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1.
Mol Psychiatry ; 22(10): 1431-1439, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28167838

RESUMEN

The molecular genetics of panic disorder (PD) with and without agoraphobia (AG) are still largely unknown and progress is hampered by small sample sizes. We therefore performed a genome-wide association study with a dimensional, PD/AG-related anxiety phenotype based on the Agoraphobia Cognition Questionnaire (ACQ) in a sample of 1370 healthy German volunteers of the CRC TRR58 MEGA study wave 1. A genome-wide significant association was found between ACQ and single non-coding nucleotide variants of the GLRB gene (rs78726293, P=3.3 × 10-8; rs191260602, P=3.9 × 10-8). We followed up on this finding in a larger dimensional ACQ sample (N=2547) and in independent samples with a dichotomous AG phenotype based on the Symptoms Checklist (SCL-90; N=3845) and a case-control sample with the categorical phenotype PD/AG (Ncombined =1012) obtaining highly significant P-values also for GLRB single-nucleotide variants rs17035816 (P=3.8 × 10-4) and rs7688285 (P=7.6 × 10-5). GLRB gene expression was found to be modulated by rs7688285 in brain tissue, as well as cell culture. Analyses of intermediate PD/AG phenotypes demonstrated increased startle reflex and increased fear network, as well as general sensory activation by GLRB risk gene variants rs78726293, rs191260602, rs17035816 and rs7688285. Partial Glrb knockout mice demonstrated an agoraphobic phenotype. In conjunction with the clinical observation that rare coding GLRB gene mutations are associated with the neurological disorder hyperekplexia characterized by a generalized startle reaction and agoraphobic behavior, our data provide evidence that non-coding, although functional GLRB gene polymorphisms may predispose to PD by increasing startle response and agoraphobic cognitions.


Asunto(s)
Agorafobia/genética , Agorafobia/metabolismo , Receptores de Glicina/genética , Adulto , Alelos , Ansiedad/complicaciones , Trastornos de Ansiedad/genética , Encéfalo/metabolismo , Encéfalo/fisiología , Estudios de Casos y Controles , Cognición/fisiología , Miedo/fisiología , Miedo/psicología , Femenino , Frecuencia de los Genes/genética , Predisposición Genética a la Enfermedad/genética , Estudio de Asociación del Genoma Completo , Genotipo , Alemania , Humanos , Masculino , Mutación/genética , Trastorno de Pánico/genética , Receptores de Glicina/metabolismo , Reflejo de Sobresalto/genética
2.
Eur Arch Psychiatry Clin Neurosci ; 267(8): 767-779, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28337537

RESUMEN

Previous studies suggest an inhibitory top-down control of the amygdala by the prefrontal cortex (PFC). Both brain regions play a role in the modulation of prepulse modification (PPM) of the acoustic startle response by a pre-stimulus. Repetitive transcranial magnetic stimulation (rTMS) can modulate the activity of the PFC and might thus affect PPM. This study tested the effect of inhibitory rTMS on PPM accounting for a genetic variant of the dopamine transporter gene (DAT1). Healthy participants (N = 102) were stimulated with continuous theta burst stimulation (cTBS, an intense form of inhibitory rTMS) or sham treatment over the right PFC. Afterwards, during continuous presentation of a background white noise a louder noise burst was presented either alone (control startle) or preceded by a prepulse. Participants were genotyped for a DAT1 variable number tandem repeat (VNTR) polymorphism. Two succeeding sessions of cTBS over the right PFC (2 × 600 stimuli with a time lag of 15 min) attenuated averaged prepulse inhibition (PPI) in participants with a high resting motor threshold. An attenuation of PPI induced by prepulses with great distances to the pulse (480, 2000 ms) was observed following active cTBS in participants that were homozygous carriers of the 10-repeat-allele of the DAT1 genotype and had a high resting motor threshold. Our results confirm the importance of the prefrontal cortex for the modulation of PPM. The effects were observed in participants with a high resting motor threshold only, probably because they received a higher dose of cTBS. The effects in homozygous carriers of the DAT1 10-repeat allele confirm the relevance of dopamine for PPM. Conducting an exploratory study we decided against the use of a correction for multiple testing.


Asunto(s)
Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/genética , Potenciales Evocados Motores/fisiología , Corteza Prefrontal/fisiología , Inhibición Prepulso/fisiología , Reflejo de Sobresalto/fisiología , Ritmo Teta/fisiología , Estimulación Magnética Transcraneal/métodos , Adulto , Femenino , Genotipo , Humanos , Masculino , Repeticiones de Minisatélite , Polimorfismo Genético , Adulto Joven
3.
Nervenarzt ; 87(9): 1017-29, 2016 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-27531211

RESUMEN

Late-onset depression (LOD) is defined as depression manifesting for the first time in later life. Up to now, there has been no exact definition of the lower age limit for LOD. Psychopathological symptoms of LOD do not fundamentally differ from depression in other phases of life; however, cognitive deficits are typically more pronounced. The LOD is associated with an increased risk of developing dementia. Imaging studies show reduction in gray matter volume and white matter lesions caused by vascular diseases. The occurrence of depression with vascular lesions of the brain is also referred to as "vascular depression". The diagnostic procedure includes a detailed medical history and the observation of psychopathological changes, physical examination, laboratory tests, electroencephalograph (EEG), electrocardiograph (ECG) and magnetic resonance imaging (MRI) of the head and neuropsychological tests to measure cognitive deficits. Psychotherapy is an effective treatment option. Selective serotonin reuptake inhibitors are the first-line pharmacological therapy.


