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Li M, Racey C, Rae CL, Strawson W, Critchley HD, Ward J. Can the neural representation of physical pain predict empathy for pain in others? Soc Cogn Affect Neurosci 2024; 19:nsae023. [PMID: 38481007 PMCID: PMC11008503 DOI: 10.1093/scan/nsae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/25/2023] [Revised: 01/16/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
The question of whether physical pain and vicarious pain have some shared neural substrates is unresolved. Recent research has argued that physical and vicarious pain are represented by dissociable multivariate brain patterns by creating biomarkers for physical pain (Neurologic Pain Signature, NPS) and vicarious pain (Vicarious Pain Signature, VPS), respectively. In the current research, the NPS and two versions of the VPS were applied to three fMRI datasets (one new, two published) relating to vicarious pain which focused on between-subject differences in vicarious pain (Datasets 1 and 3) and within-subject manipulations of perspective taking (Dataset 2). Results show that (i) NPS can distinguish brain responses to images of pain vs no-pain and to a greater extent in vicarious pain responders who report experiencing pain when observing pain and (ii) neither version of the VPS mapped on to individual differences in vicarious pain and the two versions differed in their success in predicting vicarious pain overall. This study suggests that the NPS (created to detect physical pain) is, under some circumstances, sensitive to vicarious pain and there is significant variability in VPS measures (created to detect vicarious pain) to act as generalizable biomarkers of vicarious pain.
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Affiliation(s)
- M Li
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - C Racey
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - C L Rae
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - W Strawson
- Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - H D Critchley
- Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - J Ward
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
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Critchley HD, Yarovova E, Howell S, Rosen SD. Appreciating the links between heart failure and depression. QJM 2024; 117:3-8. [PMID: 37769246 DOI: 10.1093/qjmed/hcad213] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
Depression and heart failure frequently occur together, symptoms overlap and the prognosis is worsened. Both conditions share biopsychosocial risk factors and are accompanied by behavioural/lifestyle, neurohormonal, inflammatory and autonomic changes that are implicated aetiologically. Depression has been conceptualized as a decompensated response to allostatic overload, wherein adaptive psychological, behavioural and physiological responses to chronic and/or severe stress, become unsustainable. Heart failure can similarly be viewed as a decompensated response to circulatory overload, wherein adaptive functional (neurohormonal effects on circulation, inotropic effects on heart) and structural (myocardial remodelling) changes, become unsustainable. It has been argued that the disengaged state of depression can initially be protective, limiting an individual's exposure to external challenges, such that full recovery is often possible. In contrast, heart failure, once past a tipping-point, can progress relentlessly. Here, we consider the bidirectional interactions between depression and heart failure. Targeted treatment of depression in the context of heart failure may improve quality of life, yet overall benefits on mortality remain elusive. However, effective treatment of heart failure typically enhances function and improves key psychological and behavioural determinants of low mood. Prospectively, research that examines the mechanistic associations between depression and heart failure offers fresh opportunity to optimize personalized management in the advent of newer interventions for both conditions.
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Affiliation(s)
- H D Critchley
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - E Yarovova
- Faculty of Medicine, Imperial College, London, UK
| | - S Howell
- Cardiovascular Imaging, King's College, London, UK
| | - S D Rosen
- National Heart and Lung Institute, Imperial College, London, UK
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Elkommos S, Martin-Lopez D, Koreki A, Jolliffe C, Kandasamy R, Mula M, Critchley HD, Edwards MJ, Garfinkel S, Richardson MP, Yogarajah M. Changes in the heartbeat-evoked potential are associated with functional seizures. J Neurol Neurosurg Psychiatry 2023; 94:769-775. [PMID: 37230745 DOI: 10.1136/jnnp-2022-330167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/17/2022] [Accepted: 04/05/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Patients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation reflects disembodiment, which may be related to changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalogram (EEG) marker of interoceptive processing. AIM To assess whether alterations in interoceptive processing indexed by HEP occur prior to FS and compare this with epileptic seizures (ES). METHODS HEP amplitudes were calculated from EEG during video-EEG monitoring in 25 patients with FS and 19 patients with ES, and were compared between interictal and preictal states. HEP amplitude difference was calculated as preictal HEP amplitude minus interictal HEP amplitude. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of HEP amplitude difference in discriminating FS from ES. RESULTS The FS group demonstrated a significant reduction in HEP amplitude between interictal and preictal states at F8 (effect size rB=0.612, false discovery rate (FDR)-corrected q=0.030) and C4 (rB=0.600, FDR-corrected q=0.035). No differences in HEP amplitude were found between states in the ES group. Between diagnostic groups, HEP amplitude difference differed between the FS and ES groups at F8 (rB=0.423, FDR-corrected q=0.085) and C4 (rB=0.457, FDR-corrected q=0.085). Using HEP amplitude difference at frontal and central electrodes plus sex, we found that the ROC curve demonstrated an area under the curve of 0.893, with sensitivity=0.840 and specificity=0.842. CONCLUSION Our data support the notion that aberrant interoception occurs prior to FS. Changes in HEP amplitude may reflect a neurophysiological biomarker of FS and may have diagnostic utility in differentiating FS and ES.
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Affiliation(s)
- Samia Elkommos
- School of Neuroscience, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Epilepsy Group, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, UK
| | - David Martin-Lopez
- Clinical Neurophysiology, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, UK
| | - Akihiro Koreki
- Psychiatry, National Hospital Organisation Shimofusa Psychiatric Medical Center, Chiba, Japan
- Neuroscience Research Centre, St George's University of London, London, UK
| | - Claire Jolliffe
- Clinical Neurophysiology, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, UK
| | - Rohan Kandasamy
- Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Experimental Epilepsy, University College London, London, UK
| | - Marco Mula
- Epilepsy Group, St George's Hospital Atkinson Morley Regional Neuroscience Centre, London, UK
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Hugo D Critchley
- Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Research and Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Mark J Edwards
- Centre for Clinical Neuroscience, St George's University of London, London, UK
- Atkinson Morley Regional Neuroscience Centre, St George's Hospital, London, UK
| | - Sarah Garfinkel
- Institute of Cognitive Neuroscience, University College London Institute of Cognitive Neuroscience, London, UK
| | - Mark P Richardson
- School of Neuroscience, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Centre for Epilepsy, King's College Hospital NHS Foundation Trust, London, UK
| | - Mahinda Yogarajah
- Department of Clinical and Experimental Epilepsy, University College London, London, UK
- Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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Rae CL, Raykov P, Ambridge EM, Colling LJ, Gould van Praag CD, Bouyagoub S, Polanski L, Larsson DEO, Critchley HD. Elevated representational similarity of voluntary action and inhibition in Tourette syndrome. Brain Commun 2023; 5:fcad224. [PMID: 37705680 PMCID: PMC10497185 DOI: 10.1093/braincomms/fcad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/07/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Many people with Tourette syndrome are able to volitionally suppress tics, under certain circumstances. To understand better the neural mechanisms that underlie this ability, we used functional magnetic resonance neuroimaging to track regional brain activity during performance of an intentional inhibition task. On some trials, Tourette syndrome and comparison participants internally chose to make or withhold a motor action (a button press), while on other trials, they followed 'Go' and 'NoGo' instructions to make or withhold the same action. Using representational similarity analysis, a functional magnetic resonance neuroimaging multivariate pattern analysis technique, we assessed how Tourette syndrome and comparison participants differed in neural activity when choosing to make or to withhold an action, relative to externally cued responses on Go and NoGo trials. Analyses were pre-registered, and the data and code are publicly available. We considered similarity of action representations within regions implicated as critical to motor action release or inhibition and to symptom expression in Tourette syndrome, namely the pre-supplementary motor area, inferior frontal gyrus, insula, caudate nucleus and primary motor cortex. Strikingly, in the Tourette syndrome compared to the comparison group, neural activity within the pre-supplementary motor area displayed greater representational similarity across all action types. Within the pre-supplementary motor area, there was lower response-specific differentiation of activity relating to action and inhibition plans and to internally chosen and externally cued actions, implicating the region as a functional nexus in the symptomatology of Tourette syndrome. Correspondingly, patients with Tourette syndrome may experience volitional tic suppression as an effortful and tiring process because, at the top of the putative motor decision hierarchy, activity within the population of neurons facilitating action is overly similar to activity within the population of neurons promoting inhibition. However, not all pre-supplementary motor area group differences survived correction for multiple comparisons. Group differences in representational similarity were also present in the primary motor cortex. Here, representations of internally chosen and externally cued inhibition were more differentiated in the Tourette syndrome group than in the comparison group, potentially a consequence of a weaker voluntary capacity earlier in the motor hierarchy to suppress actions proactively. Tic severity and premonitory sensations correlated with primary motor cortex and caudate nucleus representational similarity, but these effects did not survive correction for multiple comparisons. In summary, more rigid pre-supplementary motor area neural coding across action categories may constitute a central feature of Tourette syndrome, which can account for patients' experience of 'unvoluntary' tics and effortful tic suppression.
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Affiliation(s)
- Charlotte L Rae
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - Petar Raykov
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | | | | | | | - Samira Bouyagoub
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton BN1 9RY, UK
| | - Liliana Polanski
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin 14195, Germany
| | - Dennis E O Larsson
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton BN1 9RY, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton BN1 9RY, UK
- Sussex Partnership NHS Foundation Trust, Worthing BN3 7HZ, UK
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Critchley HD, Sherrill SP, Ewing DL, van Praag CG, Habash-Bailey H, Quadt L, Eccles JA, Meeten F, Jones AM, Garfinkel SN. Cardiac interoception in patients accessing secondary mental health services: A transdiagnostic study. Auton Neurosci 2023; 245:103072. [PMID: 36709619 DOI: 10.1016/j.autneu.2023.103072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/05/2022] [Revised: 12/19/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Abnormalities in the regulation of physiological arousal and interoceptive processing are implicated in the expression and maintenance of specific psychiatric conditions and symptoms. We undertook a cross-sectional characterisation of patients accessing secondary mental health services, recording measures relating to cardiac physiology and interoception, to understand how physiological state and interoceptive ability relate transdiagnostically to affective symptoms. METHODS Participants were patients (n = 258) and a non-clinical comparison group (n = 67). Clinical diagnoses spanned affective disorders, complex personality presentations and psychoses. We first tested for differences between patient and non-clinical participants in terms of cardiac physiology and interoceptive ability, considering interoceptive tasks and a self-report measure. We then tested for correlations between cardiac and interoceptive measures and affective symptoms. Lastly, we explored group differences across recorded clinical diagnoses. RESULTS Patients exhibited lower performance accuracy and confidence in heartbeat discrimination and lower heartbeat tracking confidence relative to comparisons. In patients, greater anxiety and depression predicted greater self-reported interoceptive sensibility and a greater mismatch between performance accuracy and sensibility. This effect was not observed in comparison participants. Significant differences between patient groups were observed for heart rate variability (HRV) although post hoc differences were not significant after correction for multiple comparisons. Finally, accuracy in heartbeat tracking was significantly lower in schizophrenia compared to other diagnostic groups. CONCLUSIONS The multilevel characterisation presented here identified certain physiological and interoceptive differences associated with psychiatric symptoms and diagnoses. The clinical stratification and therapeutic targeting of interoceptive mechanisms is therefore of potential value in treating certain psychiatric conditions.
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Affiliation(s)
- Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland.
| | - Samantha P Sherrill
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Donna L Ewing
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Humanities and Social Science, University of Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Cassandra Gould van Praag
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Department of Psychiatry, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Haniah Habash-Bailey
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Sussex Neuroscience, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Fran Meeten
- Department of Neuroscience, Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, United Kingdom of Great Britain and Northern Ireland
| | - Anna-Marie Jones
- Sussex Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sarah N Garfinkel
- Institute of Cognitive Neuroscience, University College London, United Kingdom of Great Britain and Northern Ireland
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Eccles JA, Quadt L, McCarthy H, Davies KA, Bond R, David AS, Harrison NA, Critchley HD. Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case-control study. BMJ Open 2022; 12:e066130. [PMID: 36450437 PMCID: PMC9723902 DOI: 10.1136/bmjopen-2022-066130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To test whether variant connective tissue structure, as indicated by the presence of joint hypermobility, poses a developmental risk for mood disorders in adolescence. DESIGN Cohort-based case-control study. SETTING Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were interrogated. PARTICIPANTS 6105 children of the ALSPAC cohort at age 14 years old, of whom 3803 also were assessed when aged 18 years. MAIN OUTCOME MEASURES In a risk analysis, we examined the relationship between generalised joint hypermobility (GJH) at age 14 years with psychiatric symptoms at age 18 years. In an association analysis, we examined the relationship between presence of symptomatic joint hypermobility syndrome (JHS) and International Classification of Diseases-10 indication of depression and anxiety (Clinical Interview Schedule Revised (CIS-R), Anxiety Sensitivity Index) at age 18 years. RESULTS GJH was more common in females (n=856, 28%) compared with males (n=319, 11%; OR: 3.20 (95% CI: 2.78 to 3.68); p<0.001). In males, GJH at age 14 years was associated with depression at 18 years (OR: 2.10 (95% CI: 1.17 to 3.76); p=0.013). An index of basal physiological arousal, elevated resting heart rate, mediated this effect. Across genders, the diagnosis of JHS at age 18 years was associated with the presence of depressive disorder (adjusted OR: 3.53 (95% CI: 1.67 to 7.40); p=0.001), anxiety disorder (adjusted OR: 3.14 (95% CI: 1.52 to 6.46); p=0.002), level of anxiety (B=8.08, t(3278)=3.95; p<0.001) and degree of psychiatric symptomatology (B=5.89, t(3442)=5.50; p<0.001). CONCLUSIONS Variant collagen, indexed by joint hypermobility, is linked to the emergence of depression and anxiety in adolescence, an effect mediated by autonomic factors in males. Recognition of this association may motivate further evaluation, screening and interventions to mitigate development of psychiatric disorders and improve health outcomes.
