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1.
Adv Exp Med Biol ; 1191: 3-20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002919

RESUMO

Magnetic resonance imaging (MRI) is a good tool for researchers to understand the biological mechanisms and pathophysiology of the brain due to the translational characteristics of MRI methods. For the psychiatric illness, this kind of mental disorders usually have minor alterations when compared to traditional neurological disorders. Therefore the functional study, such as functional connectivity, would play a significant role for understanding the pathophysiology of mental disorders. This chapter would focus on the discussion of task MRI-based functional network studies in anxiety. For social anxiety disorder, the limbic system, such as the temporal lobe, amygdala, and hippocampus, would show alterations in the functional connectivity with frontal regions, such as anterior cingulate, prefrontal, and orbitofrontal cortices. PD has anterior cingulate cortex-amygdala alterations in fear conditioning, frontoparietal alterations in attention network task, and limbic-prefrontal alterations in emotional task. A similar amygdala-based aberrant functional connectivity in specific phobia is observed. The mesocorticolimbic and limbic-prefrontal functional alterations are found in generalized anxiety disorder. The major components of task MRI-based functional connectivity in anxiety include limbic and frontal regions which might play a vital role for the origination of anxiety under different scenarios and tasks.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Ansiedade/fisiopatologia , Mapeamento Encefálico , Encéfalo/fisiopatologia , Imagem por Ressonância Magnética , Humanos
2.
Adv Exp Med Biol ; 1191: 21-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002920

RESUMO

Network-based approach for psychological phenotypes assumes the dynamical interactions among the psychiatric symptoms, psychological characteristics, and neurocognitive performances arise, as they coexist, propagate, and inhibit other components within the network of mental phenomena. For differential types of dataset from which the phenotype network is to be estimated, a Gaussian graphical model, an Ising model, a directed acyclic graph, or an intraindividual covariance network could be used. Accordingly, these network-based approaches for anxiety-related psychological phenomena have been helpful in quantitative and pictorial understanding of qualitative dynamics among the diverse psychological phenomena as well as mind-environment interactions. Brain structural covariance refers to the correlative patterns of diverse brain morphological features among differential brain regions comprising the brain, as calculated per participant or across the participants. These covarying patterns of brain morphology partly overlap with longitudinal patterns of brain cortical maturation and also with propagating pattern of brain morphological changes such as cortical thinning and brain volume reduction in patients diagnosed with neurologic or psychiatric disorders along the trajectory of disease progression. Previous studies that used the brain structural covariance network could show neural correlates of specific anxiety disorder such as panic disorder and also elucidate the neural underpinning of anxiety symptom severity in diverse psychiatric and neurologic disorder patients.


Assuntos
Transtornos de Ansiedade/patologia , Transtornos de Ansiedade/fisiopatologia , Ansiedade/patologia , Ansiedade/fisiopatologia , Encéfalo/patologia , Encéfalo/fisiopatologia , Fenótipo , Humanos , Vias Neurais
3.
Adv Exp Med Biol ; 1191: 35-59, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002921

RESUMO

Electrocortical network dynamics are integral to brain function. Linear and nonlinear connectivity applications enrich neurophysiological investigations into anxiety disorders. Discrete EEG-based connectivity networks are unfolding with some homogeneity for anxiety disorder subtypes. Attenuated delta/theta/beta connectivity networks, pertaining to anterior-posterior nodes, characterize panic disorder. Nonlinear measures suggest reduced connectivity of ACC as an executive neuro-regulator in germane "fear circuitry networks" might be more central than considered. Enhanced network complexity and theta network efficiency at rest define generalized anxiety disorder, with similar tonic hyperexcitability apparent in social anxiety disorder further extending to task-related/state functioning. Dysregulated alpha connectivity and integration of mPFC-ACC/mPFC-PCC relays implicated with attentional flexibility and choice execution/congruence neurocircuitry are observed in trait anxiety. Conversely, state anxiety appears to recruit converging delta and beta connectivity networks as panic, suggesting trait and state anxiety are modulated by discrete neurobiological mechanisms. Furthermore, EEG connectivity dynamics distinguish anxiety from depression, despite prevalent clinical comorbidity. Rethinking mechanisms implicated in the etiology, maintenance, and treatment of anxiety from the perspective of EEG network science across micro- and macroscales serves to shed light and move the field forward.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Eletroencefalografia , Rede Nervosa , Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Medo , Humanos
4.
Adv Exp Med Biol ; 1191: 71-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002923

