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1.
Neurobiol Aging ; 101: 13-21, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33561786

RESUMO

Older adults with anxiety have lower gray matter brain volume-a component of accelerated aging. We have previously validated a machine learning model to predict brain age, an estimate of an individual's age based on voxel-wise gray matter images. We investigated associations between brain age and anxiety, depression, stress, and emotion regulation. We recruited 78 participants (≥50 years) along a wide range of worry severity. We collected imaging data and computed voxel-wise gray matter images, which were input into an existing machine learning model to estimate brain age. We conducted a multivariable linear regression between brain age and age, sex, race, education, worry, anxiety, depression, rumination, neuroticism, stress, reappraisal, and suppression. We found that greater brain age was significantly associated with greater age, male sex, greater worry, greater rumination, and lower suppression. Male sex, worry, and rumination are associated with accelerated aging in late life and expressive suppression may have a protective effect. These results provide evidence for the transdiagnostic model of negative repetitive thoughts, which are associated with cognitive decline, amyloid, and tau.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33563521
3.
4.
Am J Geriatr Psychiatry ; 28(12): 1308-1316, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33023798

RESUMO

OBJECTIVE: This study aimed to investigate the different clinical characteristics among elderly coronavirus disease 2019 (COVID-19) patients with and without mental disorders in South Korea and determine if these characteristics have an association with underlying mental disorders causing mortality. METHOD: A population-based comparative cohort study was conducted using the national claims database. Individuals aged ≥65 years with confirmed COVID-19 between January 1, 2020 and April 10, 2020 were assessed. The endpoints for evaluating mortality for all participants were death, 21 days after diagnosis, or April 10, 2020. The risk of mortality associated with mental disorders was estimated using Cox hazards regression. RESULTS: We identified 814 elderly COVID-19 patients (255 [31.3%] with mental disorder and 559 [68.7%] with nonmental disorder). Individuals with mental disorders were found more likely to be older, taking antithrombotic agents, and had diabetes, hypertension, chronic obstructive lung disease, and urinary tract infections than those without mental disorders. After propensity score stratification, our study included 781 patients in each group (236 [30.2%] with mental disorder and 545 [69.8%] with nonmental disorder). The mental disorder group showed higher mortality rates than the nonmental disorder group (12.7% [30/236] versus 6.8% [37/545]). However, compared to patients without mental disorders, the hazard ratio (HR) for mortality in elderly COVID-19 patients with mental disorders was not statistically significant (HR: 1.57, 95%CI: 0.95-2.56). CONCLUSION: Although the association between mental disorders in elderly individuals and mortality in COVID-19 is unclear, this study suggests that elderly patients with comorbid conditions and those taking psychiatric medications might be at a higher risk of COVID-19.


Assuntos
Infecções por Coronavirus , Transtornos Mentais , Pandemias , Pneumonia Viral , Idoso , Betacoronavirus , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/virologia , Saúde Mental/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco
5.
Hum Brain Mapp ; 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32596977

RESUMO

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.

6.
Adv Exp Med Biol ; 1191: 561-576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002946

RESUMO

Recent data has linked anxiety and its disorders in late life to increased morbidity and mortality, especially related to a higher cardiovascular burden and an increased cognitive decline. Clinically, anxiety symptoms may be more difficult to elicit in older adults who are less accurate in identifying anxiety symptoms and tend to minimize symptoms and to attribute symptoms to physical illness. Although SSRIs have proven more effective than psychotherapy in late-life anxiety, many elderly anxious subjects prefer psychotherapeutic interventions. These interventions appear to work best when tailored for the needs, expectations, and cultural background of older anxious subjects.


