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Talesh A, Zarei A, Yazdi-Ravandi S, Ghaleiha A, Shamsaei F, Matinnia N, Shams J, Ahmadpanah M, Taslimi Z, Moghimbeigi A, Khosrowabadi R. Balance-energy of resting state network in obsessive-compulsive disorder. Sci Rep 2023; 13:10423. [PMID: 37369689 DOI: 10.1038/s41598-023-37304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
Stability of the brain functional network is directly linked to organization of synchronous and anti-synchronous activities. Nevertheless, impact of arrangement of positive and negative links called links topology requires to be well understood. In this study, we investigated how topology of the functional links reduce balance-energy of the brain network in obsessive-compulsive disorder (OCD) and push the network to a more stable state as compared to healthy controls. Therefore, functional associations between the regions were measured using the phase synchrony between the EEG activities. Subsequently, balance-energy of the brain functional network was estimated based on the quality of triadic interactions. Occurrence rates of four different types of triadic interactions including weak and strong balanced, and unbalanced interactions were compared. In addition, impact of the links topology was also investigated by looking at the tendency of positive and negative links to making hubs. Our results showed although the number of positive and negative links were not statistically different between OCD and healthy controls, but positive links in OCDs' brain networks have more tendency to make hub. Moreover, lower number of unbalanced triads and higher number of strongly balanced triad reduced the balance-energy in OCDs' brain networks that conceptually has less requirement to change. We hope these findings could shed a light on better understanding of brain functional network in OCD.
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Affiliation(s)
- Alireza Talesh
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Asghar Zarei
- Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran
- Biomedical Engineering Faculty, Sahand University of Technology, Tabriz, Iran
| | - Saeid Yazdi-Ravandi
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Ali Ghaleiha
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nasrin Matinnia
- Department of Nursing, College of Basic Science, Hamadan Branch, Islamic Azad University, Hamadan, Iran
| | - Jamal Shams
- Behavioral ScienBces Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ahmadpanah
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Taslimi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- Department of Biostatistics, Modeling of Noncommunicable Disease Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reza Khosrowabadi
- Institute for Cognitive and Brain Science, Shahid Beheshti University, Evin Sq., Tehran, 19839-63113, Iran.
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2
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Giomi S, Siri F, Ferro A, Moltrasio C, Ariyo M, Delvecchio G, Brambilla P. Executive Functions in panic disorder: A mini-review. J Affect Disord 2021; 288:107-113. [PMID: 33848752 DOI: 10.1016/j.jad.2021.03.084] [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: 11/27/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Panic disorder (PD) is an anxiety disorder characterized by recurrent panic attacks whose aetiology might be associated with alterations of the prefrontal-amygdala circuitry. The prefrontal cortex is a key region involved in executive functioning (EF) whose disturbance may imply harsh consequences over personal, social, and working aspects of PD patients. Indeed, defining the real involvement of EF in PD could lead to early assessment, better treatment, and rehabilitation options. These could have a substantial impact on the quality of life of these patients and their caregivers, thus reducing long-term health care needs. METHODS We reviewed findings from different studies that investigated executive functioning in PD patients using standardized neuropsychological measures. The review was conducted with the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA). In addition, peer-reviewed human-based research articles were selected and twelve studies were retrieved through a search on PubMed. Four uniquely focused on PD patients, two also included a sample of first-degree relatives, while six included a mixed sample of different psychiatric illnesses, including PD. RESULTS The majority of the studies found no alterations in PD patients, suggesting that EF might not be a core deficit in this disorder. However, some studies (N = 4) found EF deficits in selective domains, which included attention and set-shifting processes, cognitive flexibility, decision-making abilities, and working memory in PD patients and/or in their first-degree relatives. LIMITATIONS Unbalanced and small samples, unmonitored therapies, and the heterogeneity of cognitive and diagnostic assessment measures might have limited the generalizability of the results. CONCLUSIONS Overall, the results point towards the hypothesis that PD patients had preserved EF. However, future studies with standardized methodological procedures and with a gold standard assessment of EF will be required to finally exclude its involvement in the disease.
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Affiliation(s)
- Serena Giomi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Siri
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mayowa Ariyo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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3
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Multi-domain potential biomarkers for post-traumatic stress disorder (PTSD) severity in recent trauma survivors. Transl Psychiatry 2020; 10:208. [PMID: 32594097 PMCID: PMC7320966 DOI: 10.1038/s41398-020-00898-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Contemporary symptom-based diagnosis of post-traumatic stress disorder (PTSD) largely overlooks related neurobehavioral mechanisms and relies entirely on subjective interpersonal reporting. Previous studies associating biomarkers with PTSD have mostly used symptom-based diagnosis as the main outcome measure, disregarding the wide variability and richness of PTSD phenotypical features. Here, we aimed to computationally derive potential biomarkers that could efficiently differentiate PTSD subtypes among recent trauma survivors. A three-staged semi-unsupervised method ("3C") was used to firstly categorize individuals by current PTSD symptom severity, then derive clusters based on clinical features related to PTSD (e.g. anxiety and depression), and finally to classify participants' cluster membership using objective multi-domain features. A total of 256 features were extracted from psychometrics, cognitive functioning, and both structural and functional MRI data, obtained from 101 adult civilians (age = 34.80 ± 11.95; 51 females) evaluated within 1 month of trauma exposure. The features that best differentiated cluster membership were assessed by importance analysis, classification tree, and ANOVA. Results revealed that entorhinal and rostral anterior cingulate cortices volumes (structural MRI domain), in-task amygdala's functional connectivity with the insula and thalamus (functional MRI domain), executive function and cognitive flexibility (cognitive testing domain) best differentiated between two clusters associated with PTSD severity. Cross-validation established the results' robustness and consistency within this sample. The neural and cognitive potential biomarkers revealed by the 3C analytics offer objective classifiers of post-traumatic morbidity shortly following trauma. They also map onto previously documented neurobehavioral mechanisms associated with PTSD and demonstrate the usefulness of standardized and objective measurements as differentiating clinical sub-classes shortly after trauma.
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Ben-Zion Z, Artzi M, Niry D, Keynan NJ, Zeevi Y, Admon R, Sharon H, Halpern P, Liberzon I, Shalev AY, Hendler T. Neuroanatomical Risk Factors for Posttraumatic Stress Disorder in Recent Trauma Survivors. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:311-319. [PMID: 31973980 PMCID: PMC7064406 DOI: 10.1016/j.bpsc.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low hippocampal volume could serve as an early risk factor for posttraumatic stress disorder (PTSD) in interaction with other brain anomalies of developmental origin. One such anomaly may well be the presence of a large cavum septum pellucidum (CSP), which has been loosely associated with PTSD. We performed a longitudinal prospective study of recent trauma survivors. We hypothesized that at 1 month after trauma exposure the relation between hippocampal volume and PTSD symptom severity will be moderated by CSP volume, and that this early interaction will account for persistent PTSD symptoms at subsequent time points. METHODS One hundred seventy-one adults (87 women, average age 34.22 years [range, 18-65 years of age]) who were admitted to a general hospital's emergency department after a traumatic event underwent clinical assessment and structural magnetic resonance imaging within 1 month after trauma. Follow-up clinical evaluations were conducted at 6 (n = 97) and 14 (n = 78) months after trauma. Hippocampal and CSP volumes were measured automatically by FreeSurfer software and verified manually by a neuroradiologist (D.N.). RESULTS At 1 month after trauma, CSP volume significantly moderated the relation between hippocampal volume and PTSD severity (p = .026), and this interaction further predicted symptom severity at 14 months posttrauma (p = .018). Specifically, individuals with a smaller hippocampus and larger CSP at 1 month posttrauma showed more severe symptoms at 1 and 14 months after trauma exposure. CONCLUSIONS Our study provides evidence for an early neuroanatomical risk factors for PTSD, which could also predict the progression of the disorder in the year after trauma exposure. Such a simple-to-acquire neuroanatomical signature for PTSD could guide early management as well as long-term monitoring.
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Affiliation(s)
- Ziv Ben-Zion
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Moran Artzi
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Niry
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Jackob Keynan
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Zeevi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Roee Admon
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Haggai Sharon
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Institute of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pain Management and Neuromodulation Centre, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Pinchas Halpern
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M Health Science Center, Bryan, Texas
| | - Arieh Y Shalev
- Department of Psychiatry, New York University Langone Medical Center, New York, New York
| | - Talma Hendler
- Sagol Brain Institute Tel Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel.
