi KR, Zelena D, Sipos E, Szebik H, Török B, Mikics E, Toth M. Neurochemically distinct populations of the bed nucleus of stria terminalis modulate innate fear response to weak threat evoked by predator odor stimuli. Neurobiol Stress 2021; 15:100415. [PMID: 34765699 PMCID: PMC8572958 DOI: 10.1016/j.ynstr.2021.100415] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 10/25/2022] Open
Abstract
Anxiety and trauma-related disorders are characterized by significant alterations in threat detection, resulting in inadequate fear responses evoked by weak threats or safety stimuli. Recent research pointed out the important role of the bed nucleus of stria terminalis (BNST) in threat anticipation and fear modulation under ambiguous threats, hence, exaggerated fear may be traced back to altered BNST function. To test this hypothesis, we chemogenetically inhibited specific BNST neuronal populations (corticotropin-releasing hormone - BNSTCRH and somatostatin - BNSTSST expressing neurons) in a predator odor-evoked innate fear paradigm. The rationale for this paradigm was threefold: (1) predatory cues are particularly strong danger signals for all vertebrate species evoking defensive responses on the flight-avoidance-freezing dimension (conservative mechanisms), (2) predator odor can be presented in a scalable manner (from weak to strong), and (3) higher-order processing of olfactory information including predatory odor stimuli is integrated by the BNST. Accordingly, we exposed adult male mice to low and high predatory threats presented by means of cat urine, or low- and high-dose of 2-methyl-2-thiazoline (2MT), a synthetic derivate of a fox anogenital product, which evoked low and high fear response, respectively. Then, we tested the impact of chemogenetic inhibition of BNSTCRH and BNSTSST neurons on innate fear responses using crh- and sst-ires-cre mouse lines. We observed that BNSTSST inhibition was effective only under low threat conditions, resulting in reduced avoidance and increased exploration of the odor source. In contrast, BNSTCRH inhibition had no impact on 2MT-evoked responses, but enhanced fear responses to cat odor, representing an even weaker threat stimulus. These findings support the notion that BNST is recruited by uncertain or remote, potential threats, and CRH and SST neurons orchestrate innate fear responses in complementary ways.
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Affiliation(s)
- Biborka Bruzsik
- Laboratory of Translational Behavioural Neuroscience, Institute of Experimental Medicine, Budapest, Hungary.,Janos Szentagothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Laszlo Biro
- Laboratory of Translational Behavioural Neuroscience, Institute of Experimental Medicine, Budapest, Hungary.,Laboratory of Thalamus Research, Institute of Experimental Medicine, Budapest, Hungary
| | - Klara Rebeka Sarosdi
- Laboratory of Translational Behavioural Neuroscience, Institute of Experimental Medicine, Budapest, Hungary
| | - Dora Zelena
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary.,Center for Neuroscience, Szentágothai Research Center, Institute of Physiology, Medical School, University of Pécs, Pécs, Hungary
| | - Eszter Sipos
- Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
| | - Huba Szebik
- Laboratory of Translational Behavioural Neuroscience, Institute of Experimental Medicine, Budapest, Hungary.,Janos Szentagothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Bibiána Török
- Janos Szentagothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary.,Laboratory of Behavioural and Stress Studies, Institute of Experimental Medicine, Budapest, Hungary
| | - Eva Mikics
- Laboratory of Translational Behavioural Neuroscience, Institute of Experimental Medicine, Budapest, Hungary
| | - Mate Toth
- Laboratory of Translational Behavioural Neuroscience, Institute of Experimental Medicine, Budapest, Hungary
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13
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Siminski N, Borgmann L, Becker MPI, Hofmann D, Gathmann B, Leehr EJ, Böhnlein J, Seeger FR, Schwarzmeier H, Roesmann K, Junghöfer M, Dannlowski U, Lueken U, Straube T, Herrmann MJ. Centromedial amygdala is more relevant for phobic confrontation relative to the bed nucleus of stria terminalis in patients with spider phobia. J Psychiatr Res 2021; 143:268-275. [PMID: 34530337 DOI: 10.1016/j.jpsychires.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 01/31/2023]
Abstract
Recent studies indicate differential involvement of the centromedial amygdala (CM) and the bed nucleus of the stria terminalis (BNST) during processing (anticipation and confrontation) of threat stimuli. Here, temporal predictability was shown to be a relevant factor. In this study, we want to investigate the relevance of these effects, which were found in healthy subjects, for anxiety disorders. Therefore, we investigated the differential involvement of CM and BNST in the anticipation and confrontation of phobic stimuli under variation of temporal predictability in spider phobia. 21 patients with spider phobia and 21 healthy controls underwent a temporally predictable/unpredictable phobic and neutral anticipation and confrontation paradigm using functional magnetic resonance imaging (fMRI) and ROI analyses. During the anticipation phase, healthy controls showed higher CM and BNST activity during the predictable compared with the unpredictable condition compared with the anxiety patients. During a confrontation phase that followed the anticipation phase, CM was more activated than BNST during the phobic compared with the neutral confrontation. While this effect was independent of threat predictability in patients, healthy controls showed higher activation in the CM compared with the BNST only during the predictable spider confrontation compared with the predictable bird confrontation. The results contribute to a better understanding of the separate roles of the CM and BNST during phobic processes. The CM was found to be more relevant to phobic confrontation in patients with spider phobia compared with the BNST.
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Affiliation(s)
- N Siminski
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - L Borgmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - D Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - B Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - E J Leehr
- Institute for Translational Psychiatry, University of Münster, Germany
| | - J Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - F R Seeger
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany; Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - H Schwarzmeier
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - K Roesmann
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany
| | - M Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
| | - U Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - U Lueken
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Germany
| | - M J Herrmann
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
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14
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Daniel-Watanabe L, Fletcher PC. Are Fear and Anxiety Truly Distinct? BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 2:341-349. [DOI: 10.1016/j.bpsgos.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022] Open
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15
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Pang M, Zhong Y, Hao Z, Xu H, Wu Y, Teng C, Li J, Xiao C, Fox PT, Zhang N, Wang C. Resting-state causal connectivity of the bed nucleus of the stria terminalis in panic disorder. Brain Imaging Behav 2021; 15:25-35. [PMID: 31833015 DOI: 10.1007/s11682-019-00229-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Panic disorder (PD) is associated with anticipatory anxiety, a sustained threat response that appears to be related to the bed nucleus of the stria terminalis (BNST). Individuals with panic disorder may demonstrate significant differences in causal connectivity of the BNST in comparison to healthy controls. To test this hypothesis, resting-state functional magnetic resonance imaging (fMRI) was used to identify aberrant causal connectivity of the BNST in PD patients. 19 PD patients and 18 healthy controls (HC) matched for gender, age and education were included. Granger causality analysis (GCA) utilizing the BNST as a seed region was used to investigate changes in directional connectivity. Relative to healthy controls, PD patients displayed abnormal directional connectivity of the BNST including enhanced causal connectivity between the left parahippocampal gyrus and left BNST, the right insula and the right BNST, the left BNST and the right dorsolateral prefrontal cortex (dlPFC) and right BNST to the left and right dlPFC. Furthermore, PD patients displayed weakened causal connectivity between the right dlPFC and the left BNST, the left dlPFC and the right BNST, the left BNST and the left dorsomedial prefrontal cortex (dmPFC), right insula, right fusiform, and right BNST to the right insula. The results suggest that PD strongly correlates with increased causal connectivity between emotional processing regions and the BNST and enhanced causal connectivity between the BNST and cognitive control regions.
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Affiliation(s)
- Manlong Pang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Ziyu Hao
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Huazhen Xu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yun Wu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changjun Teng
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Li
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China
| | - Chaoyong Xiao
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peter T Fox
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China.,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China.,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China. .,School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China. .,Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, Jiangsu, China. .,Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, China.