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Affiliation(s)
- Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Hannah McCarthy
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Kevin A Davies
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Rod Bond
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Neil A Harrison
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Brain Research Imaging Centre, Cardiff University, Cardiff, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
- Sussex Partnership NHS Foundation Trust, Worthing, UK
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Witchel HJ, Jones CI, Thompson GA, Westling CEI, Romero J, Nicotra A, Maag B, Critchley HD. Spelling Errors in Brief Computer-Mediated Texts Implicitly Lead to Linearly Additive Penalties in Trustworthiness. Front Psychol 2022; 13:873844. [PMID: 35602734 PMCID: PMC9121982 DOI: 10.3389/fpsyg.2022.873844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Background Spelling errors in documents lead to reduced trustworthiness, but the mechanism for weighing the psychological assessment (i.e., integrative versus dichotomous) has not been elucidated. We instructed participants to rate content of texts, revealing that their implicit trustworthiness judgments show marginal differences specifically caused by spelling errors. Methods An online experiment with 100 English-speaking participants were asked to rate 27 short text excerpts (∼100 words) about multiple sclerosis in the format of unmoderated health forum posts. In a counterbalanced design, some excerpts had no typographic errors, some had two errors, and some had five errors. Each participant rated nine paragraphs with a counterbalanced mixture of zero, two or five errors. A linear mixed effects model (LME) was assessed with error number as a fixed effect and participants as a random effect. Results Using an unnumbered scale with anchors of "completely untrustworthy" (left) and "completely trustworthy" (right) recorded as 0 to 100, two spelling errors resulted in a penalty to trustworthiness of 5.91 ± 1.70 (robust standard error) compared to the reference excerpts with zero errors, while the penalty for five errors was 13.5 ± 2.47; all three conditions were significantly different from each other (P < 0.001). Conclusion Participants who rated information about multiple sclerosis in a context mimicking an online health forum implicitly assigned typographic errors nearly linearly additive trustworthiness penalties. This contravenes any dichotomous heuristic or local ceiling effect on trustworthiness penalties for these numbers of typographic errors. It supports an integrative model for psychological judgments of trustworthiness.
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Affiliation(s)
- Harry J. Witchel
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Christopher I. Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Georgina A. Thompson
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Carina E. I. Westling
- Faculty of Media and Communication, Bournemouth University, Bournemouth, United Kingdom
| | | | | | - Bruno Maag
- Dalton Maag Ltd., London, United Kingdom
| | - Hugo D. Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
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Boukarras S, Garfinkel SN, Critchley HD. Cardiac deceleration following positive and negative feedback is influenced by competence-based social status. Soc Neurosci 2022; 17:170-180. [PMID: 35260046 DOI: 10.1080/17470919.2022.2050295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous studies indicate that neurophysiological signatures of feedback processing might be enhanced when participants are assigned a low-status position. Error commission and negative feedback can evoke responses in the peripheral (autonomic) nervous system including heart rate deceleration. We conducted an exploratory study to investigate whether such activity can be modulated by the participant's social status in a competence-based hierarchy. Participants were engaged in a cooperative time estimation task with two same-gender confederates. On each trial, they were provided with positive or negative feedback depending on their time estimation performance. Their social status varied during the task, so that they were either at the top (high-status) or at the bottom (low-status) of the hierarchy in different blocks. Results showed that cardiac deceleration was significantly modulated by feedback valence in the high-status but not in the low-status condition. We interpret this result as an increased activation of the performance monitoring system elicited by the desire to maintain a high-status position in an unstable hierarchy. In this vein, negative feedback might be processed as an aversive stimulus that signals a threat to the acquired status.
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Affiliation(s)
- Sarah Boukarras
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Santa Lucia Foundation, Rome, Italy
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, UK.,Institute of Cognitive Neuroscience, UCL, London, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, UK.,Sackler Centre for Consciousness Science, University of Sussex, UK.,Sussex Partnership NHS Foundation Trust, London, UK
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Sherman MT, Wang HT, Garfinkel SN, Critchley HD. The Cardiac Timing Toolbox (CaTT): Testing for physiologically plausible effects of cardiac timing on behaviour. Biol Psychol 2022; 170:108291. [PMID: 35202742 DOI: 10.1016/j.biopsycho.2022.108291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 02/19/2022] [Accepted: 02/19/2022] [Indexed: 12/13/2022]
Abstract
There is a long history of, and renewed interest in, cardiac timing effects on behaviour and cognition. Cardiac timing effects may be identified by expressing events as a function of their location in the cardiac cycle, and applying circular (i.e. directional) statistics to test cardiac time-behaviour associations. Typically this approach 'stretches' all points in the cardiac cycle equally, but this is not necessarily physiologically valid. Moreover, many tests impose distributional assumptions that are not met by such data. We present a set of statistical techniques robust to this, instantiated within our new Cardiac Timing Toolbox (CaTT) for MATLAB: A physiologically-motivated method of wrapping behaviour to the cardiac cycle; and a set of non-parametric statistical tests that control for common confounds and distributional characteristics of these data. Using a reanalysis of previously published data, we guide readers through analyses using CaTT, aiding researchers in identifying physiologically plausible associations between heart-timing and cognition.
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Affiliation(s)
- Maxine T Sherman
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK; School of Engineering and Informatics, University of Sussex, Brighton, UK.
| | - Hao-Ting Wang
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - Sarah N Garfinkel
- Brighton and Sussex Medical School, Brighton, UK; Institute of Cognitive Neuroscience, UCL, London, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
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Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Freitag GF, Harrewijn A, Hilbert K, Jahanshad N, Thomopoulos SI, Thompson PM, Veltman DJ, Winkler AM, Lueken U, Pine DS, Wee NJA, Stein DJ, Agosta F, Åhs F, An I, Alberton BAV, Andreescu C, Asami T, Assaf M, Avery SN, Nicholas L, Balderston, Barber JP, Battaglia M, Bayram A, Beesdo‐Baum K, Benedetti F, Berta R, Björkstrand J, Blackford JU, Blair JR, Karina S, Blair, Boehme S, Brambilla P, Burkhouse K, Cano M, Canu E, Cardinale EM, Cardoner N, Clauss JA, Cividini C, Critchley HD, Udo, Dannlowski, Deckert J, Demiralp T, Diefenbach GJ, Domschke K, Doruyter A, Dresler T, Erhardt A, Fallgatter AJ, Fañanás L, Brandee, Feola, Filippi CA, Filippi M, Fonzo GA, Forbes EE, Fox NA, Fredrikson M, Furmark T, Ge T, Gerber AJ, Gosnell SN, Grabe HJ, Grotegerd D, Gur RE, Gur RC, Harmer CJ, Harper J, Heeren A, Hettema J, Hofmann D, Hofmann SG, Jackowski AP, Andreas, Jansen, Kaczkurkin AN, Kingsley E, Kircher T, Kosti c M, Kreifelts B, Krug A, Larsen B, Lee S, Leehr EJ, Leibenluft E, Lochner C, Maggioni E, Makovac E, Mancini M, Manfro GG, Månsson KNT, Meeten F, Michałowski J, Milrod BL, Mühlberger A, Lilianne R, Mujica‐Parodi, Munjiza A, Mwangi B, Myers M, Igor Nenadi C, Neufang S, Nielsen JA, Oh H, Ottaviani C, Pan PM, Pantazatos SP, Martin P, Paulus, Perez‐Edgar K, Peñate W, Perino MT, Peterburs J, Pfleiderer B, Phan KL, Poletti S, Porta‐Casteràs D, Price RB, Pujol J, Andrea, Reinecke, Rivero F, Roelofs K, Rosso I, Saemann P, Salas R, Salum GA, Satterthwaite TD, Schneier F, Schruers KRJ, Schulz SM, Schwarzmeier H, Seeger FR, Smoller JW, Soares JC, Stark R, Stein MB, Straube B, Straube T, Strawn JR, Suarez‐Jimenez B, Boris, Suchan, Sylvester CM, Talati A, Tamburo E, Tükel R, Heuvel OA, Van der Auwera S, Nieuwenhuizen H, Tol M, van Velzen LS, Bort CV, Vermeiren RRJM, Visser RM, Volman I, Wannemüller A, Wendt J, Werwath KE, Westenberg PM, Wiemer J, Katharina, Wittfeld, Wu M, Yang Y, Zilverstand A, Zugman A, Zwiebel HL. ENIGMA-anxiety working group: Rationale for and organization of large-scale neuroimaging studies of anxiety disorders. Hum Brain Mapp 2022; 43:83-112. [PMID: 32618421 PMCID: PMC8805695 DOI: 10.1002/hbm.25100] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Anxiety disorders are highly prevalent and disabling but seem particularly tractable to investigation with translational neuroscience methodologies. Neuroimaging has informed our understanding of the neurobiology of anxiety disorders, but research has been limited by small sample sizes and low statistical power, as well as heterogenous imaging methodology. The ENIGMA-Anxiety Working Group has brought together researchers from around the world, in a harmonized and coordinated effort to address these challenges and generate more robust and reproducible findings. This paper elaborates on the concepts and methods informing the work of the working group to date, and describes the initial approach of the four subgroups studying generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobia. At present, the ENIGMA-Anxiety database contains information about more than 100 unique samples, from 16 countries and 59 institutes. Future directions include examining additional imaging modalities, integrating imaging and genetic data, and collaborating with other ENIGMA working groups. The ENIGMA consortium creates synergy at the intersection of global mental health and clinical neuroscience, and the ENIGMA-Anxiety Working Group extends the promise of this approach to neuroimaging research on anxiety disorders.
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Affiliation(s)
- Janna Marie Bas‐Hoogendam
- Department of Developmental and Educational PsychologyLeiden University, Institute of Psychology Leiden The Netherlands
- Department of PsychiatryLeiden University Medical Center Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Mental HealthUniversity of Cape Town Cape Town South Africa
| | - Moji Aghajani
- Department of PsychiatryAmsterdam UMC / VUMC Amsterdam The Netherlands
- Department of Research & InnovationGGZ inGeest Amsterdam The Netherlands
| | - Gabrielle F. Freitag
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Anita Harrewijn
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu Berlin Berlin Germany
| | - Neda Jahanshad
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Sophia I. Thomopoulos
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Paul M. Thompson
- University of Southern California Keck School of MedicineImaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute Los Angeles California USA
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam UMC / VUMC Amsterdam The Netherlands
| | - Anderson M. Winkler
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu Berlin Berlin Germany
| | - Daniel S. Pine
- National Institute of Mental Health, Emotion and Development Branch Bethesda Maryland USA
| | - Nic J. A. Wee
- Department of PsychiatryLeiden University Medical Center Leiden The Netherlands
- Leiden Institute for Brain and Cognition Leiden The Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Mental HealthUniversity of Cape Town Cape Town South Africa
- University of Cape TownSouth African MRC Unit on Risk & Resilience in Mental Disorders Cape Town South Africa
- University of Cape TownNeuroscience Institute Cape Town South Africa
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11
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Zugman A, Harrewijn A, Cardinale EM, Zwiebel H, Freitag GF, Werwath KE, Bas‐Hoogendam JM, Groenewold NA, Aghajani M, Hilbert K, Cardoner N, Porta‐Casteràs D, Gosnell S, Salas R, Blair KS, Blair JR, Hammoud MZ, Milad M, Burkhouse K, Phan KL, Schroeder HK, Strawn JR, Beesdo‐Baum K, Thomopoulos SI, Grabe HJ, Van der Auwera S, Wittfeld K, Nielsen JA, Buckner R, Smoller JW, Mwangi B, Soares JC, Wu M, Zunta‐Soares GB, Jackowski AP, Pan PM, Salum GA, Assaf M, Diefenbach GJ, Brambilla P, Maggioni E, Hofmann D, Straube T, Andreescu C, Berta R, Tamburo E, Price R, Manfro GG, Critchley HD, Makovac E, Mancini M, Meeten F, Ottaviani C, Agosta F, Canu E, Cividini C, Filippi M, Kostić M, Munjiza A, Filippi CA, Leibenluft E, Alberton BAV, Balderston NL, Ernst M, Grillon C, Mujica‐Parodi LR, van Nieuwenhuizen H, Fonzo GA, Paulus MP, Stein MB, Gur RE, Gur RC, Kaczkurkin AN, Larsen B, Satterthwaite TD, Harper J, Myers M, Perino MT, Yu Q, Sylvester CM, Veltman DJ, Lueken U, Van der Wee NJA, Stein DJ, Jahanshad N, Thompson PM, Pine DS, Winkler AM. Mega-analysis methods in ENIGMA: The experience of the generalized anxiety disorder working group. Hum Brain Mapp 2022; 43:255-277. [PMID: 32596977 PMCID: PMC8675407 DOI: 10.1002/hbm.25096] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 12/15/2022] Open
Abstract
The ENIGMA group on Generalized Anxiety Disorder (ENIGMA-Anxiety/GAD) is part of a broader effort to investigate anxiety disorders using imaging and genetic data across multiple sites worldwide. The group is actively conducting a mega-analysis of a large number of brain structural scans. In this process, the group was confronted with many methodological challenges related to study planning and implementation, between-country transfer of subject-level data, quality control of a considerable amount of imaging data, and choices related to statistical methods and efficient use of resources. This report summarizes the background information and rationale for the various methodological decisions, as well as the approach taken to implement them. The goal is to document the approach and help guide other research groups working with large brain imaging data sets as they develop their own analytic pipelines for mega-analyses.