Asunto(s)
Depresión/diagnóstico , Depresión/terapia , Técnicas de Diagnóstico Neurológico , Evaluación Geriátrica/métodos , Enfermedades de Inicio Tardío/diagnóstico , Enfermedades de Inicio Tardío/terapia , Anciano , Anciano de 80 o más Años , Terapia Combinada/métodos , Depresión/psicología , Femenino , Humanos , Enfermedades de Inicio Tardío/psicología , Masculino , Persona de Mediana Edad , Examen Físico/métodos , Psicoterapia/métodos , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico
4.
Nervenarzt ; 86(7): 840-4, 2015 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-25777131

RESUMEN

BACKGROUND: In medical ethics there is broad agreement that patients should be empowered to make autonomous decisions about their health and that objective, detailed information promotes these decisions. According to German law patients have a right of access to their own medical records. OBJECTIVES: Which advantages and disadvantages does the access to records have for doctors and patients in psychiatry? Which requirements should be met to make access reasonable for patients? MATERIAL AND METHODS: This article presents an analysis of the legal situation and the state of research, evaluation of empirical studies, discussion of features of psychiatry, its language and patients as well as their influence on access to medical records. RESULTS: Psychiatrists are sometimes concerned about patient access to medical records and some psychiatric patients feel upset or uncomfortable after having inspected their records. The misunderstanding and stigmatization of psychiatric terms, the vulnerability of psychiatric patients and the nature of psychiatric disorders, the description of which affects fundamental aspects of personality, all play a role in this. In addition, in having access to their records patients use a source of information that was originally written for other addressees. Information content and language are not adapted to their needs. Possible solutions could involve improvements in patient education and (stylistic) changes in writing records.


Asunto(s)
Acceso de los Pacientes a los Registros/ética , Acceso de los Pacientes a los Registros/legislación & jurisprudencia , Relaciones Médico-Paciente/ética , Psiquiatría/ética , Psiquiatría/legislación & jurisprudencia , Actitud del Personal de Salud , Alemania , Rol del Médico , Estereotipo
5.
Artículo en Inglés | MEDLINE | ID: mdl-28259723

RESUMEN

OBJECTIVE: Anxiety disorders are among the most frequent psychiatric disorders. Current treatment guidelines recommend antidepressants, the calcium modulator gabapentin, and benzodiazepines as pharmacological treatments. However, delayed onset of action precludes the use of antidepressants as an acute treatment, while benzodiazepines can be recommended only as an emergency treatment due to their inherent risk of dependence. Therefore, an alternative pharmacological agent with acute efficacy is needed. Preliminary evidence points towards possible anxiolytic properties of the atypical antipsychotic quetiapine. The goals of this study were to test the acute anxiolytic properties of quetiapine in patients suffering from arachnophobia in a challenge paradigm, and to assess the effects of quetiapine on the central nervous fear network. METHODS: In a randomized, double-blind, placebo-controlled proof-of-concept study, n=58 arachnophobic patients underwent an fMRI scan while looking at phobia-related and neutral stimuli. Subjective anxiety was evaluated retrospectively in questionnaires. RESULTS: The functional imaging data revealed that patients showed stronger amygdala activation to phobia-related than to neutral stimuli. However, no effect of quetiapine on fear network activity was detected. Further, on questionnaire measures, quetiapine significantly reduced somatic anxiety symptoms, but had no effect on general psychological anxiety. CONCLUSION: Viewing phobic pictures resulted in a robust amygdala activation in arachnophobic patients. Quetiapine seems to have no influence on activation in anxiety-related brain areas but appears to reduce acute somatic anxiety symptoms in patients with specific phobia. The central nervous correlates of the anxiolytic effects of quetiapine remain to be clarified in future studies.


Asunto(s)
Amígdala del Cerebelo/efectos de los fármacos , Amígdala del Cerebelo/fisiopatología , Ansiolíticos/farmacología , Antipsicóticos/farmacología , Trastornos Fóbicos/tratamiento farmacológico , Trastornos Fóbicos/fisiopatología , Fumarato de Quetiapina/farmacología , Adulto , Amígdala del Cerebelo/diagnóstico por imagen , Ansiolíticos/administración & dosificación , Antipsicóticos/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Trastornos Fóbicos/diagnóstico por imagen , Prueba de Estudio Conceptual , Fumarato de Quetiapina/administración & dosificación , Adulto Joven
6.
Behav Brain Res ; 307: 208-17, 2016 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-26996315