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16
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Bashford-Largo J, Aloi J, Lukoff J, Johnson K, White SF, Dobbertin M, Blair RJ, Blair KS. Reduced top-down attentional control in adolescents with generalized anxiety disorder. Brain Behav 2021; 11:e01994. [PMID: 33369286 PMCID: PMC7882153 DOI: 10.1002/brb3.1994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/14/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) can significantly impair quality of life and is associated with a relatively poor long-term prognosis. Anxiety disorders are often associated with hyper-responsiveness to threat, perhaps coupled with impaired executive functioning. However, GAD, particularly adolescent GAD, has been the focus of little functional neuroimaging work compared to other anxiety disorders. Here, we examine the neural association of adolescent GAD with responsiveness to threat and response control. METHODS The study involved 35 adolescents with GAD and 34 healthy comparison individuals (N = 69) matched on age, gender, and IQ. Participants were scanned during an affective number Stroop task. RESULTS We found significant Group-by-Task Condition interactions in regions involved in response control/motor responding (bilateral precentral gyri and cerebellum) and/or cognitive control/attention (dorsomedial and lateral frontal cortex, posterior cingulate cortex, cuneus, and precuneus). In line with predictions, the youth with GAD showed significantly less recruitment during task trials than the healthy comparison individuals. However, no indications of specific heightened responses to threat were seen. CONCLUSIONS GAD involves reduced capacity for engaging regions involved in response control/motor responding and/or cognitive control/attention. This might reflect either a secondary consequence of the patient's worry or an early risk factor for the development of worry.
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Affiliation(s)
| | - Joseph Aloi
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennie Lukoff
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - Kimberly Johnson
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - Stuart F White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - Matthew Dobbertin
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - Robert James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, NE, USA
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17
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Hulsman AM, Terburg D, Roelofs K, Klumpers F. Roles of the bed nucleus of the stria terminalis and amygdala in fear reactions. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:419-432. [PMID: 34225979 DOI: 10.1016/b978-0-12-819975-6.00027-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The bed nucleus of the stria terminalis (BNST) plays a critical modulatory role in driving fear responses. Part of the so-called extended amygdala, this region shares many functions and connections with the substantially more investigated amygdala proper. In this chapter, we review contributions of the BNST and amygdala to subjective, behavioral, and physiological aspects of fear. Despite the fact that both regions are together involved in each of these aspects of fear, they appear complimentary in their contributions. Specifically, the basolateral amygdala (BLA), through its connections to sensory and orbitofrontal regions, is ideally poised for fast learning and controlling fear reactions in a variety of situations. The central amygdala (CeA) relies on BLA input and is particularly important for adjusting physiological and behavioral responses under acute threat. In contrast, the BNST may profit from more extensive striatal and dorsomedial prefrontal connections to drive anticipatory responses under more ambiguous conditions that allow more time for planning. Thus current evidence suggests that the BNST is ideally suited to play a critical role responding to distant or ambiguous threats and could thereby facilitate goal-directed defensive action.
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Affiliation(s)
- Anneloes M Hulsman
- Experimental Psychopathology & Treatment, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Affective Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - David Terburg
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Karin Roelofs
- Experimental Psychopathology & Treatment, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Affective Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Floris Klumpers
- Experimental Psychopathology & Treatment, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Affective Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.
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18
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Hofmann D, Straube T. Effective connectivity between bed nucleus of the stria terminalis and amygdala: Reproducibility and relation to anxiety. Hum Brain Mapp 2020; 42:824-836. [PMID: 33155747 PMCID: PMC7814768 DOI: 10.1002/hbm.25265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022] Open
Abstract
In a previous study, we investigated the resting‐state fMRI effective connectivity (EC) between the bed nucleus of the stria terminalis (BNST) and the laterobasal (LB), centromedial (CM), and superficial (SF) amygdala. We found strong negative EC from all amygdala nuclei to the BNST, while the BNST showed positive EC to the amygdala. However, the validity of these findings remains unclear, since a reproduction in different samples has not been done. Moreover, the association of EC with measures of anxiety offers deeper insight, due to the known role of the BNST and amygdala in fear and anxiety. Here, we aimed to reproduce our previous results in three additional samples. We used spectral Dynamic Causal Modeling to estimate the EC between the BNST, the LB, CM, and SF, and its association with two measures of self‐reported anxiety. Our results revealed consistency over samples with regard to the negative EC from the amygdala nuclei to the BNST, while the positive EC from BNST to the amygdala was also found, but weaker and more heterogenic. Moreover, we found the BNST‐BNST EC showing a positive and the CM‐BNST EC, showing a negative association with anxiety. Our study suggests a reproducible pattern of negative EC from the amygdala to the BNST along with weaker positive EC from the BNST to the amygdala. Moreover, less BNST self‐inhibition and more inhibitory influence from the CM to the BNST seems to be a pattern of EC that is related to higher anxiety.
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Affiliation(s)
- David Hofmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
| | - Thomas Straube
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
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19
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Grillon C, Ernst M. A way forward for anxiolytic drug development: Testing candidate anxiolytics with anxiety-potentiated startle in healthy humans. Neurosci Biobehav Rev 2020; 119:348-354. [PMID: 33038346 DOI: 10.1016/j.neubiorev.2020.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
This review introduces a research strategy that may radically transform the pursuit of new anxiolytics, via the use of human models of anxiety in healthy individuals. Despite enormous investments in developing novel pharmacological treatments for anxiety disorders, pharmacotherapy for these conditions remains suboptimal. Most candidate anxiolytics from animal studies fail in clinical trials. We propose an additional screening step to help select candidate anxiolytics before launching clinical trials. This intermediate step moves the evidence for the potential anxiolytic property of candidate drugs from animals to humans, using experimental models of anxiety in healthy individuals. Anxiety-potentiated startle is a robust translational model of anxiety. The review of its face, construct, and predictive validity as well as its psychometric properties in humans establishes it as a promising tool for anxiolytic drug development. In conclusion, human models of anxiety may stir a faster, more efficient path for the development of clinically effective anxiolytics.
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Affiliation(s)
- Christian Grillon
- National Institute of Mental Health, Section on the Neurobiology of Fear and Anxiety, Building 15K, Room 203, Bethesda, MD 20814 USA.
| | - Monique Ernst
- National Institute of Mental Health, Section on the Neurobiology of Fear and Anxiety, Building 15K, Room 203, Bethesda, MD 20814 USA.
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20
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Hessel M, Pape HC, Seidenbecher T. Stimulation of 5-HT receptors in anterodorsal BNST guides fear to predictable and unpredictable threat. Eur Neuropsychopharmacol 2020; 39:56-69. [PMID: 32873441 DOI: 10.1016/j.euroneuro.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 01/31/2023]
Abstract
Through pharmacological manipulation of the serotonergic (5-Hydroxytryptamin, 5-HT) system, combined with behavioral analysis, we tested the hypothesis that fear responses to predictable and unpredictable threat are regulated through stimulation of 5-HT receptors (5-HT-R) in the anterodorsal section of the bed nucleus of the stria terminalis (adBNST). Local adBNST application of 5-HT1A-R antagonist WAY100635 and 5-HT1B-R antagonist NAS-181 before fear retrieval enhanced freezing, 24 h after predictable fear conditioning. In contrast, increased fear responses to unpredictable threat were blocked by 5-HT1A-R agonist Buspirone (given before conditioning or retrieval) and 5-HT1B-R agonist CP-94253 (applied before training). Prolonged fear responses were also blocked by local application of the 5-HT2A-R antagonist R-96544 before fear retrieval, and conversely, local application of the 5-HT2A-R agonist NBOH-2C-CN hydrochloride before fear retrieval enhanced freezing 24 h after predictable conditioning, indicating augmented fear responses. Activation of inhibitory 5-HT1A- or 5-HT1B-Rs and the blockade of the excitatory 5-HT2A-R before unpredictable fear conditioning significantly reduced freezing during retrieval. The results from this study suggest that modulation of inhibitory 5-HT1A/1B-R and/or excitatory 5-HT2A-R activity in the adBNST may represent potential targets for the development of new treatment strategies in anxiety disorders. In addition, this study supports the validity and reliability of the mouse model of modulated fear to predictable and unpredictable threats to study mechanisms of fear and anxiety in combination with pharmacological manipulations.