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5
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Updating the evidence for an association between anxiety and risk of Alzheimer's disease: A meta-analysis of prospective cohort studies. J Affect Disord 2020; 262:397-404. [PMID: 31744742 DOI: 10.1016/j.jad.2019.11.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/16/2019] [Accepted: 11/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Anxiety is postulated to be a modifiable risk factor for Alzheimer's disease (AD). Our primary aim was to conduct a meta-analysis of prospective cohort studies investigating the association between anxiety and AD risk. DESIGN We searched multiple scientific databases to identify relevant papers published up to March 2019. Inclusion criteria were: prospective cohort studies with a minimum follow-up period of 1 year, baseline anxiety assessment, absence of dementia at baseline, investigated the association between anxiety and AD incidence, and reporting Relative Risks (RRs), or equivalents (HRs and SHRs), for the association between anxiety and AD risk. We excluded studies that: focused on subjective memory or mild cognitive impairment samples, review and meta-analyses, not reporting original, published peer-reviewed results. We used a random-effects model that accommodated the differences in association statistics. RESULTS 7 prospective cohorts (reported in 6 studies), with a total of 24,528 participants, were included in our meta-analysis. A marginally significant association between anxiety and AD risk was found, with a pooled RR of 1.45 (95% CI: 1.00-2.12), and a population attributable fraction for AD of 2.8% (95% CI: 1.2%-4.3%). LIMITATIONS There was a high level of heterogeneity across the studies, which may be associated with differences in the covariates adjusted for. Studies also differed considerably in how they measured anxiety. CONCLUSION Anxiety is marginally associated with an increased risk of AD in this meta-analysis. Future research is needed to determine the extent to which anxiety might be a cause of AD rather than a prodrome or marker.
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Jayakar R, Tone EB, Crosson B, Turner JA, Anderson PL, Phan KL, Klumpp H. Amygdala volume and social anxiety symptom severity: Does segmentation technique matter? Psychiatry Res Neuroimaging 2020; 295:111006. [PMID: 31760338 PMCID: PMC6982531 DOI: 10.1016/j.pscychresns.2019.111006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Abstract
The amygdala factors prominently in neurobiological models of social anxiety (SA), yet amygdala volume findings regarding SA have been inconsistent and largely focused on case-control characterization. One source of discrepant findings could be variability in volumetric techniques. Therefore, we compared amygdala volumes derived via an automated technique (Freesurfer) against a manually corrected approach, also involving Freesurfer. Additionally, we tested whether the relationship between volume and SA symptom severity would differ across volumetric techniques. We pooled participants (n = 76) from archival studies. SA severity was assessed with the Liebowitz Social Anxiety Scale; scores ranged from non-clinical to clinical levels. Freesurfer produced significantly larger amygdalar volumes for participants with poor image quality. Even after excluding such participants, paired sample t-tests showed Freesurfer's boundaries produced significantly larger amygdalar volumes than manually corrected ones, bilaterally. Yet, intra-class correlation coefficients between the two methods were high, which suggests that Freesurfer's over-estimation of amygdala volume was systemic. Regardless of segmentation technique, volumes were not associated with SA symptom severity. Potentially, amygdala sub-regions may yield clearer patterns regarding SA symptoms. Further, our study underscores the importance of image quality for segmentation of the amygdala, and image quality may be particularly valuable when examining anatomical data for subtle inter-individual differences.
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Affiliation(s)
- Reema Jayakar
- Department of Psychology, Georgia State University, Atlanta, GA 30303, USA.
| | - Erin B Tone
- Department of Psychology, Georgia State University, Atlanta, GA 30303, USA.
| | - Bruce Crosson
- Department of Psychology, Georgia State University, Atlanta, GA 30303, USA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA 30033, USA; Department of Neurology, Emory University, Atlanta, GA 30329, USA.
| | - Jessica A Turner
- Department of Psychology, Georgia State University, Atlanta, GA 30303, USA.
| | - Page L Anderson
- Department of Psychology, Georgia State University, Atlanta, GA 30303, USA.
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
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7
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Indovina I, Conti A, Lacquaniti F, Staab JP, Passamonti L, Toschi N. Lower Functional Connectivity in Vestibular-Limbic Networks in Individuals With Subclinical Agoraphobia. Front Neurol 2019; 10:874. [PMID: 31456740 PMCID: PMC6701404 DOI: 10.3389/fneur.2019.00874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/26/2019] [Indexed: 02/02/2023] Open
Abstract
Background: Agoraphobia was described in 1871 as a condition of fear-related alterations in spatial orientation and locomotor control triggered by places or situations that might cause a patient to panic and feel trapped. In contemporary nosology, however, this original concept of agoraphobia was split into two diagnostic entities, i.e., the modern anxiety disorder of agoraphobia, consisting solely of phobic/avoidant symptoms in public spaces, and the recently defined vestibular disorder of persistent postural perceptual dizziness (PPPD), characterized by dizziness, and unsteadiness exacerbated by visual motion stimuli. Previous neuroimaging studies found altered brain activity and connectivity in visual-vestibular networks of patients with PPPD vs. healthy controls. Neuroticism and introversion, which pre-dispose to both agoraphobia and PPPD, influenced brain responses to vestibular and visual motion stimuli in patients with PPPD. Similar neuroimaging studies have not been undertaken in patients with agoraphobia in its current definition. Given their shared history and pre-disposing factors, we sought to test the hypotheses that individuals with agoraphobic symptoms have alterations in visual-vestibular networks similar to those of patients with PPPD, and that these alterations are influenced by neuroticism and introversion. Methods: Drawing from the Human Connectome Project (HCP) database, we matched 52 participants with sub-clinical agoraphobia and 52 control subjects without agoraphobic symptoms on 19 demographic and psychological/psychiatric variables. We then employed a graph-theoretical framework to compare resting-state functional magnetic resonance images between groups and evaluated the interactive effects of neuroticism and introversion on the brain signatures of agoraphobia. Results: Individuals with subclinical agoraphobia had lower global clustering, efficiency and transitivity relative to controls. They also had lower connectivity metrics in two brain networks, one positioned to process incoming visual space-motion information, assess threat, and initiate/inhibit behavioral responses (visuospatial-emotional network) and one positioned to control and monitor locomotion (vestibular-navigational network). Introversion interacted with agoraphobic symptoms to lower the connectivity of the visuospatial-emotional network. This contrasted with previous findings describing neuroticism-associated higher connectivity in a narrower visual-spatial-frontal network in patients with PPPD. Conclusion: Functional connectivity was lower in two brain networks in subclinical agoraphobia as compared to healthy controls. These networks integrate visual vestibular and emotional response to guide movement in space.
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Affiliation(s)
- Iole Indovina
- Department of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences, Rome, Italy,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy,*Correspondence: Iole Indovina
| | - Allegra Conti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy,Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, Rome, Italy
| | - Jeffrey P. Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom,Institute of Bioimaging and Molecular Physiology, National Research Council, Milan, Italy,Luca Passamonti
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States
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Ben-Zion Z, Fine NB, Keynan NJ, Admon R, Halpern P, Liberzon I, Hendler T, Shalev AY. Neurobehavioral moderators of post-traumatic stress disorder (PTSD) trajectories: study protocol of a prospective MRI study of recent trauma survivors. Eur J Psychotraumatol 2019; 10:1683941. [PMID: 31762950 PMCID: PMC6853209 DOI: 10.1080/20008198.2019.1683941] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/03/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) is triggered by distinct events and is therefore amenable to studies of its early pathogenesis. Longitudinal studies during the year that follows trauma exposure revealed typical symptom trajectories leading to either recovery or protracted PTSD. Thezneurobehavioral correlates of early PTSD symptoms' trajectories have not been longitudinally explored. Objective: To present the rationale and design of a longitudinal study exploring the relationship between evolving PTSD symptoms and co-occurring cognitive functioning and structural and functional brain imaging parameters. Method: Adult civilians consecutively admitted to a general hospital emergency room (ER) for traumatic injury will be screened for early PTSD symptoms suggestive of chronic PTSD risk, and consecutively evaluated 1, 6 and 14 months following the traumatic event. Consecutive assessments will include structured clinical interviews for PTSD and comorbid disorders, self-reported depression and anxiety symptoms, a web-based assessment of cognitive domains previously linked with PTSD (e.g., memory, executive functions, cognitive flexibility), high-resolution structural MRI of both grey and white matter, functional resting-state connectivity, and fMRI tasks examining emotional reactivity and regulation, as well as motivation processing and sensitivity to risk and reward. Data analyses will explore putative cognitive predictors of non-remitting PTSD, and brain structural and functional correlates of PTSD persistence or recovery. Conclusion: This work will longitudinally document patterns of brain structures, connectivity, and functioning, predictive of (or associated with) emerging PTSD during the critical first year of after the traumatic event. It will thereby inform our understanding of the disorder's pathogenesis and underlying neuropathology. Challenges to longitudinal MRI studies of recent survivors, and methodological choices used to optimize the study's design are discussed.
