1
|
Brehl AK, Kohn N, Schene AH, Fernández G. A mechanistic model for individualised treatment of anxiety disorders based on predictive neural biomarkers. Psychol Med 2020; 50:727-736. [PMID: 32204741 PMCID: PMC7168651 DOI: 10.1017/s0033291720000410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/09/2019] [Accepted: 02/09/2020] [Indexed: 12/29/2022]
Abstract
Increased amygdala responsiveness is the hallmark of fear and a characteristic across patients with anxiety disorders. The amygdala is embedded in a complex regulatory circuit. Multiple different mechanisms may elevate amygdala responsiveness and lead to the occurrence of an anxiety disorder. While top-down control by the prefrontal cortex (PFC) downregulates amygdala responses, the locus coeruleus (LC) drives up amygdala activation via noradrenergic projections. This indicates that the same fearful phenotype may result from different neural mechanisms. We propose a mechanistic model that defines three different neural biomarkers causing amygdala hyper-responsiveness in patients with anxiety disorders: (a) inherent amygdala hypersensitivity, (b) low prefrontal control and (c) high LC drive. First-line treatment for anxiety disorders is exposure-based cognitive behavioural therapy, which strengthens PFC recruitment during emotion regulation and thus targets low-prefrontal control. A treatment response rate around 50% (Loerinc et al., 2015, Clinical Psychological Reviews, 42, 72-82) might indicate heterogeneity of underlying neurobiological mechanisms among patients, presumably leading to high variation in treatment benefit. Transforming insights from cognitive neuroscience into applicable clinical heuristics to categorise patients based on their underlying biomarker may support individualised treatment selection in psychiatry. We review literature on the three anxiety-related mechanisms and present a mechanistic model that may serve as a rational for pathology-based diagnostic and biomarker-guided treatment selection in psychiatry.
Collapse
Affiliation(s)
- Anne-Kathrin Brehl
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Nils Kohn
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Guillen Fernández
- Radboud University, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Moreno-Rius J. The cerebellum in fear and anxiety-related disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 85:23-32. [PMID: 29627508 DOI: 10.1016/j.pnpbp.2018.04.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 01/06/2023]
Abstract
Fear and anxiety-related disorders are highly prevalent psychiatric conditions characterized by avoidant and fearful reactions towards specific stimuli or situations, which are disproportionate given the real threat such stimuli entail. These conditions comprise the most common mental disorder group. There are a high proportion of patients who fail to achieve remission and the presence of high relapse rates indicate the therapeutic options available are far from being fully efficient. Despite an increased understanding the neural circuits underlying fear and anxiety-related behaviors in the last decades, a factor that could be partially contributing to the lack of adequate therapies may be an insufficient understanding of the core features of the disorders and their associated neurobiology. Interestingly, the cerebellum shows connections with fear and anxiety-related brain areas and functional involvement in such processes, but explanations for its role in anxiety disorders are lacking. Therefore, the aims of this review are to provide an overview of the neural circuitry of fear and anxiety and its connections to the cerebellum, and of the animal studies that directly assess an involvement of the cerebellum in these processes. Then, the studies performed in patients suffering from anxiety disorders that explore the cerebellum will be discussed. Finally, we'll propose a function for the cerebellum in these disorders, which could guide future experimental approaches to the topic and lead to a better understanding of the neurobiology of anxiety-related disorders, ultimately helping to develop more effective treatments for these conditions.
Collapse
Affiliation(s)
- Josep Moreno-Rius
- Department of Pharmacology and Toxicology, University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
3
|
Guo ZN, Lv S, Liu J, Wang Z, Jin H, Qiu Q, Sun X, Yang Y. Compromised dynamic cerebral autoregulation in patients with generalized anxiety disorder: a study using transfer function analysis. BMC Psychiatry 2018; 18:164. [PMID: 29859053 PMCID: PMC5984810 DOI: 10.1186/s12888-018-1713-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 05/02/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with generalized anxiety disorder (GAD) usually present with various neurological symptoms, but the mechanisms remain unclear. We aimed to analyze the characteristics of dynamic cerebral autoregulation (dCA) in patients with GAD. METHODS Patients (aged ≥18 years) who were diagnosed with GAD were enrolled in this study. Medically and psychiatrically healthy volunteers were recruited as controls. Subjects received the Hamilton Rating Scale for Anxiety (HAMA) and 17-item Hamilton Depression Rating Scale (HAMD) evaluation. Noninvasive continuous arterial blood pressure and bilateral middle cerebral artery blood flow velocity were recorded simultaneously from each subject. Transfer function analysis was used to derive the autoregulatory parameters, including phase difference, gain, and coherence function. RESULTS A total of 57 patients with GAD and 40 healthy volunteers were enrolled. We found that the phase difference values were significantly compromised in patients with GAD. In the Spearman correlation analysis, the phase difference values were negatively correlated with the HAMA scores and the HAMD scores. In the multiple linear regression analysis, GAD is negatively correlated with the phase difference values, whereas age is positively correlated with the phase difference values. CONCLUSIONS Our results suggested that the dCA was compromised in patients with GAD and negatively correlated with the score of anxiety. Improving the dCA may be a potential therapeutic method for treating the neurological symptoms of GAD patients.
