1
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Abend R. Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum. Neurosci Biobehav Rev 2023; 152:105305. [PMID: 37414377 PMCID: PMC10528507 DOI: 10.1016/j.neubiorev.2023.105305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.
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Affiliation(s)
- Rany Abend
- School of Psychology, Reichman University, P.O. Box 167, Herzliya 4610101, Israel; Section on Development and Affective Neuroscience, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
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2
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Khedr EM, Elbeh K, Saber M, Abdelrady Z, Abdelwarith A. A double blind randomized clinical trial of the effectiveness of low frequency rTMS over right DLPFC or OFC for treatment of obsessive-compulsive disorder. J Psychiatr Res 2022; 156:122-131. [PMID: 36244200 DOI: 10.1016/j.jpsychires.2022.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
We compared the effectiveness of low frequency repetitive transcranial magnetic stimulation over right dorsolateral prefrontal cortex (DLPFC), right orbitofrontal cortex (OFC) and sham for treatment of obsessive-compulsive disorder (OCD) and sought to determine possible predictors of effective treatment. Sixty OCD patients participated and were randomly allocated to one of the 3 treatment groups. Treatment was administered daily for 10 days. Assessments were made at the beginning and end of therapy as well as three months later using the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory (BDI), and Clinical Global Impression - Severity scale (CGI-S). There were no significant demographic or clinical differences between the groups at baseline. One-way repeated measures ANOVA showed that participants in all 3 groups improved their scores on all rating scales following treatment. A two-way repeated measures ANOVA revealed a significant time and group interaction due to the fact that both active treatment groups outperformed the sham group, although there was no significant difference between the two. Percent improvement had significant negative correlations with the following factors: duration of illness, baseline Y-BOCS, HAM-A, and BDI. We conclude that rTMS over either right DLPFC or OFC has a therapeutic effect on OCD symptoms. Patients with lower Y-BOCS and fewer comorbidities responded best to rTMS.
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Affiliation(s)
- Eman M Khedr
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt; Department of Neuropsychiatry, Aswan University, Aswan, Egypt.
| | - Khaled Elbeh
- Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt
| | - Mostafa Saber
- Department of Neuropsychiatry, Aswan University, Aswan, Egypt
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3
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Campbell AA, Wisco BE. Respiratory sinus arrhythmia reactivity in anxiety and posttraumatic stress disorder: A review of literature. Clin Psychol Rev 2021; 87:102034. [PMID: 33930767 DOI: 10.1016/j.cpr.2021.102034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 12/24/2022]
Abstract
Respiratory sinus arrhythmia (RSA) reactivity is thought to indicate how adaptively one responds to stress. RSA reactivity has been examined across anxiety disorders and posttraumatic stress disorder (PTSD), to better understand the psychophysiological stress response of these disorders. The current state of the literature is mixed, and the association between RSA reactivity and PTSD/anxiety is unclear. This review examines RSA reactivity in response to laboratory stressor tasks across samples with anxiety and PTSD. Results indicated a complex literature that may suggest an association between anxiety/PTSD and RSA reactivity. There is evidence to suggest a pattern of heightened RSA withdrawal in PTSD and trait anxious samples. There was little evidence to suggest a heightened RSA withdrawal pattern in other anxiety disorders. This review also highlights methodological considerations which may allow for clearer interpretations of RSA reactivity. The current literature includes heterogeneity across stressor tasks, RSA measures, and comorbidities that complicates interpretation of results. Studies using samples with comorbid depression produce more consistent evidence of heightened RSA withdrawal in anxiety/PTSD. Future directions for understanding the contribution of these variables (i.e., stressor tasks, RSA measures, comorbid depression) and mechanisms contributing to the possible association between RSA reactivity and anxiety/PTSD are considered.