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Affiliation(s)
- André Zugman
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Anita Harrewijn
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Elise M. Cardinale
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Hannah Zwiebel
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Gabrielle F. Freitag
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Katy E. Werwath
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Janna M. Bas‐Hoogendam
- Leiden University Medical Center, Department of PsychiatryLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
- Leiden University, Institute of Psychology, Developmental and Educational PsychologyLeidenThe Netherlands
| | - Nynke A. Groenewold
- Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Moji Aghajani
- Department. of PsychiatryAmsterdam UMC/VUMCAmsterdamThe Netherlands
- GGZ InGeestDepartment of Research & InnovationAmsterdamThe Netherlands
| | - Kevin Hilbert
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Narcis Cardoner
- Department of Mental HealthUniversity Hospital Parc Taulí‐I3PTBarcelonaSpain
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud MentalCarlos III Health InstituteMadridSpain
| | - Daniel Porta‐Casteràs
- Department of Mental HealthUniversity Hospital Parc Taulí‐I3PTBarcelonaSpain
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud MentalCarlos III Health InstituteMadridSpain
| | - Savannah Gosnell
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Karina S. Blair
- Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - James R. Blair
- Center for Neurobehavioral ResearchBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Mira Z. Hammoud
- Department of PsychiatryNew York UniversityNew YorkNew YorkUSA
| | - Mohammed Milad
- Department of PsychiatryNew York UniversityNew YorkNew YorkUSA
| | - Katie Burkhouse
- Department of PsychiatryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - K. Luan Phan
- Department of Psychiatry and Behavioral HealthThe Ohio State UniversityColumbusOhioUSA
| | - Heidi K. Schroeder
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOhioUSA
| | - Jeffrey R. Strawn
- Department of Psychiatry & Behavioral NeuroscienceUniversity of CincinnatiCincinnatiOhioUSA
| | - Katja Beesdo‐Baum
- Behavioral EpidemiologyInstitute of Clinical Psychology and Psychotherapy, Technische Universität DresdenDresdenGermany
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Hans J. Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Sandra Van der Auwera
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Jared A. Nielsen
- Department of PsychologyHarvard UniversityCambridgeMassachusettsUSA
- Center for Brain ScienceHarvard UniversityCambridgeMassachusettsUSA
| | - Randy Buckner
- Department of PsychologyHarvard UniversityCambridgeMassachusettsUSA
- Center for Brain ScienceHarvard UniversityCambridgeMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Jordan W. Smoller
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Jair C. Soares
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Mon‐Ju Wu
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Giovana B. Zunta‐Soares
- Center Of Excellence On Mood Disorders, Department of Psychiatry and Behavioral SciencesThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Andrea P. Jackowski
- LiNC, Department of PsychiatryFederal University of São PauloSão PauloSão PauloBrazil
| | - Pedro M. Pan
- LiNC, Department of PsychiatryFederal University of São PauloSão PauloSão PauloBrazil
| | - Giovanni A. Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do SulPorto AlegreRio Grande do SulBrazil
| | - Michal Assaf
- Olin Neuropsychiatry Research CenterInstitute of Living, Hartford HospitalHartfordConnecticutUSA
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Gretchen J. Diefenbach
- Anxiety Disorders CenterInstitute of Living, Hartford HospitalHartfordConnecticutUSA
- Yale School of MedicineNew HavenConnecticutUSA
| | - Paolo Brambilla
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Eleonora Maggioni
- Department of Neurosciences and Mental HealthFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of MuensterMuensterGermany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of MuensterMuensterGermany
| | - Carmen Andreescu
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rachel Berta
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Erica Tamburo
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Rebecca Price
- Department of Psychiatry & PsychologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Gisele G. Manfro
- Anxiety Disorder ProgramHospital de Clínicas de Porto AlegrePorto AlegreRio Grande do SulBrazil
- Department of PsychiatryFederal University of Rio Grande do SulPorto AlegreRio Grande do SulBrazil
| | - Hugo D. Critchley
- Department of NeuroscienceBrighton and Sussex Medical School, University of SussexBrightonUK
| | - Elena Makovac
- Centre for Neuroimaging ScienceKings College LondonLondonUK
| | - Matteo Mancini
- Department of NeuroscienceBrighton and Sussex Medical School, University of SussexBrightonUK
| | | | | | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Camilla Cividini
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
- Neurology and Neurophysiology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Milutin Kostić
- Institute of Mental Health, University of BelgradeBelgradeSerbia
- Department of Psychiatry, School of MedicineUniversity of BelgradeBelgradeSerbia
| | - Ana Munjiza
- Institute of Mental Health, University of BelgradeBelgradeSerbia
| | - Courtney A. Filippi
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Ellen Leibenluft
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Bianca A. V. Alberton
- Graduate Program in Electrical and Computer Engineering, Universidade Tecnológica Federal do ParanáCuritibaPuerto RicoBrazil
| | - Nicholas L. Balderston
- Center for Neuromodulation in Depression and StressUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Monique Ernst
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Christian Grillon
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | | | | | - Gregory A. Fonzo
- Department of PsychiatryThe University of Texas at Austin Dell Medical SchoolAustinTexasUSA
| | | | - Murray B. Stein
- Department of Psychiatry & Family Medicine and Public HealthUniversity of CaliforniaLa JollaCaliforniaUSA
| | - Raquel E. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ruben C. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Bart Larsen
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Jennifer Harper
- Department of PsychiatryWashington UniversitySt. LouisMissouriUSA
| | - Michael Myers
- Department of PsychiatryWashington UniversitySt. LouisMissouriUSA
| | | | - Qiongru Yu
- Department of PsychiatryWashington UniversitySt. LouisMissouriUSA
| | | | - Dick J. Veltman
- Department. of PsychiatryAmsterdam UMC/VUMCAmsterdamThe Netherlands
| | - Ulrike Lueken
- Department of PsychologyHumboldt‐Universität zu BerlinBerlinGermany
| | - Nic J. A. Van der Wee
- Leiden University Medical Center, Department of PsychiatryLeidenThe Netherlands
- Leiden Institute for Brain and Cognition (LIBC)LeidenThe Netherlands
| | - Dan J. Stein
- Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- SAMRC Unite on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Daniel S. Pine
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Anderson M. Winkler
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH)BethesdaMarylandUSA
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Strawson WH, Wang HT, Quadt L, Sherman M, Larsson DEO, Davies G, Mckeown BLA, Silva M, Fielding-Smith S, Jones AM, Hayward M, Smallwood J, Critchley HD, Garfinkel SN. Voice Hearing in Borderline Personality Disorder Across Perceptual, Subjective, and Neural Dimensions. Int J Neuropsychopharmacol 2021; 25:375-386. [PMID: 34940826 PMCID: PMC9154289 DOI: 10.1093/ijnp/pyab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) commonly occur in the context of borderline personality disorder (BPD) yet remain poorly understood. AVH are often perceived by patients with BPD as originating from inside the head and hence viewed clinically as "pseudohallucinations," but they nevertheless have a detrimental impact on well-being. METHODS The current study characterized perceptual, subjective, and neural expressions of AVH by using an auditory detection task, experience sampling and questionnaires, and functional neuroimaging, respectively. RESULTS Perceptually, reported AVH correlated with a bias for reporting the presence of a voice in white noise. Subjectively, questionnaire measures indicated that AVH were significantly distressing and persecutory. In addition, AVH intensity, but not perceived origin (i.e., inside vs outside the head), was associated with greater concurrent anxiety. Neurally, fMRI of BPD participants demonstrated that, relative to imagining or listening to voices, periods of reported AVH induced greater blood oxygenation level-dependent activity in anterior cingulate and bilateral temporal cortices (regional substrates for language processing). AVH symptom severity was associated with weaker functional connectivity between anterior cingulate and bilateral insular cortices. CONCLUSION In summary, our results indicate that AVH in participants with BPD are (1) underpinned by aberrant perceptual-cognitive mechanisms for signal detection, (2) experienced subjectively as persecutory and distressing, and (3) associated with distinct patterns of neural activity that inform proximal mechanistic understanding. Our findings are like analogous observations in patients with schizophrenia and validate the clinical significance of the AVH experience in BPD, often dismissed as "pseudohallucinations." These highlight a need to reconsider this experience as a treatment priority.
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Affiliation(s)
- Will H Strawson
- Correspondence: Will H. Strawson, MSci, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, BN1 9RY, UK ()
| | - Hao-Ting Wang
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK
| | - Maxine Sherman
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK,Department of Informatics, University of Sussex, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Department of Psychology, Falmer, UK,Leverhulme Trust London, UK
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | | | - Marta Silva
- Cognition and Brain Plasticity Unit, Barcelona, Catalunya, Spain,Institute of Neurosciences, University of Barcelona, Catalunya, Spain
| | - Sarah Fielding-Smith
- University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK,Oxford Health NHS Foundation Trust, Oxford, UK,Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
| | - Anna-Marie Jones
- University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Mark Hayward
- Department of Psychology, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Jonathan Smallwood
- Department of Psychology, University of York, York, UK,Department of Psychology, Queen’s University, Kingston, ON, Canada
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK,Institute of Cognitive Neuroscience, University College London, London, UK
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13
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Csecs JLL, Dowell NG, Savage GK, Iodice V, Mathias CJ, Critchley HD, Eccles JA. Variant connective tissue (joint hypermobility) and dysautonomia are associated with multimorbidity at the intersection between physical and psychological health. Am J Med Genet C Semin Med Genet 2021; 187:500-509. [PMID: 34806825 DOI: 10.1002/ajmg.c.31957] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
The symptoms of joint hypermobility extend beyond articular pain. Hypermobile people commonly experience autonomic symptoms (dysautonomia), and anxiety or related psychological issues. We tested whether dysautonomia might mediate the association between hypermobility and anxiety in adults diagnosed with mental health disorders and/or neurodevelopmental conditions (hereon referred to as patients), by quantifying joint hypermobility and symptoms of autonomic dysfunction. Prevalence of generalized joint laxity (hypermobility) in 377 individuals with diagnoses of mental health disorders and/or neurodevelopmental conditions was compared to prevalence recorded in the general population. Autonomic symptom burden was compared between hypermobile and non-hypermobile patients. Mediation analysis explored relationships between hypermobility, autonomic dysfunction, and anxiety. Patient participants had elevated prevalence of generalized joint laxity (38%) compared to the general population rate of 19% (odds ratio: 2.54 [95% confidence interval: 2.05, 3.16]). Hypermobile participants reported significantly more autonomic symptoms. Symptoms of orthostatic intolerance mediated the relationship between hypermobility and diagnosis of an anxiety disorder. Patients with mental health disorders and/or neurodevelopmental conditions have high rates of joint hypermobility. Accompanying autonomic dysfunction mediates the association between joint hypermobility and clinical anxiety status. Increased recognition of this association can enhance mechanistic understanding and improve the management of multimorbidity expressed in physical symptoms and mental health difficulties.
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Affiliation(s)
- Jenny L L Csecs
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Nicholas G Dowell
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Georgia K Savage
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.,UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Christopher J Mathias
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.,UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Neurovascular Medicine (Pickering Unit), St Mary's Hospital, Imperial College London, London, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, UK
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14
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Botan V, Salisbury A, Critchley HD, Ward J. Vicarious pain is an outcome of atypical body ownership: Evidence from the rubber hand illusion and enfacement illusion. Q J Exp Psychol (Hove) 2021; 74:1888-1899. [PMID: 34049467 PMCID: PMC8450990 DOI: 10.1177/17470218211024822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
Some people report localised pain on their body when seeing other people in pain (sensory-localised vicarious pain responders). In this study, we assess whether this is related to atypical computations of body ownership which, in paradigms such as the rubber hand illusion (RHI), can be conceptualised as a Bayesian inference as to whether multiple sources of sensory information (visual, somatosensory) belong together on a single body (one's own) or are distributed across several bodies (vision = other, somatosensory = self). According to this model, computations of body ownership depend on the degree (and precision) of sensory evidence, rather than synchrony per se. Sensory-localised vicarious pain responders exhibit the RHI following synchronous stroking and-unusually-also after asynchronous stroking. Importantly, this occurs only in asynchronous conditions in which the stroking is predictable (alternating) rather than unpredictable (random). There was no evidence that their bottom-up proprioceptive signals are less precise, suggesting individual differences in the top-down weighting of sensory evidence. Finally, the enfacement illusion (EI) was also employed as a conceptually related bodily illusion paradigm that involves a completely different response judgement (based on vision rather than proprioception). Sensory-localised responders show a comparable pattern on this task after synchronous and asynchronous stroking. This is consistent with the idea that they have top-down (prior) differences in the way body ownership is inferred that transcends the exact judgement being made (visual or proprioceptive).
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Affiliation(s)
- Vanessa Botan
- School of Psychology, University of Sussex, Brighton, UK
- Sackler Centre for Consciousness Science, Brighton, UK
| | | | - Hugo D Critchley
- School of Psychology, University of Sussex, Brighton, UK
- Sackler Centre for Consciousness Science, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Jamie Ward
- School of Psychology, University of Sussex, Brighton, UK
- Sackler Centre for Consciousness Science, Brighton, UK
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15
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Larsson DEO, Esposito G, Critchley HD, Dienes Z, Garfinkel SN. Sensitivity to changes in rate of heartbeats as a measure of interoceptive ability. J Neurophysiol 2021; 126:1799-1813. [PMID: 34669507 DOI: 10.1152/jn.00059.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Individuals vary in their ability to perceive, as conscious sensations, signals like the beating of the heart. Tests of such interoceptive ability are, however, constrained in nature and reliability. Performance of the heartbeat tracking task, a widely used test of cardiac interoception, often corresponds well with individual differences in emotion and cognition, yet is susceptible to reporting bias and influenced by higher-order knowledge, e.g., of expected heart rate. The present study introduces a new way of assessing cardiac interoceptive ability, focusing on sensitivity to short-term, naturalistic changes in frequency of heartbeats. At rest, such heart rate variability typically reflects the dominant influence of respiration on vagus parasympathetic control of the sinoatrial pacemaker. We observed an overall tendency of healthy participants to report feeling fewer heartbeats during increases in heart rate, which we speculate reflects a reduction in heartbeat strength and salience during inspiratory periods when heart rate typically increases to maintain a stable cardiac output. Within-participant performance was more variable on this measure of cardiac interoceptive sensitivity relative to the "classic" heartbeat tracking task. Our findings indicate that cardiac interoceptive ability, rather than reflecting the veridical monitoring of subtle variations in physiology, appears to involve more interpolation wherein interoceptive decisions are informed by dynamic working estimates derived from the integration of afferent signaling and higher-order predictions.NEW & NOTEWORTHY This study presents a new method for evaluating cardiac interoceptive ability, measuring sensitivity to naturalistic changes in the number of heartbeats over time periods. Results show participants have an overall tendency toward sensing fewer heartbeats during higher heart rates. This likely reflects the influence of changing heartbeat strength on cardiac interoception at rest, which should be taken into account when evaluating cardiac interoceptive ability and its relationship to anxiety and psychosomatic conditions.
