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Bonnekoh LM, Seidenbecher S, Knigge K, Hünecke AK, Metzger CD, Tempelmann C, Kanowski M, Kaufmann J, Meyer-Lotz G, Schlaaff K, Dobrowolny H, Tozzi L, Gescher DM, Steiner J, Kirschbaum C, Frodl T. Long-term cortisol stress response in depression and comorbid anxiety is linked with reduced N-acetylaspartate in the anterior cingulate cortex. World J Biol Psychiatry 2023; 24:34-45. [PMID: 35332851 DOI: 10.1080/15622975.2022.2058084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Major Depression (MDD) and anxiety disorders are stress-related disorders that share pathophysiological mechanisms. There is evidence for alterations of glutamate-glutamine, N-acetylaspartate (NAA) and GABA in the anterior cingulate cortex (ACC), a stress-sensitive region affected by hypothalamic-pituitary-adrenal axis (HPA). The aim was to investigate metabolic alterations in the ACC and whether hair cortisol, current stress or early life adversity predict them. METHODS We investigated 22 patients with MDD and comorbid anxiety disorder and 23 healthy controls. Proton magnetic resonance spectroscopy was performed with voxels placed in pregenual (pg) and dorsal (d) ACC in 3 T. Analysis of hair cortisol was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS The N-acetylaspartate/Creatin ratio (NAA/Cr) was reduced in patients in both pgACC (p = .040) and dACC (p = .016). A significant interactive effect of diagnosis and cortisol on both pg-NAA/Cr (F = 5.00, p = .033) and d-NAA/Cr (F = 7.86, p = .009) was detected, whereby in controls cortisol was positively correlated with d-NAA/Cr (r = 0.61, p = .004). CONCLUSIONS Our results suggest a relationship between NAA metabolism in ACC and HPA axis activity as represented by long-term cortisol output.
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Affiliation(s)
- Linda M Bonnekoh
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Münster, Münster, Germany
| | - Stephanie Seidenbecher
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Katrin Knigge
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Anne-Kathrin Hünecke
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Coraline D Metzger
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Claus Tempelmann
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany.,Center of Behavioral Brain Sciences (CBBS), Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - Martin Kanowski
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Gabriela Meyer-Lotz
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Konstantin Schlaaff
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Translational Psychiatry Laboratory, Otto von Guericke University, Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Leonardo Tozzi
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Dorothee M Gescher
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University RWTH, Aachen, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Translational Psychiatry Laboratory, Otto von Guericke University, Magdeburg, Germany
| | - Clemens Kirschbaum
- Department of Psychology, Dresden University of Technology, Dresden, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Center of Behavioral Brain Sciences (CBBS), Otto von Guericke Universität Magdeburg, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University RWTH, Aachen, Germany
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Erbay MF, Zayman EP. The Role of Insular Cortex in Response to Group Therapy in Vaginismus Patients: Magnetic Resonance Spectroscopy Study. Psychiatry Investig 2020; 17:608-612. [PMID: 32517415 PMCID: PMC7324733 DOI: 10.30773/pi.2019.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/05/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Disgust has been propounded as a potential etiological factor in certain sexual dysfunctions such as vaginismus. Studies reports that insular cortex is activated as a response to disgust. The present study aimed to investigate the predictive role of metabolites in insular cortex in response to group therapy among vaginismus patients. METHODS Study sample consisted of 51 vaginismus patients attended an ambulatory group therapy, of whom 26 benefited from 8-week group therapy and 25 were unresponsive to group therapy. All of the patients underwent H magnetic resonance spectroscopy (H-MRS), and insular cortex N-acetyl aspartate (NAA), Creatinine (Cr), Glutamine (Gln), Glutathione (GSH), Choline (Cho), Myo-inositol (mIns), Glutamate (Glu) and Lactate (Lac) concentrations were compared between the groups. RESULTS Comparing insular cortex metabolite concentrations between the groups, Cho was statistically significantly higher (p=0.005) but mIns was significantly lower (p=0.001) in the unresponsive to group therapy group. CONCLUSION MR spectroscopy findings of the present study indicated significant metabolic changes such as increased Cho/Cr ratio and decreased mIns/Cr ratio in the insular cortex of vaginismus patients who were unresponsive to group therapy. Our results support the studies suggesting that disgust is an important emotion in vaginismus patients and also that insula plays a role in the neurobiology of disgust.