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Affiliation(s)
- Allison A Campbell
- Department of Psychology, University of North Carolina at Greensboro, United States of America.
| | - Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, United States of America
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4
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Song P, Tong H, Zhang L, Lin H, Hu N, Zhao X, Hao W, Xu P, Wang Y. Repetitive Transcranial Magnetic Stimulation Modulates Frontal and Temporal Time-Varying EEG Network in Generalized Anxiety Disorder: A Pilot Study. Front Psychiatry 2021; 12:779201. [PMID: 35095597 PMCID: PMC8795864 DOI: 10.3389/fpsyt.2021.779201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Generalized Anxiety Disorder (GAD) is a highly prevalent yet poorly understood chronic mental disorder. Previous studies have associated GAD with excessive activation of the right dorsolateral prefrontal cortex (DLPFC). This study aimed to investigate the effect of low-frequency repetitive transcranial magnetic stimulation (repetitive TMS, rTMS) targeting the right DLPFC on clinical symptoms and TMS-evoked time-varying brain network connectivity in patients with GAD. Eleven patients with GAD received 1 Hz rTMS treatment targeting the right DLPFC for 10 days. The severity of the clinical symptoms was evaluated using the Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) at baseline, right after treatment, and at the one-month follow-up. Co-registration of single-pulse TMS (targeting the right DLPFC) and electroencephalography (TMS-EEG) was performed pre- and post-treatment in these patients and 11 healthy controls. Time-varying brain network connectivity was analyzed using the adaptive directed transfer function. The scores of HAMA and HAMD significantly decreased after low-frequency rTMS treatment, and these improvements in ratings remained at the one-month follow-up. Analyses of the time-varying EEG network in the healthy controls showed a continuous weakened connection information outflow in the left frontal and mid-temporal regions. Compared with the healthy controls, the patients with GAD showed weakened connection information outflow in the left frontal pole and the posterior temporal pole at baseline. After 10-day rTMS treatment, the network patterns showed weakened connection information outflow in the left frontal and temporal regions. The time-varying EEG network changes induced by TMS perturbation targeting right DLPFC in patients with GAD were characterized by insufficient information outflow in the left frontal and temporal regions. Low-frequency rTMS targeting the right DLPFC reversed these abnormalities and improved the clinical symptoms of GAD.
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Affiliation(s)
- Penghui Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Central Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Geriatric Medical Research Center, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Han Tong
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Luyan Zhang
- Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ningning Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wensi Hao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Xu
- Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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5
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Fishback GM, Chriki L, Thayer JF, Vasey MW. Heart Rate Variability Moderates the Association Between Beliefs About Worry and Generalized Anxiety Disorder Symptoms. Front Neurosci 2020; 14:569359. [PMID: 33132829 PMCID: PMC7579429 DOI: 10.3389/fnins.2020.569359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 01/04/2023] Open
Abstract
Paradoxically, some individuals who experience pathological worry also have good capacity for top-down control over their thoughts. Why such individuals would nevertheless worry excessively remains unclear. One explanation is suggested by research showing that those experiencing pathological worry are set apart from healthy controls by their beliefs that worry has utility and that effective worrying requires them to consider all possibilities before terminating a worry bout. This suggests that worriers with good capacity for cognitive control may engage in prolonged worry because they believe it is adaptive to do so. In a sample of 109 college students, among whom individuals reporting pathological worry were overrepresented, we tested this hypothesis using an objective index of top-down control capacity (i.e., resting vagally mediated heart rate variability [vmHRV]) and self-report measures of beliefs about worry and generalized anxiety disorder (GAD) symptom severity/status. As predicted, GAD symptom severity and vmHRV interacted to predict beliefs about worry. Specifically, high GAD symptoms were most strongly associated with beliefs that worry has utility at higher levels of vmHRV. Furthermore, this pattern was mostly a function of the belief that worry serves to distract the worrier from more emotional things. Similarly, high GAD symptoms were most strongly associated with endorsement of an ‘as many as can’ (AMAC) problem-solving rule when vmHRV was high. From the opposite perspective, both worry utility beliefs and AMAC rule endorsement were associated with the highest GAD symptom severity at higher levels of vmHRV. This was also true for the belief that worry distracts from more emotional things predicting analog GAD status. These results suggest that worriers who have higher levels of top-down control capacity may initiate and persist in worry, at least initially, because they value it. However, why they nevertheless rate their worry as excessive and uncontrollable is an important question for future research.