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Affiliation(s)
- Ziv Ben-Zion
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Naomi B Fine
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nimrod Jackob Keynan
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Roee Admon
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Pinchas Halpern
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M Health Science Center, Austin, TX, USA
| | - Talma Hendler
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Y Shalev
- Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
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9
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Yazdi-Ravandi S, Akhavanpour H, Shamsaei F, Matinnia N, Ahmadpanah M, Ghaleiha A, Khosrowabadi R. Differential pattern of brain functional connectome in obsessive-compulsive disorder versus healthy controls. EXCLI JOURNAL 2018; 17:1090-1100. [PMID: 30564085 PMCID: PMC6295628 DOI: 10.17179/excli2018-1757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/31/2018] [Indexed: 02/06/2023]
Abstract
Researchers believe that recognition of functional impairment in some of brain networks such as frontal-parietal, default mode network (DMN), anterior medial prefrontal cortex (MPFC) and striatal structures could be a beneficial biomarker for diagnosis of obsessive-compulsive disorder (OCD). Although it is well recognized brain functional connectome in OCD patients shows changes, debate still remains on characteristics of the changes. In this regard, little has been done so far to statistically assess the altered pattern using whole brain electroencephalography. In this study, resting state EEG data of 39 outpatients with OCD and 19 healthy controls (HC) were recorded. After, brain functional network was estimated from the cleaned EEG data using the weighted phase lag index algorithm. Output matrices of OCD group and HCs were then statistically compared to represent meaningful differences. Significant differences in functional connectivity pattern were demonstrated in several regions. As expected the most significant changes were observed in frontal cortex, more significant in frontal-temporal connections (between F3 and F7, and T5 regions). These results in OCD patients are consistent with previous studies and confirm the role of frontal and temporal brain regions in OCD.
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Affiliation(s)
- Saeid Yazdi-Ravandi
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hassan Akhavanpour
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University GC, Tehran, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nasrin Matinnia
- Department of Nursing, College of Basic Science, Hamadan Branch, Islamic Azad University, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Ghaleiha
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reza Khosrowabadi
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University GC, Tehran, Iran
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10
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Besteher B, Squarcina L, Spalthoff R, Bellani M, Gaser C, Nenadić I, Brambilla P. Subclinical Agoraphobia Symptoms and Regional Brain Volumes in Non-clinical Subjects: Between Compensation and Resilience? Front Psychiatry 2018; 9:541. [PMID: 30546323 PMCID: PMC6279873 DOI: 10.3389/fpsyt.2018.00541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/11/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Symptoms of anxiety are present not only in panic disorder or other anxiety disorders, but are highly prevalent in the general population. Despite increasing biological research on anxiety disorders, there is little research on understanding subclinical or sub-threshold symptoms relating to anxiety in non-clinical community samples, which could give clues to factors relating to resilience or compensatory changes. Aims:This study focused on brain structural correlates of subclinical anxiety/agoraphobia symptoms from a multi-center imaging study. Methods: We obtained high-resolution structural T1 MRI scans of 409 healthy young participants and used the CAT12 toolbox for voxel-based morphometry (VBM) analysis. Subjects provided self-ratings of anxiety using the SCL-90-R, from which we used the phobia subscale, covering anxiety symptoms related to those of panic and agoraphobia spectrum. Results: We found significant (p < 0.05, FDR-corrected) correlations (mostly positive) of cortical volume with symptom severity, including the right lingual gyrus and calcarine sulcus, as well as left calcarine sulcus, superior, middle, and inferior temporal gyri. Uncorrected exploratory analysis also revealed positive correlations with GMV in orbitofrontal cortex, precuneus, and insula. Conclusions: Our findings show brain structural associations of subclinical symptoms of anxiety, which overlap with those seen in panic disorder or agoraphobia. This is consistent with a dimensional model of anxiety, which is reflected not only functionally but also on the structural level.
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Affiliation(s)
- Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | | | - Robert Spalthoff
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Marcella Bellani
- Department of Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Jena, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Marburg, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Giessen and Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMMB), Marburg, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioural Neurosciences, UT Houston Medical School, Houston, TX, United States
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11
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Neonatal blockade of GABA‐A receptors alters behavioral and physiological phenotypes in adult mice. Int J Dev Neurosci 2017; 57:62-71. [DOI: 10.1016/j.ijdevneu.2017.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/11/2016] [Accepted: 01/16/2017] [Indexed: 11/21/2022] Open
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12
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Abstract
Obsessive compulsive disorder (OCD) is a relatively common psychiatric illness with a lifetime prevalence of 2-3% in general population. The pathophysiology of OCD is not yet fully understood, however over the last few decades, evidence for abnormalities of cortico-striatal-thalamic-cortico (CSTC) circuitry in etiopathogenesis of OCD has accumulated. Recent brain imaging techniques have been particularly convincing in suggesting that CSTC circuits are responsible for mediation of OCD symptoms. Neuroimaging studies, especially more recent studies using functional neuroimaging methods have looked for possible changes seen in the brain of patients with OCD, the specificity of the findings (as compared to other psychiatric illnesses) and the effects of treatment (pharmacotherapy/psychotherapy) on such changes were observed. This narrative review discusses the neuroimaging findings seen in patients with OCD with a special focus on relatively more recent neuroimaging modalities such as magnetic resonance spectroscopy and magnetoencephalography.
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Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
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13
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Are Anxiety Disorders Associated with Accelerated Aging? A Focus on Neuroprogression. Neural Plast 2015; 2016:8457612. [PMID: 26881136 PMCID: PMC4736204 DOI: 10.1155/2016/8457612] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 12/16/2022] Open
Abstract
Anxiety disorders (AnxDs) are highly prevalent throughout the lifespan, with detrimental effects on daily-life functioning, somatic health, and quality of life. An emerging perspective suggested that AnxDs may be associated with accelerated aging. In this paper, we explored the association between AnxDs and hallmarks of accelerated aging, with a specific focus on neuroprogression. We reviewed animal and human findings that suggest an overlap between processes of impaired neurogenesis, neurodegeneration, structural, functional, molecular, and cellular modifications in AnxDs, and aging. Although this research is at an early stage, our review suggests a link between anxiety and accelerated aging across multiple processes involved in neuroprogression. Brain structural and functional changes that accompany normal aging were more pronounced in subjects with AnxDs than in coevals without AnxDs, including reduced grey matter density, white matter alterations, impaired functional connectivity of large-scale brain networks, and poorer cognitive performance. Similarly, molecular correlates of brain aging, including telomere shortening, Aβ accumulation, and immune-inflammatory and oxidative/nitrosative stress, were overrepresented in anxious subjects. No conclusions about causality or directionality between anxiety and accelerated aging can be drawn. Potential mechanisms of this association, limitations of the current research, and implications for treatments and future studies are discussed.
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Talati A, Pantazatos SP, Hirsch J, Schneier F. A pilot study of gray matter volume changes associated with paroxetine treatment and response in social anxiety disorder. Psychiatry Res 2015; 231:279-85. [PMID: 25659476 PMCID: PMC4363180 DOI: 10.1016/j.pscychresns.2015.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/09/2014] [Accepted: 01/09/2015] [Indexed: 12/17/2022]
Abstract
Social anxiety disorder (SAD) has received relatively little attention in neurobiological studies. We sought to identify neuro-anatomical changes associated with successful treatment for the disorder. Fourteen patients (31 years; 57% female) with DSM-IV generalized SAD were imaged before and after 8-weeks of paroxetine treatment on a 1.5 T GE Signa MRI scanner. Symptoms were assessed by a clinician using the Liebowitz Social Anxiety Scale (LSAS). Longitudinal changes in voxel based morphometry (VBM) were determined using the VBM8 Toolbox for SPM8. Symptom severity decreased by 46% following treatment (p<0.001). At week 8, significant gray matter reductions were detected in bilateral caudate and putamen, and right thalamus, and increases in the cerebellum. Gray matter decreases in left thalamus were correlated with clinical response. This is the first study to our knowledge to identify treatment related correlates of symptom improvement for SAD. Replication in larger samples with control groups is needed to confirm these findings, as well as to test their specificity and temporal stability.