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Affiliation(s)
- Margarita Hessel
- Institute of Physiology I, Westfälische Wilhelms-University Münster, Robert-Koch-Str. 27a, D-48149 Münster, Germany
| | - Hans-Christian Pape
- Institute of Physiology I, Westfälische Wilhelms-University Münster, Robert-Koch-Str. 27a, D-48149 Münster, Germany
| | - Thomas Seidenbecher
- Institute of Physiology I, Westfälische Wilhelms-University Münster, Robert-Koch-Str. 27a, D-48149 Münster, Germany.
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21
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Siminski N, Böhme S, Zeller JBM, Becker MPI, Bruchmann M, Hofmann D, Breuer F, Mühlberger A, Schiele MA, Weber H, Schartner C, Deckert J, Pauli P, Reif A, Domschke K, Straube T, Herrmann MJ. BNST and amygdala activation to threat: Effects of temporal predictability and threat mode. Behav Brain Res 2020; 396:112883. [PMID: 32860830 DOI: 10.1016/j.bbr.2020.112883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 12/28/2022]
Abstract
Recent animal and human studies highlight the uncertainty about the onset of an aversive event as a crucial factor for the involvement of the centromedial amygdala (CM) and bed nucleus of the stria terminalis (BNST) activity. However, studies investigating temporally predictable or unpredictable threat anticipation and confrontation processes are rare. Furthermore, the few existing fMRI studies analyzing temporally predictable and unpredictable threat processes used small sample sizes or limited fMRI paradigms. Therefore, we measured functional brain activity in 109 predominantly female healthy participants during a temporally predictable-unpredictable threat paradigm, which aimed to solve limited aspects of recent studies. Results showed higher BNST activity compared to the CM during the cue indicating that the upcoming confrontation is aversive relative to the cue indicating an upcoming neutral confrontation. Both the CM and BNST showed higher activity during the confrontation with unpredictable and aversive stimuli, but the reaction to aversive confrontation relative to neutral confrontation was stronger in the CM compared to the BNST. Additional modulation analyses by NPSR1 rs324981 genotype revealed higher BNST activity relative to the CM in unpredictable anticipation relative to predictable anticipation in T-carriers compared to AA carriers. Our results indicate that during the confrontation with aversive or neutral stimuli, temporal unpredictability modulates CM and BNST activity. Further, there is a differential activity concerning threat processing, as BNST is more involved when focussing on fear-related anticipation processes and CM is more involved when focussing on threat confrontation.
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Affiliation(s)
- N Siminski
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - S Böhme
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany; Department of Clinical Psychology and Psychotherapy, University of Erlangen, Erlangen, Germany
| | - J B M Zeller
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - M Bruchmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - D Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - F Breuer
- Fraunhofer Institute for Integrated Circuits (IIS), Development Center for X-ray Technology (EZRT), Wuerzburg, Germany
| | - A Mühlberger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - M A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Weber
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - C Schartner
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - J Deckert
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - P Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Wuerzburg, Wuerzburg, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuro Modulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - M J Herrmann
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
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22
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Xin F, Zhou X, Dong D, Zhao Z, Yang X, Wang Q, Gu Y, Kendrick KM, Chen A, Becker B. Oxytocin Differentially Modulates Amygdala Responses during Top-Down and Bottom-Up Aversive Anticipation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:2001077. [PMID: 32832361 PMCID: PMC7435249 DOI: 10.1002/advs.202001077] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/22/2020] [Indexed: 06/11/2023]
Abstract
The ability to successfully regulate negative emotions such as fear and anxiety is vital for mental health. Intranasal administration of the neuropeptide oxytocin (OXT) has been shown to reduce amygdala activity but to increase amygdala-prefrontal cortex connectivity during exposure to threatening stimuli suggesting that it may act as an important modulator of emotion regulation. The present randomized, between-subject, placebo-controlled pharmacological study combines the intranasal administration of OXT with functional magnetic resonance imaging (fMRI) during an explicit emotion regulation paradigm in 65 healthy male participants to investigate the modulatory effects of OXT on both bottom-up and top-down emotion regulation. OXT attenuates the activation in the posterior insular cortex and amygdala during anticipation of top-down regulation of predictable threat stimuli in participants with high trait anxiety. In contrast, OXT enhances amygdala activity during the bottom-up anticipation of unpredictable threat stimuli in participants with low trait anxiety. OXT may facilitate top-down goal-directed attention by attenuating amygdala activity in high anxiety individuals, while promoting bottom-up attention/vigilance to unexpected threats by enhancing amygdala activity in low anxiety individuals. OXT may thus have the potential to promote an adaptive balance between bottom-up and top-down attention systems depending on an individual's trait anxiety level.
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Affiliation(s)
- Fei Xin
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Xinqi Zhou
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Debo Dong
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Zhongbo Zhao
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Xi Yang
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Qianqian Wang
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Yan Gu
- Key Laboratory of Cognition and Personality Ministry of Education, Faculty of Psychology Southwest University Tiansheng Road 2 Chongqing 400715 China
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
| | - Antao Chen
- Key Laboratory of Cognition and Personality Ministry of Education, Faculty of Psychology Southwest University Tiansheng Road 2 Chongqing 400715 China
| | - Benjamin Becker
- The Clinical Hospital of Chengdu Brain Science Institute MOE Key Laboratory for Neuroinformation University of Electronic Science and Technology of China Xiyuan Avenue 2006 Chengdu 611731 China
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23
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Jenks SK, Zhang S, Li CSR, Hu S. Threat bias and resting state functional connectivity of the amygdala and bed nucleus stria terminalis. J Psychiatr Res 2020; 122:54-63. [PMID: 31927266 PMCID: PMC7010552 DOI: 10.1016/j.jpsychires.2019.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous research has distinguished the activations of the amygdala and bed nucleus of stria terminalis (BNST) during threat-related contingencies. However, how intrinsic connectivities of the amygdala and BNST relate to threat bias remains unclear. Here, we investigated how resting state functional connectivity (rsFC) of the amygdala and BNST in healthy controls (HC) and patients with anxiety-related disorders (PAD) associate with threat bias in a dot-probe task. METHODS Imaging and behavioral data of 30 PAD and 83 HC were obtained from the Nathan Kline Institute - Rockland sample and processed according to published routines. All imaging results were evaluated at voxel p < 0.001 and cluster p < 0.05, FWE corrected in SPM. RESULTS PAD and HC did not show differences in whole brain rsFC with either the amygdala or BNST. In linear regressions threat bias was positively correlated with amygdala-thalamus/anterior cingulate cortex (ACC) rsFC in HC but not PAD, and with BNST-caudate rsFC in PAD but not HC. Slope tests confirmed group differences in the correlations between threat bias and amygdala-thalamus/ACC as well as BNST-caudate rsFC. LIMITATIONS As only half of the patients included were diagnosed with comorbid anxiety, the current findings need to be considered with the clinical heterogeneity and require replication in populations specifically with anxiety disorders. CONCLUSIONS Together, these results suggest amygdala and BNST connectivities as new neural markers of anxiety disorders. Whereas amygdala-thalamus/ACC rsFC support adaptive regulation of threat response in the HC, BNST-caudate rsFC may reflect maladaptive neural processes that are dominated by anticipatory anxiety.