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Affiliation(s)
- Grace M Fishback
- Department of Neurology, University of Colorado School of Medicine, Denver, CO, United States
| | | | - Julian F Thayer
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, CA, United States
| | - Michael W Vasey
- Department of Psychology, The Ohio State University, Columbus, OH, United States
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6
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Morris LS, McCall JG, Charney DS, Murrough JW. The role of the locus coeruleus in the generation of pathological anxiety. Brain Neurosci Adv 2020; 4:2398212820930321. [PMID: 32954002 PMCID: PMC7479871 DOI: 10.1177/2398212820930321] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022] Open
Abstract
This review aims to synthesise a large pre-clinical and clinical
literature related to a hypothesised role of the locus coeruleus
norepinephrine system in responses to acute and chronic threat, as
well as the emergence of pathological anxiety. The locus coeruleus has
widespread norepinephrine projections throughout the central nervous
system, which act to globally modulate arousal states and adaptive
behavior, crucially positioned to play a significant role in
modulating both ascending visceral and descending cortical
neurocognitive information. In response to threat or a stressor, the
locus coeruleus–norepinephrine system globally modulates arousal,
alerting and orienting functions and can have a powerful effect on the
regulation of multiple memory systems. Chronic stress leads to
amplification of locus coeruleus reactivity to subsequent stressors,
which is coupled with the emergence of pathological anxiety-like
behaviors in rodents. While direct in vivo evidence for locus
coeruleus dysfunction in humans with pathological anxiety remains
limited, recent advances in high-resolution 7-T magnetic resonance
imaging and computational modeling approaches are starting to provide
new insights into locus coeruleus characteristics.
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Affiliation(s)
- Laurel S Morris
- The Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan G McCall
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Dennis S Charney
- Dean's Office, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Murrough
- The Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Makovac E, Fagioli S, Rae CL, Critchley HD, Ottaviani C. Can't get it off my brain: Meta-analysis of neuroimaging studies on perseverative cognition. Psychiatry Res Neuroimaging 2020; 295:111020. [PMID: 31790922 DOI: 10.1016/j.pscychresns.2019.111020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022]
Abstract
Perseverative cognition (i.e. rumination and worry) describes intrusive, uncontrollable, repetitive thoughts. These negative affective experiences are accompanied by physiological arousal, as if the individual were facing an external stressor. Perseverative cognition is a transdiagnostic symptom, yet studies of neural mechanisms are largely restricted to specific clinical populations (e.g. patients with major depression). The present study applied activation likelihood estimation (ALE) meta-analyses to 43 functional neuroimaging studies of perseverative cognition to elucidate the neurobiological substrates across individuals with and without psychopathological conditions. Task-related and resting state functional connectivity studies were examined in separate meta-analyses. Across task-based studies, perseverative cognition engaged medial frontal gyrus, cingulate gyrus, insula, and posterior cingulate cortex. Resting state functional connectivity studies similarly implicated posterior cingulate cortex together with thalamus and anterior cingulate cortex (ACC), yet the involvement of ACC distinguished between perseverative cognition in healthy controls (HC) and clinical groups. Perseverative cognition is accompanied by the engagement of prefrontal, insula and cingulate regions, whose interaction may support the characteristic conjunction of self-referential and affective processing with (aberrant) cognitive control and embodied (autonomic) arousal. Within this context, ACC engagement appears critical for the pathological expression of rumination and worry.
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Affiliation(s)
- Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK.
