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Nelson KL, Lu SE, Oken T, Lehrer PM, Feldman JM. Further Exploration of Treatment Response in Latinos with Comorbid Asthma and Panic Disorder: A Brief Report of HRV and ETCO2 as Potential Mediators of Treatment Response. Appl Psychophysiol Biofeedback 2021; 45:67-74. [PMID: 32193714 DOI: 10.1007/s10484-020-09454-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart rate variability (HRV) and end tidal CO2 (ETCO2) in relation to treatment response have not been studied in Latino populations or in comorbid asthma and panic disorder (PD). An extension of previously published research, the current study explored psychophysiological variables as possible mediators of treatment response. Latino treatment completers (N = 32) in the Bronx with asthma-PD received either Cognitive-Behavioral Psychophysiological Therapy (CBPT) or Music Relaxation Therapy (MRT). CBPT included HRV-biofeedback (HRVB); in-the-moment heart rate data to help an individual learn to influence his/her own heart rate. The sample was primarily female (93.8%) and Puerto Rican (81.25%). Treatment groups did not differ on demographics, except for less education in CBPT. The Panic Disorder Severity Scale (PDSS) and Asthma Control Questionnaire (ACQ) assessed changes in symptoms. HRV and ETCO2 were measured at four of eight therapy sessions. Baseline ETCO2 and changes in HRV from first to last of psychophysiology sessions were investigated as mediators of change on ACQ and PDSS. Mixed model analyses indicated in the CPBT group, changes in both asthma control and PD severity were not mediated by changes in HRV. In the CBPT and MRT groups combined, changes in PD severity were not mediated by baseline ETCO2. These findings may be due to the brevity of HRVB in CBPT, multiple treatment components, ETCO2 not directly targeted, and/or unique physiological pathways in Latinos with asthma-PD.
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Affiliation(s)
- Krista L Nelson
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA
| | - Shou-En Lu
- Rutgers - School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Tanya Oken
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA
| | - Paul M Lehrer
- Department of Psychiatry, Rutgers - Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA
| | - Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA.
- Department of Pediatrics (Academic General Pediatrics), Albert Einstein College of Medicine/Children's Hospital at Montefiore, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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Abstract
ABSTRACT The objective of this study was to investigate potential correlates of dispositional optimism and quality of life in patients with depression and panic disorder. The study used a cross-sectional design. The analyzed sample consisted of 77 participants with panic disorder and 75 participants with depression attending two outpatient clinics at the Psychiatry Institute of the Federal University of Rio de Janeiro. Both groups presented similar impairments in optimism and quality of life. In the panic disorder group, optimism scores were significantly correlated with a decrease in anxiety and depression scores (r = 0.26 and r = 0.37, respectively); in the depression group, increases in optimism scores were significantly correlated with decreases in anxiety and depression scores (r = 0.23 and r = 0.3, respectively). The present study showed that high anxiety and depression are correlated with poor optimism and quality of life scores in panic disorder and depression groups. Thus, psychological treatments that can address these topics, besides acute symptoms, are crucial to the absolute recovery of patients.
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Affiliation(s)
- Michele F Rodrigues
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro
| | - Ruan Vianna
- Institute of Mathematics and Statistics, Federal Fluminense University, Niterói, Rio de Janeiro
| | | | - Antonio Egídio Nardi
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro
| | - José Carlos Appolinário
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro
| | - Michelle N Levitan
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro
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Batista LA, Lopes JB, Brianis RC, Haibara AS, Moreira FA. Intravenous doxapram administration as a potential model of panic attacks in rats. Behav Pharmacol 2021; 32:182-193. [PMID: 33136614 DOI: 10.1097/fbp.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Panic disorder can be categorized into the nonrespiratory or the respiratory subtypes, the latter comprising dyspnea, shortness of breath, chest pain, feelings of suffocation, and paresthesias. Doxapram is an analeptic capable of inducing panic attacks with respiratory symptoms in individuals diagnosed with the disorder; however, its neuroanatomical targets and its effects on experimental animals remain uncharacterized. One of the brain regions proposed to trigger panic attacks is the midbrain periaqueductal gray (PAG). Therefore, in this study, we evaluated the effects of doxapram in Fos (c-Fos) protein expression in the PAG and characterized its cardiorespiratory and behavioral effects on the elevated T maze and in the conditioned place aversion (CPA) paradigms. Doxapram increased Fos expression in different columns of the PAG, increased respiratory frequency, decreased heart rate, and increased arterial pressure when injected via intravenous route. Alprazolam, a panicolytic benzodiazepine, injected via intraperitoneal route, decreased respiratory frequency, whereas URB597, an anandamide hydrolysis inhibitor injected via intraperitoneal route, was ineffective. Doxapram injected via intraperitoneal route induced an anxiogenic-like effect in the elevated T-maze model; however, it failed to induce CPA. This study suggests that the cardiorespiratory and behavioral effects of doxapram in rodents serve as an experimental model that can provide insights into the neurobiology of panic attacks.
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Affiliation(s)
| | | | | | - Andrea S Haibara
- Departament of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Abstract
BACKGROUND Panic disorder (PD), defined by repeated and unexpected panic attacks, severely affects patients' living quality and social function. Perimenopausal women are high-risk group of PD and suffer greatly from it. Modern medicine therapies for this disorder have many side reactions and poor effects, so nonpharmacological modality is an urgent need. Although acupoint catgut embedding is widely used in clinical practice, there is no persuasive evidence of its effect for perimenopausal PD. The aim of this study is to investigate the effectiveness and safety of acupoint catgut embedding for perimenopausal PD and to elucidate the correlations among brain neural activation, bio-markers (amino acids) and clinical outcomes with radiographic evidence, thus to explore its neural mechanism. METHODS The parallel designed, exploratory randomized controlled trial will include 70 outpatients with perimenopausal PD recruited from two hospitals of Chinese Medicine. These subjects will be randomly allocated to an intervention group (Group Embedding) and a control group (Group Medication) in a 1:1 ratio. The subjects in the intervention group will receive acupoint catgut embedding treatment two weeks a time in the following predefined acupuncture points: Shenshu (BL23), Sanyinjiao (SP6), Guanyuan (RN4), Ganshu (BL18), Zusanli (ST36) and Pishu (BL20). The included women of the control group will take 0.4 mg Alprazolam tablet orally, 1 tablet a time, 3 times a day. There is a study period of 3 months and a follow-up period of 1 month for each group. The primary outcomes will be the following therapeutic indexes: the frequency of panic attack, Panic Disorder Severity Score (PDSS), and Panic-associated Symptoms Score (PASS) during the observation period and follow-up period. The changes in Hamilton Anxiety Scale (HAMA) Score and Symptom Checklist 90 (SCL-90) Score will also be compared between these two groups. Additionally, functional magnetic resonance imaging (fMRI) and proton magnetic resonance spectroscopy (1H-MRS) scans will be done before and after the observation period to show cranial neuroimaging changes. DISCUSSION We present a study design and rationale to explore the effectiveness and neural mechanism of acupoint catgut embedding for perimenopausal PD. There are still several factors restrict our research such as no unified standard of diagnostic criteria and curative effect evaluation. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16009724, registered in November 2016.
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Affiliation(s)
- Guizhen Chen
- The Bao’an District TCM Hospital, The Affiliated Hospital of Guangzhou University of Chinese Medicine, Shenzhen
| | - Xue Wang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuo Zhang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaokang Xu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junquan Liang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunxiang Xu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Afsin A, Asoğlu R, Orum MH, Cicekci E. Evaluation of TP-E Interval and TP-E/QT Ratio in Panic Disorder. Medicina (Kaunas) 2020; 56:E215. [PMID: 32353958 PMCID: PMC7279486 DOI: 10.3390/medicina56050215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The autonomic nervous system (ANS) is involved in panic disorders. ANS dysfunction has been shown to be associated with ventricular arrhythmia and increased heterogeneity of ventricular repolarization. However, there remains limited evidence of the relationship between panic disorders and ventricular depolarization markers, including the Tp-e interval and Tp-e/QT ratio. This study aimed to evaluate ventricular repolarization parameters in patients with panic disorder. Materials and Methods: In total, 40 patients with panic disorder, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, were included in the study group. The control group comprised of 50 age- and sex-matched healthy individuals. A standard 12 lead electrocardiogram was recorded on all participants, and heart rate, QT interval, QRS duration, Tp-e interval, and Tp-e/QT ratio were measured. Results: QRS durations and QT intervals were similar in the study and control groups. Compared to the control group, QTd, Tp-e, and cTp-e intervals as well as Tp-e/QT and Tp-e/QTc ratios were significantly increased in patients with panic disorder (p < 0.05 for all). In the study group, the Severity Measure for Panic Disorder-Adult score had a significant positive correlation with the Tp-e interval (r = 0.369, p < 0001), cTp-e interval (r = 0.531, p < 0.001), Tp-e/QT ratio (r = 0.358, p = 0.001), and Tp-e/QTc ratio (r = 0.351, p = 0.001). Conclusion: These findings indicate that panic disorders are associated with increased ventricular repolarization heterogeneity, which may be attributed to ANS dysregulation.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, M.D, Kahta State Hospital, Adıyaman 02450, Turkey
| | - Ramazan Asoğlu
- Department of Cardiology, M.D, Adıyaman Training and Research Hospital, Adıyaman 02450, Turkey;
| | - Mehmet Hamdi Orum
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
| | - Elvan Cicekci
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
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Valt C, Huber D, Stürmer B. Treatment-related changes towards normalization of the abnormal external signal processing in panic disorder. PLoS One 2020; 15:e0227673. [PMID: 31986163 PMCID: PMC6984717 DOI: 10.1371/journal.pone.0227673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022] Open
Abstract
Despite the scientific consensus on the efficacy of psychotherapy for the treatment of psychological disorders, the evidence of treatment-related changes towards normalization of abnormal brain functions in patients is mixed. In the present experiment, we investigated whether treatment can affect early information processing, by testing abnormal event-related potentials (ERPs) evoked by internal and external signals in panic disorder. Sixteen patients with panic disorder and comorbid personality disorder and sixteen control participants performed a response-choice task and a passive viewing task in two testing sessions, separated by around 14 months. During this period, patients received psychological treatment. In agreement with previous studies of performance monitoring, the abnormal amplitude of the Ne/ERN–an index of error processing based on internal signals—did not change between the first and second testing session. However, treatment-related changes were evident for the abnormal vertex positive potential (VPP) evoked by external signals in the response-choice task and the passive viewing task. In patients, the VPP was smaller in the second session compared to the first session, whereas no significant changes occurred in controls. This result supplies evidence of treatment-related changes towards normalization in the early information processing of external visual stimuli in panic disorder.