Assuntos
Transtornos de Ansiedade , Idoso , Ansiolíticos/uso terapêutico , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Doenças Cardiovasculares/complicações , Comorbidade , Humanos , Psicoterapia , Inibidores de Captação de Serotonina/uso terapêutico
7.
J Exp Psychol Gen ; 149(4): 732-745, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31414860

RESUMO

Close social bonds are critical to immediate and long-term well-being. However, the neurochemical mechanisms by which we remain connected to our closest loved ones are not well understood. Opioids have long been theorized to contribute to social bonding via their actions on the brain. But feelings of social connection toward one's own close others and direct comparisons of ventral striatum (VS) activity in response to close others and strangers, a neural correlate of social bonding, have not been explored. Therefore, the current clinical trial examined whether opioids causally affect neural and experiential signatures of social bonding. Eighty participants were administered naltrexone (n = 40), an opioid antagonist that blocks natural opioid processing, or placebo (n = 40) before completing a functional MRI scan where they viewed images of their close others and individuals they had not seen before (i.e., strangers). Feelings of social connection to the close others and physical symptoms commonly experienced when taking naltrexone were also collected. In support of hypotheses, naltrexone (vs. placebo) reduced feelings of social connection toward the close others (e.g., family, friends, romantic partners). Furthermore, naltrexone (vs. placebo) reduced left VS activity in response to images of the same close others, but did not alter left VS activity to strangers. Finally, the positive correlation between feelings of connection and VS activity to close others present in the placebo condition was erased by naltrexone. Effects remained after adjusting for physical symptoms. Together, results lend support to theories suggesting that opioids contribute to social bonding, especially with our closest loved ones. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Emoções/efeitos dos fármacos , Naltrexona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Recompensa , Comportamento Social , Estriado Ventral/efeitos dos fármacos , Adolescente , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estriado Ventral/diagnóstico por imagem , Adulto Jovem
8.
Am J Geriatr Psychiatry ; 28(1): 99-107, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31300193

RESUMO

OBJECTIVES: To investigate potential birth cohort effects in depression symptoms in older adults. DESIGN: Population-based prospective cohort. SETTING: Small-town communities in Pennsylvania. PARTICIPANTS: Three thousand two hundred and twenty seven older adults (average baseline age = 71.6) born between 1902 and 1941. MEASUREMENTS: Four decade-long birth cohorts were the primary predictors in this study: 1902-1911, 1912-1921, 1922-1931, and 1932-1941. The outcome was symptoms of depression assessed at baseline and follow-up study visits using a modified Center for Epidemiologic Studies Depression Scale (mCES-D). The depression outcome was operationalized as: 1). A binary outcome of having greater than equal to 5 depression symptoms on the total mCES-D at any study visit, and 2). A continuous outcome of four factor-analyzed component scores of the mCES-D including depressed mood, anergia/hopelessness, withdrawal, and poor self-esteem. All analyses were jointly modeled with attrition and adjusted for age, sex, education, Mini Mental State Examination score, antidepressant medications, and total prescription medications. RESULTS: Participants from more recently born cohorts were significantly less likely to have a study visit in which they reported greater than or equal to 5 depression symptoms, controlling for attrition. Specifically, in comparison to the 1902-1911 referent cohort, the 1912-1921 birth cohort was 43% less likely (odds ratio [OR] = 0.566, 95% confidence interval [CI]: 0.341-0.939), the 1922-1931 birth cohort was 63% less likely (OR = 0.0369, 95% CI: 0.215-0.632), and the 1932-1941 cohort was 79% less likely (OR = 0.205, 95% CI: 0.106-0.399). The cohort effect was most evident in the depressed mood and anergia/hopelessness symptom composites. CONCLUSION: Reduced rates of depression symptoms observed in successive birth cohorts of older adults may reflect compression of morbidity or other secular trends.

9.
Am J Geriatr Psychiatry ; 27(12): 1316-1330, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31477459

RESUMO

The significant public health burden associated with late-life depression (LLD) is magnified by the high rates of recurrence. In this manuscript, we review what is known about recurrence risk factors, conceptualize recurrence within a model of homeostatic disequilibrium, and discuss the potential significance and challenges of new research into LLD recurrence. The proposed model is anchored in the allostatic load theory of stress. We review the allostatic response characterized by neural changes in network function and connectivity and physiologic changes in the hypothalamic-pituitary-adrenal axis, autonomic nervous system, immune system, and circadian rhythm. We discuss the role of neural networks' instability following treatment response as a source of downstream disequilibrium, triggering and/or amplifying abnormal stress response, cognitive dysfunction and behavioral changes, ultimately precipitating a full-blown recurrent episode of depression. We propose strategies to identify and capture early change points that signal recurrence risk through mobile technology to collect ecologically measured symptoms, accompanied by automated algorithms that monitor for state shifts (persistent worsening) and variance shifts (increased variability) relative to a patient's baseline. Identifying such change points in relevant sensor data could potentially provide an automated tool that could alert clinicians to at-risk individuals or relevant symptom changes even in a large practice.