Collapse
Affiliation(s)
- Zhen-Ni Guo
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Chang Chun, 130021 China ,grid.430605.4Clinical Trail and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Chang Chun, China
| | - Shan Lv
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Chang Chun, 130021 China
| | - Jia Liu
- 0000 0001 0483 7922grid.458489.cShenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Xueyuan Avenue, Shenzhen University Town, Shenzhen, China
| | - Zan Wang
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Chang Chun, 130021 China
| | - Hang Jin
- grid.430605.4Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Chang Chun, 130021 China
| | - Quanli Qiu
- 0000 0001 0483 7922grid.458489.cShenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Xueyuan Avenue, Shenzhen University Town, Shenzhen, China
| | - Xin Sun
- Clinical Trail and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Chang Chun, 130021, China. .,Clinical Trail and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
| |
Collapse
|
4
|
Xia L, Li S, Wang T, Guo Y, Meng L, Feng Y, Cui Y, Wang F, Ma J, Jiang G. Spontaneous alterations of regional brain activity in patients with adult generalized anxiety disorder. Neuropsychiatr Dis Treat 2017; 13:1957-1965. [PMID: 28790831 PMCID: PMC5530096 DOI: 10.2147/ndt.s133853] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We aimed to examine how spontaneous brain activity might be related to the pathophysiology of generalized anxiety disorder (GAD). PATIENTS AND METHODS Using resting-state functional MRI, we examined spontaneous regional brain activity in 31 GAD patients (mean age, 36.87±9.16 years) and 36 healthy control participants (mean age, 39.53±8.83 years) matched for age, education, and sex from December 2014 to October 2015. We performed a two-sample t-test on the voxel-based analysis of the regional homogeneity (ReHo) maps. We used Pearson correlation analysis to compare scores from the Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, State-Trait Anxiety Scale-Trait Scale, and mean ReHo values. RESULTS We found abnormal spontaneous activity in multiple regions of brain in GAD patients, especially in the sensorimotor cortex and emotional regions. GAD patients showed decreased ReHo values in the right orbital middle frontal gyrus, left anterior cingulate cortex, right middle frontal gyrus, and bilateral supplementary motor areas, with increased ReHo values in the left middle temporal gyrus, left superior temporal gyrus, and right superior occipital gyrus. The ReHo value of the left middle temporal gyrus correlated positively with the Hamilton Anxiety Rating Scale scores. CONCLUSION These results suggest that altered local synchronization of spontaneous brain activity may be related to the pathophysiology of GAD.
Collapse
Affiliation(s)
- Likun Xia
- Department of Magnetic Resonance Imaging, People's Hospital of Yuxi City, Yuxi
| | - Shumei Li
- Department of Medical Imaging, Guangdong No 2 Provincial People's Hospital, Guangzhou
| | - Tianyue Wang
- Department of Medical Imaging, Guangdong No 2 Provincial People's Hospital, Guangzhou
| | - Yaping Guo
- Department of Rehabilitation Medicine, People's Hospital of Yuxi City, Yuxi, People's Republic of China
| | - Lihong Meng
- Department of Rehabilitation Medicine, People's Hospital of Yuxi City, Yuxi, People's Republic of China
| | - Yunping Feng
- Department of Rehabilitation Medicine, People's Hospital of Yuxi City, Yuxi, People's Republic of China
| | - Yu Cui
- Department of Magnetic Resonance Imaging, People's Hospital of Yuxi City, Yuxi
| | - Fan Wang
- Department of Magnetic Resonance Imaging, People's Hospital of Yuxi City, Yuxi
| | - Jian Ma
- Department of Magnetic Resonance Imaging, People's Hospital of Yuxi City, Yuxi
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong No 2 Provincial People's Hospital, Guangzhou
| |
Collapse
|
5
|
Stephens DN, King SL, Lambert JJ, Belelli D, Duka T. GABAAreceptor subtype involvement in addictive behaviour. GENES BRAIN AND BEHAVIOR 2016; 16:149-184. [DOI: 10.1111/gbb.12321] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/19/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | - S. L. King
- School of Psychology; University of Sussex; Brighton UK
| | - J. J. Lambert
- Division of Neuroscience; University of Dundee; Dundee UK
| | - D. Belelli
- Division of Neuroscience; University of Dundee; Dundee UK
| | - T. Duka
- School of Psychology; University of Sussex; Brighton UK
| |
Collapse
|
6
|
Cui H, Zhang J, Liu Y, Li Q, Li H, Zhang L, Hu Q, Cheng W, Luo Q, Li J, Li W, Wang J, Feng J, Li C, Northoff G. Differential alterations of resting-state functional connectivity in generalized anxiety disorder and panic disorder. Hum Brain Mapp 2016; 37:1459-73. [PMID: 26800659 DOI: 10.1002/hbm.23113] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/14/2015] [Accepted: 12/29/2015] [Indexed: 12/12/2022] Open
Abstract