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Affiliation(s)
- Christian Valt
- International Psychoanalytic University Berlin, Berlin, Germany
- * E-mail:
| | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Birgit Stürmer
- International Psychoanalytic University Berlin, Berlin, Germany
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Solomonov N, Falkenström F, Gorman BS, McCarthy KS, Milrod B, Rudden MG, Chambless DL, Barber JP. Differential effects of alliance and techniques on Panic-Specific Reflective Function and misinterpretation of bodily sensations in two treatments for panic. Psychother Res 2020; 30:97-111. [PMID: 30821630 PMCID: PMC6778028 DOI: 10.1080/10503307.2019.1585591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022] Open
Abstract
ABSTRACTObjective: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. Method: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT. Data were collected on patient-reported working alliance, misinterpretations, PSRF, observer-coded use of techniques, and interviewer-rated panic severity. Random-Intercept Cross-Lagged Panel Models assessed bi-directional associations, disentangling within- and between-patient effects, and accounting for prior change. Results: Higher alliance predicted subsequent within-patient improvement in PSRF in PFPP, but worsening in CBT. In both treatments, focus on interpersonal relationships predicted PRSF improvement (with stronger effects in CBT), while focus on thoughts and behaviors predicted worsening in PSRF. In CBT only, early focus on affect and moment-to-moment experience predicted reduced misinterpretation, while high focus on thoughts and cognitions predicted subsequent increase in misinterpretation. Conclusion: The quality of the alliance has differential effects on PSRF in distinct treatments. Interpersonal, rather than cognitive or behavioral focus, even when delivered differently within distinct treatments with high adherence, could facilitate improvement in PSRF. Additionally, early focus on affect and moment-to-moment experiences in CBT could reduce misinterpretations.
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Affiliation(s)
- Nili Solomonov
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
- Weill Cornell Geriatric Psychiatry Institute, Weill Cornell Medical College, White Plains, NY
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Fredrik Falkenström
- Center for Clinical Research Sörmland and Department of Neuroscience, Uppsala University, Sweden
| | - Bernard S. Gorman
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
| | - Kevin S. McCarthy
- Chestnut Hill College, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara Milrod
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Marie G. Rudden
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | | | - Jacques P. Barber
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
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8
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Ridderbusch IC, Richter J, Yang Y, Hoefler M, Weber H, Reif A, Hamm A, Pané-Farré CA, Gerlach AL, Stroehle A, Pfleiderer B, Arolt V, Wittchen HU, Gloster A, Lang T, Helbig-Lang S, Fehm L, Pauli P, Kircher T, Lueken U, Straube B. Association of rs7688285 allelic variation coding for GLRB with fear reactivity and exposure-based therapy in patients with panic disorder and agoraphobia. Eur Neuropsychopharmacol 2019; 29:1138-1151. [PMID: 31444036 DOI: 10.1016/j.euroneuro.2019.07.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 05/20/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Abstract
The gene coding for glycine receptor β subunits (GLRB) has been found to be related to panic disorder and agoraphobia (PD/AG) and to be associated with altered insular BOLD activation during fear conditioning, as an intermediate phenotype of defensive system reactivity in healthy subjects. In a multicenter clinical trial on PD/AG patients we investigated in three sub-samples whether GLRB allelic variation (A/G; A-allele identified as «risk») in the single nucleotide polymorphism rs7688285 was associated with autonomic (behavioral avoidance test BAT; n = 267 patients) and neural (differential fear conditioning; n = 49 patients, n = 38 controls) measures, and furthermore with responding towards exposure-based cognitive behavioral therapy (CBT, n = 184 patients). An interaction of genotype with current PD/AG diagnosis (PD/AG vs. controls; fMRI data only) and their modification after CBT was tested as well. Exploratory fMRI results prior to CBT, revealed A-allele carriers irrespective of diagnostic status to show overall higher BOLD activation in the hippocampus, motor cortex (MC) and insula. Differential activation in the MC, anterior cingulate cortex (ACC) and insula was found in the interaction genotype X diagnosis. Differential activation in ACC and hippocampus was present in differential fear learning. ACC activation was modified after treatment, while no overall rs7688285 dependent effect on clinical outcomes was found. On the behavioral level, A-allele carriers showed pronounced fear reactivity prior to CBT which partially normalized afterwards. In sum, rs7688285 variation interacts in a complex manner with PD/AG on a functional systems level and might be involved in the development of PD/AG but not in their treatment.
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Affiliation(s)
- Isabelle C Ridderbusch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany.
| | - Jan Richter
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Michael Hoefler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alfons Hamm
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Christiane A Pané-Farré
- Institute of Psychology, University of Greifswald, Greifswald, Germany; Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Alexander L Gerlach
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andreas Stroehle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Pfleiderer
- Medical Faculty, University of Münster and Department Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Andrew Gloster
- Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
| | - Thomas Lang
- Christoph-Dornier-Stiftung für Klinische Psychologie, Bremen, Germany; Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Sylvia Helbig-Lang
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Paul Pauli
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
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Kaldewaij R, Reinecke A, Harmer CJ. A lack of differentiation in amygdala responses to fearful expression intensity in panic disorder patients. Psychiatry Res Neuroimaging 2019; 291:18-25. [PMID: 31357097 DOI: 10.1016/j.pscychresns.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 11/29/2022]
Abstract
Patients with panic disorder show abnormalities in threat processing and regulation, both on a behavioural and neural level. Better understanding of the underlying mechanisms could help to develop new treatment strategies. In this study, we investigated brain region activation in 18 patients with untreated panic disorder (PD) and 17 healthy controls (HC) during the processing of emotional faces with fearful, happy and neutral expressions, using functional MRI. The intensity of the expressions was either prototypically high, medium or low. PD patients showed significantly increased activity in the dorso-medial prefrontal cortex (dmPFC) in response to faces in general and specifically for happy faces. While HC showed a decreased amygdala response to medium/low fearful versus high fearful faces, this effect was not present in PD: amygdala activation was stable across all fearful faces in this group. Psycho-physiological interaction analyses indicated more negative connectivity between the amygdala and prefrontal areas in the PD group during the task. Amygdala activation in panic patients appears to be less sensitive to decreasing intensities of fearful facial expressions and salience monitoring areas were less active during fearful faces in general in this group. This suggests PD patients might avoid more extensive processing of fearful faces.
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Affiliation(s)
- Reinoud Kaldewaij
- Department of Psychiatry, University of Oxford, United Kingdom; Currently at Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Cognitive Neuro-imaging, Radboud University Nijmegen, the Netherlands.
| | - Andrea Reinecke
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS foundation Trust, Warneford Hospital, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS foundation Trust, Warneford Hospital, United Kingdom
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10
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Stevens ES, Lieberman L, Funkhouser CJ, Correa KA, Shankman SA. Startle during threat longitudinally predicts functional impairment independent of DSM diagnoses. Psychiatry Res 2019; 279:207-215. [PMID: 30853118 PMCID: PMC6713600 DOI: 10.1016/j.psychres.2019.02.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
Heightened responsivity to unpredictable, and perhaps predictable, threat characterizes some internalizing disorders and may be vulnerability factors for psychopathology as well. However, few studies have directly tested whether individual differences in unpredictable and/or predictable threat responding longitudinally predict symptoms of psychopathology and functional outcomes. Examining functioning is particularly important given that functioning is separable from symptoms of psychopathology. The present study examined whether electromyography startle measures of predictable and/or unpredictable threat responding was associated with interviewer-assessed symptoms of internalizing psychopathology and functional impairment at baseline (n = 409) and one-year follow-up (n = 104). Elevated startle responding to unpredictable and predictable threat longitudinally predicted a worsening of functioning over time and this effect was independent of change of symptoms over time. Importantly, threat responding at baseline predicted functional impairment during the follow-up independent of the effects of DSM-defined fear-based (e.g., panic disorder) or distress-misery (e.g., major depressive disorder) internalizing disorders. These findings provide initial support for the incremental validity of neurobiological vulnerability markers of threat responding over and above DSM disorders and highlight the importance of distinguishing functional outcomes from symptom outcomes.
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Affiliation(s)
| | - Lynne Lieberman
- Department of Psychology, University of Illinois at Chicago, IL, USA
| | | | - Kelly A Correa
- Department of Psychology, University of Illinois at Chicago, IL, USA
| | - Stewart A Shankman
- Department of Psychology, University of Illinois at Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
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11
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Neufang S, Geiger MJ, Homola GA, Mahr M, Schiele MA, Gehrmann A, Schmidt B, Gajewska A, Nowak J, Meisenzahl-Lechner E, Pham M, Romanos M, Akhrif A, Domschke K. Cognitive-behavioral therapy effects on alerting network activity and effective connectivity in panic disorder. Eur Arch Psychiatry Clin Neurosci 2019; 269:587-598. [PMID: 30288559 DOI: 10.1007/s00406-018-0945-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
Given the particular relevance of arousal and alerting in panic disorder (PD), here the alerting network was investigated (1) contrasting patients with PD and healthy controls, (2) as a function of anxiety sensitivity constituting a dimensional measure of panic-related anxiety, and (3) as a possible correlate of treatment response. Using functional magnetic resonance imaging (fMRI), 45 out-patients with PD (f = 34) and 51 matched healthy controls were investigated for brain activation patterns and effective connectivity (Dynamic Causal Modeling, DCM) while performing the Attention Network Task (ANT). Anxiety sensitivity was ascertained by the Anxiety Sensitivity Index (ASI). Forty patients and 48 controls were re-scanned after a 6 weeks cognitive-behavioral treatment (CBT) or an equivalent waiting time, respectively. In the alerting condition, patients showed decreased activation in fronto-parietal pathways including the middle frontal gyrus and the superior parietal lobule (MFG, SPL). In addition, ASI scores were negatively correlated with connectivity emerging from the SPL, the SFB and the LC and going to the MFG in patients but not in healthy controls. CBT resulted in an increase in middle frontal and parietal activation along with increased connectivity going from the MFG to the SPL. This change in connectivity was positively correlated with reduction in ASI scores. There were no changes in controls. The present findings point to a pathological disintegration of the MFG in a fronto-parietal pathway in the alerting network in PD which was observed to be reversible by a successful CBT intervention.
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Affiliation(s)
- Susanne Neufang
- Center of Mental Health, Department of Child and Adolescent Psychiatry, University of Wuerzburg, 97080, Wuerzburg, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40204, Duesseldorf, Germany.
| | - Maximilian J Geiger
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
- Epilepsy Center, Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - György A Homola
- Institute for Diagnostical and Interventional Neuroradiology, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Marina Mahr
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Miriam A Schiele
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Centre, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany
| | - Andrea Gehrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Brigitte Schmidt
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Agnieszka Gajewska
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Johannes Nowak
- Institute for Diagnostical and Interventional Radiology, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Eva Meisenzahl-Lechner
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, 40204, Duesseldorf, Germany
| | - Mirko Pham
- Institute for Diagnostical and Interventional Neuroradiology, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Atae Akhrif
- Center of Mental Health, Department of Child and Adolescent Psychiatry, University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Katharina Domschke
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, 97080, Wuerzburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Centre, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany
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Cheng CH, Chan PYS, Hsu SC, Liu CY. Abnormal frontal generator during auditory sensory gating in panic disorder: An MEG study. Psychiatry Res Neuroimaging 2019; 288:60-66. [PMID: 31014913 DOI: 10.1016/j.pscychresns.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 01/08/2023]
Abstract
Patients with panic disorder (PD) exhibit abnormalities in early-stage information processing, even for the nonthreatening stimuli. A previous event-related potential study reported that PD patients show a deficit in sensory gating (SG), a protective mechanism of the brain to filter out irrelevant sensory inputs. However, there is no clear understanding about the neural correlates of SG deficits in PD. Moreover, whether SG deficits, if any, are associated with clinical manifestations remain unknown. In this study, 18 patients with PD and 20 age- and gender-matched healthy controls were recruited to perform auditory paired-stimulus paradigm using magnetoencephalographic (MEG) recordings. Results showed that PD patients demonstrated significantly higher M50 SG ratios in the right inferior frontal gyrus (RIFG) and higher M100 SG ratios in both RIFG and right superior temporal gyrus (RSTG) than those of the control group. It was important to note that in the RIFG, the M50 SG ratios correlated significantly with the scores of Body Sensation Questionnaire (BSQ) and Distractibility scale of Sensory Gating Inventory among patients with PD. In conclusion, this study suggests that PD patients exhibited a deficient ability to filter out irrelevant information, and such a defect might lead to cognitive misinterpretation of somatic sensations and distractibility.