Assuntos
Alostase , Encéfalo/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Estresse Psicológico/fisiopatologia , Idoso , Sistema Nervoso Autônomo , Ritmo Circadiano , Homeostase , Humanos , Sistema Hipotálamo-Hipofisário , Modelos Neurológicos , Modelos Psicológicos , Vias Neurais/fisiopatologia , Sistema Hipófise-Suprarrenal , Recidiva
10.
Case Rep Psychiatry ; 2019: 9694765, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31139486

RESUMO

The following case describes the utilization of bitemporal ECT as a treatment of last resort in a 47-year-old woman with profoundly treatment-resistant behavioral disturbance poststroke. The use of ECT led to improvement in symptoms sufficient for discharge from an inpatient psychiatric unit to the nursing home. Neuropsychiatric sequelae of stroke include poststroke depression, anxiety, mania, psychosis, apathy, pathological laughter and crying, catastrophic reaction, and mild and major vascular neurocognitive disorders. Behavioral disturbance is common and may pose diagnostic and therapeutic difficulty in the poststroke patient. In most cases, first-line treatment includes pharmacologic intervention tailored to the most likely underlying syndrome. Frequent use of sedating medications is a more drastic option when behaviors prove recalcitrant to first-line approaches and markedly affect quality of life and patient safety. ECT is generally safe, is well tolerated, and may be effective in improving symptoms in treatment-resistant behavioral disturbance secondary to stroke with major neurocognitive impairment, as suggested in this case.

11.
Soc Cogn Affect Neurosci ; 14(5): 471-479, 2019 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-30976797

RESUMO

Socially warm experiences, when one feels connected to others, have been linked with physical warmth. Opioids, hypothesized to support social bonding with close others and, separately, physical warmth, may underlie both experiences. In order to test this hypothesis, 80 participants were randomly assigned to the opioid antagonist, naltrexone or placebo before neural and emotional responses to social and physical warmth were collected. Social and physical warmth led to similar increases in ventral striatum (VS) and middle-insula (MI) activity. Further, feelings of social connection were positively related to neural activity to social warmth. However, naltrexone (vs placebo) disrupted these effects by (i) reducing VS and MI activity to social and physical warmth, (ii) erasing the subjective experience-brain association to social warmth and (iii) disrupting the neural overlap between social and physical warmth. Results provide additional support for the theory that social and physical warmth share neurobiological, opioid receptor-dependent mechanisms and suggest multiple routes by which social connections may be maintained.


Assuntos
Naltrexona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Apego ao Objeto , Meio Social , Sensação Térmica/efeitos dos fármacos , Córtex Cerebral/efeitos dos fármacos , Emoções/efeitos dos fármacos , Feminino , Humanos , Relações Interpessoais , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Percepção Social , Estriado Ventral/efeitos dos fármacos , Adulto Jovem
12.
J Clin Psychiatry ; 79(6)2018 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-30358242

RESUMO

OBJECTIVE: Studies have identified longitudinally that there exists an association between depression, cerebral blood flow (CBF), and white matter hyperintensities that are thought to be due to vascular pathologies in the brain. However, the changes in CBF, a measure that reflects cerebrovascular integrity, following pharmacotherapy are not well understood. In this study, we investigated the dynamic CBF changes over the course of antidepressant treatment and the association of these changes with depressive symptoms. METHODS: We used pseudocontinuous arterial spin labeling to investigate CBF changes in a sample of older patients (≥ 50 years of age; N = 46; 29 female) with a DSM-IV diagnosis of major depressive disorder. Participants had 5 magnetic resonance imaging scans (at baseline, the day after receiving a placebo, the day after receiving a first dose of venlafaxine, a week after starting venlafaxine treatment, and at the end of trial [12 weeks]). Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity and treatment outcome. We investigated the association between changes in depression severity with changes in voxel-wise CBF while adjusting for potential confounding factors. RESULTS: Increased CBF in the middle and posterior cingulate between baseline and end of treatment was significantly associated with percent decrease in MADRS score, independent of sex and Mini-Mental State Examination score (5,000 permutations, cluster forming threshold P < .005, family-wise error P < .05). No significant effects were detected between baseline and other scans (ie, placebo, acute [single dose], or subacute [after a week]). CONCLUSIONS: Regional CBF increases were associated with decreases in depressive symptoms. This observation is consistent with the vascular depression hypothesis in late-life depression. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT00892047 and NCT01124188.