| | - Sabrina Fagioli
- Department of Education, University of Roma Tre, Rome, Italy; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Charlotte L Rae
- School of Psychology, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK; Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
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8
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Task MRI-Based Functional Brain Network of Anxiety. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:3-20. [PMID: 32002919 DOI: 10.1007/978-981-32-9705-0_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance imaging (MRI) is a good tool for researchers to understand the biological mechanisms and pathophysiology of the brain due to the translational characteristics of MRI methods. For the psychiatric illness, this kind of mental disorders usually have minor alterations when compared to traditional neurological disorders. Therefore the functional study, such as functional connectivity, would play a significant role for understanding the pathophysiology of mental disorders. This chapter would focus on the discussion of task MRI-based functional network studies in anxiety. For social anxiety disorder, the limbic system, such as the temporal lobe, amygdala, and hippocampus, would show alterations in the functional connectivity with frontal regions, such as anterior cingulate, prefrontal, and orbitofrontal cortices. PD has anterior cingulate cortex-amygdala alterations in fear conditioning, frontoparietal alterations in attention network task, and limbic-prefrontal alterations in emotional task. A similar amygdala-based aberrant functional connectivity in specific phobia is observed. The mesocorticolimbic and limbic-prefrontal functional alterations are found in generalized anxiety disorder. The major components of task MRI-based functional connectivity in anxiety include limbic and frontal regions which might play a vital role for the origination of anxiety under different scenarios and tasks.
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9
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Wu M, Mennin DS, Ly M, Karim HT, Banihashemi L, Tudorascu DL, Aizenstein HJ, Andreescu C. When worry may be good for you: Worry severity and limbic-prefrontal functional connectivity in late-life generalized anxiety disorder. J Affect Disord 2019; 257:650-657. [PMID: 31357162 PMCID: PMC6711791 DOI: 10.1016/j.jad.2019.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/31/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late-life generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older adults. However, its neural markers have received relatively little attention. In this study, we explored the association between worry severity and limbic-prefrontal connectivity during emotional reactivity in late-life GAD. METHODS We recruited 16 anxious (GAD) and 20 non-anxious (HC) older adults to perform the faces/shapes emotional reactivity task during functional magnetic resonance imaging (fMRI). We investigated the functional connectivity of both the amygdala and the bed nucleus of stria terminalis (BNST) with the prefrontal cortex (PFC) using generalized psychophysiological interaction (gPPI) analysis. We tested for (1) group differences in connectivity, (2) association between worry severity and connectivity, and (3) interaction between group and worry severity and its association with connectivity. RESULTS Amygdala-PFC and BNST-PFC functional connectivity were associated with worry severity in an inverse U-shape, and was independent of depression severity, global anxiety, neuroticism, and general cognitive function. LIMITATIONS Our limitations include slightly skewed PSWQ distributions, lack of non-anxious individuals with high worry, small sample size, and low depression comorbidity in a sample of late-life GAD that may not generalize to GAD in younger populations. CONCLUSIONS This suggests that moderate worry is associated with maximum engagement of the limbic-PFC connectivity, while severe worry is associated with failure of the limbic-PFC emotional regulation circuit. This may explain the aberrant and exaggerated responses to negative stimuli observed in participants with pathological worry.
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Affiliation(s)
- M Wu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DS Mennin
- Teachers college, Columbia University, New York City, NY
| | - M Ly
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - HT Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - L Banihashemi
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DL Tudorascu
- Department of Internal Medicine, Graduate School of Public health, Pittsburgh, PA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
| | - HJ Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - C Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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10
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Abstract
BACKGROUND Excessive worry is a defining feature of generalized anxiety disorder and is present in a wide range of other psychiatric conditions. Therefore, individualized predictions of worry propensity could be highly relevant in clinical practice, with respect to the assessment of worry symptom severity at the individual level. METHODS We applied a multivariate machine learning approach to predict dispositional worry based on microstructural integrity of white matter (WM) tracts. RESULTS We demonstrated that the machine learning model was able to decode individual dispositional worry scores from microstructural properties in widely distributed WM tracts (mean absolute error = 10.46, p < 0.001; root mean squared error = 12.82, p < 0.001; prediction R2 = 0.17, p < 0.001). WM tracts that contributed to worry prediction included the posterior limb of internal capsule, anterior corona radiate, and cerebral peduncle, as well as the corticolimbic pathways (e.g. uncinate fasciculus, cingulum, and fornix) already known to be critical for emotion processing and regulation. CONCLUSIONS The current work thus elucidates potential neuromarkers for clinical assessment of worry symptoms across a wide range of psychiatric disorders. In addition, the identification of widely distributed pathways underlying worry propensity serves to better improve the understanding of the neurobiological mechanisms associated with worry.