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Affiliation(s)
- Samantha K. Jenks
- Department of Psychology, State University of New York at Oswego, Oswego, NY 13126
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519
| | - Chiang-shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520,Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520
| | - Sien Hu
- Department of Psychology, State University of New York at Oswego, Oswego, NY, 13126, USA.
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24
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Anticipatory feelings: Neural correlates and linguistic markers. Neurosci Biobehav Rev 2020; 113:308-324. [PMID: 32061891 DOI: 10.1016/j.neubiorev.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/12/2020] [Indexed: 02/07/2023]
Abstract
This review introduces anticipatory feelings (AF) as a new construct related to the process of anticipation and prediction of future events. AF, defined as the state of awareness of physiological and neurocognitive changes that occur within an oganism in the form of a process of adapting to future events, are an important component of anticipation and expectancy. They encompass bodily-related interoceptive and affective components and are influenced by intrapersonal and dispositional factors, such as optimism, hope, pessimism, or worry. In the present review, we consider evidence from animal and human research, including neuroimaging studies, to characterize the brain structures and brain networks involved in AF. The majority of studies reviewed revealed three brain regions involved in future oriented feelings: 1) the insula; 2) the ventromedial prefrontal cortex (vmPFC); and 3) the amygdala. Moreover, these brain regions were confirmed by a meta-analysis, using a platform for large-scale, automated synthesis of fMRI data. Finally, by adopting a neurolinguistic and a big data approach, we illustrate how AF are expressed in language.
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25
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Bravo IM, Luster BR, Flanigan ME, Perez PJ, Cogan ES, Schmidt KT, McElligott ZA. Divergent behavioral responses in protracted opioid withdrawal in male and female C57BL/6J mice. Eur J Neurosci 2020; 51:742-754. [PMID: 31544297 PMCID: PMC7069788 DOI: 10.1111/ejn.14580] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 01/24/2023]
Abstract
Persons suffering from opioid use disorder (OUD) experience long-lasting dysphoric symptoms well into extended periods of withdrawal. This protracted withdrawal syndrome is notably characterized by heightened anxiety and hyperkatifeia. Here, we investigated if an exacerbated withdrawal model of acute morphine dependence results in lasting behavioral adaptation 6 weeks into forced abstinence in C57BL/6J mice. We found that our exacerbated morphine withdrawal paradigm produced distinct alterations in behavior in elevated plus maze (EPM), open field, and social interaction tests in male and female mice. Following protracted withdrawal male mice showed enhanced exploration of the open arms of the EPM, reduced latency to enter the corner of the OF, and a social interaction deficit. In contrast, female mice showed enhanced thigmotaxis in the OF. In both sexes, protracted withdrawal enhanced locomotor behavior in response to subsequent morphine challenge, albeit at different doses. These findings will be relevant for future investigation examining the neural mechanisms underlying these behaviors and will aid in uncovering physiological sex differences in response to opioid withdrawal.
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Affiliation(s)
- Isabel M. Bravo
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brennon R. Luster
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Meghan E. Flanigan
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Patric J. Perez
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Post-baccalaureate Research Education Program, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Elizabeth S. Cogan
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karl T. Schmidt
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Zoe A. McElligott
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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26
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Flook EA, Feola B, Avery SN, Winder DG, Woodward ND, Heckers S, Blackford JU. BNST-insula structural connectivity in humans. Neuroimage 2020; 210:116555. [PMID: 31954845 DOI: 10.1016/j.neuroimage.2020.116555] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/10/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST) is emerging as a critical region in multiple psychiatric disorders including anxiety, PTSD, and alcohol and substance use disorders. In conjunction with growing knowledge of the BNST, an increasing number of studies examine connections of the BNST and how those connections impact BNST function. The importance of this BNST network is highlighted by rodent studies demonstrating that projections from other brain regions regulate BNST activity and influence BNST-related behavior. While many animal and human studies replicate the components of the BNST network, to date, structural connections between the BNST and insula have only been described in rodents and have yet to be shown in humans. In this study, we used probabilistic tractography to examine BNST-insula structural connectivity in humans. We used two methods of dividing the insula: 1) anterior and posterior insula, to be consistent with much of the existing insula literature; and 2) eight subregions that represent informative cytoarchitectural divisions. We found evidence of a BNST-insula structural connection in humans, with the strongest BNST connectivity localized to the anteroventral insula, a region of agranular cortex. BNST-insula connectivity differed by hemisphere and was moderated by sex. These results translate rodent findings to humans and lay an important foundation for future studies examining the role of BNST-insula pathways in psychiatric disorders.
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Affiliation(s)
- Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
| | - Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Suzanne N Avery
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danny G Winder
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA; Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Neil D Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA; Research and Development, Department of Veterans Affairs Medical Center, Nashville, TN, USA.
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27
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Dzafic I, Oestreich L, Martin AK, Mowry B, Burianová H. Stria terminalis, amygdala, and temporoparietal junction networks facilitate efficient emotion processing under expectations. Hum Brain Mapp 2019; 40:5382-5396. [PMID: 31460690 PMCID: PMC6864902 DOI: 10.1002/hbm.24779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/11/2019] [Accepted: 08/18/2019] [Indexed: 01/17/2023] Open
Abstract
Rapid emotion processing is an ecologically essential ability for survival in social environments in which threatening or advantageous encounters dynamically and rapidly occur. Efficient emotion recognition is subserved by different processes, depending on one's expectations; however, the underlying functional and structural circuitry is still poorly understood. In this study, we delineate brain networks that subserve fast recognition of emotion in situations either congruent or incongruent with prior expectations. For this purpose, we used multimodal neuroimaging and investigated performance on a dynamic emotion perception task. We show that the extended amygdala structural and functional networks relate to speed of emotion processing under threatening conditions. Specifically, increased microstructure of the right stria terminalis, an amygdala white-matter pathway, was related to faster detection of emotion during actual presentation of anger or after cueing anger. Moreover, functional connectivity of right amygdala with limbic regions was related to faster detection of anger congruent with cue, suggesting selective attention to threat. On the contrary, we found that faster detection of anger incongruent with cue engaged the ventral attention "reorienting" network. Faster detection of happiness, in either expectancy context, engaged a widespread frontotemporal-subcortical functional network. These findings shed light on the functional and structural circuitries that facilitate speed of emotion recognition and, for the first time, elucidate a role for the stria terminalis in human emotion processing.