Assuntos
Antidepressivos de Segunda Geração/farmacologia , Circulação Cerebrovascular/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Substância Cinzenta/efeitos dos fármacos , Cloridrato de Venlafaxina/farmacologia , Antidepressivos de Segunda Geração/administração & dosagem , Transtorno Depressivo Maior/etiologia , Feminino , Substância Cinzenta/irrigação sanguínea , Substância Cinzenta/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Doenças Vasculares/complicações , Cloridrato de Venlafaxina/administração & dosagem
13.
Neuroimage Clin ; 19: 831-839, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30013927

RESUMO

Pharmacological treatment of major depressive disorder (MDD) typically involves a lengthy trial and error process to identify an effective intervention. This lengthy period prolongs suffering and worsens all-cause mortality, including from suicide, and is typically longer in late-life depression (LLD). Our group has recently demonstrated that during an open-label venlafaxine (serotonin-norepinephrine reuptake inhibitor) trial, significant changes in functional resting state connectivity occurred following a single dose of treatment, which persisted until the end of the trial. In this work, we propose an analysis framework to translate these perturbations in functional networks into predictors of clinical remission. Participants with LLD (N = 49) completed 12-weeks of treatment with venlafaxine and underwent functional magnetic resonance imaging (fMRI) at baseline and a day following a single dose of venlafaxine. Data was collected at rest as well as during an emotion reactivity task and an emotion regulation task. Remission was defined as a Montgomery-Asberg Depression Rating Scale (MADRS) ≤10 for two weeks. We computed eigenvector centrality (whole brain connectivity) and activation during the emotion regulation and emotion reactivity tasks. We employed principal components analysis, Tikhonov-regularized logistic classification, and least angle regression feature selection to predict remission by the end of the 12-week trial. We utilized ten-fold cross-validation and Receiver Operator Curves (ROC) curve analysis. To determine task-region pairs that significantly contributed to the algorithm's ability to predict remission, we used permutation testing. Using the fMRI data at both baseline and after the first dose of treatment yielded a sensitivity of 72% and a specificity of 68% (AUC = 0.77), a 15% increase in accuracy over baseline MADRS. In general, the accuracy at baseline was further improved by using the change in activation following a single dose. Activation of the frontal cortex, hippocampus, parahippocampus, caudate, thalamus, medial temporal cortex, middle cingulate, and visual cortex predicted treatment remission. Acute, dynamic trajectories of functional imaging metrics in response to a pharmacological intervention are a valuable tool for predicting treatment response in late-life depression and elucidating the mechanism of pharmacological therapies in the context of the brain's functional architecture.


Assuntos
Antidepressivos/uso terapêutico , Encéfalo/diagnóstico por imagem , Transtorno Depressivo Maior/diagnóstico por imagem , Inibidores de Captação de Serotonina/uso terapêutico , Cloridrato de Venlafaxina/uso terapêutico , Idoso , Transtorno Depressivo Maior/tratamento farmacológico , Emoções/fisiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Falha de Tratamento
14.
Curr Psychiatry Rep ; 20(1): 7, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29492705

RESUMO

PURPOSE OF REVIEW: Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders. RECENT FINDINGS: In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through "personalized pharmacotherapy" or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation. This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.