Generalized anxiety disorder (GAD) and panic disorder (PD) are most common anxiety disorders with high lifetime prevalence while the pathophysiology and disease-specific alterations still remain largely unclear. Few studies have taken a whole-brain perspective in the functional connectivity (FC) analysis of these two disorders in resting state. It limits the ability to identify regionally and psychopathologically specific network abnormalities with their subsequent use as diagnostic marker and novel treatment strategy. The whole brain FC using a novel FC metric was compared, that is, scaled correlation, which they demonstrated to be a reliable FC statistics, but have higher statistical power in two-sample t-test of whole brain FC analysis. About 21 GAD and 18 PD patients were compared with 22 matched control subjects during resting-state, respectively. It was found that GAD patients demonstrated increased FC between hippocampus/parahippocampus and fusiform gyrus among the most significantly changed FC, while PD was mainly associated with greater FC between somatosensory cortex and thalamus. Besides such regional specificity, it was observed that psychopathological specificity in that the disrupted FC pattern in PD and GAD correlated with their respective symptom severity. The findings suggested that the increased FC between hippocampus/parahippocampus and fusiform gyrus in GAD were mainly associated with a fear generalization related neural circuit, while the greater FC between somatosensory cortex and thalamus in PD were more likely linked to interoceptive processing. Due to the observed regional and psychopathological specificity, their findings bear important clinical implications for the potential treatment strategy.
Collapse
Affiliation(s)
- Huiru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jie Zhang
- Centre for Computational Systems Biology, Fudan University, Shanghai, People's Republic of China.,Department of Radiology, Jinling Hospital of Nanjing, Nanjing, People's Republic of China
| | - Yicen Liu
- Centre for Computational Systems Biology, Fudan University, Shanghai, People's Republic of China
| | - Qingwei Li
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lanlan Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qiang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wei Cheng
- Centre for Computational Systems Biology, Fudan University, Shanghai, People's Republic of China
| | - Qiang Luo
- Centre for Computational Systems Biology, Fudan University, Shanghai, People's Republic of China
| | - Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, East China Normal University, Shanghai, People's Republic of China
| | - Wei Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jianfeng Feng
- Centre for Computational Systems Biology, Fudan University, Shanghai, People's Republic of China.,Department of Computer Science, University of Warwick, Coventry, CV4 7AL, United Kingdom.,Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, People's Republic of China.,Shanghai Center for Mathematical Sciences, Shanghai, People's Republic of China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.,Centre for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, People's Republic of China.,Centre for Brain and Consciousness, Taipei Medical University (TMU), Taipei, Taiwan
| |
Collapse
|
7
|
Hilbert K, Lueken U, Beesdo-Baum K. Neural structures, functioning and connectivity in Generalized Anxiety Disorder and interaction with neuroendocrine systems: a systematic review. J Affect Disord 2014; 158:114-26. [PMID: 24655775 DOI: 10.1016/j.jad.2014.01.022] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/30/2014] [Accepted: 01/31/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Research on the neurobiological basis of Generalized Anxiety Disorder (GAD) has considerably expanded in recent years. However, many studies investigated different domains and used different methods and paradigms. Therefore, this review aims to integrate the findings to date and to identify the core correlates of neurobiological underpinnings of GAD discovered so far. METHODS We conducted a systematic review of original papers investigating neural correlates, connectivity, or structural changes as well as reporting changes in the serotonergic system, noradrenergic system and cortisol levels in DSM-IV-defined GAD samples until December 2013. RESULTS Studies have identified abnormal amygdala and prefrontal cortex activation in patients and decreased functional connectivity between these areas. Furthermore, studies showed increased gray matter volume and decreased structural connectivity between these structures. Neuroendocrine findings are less consistent, but increased reactivity of the noradrenergic system and perpetuations in the cortisol secretion have been reported. LIMITATIONS Only studies on DSM-IV defined Generalized Anxiety Disorder which employed a group comparison were included. CONCLUSIONS Current research suggests a distinct set of neurobiological alterations in Generalized Anxiety Disorder. However, future research on the interaction between these structures and systems and on the specificity of these findings in relation to other mental disorders is urgently needed.
Collapse
Affiliation(s)
- Kevin Hilbert
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Neuroimaging Center, Technische Universität Dresden, Dresden, Germany.
| | - Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
8
|
Buoli M, Caldiroli A, Caletti E, Paoli RA, Altamura AC. New approaches to the pharmacological management of generalized anxiety disorder. Expert Opin Pharmacother 2013; 14:175-84. [DOI: 10.1517/14656566.2013.759559] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|