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Affiliation(s)
- Dennis E O Larsson
- Department of Psychology, grid.12082.39University of Sussex, Falmer, United Kingdom.,Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Giulia Esposito
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, United Kingdom.,Sussex Partnership NHS Foundation Trust, Swandean, Worthing, West Sussex, United Kingdom
| | - Zoltan Dienes
- Department of Psychology, grid.12082.39University of Sussex, Falmer, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, United Kingdom
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom.,Sussex Partnership NHS Foundation Trust, Swandean, Worthing, West Sussex, United Kingdom.,Institute of Cognitive Neuroscience, University College London, London, United Kingdom
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16
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Sharp HEC, Critchley HD, Eccles JA. Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression. World J Psychiatry 2021; 11:805-820. [PMID: 34733643 PMCID: PMC8546774 DOI: 10.5498/wjp.v11.i10.805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/12/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
The mind is embodied; thoughts and feelings interact with states of physiological arousal and physical integrity of the body. In this context, there is mounting evidence for an association between psychiatric presentations and the expression variant connective tissue, commonly recognised as joint hypermobility. Joint hypermobility is common, frequently under-recognised, significantly impacts quality of life, and can exist in isolation or as the hallmark of hypermobility spectrum disorders (encompassing joint hypermobility syndrome and hypermobile Ehlers-Danlos syndrome). In this narrative review, we appraise the current evidence linking psychiatric disorders across the lifespan, beginning with the relatively well-established connection with anxiety, to hypermobility. We next consider emerging associations with affective illnesses, eating disorders, alongside less well researched links with personality disorders, substance misuse and psychosis. We then review related findings relevant to neurodevelopmental disorders and stress-sensitive medical conditions. With growing understanding of mind-body interactions, we discuss potential aetiopathogenetic contributions of dysautonomia, aberrant interoceptive processing, immune dysregulation and proprioceptive impairments in the context of psychosocial stressors and genetic predisposition. We examine clinical implications of these evolving findings, calling for increased awareness amongst healthcare professionals of the transdiagnostic nature of hypermobility and related disorders. A role for early screening and detection of hypermobility in those presenting with mental health and somatic symptoms is further highlighted, with a view to facilitate preventative approaches alongside longer-term holistic management strategies. Finally, suggestions are offered for directions of future scientific exploration which may be key to further delineating fundamental mind-body-brain interactions.
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Affiliation(s)
- Harriet Emma Clare Sharp
- Department of Medical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, East Sussex, United Kingdom
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, West Sussex, United Kingdom
| | - Hugo D Critchley
- Department of Medical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, East Sussex, United Kingdom
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, West Sussex, United Kingdom
| | - Jessica A Eccles
- Department of Medical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, East Sussex, United Kingdom
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, West Sussex, United Kingdom
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17
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Harrewijn A, Cardinale EM, Groenewold NA, Bas-Hoogendam JM, Aghajani M, Hilbert K, Cardoner N, Porta-Casteràs D, Gosnell S, Salas R, Jackowski AP, Pan PM, Salum GA, Blair KS, Blair JR, Hammoud MZ, Milad MR, Burkhouse KL, Phan KL, Schroeder HK, Strawn JR, Beesdo-Baum K, Jahanshad N, Thomopoulos SI, Buckner R, Nielsen JA, Smoller JW, Soares JC, Mwangi B, Wu MJ, Zunta-Soares GB, Assaf M, Diefenbach GJ, Brambilla P, Maggioni E, Hofmann D, Straube T, Andreescu C, Berta R, Tamburo E, Price RB, Manfro GG, Agosta F, Canu E, Cividini C, Filippi M, Kostić M, Munjiza Jovanovic A, Alberton BAV, Benson B, Freitag GF, Filippi CA, Gold AL, Leibenluft E, Ringlein GV, Werwath KE, Zwiebel H, Zugman A, Grabe HJ, Van der Auwera S, Wittfeld K, Völzke H, Bülow R, Balderston NL, Ernst M, Grillon C, Mujica-Parodi LR, van Nieuwenhuizen H, Critchley HD, Makovac E, Mancini M, Meeten F, Ottaviani C, Ball TM, Fonzo GA, Paulus MP, Stein MB, Gur RE, Gur RC, Kaczkurkin AN, Larsen B, Satterthwaite TD, Harper J, Myers M, Perino MT, Sylvester CM, Yu Q, Lueken U, Veltman DJ, Thompson PM, Stein DJ, Van der Wee NJA, Winkler AM, Pine DS. Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group. Transl Psychiatry 2021; 11:502. [PMID: 34599145 PMCID: PMC8486763 DOI: 10.1038/s41398-021-01622-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.
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Affiliation(s)
- Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA.
| | - Elise M Cardinale
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Nynke A Groenewold
- Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Janna Marie Bas-Hoogendam
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ InGeest, Amsterdam, The Netherlands
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Narcis Cardoner
- Department of Mental Health, University Hospital Parc Taulí-I3PT, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Daniel Porta-Casteràs
- Department of Mental Health, University Hospital Parc Taulí-I3PT, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid, Spain
| | - Savannah Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrea P Jackowski
- LiNC, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Pedro M Pan
- LiNC, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Giovanni A Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karina S Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - James R Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Mira Z Hammoud
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, USA
| | - Mohammed R Milad
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, USA
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Heidi K Schroeder
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey R Strawn
- Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Randy Buckner
- Center for Brain Science & Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jared A Nielsen
- Center for Brain Science & Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychology Department & Neuroscience Center, Brigham Young University, Provo, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jair C Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mon-Ju Wu
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Giovana B Zunta-Soares
- Center Of Excellence On Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Gretchen J Diefenbach
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rachel Berta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica Tamburo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gisele G Manfro
- Anxiety Disorder Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Cividini
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Milutin Kostić
- Institute of Mental Health, University of Belgrade, Belgrade, Serbia
- Department of Psychiatry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Bianca A V Alberton
- Graduate Program in Electrical and Computer Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Puerto Rico, Brazil
| | - Brenda Benson
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Gabrielle F Freitag
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Courtney A Filippi
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Andrea L Gold
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Grace V Ringlein
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kathryn E Werwath
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Hannah Zwiebel
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - André Zugman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Katharina Wittfeld
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | - Christian Grillon
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, Bethesda, MD, USA
| | | | | | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK
| | - Matteo Mancini
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Frances Meeten
- School of Psychology, University of Sussex, Brighton, UK
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Santa Lucia Foundation, Rome, Italy
| | - Tali M Ball
- Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | - Murray B Stein
- Department of Psychiatry, School of Medicine and Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bart Larsen
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jennifer Harper
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Michael Myers
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Michael T Perino
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Chad M Sylvester
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Qiongru Yu
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nic J A Van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Anderson M Winkler
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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18
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Davies G, Csecs JLL, Ball H, Dare J, Bremner S, Hosking R, Critchley HD, Grey N, Eccles JA. Altering Dynamics of Autonomic Processing Therapy (ADAPT) trial: a novel, targeted treatment for reducing anxiety in joint hypermobility. Trials 2021; 22:645. [PMID: 34548065 PMCID: PMC8453027 DOI: 10.1186/s13063-021-05555-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background Hypermobility is a poorly recognised and understood musculoskeletal disorder thought to affect around 20% of the population. Hypermobility is associated with reduced physiological and psychological functioning and quality of life and is a known risk factor for the development of an anxiety disorder. To date, no evidence-based, targeted treatment for anxiety in the context of hypermobility exists. The present intervention (ADAPT—Altering Dynamics of Autonomic Processing Therapy) is a novel therapy combining bio-behavioural training with cognitive approaches from clinical health psychology targeting the catastrophisation of internal sensations, with aim to improve autonomic trait prediction error. Method Eighty individuals with diagnosed hypermobility will be recruited and the efficacy of ADAPT to treat anxiety will be compared to an Emotion-Focused Supportive Therapy (EFST) comparator therapy in a randomised controlled trial. The primary treatment target will be post therapy score on the Beck Anxiety Inventory, and secondary outcomes will also be considered in relation to interoception, depression, alexithymia, social and work adjustment, panic symptoms and dissociation. Due to COVID restrictions, the intervention will be moved to online delivery and qualitative assessment of treatment tolerance to online therapy will also be assessed. Discussion Online delivery of an intervention targeting anxiety would improve the quality of life for those experiencing anxiety disorder and help to reduce the £11.7 billion that anxiety disorders cost the UK economy annually. Trial registration World Health Organization ISRCTN17018615. Registered on 20th February 2019; trial protocol version 2
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Affiliation(s)
- Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Jenny L L Csecs
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Heather Ball
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Jess Dare
- Sussex Community NHS Foundation Trust, Brighton, UK
| | - Stephen Bremner
- Brighton and Sussex Clinical Trials Unit, Brighton & Sussex Medical School, Falmer, UK
| | - Robin Hosking
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Falmer, UK
| | - Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK. .,Sussex Partnership NHS Foundation Trust, Worthing, UK. .,Trafford Centre for Medical Research, University of Sussex, Falmer, BN1 9RY, UK.
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19
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Quadt L, Garfinkel SN, Mulcahy JS, Larsson DEO, Silva M, Jones AM, Strauss C, Critchley HD. Interoceptive training to target anxiety in autistic adults (ADIE): A single-center, superiority randomized controlled trial. EClinicalMedicine 2021; 39:101042. [PMID: 34401684 PMCID: PMC8350004 DOI: 10.1016/j.eclinm.2021.101042] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This trial tested if a novel therapy, Aligning Dimensions of Interoceptive Experience (ADIE), reduces anxiety in autistic adults. ADIE targets the association of anxiety with mismatch between subjective and behavioral measures of an individual's interoceptive sensitivity to bodily signals, including heartbeats. METHODS In this superiority randomized controlled trial, autistic adults (18-65 years) from clinical and community settings in Southern England were randomly assigned (1:1) to receive six sessions of ADIE or an active 'exteroceptive' control therapy (emotional prosody identification). Researchers conducting outcome assessments were blind to allocation. ADIE combines two modified heartbeat detection tasks with performance feedback and physical activity manipulation that transiently increases cardiac arousal. Participants were followed-up one-week (T1) and 3-months post-intervention (T2). The primary outcome was Spielberger Trait Anxiety Score (STAI-T) at T2. Outcomes were assessed on an intention-to-treat basis using multiple imputation for dealing with missing values. This trial was registered at International Standard Randomized Controlled Trial Registry, ISRCTN14848787. FINDINGS Between July 01, 2017, and December 31, 2019, 121 participants were randomly allocated to ADIE (n = 61) or prosody (n = 60) intervention groups. Data at T1 was provided by 85 (70%) participants (46 [75%] ADIE; 39 [65%] prosody). Data at T2 was provided by 61 (50%) participants (36 [59%] ADIE; 25 [42%] prosody). One adverse event (cardiac anxiety following ADIE) was recorded. A statistically significant group effect of ADIE on trait anxiety continued at T2 (estimated mean difference 3•23 [95% CI 1•13 to 5•29]; d = 0•30 [95% CI 0•09 to 0•51]; p = 0•005) with 31% of ADIE group participants meeting trial criteria for recovery (compared to 16% in the control group). INTERPRETATION ADIE can reduce anxiety in autistic adults, putatively improving regulatory control over internal stimuli. With little reliance on language and emotional insight, ADIE may constitute an inclusive intervention. FUNDING MQ Transforming Mental Health PsyImpact Grant.
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Affiliation(s)
- Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- Institute for Cognitive Neuroscience, University College London, London, United Kingdom
| | - James S Mulcahy
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
| | - Dennis EO Larsson
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Leverhulme Trust, London, United Kingdom
| | - Marta Silva
- Cognition and Brain Plasticity Unit, Institute for Neurosciences, University of Barcelona, Barcelona, Spain
| | - Anna-Marie Jones
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
| | - Clara Strauss
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School,Trafford Centre, University of Sussex Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust Brighton, United Kingdom
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Bonaz B, Lane RD, Oshinsky ML, Kenny PJ, Sinha R, Mayer EA, Critchley HD. Diseases, Disorders, and Comorbidities of Interoception. Trends Neurosci 2021; 44:39-51. [PMID: 33378656 DOI: 10.1016/j.tins.2020.09.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
Interoception, the sense of the body's internal physiological state, underpins homeostatic reflexes, motivational states, and sensations contributing to emotional experiences. The continuous nature of interoceptive processing, coupled to behavior, is implicated in the neurobiological construction of the sense of self. Aberrant integration and control of interoceptive signals, originating in the brain and/or the periphery, can perturb the whole system. Interoceptive abnormalities are implicated in the pathophysiology of psychiatric disorders and in the symptomatic expression of developmental, neurodegenerative, and neurological disorders. Moreover, interoceptive mechanisms appear central to somatic disorders of brain-body interactions, including functional digestive disorders, chronic pain, and comorbid conditions. The present article provides an overview of disorders of interoception and suggests future directions for better understanding, diagnosis, and management of these disorders.