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Affiliation(s)
- Ardesheer Talati
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA.
| | - Spiro P. Pantazatos
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Joy Hirsch
- Departments of Psychiatry and Neurobiology, Yale School of Medicine, New Haven CT, USA
| | - Franklin Schneier
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
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15
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Jones JE, Jackson DC, Chambers KL, Dabbs K, Hsu DA, Stafstrom CE, Seidenberg M, Hermann BP. Children with epilepsy and anxiety: Subcortical and cortical differences. Epilepsia 2015; 56:283-90. [PMID: 25580566 PMCID: PMC4340751 DOI: 10.1111/epi.12832] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Using a hypothesis-driven approach, subcortical and cortical regions implicated in anxiety disorders in the general population were examined in children with recent-onset epilepsy with versus without anxiety compared to controls. This study reports frequency of anxiety disorders while examining familial, clinical, and demographic variables associated with anxiety in children with epilepsy. METHOD Participants included 88 children with epilepsy aged 8-18 years: 25 with a current anxiety disorder and 63 children with epilepsy and no current anxiety disorder. Forty-nine controls without anxiety disorders were included. T1 volumetric magnetic resonance imaging (MRI) scans were collected; subcortical volumes and cortical thickness were computed using the FreeSurfer image analysis suite. Analyses focused on adjusted measures of subcortical volumes and cortical thickness. RESULTS Relative to controls, larger left amygdala volumes were found in the Epilepsy with Anxiety group compared to the Epilepsy without Anxiety group (p = 0.027). In the hippocampus, there were no significant differences between groups. Examination of cortical thickness demonstrated that the Epilepsy with Anxiety group showed thinning in left medial orbitofrontal (p = 0.001), right lateral orbitofrontal (p = 0.017), and right frontal pole (p = 0.009). There were no differences between groups in age, sex, IQ, age of onset, medications, or duration of epilepsy. There were more family members with a history of anxiety disorders in the Epilepsy with Anxiety group compared to the Epilepsy without Anxiety group (p = 0.005). SIGNIFICANCE Anxiety is a common psychiatric comorbidity in children with recent-onset epilepsy with volumetric enlargement of the amygdala and thinner cortex in orbital and other regions of prefrontal cortex, suggesting structural abnormalities in brain regions that are part of the dysfunctional networks reported in individuals with anxiety disorders in the general population. These findings are evident early in the course of epilepsy, are not related to chronicity of seizures, and may be linked to a family history of anxiety and depressive disorders.
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Affiliation(s)
- Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Daren C. Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Karlee L. Chambers
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - David A. Hsu
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Carl E. Stafstrom
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin School of Medicine and Science, North Chicago IL
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison WI
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16
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Machado S, Arias-Carrión O, Paes F, Vieira RT, Caixeta L, Novaes F, Marinho T, Almada LF, Silva AC, Nardi AE. Repetitive transcranial magnetic stimulation for clinical applications in neurological and psychiatric disorders: an overview. Eurasian J Med 2015; 45:191-206. [PMID: 25610279 DOI: 10.5152/eajm.2013.39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 01/01/2023] Open
Abstract
Neurological and psychiatric disorders are characterized by several disabling symptoms for which effective, mechanism-based treatments remain elusive. Consequently, more advanced non-invasive therapeutic methods are required. A method that may modulate brain activity and be viable for use in clinical practice is repetitive transcranial magnetic stimulation (rTMS). It is a non-invasive procedure whereby a pulsed magnetic field stimulates electrical activity in the brain. Here, we focus on the basic foundation of rTMS, the main stimulation parametters, the factors that influence individual responses to rTMS and the experimental advances of rTMS that may become a viable clinical application to treat neurological and psychiatric disorders. The findings showed that rTMS can improve some symptoms associated with these conditions and might be useful for promoting cortical plasticity in patients with neurological and psychiatric disorders. However, these changes are transient and it is premature to propose these applications as realistic therapeutic options, even though the rTMS technique has been evidenced as a potential modulator of sensorimotor integration and neuroplasticity. Functional imaging of the region of interest could highlight the capacity of rTMS to bring about plastic changes of the cortical circuitry and hint at future novel clinical interventions. Thus, we recommend that further studies clearly determine the role of rTMS in the treatment of these conditions. Finally, we must remember that however exciting the neurobiological mechanisms might be, the clinical usefulness of rTMS will be determined by its ability to provide patients with neurological and psychiatric disorders with safe, long-lasting and substantial improvements in quality of life.
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Affiliation(s)
- Sergio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ); National Institute for Translational Medicine (INCT-TM), Brazil ; Quiropraxia Program of Faculty of Health Sciences, Central University (UCEN), Santiago, Chile ; Institute of Phylosophy of Federal University of Uberlândia (IFILO/UFU), Brazil ; Physical Activity Neuroscience Laboratory, Physical Activity Sciences Postgraduate Program of Salgado de Oliveira University, Niterói, Brazil
| | - Oscar Arias-Carrión
- Movement Disorders and Transcranial Magnetic Stimulation Unit, Hospital General Dr. Manuel Gea González, México DF, México
| | - Flávia Paes
- Panic and Respiration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ); National Institute for Translational Medicine (INCT-TM), Brazil
| | | | - Leonardo Caixeta
- Faculty of Medicine of Federal University of Goiás, Goiás-GO, Brazil
| | - Felipe Novaes
- Panic and Respiration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ); National Institute for Translational Medicine (INCT-TM), Brazil
| | - Tamires Marinho
- Panic and Respiration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ); National Institute for Translational Medicine (INCT-TM), Brazil
| | | | - Adriana Cardoso Silva
- Panic and Respiration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ); National Institute for Translational Medicine (INCT-TM), Brazil
| | - Antonio Egidio Nardi
- Panic and Respiration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ); National Institute for Translational Medicine (INCT-TM), Brazil
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17
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Lijffijt M, Rourke ED, Swann AC, Zunta-Soares GB, Soares JC. Illness-course modulates suicidality-related prefrontal gray matter reduction in women with bipolar disorder. Acta Psychiatr Scand 2014; 130:374-87. [PMID: 25039251 DOI: 10.1111/acps.12314] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Explore interrelationships between suicide attempt history (Objective 1) or suicide attempt severity (Objective 2) with prefrontal cortex gray matter (PFCGM ) volume and illness-course in patients with bipolar disorder (BD). METHOD Ninety-three women with BD-I or -II diagnosis (51 with and 42 without suicide attempt history) underwent structural MRI and filled out questionnaires. Measured were GM volumes of 11 PFC regions, BD illness-course, and attempt history and severity. Effects were examined with repeated measures GLM or logit analyses. RESULTS Objective 1: Attempt history was associated with increased trait impulsivity and aggression, and higher prevalence of BD-I, past drug use disorder, and past psychiatric hospitalization. PFCGM volume was lower in patients with than without attempt history in those with past psychiatric hospitalization. PFCGM volume was higher in patients with than without attempt history in those without hospitalization. Higher trait aggression predicted attempt history. Objective 2: Increased frontal pole volume and younger age at first hospitalization predicted many suicide attempts. CONCLUSION Attempt history in patients with BD related to PFCGM volume reduction or increase. Volume modulation by psychiatric hospitalization could reflect effects of illness-course or care. Attempt severity was not related to volume reduction. Research on suicidality-brain relationships should include illness-course and attempt severity measures.
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Affiliation(s)
- M Lijffijt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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18
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Neuroimaging in social anxiety disorder—A meta-analytic review resulting in a new neurofunctional model. Neurosci Biobehav Rev 2014; 47:260-80. [PMID: 25124509 DOI: 10.1016/j.neubiorev.2014.08.003] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/26/2014] [Accepted: 08/01/2014] [Indexed: 01/30/2023]
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19
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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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20
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Abstract
BACKGROUND Abnormal brain pH has been suggested to play a critical role in panic disorder. To investigate this possibility, we employed a pH-sensitive magnetic resonance (MR) imaging strategy (T1 relaxation in the rotating frame [T1ρ]) and conventional blood oxygen level-dependent (BOLD) imaging. METHODS Thirteen panic disorder participants and 13 matched control subjects were enrolled in the study. T1ρ and BOLD were used to study the functional response to a visual flashing checkerboard and their relationship to panic symptoms assessed using the Beck Anxiety Inventory. RESULTS In response to visual stimulation, T1ρ imaging revealed a significantly greater increase in the visual cortex of panic disorder participants. T1ρ also detected a stimulus-evoked decrease in the anterior cingulate cortex. Blood oxygen level-dependent imaging detected no functional differences between groups. The correspondence between panic symptoms and functional T1ρ response identified significant relationships within the left inferior parietal lobe, left middle temporal gyrus, and right insula. No relationships were found between panic symptoms and the BOLD signal. CONCLUSIONS The data suggest greater activity-evoked T1ρ changes in the visual cortex and anterior cingulate cortex of panic disorder participants. These observations are consistent with a pH dysregulation in panic disorder. In addition, our data suggest that T1ρ imaging may provide information about panic disorder that is distinct from conventional BOLD imaging and may reflect abnormalities in pH and/or brain metabolism.