RESUMO

Anxiety disorders include a variety of different disorders including panic disorder (PD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and phobias. We here focus our review on GAD, SAD, and PD and put a specific emphasis on resting state networks and the coupling between the brain and the heart as all anxiety disorders exhibit abnormal perception of their own heartbeat in some way or the other. Resting state functional connectivity (rsFC) studies demonstrate abnormalities in default-mode network (DMN) in all anxiety disorders, e.g., mostly decreases in rsFC of DMN. In contrast, resting state fMRI shows increased rsFC in salience network (SN) (SAD, GAD) and/or somato-motor/sensory network (SMN) (PD). Since rsFC is coherence- or phase-based operating in the infraslow frequency domain (0.01-0.1 Hz), these data suggest spatiotemporal hypo- or hyper-synchronization in DMN and SMN/SN, respectively. These abnormalities in the neural network's spatiotemporal synchronization may, in turn, impact phase-based temporal synchronization of neural and cardiac activities resulting in decreased (DMN) or increased (SMN/SN) neuro-cardiac coupling in anxiety disorders. That, in turn, may be related to the various psychopathological symptoms like unstable sense of self (as based on unstable DMN showing spatiotemporal hypo-synchronization), increased emotions and specifically anxiety (as related to increased SN showing spatiotemporal hyper-synchronization), and increased bodily awareness (mediated by increased SMN with spatiotemporal hyper-synchronization) in anxiety disorders. Taken together, we here suggest altered spatiotemporal synchronization of neural and cardiac activity within the brain's resting state to underlie various psychopathological symptoms in anxiety disorders. Such spatiotemporal basis of psychopathological symptoms is well compatible with the recently suggested "Spatiotemporal Psychopathology."


Assuntos
Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Psicopatologia , Descanso , Mapeamento Encefálico , Humanos , Imagem por Ressonância Magnética
5.
Adv Exp Med Biol ; 1191: 121-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002926

RESUMO

Discovery of innovative anxiolytics is severely hampering. Existing anxiolytics are developed decades ago and are still the therapeutics of choice. Moreover, lack of new drug targets forecasts a severe jeopardy in the future treatment of the huge population of CNS-diseased patients. We simply lack the knowledge on what is wrong in brains of anxious people (normal and diseased). Translational research, based on interacting clinical and preclinical research, is extremely urgent. In this endeavor, genetic and genomic approaches are part of the spectrum of contributing factors. We focus on three druggable targets: serotonin transporter, 5-HT1A, and GABAA receptors. It is still uncertain whether and how these targets are involved in normal and diseased anxiety processes. For serotonergic anxiolytics, the slow onset of action points to indirect effects leading to plasticity changes in brain systems leading to reduced anxiety. For GABAA benzodiazepine drugs, acute anxiolytic effects are found indicating primary mechanisms directly influencing anxiety processes. Close translational collaboration between fundamental academic and discovery research will lead to badly needed breakthroughs in the search for new anxiolytics.


Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/fisiopatologia , Ansiedade/fisiopatologia , Descoberta de Drogas , Neurotransmissores/metabolismo , Pesquisa Médica Translacional , Ansiolíticos/farmacologia , Ansiedade/tratamento farmacológico , Ansiedade/metabolismo , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/metabolismo , Humanos
6.
Adv Exp Med Biol ; 1191: 141-153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002927