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Affiliation(s)
- Bruno Bonaz
- Université Grenoble Alpes, Inserm, U1216, Grenoble Institute Neurosciences and Division of Hepato-Gastroenterology, CHU Grenoble Alpes, 38000 Grenoble, France.
| | - Richard D Lane
- Department of Psychiatry, University of Arizona, Tucson, AZ 85724-5002, USA; Department of Psychology, University of Arizona, Tucson, AZ 85724-5002, USA; Department of Neuroscience, University of Arizona, Tucson, AZ 85724-5002, USA
| | - Michael L Oshinsky
- National Institute of Neurological Disorders and Stroke/National Institutes of Health, Bethesda, MD 20894, USA
| | - Paul J Kenny
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajita Sinha
- Yale Stress Center, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
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21
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Savage GK, Csecs JLL, Davies G, Critchley HD, Eccles JA. #3085 Relationship between variant connective tissue (hypermobility) and autism sensory processing: externally oriented thinking as a mediator. J Neurol Psychiatry 2021. [DOI: 10.1136/jnnp-2021-bnpa.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives/AimsAutism is a neurodevelopmental condition characterised by differences in sensory processing, social communication and restricted/repetitive behaviors. Joint hypermobility is a common connective tissue variant, reportedly overrepresented in Autism. Alexithymia is a personality construct characterised by altered emotional awareness which has notably high rates of overlap with autism spectrum disorder. This study tested whether hypermobility was associated with autistic traits and examined alexithymia as a mediator of this association.MethodForty-two people underwent eligibility assessment for a study of joint hypermobility and anxiety (ISRCTN17018615). Hypermobility was assessed using both the Brighton Criteria for Joint Hypermobilty Syndrome (JHS) and 2017 Hypermobile Ehlers Danlos Syndrome (hEDS) Criteria. Participants completed the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS R: sensory/motor, language, social relatedness and circumscribed interest domains) to quantify autistic traits. No participant had a prior diagnosis of Autism. Participants also completed the Toronto Alexithymia Scale (TAS-20) to measure alexithymia. The TAS-20 has three domains: difficulty describing feelings, difficulty identifying feelings and externally oriented thinking.ResultsAll 42 participants met criteria for JHS, 26 participants also met criteria for hEDS. Strikingly, 22/42 (52.4%) scored above threshold for suspected Autism (26/42 in the sensory/motor domain; 22/42 in language domain; 22/42 in social relatedness domain; 17/42 in circumscribed interests domain). There were no significant differences in RAADS-R scores depending on hypermobility diagnosis. The number of connective tissue features (hEDS Criterion 2A) correlated with RAADS-R sensory/motor score (r = 0.418, p = 0.006) but not social relatedness nor circumscribed interests sub-scores. Full mediation of the relationship between the number of connective tissue features and RAADs sensory/motor score by TAS-20 externally oriented thinking was found using the method of Baron-Kenny (1986) and estimation of indirect effects (Hayes, 2018; bootstrapped confidence intervals (n = 5000, do not cross zero)). Difficulty identifying feelings and difficulty describing feelings domains did not mediate this relationship.ConclusionThese results add to evidence linking variant connective tissue to neurodevelopmental conditions (including Autism) and interestingly, specifically to sensory processing differences. Our study provides a strong rationale for screening for neurodevelopmental conditions in people with hypermobility and motivates further to understand symptom expression in this group. Our results also provide an insight into the processes underlying this relationship, which maybe important for informing interventions for people with hypermobility and autistic traits.
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22
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Hayward M, Jones AM, Strawson WH, Quadt L, Larsson DEO, Silva M, Davies G, Fielding-Smith S, Hazell CM, Critchley HD, Garfinkel SN. A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder. Clin Psychol Psychother 2021; 29:631-641. [PMID: 34322956 DOI: 10.1002/cpp.2655] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The presence of auditory verbal hallucinations (AVHs) does not currently feature in the main diagnostic criteria for borderline personality disorder (BPD). However, there is accumulating evidence that a high proportion of BPD patients report longstanding and frequent AVHs which constitute a significant risk factor for suicide plans and attempts, and hospitalization. AIM This study addressed questions about the validity and phenomenology of AVHs in the context of BPD. The longer-term aim is to facilitate the development and translation of treatment approaches to address the unmet need of this population. METHOD This was a cross-sectional study, combining phenomenological and psychological assessments administered in person and online. We explored the experiences of 48 patients with a diagnosis of BPD who were hearing AVHs. RESULTS Participants gave 'consistent' reports on the measure of AVH phenomenology, suggesting that these experiences were legitimate. Similar to AVHs in a psychosis context, AVHs were experienced as distressing and appraised as persecutory. AVHs were found to be weakly associated with BPD symptoms. AVHs were also rated highly as a treatment priority by the majority of participants. CONCLUSION The findings suggest that AVH is a legitimate and distressing symptom of BPD and a treatment priority for some patients. The relative independence of AVHs from other BPD symptoms and emotional states suggests that psychological treatment may need to be targeted specifically at the symptom of AVHs. This treatment could be adapted from cognitive behaviour therapy, the psychological intervention that is recommended for the treatment of AVHs in the context of psychosis.
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Affiliation(s)
- Mark Hayward
- Sussex Partnership NHS Foundation Trust, Brighton, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Will H Strawson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK.,Leverhulme Trust, London, UK
| | - Marta Silva
- Cognition and Brain Plasticity Unit, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Cassie M Hazell
- Social Sciences Department, University of Westminster, London, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
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23
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Koenig J, Abler B, Agartz I, Åkerstedt T, Andreassen OA, Anthony M, Bär KJ, Bertsch K, Brown RC, Brunner R, Carnevali L, Critchley HD, Cullen KR, de Geus EJC, de la Cruz F, Dziobek I, Ferger MD, Fischer H, Flor H, Gaebler M, Gianaros PJ, Giummarra MJ, Greening SG, Guendelman S, Heathers JAJ, Herpertz SC, Hu MX, Jentschke S, Kaess M, Kaufmann T, Klimes-Dougan B, Koelsch S, Krauch M, Kumral D, Lamers F, Lee TH, Lekander M, Lin F, Lotze M, Makovac E, Mancini M, Mancke F, Månsson KNT, Manuck SB, Mather M, Meeten F, Min J, Mueller B, Muench V, Nees F, Nga L, Nilsonne G, Ordonez Acuna D, Osnes B, Ottaviani C, Penninx BWJH, Ponzio A, Poudel GR, Reinelt J, Ren P, Sakaki M, Schumann A, Sørensen L, Specht K, Straub J, Tamm S, Thai M, Thayer JF, Ubani B, van der Mee DJ, van Velzen LS, Ventura-Bort C, Villringer A, Watson DR, Wei L, Wendt J, Schreiner MW, Westlye LT, Weymar M, Winkelmann T, Wu GR, Yoo HJ, Quintana DS. Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis. Psychophysiology 2021; 58:e13688. [PMID: 33037836 DOI: 10.1111/psyp.13688] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 01/24/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022]
Abstract
Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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Affiliation(s)
- Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mia Anthony
- University of Rochester Medical Center, Rochester, NY, USA
| | - Karl-Jürgen Bär
- Department of Psychosomatic Medicine, University Hospital Jena, Jena, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Romuald Brunner
- Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Luca Carnevali
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Hugo D Critchley
- Psychiatry, BSMS Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Eco J C de Geus
- Department of Biological Psychology, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | | | - Isabel Dziobek
- Department of Psychology, Berlin School of Mind and Brain, Humboldt Universität, Berlin, Germany
| | - Marc D Ferger
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Håkan Fischer
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Gaebler
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melita J Giummarra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Caulfield Pain Management and Research Centre, Caulfield, VIC, Australia
| | - Steven G Greening
- Department of Psychology, Cognitive and Brain Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - Simon Guendelman
- Berlin School of Mind and Brain, Humboldt Universität, Berlin, Germany
| | | | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Mandy X Hu
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sebastian Jentschke
- Cluster "Languages of Emotion", Freie Universität Berlin, Berlin, Germany
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Tobias Kaufmann
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, College of Liberal Arts, Minneapolis, MN, USA
| | - Stefan Koelsch
- Cluster "Languages of Emotion", Freie Universität Berlin, Berlin, Germany
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Deniz Kumral
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Femke Lamers
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tae-Ho Lee
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Mats Lekander
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Feng Lin
- University of Rochester Medical Center, Rochester, NY, USA
| | - Martin Lotze
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
| | - Elena Makovac
- Centre for Neuroimaging Science, King's College London, London, UK
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Mancini
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Falk Mancke
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Kristoffer N T Månsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Stephen B Manuck
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mara Mather
- Leonard Davis School of Gerontology, Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Frances Meeten
- School of Psychology, University of Sussex, Brighton, UK
| | - Jungwon Min
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Vera Muench
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Lin Nga
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Gustav Nilsonne
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Bjorgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Allison Ponzio
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Govinda R Poudel
- Behaviour Environment and Cognition Research Program, Mary MacKillop Institute for Health Research, Melbourne, VIC, Australia
| | - Janis Reinelt
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ping Ren
- University of Rochester Medical Center, Rochester, NY, USA
| | - Michiko Sakaki
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Research Institute, Kochi University of Technology, Kami, Japan
| | - Andy Schumann
- Department of Psychosomatic Medicine, University Hospital Jena, Jena, Germany
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Education, UiT/The Arctic University of Norway, Tromsø, Norway
| | - Joana Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Sandra Tamm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Michelle Thai
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Julian F Thayer
- Department of Psychological Science, The University of California, Irvine, CA, USA
| | - Benjamin Ubani
- Boston University, School of Public Health, Boston, MA, USA
| | - Denise J van der Mee
- Department of Biological Psychology, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Laura S van Velzen
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University, Medical Center and GGZ inGeest, Amsterdam, the Netherlands
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - David R Watson
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Luqing Wei
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
| | - Julia Wendt
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | | | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Tobias Winkelmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
| | - Hyun Joo Yoo
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Daniel S Quintana
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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24
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Eccles JA, Thompson B, Themelis K, Amato ML, Stocks R, Pound A, Jones AM, Cipinova Z, Shah-Goodwin L, Timeyin J, Thompson CR, Batty T, Harrison NA, Critchley HD, Davies KA. Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study. Clin Med (Lond) 2021; 21:53-58. [PMID: 33479068 DOI: 10.7861/clinmed.2020-0743] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fibromyalgia and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) are poorly understood conditions with overlapping symptoms, fuelling debate as to whether they are manifestations of the same spectrum or separate entities. Both are associated with hypermobility, but this remains significantly undiagnosed, despite impact on quality of life. OBJECTIVE We planned to understand the relevance of hypermobility to symptoms in fibromyalgia and ME/CFS. METHOD Sixty-three patient participants presented with a confirmed diagnosis of fibromyalgia and/or ME/CFS; 24 participants were healthy controls. Patients were assessed for symptomatic hypermobility. RESULTS Evaluations showed exceptional overlap in patients between fibromyalgia and ME/CFS, plus 81% met Brighton criteria for hypermobility syndrome (odds ratio 7.08) and 18% met 2017 hypermobile Ehlers-Danlos syndrome (hEDS) criteria. Hypermobility scores significantly predicted symptom levels. CONCLUSION Symptomatic hypermobility is particularly relevant to fibromyalgia and ME/CFS, and our findings highlight high rates of mis-/underdiagnosis. These poorly understood conditions have a considerable impact on quality of life and our observations have implications for diagnosis and treatment targets.
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Affiliation(s)
- Jessica A Eccles
- Brighton and Sussex Medical School, Falmer, UK, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Sussex Partnership Foundation NHS Trust, Brighton, UK
| | | | | | | | | | - Amy Pound
- Brighton and Sussex Medical School, Falmer, UK and Sussex Partnership Foundation NHS Trust, Brighton, UK
| | | | - Zdenka Cipinova
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Jean Timeyin
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Charlotte R Thompson
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK
| | - Thomas Batty
- Brighton and Sussex Medical School, Falmer, UK and Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Neil A Harrison
- Brighton and Sussex Medical School, Falmer, UK and Cardiff University Brain Research Imaging Centre, Cardiff, UK
| | - Hugo D Critchley
- Brighton and Sussex Medical School, Falmer, UK, University of Sussex, Falmer and Sussex Partnership Foundation NHS Trust, Brighton, UK
| | - Kevin A Davies
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK
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25
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Botan V, Critchley HD, Ward J. Different psychophysiological and clinical symptoms are linked to affective versus sensory vicarious pain experiences. Psychophysiology 2021; 58:e13826. [PMID: 33942318 DOI: 10.1111/psyp.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
For some people, seeing pain in others triggers a pain-like experience in themselves: these experiences can either be described in sensory terms and localized to specific body parts (sensory-localized, or S/L) or in affective terms and nonlocalized or whole-body experiences (affective-general, or A/G). In two studies, it is shown that these are linked to different clinical and psychophysiological profiles relative to controls. Study 1 shows that the A/G profile is linked to symptoms of Blood-Injection-Injury Phobia whereas the S/L profile shows some tendency toward eating disorders. Study 2 shows that the A/G profile is linked to poor interoceptive accuracy (for heartbeat detection) whereas the S/L profile is linked to higher heart-rate variability (HRV) when observing pain, which is typically regarded as an index of good autonomic emotion regulation. Neither group showed significant differences in overall heart rate, systolic blood pressure (SBP), or skin conductance response (SCR) when observing pain, and no overall differences in state or trait anxiety. Overall, the research points to different underlying mechanisms linked to different manifestations of vicarious pain response. Affective-General pain responders have strong subjective bodily experiences (likely of central origin given the absence of major differences in autonomic responsiveness) coupled with a worse ability to read objective interoceptive signals. Sensory-localized pain responders have differences in their ability to construct a multi-sensory body schema (as evidenced by prior research on the Rubber Hand Illusion) coupled with enhanced cardiovagal (parasympathetic) reactivity often indicative of better stress adaptation.
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Affiliation(s)
- V Botan
- School of Psychology, University of Sussex, East Sussex, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
| | - H D Critchley
- School of Psychology, University of Sussex, East Sussex, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - J Ward
- School of Psychology, University of Sussex, East Sussex, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
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26
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Witchel HJ, Thompson GA, Jones CI, Westling CEI, Romero J, Nicotra A, Maag B, Critchley HD. Correction: Spelling Errors and Shouting Capitalization Lead to Additive Penalties to Trustworthiness of Online Health Information: Randomized Experiment With Laypersons. J Med Internet Res 2021; 23:e29452. [PMID: 33848255 PMCID: PMC8080145 DOI: 10.2196/29452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harry J Witchel
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Georgina A Thompson
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Christopher I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Carina E I Westling
- Faculty of Media and Communication, Bournemouth University, Bournemouth, United Kingdom
| | | | | | | | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
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27
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Critchley HD, Botan V, Ward J. Absence of reliable physiological signature of illusory body ownership revealed by fine-grained autonomic measurement during the rubber hand illusion. PLoS One 2021; 16:e0237282. [PMID: 33793569 PMCID: PMC8016256 DOI: 10.1371/journal.pone.0237282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/21/2020] [Accepted: 03/10/2021] [Indexed: 01/15/2023] Open
Abstract
The neural representation of a 'biological self' is linked theoretically to the control of bodily physiology. In an influential model, selfhood relates to internal agency and higher-order interoceptive representation, inferred from the predicted impact of efferent autonomic nervous activity on afferent viscerosensory feedback. Here we tested if an altered representation of physical self (illusory embodiment of an artificial hand) is accompanied by sustained shifts in autonomic activity. Participants (N = 37) underwent procedures for induction of the rubber hand illusion (synchronous stroking of own unseen hand and observed stroking of artificial hand) and a control condition (asychronous stroking). We recorded electrocardiography, electrodermal activity, and a non-invasive measure of multiunit skin sympathetic nerve activity (SKNA) from the chest. We compared these autonomic indices between task conditions, and between individuals who did and did not experience the illusion. Bayes factors quantified the strength of evidence for and against null hypotheses. Observed proprioceptive drift and subjective reports confirmed the efficacy of the synchronous (vs asynchronous) condition in inducing illusory hand ownership. Stringent discriminant analysis classified 24/37 individuals as experiencing the rubber hand illusion. Surprisingly, heart rate, heart rate variability, electrodermal activity, and SKNA measures revealed no autonomic differences between synchronous vs asynchronous conditions, nor between individuals who did or did not experience the rubber hand illusion. Bayes factors indicated substantial evidence for no physiological differences. In contrast to earlier reports, our autonomic data show the absence of a reliable change in physiological state during the rubber hand illusion. More encompassing perturbations of self-experience, for example in full body illusions, may nevertheless be coupled to, or facilitated by, changes in efferent autonomic activity and afferent viscerosensory feedback. Our findings suggest that such changes in bodily physiology are not sustained as an obligatory component of the rubber hand illusion.