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Affiliation(s)
- Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan; Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan.
| | - Pei-Ying S Chan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Chieh Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Tural Ü, Alioğlu F. [A Meta-Analysis of Efficacy of Carbon Dioxide Inhalation as a Challenge Test in Panic Disorder]. Turk Psikiyatri Derg 2019; 30:99-108. [PMID: 31487375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study is to perform a systematic review and meta-analysis on whether patients with panic disorder (PD) and their healthy first-degree relatives have an increased sensitivity to carbon dioxide inhalation test compared to healthy controls (HC) or patients with psychiatric disorders other than panic disorder. METHOD The databases of PubMed, EMBASE and PsycNET were searched using Boolean operators "panic AND carbon dioxide" and "panic AND CO2". Selected research articles were classified according to the carbon dioxide concentrations used in testing and the clinical characteristics of the samples. The assumption of heterogeneity across the studies was assessed by chi square based Q and I2 statistics. Publication biases were explored by Begg-Mazumdar's and Egger's tests in addition to funnel graphics. Odds ratios representing effect size of the carbon dioxide inhalation procedure were calculated according to fixed effect and random effect models after obtaining percent weight effects of each study. RESULTS Meta-Analysis was conducted on 33 research studies that include 2114 participants totally. Participants with PD experienced significantly more frequent panic attacks (PA) compared to HC following in both 5% (OR=14.713, 95% CI 7.532 - 28.739) and 35% carbon dioxide inhalation (OR=11.507, 95% CI 7.775 - 17.031). HC who have a first-degree relative with PD experienced PA approximately 3 times more than HC who have not a first-degree relative with PD (OR=2.658, 95% CI 1.678 - 4.212) following carbon dioxide inhalation test. Participants with PD experienced significantly more frequent PA than the patients with other psychiatric disorders following the carbon dioxide inhalation test (OR = 3.524, 95% CI 1.945 - 6.384). CONCLUSION There is an increased sensitivity of carbon dioxide inhalation in patients with PD and their healthy first-degree relatives. The role and possible mechanisms of carbon dioxide in etiology and physiopathology of PD should be studied extensively.
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Gündüz N, Akpınar Aslan E, Eren F, Sodan Turan H, Öztürk M, Tural Ü. Analysis of 24-Hour Heart Rate Variability among Panic Disorder Patients without Previous Drug Treatment and Comorbid Disorders. Turk Psikiyatri Derg 2019; 30:236-244. [PMID: 32594484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE One of the METHODS used to assess autonomic nervous system dysfunction in the etiology of panic disorder (PD) is heart rate variability (HRV). HRV is controlled by the sympathetic and parasympathetic (vagal) branches of the autonomic nervous system and reflects the capacity of autonomic stimulation by the parasympathetic system. The aim of this study was to evaluate heart rate variability (HRV) time domain parameters based on twenty four hour holter ECG analysis among drug-naive patients with panic disorder (PD) without any other medical and psychiatric comorbidity. METHOD The study group consisted of 41 patients with PD and 46 healthy controls. Participants were evaluated with SCID-1 for psychiatric diagnoses. Then Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Panic Disorder Severity Scale (PDSS) and Clinical Global Impression Scale (CGI-S) were applied to participants. Twenty four hour Holter ECG outcomes were analyzed on a computer program and time domain parameters were evaluated. RESULTS Among the parameters analyzed from HRV, SDANN was significantly higher (p <0.001); duration of RMSSD, NN50 and pNN50 were lower in PD group than the control group (p = 0.003, p = 0.005, p = 0.047, respectively). In the correlation analysis, there was a moderate negative correlation between CGI-S and NN50 and pNN50. In logistic regression analysis, the increase in SDNN was found to increase the probability of PD by 1.11 (95% CI, 1.010-1.209); the increase in SDANN was found to decrease the probability of PD by 0.892 (95% CI, 0.818-0.973), and the increase in pNN50 was found to decrease the probability of PD by 0.523 (95% CI, 0.342-0.801). CONCLUSION The data obtained in our study confirm that there is a decrease in some HRV parameters like RMSSD, NN50 and pNN50 reflecting parasympathetic activity among patients with PD.
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Olaya B, Moneta MV, Miret M, Ayuso-Mateos JL, Haro JM. Epidemiology of panic attacks, panic disorder and the moderating role of age: Results from a population-based study. J Affect Disord 2018; 241:627-633. [PMID: 30172214 DOI: 10.1016/j.jad.2018.08.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/25/2018] [Accepted: 08/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of panic attacks (PA) and panic disorder (PD) over the lifespan, determine the main correlates and analyze the potential moderating role of age. METHOD We analyzed cross-sectional data from a nationally-representative sample of 4,569 non-institutionalized adults. Three panic groups were created according to results in the CIDI interview: non-panic, PA (without PD) and PD. Panic groups were used as outcomes in adjusted multinomial regression models where several correlates were investigated. Interactions between each covariate and age were explored. RESULTS The highest prevalence rates of PA (9.5%) and PD (3.3%) were found in people aged 30-39 and 40-49, respectively. Respondents aged 80 + presented the lowest rates. In the adjusted multinomial model, younger ages, having depression, and poorer levels of quality of life were significant correlates for both PA and PD, whereas being female and having 2 or more chronic conditions were only significant for PA (not for PD) and being a frequent drinker (last 12-months) only for PD. Age significantly interacted with frequent alcohol consumption in the last 12-months for PD. The predicted probability of having PD decreased with age for life-abstainer or occasional drinkers, whereas the probability increased with older ages for frequent drinkers. LIMITATIONS Low prevalence of PA and PD resulted in large confidence intervals whereas self-reports could be affected by recall bias. CONCLUSIONS Overall, our results suggest that the probability of having PA and PD decreases as people age and that the significant risk factors are independent of age. However, older adults with a frequent drink pattern seem to be at higher risk of PD. Future longitudinal studies are needed to determine the trajectories of PD and alcohol consumption over the lifespan.
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Affiliation(s)
- Beatriz Olaya
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Maria Victoria Moneta
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IP), Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Valt C, Huber D, Erhardt I, Stürmer B. Internal and external signal processing in patients with panic disorder: An event-related potential (ERP) study. PLoS One 2018; 13:e0208257. [PMID: 30496321 PMCID: PMC6264869 DOI: 10.1371/journal.pone.0208257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022] Open
Abstract
Self-absorption describes a pathological tendency towards the internal mental world (internalization) that often conflicts with the accurate monitoring of the external world. In performance monitoring, an augmented electrophysiological response evoked by internal signals in patients with anxiety or depressive disorder seems to reflect this tendency. Specifically, the error-related negativity (Ne/ERN), an index of error processing based on internal signals, is larger in patients compared to controls. In the present experiment, we investigated whether the preferential processing of internal signals in patients is linked to diminished and inflexible external signal processing. To this end, the electrophysiological response evoked by external signals was analysed in patients with panic disorder and healthy controls. Participants performed a choice-response task, where informative or uninformative feedback followed each response, and a passive viewing task. As a replication of previous studies, patients presented an augmented Ne/ERN, indexing enhanced processing of internal signals related to errors. Furthermore, the vertex positive potential (VPP) evoked by visual stimuli was larger in patients than in controls, suggesting enhanced attention to external signals. Moreover, patients and controls showed similar sensitivity to the feedback information content, indicating a normal flexibility in the allocation of monitoring resources to external signals depending on how informative these signals are for performance monitoring. These results suggest that the tendency towards internal signals in patients with panic disorder does not hinder the flexible processing of external signals. On the contrary, external signals seem to attract enhanced processing in patients compared to controls.
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Affiliation(s)
- Christian Valt
- International Psychoanalytic University Berlin, Berlin, Germany
- * E-mail:
| | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München, Munich, Germany
| | - Ingrid Erhardt
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München, Munich, Germany
| | - Birgit Stürmer
- International Psychoanalytic University Berlin, Berlin, Germany
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - George L Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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18
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Cooper SE, Grillon C, Lissek S. Impaired discriminative fear conditioning during later training trials differentiates generalized anxiety disorder, but not panic disorder, from healthy control participants. Compr Psychiatry 2018; 85:84-93. [PMID: 30005181 PMCID: PMC6100804 DOI: 10.1016/j.comppsych.2018.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Fear conditioning is implicated as a central psychopathological mechanism of anxiety disorders. People with anxiety disorders typically demonstrate reduced affective discrimination between conditioned danger and safety cues. Here, affective discrimination refers to the ability to selectively display fear to dangerous but not safe situations. Though both generalized anxiety disorder (GAD) and panic disorder (PD) are linked to impaired affective discrimination, the clinical phenomenology of these disorders suggests that people with GAD versus PD might be less able to overcome such deficits. It is unclear how this potential difference would manifest during lab-based conditioning. METHODS We used a classical fear conditioning paradigm over two discrimination training sessions to examine whether those with GAD, but not PD, would display persistent discrimination deficits. Sixty-seven participants (21 GAD, 19 PD, 27 Healthy Controls) completed a task in which conditioned fear was measured psychophysiologically (fear-potentiated startle), behaviorally, and via self-report. RESULTS Although similar levels of impaired discrimination were found for both GAD and PD groups during initial training, such impairments tended to persist across a subsequent training session only for patients with GAD when compared with Controls. CONCLUSION Our results provide a foundation for additional research of discrimination deficits in specific anxiety disorders, with an ultimate goal of improved customization of psychological treatments.
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Affiliation(s)
- Samuel E Cooper
- Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Twin City Campus, United States of America
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, DIRP, NIMH, United States of America
| | - Shmuel Lissek
- Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Twin City Campus, United States of America.