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Affiliation(s)
- Mehmet Fatih Erbay
- Department of Radiology, Inonu University School of Medicine, Malatya,Turkey
| | - Esra Porgalı Zayman
- Department of Psychiatry, Inonu University School of Medicine, Malatya,Turkey
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3
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Wang R, Fan Q, Zhang Z, Chen Y, Zhu Y, Li Y. Anterior thalamic radiation structural and metabolic changes in obsessive-compulsive disorder: A combined DTI-MRS study. Psychiatry Res Neuroimaging 2018; 277:39-44. [PMID: 29807209 DOI: 10.1016/j.pscychresns.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/13/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
Abstract
Numerous studies indicate the cortico-striato-thalamo-cortical (CSTC) circuit plays an important role in the pathophysiology of obsessive-compulsive disorder (OCD). The anterior thalamic radiation (ATR), as a major fiber in the fronto-thalamic circuitry, contributes to symptomology of OCD. However, the underlying biochemical mechanism in relation with its structural alteration remains not understood. This study investigated the structural abnormality of ATR and its correlation with thalamic metabolic alteration in OCD, using diffusion tensor image (DTI) and proton magnetic resonance spectroscopy (1H-MRS). Twenty-six unmedicated adult OCD patients and twenty-six matched healthy controls participated in DTI study. Thirteen OCD patients and thirteen healthy controls, a subset of DTI participants, took part in MRS study. The results showed that mean fiber length of right ATR negatively correlated with ipsilateral thalamic choline (Cho) level in OCD patients. Additionally, significantly higher Cho concentration was detected in right thalamus of OCD patients compared to healthy controls. Moreover, the mean fractional anisotropy (FA) value of right ATR positively correlated with patients Yale-Brown Obsessive Compulsive Scale (YBOCS) total score, as well as YBOCS compulsion score. These results suggested the coupling of structural and metabolic changes in right ATR, which might serve as a multi-modal biomarker contributing to the pathogenesis of OCD.
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Affiliation(s)
- Ruilin Wang
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030,China.
| | - Zongfeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030,China
| | - Yongjun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030,China
| | - Yajing Zhu
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yao Li
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
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4
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Shin JE, Choi CH, Lee JM, Kwon JS, Lee SH, Kim HC, Han NY, Choi SH, Yoo SY. Association between memory impairment and brain metabolite concentrations in North Korean refugees with posttraumatic stress disorder. PLoS One 2017; 12:e0188953. [PMID: 29216235 PMCID: PMC5720673 DOI: 10.1371/journal.pone.0188953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/13/2017] [Indexed: 11/18/2022] Open
Abstract
Individuals with posttraumatic stress disorder (PTSD) had experiences of enormous psychological stress that can result in neurocognitive and neurochemical changes. To date, the causal relationship between them remains unclear. The present study is to investigate the association between neurocognitive characteristics and neural metabolite concentrations in North Korean refugees with PTSD. A total of 53 North Korean refugees with or without PTSD underwent neurocognitive function tests. For neural metabolite scanning, magnetic resonance spectroscopy of the hippocampus and anterior cingulate cortex (ACC) has been conducted. We assessed between-group differences in neurocognitive test scores and metabolite levels. Additionally, a multiple regression analysis was carried out to evaluate the association between neurocognitive function and metabolite levels in patients with PTSD. Memory function, but not other neurocognitive functions, was significantly lower in the PTSD group compared with the non-PTSD group. Hippocampal N-acetylaspartate (NAA) levels were not different between groups; however, NAA levels were significantly lower in the ACC of the PTSD group than the non-PTSD group (t = 2.424, p = 0.019). The multiple regression analysis showed a negative association between hippocampal NAA levels and delayed recall score on the auditory verbal learning test (β = -1.744, p = 0.011) in the non-PTSD group, but not in the PTSD group. We identified specific memory impairment and the role of NAA levels in PTSD. Our findings suggest that hippocampal NAA has a protective role in memory impairment and development of PTSD after exposure to traumatic events.