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Affiliation(s)
- Chunliang Feng
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- College of Information Science and Technology, Beijing Normal University, Beijing 100875, China
| | - Zaixu Cui
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA19104, USA
| | - Dazhi Cheng
- Department of Pediatric Neurology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ruolei Gu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
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11
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Mulcahy JS, Larsson DEO, Garfinkel SN, Critchley HD. Heart rate variability as a biomarker in health and affective disorders: A perspective on neuroimaging studies. Neuroimage 2019; 202:116072. [PMID: 31386920 DOI: 10.1016/j.neuroimage.2019.116072] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 12/30/2022] Open
Abstract
The dynamic embodiment of psychological processes is evident in the association of health outcomes, behavioural traits and psychological functioning with Heart Rate Variability (HRV). The dominant high-frequency component of HRV is an index of the central neural control of heart rhythm, mediated via the parasympathetic vagus nerve. HRV provides a potential objective measure of action policies for the adaptive and predictive allostatic regulation of homeostasis within the cardiovascular system. In its support, a network of brain regions (referred to as the 'central autonomic network') maps internal state, and controls autonomic responses. This network includes regions of prefrontal cortex, anterior cingulate cortex, insula, amygdala, periaqueductal grey, pons and medulla. Human neuroimaging studies of neural activation and functional connectivity broadly endorse this architecture, and its link with cardiac regulation at rest and dysregulation in clinical states that include affective disorders. In this review, we appraise neuroimaging research and related evidence for HRV as an informative marker of autonomic integration with affect and cognition, taking a perspective on function and organisation. We consider evidence for the utility of HRV as a metric to inform targeted interventions to improve autonomic and affective dysregulation, and suggest research questions for further investigation.
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Affiliation(s)
- James S Mulcahy
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK.
| | | | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, BN1 9RR, UK; Sussex Partnership NHS Foundation Trust, Brighton, BN2 3EW, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, BN1 9RR, UK; Sussex Partnership NHS Foundation Trust, Brighton, BN2 3EW, UK
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12
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Madonna D, Delvecchio G, Soares JC, Brambilla P. Structural and functional neuroimaging studies in generalized anxiety disorder: a systematic review. ACTA ACUST UNITED AC 2019; 41:336-362. [PMID: 31116259 PMCID: PMC6804309 DOI: 10.1590/1516-4446-2018-0108] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/16/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Brain imaging studies carried out in patients suffering from generalized anxiety disorder (GAD) have contributed to better characterize the pathophysiological mechanisms underlying this disorder. The present study reviews the available functional and structural brain imaging evidence on GAD, and suggests further strategies for investigations in this field. METHODS A systematic literature review was performed in PubMed, PsycINFO, and Google Scholar, aiming to identify original research evaluating GAD patients with the use of structural and functional magnetic resonance imaging as well as diffusion tensor imaging. RESULTS The available studies have shown impairments in ventrolateral and dorsolateral prefrontal cortex, anterior cingulate, posterior parietal regions, and amygdala in both pediatric and adult GAD patients, mostly in the right hemisphere. However, the literature is often tentative, given that most studies have employed small samples and included patients with comorbidities or in current use of various medications. Finally, different methodological aspects, such as the type of imaging equipment used, also complicate the generalizability of the findings. CONCLUSIONS Longitudinal neuroimaging studies with larger samples of both juvenile and adult GAD patients, as well as at risk individuals and unaffected relatives, should be carried out in order to shed light on the specific biological signature of GAD.