Assuntos
Transtornos de Ansiedade/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Avaliação Geriátrica/métodos , Transtornos do Humor/diagnóstico por imagem , Neuroimagem/métodos , Idoso , Transtorno Bipolar/diagnóstico , Transtorno Depressivo/diagnóstico por imagem , Humanos
15.
Psychiatry Res Neuroimaging ; 268: 15-21, 2017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-28837828

RESUMO

Late-life Generalized Anxiety Disorder (GAD) is relatively understudied and the underlying structural and functional neuroanatomy has received little attention. In this study, we compare the brain structural characteristics in white and gray matter in 31 non-anxious older adults and 28 late-life GAD participants. Gray matter indices (cortical thickness and volume) were measured using FreeSurfer parcellation and segmentation, and mean diffusivity was obtained through Diffusion Tensor Imaging (DTI). We assessed both macroscopic white matter changes [using white matter hyperintensity (WMH) burden] and microscopic white matter integrity [using fractional anisotropy (FA)]. No differences in macro- or microscopic white matter integrity were found between GAD and non-anxious controls (HC). GAD participants had lower cortical thickness in the orbitofrontal cortex (OFC), inferior frontal gyrus, and pregenual anterior cingulate cortex (ACC). Higher worry severity was associated with gray matter changes in OFC, ACC and the putamen. The results did not survive the multiple comparison correction, but the effect sizes indicate a moderate effect. The study suggests that late-life GAD is associated with gray matter changes in areas involved in emotion regulation, more so than with white matter changes. We conclude that anxiety-related chronic hypercortisolemia may have a dissociative effect on gray and white matter integrity.


Assuntos
Transtornos de Ansiedade/patologia , Encéfalo/patologia , Substância Cinzenta/patologia , Substância Branca/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anisotropia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Encéfalo/diagnóstico por imagem , Síndrome de Cushing/etiologia , Síndrome de Cushing/patologia , Síndrome de Cushing/psicologia , Imagem de Tensor de Difusão/métodos , Emoções , Feminino , Substância Cinzenta/diagnóstico por imagem , Giro do Cíngulo/diagnóstico por imagem , Giro do Cíngulo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/patologia , Índice de Gravidade de Doença , Substância Branca/diagnóstico por imagem
16.
Am J Geriatr Psychiatry ; 24(11): 1040-1050, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27633897

RESUMO

OBJECTIVE: Generalized anxiety disorder (GAD) in older adults is associated with persistent deficits in emotion reactivity (ER) and regulation, yet the neural basis of these deficits has not been explored. This study focuses on the neural basis of ER deficits in late-life GAD and the association with cerebrovascular burden. METHODS: Twenty elderly nonanxious participants and 17 late-life GAD participants were included. The faces-shapes functional magnetic resonance imaging task was used to assess ER; the Hamilton Anxiety Rating Scale and the Penn State Worry Questionnaire to measure global anxiety and worry, respectively; linear regression models to examine the association between ER and global anxiety severity and between ER and worry severity; and mediation analysis to explore the effect of ER on the relationship between global anxiety/worry severity and cerebrovascular burden. RESULTS: A positive association was found between ER and global anxiety in the left parahippocampus, left and right precuneus, and right superior occipital gyrus. A negative association was found between ER and worry severity in the left and right precuneus. The association between cerebrovascular burden and anxiety/worry severity was indirectly mediated by increased ER in limbic and paralimbic areas and by decreased ER in prefrontal regulatory regions. CONCLUSION: These results indicate that ER is associated with different neural activation patterns for worry and global anxiety and that ER-related functional connectivity indirectly mediates the relationship between cerebrovascular burden and late-life GAD. This latter result supports a yet-unexplored cerebrovascular pathway involved in the pathophysiology of late-life anxiety.


Assuntos
Transtornos de Ansiedade/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos de Início Tardio/diagnóstico por imagem , Idoso , Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Estudos de Casos e Controles , Transtornos Cerebrovasculares/fisiopatologia , Emoções , Feminino , Neuroimagem Funcional , Humanos , Processamento de Imagem Assistida por Computador , Transtornos de Início Tardio/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Lobo Occipital/diagnóstico por imagem , Lobo Occipital/fisiopatologia , Giro Para-Hipocampal/diagnóstico por imagem , Giro Para-Hipocampal/fisiopatologia , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiopatologia , Autocontrole , Índice de Gravidade de Doença
17.
Am J Geriatr Psychiatry ; 24(10): 791-801, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27364483