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Affiliation(s)
- Hugo D. Critchley
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Brighton and Sussex Medical School, University of Sussex and University of Brighton, Brighton, United Kingdom
| | - Vanessa Botan
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Jamie Ward
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
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28
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Rae CL, Parkinson J, Betka S, Gouldvan Praag CD, Bouyagoub S, Polyanska L, Larsson DEO, Harrison NA, Garfinkel SN, Critchley HD. Amplified engagement of prefrontal cortex during control of voluntary action in Tourette syndrome. Brain Commun 2021; 2:fcaa199. [PMID: 33409490 PMCID: PMC7772099 DOI: 10.1093/braincomms/fcaa199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Tourette syndrome is characterized by ‘unvoluntary’ tics, which are compulsive, yet often temporarily suppressible. The inferior frontal gyrus is implicated in motor control, including inhibition of pre-potent actions through influences on downstream subcortical and motor regions. Although tic suppression in Tourette syndrome also engages the inferior frontal gyrus, it is unclear whether such prefrontal control of action is also dysfunctional: Tic suppression studies do not permit comparison with control groups, and neuroimaging studies of motor inhibition can be confounded by the concurrent expression or suppression of tics. Here, patients with Tourette syndrome were directly compared to control participants when performing an intentional inhibition task during functional MRI. Tic expression was recorded throughout for removal from statistical models. Participants were instructed to make a button press in response to Go cues, withhold responses to NoGo cues, and decide whether to press or withhold to ‘Choose’ cues. Overall performance was similar between groups, for both intentional inhibition rates (% Choose-Go) and reactive NoGo inhibition commission errors. A subliminal face prime elicited no additional effects on intentional or reactive inhibition. Across participants, the task activated prefrontal and motor cortices and subcortical nuclei, including pre-supplementary motor area, inferior frontal gyrus, insula, caudate nucleus, thalamus and primary motor cortex. In Tourette syndrome, activity was elevated in the inferior frontal gyrus, insula and basal ganglia, most notably within the right inferior frontal gyrus during voluntary action and inhibition (Choose-Go and Choose-NoGo), and reactive inhibition (NoGo-correct). Anatomically, the locus of this inferior frontal gyrus hyperactivation during control of voluntary action matched that previously reported for tic suppression. In Tourette syndrome, activity within the caudate nucleus was also enhanced during both intentional (Choose-NoGo) and reactive (NoGo-correct) inhibition. Strikingly, despite the absence of overt motor behaviour, primary motor cortex activity increased in patients with Tourette syndrome but decreased in controls during both reactive and intentional inhibition. Additionally, severity of premonitory sensations scaled with functional connectivity of the pre-supplementary motor area to the caudate nucleus, globus pallidus and thalamus when choosing to respond (Choose-Go). Together, these results suggest that patients with Tourette syndrome use equivalent prefrontal mechanisms to suppress tics and withhold non-tic actions, but require greater inferior frontal gyrus engagement than controls to overcome motor drive from hyperactive downstream regions, notably primary motor cortex. Moreover, premonitory sensations may cue midline motor regions to generate tics through interactions with the basal ganglia.
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Affiliation(s)
- Charlotte L Rae
- School of Psychology, University of Sussex, Sussex BN1 9QH, UK
| | - Jim Parkinson
- School of Psychology, University of Sussex, Sussex BN1 9QH, UK
| | - Sophie Betka
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | | | - Samira Bouyagoub
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | - Liliana Polyanska
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | | | - Neil A Harrison
- Department of Neuroscience, Brighton & Sussex Medical School, Sussex BN1 9RY, UK
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Sussex, UK
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29
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Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, Savage GK, Dowell NG, Prowse F, Themelis K, Mathias CJ, Critchley HD, Eccles JA. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Front Psychiatry 2021; 12:786916. [PMID: 35185636 PMCID: PMC8847158 DOI: 10.3389/fpsyt.2021.786916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/20/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Autism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social, and emotional processes. Increased likelihood of chronic physical symptoms, including fatigue and pain, are also recognized. The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts susceptibility to psychological symptoms alongside recognized physical symptoms. Here, we tested for increased prevalence of joint hypermobility, autonomic dysfunction, and musculoskeletal symptoms in 109 adults with neurodevelopmental condition diagnoses. METHODS Rates of generalized joint hypermobility (GJH, henceforth hypermobility) in adults with a formal diagnosis of neurodevelopmental conditions (henceforth neurodivergent group, n = 109) were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms were compared to a separate comparison group (n = 57). Age specific cut-offs for GJH were possible to determine in the neurodivergent and comparison group only. RESULTS The neurodivergent group manifested elevated prevalence of hypermobility (51%) compared to the general population rate of 20% and a comparison population (17.5%). Using a more stringent age specific cut-off, in the neurodivergent group this prevalence was 28.4%, more than double than the comparison group (12.5%). Odds ratio for presence of hypermobility in neurodivergent group, compared to the general population was 4.51 (95% CI 2.17-9.37), with greater odds in females than males. Using age specific cut-off, the odds ratio for GJH in neurodivergent group, compared to the comparison group, was 2.84 (95% CI 1.16-6.94). Neurodivergent participants reported significantly more symptoms of orthostatic intolerance and musculoskeletal skeletal pain than the comparison group. The number of hypermobile joints was found to mediate the relationship between neurodivergence and symptoms of both dysautonomia and pain. CONCLUSIONS In neurodivergent adults, there is a strong link between the expression of joint hypermobility, dysautonomia, and pain, more so than in the comparison group. Moreover, joint hypermobility mediates the link between neurodivergence and symptoms of dysautonomia and pain. Increased awareness and understanding of this association may enhance the management of core symptoms and allied difficulties in neurodivergent people, including co-occurring physical symptoms, and guide service delivery in the future.
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Affiliation(s)
- Jenny L L Csecs
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Charlotte L Rae
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Alice Brooke
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Rebecca Simmons
- Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Georgia K Savage
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Nicholas G Dowell
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Centre for Regenerative Medicine and Devices, University of Brighton, Brighton, United Kingdom
| | - Fenella Prowse
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Department of Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kristy Themelis
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Christopher J Mathias
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Pickering Unit, Neurovascular Medicine, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom.,Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Jessica A Eccles
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,Research and Development, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom.,Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
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30
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Garfinkel SN, Gould van Praag CD, Engels M, Watson D, Silva M, Evans SL, Duka T, Critchley HD. Interoceptive cardiac signals selectively enhance fear memories. J Exp Psychol Gen 2020; 150:1165-1176. [PMID: 33180532 DOI: 10.1037/xge0000967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fear is coupled to states of physiological arousal. We tested how learning and memory of threat, specifically conditioned fear, is influenced by interoceptive signals. Forty healthy individuals were exposed to two threat (conditioned stimuli [CS+], paired with electrocutaneous shocks) and two safety (CS-) stimuli, time-locked to either cardiac ventricular systole (when arterial baroreceptors signal cardiovascular arousal to brainstem), or diastole (when these afferent signals are quiescent). Threat learning was indexed objectively using skin conductance responses (SCRs). During acquisition of threat contingencies, cardiac effects dominated: Stimuli (both CS+ and CS-) presented at systole evoked greater SCR responses, relative to stimuli (both CS+ and CS-) presented at diastole. This difference was amplified in more anxious individuals. Learning of conditioned fear was established by the end of the acquisition phase, which was followed by an extinction phase when unpaired CSs were presented at either the same or switched cardiac contingencies. One day later, electrocutaneous shocks triggered the reinstatement of fear responses. Subsequent presentation of stimuli previously encoded at systole evoked higher SCRs. Moreover, only those participants for whom stimuli had the same cardiac-contingency over both acquisition and extinction phases retained conditioned fear memory (i.e., CS+ > CS-). Our findings reveal two important cardiac afferent effects on threat learning and memory: 1) Cardiac signals bias processing toward threat; and 2) cardiac signals are a context for fear memory; altering this context can disrupt the memory. These observations suggest how threat reactivity may be reinforced and maintained by both acute and enduring states of cardiac arousal. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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31
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Quadt L, Esposito G, Critchley HD, Garfinkel SN. Brain-body interactions underlying the association of loneliness with mental and physical health. Neurosci Biobehav Rev 2020; 116:283-300. [DOI: 10.1016/j.neubiorev.2020.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
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Herman AM, Critchley HD, Duka T. Trait Impulsivity Associated With Altered Resting-State Functional Connectivity Within the Somatomotor Network. Front Behav Neurosci 2020; 14:111. [PMID: 32670033 PMCID: PMC7326939 DOI: 10.3389/fnbeh.2020.00111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/05/2020] [Indexed: 12/26/2022] Open
Abstract
Knowledge of brain mechanisms underlying self-regulation can provide valuable insights into how people regulate their thoughts, behaviors, and emotional states, and what happens when such regulation fails. Self-regulation is supported by coordinated interactions of brain systems. Hence, behavioral dysregulation, and its expression as impulsivity, can be usefully characterized using functional connectivity methodologies applied to resting brain networks. The current study tested whether individual differences in trait impulsivity are reflected in the functional architecture within and between resting-state brain networks. Thirty healthy individuals completed a self-report measure of trait impulsivity and underwent resting-state functional magnetic resonance imaging. Using Probabilistic Independent Components Analysis in FSL MELODIC, we identified across participants 10 networks of regions (resting-state networks) with temporally correlated time courses. We then explored how individual expression of these spatial networks covaried with trait impulsivity. Across participants, we observed that greater self-reported impulsivity was associated with decreased connectivity of the right lateral occipital cortex (peak mm 46/-70/16, FWE 1-p = 0.981) with the somatomotor network. No supratheshold differences were observed in between-network connectivity. Our findings implicate the somatomotor network, and its interaction with sensory cortices, in the control of (self-reported) impulsivity. The observed “decoupling” may compromise effective integration of early perceptual information (from visual and somatosensory cortices) with behavioral control programs, potentially resulting in negative consequences.
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Affiliation(s)
- Aleksandra M Herman
- Department of Psychology, Royal Holloway, University of London, Egham, United Kingdom.,Behavioural and Clinical Neuroscience, University of Sussex, Brighton, United Kingdom
| | - Hugo D Critchley
- Brighton and Sussex Medical School, Brighton, United Kingdom.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Theodora Duka
- Behavioural and Clinical Neuroscience, University of Sussex, Brighton, United Kingdom.,Sussex Addiction Research and Intervention Centre, Brighton, United Kingdom
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33
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De Pirro S, Lush P, Parkinson J, Duka T, Critchley HD, Badiani A. Effect of alcohol on the sense of agency in healthy humans. Addict Biol 2020; 25:e12796. [PMID: 31222868 DOI: 10.1111/adb.12796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
Even at low to moderate doses, ingestion of the widely used recreational drug alcohol (ethanol) can impact cognitive and emotional processing. Recent studies show that the sense of agency (SoA; ie, the subjective experience of voluntary control over actions) can be modulated by specific pharmacological manipulations. The SoA, as quantified by the intentional binding (IB) paradigm, is enhanced by direct or indirect dopaminergic agonists in patients with Parkinson's disease and by ketamine (an N-methyl-D-aspartate (NMDA) receptor antagonist) in healthy individuals. These findings implicate dopaminergic and glutamatergic neurotransmission in mechanisms underlying SoA. Alcohol has a complex set of actions, including disinhibition of dopaminergic neurotransmission and allosteric antagonism at NMDA receptors. Here, we tested the hypothesis that low to moderate doses of alcohol would enhance SoA, and impact impulsivity and subjective emotional state. We conducted two experiments in 59 healthy male and female social drinkers, who ingested either a placebo "vehicle," or one of two doses of ethanol: 0.4 and 0.6 g/kg. In both experiments, we observed increased SoA/IB at both doses of alcohol exposure, relative to the placebo condition. We found no correlation between the effects of alcohol on IB and on impulsivity or subjective emotional state. Our findings might have implications for social and legal responsibility related to alcohol use, particularly in states prior to overt intoxication. Further studies are necessary to investigate the effects of alcohol and other addictive substances on the SoA.
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Affiliation(s)
- Silvana De Pirro
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology University of Sussex Brighton UK
- Sussex Neuroscience University of Sussex Brighton UK
- Department of Physiology and Pharmacology Sapienza University of Rome Rome Italy
| | - Peter Lush
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology University of Sussex Brighton UK
- Sackler Centre for Consciousness Science University of Sussex Brighton UK
| | - Jim Parkinson
- Sackler Centre for Consciousness Science University of Sussex Brighton UK
| | - Theodora Duka
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology University of Sussex Brighton UK
- Sussex Neuroscience University of Sussex Brighton UK
| | - Hugo D. Critchley
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology University of Sussex Brighton UK
- Sussex Neuroscience University of Sussex Brighton UK
- Sackler Centre for Consciousness Science University of Sussex Brighton UK
| | - Aldo Badiani
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology University of Sussex Brighton UK
- Sussex Neuroscience University of Sussex Brighton UK
- Department of Physiology and Pharmacology Sapienza University of Rome Rome Italy
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Rae CL, Gierski F, Smith KW, Nikolaou K, Davies A, Critchley HD, Naassila M, Duka T. Differential brain responses for perception of pain during empathic response in binge drinkers compared to non-binge drinkers. Neuroimage Clin 2020; 27:102322. [PMID: 32645662 PMCID: PMC7338615 DOI: 10.1016/j.nicl.2020.102322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022]
Abstract
We measure empathic responses to imagery pain while adopting a ‘self’ vs ‘other’ perspective. Social drinkers who binge drink respond more slowly to imagery pain than those who do not. Binge drinkers show also stronger activation in fusiform body area to imagery pain ‘other’ Differences between binge and non-binge drinkers relate to ‘self’ vs. ‘other’ distinction.