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Affiliation(s)
- Jung Eun Shin
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi-Hoon Choi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jong Min Lee
- Computational NeuroImage Analysis Laboratory, Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry and Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Hyun-Chung Kim
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Na Young Han
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry and Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
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5
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Tükel R, Aydın K, Ertekin E, Özyıldırım SŞ, Barburoğlu M. 1H-magnetic resonance spectroscopy in obsessive-compulsive disorder: effects of 12 weeks of sertraline treatment on brain metabolites. Eur Arch Psychiatry Clin Neurosci 2015; 265:219-26. [PMID: 25256264 DOI: 10.1007/s00406-014-0545-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
Several neuroimaging studies have investigated brain metabolite abnormalities in patients with obsessive-compulsive disorder (OCD) and also explored metabolic changes after OCD treatments using proton magnetic resonance spectroscopy ((1)H-MRS). The main objective of this study was to investigate the effects of a selective serotonin re-uptake inhibitor (SSRI) treatment on the neurochemical levels in patients with OCD. In the present study, levels of N-acetylaspartate (NAA), choline, and myo-Inositol were measured in terms of their ratios with creatine (Cr) using (1)H-MRS. The ratios of metabolite levels in the three brain regions for 19 unmedicated patients with OCD, including 10 who were drug-naïve, at baseline and following 12 weeks of sertraline treatment and for 19 healthy control subjects were compared with ANOVA. In post hoc analysis, the NAA/Cr levels were significantly lower in patients with OCD at baseline than in healthy controls in the anterior cingulate and in the caudate. On the other hand, no significant differences were detected in terms of the NAA/Cr in the anterior cingulate, caudate, and putamen between the patients with OCD after 12 weeks of sertraline treatment and healthy controls. The paired t test revealed that NAA/Cr levels were significantly higher in patients with OCD after 12 weeks of sertraline treatment compared with those at baseline in the anterior cingulate and in the caudate. Our results suggest that reductions in NAA can be reversed with SSRI treatment, which may indicate an improvement in neuronal integrity.
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Affiliation(s)
- Raşit Tükel
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey,
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6
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Linares IMP, Jackowski AP, Trzesniak CMF, Arrais KC, Chagas MHN, Sato JR, Santos AC, Hallak JEC, Zuardi AW, Nardi AE, Coimbra NC, Crippa JAS. Cortical thinning of the right anterior cingulate cortex in spider phobia: a magnetic resonance imaging and spectroscopy study. Brain Res 2014; 1576:35-42. [PMID: 24892191 DOI: 10.1016/j.brainres.2014.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
Abstract
There a lack of consistent neuroimaging data on specific phobia (SP) and a need to assess volumetric and metabolic differences in structures implicated in this condition. The aim of this study is investigate possible metabolic (via (1)H MRS) and cortical thickness abnormalities in spider-phobic patients compared to healthy volunteers. Participants were recruited via public advertisement and underwent clinical evaluations and MRI scans. The study started in 2010 and the investigators involved were not blind in respect to patient groupings. The study was conducted at the Ribeirão Preto Medical School University Hospital of the University of São Paulo, Brazil. Patients with spider phobia (n=19) were matched to 17 healthy volunteers with respect to age, education and socio-economic status. The spider SP group fulfilled the diagnostic criteria for spider phobia according to the Structured Clinical Interview for DSM-IV. None of the participants had a history of neurological, psychiatric or other relevant organic diseases, use of prescribed psychotropic medication or substance abuse. All imaging and spectroscopy data were collected with a 3 T MRI scanner equipped with 25 mT gradient coils in 30-minute scans. The Freesurfer image analysis package and LC Model software were used to analyze data. The hypothesis being tested was formulated before the data collection (neural correlates of SP would include the amygdala, insula, anterior cingulate gyrus and others). The results indicated the absence of metabolic alterations, but thinning of the right anterior cingulate cortex (ACC) in the SP group when compared to the healthy control group (mean cortical thickness±SD: SP=2.11±0.45 mm; HC=2.16±0.42 mm; t (34)=3.19, p=0.001 [-35.45, 71.00, -23.82]). In spectroscopy, the ratios between N-acetylaspartate and creatine and choline levels were measured. No significant effect or correlation was found between MRS metabolites and scores in the Spider Phobia Questionnaire and Beck Anxiety Inventory (p>0.05). The ACC is known to be related to the cognitive processing of fear and anxiety and to be linked with the conditioning circuit. The MRS findings are preliminary and need more studies. The finding of reduced ACC thickness in SP is in agreement with evidence from previous functional neuroimaging studies and highlights the importance of this brain area in the pathophysiology of SP.