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Affiliation(s)
- Domenico Madonna
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá di Milano, Milano, Italy.,Dipartimento di Neuroscienze e Salute Mentale, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuseppe Delvecchio
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universitá di Milano, Milano, Italy
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Paolo Brambilla
- Dipartimento di Neuroscienze e Salute Mentale, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX, USA
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13
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Makovac E, Fagioli S, Watson DR, Meeten F, Smallwood J, Critchley HD, Ottaviani C. Response time as a proxy of ongoing mental state: A combined fMRI and pupillometry study in Generalized Anxiety Disorder. Neuroimage 2019; 191:380-391. [DOI: 10.1016/j.neuroimage.2019.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/27/2023] Open
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14
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Kocsel N, Köteles F, Szemenyei E, Szabó E, Galambos A, Kökönyei G. The association between perseverative cognition and resting heart rate variability: A focus on state ruminative thoughts. Biol Psychol 2019; 145:124-133. [PMID: 31051207 DOI: 10.1016/j.biopsycho.2019.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Two studies were conducted to shed light on the associations between trait and state rumination and worry and a time-domain metric of heart rate variability, the root mean square of successive differences (RMSSD) of cardiac interbeat-interval (IBI). METHOD Study 1 involved 130 healthy adults (118 females; mean age = 23.4 ± 3.59 years), while 72 healthy participants (58 females; mean age = 22.2 ± 1.79 years) were involved in Study 2. RMSSD was calculated from a 5-min baseline recording and state ruminative thoughts were assessed during measurement. Trait perseverative cognitions were measured using self-reported questionnaires. RESULTS In Study 1, we found that a higher level of state but not trait ruminative thoughts showed weak negative association with lnRMSSD. In Study 2, we replicated the results of Study 1 and we found that trait reflection moderated the relationship between state rumination and lnRMSSD. CONCLUSION State rumination may reflect actual cardiovascular activity better than trait preservative cognitions, although trait reflection could be a protective factor.
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Affiliation(s)
- Natália Kocsel
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Ferenc Köteles
- Institution of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Szemenyei
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Edina Szabó
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Attila Galambos
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; SE-NAP2 Genetic Brain Imaging Migraine Research Group, Semmelweis University, Budapest, Hungary; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.
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15
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Carnevali L, Mancini M, Koenig J, Makovac E, Watson DR, Meeten F, Critchley HD, Ottaviani C. Cortical morphometric predictors of autonomic dysfunction in generalized anxiety disorder. Auton Neurosci 2019; 217:41-48. [DOI: 10.1016/j.autneu.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022]
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16
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Weber-Goericke F, Muehlhan M. A quantitative meta-analysis of fMRI studies investigating emotional processing in excessive worriers: Application of activation likelihood estimation analysis. J Affect Disord 2019; 243:348-359. [PMID: 30266026 DOI: 10.1016/j.jad.2018.09.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/27/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Excessive worry is a highly impairing cognitive activity which features a range of psychological disorders. Investigations of its disturbed underlying neural mechanisms have presented largely heterogeneous results. This quantitative neuroimaging meta-analysis aims to identify consistent functional disturbances in emotional processing associated with excessive worry across previously published studies. METHODS We used the activation likelihood estimation (ALE) method to test for significant convergence across findings of 16 neuroimaging experiments reporting functional aberrations during emotional processing between individuals experiencing high versus normal levels of worry. RESULTS Results demonstrated convergent aberrations in high compared to normal worriers mainly in a left-hemispheric cluster comprising parts of the middle frontal gyrus, inferior frontal gyrus and anterior insula. Behavioral characterization indicated the identified cluster to be associated with language processing and memory, while meta-analytic connectivity mapping yielded strong functional connections between the observed convergent regions and parts of the salience network as well as the default mode network. LIMITATIONS The ALE method cannot consider findings based on regions of interest analyses and studies without significant group differences. CONCLUSION Our results indicate that in response to emotional contexts worry prone individuals exhibit disturbed functioning in brain areas which are possibly associated with deviant inner speech processes experienced by these individuals. The observed clusters may further constitute key nodes within interacting neural networks that support internally and externally oriented cognition and control the dynamic interplay among these processes.
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Affiliation(s)
- Fanny Weber-Goericke
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden Germany
| | - Markus Muehlhan
- Department of Psychology, Faculty of Human Science, Medical School Hamburg, Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden Germany.