Individuals who engage in binge drinking behaviors may show evidence of impaired cognitive function and emotional dysregulation. Impaired empathy, characterized by a reduced ability to understand and respond appropriately to feelings of others, is increasingly recognized for its role in Alcohol Use Disorders (AUD). The present study examined a population of young adult social drinkers to compare individuals who show binge drinking behavior to those who do not on measures of empathic processing and associated neural responses. A secondary aim explored similarities and differences between binge drinkers living in the UK and France. Alcohol drinking history and impulsivity ratings were recorded from seventy-one participants [(37 UK (Binge drinkers N = 19); 34 France (Binge drinkers N = 17)], who then underwent a neuroimaging study. During functional magnetic resonance imaging, participants viewed images of bodily pain (vs. no-pain), while adopting the perspective of self (pain recipient) or other (observer of someone else experiencing pain). Anterior midcingulate cortex (aMCC) and insula activation distinguished pain from no-pain conditions. Binge drinkers showed stronger regional neural activation than non-binge drinkers within a cluster spanning fusiform gyrus and inferior temporal gyrus, encompassing the Fusiform Body Area. Binge drinkers compared to non-binge drinkers also took longer to respond when viewing pictures depicting pain, in particular when adopting the perspective of self. Relationships between changes in brain activation and behavioural responses in pain versus no pain conditions (self or other perspective) indicated that whereas non-binge drinkers engage areas supporting self to other distinction, binge drinkers do not. Our findings suggest that alcohol binge drinking is associated with different empathy-related behavioral and brain responses, consistent with the proposed importance of empathy in the development of AUD.
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Affiliation(s)
- Charlotte L Rae
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, United Kingdom; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, United Kingdom; Sackler Centre for Consciousness Science, University of Sussex, United Kingdom
| | - Fabien Gierski
- Cognition, Health, Society Laboratory (C2S, EA6291), University of Reims Champagne Ardenne, Reims, France; Groupe de Recherche sur l'Alcool et les Pharmacodépendances, Equipe Région INSERM 24, Université de Picardie Jules Verne, Amiens, France
| | - Kathleen W Smith
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, United Kingdom; Groupe de Recherche sur l'Alcool et les Pharmacodépendances, Equipe Région INSERM 24, Université de Picardie Jules Verne, Amiens, France
| | - Kyriaki Nikolaou
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, United Kingdom; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, United Kingdom
| | - Amy Davies
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, United Kingdom; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, United Kingdom
| | - Hugo D Critchley
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, United Kingdom; Sackler Centre for Consciousness Science, University of Sussex, United Kingdom; Psychiatry, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Mickaël Naassila
- Groupe de Recherche sur l'Alcool et les Pharmacodépendances, Equipe Région INSERM 24, Université de Picardie Jules Verne, Amiens, France
| | - Theodora Duka
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, United Kingdom; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, United Kingdom.
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Witchel HJ, Thompson GA, Jones CI, Westling CEI, Romero J, Nicotra A, Maag B, Critchley HD. Spelling Errors and Shouting Capitalization Lead to Additive Penalties to Trustworthiness of Online Health Information: Randomized Experiment With Laypersons. J Med Internet Res 2020; 22:e15171. [PMID: 32519676 PMCID: PMC7315370 DOI: 10.2196/15171] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The written format and literacy competence of screen-based texts can interfere with the perceived trustworthiness of health information in online forums, independent of the semantic content. Unlike in professional content, the format in unmoderated forums can regularly hint at incivility, perceived as deliberate rudeness or casual disregard toward the reader, for example, through spelling errors and unnecessary emphatic capitalization of whole words (online shouting). OBJECTIVE This study aimed to quantify the comparative effects of spelling errors and inappropriate capitalization on ratings of trustworthiness independently of lay insight and to determine whether these changes act synergistically or additively on the ratings. METHODS In web-based experiments, 301 UK-recruited participants rated 36 randomized short stimulus excerpts (in the format of information from an unmoderated health forum about multiple sclerosis) for trustworthiness using a semantic differential slider. A total of 9 control excerpts were compared with matching error-containing excerpts. Each matching error-containing excerpt included 5 instances of misspelling, or 5 instances of inappropriate capitalization (shouting), or a combination of 5 misspelling plus 5 inappropriate capitalization errors. Data were analyzed in a linear mixed effects model. RESULTS The mean trustworthiness ratings of the control excerpts ranged from 32.59 to 62.31 (rating scale 0-100). Compared with the control excerpts, excerpts containing only misspellings were rated as being 8.86 points less trustworthy, those containing inappropriate capitalization were rated as 6.41 points less trustworthy, and those containing the combination of misspelling and capitalization were rated as 14.33 points less trustworthy (P<.001 for all). Misspelling and inappropriate capitalization show an additive effect. CONCLUSIONS Distinct indicators of incivility independently and additively penalize the perceived trustworthiness of online text independently of lay insight, eliciting a medium effect size.
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Affiliation(s)
- Harry J Witchel
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Georgina A Thompson
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Christopher I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Carina E I Westling
- Faculty of Media and Communication, Bournemouth University, Bournemouth, United Kingdom
| | | | | | | | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
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Koreki A, Garfkinel SN, Mula M, Agrawal N, Cope S, Eilon T, Gould Van Praag C, Critchley HD, Edwards M, Yogarajah M. Trait and state interoceptive abnormalities are associated with dissociation and seizure frequency in patients with functional seizures. Epilepsia 2020; 61:1156-1165. [PMID: 32501547 PMCID: PMC7737228 DOI: 10.1111/epi.16532] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Dissociative traits represent a disturbance in selfhood that may predispose to, and trigger, functional seizures (FSs). The predictive representation and control of the internal physiological state of the body (interoception) are proposed to underpin the integrity of the sense of self ("minimal selfhood"). Therefore, discrepancies between objective and subjective aspects of interoception may relate to symptom expression in patients with FSs. Here, we tested whether individual differences in trait measures of interoception relate to dissociative symptoms, and whether state interoceptive deficits predict FS occurrence. METHODS Forty-one participants with FSs and 30 controls completed questionnaire ratings of dissociation, and measures of (1) interoceptive accuracy (IA)-objective performance on heartbeat detection tasks; (2) trait interoceptive sensibility-subjective sensitivity to internal sensations (using the Porges Body Perception Questionnaire); and (3) state interoceptive sensibility-subjective trial-by-trial measures of confidence in heartbeat detection. Interoceptive trait prediction error (ITPE) was calculated from the discrepancy between IA and trait sensibility, and interoceptive state prediction error (ISPE) from the discrepancy between IA and state sensibility. RESULTS Patients with FSs had significantly lower IA and greater trait interoceptive sensibility than healthy controls. ITPE was the strongest predictor of dissociation after controlling for trait anxiety and depression in a regression model. ISPE correlated significantly with FS frequency after controlling for state anxiety. SIGNIFICANCE Patients with FSs have disturbances in interoceptive processing that predict both dissociative traits reflecting the disrupted integrity of self-representation, and the expression of FSs. These findings provide insight into the pathophysiology of functional neurological disorder, and could lead to novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Akihiro Koreki
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Department of NeuropsychiatryNational Hospital Organization Shimofusa Psychiatric Medical CenterChibaJapan
| | - Sarah N. Garfkinel
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
| | - Marco Mula
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Niruj Agrawal
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Sarah Cope
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Talia Eilon
- Department of NeuropsychiatrySouth West London and St George's Mental Health TrustLondonUK
| | - Cassandra Gould Van Praag
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Hugo D. Critchley
- Brighton and Sussex Medical School and The Sackler Centre for Consciousness ScienceUniversity of SussexSussexUK
| | - Mark Edwards
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
| | - Mahinda Yogarajah
- Neurosciences Research CentreSt George's University of LondonLondonUK
- Atkinson Morley Regional Neuroscience CentreSt George's HospitalLondonUK
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Abstract
Advances in digital technology have a profound impact on conventional healthcare systems. We examine the trailblazing use of online interventions to enable autonomous psychological care which can greatly enhance individual- and population-level access to services. There is strong evidence supporting online cognitive-behavioural therapy and more engaging programmes are now appearing so as to reduce user 'attrition'. The next generation of autonomous psychotherapy programmes will implement adaptive and personalised responses, moving beyond impersonalised advice on cognitive and behavioural techniques. This will be a more authentic form of psychotherapy that integrates therapy with the actual relationship experiences of the individual user.
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Affiliation(s)
| | | | - Sanaz Fallahkhair
- School of Computing Engineering and Maths, University of Brighton, UK
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38
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Turnbull A, Garfinkel SN, Ho NSP, Critchley HD, Bernhardt BC, Jefferies E, Smallwood J. Word up - Experiential and neurocognitive evidence for associations between autistic symptomology and a preference for thinking in the form of words. Cortex 2020; 128:88-106. [PMID: 32325277 DOI: 10.1016/j.cortex.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/06/2019] [Accepted: 02/06/2020] [Indexed: 01/08/2023]
Abstract
Autism symptomology has a profound impact on cognitive and affective functioning, yet we know relatively little about how it shapes patterns of ongoing thought. In an exploratory study in a large population of neurotypical individuals, we used experience sampling to characterise the relationship between ongoing cognition and self-reported autistic traits. We found that with increasing autistic symptom score, cognition was characterised by thinking more in words than images. Analysis of structural neuroimaging data found that autistic traits linked to social interaction were associated with greater cortical thickness in a region of lingual gyrus (LG) within the occipital cortex. Analysis of resting state functional neuroimaging data found autistic traits were associated with stronger connectivity between the LG and a region of motor cortex. Importantly, the strength of connectivity between the LG and motor cortex moderated the link between autistic symptoms and thinking in words: individuals showing higher connectivity showed a stronger association between autistic traits and thinking in words. Together we provide behavioural and neural evidence linking autistic traits to the tendency to think in words which may be rooted in underlying cortical organisation. These observations lay the groundwork for research into the form and content of self-generated thoughts in individuals with the established diagnosis of autism.
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Affiliation(s)
- Adam Turnbull
- Department of Psychology, University of York, York, United Kingdom.
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Nerissa S P Ho
- Department of Psychology, University of York, York, United Kingdom
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
| | - Boris C Bernhardt
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
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39
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Rae CL, Ahmad A, Larsson DEO, Silva M, Praag CDGV, Garfinkel SN, Critchley HD. Impact of cardiac interoception cues and confidence on voluntary decisions to make or withhold action in an intentional inhibition task. Sci Rep 2020; 10:4184. [PMID: 32144304 PMCID: PMC7060346 DOI: 10.1038/s41598-020-60405-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023] Open
Abstract
Interoceptive signals concerning the internal physiological state of the body influence motivational feelings and action decisions. Cardiovascular arousal may facilitate inhibition to mitigate risks of impulsive actions. Baroreceptor discharge at ventricular systole underpins afferent signalling of cardiovascular arousal. In a modified Go/NoGo task, decisions to make or withhold actions on 'Choose' trials were not influenced by cardiac phase, nor individual differences in heart rate variability. However, cardiac interoceptive awareness and insight predicted how frequently participants chose to act, and their speed of action: Participants with better awareness and insight tended to withhold actions and respond slower, while those with poorer awareness and insight tended to execute actions and respond faster. Moreover, self-reported trait urgency correlated negatively with intentional inhibition rates. These findings suggest that lower insight into bodily signals is linked to urges to move the body, putatively by engendering noisier sensory input into motor decision processes eliciting reactive behaviour.
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Affiliation(s)
- Charlotte L Rae
- School of Psychology, University of Sussex, Brighton, UK.
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.
| | - Aysha Ahmad
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton, UK
| | - Dennis E O Larsson
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton, UK
| | - Marta Silva
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton, UK
| | | | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton, UK
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK
- Department of Neuroscience, Brighton & Sussex Medical School, Brighton, UK
- Sussex Partnership NHS Foundation Trust, Brighton, UK
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40
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Makovac E, Fagioli S, Rae CL, Critchley HD, Ottaviani C. Can't get it off my brain: Meta-analysis of neuroimaging studies on perseverative cognition. Psychiatry Res Neuroimaging 2020; 295:111020. [PMID: 31790922 DOI: 10.1016/j.pscychresns.2019.111020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [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: 08/29/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022]
Abstract
Perseverative cognition (i.e. rumination and worry) describes intrusive, uncontrollable, repetitive thoughts. These negative affective experiences are accompanied by physiological arousal, as if the individual were facing an external stressor. Perseverative cognition is a transdiagnostic symptom, yet studies of neural mechanisms are largely restricted to specific clinical populations (e.g. patients with major depression). The present study applied activation likelihood estimation (ALE) meta-analyses to 43 functional neuroimaging studies of perseverative cognition to elucidate the neurobiological substrates across individuals with and without psychopathological conditions. Task-related and resting state functional connectivity studies were examined in separate meta-analyses. Across task-based studies, perseverative cognition engaged medial frontal gyrus, cingulate gyrus, insula, and posterior cingulate cortex. Resting state functional connectivity studies similarly implicated posterior cingulate cortex together with thalamus and anterior cingulate cortex (ACC), yet the involvement of ACC distinguished between perseverative cognition in healthy controls (HC) and clinical groups. Perseverative cognition is accompanied by the engagement of prefrontal, insula and cingulate regions, whose interaction may support the characteristic conjunction of self-referential and affective processing with (aberrant) cognitive control and embodied (autonomic) arousal. Within this context, ACC engagement appears critical for the pathological expression of rumination and worry.