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Affiliation(s)
- I M P Linares
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil.
| | - A P Jackowski
- Laboratory of Interdisciplinary Neurosciences (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - C M F Trzesniak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil
| | - K C Arrais
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil
| | - M H N Chagas
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil
| | - J R Sato
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - A C Santos
- Department of Medical Clinic Department, Division of Radiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - J E C Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil
| | - A W Zuardi
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil
| | - A E Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - N C Coimbra
- Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - J A S Crippa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, National Institute for Translational Medicine (INCT, CNPq), Ribeirão Preto, São Paulo, Brazil
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7
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Aoki Y, Aoki A, Suwa H. Reduction of N-acetylaspartate in the medial prefrontal cortex correlated with symptom severity in obsessive-compulsive disorder: meta-analyses of (1)H-MRS studies. Transl Psychiatry 2012; 2:e153. [PMID: 22892718 PMCID: PMC3432192 DOI: 10.1038/tp.2012.78] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/09/2012] [Accepted: 07/14/2012] [Indexed: 11/09/2022] Open
Abstract
Structural and functional neuroimaging findings suggest that disturbance of the cortico-striato-thalamo-cortical (CSTC) circuits may underlie obsessive-compulsive disorder (OCD). However, some studies with (1)H-magnetic resonance spectroscopy ((1)H-MRS) reported altered level of N-acetylaspartate (NAA), they yielded inconsistency in direction and location of abnormality within CSTC circuits. We conducted a comprehensive literature search and a meta-analysis of (1)H-MRS studies in OCD. Seventeen met the inclusion criteria for a meta-analysis. Data were separated by frontal cortex region: medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex, orbitofrontal cortex, basal ganglia and thalamus. The mean and s.d. of the NAA measure were calculated for each region. A random effects model integrating 16 separate datasets with 225 OCD patients and 233 healthy comparison subjects demonstrated that OCD patients exhibit decreased NAA levels in the frontal cortex (P=0.025), but no significant changes in the basal ganglia (P=0.770) or thalamus (P=0.466). Sensitivity analysis in an anatomically specified subgroup consisting of datasets examining the mPFC demonstrated marginally significant reduction of NAA (P=0.061). Meta-regression revealed that NAA reduction in the mPFC was positively correlated with symptom severity measured by Yale-Brown Obsessive Compulsive Scale (P=0.011). The specific reduction of NAA in the mPFC and significant relationship between neurochemical alteration in the mPFC and symptom severity indicate that the mPFC is one of the brain regions that directly related to abnormal behavior in the pathophysiology of OCD. The current meta-analysis indicates that cortices and sub-cortices contribute in different ways to the etiology of OCD.
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Affiliation(s)
- Yuta Aoki
- Department of Psychiatry, Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Ota, Tokyo, Japan.
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8
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Linares IM, Trzesniak C, Chagas MHN, Hallak JE, Nardi AE, Crippa JAS. Neuroimaging in specific phobia disorder: a systematic review of the literature. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70017-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Linares IM, Trzesniak C, Chagas MHN, Hallak JE, Nardi AE, Crippa JAS. Neuroimaging in specific phobia disorder: a systematic review of the literature. REVISTA BRASILEIRA DE PSIQUIATRIA 2012. [DOI: 10.1590/s1516-44462012000100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Maddock RJ, Buonocore MH. MR spectroscopic studies of the brain in psychiatric disorders. Curr Top Behav Neurosci 2012; 11:199-251. [PMID: 22294088 DOI: 10.1007/7854_2011_197] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The measurement of brain metabolites with magnetic resonance spectroscopy (MRS) provides a unique perspective on the brain bases of neuropsychiatric disorders. As a context for interpreting MRS studies of neuropsychiatric disorders, we review the characteristic MRS signals, the metabolic dynamics,and the neurobiological significance of the major brain metabolites that can be measured using clinical MRS systems. These metabolites include N-acetylaspartate(NAA), creatine, choline-containing compounds, myo-inositol, glutamate and glutamine, lactate, and gamma-amino butyric acid (GABA). For the major adult neuropsychiatric disorders (schizophrenia, bipolar disorder, major depression, and the anxiety disorders), we highlight the most consistent MRS findings, with an emphasis on those