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Shang J, Fu Y, Ren Z, Zhang T, Du M, Gong Q, Lui S, Zhang W. The common traits of the ACC and PFC in anxiety disorders in the DSM-5: meta-analysis of voxel-based morphometry studies. PLoS One 2014; 9:e93432. [PMID: 24676455 PMCID: PMC3968149 DOI: 10.1371/journal.pone.0093432] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/04/2014] [Indexed: 02/05/2023] Open
Abstract
Background The core domains of social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD) with and without agoraphobia (GA), and specific phobia (SP) are cognitive and physical symptoms that are related to the experience of fear and anxiety. It remains unclear whether these highly comorbid conditions that constitute the anxiety disorder subgroups of the Diagnostic and Statistical Manual for Mental Disorders – Fifth Edition (DSM-5) represent distinct disorders or alternative presentations of a single underlying pathology. Methods A systematic search of voxel-based morphometry (VBM) studies of SAD, GAD, PD, GA, and SP was performed with an effect-size signed differential mapping (ES-SDM) meta-analysis to estimate the clusters of significant gray matter differences between patients and controls. Results Twenty-four studies were eligible for inclusion in the meta-analysis. Reductions in the right anterior cingulate gyrus and the left inferior frontal gyrus gray matter volumes (GMVs) were noted in patients with anxiety disorders when potential confounders, such as comorbid major depressive disorder (MDD), age, and antidepressant use were controlled for. We also demonstrated increased GMVs in the right dorsolateral prefrontal cortex (DLPFC) in comorbid depression-anxiety (CDA), drug-naïve and adult patients. Furthermore, we identified a reduced left middle temporal gyrus and right precentral gyrus in anxiety patients without comorbid MDD. Conclusion Our findings indicate that a reduced volume of the right ventral anterior cingulate gyrus and left inferior frontal gyrus is common in anxiety disorders and is independent of comorbid depression, medication use, and age. This generic effect supports the notion that the four types of anxiety disorders have a clear degree of overlap that may reflect shared etiological mechanisms. The results are consistent with neuroanatomical DLPFC models of physiological responses, such as worry and fear, and the importance of the ventral anterior cingulate (ACC)/medial prefrontal cortex (mPFC) in mediating anxiety symptoms.
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Affiliation(s)
- Jing Shang
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Yuchuan Fu
- Radiology Department of the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Zhengjia Ren
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Tao Zhang
- West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Mingying Du
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Su Lui
- Radiology Department of the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
- * E-mail: (WZ); (SL)
| | - Wei Zhang
- Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China
- * E-mail: (WZ); (SL)
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Coutinho FC, Dias GP, Nascimento Bevilaqua MCD, Gardino PF, Rangé BP, Nardi AE. Current concept of anxiety: implications from Darwin to the DSM-V for the diagnosis of generalized anxiety disorder. Expert Rev Neurother 2014; 10:1307-20. [DOI: 10.1586/ern.10.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sex differences in anxiety and depression: role of testosterone. Front Neuroendocrinol 2014; 35:42-57. [PMID: 24076484 PMCID: PMC3946856 DOI: 10.1016/j.yfrne.2013.09.001] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/31/2013] [Accepted: 09/06/2013] [Indexed: 01/30/2023]
Abstract
Compelling evidence exists for pervasive sex differences in pathological conditions, including anxiety and depressive disorders, with females more than twice as likely to be afflicted. Gonadal hormones may be a major factor in this disparity, given that women are more likely to experience mood disturbances during times of hormonal flux, and testosterone may have protective benefits against anxiety and depression. In this review we focus on the effects of testosterone in males and females, revealed in both human and animal studies. We also present possible neurobiological mechanisms underlying testosterone's mostly protective benefits, including the brain regions, neural circuits, and cellular and molecular pathways involved. While the precise underlying mechanisms remain unclear, both activational and organizational effects of testosterone appear to contribute to these effects. Future clinical studies are necessary in order to better understand when and how testosterone therapy may be effective in both sexes.
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Levitan MN, Chagas MH, Linares IM, Crippa JA, Terra MB, Giglio AT, Cordeiro JL, Garcia GJ, Hasan R, Andrada NC, Nardi AE. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:406-15. [DOI: 10.1590/1516-4446-2012-0860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 01/30/2013] [Indexed: 11/22/2022]
Affiliation(s)
- Michelle Nigri Levitan
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Marcos H. Chagas
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Ila M. Linares
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - José A. Crippa
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Mauro B. Terra
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Centro de Estudos Jose de Barros Falcão, Brazil
| | | | - Joana L.C. Cordeiro
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Giovana J. Garcia
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Rosa Hasan
- Associação Brasileira de Neurologia, Brazil
| | | | - Antonio E. Nardi
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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Paes F, Baczynski T, Novaes F, Marinho T, Arias-Carrión O, Budde H, Sack AT, Huston JP, Almada LF, Carta M, Silva AC, Nardi AE, Machado S. Repetitive Transcranial Magnetic Stimulation (rTMS) to Treat Social Anxiety Disorder: Case Reports and a Review of the Literature. Clin Pract Epidemiol Ment Health 2013; 9:180-8. [PMID: 24278088 PMCID: PMC3837365 DOI: 10.2174/1745017901309010180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/11/2022]
Abstract
Objectives: Social anxiety disorder (SAD) is a common and debilitating anxiety disorders. However, few studies had been dedicated to the neurobiology underlying SAD until the last decade. Rates of non-responders to standard methods of treatment remain unsatisfactorily high of approximately 25%, including SAD. Advances in our understanding of SAD could lead to new treatment strategies. A potential non invasive therapeutic option is repetitive transcranial magnetic stimulation (rTMS). Thus, we reported two cases of SAD treated with rTMS Methods: The bibliographical search used Pubmed/Medline, ISI Web of Knowledge and Scielo databases. The terms chosen for the search were: anxiety disorders, neuroimaging, repetitive transcranial magnetic stimulation. Results: In most of the studies conducted on anxiety disorders, except SAD, the right prefrontal cortex (PFC), more specifically dorsolateral PFC was stimulated, with marked results when applying high-rTMS compared with studies stimulating the opposite side. However, according to the “valence hypothesis”, anxiety disorders might be characterized by an interhemispheric imbalance associated with increased right-hemispheric activity. With regard to the two cases treated with rTMS, we found a decrease in BDI, BAI and LSAS scores from baseline to follow-up. Conclusion: We hypothesize that the application of low-rTMS over the right medial PFC (mPFC; the main structure involved in SAD circuitry) combined with high-rTMS over the left mPFC, for at least 4 weeks on consecutive weekdays, may induce a balance in brain activity, opening an attractive therapeutic option for the treatment of SAD.
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Affiliation(s)
- Flávia Paes
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil ; National Institute for Translational Medicine (INCT-TM), Brazil
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Meng Y, Lui S, Qiu C, Qiu L, Lama S, Huang X, Feng Y, Zhu C, Gong Q, Zhang W. Neuroanatomical deficits in drug-naïve adult patients with generalized social anxiety disorder: a voxel-based morphometry study. Psychiatry Res 2013; 214:9-15. [PMID: 23953332 DOI: 10.1016/j.pscychresns.2013.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 04/09/2013] [Accepted: 06/11/2013] [Indexed: 11/29/2022]
Abstract
Little is known, so far, about the cerebral structural deficits in drug-naïve adult social anxiety disorder (SAD) patients. The present study aimed to explore the cerebral anatomic deficits in drug-naïve adult generalized SAD patients using voxel-based morphometric analysis with DARTEL. High-resolution T1-weighted images were acquired from 20 drug-naïve adult SAD patients and 19 age-, sex- and education-matched controls. The volumes of gray matter, white matter, cerebrospinal fluid, and total intracranial volume were compared between groups using two-sample t-tests with age and gender as covariates. Gray matter density (GMD) was compared between groups using voxel-wise two-sample t-test analysis. Correlation analysis was used to identify any associations between regional GMD and clinical symptoms. Compared with healthy controls, SAD patients showed significantly lower GMD in the bilateral thalami, right amygdala, and right precuneus. Furthermore, the GMD in the right amygdala was negatively related to the disease duration, but positively correlated with age of onset. Our findings demonstrated that cerebral anatomic deficits could be found within limbic and thalamic areas in drug-naïve SAD patients, which provides structural information to complement the functional alterations observed in the same regions.
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Affiliation(s)
- Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, 37 Guoxue Lane, 610041 Chengdu, Sichuan Province, PR China
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Weber M, Killgore WD, Rosso IM, Britton JC, Schwab ZJ, Weiner MR, Naomi MS, Pollack MH, Rauch SL. Voxel-based morphometric gray matter correlates of posttraumatic stress disorder. J Anxiety Disord 2013; 27:413-9. [PMID: 23746489 PMCID: PMC3782384 DOI: 10.1016/j.janxdis.2013.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 02/01/2013] [Accepted: 04/08/2013] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with functional abnormalities within a neurocircuitry that includes the hippocampus, amygdala, and medial prefrontal cortex. Evidence of structural abnormalities within these regions, and their association with PTSD severity and symptom burden is, however, sparse. The present study evaluated the relation between indices of gray matter volume and PTSD symptom severity using voxel-based morphometry. Fifteen individuals meeting DSM-IV criteria for PTSD completed the Clinician Administered PTSD Scale and underwent structural magnetic resonance imaging. Greater PTSD severity and avoidance/numbing were correlated with increased gray matter volume of the right amygdala-hippocampal complex. Greater hyper-arousal was associated with reduced gray matter volume in the left superior medial frontal gyrus. Findings are consistent with current neurocircuitry models of PTSD, which posit that the disorder is associated with structural and functional variance within this distributed network.