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Neumeister P, Feldker K, Heitmann CY, Buff C, Brinkmann L, Bruchmann M, Straube T. Specific amygdala response to masked fearful faces in post-traumatic stress relative to other anxiety disorders. Psychol Med 2018; 48:1209-1217. [PMID: 28950918 DOI: 10.1017/s0033291717002513] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Altered amygdala activation to fear-related stimuli has been proposed to be a potential neural correlate of heightened threat sensitivity in anxiety- and stress-related disorders. However, the role of stimulus awareness and disorder specificity remains widely unclear. Here we investigated amygdala responses to conscious and unconscious fearful faces in patients suffering from panic disorder (PD), generalized anxiety disorder (GAD), or post-traumatic stress disorder (PTSD) and in a large sample of healthy controls (HC). METHODS During event-related functional magnetic resonance imaging participants (n = 120; 20 PD, 20 GAD, 20 PTSD, 60 HC) were confronted with briefly presented fearful faces, neutral faces, and non-faces in a backward masking paradigm. The design allowed for the analysis of trial-by-trial face detection performance and amygdala responses to fearful v. neutral faces. RESULTS All participants exhibited increased amygdala activation to fearful v. neutral faces during conscious trials. Specifically during unconscious face processing, the PTSD, compared with all other groups, showed higher right basolateral (BLA) amygdala activity to fearful v. neutral faces. CONCLUSIONS The present study shows that BLA amygdala hyperactivity during unconscious, but not conscious, processing of fearful faces differentiates PTSD from the investigated disorders. This finding suggests an automatic and specific neural hyper-responsivity to general fear cues in PTSD and supports the idea of categorical differences between PTSD and other anxiety-related disorders.
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Affiliation(s)
- P Neumeister
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - K Feldker
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - C Y Heitmann
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - C Buff
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - M Bruchmann
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
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Khan JN, Reigler J, Murray SW, Ruzsics B. Cardiac CT confirmation of normal prosthetic mechanical aortic valve function in patient with presyncope and significantly increased Doppler velocities. BMJ Case Rep 2018; 2018:bcr-2018-225024. [PMID: 29700222 PMCID: PMC5926559 DOI: 10.1136/bcr-2018-225024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jamal N Khan
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jennifer Reigler
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Scott W Murray
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Balazs Ruzsics
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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McTeague LM, Laplante MC, Bulls HW, Shumen JR, Lang PJ, Keil A. Face Perception in Social Anxiety: Visuocortical Dynamics Reveal Propensities for Hypervigilance or Avoidance. Biol Psychiatry 2018; 83:618-628. [PMID: 29157845 PMCID: PMC5889302 DOI: 10.1016/j.biopsych.2017.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 09/11/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Theories of aberrant attentional processing in social anxiety, and anxiety disorders more broadly, have postulated an initial hypervigilance or facilitation to clinically relevant threats and consequent defensive avoidance. However, existing objective measurements utilized to explore this phenomenon lack the resolution to elucidate attentional dynamics, particularly covert influences. METHODS We utilized a continuous measure of visuocortical engagement, the steady-state visual evoked potential in response to naturalistic angry, fearful, happy, and neutral facial expressions. Participants were treatment-seeking patients with principal diagnoses of social anxiety circumscribed to performance situations (n = 21) or generalized across interaction contexts (n = 42), treatment-seeking patients with panic disorder with agoraphobia (n = 25), and 17 healthy participants. RESULTS At the principal disorder level, only circumscribed social anxiety patients showed sustained visuocortical facilitation to aversive facial expressions. Control participants as well as patients with panic disorder with agoraphobia and generalized social anxiety showed no bias. More finely stratifying the sample according to clinical judgment of social anxiety severity and interference revealed a linear increase in visuocortical bias to aversive expressions for all but the most severely impaired patients. This group showed an opposing sustained attentional disengagement. CONCLUSIONS Rather than shifts between covert vigilance and avoidance of aversive facial expressions, social anxiety appears to confer a sustained bias for one or the other. While vigilant attention reliably increases with social anxiety severity for the majority of patients, the most impaired patients show an opposing avoidance. These distinct patterns of attentional allocation could provide a powerful means of personalizing neuroscience-based interventions to modify attention bias and related impairment.
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Affiliation(s)
- Lisa M McTeague
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | | | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa
| | - Joshua R Shumen
- Center for the Study of Emotion and Attention at the University of Florida, Gainesville, Florida
| | - Peter J Lang
- Center for the Study of Emotion and Attention at the University of Florida, Gainesville, Florida
| | - Andreas Keil
- Center for the Study of Emotion and Attention at the University of Florida, Gainesville, Florida
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Altamura M, Iuso S, Balzotti A, Francavilla G, Dimitri A, Cibelli G, Bellomo A, Petito A. Salivary alpha-amylase and cortisol responsiveness to stress in first episode, drug-naïve patients with panic disorder. Neurosci Res 2018; 137:49-56. [PMID: 29550536 DOI: 10.1016/j.neures.2018.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 01/03/2023]
Abstract
Reported findings on reactivity to stress of the sympathetic-adreno-medullar (SAM) and hypothalamic-pituitary-adrenal (HPA) systems in panic disorder (PD) are very variable. This inconsistency may be explained by differences in treatment exposure, illness duration and emotion regulation strategies. The present study examined the reactivity to mental stress of the SAM and HPA axes in a sample of first episode, drug naïve patients with PD which avoids confounds of medications exposure and illness chronicity. Activation of the SAM axis was evaluated by dosage of salivary alpha-amylase (sAA) and heart rate. Activation of the HPA axis was tested by dosage of salivary cortisol. Psychological assessments were done by the Self-Rating Depression Scale, the Self-Rating Anxiety Scale, the State-Trait Anxiety Inventory, the Cope Orientation to Problems Experienced (COPE) Inventory and the 16 Personality Factor Questionnaire (16PF). Patients showed reduced sAA stress reactivity, higher baseline cortisol levels and a more rapid decrease in stress cortisol levels as compared with controls. A significant correlation was found between active coping strategies and cortisol levels (response to stress). The findings suggest that blunted SAM stress reactivity and a rapid decrease in stress cortisol levels reflect traits that may enhance vulnerability to psychopathology in patients with PD.
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Affiliation(s)
- Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy.
| | - Salvatore Iuso
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy
| | - Angela Balzotti
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy
| | - Girolamo Francavilla
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy
| | - Andrea Dimitri
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Section of Human Physiology, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, Psychiatry Unit, Foggia, Italy
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Held-Poschardt D, Sterzer P, Schlagenhauf F, Pehrs C, Wittmann A, Stoy M, Hägele C, Knutson B, Heinz A, Ströhle A. Reward and loss anticipation in panic disorder: An fMRI study. Psychiatry Res Neuroimaging 2018; 271:111-117. [PMID: 29169660 DOI: 10.1016/j.pscychresns.2017.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 10/21/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022]
Abstract
Anticipatory anxiety and harm avoidance are essential features of panic disorder (PD) and may involve deficits in the reward system of the brain, in particular in the ventral striatum. While neuroimaging studies on PD have focused on fearful and negative affective stimulus processing, no investigations have directly addressed deficits in reward and loss anticipation. To determine whether the ventral striatum shows abnormal neural activity in PD patients during anticipation of loss or gain, an event-related functional magnetic resonance imaging experiment using a monetary incentive delay task was employed in 10 patients with PD and 10 healthy controls. A repeated-measures ANOVA to identify effects of group (PD vs. Control) and condition (anticipation of loss vs. gain vs. neutral outcome) revealed that patients with PD showed significantly reduced bilateral ventral striatal activation during reward anticipation but increased activity during loss anticipation. Within the patient group, the degree of activation in the ventral striatum during loss-anticipation was positively correlated with harm avoidance and negatively correlated with novelty seeking. These findings suggest that behavioural impairments in panic disorder may be related to abnormal neural processing of motivational cues.
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Affiliation(s)
- Dada Held-Poschardt
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Corinna Pehrs
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208-2710, USA
| | - Andre Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Meline Stoy
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Claudia Hägele
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Brian Knutson
- Stanford Neuroscience Institute, Stanford University, Stanford, CA 94305-2130, USA
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Feldker K, Heitmann CY, Neumeister P, Brinkmann L, Bruchmann M, Zwitserlood P, Straube T. Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder. J Psychiatry Neurosci 2018; 43:26-36. [PMID: 29252163 PMCID: PMC5747532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/30/2017] [Accepted: 05/01/2017] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. METHODS The present event-related functional MRI (fMRI) study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). RESULTS We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. LIMITATIONS The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. CONCLUSION Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.
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Affiliation(s)
- Katharina Feldker
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Carina Yvonne Heitmann
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Paula Neumeister
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Leonie Brinkmann
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Maximillan Bruchmann
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Pienie Zwitserlood
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Thomas Straube
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
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Tenorio-Lopes L, Henry MS, Marques D, Tremblay MÈ, Drolet G, Bretzner F, Kinkead R. Neonatal maternal separation opposes the facilitatory effect of castration on the respiratory response to hypercapnia of the adult male rat: Evidence for the involvement of the medial amygdala. J Neuroendocrinol 2017; 29. [PMID: 29063642 DOI: 10.1111/jne.12550] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 01/09/2023]
Abstract
Respiratory manifestations of panic disorder (PD) include a greater respiratory instability and enhanced responsiveness to CO2 compared to normal individuals. Although the prevalence of PD is approximately three times greater in women compared to men, the origins of this sexual dimorphism remain poorly understood. Similar to PD patients, adult female rats previously subjected to neonatal maternal separation (NMS) show an increase in their ventilatory response to CO2 . Because this effect of NMS is not observed in males, we hypothesised that testosterone prevents NMS-induced hyper-responsiveness to CO2 . Pups subjected to NMS were placed in an incubator for 3 h d-1 from postnatal days 3-12. Control pups remained undisturbed. At adulthood (8-10 weeks of age), rats were then subjected either to sham surgery or castration. Fourteen days later, breathing was measured at rest (room air) and during acute exposure to hypercapnia (5 and 10% CO2 for 10 minutes each) using plethysmography. To gain insight into the mechanisms involved, c-fos expression was used as an indicator of neuronal activation. Brains were collected following air or CO2 exposure for quantification of c-fos positive cells by immunohistochemistry in selected regions, including the paraventricular nucleus of the hypothalamus, the dorsomedial hypothalamus and the amygdalar complex. Castration produced a 100% increase of hyperventilatory response to 10% CO2 in control rats. Unexpectedly, castration had no effect on the hyperventilatory response of NMS rats. The intensity of the hypercapnic response was inversely correlated with c-fos expression in the medial amygdala. We conclude that testosterone prevents the hyper-responsiveness to CO2 , whereas NMS attenuates sensitivity to hormone withdrawal. We propose that an inhibitory influence from the medial amygdala contributes to this effect.