with potential clinical or translational significance. Reduced NAA in specific brain regions in schizophrenia, bipolar disorder, post-traumatic stress disorder, and obsessive–compulsive disorder corroborate findings of reduced brain volumes in the same regions. Future MRS studies may help determine the extent to which the neuronal dysfunction suggested by these findings is reversible in these disorders. Elevated glutamate and glutamine (Glx) in patients with bipolar disorder and reduced Glx in patients with unipolar major depression support models of increased and decreased glutamatergic function, respectively, in those conditions. Reduced phosphomonoesters and intracellular pH in bipolar disorder and elevated dynamic lactate responses in panic disorder are consistent with metabolic models of pathogenesis in those disorders. Preliminary findings of an increased glutamine/glutamate ratio and decreased GABA in patients with schizophrenia are consistent with a model of NMDA hypofunction in that disorder. As MRS methods continue to improve, future studies may further advance our understanding of the natural history of psychiatric illnesses, improve our ability to test translational models of pathogenesis, clarify therapeutic mechanisms of action,and allow clinical monitoring of the effects of interventions on brain metabolicmarkers
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N-acetyl aspartate concentration is correlated with severity of generalized anxiety disorder. MIDDLE EAST CURRENT PSYCHIATRY 2011. [DOI: 10.1097/01.xme.0000398570.14636.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Crippa JAS, Derenusson GN, Ferrari TB, Wichert-Ana L, Duran FLS, Martin-Santos R, Simões MV, Bhattacharyya S, Fusar-Poli P, Atakan Z, Santos Filho A, Freitas-Ferrari MC, McGuire PK, Zuardi AW, Busatto GF, Hallak JEC. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. J Psychopharmacol 2011; 25:121-30. [PMID: 20829306 DOI: 10.1177/0269881110379283] [Citation(s) in RCA: 326] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Animal and human studies indicate that cannabidiol (CBD), a major constituent of cannabis, has anxiolytic properties. However, no study to date has investigated the effects of this compound on human pathological anxiety and its underlying brain mechanisms. The aim of the present study was to investigate this in patients with generalized social anxiety disorder (SAD) using functional neuroimaging. Regional cerebral blood flow (rCBF) at rest was measured twice using (99m)Tc-ECD SPECT in 10 treatment-naïve patients with SAD. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping. Relative to placebo, CBD was associated with significantly decreased subjective anxiety (p < 0.001), reduced ECD uptake in the left parahippocampal gyrus, hippocampus, and inferior temporal gyrus (p < 0.001, uncorrected), and increased ECD uptake in the right posterior cingulate gyrus (p < 0.001, uncorrected). These results suggest that CBD reduces anxiety in SAD and that this is related to its effects on activity in limbic and paralimbic brain areas.
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Affiliation(s)
- José Alexandre S Crippa
- Department of Neurosciences and Behavior, Division of Psychiatry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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13
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Trzesniak C, Uchida RR, Araújo D, Guimarães FS, Freitas-Ferrari MC, Filho AS, Santos AC, Busatto GF, Zuardi AW, Del-Ben CM, Graeff FG, Crippa JA. (1)H magnetic resonance spectroscopy imaging of the hippocampus in patients with panic disorder. Psychiatry Res 2010; 182:261-5. [PMID: 20488674 DOI: 10.1016/j.pscychresns.2010.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 03/11/2010] [Accepted: 03/16/2010] [Indexed: 01/04/2023]
Abstract
Recent theories of panic disorder propose an extensive involvement of limbic system structures, such as the hippocampus, in the pathophysiology of this condition. Despite this, no prior study has examined exclusively the hippocampal neurochemistry in this disorder. The current study used proton magnetic resonance spectroscopy imaging ((1)H-MRSI) to examine possible abnormalities in the hippocampus in panic disorder patients. Participants comprised 25 panic patients and 18 psychiatrically healthy controls. N-acetylaspartate (NAA, a putative marker of neuronal viability) and choline (Cho, involved in the synthesis and degradation of cell membranes) levels were quantified relative to creatine (Cr, which is thought to be relatively stable among individuals and in different metabolic condition) in both right and left hippocampi. Compared with controls, panic patients demonstrated significantly lower NAA/Cr in the left hippocampus. No other difference was detected. This result is consistent with previous neuroimaging findings of hippocampal alterations in panic and provides the first neurochemical evidence suggestive of involvement of this structure in the disorder. Moreover, lower left hippocampal NAA/Cr in panic disorder may possibly reflect neuronal loss and/or neuronal metabolic dysfunction, and could be related to a deficit in evaluating ambiguous cues.