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Affiliation(s)
- Mareen Weber
- McLean Hospital, Harvard Medical School, Belmont, MA
| | | | | | | | | | | | - M. Simon Naomi
- Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Mark H. Pollack
- Massachusetts General Hospital, Harvard Medical School, Boston MA
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Terlevic R, Isola M, Ragogna M, Meduri M, Canalaz F, Perini L, Rambaldelli G, Travan L, Crivellato E, Tognin S, Como G, Zuiani C, Bazzocchi M, Balestrieri M, Brambilla P. Decreased hypothalamus volumes in generalized anxiety disorder but not in panic disorder. J Affect Disord 2013; 146:390-4. [PMID: 23084182 DOI: 10.1016/j.jad.2012.09.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND The hypothalamus is a brain structure involved in the neuroendocrine aspect of stress and anxiety. Evidence suggests that generalized anxiety disorder (GAD) and panic disorder (PD) might be accompanied by dysfunction of the hypothalamus-pituitary-adrenal axis (HPA), but so far structural alterations were not studied. We investigated hypothalamic volumes in patients with either GAD or PD and in healthy controls. METHODS Twelve GAD patients, 11 PD patients and 21 healthy controls underwent a 1.5T MRI scan. Hypothalamus volumes were manually traced by a rater blind to subjects' identity. General linear model for repeated measures (GLM-RM) was used to compare groups on hypothalamic volumes, controlling for total intracranial volume, age and sex. RESULTS The hypothalamus volume was significantly reduced (p=0.04) in GAD patients, with significant reductions in both the left (p=0.02) and right side (p=0.04). Patients with PD did not differ significantly (p=0.73). Anxiety scores were inversely correlated with hypothalamic volumes. LIMITATIONS The small sample size could reduce the generalizability of the results while the lack of stress hormone measurements renders functional assessment of the hypothalamus-pituitary-adrenal axis not feasible. CONCLUSIONS The present study showed decreased hypothalamic volumes in GAD patients but not in those with PD. Future longitudinal studies should combine volumetric data with measurements of stress hormones to better elucidate the role of the HPA axis in GAD.
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Affiliation(s)
- Robert Terlevic
- Department of Experimental & Clinical Medical Sciences (DISM), Inter-University Centre for Behavioural Neurosciences, University of Udine, Udine, Italy
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29
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Mueller SC, Aouidad A, Gorodetsky E, Goldman D, Pine DS, Ernst M. Gray matter volume in adolescent anxiety: an impact of the brain-derived neurotrophic factor Val(66)Met polymorphism? J Am Acad Child Adolesc Psychiatry 2013; 52:184-95. [PMID: 23357445 PMCID: PMC3570270 DOI: 10.1016/j.jaac.2012.11.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/21/2012] [Accepted: 11/21/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Minimal research links anxiety disorders in adolescents to regional gray matter volume (GMV) abnormalities and their modulation by genetic factors. Prior research suggests that a brain-derived neurotrophic factor (BNDF) Val(66)Met polymorphism may modulate such brain morphometry profiles. METHOD Using voxel-based morphometry and magnetic resonance imaging, associations of BDNF and clinical anxiety with regional GMVs of anterior cingulate cortex, insula, amygdala, and hippocampus were examined in 39 affected (17 Met allele carriers, 22 Val/Val homozygotes) and 63 nonaffected adolescents (27 [corrected] Met allele carriers, 36 [corrected] Val/Val homozygotes). RESULTS Amygdala and anterior hippocampal GMVs were significantly smaller in patients than in healthy comparison adolescents, with a reverse pattern for the insula. Post-hoc regression analyses indicated a specific contribution of social phobia to the GMV reductions in the amygdala and hippocampus. In addition, insula and dorsal-anterior cingulate cortex (ACC) GMVs were modulated by BDNF genotype. In both regions, and GMVs were larger in the Val/Val homozygote patients than in individuals carrying the Met allele. CONCLUSIONS These results implicate reduced GMV in the amygdala and hippocampus in pediatric anxiety, particularly social phobia. In addition, the data suggest that genetic factors may modulate differences in the insula and dorsal ACC.
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Affiliation(s)
- Sven C Mueller
- Development and Affective Neuroscience, National Institute of Mental Health (NIMH), University of Ghent, Belgium.
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Talati A, Pantazatos SP, Schneier FR, Weissman MM, Hirsch J. Gray matter abnormalities in social anxiety disorder: primary, replication, and specificity studies. Biol Psychiatry 2013; 73:75-84. [PMID: 22748614 PMCID: PMC3465490 DOI: 10.1016/j.biopsych.2012.05.022] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite increasing evidence that neuroanatomical abnormalities underlie pathological anxiety, social anxiety disorder (SAD)-although among the most common of anxiety disorders-has received little attention. With magnetic resonance imaging, we: 1) examined gray matter (GM) differences between generalized SAD and healthy control groups; 2) retested the findings in an independent clinical sample; and 3) tested for specificity by contrasting the SAD group to a separate group of panic disorder (PD) subjects. METHODS The primary SAD group (n = 16) was required to meet DSM-IV criteria for SAD, with onset by age 30 years; control subjects (n = 20) had no lifetime history of anxiety. The replication sample included 17 generalized SAD and 17 control subjects. The PD comparison group (n = 16) was required to have no lifetime SAD. Images were acquired on a 1.5-Tesla GE Signa magnetic resonance imaging scanner with a three-dimensional T1-weighted spoiled gradient recalled pulse sequence. Morphological differences were determined with voxel-based morphometry, in SPM8. RESULTS After adjusting for age, gender, and total intracranial volume, SAD (as compared with control) subjects had greater GM in the left parahippocampal and middle occipital, and bilateral supramarginal and angular cortices, and left cerebellum; and lower GM in bilateral temporal poles and left lateral orbitofrontal cortex. Cerebellar, parahippocampal, and temporal pole differences were observed in both samples, survived whole brain corrections, and were not observed in the PD group, pointing to relative specificity to SAD. CONCLUSIONS These findings parallel the functional literature on SAD and suggest structural abnormalities underlying the functional disturbances.
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Affiliation(s)
- Ardesheer Talati
- Department of Psychiatry, Columbia University Medical Center, New York State PsychiatricInstitute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Spiro P. Pantazatos
- Department of Physiology and Cellular Biophysics, Columbia University Medical Center, New York, NY,Program for Imaging and Cognitive Sciences, Columbia University, New York, NY
| | - Franklin R. Schneier
- Department of Psychiatry, Columbia University Medical Center, New York, NY,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University Medical Center, New York, NY,Department of Epidemiology, Columbia University Medical Center, New York, NY,Division of Epidemiology, New York State Psychiatric Institute, New York, NY
| | - Joy Hirsch
- Department of Psychology, Columbia University Medical Center, New York, NY,Department of Neuroscience, Columbia University Medical Center, New York, NY,Department of Radiology, Columbia University Medical Center, New York, NY,Program for Imaging and Cognitive Sciences, Columbia University, New York, NY
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Macey PM, Kumar R, Yan-Go FL, Woo MA, Harper RM. Sex differences in white matter alterations accompanying obstructive sleep apnea. Sleep 2012. [PMID: 23204603 DOI: 10.5665/sleep.2228] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
STUDY OBJECTIVES Females with obstructive sleep apnea (OSA) show different psychological and physiological symptoms from males, which may be associated with sex-related variations in neural injury occurring with the disorder. To determine whether male- or female-specific brain injury is present in OSA, we assessed influences of sex on white matter changes in the condition. DESIGN Two-group factorial. SETTING University medical center. PATIENTS OR PARTICIPANTS 80 subjects total, with newly diagnosed, untreated OSA groups of 10 female (age mean ± SE: 52.6 ± 2.4 years, AHI 22.5 ± 4.1 events/h) and 20 male (age 48.9 ± 1.7, AHI 25.5 ± 2.9) patients, and 20 female (age 50.3 ± 1.7) and 30 male (age 49.2 ± 1.4) healthy control subjects. INTERVENTIONS None. MEASUREMENTS AND RESULTS Brain fiber integrity was assessed with fractional anisotropy (FA), a diffusion tensor imaging-derived measure. Sleep quality, daytime sleepiness, depression, and anxiety were assessed with questionnaires. We identified regions of differing injury in male versus female OSA patients by assessing brain regions with significant interaction effects of OSA and sex on FA. Areas of sex-specific, OSA-related FA reductions appeared in females relative to males, including in the bilateral cingulum bundle adjacent to the mid hippocampus, right stria terminalis near the amygdala, prefrontal and posterior-parietal white matter, corpus callosum, and left superior cerebellar peduncle. Females with OSA showed higher daytime sleepiness, anxiety and depression levels, and reduced sleep quality. CONCLUSIONS Sex differences in white matter structural integrity appeared in OSA patients, with females more affected than males. These female-specific structural changes may contribute to or derive from neuropsychological and physiological symptom differences between sexes.