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Affiliation(s)
- L Tenorio-Lopes
- Department of Pediatrics, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - M S Henry
- Department of Molecular Medicine, Centre de Recherche du CHU de Québec-Université Laval, Axe Neurosciences, Université Laval, Québec, QC, Canada
| | - D Marques
- Departamento de Morfologia e Fisiologia Animal Fac. de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - M-È Tremblay
- Department of Molecular Medicine, Centre de Recherche du CHU de Québec-Université Laval, Axe Neurosciences, Université Laval, Québec, QC, Canada
| | - G Drolet
- Department of Molecular Medicine, Centre de Recherche du CHU de Québec-Université Laval, Axe Neurosciences, Université Laval, Québec, QC, Canada
| | - F Bretzner
- Department of Molecular Medicine, Centre de Recherche du CHU de Québec-Université Laval, Axe Neurosciences, Université Laval, Québec, QC, Canada
| | - R Kinkead
- Department of Pediatrics, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, QC, Canada
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Brinkmann L, Buff C, Feldker K, Tupak SV, Becker MPI, Herrmann MJ, Straube T. Distinct phasic and sustained brain responses and connectivity of amygdala and bed nucleus of the stria terminalis during threat anticipation in panic disorder. Psychol Med 2017; 47:2675-2688. [PMID: 28485259 DOI: 10.1017/s0033291717001192] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Panic disorder (PD) patients are constantly concerned about future panic attacks and exhibit general hypersensitivity to unpredictable threat. We aimed to reveal phasic and sustained brain responses and functional connectivity of the amygdala and the bed nucleus of the stria terminalis (BNST) during threat anticipation in PD. METHODS Using functional magnetic resonance imaging (fMRI), we investigated 17 PD patients and 19 healthy controls (HC) during anticipation of temporally unpredictable aversive and neutral sounds. We used a phasic and sustained analysis model to disentangle temporally dissociable brain activations. RESULTS PD patients compared with HC showed phasic amygdala and sustained BNST responses during anticipation of aversive v. neutral stimuli. Furthermore, increased phasic activation was observed in anterior cingulate cortex (ACC), insula and prefrontal cortex (PFC). Insula and PFC also showed sustained activation. Functional connectivity analyses revealed partly distinct phasic and sustained networks. CONCLUSIONS We demonstrate a role for the BNST during unpredictable threat anticipation in PD and provide first evidence for dissociation between phasic amygdala and sustained BNST activation and their functional connectivity. In line with a hypersensitivity to uncertainty in PD, our results suggest time-dependent involvement of brain regions related to fear and anxiety.
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Affiliation(s)
- L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - C Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - K Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - S V Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - M J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy,Center of Mental Health, University Hospital Wuerzburg,Margarete-Hoeppel-Platz 1, Wuerzburg,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
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Deppermann S, Vennewald N, Diemer J, Sickinger S, Haeussinger FB, Dresler T, Notzon S, Laeger I, Arolt V, Ehlis AC, Fallgatter AJ, Zwanzger P. Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy. Neuroimage Clin 2017; 16:668-677. [PMID: 29085773 PMCID: PMC5650598 DOI: 10.1016/j.nicl.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/01/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND A relevant proportion of patients with panic disorder (PD) does not improve even though they receive state of the art treatment for anxiety disorders such as cognitive-behavioural therapy (CBT). At the same time, it is known, that from a neurobiological point of view, PD patients are often characterised by prefrontal hypoactivation. Intermittent Theta Burst Stimulation (iTBS) is a non-invasive type of neurostimulation which can modulate cortical activity and thus has the potential to normalise prefrontal hypoactivity found in PD. We therefore aimed at investigating the effects of iTBS as an innovative add-on to CBT in the treatment for PD. METHODS In this double-blind, bicentric study, 44 PD patients, randomised to sham or verum stimulation, received 15 sessions of iTBS over the left prefrontal cortex (PFC) in addition to 9 weeks of group CBT. Cortical activity during a cognitive as well as an emotional (Emotional Stroop) paradigm was assessed both at baseline and post-iTBS treatment using functional near-infrared spectroscopy (fNIRS) and compared to healthy controls. RESULTS In this manuscript we only report the results of the emotional paradigm; for the results of the cognitive paradigm please refer to Deppermann et al. (2014). During the Emotional Stroop test, PD patients showed significantly reduced activation to panic-related compared to neutral stimuli for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group. LIMITATIONS Limitations include insufficient blinding, the missing control for possible state-dependent iTBS effects, and the timing of iTBS application during CBT. CONCLUSION Prefrontal hypoactivity in PD patients was normalised by add-on iTBS. Clinical improvement of anxiety symptoms was not affected by iTBS.
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Key Words
- ANOVA, analysis of variance
- CAQ, Cardiac Anxiety Questionnaire
- CBSI, correlation-based signal improvement
- CBT, cognitive-behavioural therapy
- Cognitive-behavioural therapy
- ER, error rate
- Emotion regulation
- Functional near-infrared spectroscopy
- HAM-A, Hamilton Anxiety Rating Scale
- HHb, deoxyhemoglobin
- Intermittent Theta Burst Stimulation
- LOCF, last observation carried forward
- O2Hb, oxyhemoglobin
- PAS, Panic and Agoraphobia Scale
- PD, panic disorder
- PFC, prefrontal cortex
- Panic disorder
- RM-ANOVA, repeated-measures analysis of variance
- ROI, region of interest
- RT, reaction time
- fNIRS, functional near-infrared spectroscopy
- iTBS, intermittent Theta Burst Stimulation
- rTMS, repetitive Transcranial Magnetic Stimulation
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Affiliation(s)
- Saskia Deppermann
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Nadja Vennewald
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Julia Diemer
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
- kbo-Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany
| | - Stephanie Sickinger
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Florian B. Haeussinger
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
- Graduate School LEAD, Europastr. 6, University of Tuebingen, 72072 Tuebingen, Germany
| | - Swantje Notzon
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Inga Laeger
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Volker Arolt
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, Calwerstr. 14, University of Tuebingen, 72076 Tuebingen, Germany
- Graduate School LEAD, Europastr. 6, University of Tuebingen, 72072 Tuebingen, Germany
- Cluster of Excellence CIN, Otfried-Mueller-Str. 25, University of Tuebingen, 72076 Tuebingen, Germany
| | - Peter Zwanzger
- Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany
- kbo-Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany
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Yoris A, García AM, Traiber L, Santamaría-García H, Martorell M, Alifano F, Kichic R, Moser JS, Cetkovich M, Manes F, Ibáñez A, Sedeño L. The inner world of overactive monitoring: neural markers of interoception in obsessive-compulsive disorder. Psychol Med 2017; 47:1957-1970. [PMID: 28374658 DOI: 10.1017/s0033291717000368] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients' relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition. METHOD We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP). RESULTS Behaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills. CONCLUSIONS Convergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.
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Affiliation(s)
- A Yoris
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - A M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - L Traiber
- Anxiety and Trauma Clinic, INECO (Institute of Cognitive Neurology),Buenos Aires,Argentina
| | - H Santamaría-García
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - M Martorell
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - F Alifano
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - R Kichic
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - J S Moser
- Department of Psychology,Michigan State University,East Lansing, MI,USA
| | - M Cetkovich
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - F Manes
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - A Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
| | - L Sedeño
- Laboratory of Experimental Psychology and Neuroscience (LPEN),Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University,Buenos Aires,Argentina
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Sawchuk CN, Roy-Byrne P, Noonan C, Craner JR, Goldberg J, Manson S, Buchwald D. Panic attacks and panic disorder in the American Indian community. J Anxiety Disord 2017; 48:6-12. [PMID: 27720578 PMCID: PMC5380607 DOI: 10.1016/j.janxdis.2016.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/09/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
Panic disorder is a common mental health condition, but little is known about panic disorder in non-Caucasian populations. The purpose of this study is to describe the epidemiology, clinical features, and comorbidities of panic attacks and panic disorder in two large American Indian (AI) tribes (N=3084). A culturally-adapted version of the Composite International Diagnostic Interview assessed panic attacks, panic disorder, and various psychiatric comorbidities. After adjusting for age, gender, and tribe, linear and logistic regression analyses were conducted to compare AIs with panic disorder to those with panic attacks only on clinical characteristics and panic symptoms. Approximately 8.5% (N=234) of American Indians reported a lifetime history of panic attacks. Among individuals with panic attacks, comorbid posttraumatic stress disorder was higher in females (p=0.03) and comorbid alcohol-related disorders were higher in males (p≤0.001). The prevalence and clinical features of panic attacks and panic disorder in American Indians were similar to epidemiologic studies with majority populations. However, in contrast to earlier research, panic symptoms were similar in both males and females, and different patterns of comorbidity emerged. Future research should examine the availability and accessibility of evidence-based panic treatments for this traditionally underserved population.
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Affiliation(s)
- Craig N Sawchuk
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98104, United States
| | - Carolyn Noonan
- Department of and Epidemiology, University of Washington, Seattle, WA 98104, United States
| | - Julia R Craner
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jack Goldberg
- Department of and Epidemiology, University of Washington, Seattle, WA 98104, United States
| | - Spero Manson
- American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Denver, CO 80045, United States
| | - Dedra Buchwald
- Department of Medicine, Washington State University, Seattle, WA 98101, United States
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Yackle K, Schwarz LA, Kam K, Sorokin JM, Huguenard JR, Feldman JL, Luo L, Krasnow MA. Breathing control center neurons that promote arousal in mice. Science 2017; 355:1411-1415. [PMID: 28360327 DOI: 10.1126/science.aari7984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 02/01/2017] [Indexed: 05/19/2023]
Abstract
Slow, controlled breathing has been used for centuries to promote mental calming, and it is used clinically to suppress excessive arousal such as panic attacks. However, the physiological and neural basis of the relationship between breathing and higher-order brain activity is unknown. We found a neuronal subpopulation in the mouse preBötzinger complex (preBötC), the primary breathing rhythm generator, which regulates the balance between calm and arousal behaviors. Conditional, bilateral genetic ablation of the ~175 Cdh9/Dbx1 double-positive preBötC neurons in adult mice left breathing intact but increased calm behaviors and decreased time in aroused states. These neurons project to, synapse on, and positively regulate noradrenergic neurons in the locus coeruleus, a brain center implicated in attention, arousal, and panic that projects throughout the brain.
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Affiliation(s)
- Kevin Yackle
- Howard Hughes Medical Institute, Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lindsay A Schwarz
- Howard Hughes Medical Institute, Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Kaiwen Kam
- Systems Neurobiology Laboratory, Department of Neurobiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA
- Department of Cell Biology and Anatomy, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Jordan M Sorokin
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - John R Huguenard
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Jack L Feldman
- Systems Neurobiology Laboratory, Department of Neurobiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Liqun Luo
- Howard Hughes Medical Institute, Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Mark A Krasnow
- Howard Hughes Medical Institute, Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Feldker K, Heitmann CY, Neumeister P, Tupak SV, Schrammen E, Moeck R, Zwitserlood P, Bruchmann M, Straube T. Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders. Psychol Med 2017; 47:730-743. [PMID: 27869064 DOI: 10.1017/s0033291716002634] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed. METHOD The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes. RESULTS Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses. CONCLUSIONS The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.