RESUMO

OBJECTIVE: This study investigated neural substrate changes in affective processing among late-life depression (LLD) patients undergoing antidepressant treatment and determined if these changes correlated with remission status. METHODS: Thirty-three LLD patients were enrolled in a 12-week venlafaxine treatment course. During treatment functional magnetic resonance imaging (fMRI) scans, paired with an affective task that assessed emotional reactivity and regulation, were performed on days 1, 2, 3, and 7 and at week 12. Following treatment patients were classified as remitters or non-remitters. A voxel-wise two-way repeated-measures ANOVA was performed to assess the fMRI data at a significance level of α = 0.05, corrected. RESULTS: The emotional reactivity contrast demonstrated a significant interaction between remission status and scan time in the right middle temporal gyrus (MTG) (F = 24.1, df = 1,112, k = 102). Further analysis showed increased emotional reactivity-induced activity among non-remitters, and decreased activity among remitters, which significantly differed from baseline at day 7 (95% CI: 0.027, 0.540; Cohen's d = -1.35) and week 12 (95% CI: -0.171, -0.052; Cohen's d = 0.68), respectively. No significant interaction was observed with the emotional regulation contrast, but multiple regions had significant main effects of scan time, including the cuneus, occipital lobe, insula, lingual gyrus, posterior cingulate cortex, and MTG. CONCLUSIONS: During treatment of LLD patients, affective processing-induced activity in the right MTG shows changes based on remission status. This alteration becomes evident early during the course of treatment, suggesting that antidepressant pharmacotherapy may acutely affect the neural basis of emotional reactivity in a differential manner that is relevant to illness remission.


Assuntos
Encéfalo/diagnóstico por imagem , Transtorno Depressivo/diagnóstico por imagem , Idoso , Antidepressivos/uso terapêutico , Encéfalo/fisiopatologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Emoções , Feminino , Neuroimagem Funcional , Humanos , Transtornos de Início Tardio/diagnóstico por imagem , Transtornos de Início Tardio/tratamento farmacológico , Transtornos de Início Tardio/fisiopatologia , Transtornos de Início Tardio/psicologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Autocontrole , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/fisiopatologia , Cloridrato de Venlafaxina/uso terapêutico
18.
Psychiatry Res Neuroimaging ; 253: 7-14, 2016 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-27254085

RESUMO

Automated segmentation of the brain is challenging in the presence of brain pathologies such as white matter hyperintensities (WMH). A late-life depression population was used to demonstrate the effect of WMH on brain segmentation and normalization. We used an automated algorithm to detect WMH, and either filled them with normal-appearing white-matter (NAWM) intensities or performed a multi-spectral segmentation, and finally compared the standard approach to the WMH filling or multi-spectral segmentation approach using intra-class correlation coefficients (ICC). The presence of WMH affected segmentations for both approaches suggesting that studies investigating structural differences in populations with high WMH should account for WMH. We also investigated how functional data contrasts are affected using normalization between the standard compared to fill and multi-spectral approach. We found that the functional data was not affected. While replication with a larger sample is needed, this study shows that WMH can significantly affect the results of segmentation and these areas are not limited to those affected by WMH. It is clear that to study gray matter differences that some correction should be made to account for WMH. Future studies should investigate which methods for accounting for WMH are most effective.


Assuntos
Encéfalo/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Leucoencefalopatias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Substância Branca/diagnóstico por imagem , Idoso , Algoritmos , Encéfalo/patologia , Humanos , Leucoencefalopatias/patologia , Pessoa de Meia-Idade , Substância Branca/patologia
19.
J Consult Clin Psychol ; 84(4): 345-52, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26881447

RESUMO

OBJECTIVES: Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are both effective treatments for generalized anxiety disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD. METHODS: The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized estimating equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 min after waking). RESULTS: Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at posttreatment compared to the group who received escitalopram without CBT augmentation. CONCLUSIONS: CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders.


Assuntos
Transtornos de Ansiedade/sangue , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Hidrocortisona/sangue , Inibidores de Captação de Serotonina/uso terapêutico , Adulto , Idoso , Transtornos de Ansiedade/tratamento farmacológico , Biomarcadores/sangue , Citalopram/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
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