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Affiliation(s)
- Paul M Macey
- School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095-1702, USA
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Revise the revised? New dimensions of the neuroanatomical hypothesis of panic disorder. J Neural Transm (Vienna) 2012; 120:3-29. [PMID: 22692647 DOI: 10.1007/s00702-012-0811-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/16/2012] [Indexed: 12/14/2022]
Abstract
In 2000, Gorman et al. published a widely acknowledged revised version of their 1989 neuroanatomical hypothesis of panic disorder (PD). Herein, a 'fear network' was suggested to mediate fear- and anxiety-related responses: panic attacks result from a dysfunctional coordination of 'upstream' (cortical) and 'downstream' (brainstem) sensory information leading to heightened amygdala activity with subsequent behavioral, autonomic and neuroendocrine activation. Given the emergence of novel imaging methods such as fMRI and the publication of numerous neuroimaging studies regarding PD since 2000, a comprehensive literature search was performed regarding structural (CT, MRI), metabolic (PET, SPECT, MRS) and functional (fMRI, NIRS, EEG) studies on PD, which will be reviewed and critically discussed in relation to the neuroanatomical hypothesis of PD. Recent findings support structural and functional alterations in limbic and cortical structures in PD. Novel insights regarding structural volume increase or reduction, hyper- or hypoactivity, laterality and task-specificity of neural activation patterns emerged. The assumption of a generally hyperactive amygdala in PD seems to apply more to state than trait characteristics of PD, and involvement of further areas in the fear circuit, such as anterior cingulate and insula, is suggested. Furthermore, genetic risk variants have been proposed to partly drive fear network activity. Thus, the present state of knowledge generally supports limbic and cortical prefrontal involvement as originally proposed in the neuroanatomical hypothesis. Some modifications might be suggested regarding a potential extension of the fear circuit, genetic factors shaping neural network activity and neuroanatomically informed clinical subtypes of PD potentially guiding future treatment decisions.
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Hettema JM, Kettenmann B, Ahluwalia V, McCarthy C, Kates WR, Schmitt JE, Silberg JL, Neale MC, Kendler KS, Fatouros P. Pilot multimodal twin imaging study of generalized anxiety disorder. Depress Anxiety 2012; 29:202-9. [PMID: 21994092 PMCID: PMC3258467 DOI: 10.1002/da.20901] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/17/2011] [Accepted: 08/22/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a common chronic condition that is relatively understudied compared to other psychiatric syndromes. Neuroimaging studies have begun to implicate particular neural structures and circuitry in its pathophysiology; however, no genetically informative research has examined the potential sources of reported brain differences. METHODS We acquired spectroscopic, volumetric, and diffusion tensor magnetic resonance imaging data from a pilot study of 34 female subjects selected from monozygotic twin pairs based upon their affection status for GAD, and examined brain regions previously implicated in fear and anxiety for their relationship with affection status and genetic risk. RESULTS Lifetime GAD associated with increased creatine levels in the amygdala, smaller left hippocampal volume, and lower fractional anisotropy in the uncinate fasciculus which connects amygdala and frontal cortex. In addition, GAD genetic risk predicted increases in myo-inositol in the amygdala and, possibly, glutamate/glutamine/GABA alterations in the hippocampus. The association of lifetime GAD with smaller hippocampal volume was independent of major depression and might represent a common genetic risk marker for internalizing disorders. CONCLUSIONS These preliminary data suggest that GAD and its genetic risk factors are likely correlated with volumetric and spectroscopic changes in fear-related limbic structures and their connections with the frontal cortex.
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Affiliation(s)
- John M Hettema
- Departments of Psychiatry, State University of New York Upstate Medical University, Syracuse, New York, USA.
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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: 148] [Impact Index Per Article: 12.3] [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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Blackmon K, Barr WB, Carlson C, Devinsky O, DuBois J, Pogash D, Quinn BT, Kuzniecky R, Halgren E, Thesen T. Structural evidence for involvement of a left amygdala-orbitofrontal network in subclinical anxiety. Psychiatry Res 2011; 194:296-303. [PMID: 21803551 PMCID: PMC3544472 DOI: 10.1016/j.pscychresns.2011.05.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 05/03/2011] [Accepted: 05/21/2011] [Indexed: 11/23/2022]
Abstract
Functional neuroimaging implicates hyperactivity of amygdala-orbitofrontal circuitry as a common neurobiological mechanism underlying the development of anxiety. Less is known about anxiety-related structural differences in this network. In this study, a sample of healthy adults with no history of anxiety disorders completed a 3T MRI scan and self-report mood inventories. Post-processing quantitative MRI image analysis included segmentation and volume estimation of subcortical structures, which were regressed on anxiety inventory scores, with depression scores used to establish discriminant validity. We then used a quantitative vertex-based post-processing method to correlate (1) anxiety scores and (2) left amygdala volumes with cortical thickness across the whole cortical mantle. Left amygdala volumes predicted anxiety, with decreased amygdala volume associated with higher anxiety on both state and trait anxiety measures. A negative correlation between left amygdala volume and cortical thickness overlapped with a positive correlation between anxiety and cortical thickness in left lateral orbitofrontal cortex. These results suggest a structural anxiety network that corresponds with a large body of evidence from functional neuroimaging. Such findings raise the possibility that structural abnormalities may result in a greater vulnerability to anxiety or conversely that elevated anxiety symptoms may result in focal structural changes.
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Affiliation(s)
- Karen Blackmon
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - William B Barr
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - Chad Carlson
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - Jonathan DuBois
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - Daniel Pogash
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - Brian T Quinn
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA; Center for Neural Science, New York University, NY, NY, USA
| | - Ruben Kuzniecky
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA
| | - Eric Halgren
- Multimodal Imaging Laboratory, University of California, San Diego, CA, USA
| | - Thomas Thesen
- Comprehensive Epilepsy Center, Department of Neurology, New York University, NY, NY, USA; Multimodal Imaging Laboratory, University of California, San Diego, CA, USA.
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Hippocampus and amygdalar volumes in patients with somatization disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1699-703. [PMID: 21651951 DOI: 10.1016/j.pnpbp.2011.05.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 04/24/2011] [Accepted: 05/25/2011] [Indexed: 01/08/2023]
Abstract
In regard to somatization disorder which covers an important section of our patient population, there is no systematic structural magnetic resonance imaging (MRI) study in the literature. Therefore, we aimed to use structural MRI to evaluate the hippocampus amygdalar complex which is associated with both stress and regulation of emotion that are main basis clinical presentation of somatization disorder in the patients with somatization disorder. Totally 40 subjects (20 patients with somatization disorder and 20 healthy controls) were enrolled. Intracranial volume (ICV), whole brain volume, gray and white matter volumes, and hippocampus and amygdalar volumes of the subjects were measured. In regard to unadjusted mean volumes of measured structures, the patients had significantly smaller mean volumes of the left and right amygdala. However, two groups did not differ significantly in terms of whole brain, total gray and white matter or hippocampus volumes. The repeated measures ANCOVA predicting left and right amygdala volumes demonstrated a significant main effect of diagnostic group. In conclusion, the findings of the present study revealed that the patients with somatization disorder had significantly smaller mean volumes of the left and right amygdala without any differences in regard to whole brain, total gray and white matter or hippocampus volumes. On the basis of the current findings, it seems reasonable to evaluate that abnormalities in connectivity and/or metabolism dimensions and to examine the effects of drugs or psychotherapeutic approaches could be especially informative.