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Affiliation(s)
- Ilvana Dzafic
- Queensland Brain InstituteUniversity of QueenslandBrisbaneAustralia
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
- Australian Research Council Centre of Excellence for Integrative Brain FunctionAustralia
| | - Lena Oestreich
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
- University of Queensland Centre for Clinical ResearchBrisbaneAustralia
| | - Andrew K. Martin
- University of Queensland Centre for Clinical ResearchBrisbaneAustralia
- Department of PsychologyDurham UniversityDurhamUK
| | - Bryan Mowry
- Queensland Brain InstituteUniversity of QueenslandBrisbaneAustralia
- Queensland Centre for Mental Health ResearchBrisbaneAustralia
| | - Hana Burianová
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneAustralia
- Department of PsychologySwansea UniversitySwanseaUnited Kingdom
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28
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Grillon C, Robinson OJ, Cornwell B, Ernst M. Modeling anxiety in healthy humans: a key intermediate bridge between basic and clinical sciences. Neuropsychopharmacology 2019; 44:1999-2010. [PMID: 31226707 PMCID: PMC6897969 DOI: 10.1038/s41386-019-0445-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022]
Abstract
Animal models of anxiety disorders are important for elucidating neurobiological defense mechanisms. However, animal models are limited when it comes to understanding the more complex processes of anxiety that are unique to humans (e.g., worry) and to screen new treatments. In this review, we outline how the Experimental Psychopathology approach, based on experimental models of anxiety in healthy subjects, can mitigate these limitations and complement research in animals. Experimental psychopathology can bridge basic research in animals and clinical studies, as well as guide and constrain hypotheses about the nature of psychopathology, treatment mechanisms, and treatment targets. This review begins with a brief review of the strengths and limitations of animal models before discussing the need for human models of anxiety, which are especially necessary to probe higher-order cognitive processes. This can be accomplished by combining anxiety-induction procedures with tasks that probe clinically relevant processes to identify neurocircuits that are potentially altered by anxiety. The review then discusses the validity of experimental psychopathology and introduces a methodological approach consisting of five steps: (1) select anxiety-relevant cognitive or behavioral operations and associated tasks, (2) identify the underlying neurocircuits supporting these operations in healthy controls, 3) examine the impact of experimental anxiety on the targeted operations in healthy controls, (4) utilize findings from step 3 to generate hypotheses about neurocircuit dysfunction in anxious patients, and 5) evaluate treatment mechanisms and screen novel treatments. This is followed by two concrete illustrations of this approach and suggestions for future studies.
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Affiliation(s)
- Christian Grillon
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA.
| | - Oliver J Robinson
- University College London, Institute of Cognitive Neuroscience, London, UK
| | - Brian Cornwell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Monique Ernst
- Section on the Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
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29
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Weis CN, Huggins AA, Bennett KP, Parisi EA, Larson CL. High-Resolution Resting-State Functional Connectivity of the Extended Amygdala. Brain Connect 2019; 9:627-637. [DOI: 10.1089/brain.2019.0688] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Carissa N. Weis
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Ashley A. Huggins
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Kenneth P. Bennett
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Elizabeth A. Parisi
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
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30
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Wu M, Mennin DS, Ly M, Karim HT, Banihashemi L, Tudorascu DL, Aizenstein HJ, Andreescu C. When worry may be good for you: Worry severity and limbic-prefrontal functional connectivity in late-life generalized anxiety disorder. J Affect Disord 2019; 257:650-657. [PMID: 31357162 PMCID: PMC6711791 DOI: 10.1016/j.jad.2019.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/31/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late-life generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older adults. However, its neural markers have received relatively little attention. In this study, we explored the association between worry severity and limbic-prefrontal connectivity during emotional reactivity in late-life GAD. METHODS We recruited 16 anxious (GAD) and 20 non-anxious (HC) older adults to perform the faces/shapes emotional reactivity task during functional magnetic resonance imaging (fMRI). We investigated the functional connectivity of both the amygdala and the bed nucleus of stria terminalis (BNST) with the prefrontal cortex (PFC) using generalized psychophysiological interaction (gPPI) analysis. We tested for (1) group differences in connectivity, (2) association between worry severity and connectivity, and (3) interaction between group and worry severity and its association with connectivity. RESULTS Amygdala-PFC and BNST-PFC functional connectivity were associated with worry severity in an inverse U-shape, and was independent of depression severity, global anxiety, neuroticism, and general cognitive function. LIMITATIONS Our limitations include slightly skewed PSWQ distributions, lack of non-anxious individuals with high worry, small sample size, and low depression comorbidity in a sample of late-life GAD that may not generalize to GAD in younger populations. CONCLUSIONS This suggests that moderate worry is associated with maximum engagement of the limbic-PFC connectivity, while severe worry is associated with failure of the limbic-PFC emotional regulation circuit. This may explain the aberrant and exaggerated responses to negative stimuli observed in participants with pathological worry.
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Affiliation(s)
- M Wu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DS Mennin
- Teachers college, Columbia University, New York City, NY
| | - M Ly
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - HT Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - L Banihashemi
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DL Tudorascu
- Department of Internal Medicine, Graduate School of Public health, Pittsburgh, PA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
| | - HJ Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - C Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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31
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Clauss JA, Avery SN, Benningfield MM, Blackford JU. Social anxiety is associated with BNST response to unpredictability. Depress Anxiety 2019; 36:666-675. [PMID: 30953446 PMCID: PMC6679811 DOI: 10.1002/da.22891] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/04/2019] [Accepted: 03/02/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause substantial suffering and impairment. Whereas the amygdala has well-established contributions to anxiety, evidence from rodent and nonhuman primate models suggests that the bed nucleus of the stria terminalis (BNST) may play a critical, and possibly distinct, role in human anxiety disorders. The BNST mediates hypervigilance and anticipatory anxiety in response to an unpredictable or ambiguous threat, core symptoms of social anxiety, yet little is known about the BNST's role in social anxiety. METHODS Functional magnetic resonance imaging was used to measure neural responses during a cued anticipation task with an unpredictable, predictable threat, and predictable neutral cues followed by threat or neutral images. Social anxiety was examined using a dimensional approach (N = 44 adults). RESULTS For unpredictable cues, higher social anxiety was associated with lower BNST-amygdala connectivity. For unpredictable images, higher social anxiety was associated with greater connectivity between the BNST and both the ventromedial prefrontal cortex and the posterior cingulate cortex and lower connectivity between the BNST and postcentral gyrus. Social anxiety moderated the BNST-amygdala dissociation for unpredictable images; higher social anxiety was associated with BNST > amygdala response to unpredictable threat relative to unpredictable neutral images. CONCLUSIONS Social anxiety was associated with alterations in BNST responses to unpredictability, particularly in the BNST's interactions with other brain regions, including the amygdala and prefrontal cortex. To our knowledge, these findings provide the first evidence for the BNST's role in social anxiety, which may be a potential new target for prevention and intervention.
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Affiliation(s)
- Jacqueline A Clauss
- Massachusetts General and McLean Hospitals, Harvard Medical School, Boston, MA
| | - Suzanne N Avery
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret M Benningfield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Department of Psychology, Vanderbilt University, Nashville, TN,Research Service, Research and Development, Department of Veterans Affairs Medical Center, Nashville, TN
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32
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Marcinkiewcz CA, Bierlein-De La Rosa G, Dorrier CE, McKnight M, DiBerto JF, Pati D, Gianessi CA, Hon OJ, Tipton G, McElligott ZA, Delpire E, Kash TL. Sex-Dependent Modulation of Anxiety and Fear by 5-HT 1A Receptors in the Bed Nucleus of the Stria Terminalis. ACS Chem Neurosci 2019; 10:3154-3166. [PMID: 31140276 DOI: 10.1021/acschemneuro.8b00594] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Serotonin (5-hydroxytryptamine; 5-HT) coordinates behavioral responses to stress through a variety of presynaptic and postsynaptic receptors distributed across functionally diverse neuronal networks in the central nervous system. Efferent 5-HT projections from the dorsal raphe nucleus (DRN) to the bed nucleus of the stria terminalis (BNST) are generally thought to enhance anxiety and aversive learning by activating 5-HT2C receptor (5-HT2CR) signaling in the BNST, although an opposing role for postsynaptic 5-HT1A receptors has recently been suggested. In the present study, we sought to delineate a role for postsynaptic 5-HT1A receptors in the BNST in aversive behaviors using a conditional knockdown of the 5-HT1A receptor. Both males and females were tested to dissect out sex-specific effects. We found that male mice have significantly reduced fear memory recall relative to female mice and inactivation of 5-HT1A receptor in the BNST increases contextual fear conditioning in male mice so that they resemble the females. This coincided with an increase in neuronal excitability in males, suggesting that 5-HT1A receptor deletion may enhance contextual fear recall by disinhibiting fear memory circuits in the BNST. Interestingly, 5-HT1A receptor knockdown did not significantly alter anxiety-like behavior in male or female mice, which is in agreement with previous findings that anxiety and fear are modulated by dissociable circuits in the BNST. Overall, these results suggest that BNST 5-HT1A receptors do not significantly alter behavior under basal conditions, but can act as a molecular brake that buffer against excessive activation of aversive circuits in more threatening contexts.