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Affiliation(s)
- K Feldker
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - C Y Heitmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - P Neumeister
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - S V Tupak
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - E Schrammen
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - R Moeck
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | | | - M Bruchmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - T Straube
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
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Feldker K, Heitmann CY, Neumeister P, Bruchmann M, Vibrans L, Zwitserlood P, Straube T. Brain responses to disorder-related visual threat in panic disorder. Hum Brain Mapp 2016; 37:4439-4453. [PMID: 27436308 PMCID: PMC6867252 DOI: 10.1002/hbm.23320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/13/2016] [Accepted: 07/11/2016] [Indexed: 12/17/2022] Open
Abstract
Panic disorder (PD) patients show aberrant neural responses to threatening stimuli in an extended fear network, but results are only partially comparable, and studies implementing disorder-related visual scenes are lacking as stimuli. The neural responses and functional connectivity to a newly developed set of disorder-related, ecologically valid scenes as compared with matched neutral visual scenes, using event-related functional magnetic resonance imaging (fMRI) in 26 PD patients and 26 healthy controls (HC) were investigated. PD patients versus HC showed hyperactivation in an extended fear network comprising brainstem, insula, thalamus, anterior, and mid-cingulate cortex and (dorso-)medial prefrontal cortex for disorder-related versus neutral scenes. Amygdala differences between groups failed significance. Subjective levels of anxiety significantly correlated with brainstem activation in PD patients. Analysis of functional connectivity by means of beta series correlation revealed no emotion-specific alterations in connectivity in PD patients versus HC. The results suggest that subjective anxiety evoked by external stimuli is directly related to altered activation in the homeostatic alarm system in PD. With novel disorder-related stimuli, the study sheds new light on the neural underpinnings of pathological threat processing in PD. Hum Brain Mapp 37:4439-4453, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katharina Feldker
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Carina Yvonne Heitmann
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Maximilian Bruchmann
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Laura Vibrans
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | | | - Thomas Straube
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
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Vroling MS, Glashouwer KA, Lange WG, Allart-van Dam E, de Jong PJ. "What I believe is true": Belief-confirming reasoning bias in social anxiety disorder. J Behav Ther Exp Psychiatry 2016; 53:9-16. [PMID: 27664816 DOI: 10.1016/j.jbtep.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Research shows that people tend to consider believable conclusions as valid and unbelievable conclusions as invalid (belief bias). When applied to anxiogenic beliefs, this belief bias could well hinder the correction of dysfunctional convictions. Previous work has shown that high socially anxious students indeed display such fear-confirming, belief biased, reasoning. A critical next question is whether these findings translate to a clinical population of people with social anxiety disorder (SAD). We test whether (i) patients with SAD show belief bias with regard to SAD-relevant themes, (ii) this belief bias is specific for SAD patients or can also be found in panic disorder (PD) patients, (iii) differential belief bias effects in SAD are restricted to social anxiety concerns or are also evident in the context of reasoning with neutral themes. METHOD 45 SAD patients, 24 PD patients, and 45 non-symptomatic controls (NSCs) completed a syllogistic belief bias task with SAD-relevant and neutral content. RESULTS SAD patients displayed belief bias for social anxiety related materials, while the PD group and the NSC group did not. Yet, the difference between SAD and PD was not significant. All groups showed similar belief bias effects for neutral content. LIMITATIONS Content of the belief bias task was not tailored to idiosyncratic beliefs. The study lacked power to detect medium or small differences. CONCLUSIONS SAD patients showed concern-congruent belief biased interference effects when judging the logical validity of social anxiety relevant syllogisms. Such concern-relevant belief bias may contribute to the persistence of anxiogenic beliefs.
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Affiliation(s)
- Maartje S Vroling
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands; NijCare: Nijmegen Centre for Anxiety Research and Expertise, Postbus 9104, 6500 HE, Nijmegen, The Netherlands; Amarum, Expertise Centre for Eating Disorders (Part of GGNet), Den Elternweg 75, 7207 AE, Zutphen, The Netherlands.
| | - Klaske A Glashouwer
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands; Center for Eating Disorders, Accare, Child and Adolescent Psychiatry, Fazantenlaan 1, 9422 EZ, Smilde, The Netherlands.
| | - Wolf-Gero Lange
- NijCare: Nijmegen Centre for Anxiety Research and Expertise, Postbus 9104, 6500 HE, Nijmegen, The Netherlands; Department of Clinical Psychology, Radboud University of Nijmegen, Postbus 9104, 6500 HE, Nijmegen, The Netherlands.
| | - Esther Allart-van Dam
- NijCare: Nijmegen Centre for Anxiety Research and Expertise, Postbus 9104, 6500 HE, Nijmegen, The Netherlands; Overwaal, Centre for Anxiety Disorders, Tarweweg 2, 6534 AM, Nijmegen, The Netherlands.
| | - Peter J de Jong
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
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Wanders RBK, van Loo HM, Vermunt JK, Meijer RR, Hartman CA, Schoevers RA, Wardenaar KJ, de Jonge P. Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort. Psychol Med 2016; 46:3371-3382. [PMID: 27624913 DOI: 10.1017/s0033291716002221] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures. METHOD A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables. RESULTS The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms ['Somatic' (13.0%), and 'Worried' (14.0%)] and psychopathological symptoms ['Subclinical' (8.8%), and 'Clinical' (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1-12.3, and chronic stress: OR 3.7-4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found. CONCLUSIONS An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.
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Affiliation(s)
- R B K Wanders
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - H M van Loo
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - J K Vermunt
- Department of Methodology and Statistics,Tilburg University,Tilburg,The Netherlands
| | - R R Meijer
- Department of Psychometrics and Statistics,University of Groningen,Groningen,The Netherlands
| | - C A Hartman
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - R A Schoevers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - K J Wardenaar
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
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Buff C, Brinkmann L, Neumeister P, Feldker K, Heitmann C, Gathmann B, Andor T, Straube T. Specifically altered brain responses to threat in generalized anxiety disorder relative to social anxiety disorder and panic disorder. Neuroimage Clin 2016; 12:698-706. [PMID: 27761400 PMCID: PMC5065042 DOI: 10.1016/j.nicl.2016.09.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/14/2016] [Accepted: 09/30/2016] [Indexed: 11/23/2022]
Abstract
Background Despite considerable effort, the neurobiological underpinnings of hyper-responsive threat processing specific to patients suffering from generalized anxiety disorder (GAD) remain poorly understood. The current functional magnetic resonance imaging (fMRI) study aims to delineate GAD-specific brain activity during immediate threat processing by comparing GAD patients to healthy controls (HC), to social anxiety disorder (SAD) and to panic disorder (PD) patients. Method Brain activation and functional connectivity patterns to threat vs. neutral pictures were investigated using event-related fMRI. The sample consisted of 21 GAD, 21 PD, 21 SAD and 21 HC. Results GAD-specific elevated activity to threat vs. neutral pictures was found in cingulate cortex, dorsal anterior insula/frontal operculum (daI/FO) and posterior dorsolateral prefrontal cortex (dlPFC). Defining these effects as seed regions, we detected GAD-specific increased functional connectivity to threat vs. neutral pictures between posterior dlPFC and ventrolateral prefrontal cortex, between cingulate cortex and amygdala, between cingulate cortex and anterior insula, as well as decreased functional connectivity between daI/FO and mid-dlPFC. Conclusion The findings present the first evidence for GAD-specific neural correlates of hyper-responsive threat processing, possibly reflecting exaggerated threat sensitivity, maladaptive appraisal and attention-allocation processes. Threat processing investigation across multiple anxiety disorders First neural evidence of GAD-specific threat-related alterations GAD-specific alterations primarily located in prefrontal cortex Alterations are suggestive of exaggerated threat sensitivity
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Affiliation(s)
- Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
- Corresponding author.
| | - Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Katharina Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Carina Heitmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
| | - Tanja Andor
- Institute of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149 Muenster, Germany
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Yoon S, Kim JE, Kim GH, Kang HJ, Kim BR, Jeon S, Im JJ, Hyun H, Moon S, Lim SM, Lyoo IK. Subregional Shape Alterations in the Amygdala in Patients with Panic Disorder. PLoS One 2016; 11:e0157856. [PMID: 27336300 PMCID: PMC4919046 DOI: 10.1371/journal.pone.0157856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/06/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The amygdala has been known to play a pivotal role in mediating fear-related responses including panic attacks. Given the functionally distinct role of the amygdalar subregions, morphometric measurements of the amygdala may point to the pathophysiological mechanisms underlying panic disorder. The current study aimed to determine the global and local morphometric alterations of the amygdala related to panic disorder. METHODS Volumetric and surface-based morphometric approach to high-resolution three-dimensional T1-weighted images was used to examine the structural variations of the amygdala, with respect to extent and location, in 23 patients with panic disorder and 31 matched healthy individuals. RESULTS There were no significant differences in bilateral amygdalar volumes between patients with panic disorder and healthy individuals despite a trend-level right amygdalar volume reduction related to panic disorder (right, β = -0.23, p = 0.09, Cohen's d = 0.51; left, β = -0.18, p = 0.19, Cohen's d = 0.45). Amygdalar subregions were localized into three groups including the superficial, centromedial, and laterobasal groups based on the cytoarchitectonically defined probability map. Surface-based morphometric analysis revealed shape alterations in the laterobasal and centromedial groups of the right amygdala in patients with panic disorder (false discovery rate corrected p < 0.05). CONCLUSIONS The current findings suggest that subregion-specific shape alterations in the right amygdala may be involved in the development and maintenance of panic disorder, which may be attributed to the cause or effects of amygdalar hyperactivation.
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Affiliation(s)
- Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Geon Ha Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hee Jin Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Bori R. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Saerom Jeon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jooyeon Jamie Im
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Heejung Hyun
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Sohyeon Moon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
- * E-mail:
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Abstract
Functional connectome analysis in panic disorder (PDO) is a relatively new field for research. We tried to investigate the functional connectome alterations in PDO to re-examine the precision and role of fear network model for the pathophysiology of PDO.We enrolled 53 PDO patients and 54 controls with imaging data in this study. After preprocessing, we calculated the connectivity matrix of functional connectivity in whole brain for each subject. Then network-based statistics (The University of Melbourne and Melbourne Health, Australia) of connectome was used to perform group comparisons between patients and controls. The correlation between network measures of significant subnetwork and illness duration or severity of PDO was also performed.Within the 6 network models, only 1 network survived after multiple corrections. We found decreased functional connectivity in the edges between the following nodes: the left parahippocampal gyrus, bilateral precentral gyri, bilateral middle cingulate gyri, bilateral supramarginal gyri, bilateral calcarine fissures, and right lingual gyrus. The central hubs were the left parahippocampal gyrus and left precentral gyrus. The importance of limbic areas and connection with sensory and motor regions might shed light on the revision of fear network model for the pathophysiology of PDO.