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Affiliation(s)
- Clarissa Trzesniak
- Department of Neuroscience and Behavior, Division of Psychiatry, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Freitas-Ferrari MC, Hallak JEC, Trzesniak C, Filho AS, Machado-de-Sousa JP, Chagas MHN, Nardi AE, Crippa JAS. Neuroimaging in social anxiety disorder: a systematic review of the literature. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:565-80. [PMID: 20206659 DOI: 10.1016/j.pnpbp.2010.02.028] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 02/21/2010] [Accepted: 02/28/2010] [Indexed: 11/16/2022]
Abstract
Brain imaging techniques allow the in vivo evaluation of the human brain, leading to a better understanding of its anatomical, functional and metabolic substrate. The aim of this current report is to present a systematic and critical review of neuroimaging findings in Social Anxiety Disorder (SAD). A literature review was performed in the PubMed Medline, Scielo and Web of Science databases using the following keywords: 'MRI', 'functional', 'tomography', 'PET', 'SPECT', 'spectroscopy', 'relaxometry', 'tractography' and 'voxel' crossed one by one with the terms 'social anxiety' and 'social phobic', with no limit of time. We selected 196 articles and 48 of them were included in our review. Most of the included studies have explored the neural response to facial expressions of emotion, symptoms provocation paradigms, and disorder-related abnormalities in dopamine or serotonin neurotransmission. The most coherent finding among the brain imaging techniques reflects increased activity in limbic and paralimbic regions in SAD. The predominance of evidence implicating the amygdala strengthens the notion that it plays a crucial role in the pathophysiology of SAD. The observation of alterations in pre-frontal regions and the reduced activity observed in striatal and parietal areas show that much remains to be investigated within the complexity of SAD. Interesting, follow-up designed studies observed a decrease in perfusion in these same areas after either by pharmacological or psychological treatment. The medial prefrontal cortex provided additional support for a corticolimbic model of SAD pathophysiology, being a promising area to investigation. Furthermore, the dopaminergic and GABAergic hypotheses seem directed related to its physiopathology. The present review indicates that neuroimaging has contributed to a better understanding of the neurobiology of SAD. Although there were several methodological differences among the studies, the global results have often been consistent, reinforcing the evidence of a specific cerebral circuit involved in SAD, formed by limbic and cortical areas.
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Affiliation(s)
- Maria Cecilia Freitas-Ferrari
- Department of Neuroscience and Behavior of the Ribeirão Preto Medical School, University of São Paulo, INCT Translational Medicine (CNPq), São Paulo, Brazil
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Crippa JAS, Zuardi AW, Hallak JEC. Uso terapêutico dos canabinoides em psiquiatria. BRAZILIAN JOURNAL OF PSYCHIATRY 2010. [DOI: 10.1590/s1516-44462010000500009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Revisar os principais avanços no potencial uso terapêutico de alguns compostos canabinoides em psiquiatria. MÉTODO: Foi realizada busca nos bancos de dado PubMed, SciELO e Lilacs e identificados estudos e revisões da literatura sobre o uso terapêutico dos canabinoides em psiquiatria, em particular canabidiol, rimonabanto, Δ9-tetraidrocanabinol e seus análogos. RESULTADOS: O canabidiol demonstrou apresentar potencial terapêutico como antipsicótico, ansiolítico, antidepressivo e em diversas outras condições. O Δ9-tetraidrocanabinol e seus análogos demonstraram efeitos ansiolíticos, na dependência de cannabis, bem como adjuvantes no tratamento de esquizofrenia, apesar de ainda carecerem de mais estudos. O rimonabanto demonstrou eficácia no tratamento de sintomas subjetivos e fisiológicos da intoxicação pela cannabis e como adjuvante no tratamento do tabagismo. Os potenciais efeitos colaterais, de induzir depressão e ansiedade limitaram o uso clínico deste antagonista CB1. CONCLUSÃO: Os canabinoides têm demonstrado que podem ter amplo interesse terapêutico em psiquiatria, porém mais estudos controlados são necessários para confirmar estes achados e determinar a segurança destes compostos.
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Affiliation(s)
| | | | - Jaime E. C. Hallak
- Universidade de São Paulo, Brasil; INCT Translacional em Medicina, Brasil
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