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Affiliation(s)
- Catherine A. Marcinkiewcz
- Department of Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, United States
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | | | - Cayce E. Dorrier
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Mackenzie McKnight
- Department of Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, United States
| | - Jeffrey F. DiBerto
- Curriculum in Neurobiology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, United States
| | - Dipanwati Pati
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Carol A. Gianessi
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Olivia J. Hon
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Curriculum in Neurobiology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, United States
| | - Greg Tipton
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Zoe A. McElligott
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Curriculum in Neurobiology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, United States
| | - Eric Delpire
- Department of Anesthesiology, School of Medicine, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Thomas L. Kash
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- Curriculum in Neurobiology, School of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599, United States
- Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
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33
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Goossen B, van der Starre J, van der Heiden C. A review of neuroimaging studies in generalized anxiety disorder: "So where do we stand?". J Neural Transm (Vienna) 2019; 126:1203-1216. [PMID: 31222605 DOI: 10.1007/s00702-019-02024-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022]
Abstract
Generalized anxiety disorder (GAD) is a prevalent anxiety disorder, but is still poorly recognized in clinical practice. The aim of this review is to provide a coherent understanding of the functional neuroanatomy of GAD; second, to discuss the current theoretical cognitive models surrounding GAD; and finally to discuss the discrepancy between fundamental research and clinical practice and highlight several potential directions for future research in this domain. A systematic review of original papers investigating the neural correlates of DSM-IV and DSM-5 defined GAD samples was undertaken in Ovid literature search, PubMed, Medline, EMbase, PsycINFO, Google Scholar, and TRIP databases. Articles published between 2007 and 2018 were included. First, GAD seems to be characterized by limbic and (pre)frontal abnormalities. More specifically, GAD patients show difficulties in engaging the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) during emotional regulation tasks. Second, the involved brain areas appear to be characterized by heterogeneity possibly due to a variety of experimental designs and test subjects. Third, regarding the discrimination between GAD and other anxiety disorders via fMRI, results appear to be mixed. Studies report both GAD-specific activity and an inability to differentiate between GAD and other anxiety or mood disorders. The usage of different experimental tasks, test subjects, outcome measures and experimental designs limits the possibilities of generalizing results as well as conducting meta-analytical research. Certain theoretical models of GAD describe our understanding of this disorder and form the basis for treatment interventions. However, fMRI research thus far has failed to validate these models. To bridge the gap between fundamental research and clinical practice in GAD, we propose that fMRI researchers make an effort to validate the existing cognitive model of GAD. An alternative approach could be that new models would be based on current neuroimaging research as well as convergent research methods such as Heart Rate Variability (a bottom up approach).
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Affiliation(s)
- Bastiaan Goossen
- Outpatient Treatment Center GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands.
| | | | - Colin van der Heiden
- Outpatient Treatment Center Indigo, Spijkenisse, The Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Dong M, Xia L, Lu M, Li C, Xu K, Zhang L. A failed top-down control from the prefrontal cortex to the amygdala in generalized anxiety disorder: Evidence from resting-state fMRI with Granger causality analysis. Neurosci Lett 2019; 707:134314. [PMID: 31163226 DOI: 10.1016/j.neulet.2019.134314] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 12/29/2022]
Abstract
In generalized anxiety disorder (GAD), abnormal top-down control from the prefrontal cortex (PFC) to the amygdala is a widely accepted hypothesis through which an "emotional dysregulation model" may be explained. However, whether and how the PFC directly exerts abnormal top-down control on the amygdala remains largely unknown. We aimed to investigate the amygdala-based effective connectivity by using Granger causality analysis (GCA). Thirty-five drug-naive patients with GAD and thirty-six healthy controls (HC) underwent resting-state functional MR imaging. We used seed-based Granger causality analysis to examine the effective connectivity between the bilateral amygdala and the whole brain. The amygdala-based effective connectivity was compared between the HC and GAD groups. The results showed that, in the HC group, the left middle frontal gyrus exerted an inhibitory influence on the right amygdala, while in the GAD group, this influence was disrupted (single voxel P < 0.001, Gaussian random field corrected with P < 0.01). Our findings support and advance the "insufficient top-down control" hypothesis by identifying a failed top-down control from the prefrontal cortex to the amygdala in GAD.
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Affiliation(s)
- Mengshi Dong
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Likun Xia
- Department of Magnetic Resonance Imaging, People's Hospital of Yuxi City, Yuxi 653100, China
| | - Min Lu
- Department of Magnetic Resonance Imaging, People's Hospital of Yuxi City, Yuxi 653100, China
| | - Chao Li
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Ke Xu
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
| | - Lina Zhang
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
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Boecker L, Pauli P. Affective startle modulation and psychopathology: Implications for appetitive and defensive brain systems. Neurosci Biobehav Rev 2019; 103:230-266. [PMID: 31129237 DOI: 10.1016/j.neubiorev.2019.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/12/2019] [Accepted: 05/18/2019] [Indexed: 02/06/2023]
Abstract
Startle reflex potentiation versus startle attenuation to unpleasant versus pleasant stimuli likely reflect priming of the defensive versus appetitive motivational systems, respectively. This review summarizes and systemizes the literature on affective startle modulation related to psychopathologies with the aim to reveal underlying mechanisms across psychopathologies. We found evidence for psychopathologies characterized by increased startle potentiation to unpleasant stimuli (anxiety disorders), decreased startle potentiation to unpleasant stimuli (psychopathy), decreased startle attenuation to pleasant stimuli (ADHD), as well as a general hyporeactivity to affective stimuli (depression). Increased versus decreased startle responses to disorder-specific stimuli characterize specific phobia and drug dependence. No psychopathology is characterized by increased startle attenuation to standard pleasant stimuli or a general hyperreactivity to affective stimuli. This review indicates that the defensive and the appetitive systems operate independently mostly in accordance with the motivational priming hypothesis and that affective startle modulation is a highly valuable paradigm to unraveling dysfunctions of the defensive and appetitive systems in psychopathologies as requested by the Research Domain Criteria initiative.
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Affiliation(s)
- Lea Boecker
- Department of Economic Psychology, Social Psychology & Experimental Methods, Leuphana University of Lüneburg, Universitätsallee 1, 21335 Lüneburg, Germany.
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070 Germany; Center of Mental Health, Medical Faculty, University of Würzburg, Germany
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Madonna D, Delvecchio G, Soares JC, Brambilla P. Structural and functional neuroimaging studies in generalized anxiety disorder: a systematic review. ACTA ACUST UNITED AC 2019; 41:336-362. [PMID: 31116259 PMCID: PMC6804309 DOI: 10.1590/1516-4446-2018-0108] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/16/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Brain imaging studies carried out in patients suffering from generalized anxiety disorder (GAD) have contributed to better characterize the pathophysiological mechanisms underlying this disorder. The present study reviews the available functional and structural brain imaging evidence on GAD, and suggests further strategies for investigations in this field. METHODS A systematic literature review was performed in PubMed, PsycINFO, and Google Scholar, aiming to identify original research evaluating GAD patients with the use of structural and functional magnetic resonance imaging as well as diffusion tensor imaging. RESULTS The available studies have shown impairments in ventrolateral and dorsolateral prefrontal cortex, anterior cingulate, posterior parietal regions, and amygdala in both pediatric and adult GAD patients, mostly in the right hemisphere. However, the literature is often tentative, given that most studies have employed small samples and included patients with comorbidities or in current use of various medications. Finally, different methodological aspects, such as the type of imaging equipment used, also complicate the generalizability of the findings. CONCLUSIONS Longitudinal neuroimaging studies with larger samples of both juvenile and adult GAD patients, as well as at risk individuals and unaffected relatives, should be carried out in order to shed light on the specific biological signature of GAD.