RESUMO

Substantial evidence from various studies suggests a preeminent role for early adverse experiences in the development of psychopathology. The most recent studies reviewed here suggest that early life stressors are associated with an increased risk for anxiety disorders in adulthood. Early life stress predisposes individuals to develop a number of psychiatric syndromes, particularly affective disorders, including anxiety disorders, and is therefore a significant health problem.This review examines the emerging literature on the relationship between stress, hypothalamic-pituitary-adrenal (HPA) axis function, and generalized anxiety disorder (GAD), panic disorder, and phobias and the role of early life stress as an important risk factor for HPA axis dysfunction.The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortisolemia and reduced inhibitory feedback. In addition to melancholic depression, a spectrum of other conditions may be associated with increased and prolonged activation of the HPA axis, including panic, GAD, phobias and anxiety. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the anxiety syndrome. Interestingly, persistent HPA hyperactivity has been associated with higher rates of relapse. These studies suggest that an evaluation of the HPA axis during treatment may help identify patients who are at a higher risk for relapse. These findings suggest that this dysfunction of the HPA axis is partially attributable to an imbalance between glucocorticoid and mineralocorticoid receptors. Evidence has consistently demonstrated that glucocorticoid receptor function is impaired in anxiety disorders. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. Early stressful life events may provoke alterations of the stress response and thus of the HPA axis that can endure during adulthood, predisposing individuals to develop psychopathology.


Assuntos
Experiências Adversas da Infância , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/fisiopatologia , Ansiedade/etiologia , Ansiedade/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Estresse Psicológico/complicações , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Humanos , Estresse Psicológico/psicologia
7.
Adv Exp Med Biol ; 1191: 155-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002928

RESUMO

Anxiety disorders are a complex set of illnesses in which genetic factors, particularly stress, play a role in the etiopathogenesis. In recent years, inflammation and intestinal microbiota have also been included in this complex network of relationships. The functions associated with tryptophan catabolism and serotonin biosynthesis have long been associated with anxiety disorders. Tryptophan catabolism progresses toward the path of the kynurenine in the presence of stress and inflammation. The catabolism of kynurenine is a pathway in which many enzymes play a role and a large number of catabolites with neuroactive properties occur. The body's serotonin biosynthesis is primarily performed by enterochromaffin cells located in the intestines. A change in the intestinal microbiota composition (dysbiosis) directly affects the serotonin biosynthesis. Stress, unhealthy nutrition, and the use of antibiotics cause dysbiosis. In the light of this new perspective, the role of dysbiosis-induced inflammation and kynurenine pathway catabolites activated sequentially come into prominence in the etiopathogenesis of anxiety disorders.


Assuntos
Transtornos de Ansiedade/metabolismo , Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Microbioma Gastrointestinal , Cinurenina/metabolismo , Disbiose/metabolismo , Disbiose/microbiologia , Humanos , Serotonina/biossíntese , Serotonina/metabolismo
8.
Rev Saude Publica ; 53: 103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800914

RESUMO

OBJECTIVES: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression.


Assuntos
Adiposidade/fisiologia , Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Dieta , Exercício/psicologia , Obesidade/psicologia , Adolescente , Antropometria , Brasil , Proteína C-Reativa/análise , Estudos de Coortes , Exercício/fisiologia , Feminino , Humanos , Interleucina-6/sangue , Estilo de Vida , Modelos Logísticos , Masculino , Obesidade Abdominal/psicologia , Escalas de Graduação Psiquiátrica , Valores de Referência , Inquéritos e Questionários , Adulto Jovem
9.
Expert Opin Investig Drugs ; 28(11): 1003-1012, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31607187

RESUMO

Introduction: Generalized anxiety disorder (GAD) is a common and disabling psychiatric condition that affects 3% of the population and exacts significant costs to society if untreated. There are numerous treatment options available, but all have side effects, and none are reliably effective; hence, there is a significant need for new medications.Areas covered: The authors reviewed clinical Phase II and III studies listed on the clinicaltrials.gov and clinicaltrialsregister.eu websites, 2007-present. Additional information was gathered from the study sponsor websites and Pubmed. The categories of mechanisms investigated include: modulators of GABAergic or glutamatergic activity; modulators of monoaminergic systems including serotonin, norepinephrine, and dopamine; and modulators of neuropeptide corticotropin release factor.Expert opinion: There are few investigational drugs in the later stages of clinical development. Challenges include high placebo response rates, enrollment of symptomatic volunteers with minimal depressive and anxiety comorbidity, and the lack of a unifying pathophysiological model. Drug developers should consider implementing trial designs such as sequential parallel comparison design to enhance signal detection. Inclusion of depressive comorbidity may also enhance signal detection by reducing placebo-responsivity. More studies examining glutamate-mediated neuroplasticity in GAD are needed.