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Affiliation(s)
- Chien-Han Lai
- From the Department of Psychiatry (C-HL), Cheng Hsin General Hospital, Taipei City; Department of Biomedical Imaging and Radiological Sciences (C-HL, Y-TW); Institute of Biophotonics (C-HL, Y-TW); and Brain Research Center (Y-TW), National Yang-Ming University, Taipei, Taiwan, ROC
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Han K, Chao AC, Chang FC, Hsu HY, Chung CP, Sheng WY, Chan L, Wu J, Hu HH. Diagnosis of Transverse Sinus Hypoplasia in Magnetic Resonance Venography: New Insights Based on Magnetic Resonance Imaging in Combined Dataset of Venous Outflow Impairment Case-Control Studies: Post Hoc Case-Control Study. Medicine (Baltimore) 2016; 95:e2862. [PMID: 26962781 PMCID: PMC4998862 DOI: 10.1097/md.0000000000002862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measured by magnetic resonance venography (MRV) and contrast T1-weighted magnetic resonance (contrast T1) were observed. To investigate these discrepancies, and considering that TS hypoplasia is associated with neurological disorders, we performed a post hoc analysis of prospectively collected data from 3 case-control studies on transient global amnesia (TGA), transient monocular blindness (TMB), and panic disorders while retaining the original inclusion and exclusion criteria. Magnetic resonance (MR) imaging of 131 subjects was reviewed to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction.MRV without contrast revealed that TS hypoplasia was observed in 69 subjects, whom we classified into 2 subgroups according to the concordance with contrast T1 observations: concordance indicated anatomically small TS (30 subjects), and discrepancy indicated that the MRV diagnosis is in fact flow-related and that TS is not anatomically small (39 subjects). The latter subgroup was associated with at least 1 site of venous compression/stenosis in the internal jugular vein (IJV) or the left brachiocephalic vein (BCV) (P < 0.001), which was significantly larger in patients than controls. Compensatory dilatation of contralateral TS diameter was only observed with MRV, not with contrast T1 imaging.The clinical implication of these results is that using MRV only, IJV/BCV compression/stenosis may be misdiagnosed as TS hypoplasia. And contralateral TS have no compensatory dilatation in its diameter in contrast T1 imaging, just compensatory increased flow volume.
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Affiliation(s)
- Ke Han
- From the Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, Jilin, China (KH, JW), Department of Neurology, College of Medicine, Kaohsiung Medical University and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung (A-CC), Department of Radiology (F-CC), Department of Neurology Veterans General Hospital and National Yang-Ming University (C-PC, W-YS), Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung (H-YH), Department of Neurology, Taipei Medical University-Shaung Ho Hospital (LC), and Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University and Hospital (H-HH), Taipei, Taiwan
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Alciati A, Caldirola D, Sarzi-Puttini P, Atzeni F, Grassi M, Perna G. Is panic disorder associated with clinical severity of fibromyalgia? A preliminary study in a tertiary-care centre. Clin Exp Rheumatol 2016; 34:S99-S105. [PMID: 27157395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate the influence of panic disorder (PD) with/without agoraphobia on the clinical severity of fibromyalgia (FM). METHODS Eighty-one patients with FM, among those consecutively referring to a tertiary-care setting, were included in this cross-sectional study. Psychiatric diagnoses were made by the structured clinical interview in accordance with the 4th-TR version of the diagnostic and statistical manual of mental disorders. The clinical severity of FM was measured by means of the following self-administered scales: Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Status (FAS), Health Assessment Questionnaire (HAQ). RESULTS A final sample of 66 females with FM with or without past PD was included in the analyses. The two groups did not significantly differ in age, years of education, length of illness or medication distribution. We did not find significant differences between the two groups in the FIQ and FAS scale scores, whereas subjects with FM and past PD showed significantly higher HAQ scale scores than those without past PD (p<.001). CONCLUSIONS A history of PD in patients with FM increases the severity of functional impairment in performing a wide range of daily-life activities, as measured by the HAQ scale, with no effects on the severity of other clinical dimensions of FM. Potential underlying mechanisms and clinical implications will be discussed.
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Affiliation(s)
- Alessandra Alciati
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy.
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | | | | | - Massimiliano Grassi
- Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Como, Italy
| | - Giampaolo Perna
- Clinical Neurosciences, Villa S.Benedetto Menni, Hermanas Hospitalarias, Como, Italy; Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Univ. of Maastricht, Netherland; and Psychiatry & Behavioral Sciences, Univ.of Miami, USA
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Reinecke A, Filippini N, Berna C, Western DG, Hanson B, Cooper MJ, Taggart P, Harmer CJ. Effective emotion regulation strategies improve fMRI and ECG markers of psychopathology in panic disorder: implications for psychological treatment action. Transl Psychiatry 2015; 5:e673. [PMID: 26529426 PMCID: PMC5068756 DOI: 10.1038/tp.2015.160] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/26/2015] [Accepted: 09/06/2015] [Indexed: 12/25/2022] Open
Abstract
Impairments in emotion regulation are thought to have a key role in the pathogenesis of anxiety disorders, but the neurobiological underpinnings contributing to vulnerability remain poorly understood. It has been a long-held view that exaggerated fear is linked to hyperresponsivity of limbic brain areas and impaired recruitment of prefrontal control. However, increasing evidence suggests that prefrontal-cortical networks are hyperactive during threat processing in anxiety disorders. This study directly explored limbic-prefrontal neural response, connectivity and heart-rate variability (HRV) in patients with a severe anxiety disorder during incidental versus intentional emotion regulation. During 3 Tesla functional magnetic resonance imaging, 18 participants with panic disorder and 18 healthy controls performed an emotion regulation task. They either viewed negative images naturally (Maintain), or they were instructed to intentionally downregulate negative affect using previously taught strategies of cognitive reappraisal (Reappraisal). Electrocardiograms were recorded throughout to provide a functional measure of regulation and emotional processing. Compared with controls, patients showed increased neural activation in limbic-prefrontal areas and reduced HRV during incidental emotion regulation (Maintain). During intentional regulation (Reappraisal), group differences were significantly attenuated. These findings emphasize patients' ability to regulate negative affect if provided with adaptive strategies. They also bring prefrontal hyperactivation forward as a potential mechanism of psychopathology in anxiety disorders. Although these results challenge models proposing impaired allocation of prefrontal resources as a key characteristic of anxiety disorders, they are in line with more recent neurobiological frameworks suggesting that prefrontal hyperactivation might reflect increased utilisation of maladaptive regulation strategies quintessential for anxiety disorders.
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Affiliation(s)
- A Reinecke
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - N Filippini
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, UK
| | - C Berna
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, UK
- Service d'anesthésiologie Centre Hospitalier, Universitaire Vaudois, Lausanne, Switzerland
| | - D G Western
- Department of Mechanical Engineering, University College London, London, UK
- Department of Mechanical Engineering, University of Bristol, Bristol, UK
| | - B Hanson
- Department of Mechanical Engineering, University College London, London, UK
| | - M J Cooper
- Isis Education Centre, University of Oxford, Oxford, UK
| | - P Taggart
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - C J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Masdrakis VG, Markianos M, Oulis P. Lack of specific association between panicogenic properties of caffeine and HPA-axis activation. A placebo-controlled study of caffeine challenge in patients with panic disorder. Psychiatry Res 2015; 229:75-81. [PMID: 26243374 DOI: 10.1016/j.psychres.2015.07.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 06/20/2015] [Accepted: 07/26/2015] [Indexed: 12/30/2022]
Abstract
A subgroup of patients with Panic Disorder (PD) exhibits increased sensitivity to caffeine administration. However, the association between caffeine-induced panic attacks and post-caffeine hypothalamic-pituitary-adrenal (HPA)-axis activation in PD patients remains unclear. In a randomized, double-blind, cross-over experiment, 19 PD patients underwent a 400-mg caffeine-challenge and a placebo-challenge, both administered in the form of instant coffee. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulfate (DHEAS) were assessed at both baseline and post-challenge. No patient panicked after placebo-challenge, while nine patients (47.3%) panicked after caffeine-challenge. Placebo administration did not result in any significant change in hormones' plasma levels. Overall, sample's patients demonstrated significant increases in ACTH, cortisol, and DHEAS plasma levels after caffeine administration. However, post-caffeine panickers and non-panickers did not differ with respect to the magnitude of the increases. Our results indicate that in PD patients, caffeine-induced panic attacks are not specifically associated with HPA-axis activation, as this is reflected in post-caffeine increases in ACTH, cortisol and DHEAS plasma levels, suggesting that caffeine-induced panic attacks in PD patients are not specifically mediated by the biological processes underlying fear or stress. More generally, our results add to the evidence that HPA-axis activation is not a specific characteristic of panic.
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Affiliation(s)
- Vasilios G Masdrakis
- 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, Athens 11528, Greece.
| | - Manolis Markianos
- 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, Athens 11528, Greece
| | - Panagiotis Oulis
- 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, Athens 11528, Greece
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Jakuszkowiak-Wojten K, Landowski J, Wiglusz MS, Cubała WJ. Cortisol as an indicator of hypothalmic-pitituary-adrenal axis dysregulation in patients with panic disorder: a literature review. Psychiatr Danub 2015; 27 Suppl 1:S445-S451. [PMID: 26417813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dysregulation of hypothalamic-pituitary-adrenal axis (HPA) is seen in numerous mental disorders. Data of HPA axis disturbance in panic disorder are inconsistent. In panic disorder HPA axis hyperactivity has been observed with elevated cortisol levels. However, hypocortisolism has also been noted. Salivary cortisol as a biomarker of HPA-axis activity has received special attention. The aim of this paper is to review the findings on cortisol levels in panic disorder.
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Thomas SJ, Gonsalvez CJ, Johnstone SJ. Electrophysiology of facilitation priming in obsessive-compulsive and panic disorders. Clin Neurophysiol 2015; 127:464-478. [PMID: 26111486 DOI: 10.1016/j.clinph.2015.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 04/01/2015] [Accepted: 05/26/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Repeated experience with stimuli often primes faster, more efficient neuronal and behavioural responses. Exaggerated repetition priming effects have previously been reported in obsessive-compulsive disorder (OCD), however little is known of their underlying neurobiology or disorder-specificity, hence we investigated these factors. METHODS We examined event-related potentials (ERPs) and behaviour while participants with OCD, panic disorder and healthy controls (20 per group) performed a Go/NoGo task which manipulated target repetition sequences. RESULTS Both clinical groups showed stronger reaction time (RT) priming than HCs, which in OCD was greater in a checking, than washing, subgroup. Both clinical groups had similar RT deficits and ERP anomalies across several components, which correlated with psychopathology and RT priming. In OCD alone, N1 latency tended to increase to repeated stimuli, correlated with O-C symptoms, whereas it decreased in other groups. OCD-checkers had smaller target P2 amplitude than all other groups. CONCLUSIONS Enhanced neural priming is not unique to OCD and may contribute to salient sensory-cognitive experiences in anxiety generally. These effects are related to symptom severity and occur to neutral stimuli and in the context of overall RT impairment, suggesting they may be clinically relevant and pervasive. The results indicate overlapping information-processing and neurobiological factors across disorders, with indications of OCD-specific trends and subgroup differences. SIGNIFICANCE This first electrophysiological investigation of OCD priming in OCD to include anxious controls and OCD subgroups allows for differentiation between overlapping and OCD-specific phenomena, to advance neurobiological models of OCD.