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17
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Braun DJ, Van Eldik LJ. In vivo Brainstem Imaging in Alzheimer's Disease: Potential for Biomarker Development. Front Aging Neurosci 2018; 10:266. [PMID: 30254583 PMCID: PMC6141632 DOI: 10.3389/fnagi.2018.00266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/17/2018] [Indexed: 12/25/2022] Open
Abstract
The dearth of effective treatments for Alzheimer's disease (AD) is one of the largest public health issues worldwide, costing hundreds of billions of dollars per year. From a therapeutic standpoint, research efforts to date have met with strikingly little clinical success. One major issue is that trials begin after substantial pathological change has occurred, and it is increasingly clear that the most effective treatment regimens will need to be administered earlier in the disease process. In order to identify individuals within the long preclinical phase of AD who are likely to progress to dementia, improvements are required in biomarker development. One potential area of research that might prove fruitful in this regard is the in vivo detection of brainstem pathology. The brainstem is known to undergo pathological changes very early and progressively in AD. With an updated and harmonized AD research framework, and emerging advances in neuroimaging technology, the potential to leverage knowledge of brainstem pathology into biomarkers for AD will be discussed.
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Affiliation(s)
- David J Braun
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, United States.,Department of Neuroscience, University of Kentucky, Lexington, KY, United States
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18
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Quadt L, Critchley HD, Garfinkel SN. The neurobiology of interoception in health and disease. Ann N Y Acad Sci 2018; 1428:112-128. [PMID: 29974959 DOI: 10.1111/nyas.13915] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022]
Abstract
Interoception is the sensing of internal bodily sensations. Interoception is an umbrella term that encompasses (1) the afferent (body-to-brain) signaling through distinct neural and humoral (including immune and endocrine) channels; (2) the neural encoding, representation, and integration of this information concerning internal bodily state; (3) the influence of such information on other perceptions, cognitions, and behaviors; (4) and the psychological expression of these representations as consciously accessible physical sensations and feelings. Interoceptive mechanisms ensure physiological health through the cerebral coordination of homeostatic reflexes and allostatic responses that include motivational behaviors and associated affective and emotional feelings. Furthermore, the conscious, unitary sense of self in time and space may be grounded in the primacy and lifelong continuity of interoception. Body-to-brain interactions influence physical and mental well-being. Consequently, we show that systematic investigation of how individual differences, and within-individual changes, in interoceptive processing can contribute to the mechanistic understanding of physical and psychological disorders. We present a neurobiological overview of interoception and describe how interoceptive impairments at different levels relate to specific physical and mental health conditions, including sickness behaviors and fatigue, depression, eating disorders, autism, and anxiety. We frame these findings in an interoceptive predictive processing framework and highlight potential new avenues for treatments.
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Affiliation(s)
- Lisa Quadt
- Department of Psychiatry and Neuroscience, Brighton and Sussex Medical School (BSMS), Trafford Centre, University of Sussex, Brighton, United Kingdom
| | - Hugo D Critchley
- Department of Psychiatry and Neuroscience, Brighton and Sussex Medical School (BSMS), Trafford Centre, University of Sussex, Brighton, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Sarah N Garfinkel
- Department of Psychiatry and Neuroscience, Brighton and Sussex Medical School (BSMS), Trafford Centre, University of Sussex, Brighton, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
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19
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Makovac E, Smallwood J, Watson DR, Meeten F, Critchley HD, Ottaviani C. The verbal nature of worry in generalized anxiety: Insights from the brain. NEUROIMAGE-CLINICAL 2017. [PMID: 29527493 PMCID: PMC5842731 DOI: 10.1016/j.nicl.2017.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The Cognitive Avoidance Theory of Worry argues that worry is a cognitive strategy adopted to control the physiological arousal associated with anxiety. According to this theory, pathological worry, as in Generalized Anxiety Disorder (GAD), is verbal in nature, negative and abstract, rather than concrete. Neuroimaging studies link the expression of worry to characteristic modes of brain functional connectivity, especially in relation to the amygdala. However, the distinctive features of worry (verbal, abstract, negative), and their relationship to physiological arousal, have not so far been mapped to brain function. Methods We addressed this omission by undertaking a resting-state functional magnetic resonance neuroimaging study of 19 patients with GAD and 21 controls, before and after induction of perseverative cognitions, while measuring emotional bodily arousal from heart rate (HR). Seed-based analyses quantified brain changes in whole brain functional connectivity from the amygdala. Results In GAD, the induction increased negative thoughts and their verbal content. In line with predictions, the verbal expression of worry in GAD was associated with higher HR at baseline and attenuated HR increases after induction of perseverative cognitions. Within brain, the increased use of words during worry, and the associated dampening of HR after induction were mediated by the strength of functional connectivity between the amygdala and default mode network ‘hubs’ and the opercular cortex. The negative content of worry was further related to functional communication between amygdala and cingulo-opercular and temporal cortices. Conclusions Findings provide a neurobiological basis for the impact of verbal worry on HR in GAD. More negative worrisome thoughts have more words in GAD and more images in controls. Thinking in words is associated with reduced cardiac reactivity during worry. Verbal, abstract, and negative features of worry have unique neural correlates. Amygdala functional connectivity mediates use of words and HR decrease during worry. A neurobiological basis for the impact of verbal worry on HR in GAD is provided.