Assuntos
Ansiolíticos/administração & dosagem , Transtornos de Ansiedade/tratamento farmacológico , Drogas em Investigação/administração & dosagem , Animais , Ansiolíticos/farmacologia , Transtornos de Ansiedade/fisiopatologia , Desenvolvimento de Medicamentos , Drogas em Investigação/farmacologia , Humanos , Projetos de Pesquisa
10.
Postgrad Med ; 131(7): 438-444, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31482756

RESUMO

Pain is a subjective experience that is influenced by genetics, gender, social, cultural and personal parameters. Opposed to chronic pain, which by definition has to last for at least 3 months, acute pain is mostly because of trauma, acute medical conditions or treatment. The link between mood disorders and acute pain has proven to be increasingly significant since the link is bi-directional, and both act as risk factors for each other. Depression and anxiety are associated with increased perception of pain severity, whereas prolonged duration of acute pain leads to increased mood dysregulation. Although both depression and anxiety have a proven association with acute pain, the link between depression and acute pain is more thoroughly studied. Pain can be the presenting or sole complaint in depressed patients who present to primary care practices and is often overlooked by clinicians. However, reports on the perception of experimentally-induced pain in depressed patients are mixed, showing both an increased and decreased pain threshold and pain tolerance across various studies. Although less data is published about anxiety and pain, the relationship is consistent across studies as increased anxiety leads to increased severity of pain perceived and decreased pain tolerance. Anxiety as well as fear, stress, and catastrophizing are also shown to be mediators in the causal pathway between pain and disability.


Assuntos
Dor Aguda/psicologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/psicologia , Dor Aguda/epidemiologia , Dor Aguda/fisiopatologia , Dor Aguda/terapia , Analgésicos/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Catastrofização/epidemiologia , Catastrofização/fisiopatologia , Catastrofização/psicologia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/terapia , Humanos , Manejo da Dor , Limiar da Dor , Índice de Gravidade de Doença
11.
Hum Mov Sci ; 67: 102513, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31493621

RESUMO

BACKGROUND: Anxiety disorders are the most common mental disorders. Changes in psychomotor behavior can be observed in gross motor skills, with gait disturbances thought to reflect defective brain functions in psychiatric conditions. While balance deficits are well documented in anxiety, only little is known about gait characteristics of people with anxiety. OBJECTIVE: This study wishes to examine the existence of differences in gait, balance, mobility and muscle strength between people with anxiety and healthy individuals, and to investigate the relationship between level of anxiety and motor characteristics. METHODS: An observational study was conducted in a psychiatric out-patient unit at a large Israeli general hospital. The sample consisted of 93 participants, ages 18-65: 48 of them (27 female, 21 male) categorized as having anxiety, and 45 (25 female, 20 male) without anxiety. Participants were divided into two groups of various ages and both genders, and completed two questionnaires and four physical tests: objective anxiety assessment (Hamilton Anxiety Rating Scale); spatiotemporal gait parameters (10-meter walking test); balance function (Unipedal Stance Test); muscle strength evaluation, and mobility (Time Up and Go Test). No attempt was made to correlate between the anxiety and control groups based on age and/or gender. RESULTS: Participants with anxiety (both genders) were characterized by slower walking speed, shorter step length, and fewer steps per minute (p < 0.001), as well as balance deficiency and mobility dysfunction (p < 0.001), compared to the control group. Muscle strength in women with anxiety was found to be significantly lower than in healthy women. CONCLUSIONS: To the best of our knowledge, this study is the first of its kind to examine spatiotemporal gait components in patients with anxiety. Based on the findings, there is room to consider implementing gait analysis into the physical examination of patients with anxiety, as well as muscle strength, balance, and mobility function. Correct assessment and proper treatment of these aspects might contribute to the well-being of patients with anxiety.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Marcha/fisiologia , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/fisiopatologia , Amplitude de Movimento Articular , Inquéritos e Questionários , Estudos de Tempo e Movimento , Caminhada/fisiologia , Adulto Jovem
12.
J Abnorm Psychol ; 128(6): 563-573, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368735