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Affiliation(s)
- Domenico Madonna
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá di Milano, Milano, Italy.,Dipartimento di Neuroscienze e Salute Mentale, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuseppe Delvecchio
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá di Milano, Milano, Italy
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Paolo Brambilla
- Dipartimento di Neuroscienze e Salute Mentale, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, USA
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Goode TD, Ressler RL, Acca GM, Miles OW, Maren S. Bed nucleus of the stria terminalis regulates fear to unpredictable threat signals. eLife 2019; 8:46525. [PMID: 30946011 PMCID: PMC6456295 DOI: 10.7554/elife.46525] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 12/15/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST) has been implicated in conditioned fear and anxiety, but the specific factors that engage the BNST in defensive behaviors are unclear. Here we examined whether the BNST mediates freezing to conditioned stimuli (CSs) that poorly predict the onset of aversive unconditioned stimuli (USs) in rats. Reversible inactivation of the BNST selectively reduced freezing to CSs that poorly signaled US onset (e.g., a backward CS that followed the US), but did not eliminate freezing to forward CSs even when they predicted USs of variable intensity. Additionally, backward (but not forward) CSs selectively increased Fos in the ventral BNST and in BNST-projecting neurons in the infralimbic region of the medial prefrontal cortex (mPFC), but not in the hippocampus or amygdala. These data reveal that BNST circuits regulate fear to unpredictable threats, which may be critical to the etiology and expression of anxiety.
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Affiliation(s)
- Travis D Goode
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Reed L Ressler
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Gillian M Acca
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Olivia W Miles
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
| | - Stephen Maren
- Department of Psychological and Brain Sciences, Institute for Neuroscience, Texas A&M University, College Station, United States
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Hofmann D, Straube T. Resting-state fMRI effective connectivity between the bed nucleus of the stria terminalis and amygdala nuclei. Hum Brain Mapp 2019; 40:2723-2735. [PMID: 30829454 DOI: 10.1002/hbm.24555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 12/17/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST) and the laterobasal nucleus (LB), centromedial nucleus (CM), and superficial nucleus (SF) of the amygdala form an interconnected dynamical system, whose combined activity mediates a variety of behavioral and autonomic responses in reaction to homeostatic challenges. Although previous research provided deeper insight into the structural and functional connections between these nuclei, studies investigating their resting-state functional magnetic resonance imaging (fMRI) connectivity were solely based on undirected connectivity measures. Here, we used high-quality data of 391 subjects from the Human Connectome Project to estimate the effective connectivity (EC) between the BNST, the LB, CM, and SF through spectral dynamic causal modeling, the relation of the EC estimates with age and sex as well as their stability over time. Our results reveal a time-stable asymmetric EC structure with positive EC between all amygdala nuclei, which strongly inhibited the BNST while the BNST exerted positive influence onto all amygdala nuclei. Simulation of the impulse response of the estimated system showed that this EC structure shapes partially antagonistic (out of phase) activity flow between the BNST and amygdala nuclei. Moreover, the BNST-LB and BNST-CM EC parameters were less negative in males. In conclusion, our data points toward partially separated information processing between BNST and amygdala nuclei in the resting-state.
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Affiliation(s)
- David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Muenster, Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Muenster, Muenster, Germany
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39
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Phasic amygdala and BNST activation during the anticipation of temporally unpredictable social observation in social anxiety disorder patients. NEUROIMAGE-CLINICAL 2019; 22:101735. [PMID: 30878610 PMCID: PMC6423472 DOI: 10.1016/j.nicl.2019.101735] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 01/05/2023]
Abstract
Anticipation of potentially threatening social situations is a key process in social anxiety disorder (SAD). In other anxiety disorders, recent research of neural correlates of anticipation of temporally unpredictable threat suggests a temporally dissociable involvement of amygdala and bed nucleus of the stria terminalis (BNST) with phasic amygdala responses and sustained BNST activation. However, the temporal profile of amygdala and BNST responses during temporal unpredictability of threat has not been investigated in patients suffering from SAD. We used functional magnetic resonance imaging (fMRI) to investigate neural activation in the central nucleus of the amygdala (CeA) and the BNST during anticipation of temporally unpredictable aversive (video camera observation) relative to neutral (no camera observation) events in SAD patients compared to healthy controls (HC). For the analysis of fMRI data, we applied two regressors (phasic/sustained) within the same model to detect temporally dissociable brain responses. The aversive condition induced increased anxiety in patients compared to HC. SAD patients compared to HC showed increased phasic activation in the CeA and the BNST for anticipation of aversive relative to neutral events. SAD patients as well as HC showed sustained activity alterations in the BNST for aversive relative to neutral anticipation. No differential activity during sustained threat anticipation in SAD patients compared to HC was found. Taken together, our study reveals both CeA and BNST involvement during threat anticipation in SAD patients. The present results point towards potentially SAD-specific threat processing marked by elevated phasic but not sustained CeA and BNST responses when compared to HC. fMRI in SAD during anticipation of temporally unpredictable aversive events. Anticipation of social observation induces increased anxiety in SAD patients. SAD patients show elevated phasic activity in fundamental anxiety network regions. Evidence of SAD-specific threat processing.
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40
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Fox AS, Shackman AJ. The central extended amygdala in fear and anxiety: Closing the gap between mechanistic and neuroimaging research. Neurosci Lett 2019; 693:58-67. [PMID: 29195911 PMCID: PMC5976525 DOI: 10.1016/j.neulet.2017.11.056] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/30/2017] [Accepted: 11/26/2017] [Indexed: 12/19/2022]
Abstract
Anxiety disorders impose a staggering burden on public health, underscoring the need to develop a deeper understanding of the distributed neural circuits underlying extreme fear and anxiety. Recent work highlights the importance of the central extended amygdala, including the central nucleus of the amygdala (Ce) and neighboring bed nucleus of the stria terminalis (BST). Anatomical data indicate that the Ce and BST form a tightly interconnected unit, where different kinds of threat-relevant information can be integrated to assemble states of fear and anxiety. Neuroimaging studies show that the Ce and BST are engaged by a broad spectrum of potentially threat-relevant cues. Mechanistic work demonstrates that the Ce and BST are critically involved in organizing defensive responses to a wide range of threats. Studies in rodents have begun to reveal the specific molecules, cells, and microcircuits within the central extended amygdala that underlie signs of fear and anxiety, but the relevance of these tantalizing discoveries to human experience and disease remains unclear. Using a combination of focal perturbations and whole-brain imaging, a new generation of nonhuman primate studies is beginning to close this gap. This work opens the door to discovering the mechanisms underlying neuroimaging measures linked to pathological fear and anxiety, to understanding how the Ce and BST interact with one another and with distal brain regions to govern defensive responses to threat, and to developing improved intervention strategies.
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Affiliation(s)
- Andrew S Fox
- Department of Psychology and University of California, Davis, CA 95616, United States; California National Primate Research Center, University of California, Davis, CA 95616, United States.
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, MD 20742, United States; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD 20742, United States; Maryland Neuroimaging Center, University of Maryland,College Park, MD 20742, United States.