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Key Words
- Amygdala
- BDI, Beck Depression Inventory
- BOLD, blood oxygenation level dependent
- DMN, default mode network
- EPI, echoplanar imaging
- Functional connectivity
- GAD, Generalized Anxiety Disorder
- Generalized anxiety disorder
- HC, Healthy Controls
- HR, heart rate
- Heart rate
- NYC-Q, New York Cognition Questionnaire
- New York Cognition Questionnaire
- PCC, posterior cingulate cortex
- PSWQ, Penn State Worry Questionnaire
- RRS, Ruminative Response Scale
- SCID, Structured Clinical Interview for DSM
- STAI, Spielberger State Trait Anxiety Inventory
- Worry
- rsfMRI, resting-state functional magnetic resonance neuroimaging
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Affiliation(s)
- Elena Makovac
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK; Centre for Neuroimaging Science, King's College London, London, UK
| | - Jonathan Smallwood
- Department of Psychology, York Neuroimaging Centre, University of York, York, UK
| | - David R Watson
- Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK
| | - Frances Meeten
- Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK; Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Hugo D Critchley
- Psychiatry, BSMS, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, UK; Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust Sussex, Sussex, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy.
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20
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Magnetic resonance imaging of the human locus coeruleus: A systematic review. Neurosci Biobehav Rev 2017; 83:325-355. [PMID: 29107830 DOI: 10.1016/j.neubiorev.2017.10.023] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/21/2017] [Accepted: 10/24/2017] [Indexed: 01/21/2023]
Abstract
The locus coeruleus (LC), the major origin of noradrenergic modulation of the central nervous system, innervates extensive areas throughout the brain and is implicated in a variety of autonomic and cognitive functions. Alterations in the LC-noradrenergic system have been associated with healthy ageing and neuropsychiatric disorders including Parkinson's disease, Alzheimer's disease and depression. The last decade has seen advances in imaging the structure and function of the LC, and this paper systematically reviews the methodology and outcomes of sixty-nine structural and functional MRI studies of the LC in humans. Structural MRI studies consistently showed lower LC signal intensity and volume in clinical groups compared to healthy controls. Within functional studies, the LC was activated by a variety of tasks/stimuli and had functional connectivity to a range of brain regions. However, reported functional LC location coordinates were widely distributed compared to previously published neuroanatomical locations. Methodological and demographic factors potentially contributing to these differences are discussed, together with recommendations to optimize the reliability and validity of future LC imaging studies.
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21
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Haghshomar M, Rahmani F. Cognitive Challenge to Choose Healthier Food Is Reflected in Heart Rate Variability. Front Neurosci 2017; 11:353. [PMID: 28690495 PMCID: PMC5481397 DOI: 10.3389/fnins.2017.00353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Maryam Haghshomar
- Students Scientific Research Center, Tehran University of Medical SciencesTehran, Iran.,NeuroImaging Network, Universal Scientific Education and Research Network (USERN)Tehran, Iran
| | - Farzaneh Rahmani
- Students Scientific Research Center, Tehran University of Medical SciencesTehran, Iran.,NeuroImaging Network, Universal Scientific Education and Research Network (USERN)Tehran, Iran
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