RESUMO

Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention toward threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dot-probe data for n = 337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed. This article presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1,005 clinically anxious individuals enrolled in 13 ABM RCTs. Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k = 13, n = 1005, mean BI = 1.8 ms, SE = 1.26 ms, p = .144, 95% confidence interval [-0.6, 4.3]. Additional Bayes factor analyses also supported the point-zero hypothesis (BF10 = .23), whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5 ms interval. Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention toward threat. Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Viés de Atenção/fisiologia , Terapia Cognitivo-Comportamental , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
13.
J Abnorm Psychol ; 128(6): 596-609, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368736

RESUMO

Associations between stressful life events (SLEs) and internalizing psychopathology are complex and bidirectional, involving interactions among stressors across development to predict psychopathology (i.e., stress sensitization) and psychopathology predicting greater exposure to SLEs (i.e., stress generation). Although stress sensitization and generation theoretical models inherently focus on within-person effects, most previous research has compared average levels of stress and psychopathology across individuals in a sample (i.e., between-person effects). The present study addressed this gap by investigating stress sensitization and stress generation effects in a multiwave, prospective study of SLEs and adolescent depression and anxiety symptoms. Depression, anxiety, and SLE exposure were assessed every 3 months for 2 years (8 waves of data) in a sample of adolescents (n = 382, aged 11 to 15 at baseline). Multilevel modeling revealed within-person stress sensitization effects such that the association between within-person increases in SLEs and depression, but not anxiety, symptoms were stronger among adolescents who experienced higher average levels of SLEs across 2 years. We also observed within-person stress generation effects, such that adolescents reported a greater number of dependent-interpersonal SLEs during time periods after experiencing higher levels of depression at the previous wave than was typical for them. Although no within-person stress generation effects emerged for anxiety, higher overall levels of anxiety predicted greater exposure to dependent-interpersonal SLEs. Our findings extend prior work by demonstrating stress sensitization in predicting depression following normative forms of SLEs and stress generation effects for both depression and anxiety using a multilevel modeling approach. Clinical implications include an individualized approach to interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo/fisiopatologia , Estresse Psicológico/fisiopatologia , Adolescente , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino
14.
IEEE Pulse ; 10(4): 6-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380738

RESUMO

The medical benefits of mild electrical stimulation of the cranium may seem like marketing hype, but decades of clinical research studies have verified that it does alleviate symptoms in a wide range of conditions. This method delivers very-low-frequency current to electrodes placed on the head, and that tiny current spreads across the brain to influence neurons and affect brain- network connectivity. Today, psychiatrists and neurologists commonly employ this technique as part of the therapy for people with anxiety, depression, posttraumatic stress disorder, epilepsy, Parkinson's disease, and a host of other conditions. Researchers are also reporting that stimulation can improvemental performance.