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Affiliation(s)
- Susan J Thomas
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Graduate School of Medicine, University of Wollongong, NSW, Australia.
| | - Craig J Gonsalvez
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Centre for Psychophysics, Psychophysiology & Psychopharmacology, University of Wollongong, NSW, Australia; University of Western Sydney, NSW, Australia
| | - Stuart J Johnstone
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Centre for Psychophysics, Psychophysiology & Psychopharmacology, University of Wollongong, NSW, Australia
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44
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Faludi G, Gonda X, Döme P. [An update on the conceptual and classification issues of anxiety, its neuroanatomy and problems of anxiolytic drug discovery]. Neuropsychopharmacol Hung 2015; 17:69-80. [PMID: 26192900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Anxiety disorders are highly prevalent psychiatric diseases. In this short review we provide an overview of concepts of fear, anxiety and anxiety disorders. In addition, based on the recent literature, neuroanatomical structures involved in anxiety and functional/structural changes of these structures in anxiety disorders are also discussed. Furthemore, the pitfalls of anxiolytic drug discovery is also concerned in the paper.
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Affiliation(s)
- Gábor Faludi
- a Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
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45
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Grambal A, Tüdös Z, Hok P, Kamarádová D, Divéky T, Hluštík P, Praško J. Predictors of poor treatment response to additional CBT in real panic disorder patients: The role of DLPF, orbitofrontal cortex, parietal lobule, frontal eye field and amygdala in PD. Neuro Endocrinol Lett 2015; 36:269-281. [PMID: 26313395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Previous functional brain imaging studies have described various and contradictory activation findings in patients with panic disorder (PD). Our study focused on patients with a chronic PD, who were investigated and treated in a conventional manner, which represents the real PD patients in clinical practice. METHODS Continuing their medication, patients were included in a six-week cognitive-behavioral therapy (CBT) program in the psychiatry department. At the onset of the study, participants underwent clinical evaluation using standard scales and were examined using fMRI while listening to verbal threat-related stimuli contrasted to neutral words. According to the therapeutic outcome, they were subsequently divided into two groups, responders, and nonresponders and the two groups were mutually compared. RESULTS In non-responders compared to responders, we found increased pre-treatment activation in dorsolateral prefrontal cortex bilaterally, left orbitofrontal cortex, left frontal eye field, right parietal lobule and left amygdala. In addition, both groups showed negative fMRI BOLD correlation with BAI improvement and positive correlation with CGI improvement across the ROIs. We suggest that DLPFC over-activation may reveal a lack of cognitive control over emotional processing, which makes subsequent CBT less effective. CONCLUSION Despite several limitations, we found neuroimaging predictors of poor CBT response, under the conditions of standard clinical practice, in real PD patients.
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Affiliation(s)
- Aleš Grambal
- Department of Psychiatry, University Hospital Olomouc, Czech Republic
| | - Zbyněk Tüdös
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Pavel Hok
- Department of Neurology, University Hospital Olomouc, Czech Republic
| | - Dana Kamarádová
- Department of Psychiatry, University Hospital Olomouc, Czech Republic
| | - Tomáš Divéky
- Department of Psychiatry, University Hospital Olomouc, Czech Republic
| | - Petr Hluštík
- Department of Neurology, University Hospital Olomouc, Czech Republic
| | - Ján Praško
- Department of Psychiatry, University Hospital Olomouc, Czech Republic
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Grambal A, Hluštík P, Praško J. What fMRI can tell as about panic disorder: bridging the gap between neurobiology and psychotherapy. Neuro Endocrinol Lett 2015; 36:214-225. [PMID: 26313386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
Fifty years ago, when the effect of antidepressants on panic disorder was described, a significant progress in understanding this anxiety disorder has been made. Theoretical mechanisms and models of fear and panic disorder were proposed and tested in animal models and humans. With growing possibilities of non-invasive neuroimaging techniques, there is an increasing amount of information on the panic disorder. Unfortunately, a number of circumstances lead to inconsistent findings and its interpretations. In our review, we focused on functional MRI in panic disorder, limitations of current studies, possible interpretations and proposals for future direction. In our opinion, the current findings support the neuroanatomical model of panic disorder at the level of group data analysis. But at the same time, the results suggest significant inter-individual differences across the patients, which may be related to each patient's individual history, woven into their neural network and affecting the individual symptoms and response to therapy.
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Affiliation(s)
- Aleš Grambal
- Department of Psychiatry, University Hospital Olomouc, Czech Republic
| | - Petr Hluštík
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Ján Praško
- Department of Psychiatry, University Hospital Olomouc, Czech Republic
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Sugarman MA, Loree AM, Baltes BB, Grekin ER, Kirsch I. The efficacy of paroxetine and placebo in treating anxiety and depression: a meta-analysis of change on the Hamilton Rating Scales. PLoS One 2014; 9:e106337. [PMID: 25162656 PMCID: PMC4146610 DOI: 10.1371/journal.pone.0106337] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous meta-analyses of published and unpublished trials indicate that antidepressants provide modest benefits compared to placebo in the treatment of depression; some have argued that these benefits are not clinically significant. However, these meta-analyses were based only on trials submitted for the initial FDA approval of the medication and were limited to those aimed at treating depression. Here, for the first time, we assess the efficacy of a selective serotonin reuptake inhibitor (SSRI) in the treatment of both anxiety and depression, using a complete data set of all published and unpublished trials sponsored by the manufacturer. METHODS AND FINDINGS GlaxoSmithKline has been required to post the results for all sponsored clinical trials online, providing an opportunity to assess the efficacy of an SSRI (paroxetine) with a complete data set of all trials conducted. We examined the data from all placebo-controlled, double-blind trials of paroxetine that included change scores on the Hamilton Rating Scale for Anxiety (HRSA) and/or the Hamilton Rating Scale for Depression (HRSD). For the treatment of anxiety (k = 12), the efficacy difference between paroxetine and placebo was modest (d = 0.27), and independent of baseline severity of anxiety. Overall change in placebo-treated individuals replicated 79% of the magnitude of paroxetine response. Efficacy was superior for the treatment of panic disorder (d = 0.36) than for generalized anxiety disorder (d = 0.20). Published trials showed significantly larger drug-placebo differences than unpublished trials (d's = 0.32 and 0.17, respectively). In depression trials (k = 27), the benefit of paroxetine over placebo was consistent with previous meta-analyses of antidepressant efficacy (d = 0.32). CONCLUSIONS The available empirical evidence indicates that paroxetine provides only a modest advantage over placebo in treatment of anxiety and depression. Treatment implications are discussed.
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Affiliation(s)
- Michael A. Sugarman
- Wayne State University, Department of Psychology, Detroit, Michigan, United States of America
| | - Amy M. Loree
- Wayne State University, Department of Psychology, Detroit, Michigan, United States of America
| | - Boris B. Baltes
- Wayne State University, Department of Psychology, Detroit, Michigan, United States of America
| | - Emily R. Grekin
- Wayne State University, Department of Psychology, Detroit, Michigan, United States of America
| | - Irving Kirsch
- Harvard Medical School, Boston, Massachusetts, United States of America
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48
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Fadda E, Galimberti E, Cammino S, Bellodi L. Smoking, physical activity and respiratory irregularities in patients with panic disorder. Riv Psichiatr 2014; 48:293-300. [PMID: 24056828 DOI: 10.1708/1319.14625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In the past decades different evidences suggested a relationship between panic disorder (PD) and respiration, among which the presence of different respiratory irregularities at rest in PD patients. It has been hypothesized that PD could be characterized by a dysfunction of those areas involved in the central control of respiration. The aim of the present study was to elucidate possible differences in breath-by-breath respiratory function at rest between a sample of PD patients with agoraphobia and healthy controls (HC), with particular attention to smoking and physical activity as possible relevant factors in the understanding of respiratory dynamics in PD. METHODS Respiratory physiology was assessed in 32 PD patients and 24 HC. Respiratory rate (RR), tidal volume (VT), minute ventilation (VE), and end-tidal CO2 (pCO2) have been assessed. RESULTS A significant diagnosis-by-smoking interaction was found for mean RR and VT. Mean pCO2 was significantly higher in active than in sedentary patients. Anxiety state did not account for the results. CONCLUSIONS Our findings suggest an abnormal regulation of the respiratory system as a key mechanism in PD. In future studies it should be useful t o stratify data taking into account level and intensity of physical activity and smoking behaviour, as well as to consider the cardiac profile and the effect of those variables able to modulate the homeostatic brain functioning. .
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Bevins RA, Besheer J. Interoception and learning: import to understanding and treating diseases and psychopathologies. ACS Chem Neurosci 2014; 5:624-31. [PMID: 25010473 PMCID: PMC4140586 DOI: 10.1021/cn5001028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/09/2014] [Indexed: 12/23/2022] Open
Abstract
Chemotherapeutic agents nauseate cancer patients. Some individuals with schizophrenia hear voices. Chronic pain can be reduced by analgesics. Nausea, voices, and pain are examples of internal (interoceptive) stimuli closely linked with a disease and/or its treatment. There is evidence that the perception and, hence, role of these internal stimuli can be modified by one's learning history. There is also increased awareness by researchers and practitioners of the potential import of learning involving internal states to some diseases and psychopathologies. Unfortunately, the science, theory, and practice appear to be trailing behind awareness. In this mini-review, we describe two examples: smoking and panic disorder. While doing so, we discuss the need to develop translationally relevant animal models that will allow investigators to better understand the behavioral and neural mechanisms underlying interoception and learning.
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Affiliation(s)
- Rick A Bevins
- Behavioral Neuropharmacology Lab, Department of Psychology, University of Nebraska-Lincoln , Lincoln, Nebraska 68588-0308, United States
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50
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Reinecke A, Thilo K, Filippini N, Croft A, Harmer CJ. Predicting rapid response to cognitive-behavioural treatment for panic disorder: the role of hippocampus, insula, and dorsolateral prefrontal cortex. Behav Res Ther 2014; 62:120-8. [PMID: 25156399 DOI: 10.1016/j.brat.2014.07.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 07/26/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
Abstract
Although cognitive-behavioural therapy (CBT) is an effective first-line intervention for anxiety disorders, treatments remain long and cost-intensive, difficult to access, and a subgroup of patients fails to show any benefits at all. This study aimed to identify functional and structural brain markers that predict a rapid response to CBT. Such knowledge will be important to establish the mechanisms underlying successful treatment and to develop more effective, shorter interventions. Fourteen unmedicated patients with panic disorder underwent 3 T functional and structural magnetic resonance imaging (MRI) before receiving four sessions of exposure-based CBT. Symptom severity was measured before and after treatment. During functional MRI, patients performed an emotion regulation task, either viewing negative images naturally, or intentionally down-regulating negative affect by using previously taught strategies of cognitive reappraisal. Structural MRI images were analysed including left and right segmentation and volume estimation. Improved response to brief CBT was predicted by increased pre-treatment activation in bilateral insula and left dorsolateral prefrontal cortex (dlPFC) during threat processing, as well as increased right hippocampal gray matter volume. Previous work links these regions to improved threat processing and fear memory activation, suggesting that the activation of such mechanisms is crucial for exposure-based CBT to be effective.
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Affiliation(s)
| | - Kai Thilo
- Oxford Psychologists Ltd., Oxford, UK
| | - Nicola Filippini
- Department of Psychiatry, University of Oxford, UK; Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, UK
| | - Alison Croft
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, UK
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