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41
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Social brain, social dysfunction and social withdrawal. Neurosci Biobehav Rev 2019; 97:10-33. [DOI: 10.1016/j.neubiorev.2018.09.012] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/31/2018] [Accepted: 09/17/2018] [Indexed: 01/07/2023]
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Knight LK, Depue BE. New Frontiers in Anxiety Research: The Translational Potential of the Bed Nucleus of the Stria Terminalis. Front Psychiatry 2019; 10:510. [PMID: 31379626 PMCID: PMC6650589 DOI: 10.3389/fpsyt.2019.00510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/28/2019] [Indexed: 12/17/2022] Open
Abstract
After decades of being overshadowed by the amygdala, new perspectives suggest that a tiny basal forebrain region known as the bed nucleus of the stria terminalis (BNST) may hold key insights into understanding and treating anxiety disorders. Converging research indicates that the amygdala and BNST play complementary but distinct functional roles during threat processing, with the BNST specializing in the detection of a potential threat to maintain hypervigilance and anxiety, while the amygdala responds to the perceived presence of an aversive stimulus (i.e., fear). Therefore, given that human anxiety is largely driven by future-oriented hypothetical threats that may never occur, studies involving the BNST stand at the forefront of essential future research with the potential to bring about profound insights for understanding and treating anxiety disorders. In this article, we present a narrative review on the BNST, summarizing its roles in anxiety and the stress response and highlighting the most recent advances in the clinical realm. Furthermore, we discuss oversights in the current state of anxiety research and identify avenues for future exploration.
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Affiliation(s)
- Lindsay K Knight
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, United States.,Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
| | - Brendan E Depue
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
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Herrmann MJ, Simons BS, Horst AK, Boehme S, Straube T, Polak T. Modulation of sustained fear by transcranial direct current stimulation (tDCS) of the right inferior frontal cortex (rIFC). Biol Psychol 2018; 139:173-177. [DOI: 10.1016/j.biopsycho.2018.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/11/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023]
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Functional Connectivity within the Primate Extended Amygdala Is Heritable and Associated with Early-Life Anxious Temperament. J Neurosci 2018; 38:7611-7621. [PMID: 30061190 DOI: 10.1523/jneurosci.0102-18.2018] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/23/2018] [Accepted: 07/07/2018] [Indexed: 02/08/2023] Open
Abstract
Children with an extremely inhibited, anxious temperament (AT) are at increased risk for anxiety disorders and depression. Using a rhesus monkey model of early-life AT, we previously demonstrated that metabolism in the central extended amygdala (EAc), including the central nucleus of the amygdala (Ce) and bed nucleus of the stria terminalis (BST), is associated with trait-like variation in AT. Here, we use fMRI to examine relationships between Ce-BST functional connectivity and AT in a large multigenerational family pedigree of rhesus monkeys (n = 170 females and 208 males). Results demonstrate that Ce-BST functional connectivity is heritable, accounts for a significant but modest portion of the variance in AT, and is coheritable with AT. Interestingly, Ce-BST functional connectivity and AT-related BST metabolism were not correlated and accounted for non-overlapping variance in AT. Exploratory analyses suggest that Ce-BST functional connectivity is associated with metabolism in the hypothalamus and periaqueductal gray. Together, these results suggest the importance of coordinated function within the EAc for determining individual differences in AT and metabolism in brain regions associated with its behavioral and neuroendocrine components.SIGNIFICANCE STATEMENT Anxiety disorders directly impact the lives of nearly one in five people, accounting for substantial worldwide suffering and disability. Here, we use a nonhuman primate model of anxious temperament (AT) to understand the neurobiology underlying the early-life risk to develop anxiety disorders. Leveraging the same kinds of neuroimaging measures routinely used in human studies, we demonstrate that coordinated activation between the central nucleus of the amygdala and the bed nucleus of the stria terminalis is correlated with, and coinherited with, early-life AT. Understanding how these central extended amygdala regions work together to produce extreme anxiety provides a neural target for early-life interventions with the promise of preventing lifelong disability in at-risk children.
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Tillman RM, Stockbridge MD, Nacewicz BM, Torrisi S, Fox AS, Smith JF, Shackman AJ. Intrinsic functional connectivity of the central extended amygdala. Hum Brain Mapp 2018; 39:1291-1312. [PMID: 29235190 PMCID: PMC5807241 DOI: 10.1002/hbm.23917] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022] Open
Abstract
The central extended amygdala (EAc)-including the bed nucleus of the stria terminalis (BST) and central nucleus of the amygdala (Ce)-plays a critical role in triggering fear and anxiety and is implicated in the development of a range of debilitating neuropsychiatric disorders. Although it is widely believed that these disorders reflect the coordinated activity of distributed neural circuits, the functional architecture of the EAc network and the degree to which the BST and the Ce show distinct patterns of functional connectivity is unclear. Here, we used a novel combination of imaging approaches to trace the connectivity of the BST and the Ce in 130 healthy, racially diverse, community-dwelling adults. Multiband imaging, high-precision registration techniques, and spatially unsmoothed data maximized anatomical specificity. Using newly developed seed regions, whole-brain regression analyses revealed robust functional connectivity between the BST and Ce via the sublenticular extended amygdala, the ribbon of subcortical gray matter encompassing the ventral amygdalofugal pathway. Both regions displayed coupling with the ventromedial prefrontal cortex (vmPFC), midcingulate cortex (MCC), insula, and anterior hippocampus. The BST showed stronger connectivity with the thalamus, striatum, periaqueductal gray, and several prefrontal territories. The only regions showing stronger functional connectivity with the Ce were neighboring regions of the dorsal amygdala, amygdalohippocampal area, and anterior hippocampus. These observations provide a baseline against which to compare a range of special populations, inform our understanding of the role of the EAc in normal and pathological fear and anxiety, and showcase image registration techniques that are likely to be useful for researchers working with "deidentified" neuroimaging data.
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Affiliation(s)
| | - Melissa D. Stockbridge
- Department of Hearing and Speech SciencesUniversity of MarylandCollege ParkMaryland20742
| | - Brendon M. Nacewicz
- Department of PsychiatryUniversity of Wisconsin—Madison, 6001 Research Park BoulevardMadisonWisconsin53719
| | - Salvatore Torrisi
- Section on the Neurobiology of Fear and AnxietyNational Institute of Mental HealthBethesdaMaryland20892
| | - Andrew S. Fox
- Department of PsychologyUniversity of CaliforniaDavisCalifornia95616
- California National Primate Research CenterUniversity of CaliforniaDavisCalifornia95616
| | - Jason F. Smith
- Department of PsychologyUniversity of MarylandCollege ParkMaryland20742
| | - Alexander J. Shackman
- Department of PsychologyUniversity of MarylandCollege ParkMaryland20742
- Neuroscience and Cognitive Science ProgramUniversity of MarylandCollege ParkMaryland20742
- Maryland Neuroimaging CenterUniversity of MarylandCollege ParkMaryland20742
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Bordoni B, Marelli F, Morabito B, Sacconi B. Depression and anxiety in patients with chronic heart failure. Future Cardiol 2018; 14:115-119. [DOI: 10.2217/fca-2017-0073] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization & Care with Scientific Address, S Maria Nascente, Via Capecelatro 66, Milan 20100, Italy
| | - Fabiola Marelli
- CRESO, School of Osteopathic Centre for Research & Studies, Gorla Minore (VA) Piazza XXV Aprile 4, 21055, Italy
- CRESO, School of Osteopathic Centre for Research & Studies, Via Fanella, 91 61032 Fano (Pesaro Urbino), Italy
| | - Bruno Morabito
- CRESO, School of Osteopathic Centre for Research & Studies, Gorla Minore (VA) Piazza XXV Aprile 4, 21055, Italy
- CRESO, School of Osteopathic Centre for Research & Studies, Via Fanella, 91 61032 Fano (Pesaro Urbino), Italy
- Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Beatrice Sacconi
- Department of Radiological, Oncological & Anatomopathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
- Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena 291, Rome, Italy
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