Assuntos
Transtornos de Ansiedade , Encéfalo/fisiopatologia , Estimulação Encefálica Profunda , Depressão , Eletrodos Implantados , Epilepsia , Doença de Parkinson , Transtornos de Estresse Pós-Traumáticos , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Depressão/fisiopatologia , Depressão/terapia , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia
15.
Soc Cogn Affect Neurosci ; 14(6): 591-599, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31184751

RESUMO

Few studies have used matched affective paradigms to compare humans and non-human primates. In monkeys with amygdala lesions and youth with anxiety disorders, we examined cross-species pupillary responses during a saccade-based, affective attentional capture task. Given evidence of enhanced amygdala function in anxiety, we hypothesized that opposite patterns would emerge in lesioned monkeys and anxious participants. A total of 53 unmedicated youths (27 anxious, 26 healthy) and 8 adult male rhesus monkeys (Macaca mulatta) completed matched behavioral paradigms. Four monkeys received bilateral excitotoxic amygdala lesions and four served as unoperated controls. Compared to healthy youth, anxious youth exhibited increased pupillary constriction in response to emotional and non-emotional distractors (F(1,48) = 6.28, P = 0.02, η2p = 0.12). Pupillary response was associated significantly with anxiety symptoms severity (F(1,48) = 5.59, P = 0.02, η2p = 0.10). As hypothesized, lesioned monkeys exhibited the opposite pattern i.e. decreased pupillary constriction in response to distractors, compared to unoperated control monkeys (F(1,32) = 24.22, P < 0.001, η2 = 0.33). Amygdala lesioned monkeys and youth with anxiety disorders show opposite patterns of pupil constriction in the context of an affective distractor task. Such findings suggest the presence of altered amygdala circuitry functioning in anxiety. Future lesion and human neuroimaging work might examine the way in which specific amygdala sub-nuclei and downstream circuits mediate these effects.


Assuntos
Tonsila do Cerebelo/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Ansiedade/fisiopatologia , Atenção/fisiologia , Pupila/fisiologia , Adolescente , Animais , Ansiedade/diagnóstico , Transtornos de Ansiedade/diagnóstico , Criança , Emoções/fisiologia , Feminino , Humanos , Macaca mulatta , Masculino , Índice de Gravidade de Doença
16.
Artigo em Inglês | MEDLINE | ID: mdl-31152641

RESUMO

INTRODUCTION: Brain rate is parameter correlated to brain electric and metabolic activity. AIM: The aim of this study was to analyze the results obtained for brain rate parameter as an indicator for general mental arousal in anxious patients and to compare them with results of healthy young people matched in age and gender, as well as with anorectic and hyperactive children. MATERIAL AND METHODS: The diagnosis for all examinees was made according two statistic manuals (DMSIV- R and ICD-10), medical history, neuropsychological assessment, biochemical analysis and QEEG. In this study we examined the spectra power of the brain waves through quantified EEG (QEEG). The obtained results were exported to brain rate software and then calculated for each region separately. The QEEG spectra power data and the brain rate data were analyzed using Statistica software. RESULTS: According to sagittal and lateral topography maximal values of brain rate parameter were obtained in group of healthy individuals and in group of anorectic patients. The lowest results were obtained in group of hyperactive children for all three regions. CONCLUSIONS: The general conclusion will be that pathological conditions in childhood, analyzed in this research, can be defined as conditions of hypoarausal and this can be specific sign of brain dysfunction.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Ondas Encefálicas/fisiologia , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Adolescente , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Testes Neuropsicológicos/estatística & dados numéricos
17.
East Asian Arch Psychiatry ; 29(2): 41-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237245

RESUMO

OBJECTIVE: To examine the prevalence and comorbidity of gastro-oesophageal reflux disease (GORD) with generalised anxiety disorder (GAD) and major depressive episodes (MDE) in a general population using DSM-IV, and to evaluate the associations between these conditions and healthcare utilisation. METHODS: A random population-based telephone survey was conducted to record frequency of GORD symptoms, symptoms of GAD and MDE based on DSM-IV, and healthcare utilisation. RESULTS: Of 2011 respondents, 4.2% had weekly GORD and 13.9% had monthly GORD, whereas 3.8% reported GAD and 12.4% reported MDE. Those with monthly GORD had higher risk of GAD (p = 0.01) and MDE (p < 0.001). GORD symptom frequency was independently correlated with MDE and GAD in a dose-response manner. The number of psychiatric diagnoses was independently correlated with GORD. GORD symptom frequency, GAD, and MDE were correlated with consultation frequency. GORD symptom frequency was corelated with high investigation expenditure. CONCLUSION: GORD had a strong dose-response relationship with GAD and MDE in a Hong Kong population. Excessive healthcare utilisation should alert clinicians to the risk of psychiatric comorbidity.