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Machado S, Paes F, Velasques B, Teixeira S, Piedade R, Ribeiro P, Nardi AE, Arias-Carrión O. Is rTMS an effective therapeutic strategy that can be used to treat anxiety disorders? Neuropharmacology 2011; 62:125-34. [PMID: 21807002 DOI: 10.1016/j.neuropharm.2011.07.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 07/16/2011] [Accepted: 07/18/2011] [Indexed: 11/30/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure whereby a pulsed magnetic field stimulates electrical activity in the brain. Anxiety disorders are the most common of all mental health problems for which effective, mechanism-based treatments remain elusive. Consequently, more advanced non-invasive therapeutic methods are required. A possible method to modulate brain activity and potentially viable for use in clinical practice is rTMS. Here, we focus on the main findings of rTMS from animal models of anxiety and the experimental advances of rTMS that may become a viable clinical application to treat anxiety disorders, one of the most common causes of disability in the workplace in the world. Key advances in combining rTMS with neuroimaging technology may aid such future developments. This article is part of a Special Issue entitled 'Anxiety and Depression'.
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Affiliation(s)
- Sergio Machado
- Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Liao W, Xu Q, Mantini D, Ding J, Machado-de-Sousa JP, Hallak JE, Trzesniak C, Qiu C, Zeng L, Zhang W, Crippa JAS, Gong Q, Chen H. Altered gray matter morphometry and resting-state functional and structural connectivity in social anxiety disorder. Brain Res 2011; 1388:167-77. [DOI: 10.1016/j.brainres.2011.03.018] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/07/2011] [Accepted: 03/07/2011] [Indexed: 11/16/2022]
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Dresler T, Hahn T, Plichta MM, Ernst LH, Tupak SV, Ehlis AC, Warrings B, Deckert J, Fallgatter AJ. Neural correlates of spontaneous panic attacks. J Neural Transm (Vienna) 2011; 118:263-9. [DOI: 10.1007/s00702-010-0540-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022]
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Van Schuerbeek P, Baeken C, De Raedt R, De Mey J, Luypaert R. Individual differences in local gray and white matter volumes reflect differences in temperament and character: A voxel-based morphometry study in healthy young females. Brain Res 2011; 1371:32-42. [DOI: 10.1016/j.brainres.2010.11.073] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 11/19/2010] [Accepted: 11/19/2010] [Indexed: 11/24/2022]
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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: 331] [Impact Index Per Article: 25.5] [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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Altered effective connectivity network of the amygdala in social anxiety disorder: a resting-state FMRI study. PLoS One 2010; 5:e15238. [PMID: 21203551 PMCID: PMC3008679 DOI: 10.1371/journal.pone.0015238] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 11/02/2010] [Indexed: 12/04/2022] Open
Abstract
The amygdala is often found to be abnormally recruited in social anxiety disorder (SAD) patients. The question whether amygdala activation is primarily abnormal and affects other brain systems or whether it responds “normally” to an abnormal pattern of information conveyed by other brain structures remained unanswered. To address this question, we investigated a network of effective connectivity associated with the amygdala using Granger causality analysis on resting-state functional MRI data of 22 SAD patients and 21 healthy controls (HC). Implications of abnormal effective connectivity and clinical severity were investigated using the Liebowitz Social Anxiety Scale (LSAS). Decreased influence from inferior temporal gyrus (ITG) to amygdala was found in SAD, while bidirectional influences between amygdala and visual cortices were increased compared to HCs. Clinical relevance of decreased effective connectivity from ITG to amygdala was suggested by a negative correlation of LSAS avoidance scores and the value of Granger causality. Our study is the first to reveal a network of abnormal effective connectivity of core structures in SAD. This is in support of a disregulation in predescribed modules involved in affect control. The amygdala is placed in a central position of dysfunction characterized both by decreased regulatory influence of orbitofrontal cortex and increased crosstalk with visual cortex. The model which is proposed based on our results lends neurobiological support towards cognitive models considering disinhibition and an attentional bias towards negative stimuli as a core feature of the disorder.
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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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Sardinha A, Freire RCDR, Zin WA, Nardi AE. Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications. J Bras Pneumol 2010; 35:698-708. [PMID: 19669009 DOI: 10.1590/s1806-37132009000700012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/17/2009] [Indexed: 11/22/2022] Open
Abstract
Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO2, triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.
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Affiliation(s)
- Aline Sardinha
- Laboratory of Panic and Respiration, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Basal ganglia MR relaxometry in obsessive-compulsive disorder: T2 depends upon age of symptom onset. Brain Imaging Behav 2009; 4:35-45. [PMID: 20503112 DOI: 10.1007/s11682-009-9083-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 11/05/2009] [Indexed: 01/09/2023]
Abstract
Dysfunction in circuits linking frontal cortex and basal ganglia (BG) is strongly implicated in obsessive-compulsive disorder (OCD). On MRI studies, neuropsychiatric disorders with known BG pathology have abnormally short T2 relaxation values (a putative biomarker of elevated iron) in this region. We asked if BG T2 values are abnormal in OCD. We measured volume and T2 and T1 relaxation rates in BG of 32 adults with OCD and 33 matched controls. There were no group differences in volume or T1 values in caudate, putamen, or globus pallidus (GP). The OCD group had lower T2 values (suggesting higher iron content) in the right GP, with a trend in the same direction for the left GP. This effect was driven by patients whose OCD symptoms began from around adolescence to early adulthood. The results suggest a possible relationship between age of OCD onset and iron deposition in the basal ganglia.
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Crippa JAS. Does social phobia remain the 'Ugly Duckling' of anxiety disorders? BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31:297-9. [DOI: 10.1590/s1516-44462009000400002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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48
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Pallanti S, Bernardi S. Neurobiology of repeated transcranial magnetic stimulation in the treatment of anxiety: a critical review. Int Clin Psychopharmacol 2009; 24:163-73. [PMID: 19455047 DOI: 10.1097/yic.0b013e32832c2639] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been applied to a growing number of psychiatric disorders as a neurophysiological probe, a primary brain-mapping tool, and a candidate treatment. Although most investigations have focused on the treatment of major depression, increasing attention has been paid to anxiety disorders. The aim of this study is to summarize published findings about the application of TMS as a putative treatment for anxiety disorders. TMS neurophysiological and mapping findings, both clinical and preclinical, have been included when relevant. We searched Medline, PsycInfo, and the Cochrane Library from 1980 to January 2009 for the terms 'generalized anxiety disorder', 'social anxiety disorder', 'social phobia', 'panic', 'anxiety', or 'posttraumatic stress disorder' in combination with 'TMS', 'cortex excitability', 'rTMS', 'motor threshold', 'motor evoked potential', 'cortical silent period', 'intracortical inhibition', 'neuroimaging', or 'intracortical facilitation'. Most of the therapeutic experiences with repetitive TMS available in the literature are in the form of case reports, not controlled or blinded studies. Stimulation of the right dorsolateral prefrontal cortex, especially at high frequencies, has been reported to reduce anxiety symptoms in posttraumatic stress disorder and panic disorder; nevertheless, results are mixed. A specific role for the right dorsolateral prefrontal cortex in the posttraumatic stress disorder symptom core can be hypothesized. TMS remains an investigational intervention that has not yet gained approval for the clinical treatment of any anxiety disorder. Clinical sham-controlled trials are scarce. Many of these trials have supported the idea that TMS has a significant effect, but in some studies, the effect is small and short lived. The neurobiological correlates suggest possible efficacy for the treatment of social anxiety that still has to be investigated.
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Affiliation(s)
- Stefano Pallanti
- Department of Psychiatry, The Mount Sinai School of Medicine, New York, NY 10029, USA.
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Abstract
OBJETIVOS: Revisar o transtorno do pânico (TP), considerando seus aspectos clínicos, epidemiológicos, diagnósticos e etiológicos, bem como os avanços no tratamento, uma vez que o TP é uma entidade nosológica acompanhada de importante prejuízo psíquico e funcional. MÉTODO: Foi realizada uma revisão narrativa da literatura nas principais bases de dados existentes (MEDLINE, PsychINFO e SciELO) e em livros-textos atualizados. RESULTADOS: Devido à sintomatologia predominantemente física desse transtorno, os pacientes geralmente procuram vários atendimentos clínicos até que o diagnóstico seja feito. Em função desses aspectos e da sua cronicidade, o TP está associado a elevados custos econômicos. O tratamento do TP pode ser feito com psicoterapia e/ou psicofármacos. As diversas abordagens terapêuticas são apresentadas com o nível de evidência de cada recomendação. Em virtude da cronicidade e morbidade do TP, pesquisas têm se voltado para o estudo de estratégias de prevenção já na infância. CONCLUSÕES: O TP é um transtorno crônico e com baixas taxas de remissão dos sintomas em longo prazo. Sendo assim, sugere-se que sejam delineados novos estudos para tratamento precoce dos transtornos de ansiedade ou mesmo para prevenção em crianças de risco.
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Affiliation(s)
- Giovanni Abrahão Salum
- Conselho Nacional de Desenvolvimento Científico e Tecnológico; Hospital de Clínicas de Porto Alegre
| | | | - Gisele Gus Manfro
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas de Porto Alegre
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