RESUMEN

A number of studies/meta-analyses reported moderate antidepressant effects of activating repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex (PFC). Regarding the treatment of anxiety, study outcomes are inconsistent, probably because of the heterogenity of anxiety disorders/study designs. To specifically evaluate the impact of rTMS on emotion regulation in fear-relevant situations we applied a sham-controlled activating protocol (intermittent Theta Burst Stimulation/iTBS) over the left PFC (F3) succeeded by a virtual reality (VR) challenge in n=41 participants with spider phobia and n=42 controls. Prior to/after iTBS and following VR prefrontal activation was assessed by functional near-infrared spectroscopy during an emotional Stroop paradigm. Performance (reaction times/error rates) was evaluated. Stimuli were rated regarding valence/arousal at both measurements. We found diminished activation in the left inferior frontal gyrus (IFG) of participants with spider phobia compared to controls, particularly elicited by emotionally-irrelevant words. Simultaneously, a functional connectivity analysis showed increased co-activation between the left IFG and the contra-lateral hemisphere. Behavioural performance was unimpaired. After iTBS/VR no significant differences in cortical activation between the phobic and control group remained. However, verum-iTBS did not cause an additional augmentation. We interpreted our results in terms of a prefrontal network which gets activated by emotionally-relevant stimuli and supports the maintenance of adequate behavioural reactions. The missing add-on effects of iTBS might be due to a ceiling effect of VR, thereby supporting its potential during exposure therapy. Concurrently, it implies that the efficient application of iTBS in the context of emotion regulation still needs to be studied further.


Asunto(s)
Miedo/psicología , Trastornos Fóbicos/terapia , Corteza Prefrontal/fisiología , Estimulación Magnética Transcraneal/métodos , Terapia de Exposición Mediante Realidad Virtual/métodos , Adolescente , Adulto , Análisis de Varianza , Animales , Mapeo Encefálico , Electroencefalografía , Femenino , Lateralidad Funcional , Humanos , Masculino , Trastornos Fóbicos/diagnóstico por imagen , Corteza Prefrontal/diagnóstico por imagen , Tiempo de Reacción , Método Simple Ciego , Espectroscopía Infrarroja Corta , Arañas , Adulto Joven
7.
World J Biol Psychiatry ; 17(1): 76-83, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26488131

RESUMEN

OBJECTIVES: Social anxiety has been suggested to be promoted by an insecure attachment style. Oxytocin is discussed as a mediator of trust and social bonding as well as a modulator of social anxiety. Applying a gene-environment (G × E) interaction approach, in the present pilot study the main and interactive effects of attachment styles and oxytocin receptor (OXTR) gene variation were probed in a combined risk factor model of social anxiety in healthy probands. METHODS: Participants (N = 388; 219 females, 169 males; age 24.7 ± 4.7 years) were assessed for anxiety in social situations (Social Phobia and Anxiety Inventory) depending on attachment style (Adult Attachment Scale, AAS) and OXTR rs53576 A/G genotype. RESULTS: A less secure attachment style was significantly associated with higher social anxiety. This association was partly modulated by OXTR genotype, with a stronger negative influence of a less secure attachment style on social anxiety in A allele carriers as compared to GG homozygotes. CONCLUSIONS: The present pilot data point to a strong association of less secure attachment and social anxiety as well as to a gene-environment interaction effect of OXTR rs53576 genotype and attachment style on social anxiety possibly constituting a targetable combined risk marker of social anxiety disorder.


Asunto(s)
Ansiedad/diagnóstico , Ansiedad/genética , Interacción Gen-Ambiente , Variación Genética , Apego a Objetos , Receptores de Oxitocina/genética , Adulto , Femenino , Genotipo , Alemania , Voluntarios Sanos , Humanos , Masculino , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Autoinforme , Adulto Joven
8.
Biol Psychol ; 112: 66-76, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26476332

RESUMEN

Preliminary evidence suggests beneficial effects of transcranial magnetic stimulation (TMS) on anxiety. The objective of this study was to investigate the effects of intermittent theta burst stimulation (iTBS) as a form of TMS on acute anxiety provoked by a virtual reality (VR) scenario. Participants with spider phobia (n=41) and healthy controls (n=42) were exposed to a spider scenario in VR after one session of iTBS over the prefrontal cortex or sham treatment. Participants with spider phobia reacted with more anxiety compared to healthy controls. Their heart rate and skin conductance increased compared to baseline. Contrary to expectations, iTBS did not influence these reactions, but modulated heart rate variability (HRV). Sympathetic influence on HRV showed an increase in the active iTBS group only. This study does not support the idea of beneficial effects of a single session of iTBS on anxiety, although other protocols or repeated sessions might be effective.


Asunto(s)
Trastornos Fóbicos/terapia , Corteza Prefrontal/fisiopatología , Ritmo Teta/fisiología , Estimulación Magnética Transcraneal/métodos , Adolescente , Adulto , Animales , Femenino , Respuesta Galvánica de la Piel/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Trastornos Fóbicos/fisiopatología , Método Simple Ciego , Arañas , Resultado del Tratamiento , Adulto Joven
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