Assuntos
Transtornos de Ansiedade , Transtorno Depressivo Maior , Refluxo Gastroesofágico , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/fisiopatologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/psicologia , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Medição de Risco
18.
East Asian Arch Psychiatry ; 29(1): 3-9, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31237250

RESUMO

BACKGROUND: Hypervigilance to threat is a mechanism contributing to generalised anxiety disorder (GAD). Although attentional bias modification training (ABMT) is designed to reduce attention to threat, its use as a mechanistically focused psychological intervention for GAD has not been examined. We aimed to investigate the effect of a brief ABMT on reducing anxiety, worry, and attentional bias in outpatients with GAD, and to determine the association between change in attentional bias and changes in anxiety and worry. METHODS: This was a parallel-group, double-blind, randomised controlled trial. Patients with GAD who had no changes after medication treatment for the past 8 weeks were randomly allocated to either the treatment or control group to receive 4 weekly sessions of ABMT or sham ABMT, respectively, in addition to standard care. Anxiety was measured using the Hamilton Anxiety Rating Scale and the State-Trait Anxiety Inventory - trait anxiety subscale. Pathological worry was measured using the Penn State Worry Questionnaire. Attentional bias was measured using the bias score. RESULTS: A total of 33 participants were allocated to the treatment (n = 17) or control (n = 16) groups. Both groups reported a significant reduction in levels of anxiety and worry after intervention, but the reduction was not greater after ABMT than sham ABMT. There was no significant change in attentional bias after ABMT; change in attentional bias was not correlated to changes in anxiety and worry. CONCLUSION: The efficacy of the brief ABMT as a mechanistically focused treatment for GAD was not supported. The small sample size and short duration of treatment may have rendered the results inconclusive.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/terapia , Viés de Atenção/fisiologia , Psicoterapia Breve/métodos , Adulto , Transtornos de Ansiedade/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Neuropsychology ; 33(5): 711-724, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144830

RESUMO

OBJECTIVE: It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD: To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS: Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION: These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/fisiopatologia , Atenção/fisiologia , Concussão Encefálica/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Distúrbios de Guerra/fisiopatologia , Função Executiva/fisiologia , Transtornos do Humor/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Veteranos , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Concussão Encefálica/complicações , Concussão Encefálica/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Distúrbios de Guerra/complicações , Distúrbios de Guerra/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/complicações , Transtornos do Humor/epidemiologia , Testes Neuropsicológicos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos
20.
Neuroimage ; 197: 450-456, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31075391

RESUMO

Voices and faces are the most common sources of threat in social anxiety (SA) where the fear of negative evaluation and social exclusion is the central element. SA itself is spectrally distributed among the general population and its clinical manifestation, termed social anxiety disorder, is one of the most common anxiety disorders. While heightened cerebral responses to angry or contemptuous facial or vocal expressions are well documented, it remains unclear if the brain of socially anxious individuals is generally more sensitive to voices and faces. Using functional magnetic resonance imaging, we investigated how SA affects the cerebral processing of voices and faces as compared to various other stimulus types in a study population with greatly varying SA (N = 50, 26 female). While cerebral voice-sensitivity correlated positively with SA in the left temporal voice area (TVA) and the left amygdala, an association of face-sensitivity and SA was observed in the right fusiform face area (FFA) and the face processing area of the right posterior superior temporal sulcus (pSTSFA). These results demonstrate that the increase of cerebral responses associated with social anxiety is not limited to facial or vocal expressions of social threat but that the respective sensory and emotion processing structures are also generally tuned to voices and faces.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Ansiedade/fisiopatologia , Percepção Auditiva/fisiologia , Encéfalo/fisiopatologia , Percepção Visual/fisiologia , Adulto , Expressão Facial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Voz , Adulto Jovem
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