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Affiliation(s)
- Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK.
| | - Sabrina Fagioli
- Department of Education, University of Roma Tre, Rome, Italy; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Charlotte L Rae
- School of Psychology, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK; Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
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41
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Rae CL, Gierski F, Smith KW, Nikolaou K, Davies A, Critchley HD, Naassila M, Duka T. Corrigendum to “Differential brain responses for perception of pain during empathic response in binge drinkers compared to non-binge drinkers” [Neuroimage Clin., 27 (2020) 1–11/102322]. NeuroImage: Clinical 2020; 28:102448. [DOI: 10.1016/j.nicl.2020.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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42
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Mulcahy JS, Larsson DEO, Garfinkel SN, Critchley HD. Heart rate variability as a biomarker in health and affective disorders: A perspective on neuroimaging studies. Neuroimage 2019; 202:116072. [PMID: 31386920 DOI: 10.1016/j.neuroimage.2019.116072] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 12/30/2022] Open
Abstract
The dynamic embodiment of psychological processes is evident in the association of health outcomes, behavioural traits and psychological functioning with Heart Rate Variability (HRV). The dominant high-frequency component of HRV is an index of the central neural control of heart rhythm, mediated via the parasympathetic vagus nerve. HRV provides a potential objective measure of action policies for the adaptive and predictive allostatic regulation of homeostasis within the cardiovascular system. In its support, a network of brain regions (referred to as the 'central autonomic network') maps internal state, and controls autonomic responses. This network includes regions of prefrontal cortex, anterior cingulate cortex, insula, amygdala, periaqueductal grey, pons and medulla. Human neuroimaging studies of neural activation and functional connectivity broadly endorse this architecture, and its link with cardiac regulation at rest and dysregulation in clinical states that include affective disorders. In this review, we appraise neuroimaging research and related evidence for HRV as an informative marker of autonomic integration with affect and cognition, taking a perspective on function and organisation. We consider evidence for the utility of HRV as a metric to inform targeted interventions to improve autonomic and affective dysregulation, and suggest research questions for further investigation.
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Affiliation(s)
- James S Mulcahy
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK.
| | | | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, BN1 9RR, UK; Sussex Partnership NHS Foundation Trust, Brighton, BN2 3EW, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, BN1 9RR, UK; Sussex Partnership NHS Foundation Trust, Brighton, BN2 3EW, UK
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43
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Sethi A, Voon V, Critchley HD, Cercignani M, Harrison NA. A neurocomputational account of reward and novelty processing and effects of psychostimulants in attention deficit hyperactivity disorder. Brain 2019; 141:1545-1557. [PMID: 29547978 PMCID: PMC5917772 DOI: 10.1093/brain/awy048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/06/2018] [Indexed: 01/01/2023] Open
Abstract
Computational models of reinforcement learning have helped dissect discrete components of reward-related function and characterize neurocognitive deficits in psychiatric illnesses. Stimulus novelty biases decision-making, even when unrelated to choice outcome, acting as if possessing intrinsic reward value to guide decisions toward uncertain options. Heightened novelty seeking is characteristic of attention deficit hyperactivity disorder, yet how this influences reward-related decision-making is computationally encoded, or is altered by stimulant medication, is currently uncertain. Here we used an established reinforcement-learning task to model effects of novelty on reward-related behaviour during functional MRI in 30 adults with attention deficit hyperactivity disorder and 30 age-, sex- and IQ-matched control subjects. Each participant was tested on two separate occasions, once ON and once OFF stimulant medication. OFF medication, patients with attention deficit hyperactivity disorder showed significantly impaired task performance (P = 0.027), and greater selection of novel options (P = 0.004). Moreover, persistence in selecting novel options predicted impaired task performance (P = 0.025). These behavioural deficits were accompanied by a significantly lower learning rate (P = 0.011) and heightened novelty signalling within the substantia nigra/ventral tegmental area (family-wise error corrected P < 0.05). Compared to effects in controls, stimulant medication improved attention deficit hyperactivity disorder participants' overall task performance (P = 0.011), increased reward-learning rates (P = 0.046) and enhanced their ability to differentiate optimal from non-optimal novel choices (P = 0.032). It also reduced substantia nigra/ventral tegmental area responses to novelty. Preliminary cross-sectional evidence additionally suggested an association between long-term stimulant treatment and a reduction in the rewarding value of novelty. These data suggest that aberrant substantia nigra/ventral tegmental area novelty processing plays an important role in the suboptimal reward-related decision-making characteristic of attention deficit hyperactivity disorder. Compared to effects in controls, abnormalities in novelty processing and reward-related learning were improved by stimulant medication, suggesting that they may be disorder-specific targets for the pharmacological management of attention deficit hyperactivity disorder symptoms.
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Affiliation(s)
- Arjun Sethi
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Mara Cercignani
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Neil A Harrison
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sackler Centre for Consciousness Science, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
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44
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Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G, Wenderoth N, Lutterotti A, Müller A, Stephan KE. Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:642-651. [PMID: 30683707 PMCID: PMC6581095 DOI: 10.1136/jnnp-2018-320050] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
Fatigue is one of the most common symptoms in multiple sclerosis (MS), with a major impact on patients' quality of life. Currently, treatment proceeds by trial and error with limited success, probably due to the presence of multiple different underlying mechanisms. Recent neuroscientific advances offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. However, development of these tools for differential diagnosis will require guidance by pathophysiological and cognitive theories that propose mechanisms which can be assessed in individual patients. This article provides an overview of contemporary pathophysiological theories of fatigue in MS and discusses how the mechanisms they propose may become measurable with emerging technologies and thus lay a foundation for future personalised treatments.
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Affiliation(s)
- Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland .,Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Neil A Harrison
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Cao Tri Do
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Gabor Stefanics
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research (SNS), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Nicole Wenderoth
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Andreas Lutterotti
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Alfred Müller
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Max Planck Institute for Metabolism Research, Cologne, Germany
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45
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Makovac E, Fagioli S, Watson DR, Meeten F, Smallwood J, Critchley HD, Ottaviani C. Response time as a proxy of ongoing mental state: A combined fMRI and pupillometry study in Generalized Anxiety Disorder. Neuroimage 2019; 191:380-391. [DOI: 10.1016/j.neuroimage.2019.02.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/27/2023] Open
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46
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Rae CL, Critchley HD, Seth AK. A Bayesian Account of the Sensory-Motor Interactions Underlying Symptoms of Tourette Syndrome. Front Psychiatry 2019; 10:29. [PMID: 30890965 PMCID: PMC6412155 DOI: 10.3389/fpsyt.2019.00029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
Tourette syndrome is a hyperkinetic movement disorder. Characteristic features include tics, recurrent movements that are experienced as compulsive and "unwilled"; uncomfortable premonitory sensations that resolve through tic release; and often, the ability to suppress tics temporarily. We demonstrate how these symptoms and features can be understood in terms of aberrant predictive (Bayesian) processing in hierarchical neural systems, explaining specifically: why tics arise, their "unvoluntary" nature, how premonitory sensations emerge, and why tic suppression works-sometimes. In our model, premonitory sensations and tics are generated through over-precise priors for sensation and action within somatomotor regions of the striatum. Abnormally high precision of priors arises through the dysfunctional synaptic integration of cortical inputs. These priors for sensation and action are projected into primary sensory and motor areas, triggering premonitory sensations and tics, which in turn elicit prediction errors for unexpected feelings and movements. We propose experimental paradigms to validate this Bayesian account of tics. Our model integrates behavioural, neuroimaging, and computational approaches to provide mechanistic insight into the pathophysiological basis of Tourette syndrome.
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Affiliation(s)
- Charlotte L. Rae
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Hugo D. Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Anil K. Seth
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- School of Engineering and Informatics, University of Sussex, Brighton, United Kingdom
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47
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Carnevali L, Mancini M, Koenig J, Makovac E, Watson DR, Meeten F, Critchley HD, Ottaviani C. Cortical morphometric predictors of autonomic dysfunction in generalized anxiety disorder. Auton Neurosci 2019; 217:41-48. [DOI: 10.1016/j.autneu.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/03/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022]
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48
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Herman AM, Rae CL, Critchley HD, Duka T. Interoceptive accuracy predicts nonplanning trait impulsivity. Psychophysiology 2019; 56:e13339. [DOI: 10.1111/psyp.13339] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/01/2018] [Accepted: 12/30/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Aleksandra M. Herman
- Behavioural and Clinical Neuroscience School of Psychology, University of Sussex Brighton United Kingdom
- Sussex Addiction and Intervention Centre University of Sussex Brighton United Kingdom
| | - Charlotte L. Rae
- Sackler Centre for Consciousness Science University of Sussex Brighton United Kingdom
- Department of Neuroscience Brighton and Sussex Medical School Brighton United Kingdom
| | - Hugo D. Critchley
- Sackler Centre for Consciousness Science University of Sussex Brighton United Kingdom
- Department of Neuroscience Brighton and Sussex Medical School Brighton United Kingdom
- Sussex Partnership, NHS Foundation Trust Brighton United Kingdom
| | - Theodora Duka
- Behavioural and Clinical Neuroscience School of Psychology, University of Sussex Brighton United Kingdom
- Sussex Addiction and Intervention Centre University of Sussex Brighton United Kingdom
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Makovac E, Mancini M, Fagioli S, Watson DR, Meeten F, Rae CL, Critchley HD, Ottaviani C. Network abnormalities in generalized anxiety pervade beyond the amygdala-pre-frontal cortex circuit: Insights from graph theory. Psychiatry Res Neuroimaging 2018; 281:107-116. [PMID: 30290286 DOI: 10.1016/j.pscychresns.2018.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/04/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/30/2022]
Abstract
Generalized anxiety disorder (GAD) has excessive anxiety and uncontrollable worry as core symptoms. Abnormal cerebral functioning underpins the expression and perhaps pathogenesis of GAD:. Studies implicate impaired communication between the amygdala and the pre-frontal cortex (PFC). Our aim was to longitudinally investigate whether such network abnormalities are spatially restricted to this circuit or if the integrity of functional brain networks is globally disrupted in GAD. We acquired resting-state functional magnetic resonance imaging data from 16 GAD patients and 16 matched controls at baseline and after 1 year. Using network modeling and graph-theory, whole-brain connectivity was characterized from local and global perspectives. Overall lower global efficiency, indicating sub-optimal brain-wide organization and integration, was present in patients with GAD compared to controls. The amygdala and midline cortices showed higher betweenness centrality, reflecting functional dominance of these brain structures. Third, lower betweenness centrality and lower degree emerged for PFC, suggesting weakened inhibitory control. Overall, network organization showed impairments consistent with neurobiological models of GAD (involving amygdala, PFC, and cingulate cortex) and further pointed to an involvement of temporal regions. Such impairments tended to progress over time and predict anxiety symptoms. A graph-analytic approach represents a powerful approach to deepen our understanding of GAD.
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Affiliation(s)
- Elena Makovac
- Centre for Neuroimaging Science, Kings College London, London, UK; Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Mancini
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Centre for Medical Image Computing, University College London, London, UK
| | - Sabrina Fagioli
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Education, University of Roma Tre, Rome, Italy
| | - David R Watson
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Frances Meeten
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Department of Psychology, Kings College London, London, UK
| | - Charlotte L Rae
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK
| | - Hugo D Critchley
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK; Psychiatry, BSMS Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy.
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Rae CL, Polyanska L, Gould van Praag CD, Parkinson J, Bouyagoub S, Nagai Y, Seth AK, Harrison NA, Garfinkel SN, Critchley HD. Face perception enhances insula and motor network reactivity in Tourette syndrome. Brain 2018; 141:3249-3261. [PMID: 30346484 PMCID: PMC6202569 DOI: 10.1093/brain/awy254] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 05/08/2018] [Revised: 07/24/2018] [Accepted: 08/15/2018] [Indexed: 11/25/2022] Open
Abstract
Tourette syndrome is a neurodevelopmental disorder, characterized by motor and phonic tics. Tics are typically experienced as avolitional, compulsive, and associated with premonitory urges. They are exacerbated by stress and can be triggered by external stimuli, including social cues like the actions and facial expressions of others. Importantly, emotional social stimuli, with angry facial stimuli potentially the most potent social threat cue, also trigger behavioural reactions in healthy individuals, suggesting that such mechanisms may be particularly sensitive in people with Tourette syndrome. Twenty-one participants with Tourette syndrome and 21 healthy controls underwent functional MRI while viewing faces wearing either neutral or angry expressions to quantify group differences in neural activity associated with processing social information. Simultaneous video recordings of participants during neuroimaging enabled us to model confounding effects of tics on task-related responses to the processing of faces. In both Tourette syndrome and control participants, face stimuli evoked enhanced activation within canonical face perception regions, including the occipital face area and fusiform face area. However, the Tourette syndrome group showed additional responses within the anterior insula to both neutral and angry faces. Functional connectivity during face viewing was then examined in a series of psychophysiological interactions. In participants with Tourette syndrome, the insula showed functional connectivity with a set of cortical regions previously implicated in tic generation: the presupplementary motor area, premotor cortex, primary motor cortex, and the putamen. Furthermore, insula functional connectivity with the globus pallidus and thalamus varied in proportion to tic severity, while supplementary motor area connectivity varied in proportion to premonitory sensations, with insula connectivity to these regions increasing to a greater extent in patients with worse symptom severity. In addition, the occipital face area showed increased functional connectivity in Tourette syndrome participants with posterior cortical regions, including primary somatosensory cortex, and occipital face area connectivity with primary somatosensory and primary motor cortices varied in proportion to tic severity. There were no significant psychophysiological interactions in controls. These findings highlight a potential mechanism in Tourette syndrome through which heightened representation within insular cortex of embodied affective social information may impact the reactivity of subcortical motor pathways, supporting programmed motor actions that are causally implicated in tic generation. Medicinal and psychological therapies that focus on reducing insular hyper-reactivity to social stimuli may have potential benefit for tic reduction in people with Tourette syndrome.
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Affiliation(s)
- Charlotte L Rae
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Liliana Polyanska
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Cassandra D Gould van Praag
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Department of Psychiatry, University of Oxford, UK
| | - Jim Parkinson
- Sackler Centre for Consciousness Science, University of Sussex, UK
- School of Psychology, University of Sussex, UK
| | - Samira Bouyagoub
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Yoko Nagai
- Department of Neuroscience, Brighton and Sussex Medical School, UK
| | - Anil K Seth
- Sackler Centre for Consciousness Science, University of Sussex, UK
- School of Engineering and Informatics, University of Sussex, UK
| | - Neil A Harrison
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Sarah N Garfinkel
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, UK
- Department of Neuroscience, Brighton and Sussex Medical School, UK
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