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1.
BMC Neurol ; 21(1): 84, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33610173

RESUMO

BACKGROUND: Stroke in children easily causes long-term dysfunction. Whether the prognoses of motor and anxiety disorders are related to the affected stroke area has not been reported. METHODS: One hundred nine cases of children with ischaemic stroke were reviewed and divided into three groups: lenticular nucleus lesions only (lenticular nucleus group), lenticular nucleus and caudate head lesions (caudate head group), and lenticular nucleus and thalamus lesions (thalamus group). Overall prognosis was evaluated by the mRS score. The SCAS-P was used to evaluate anxiety in children aged ≥6 years. RESULTS: mRS scores were ≤ 2 points (mean: 0.62), no significant difference among groups. 3/21 (14.2%) patients in the caudate head group changed handedness, which is significantly higher than other groups. Patients with lesions in thalamus group had significantly higher SCAS-P scores. CONCLUSIONS: The overall prognosis of children with basal ganglia ischaemic stroke is good. However, hand preference changes and anxiety disorders may develop. Patients in the caudate head groups are more likely to suffer from fine motor disorders and changes in handedness. Patients within the thalamus group are more prone to anxiety than patients in the other groups. Anxiety disorders should be noted in children with basal ganglia stroke.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Doença Cerebrovascular dos Gânglios da Base/fisiopatologia , Núcleo Caudado , Corpo Estriado , Lateralidade Funcional , Destreza Motora/fisiologia , Tálamo , Adolescente , Gânglios da Base , Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Doença Cerebrovascular dos Gânglios da Base/psicologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , /psicologia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Tomografia Computadorizada por Raios X
2.
Rinsho Shinkeigaku ; 60(10): 663-667, 2020 Oct 24.
Artigo em Japonês | MEDLINE | ID: mdl-32893245

RESUMO

In elderly patients with so-called psychogenic physical symptoms, changes with age of the symptoms were discussed from the standpoint of geriatric psychiatry. In recent years, the diagnostic criteria for psychogenic physical symptoms have been revised and are closer to the definition of psychosomatic disorders. In aging, the aging phenomenon of each body organ progresses, and the brain is no exception. Clinical findings suggest that conventional physical and mental symptoms are alleviated as brain function declines in general. If dementia is added, the speed of relief will increase. In Japan, where super-aging is advancing, the need to focus on the positive aspects of aging is discussed.


Assuntos
Envelhecimento/fisiologia , Encéfalo/fisiopatologia , Psiquiatria Geriátrica , Transtornos Psicofisiológicos/fisiopatologia , Transtornos Psicofisiológicos/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Feminino , Humanos , Masculino , Transtornos Psicofisiológicos/diagnóstico
3.
PLoS One ; 15(7): e0235346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667951

RESUMO

Several studies have recently suggested that an abnormal processing of respiratory interoceptive and nociceptive (painful) stimuli may contribute to eating disorder (ED) pathophysiology. Mood and anxiety disorders (MA) are also characterized by abnormal respiratory symptoms, and show substantial comorbidity with ED. However, no studies have examined both respiratory and pain processing simultaneously within ED and MA. The present study systematically evaluated responses to perturbations of respiratory and nociceptive signals across the levels of physiology, behavior, and symptom report in a transdiagnostic ED sample (n = 51) that was individually matched to MA individuals (n = 51) and healthy comparisons (HC; n = 51). Participants underwent an inspiratory breath-holding challenge as a probe of respiratory interoception and a cold pressor challenge as a probe of pain processing. We expected both clinical groups to report greater stress and fear in response to respiratory and nociceptive perturbation than HCs, in the absence of differential physiological and behavioral responses. During breath-holding, both the ED and MA groups reported significantly more stress, feelings of suffocation, and suffocation fear than HC, with the ED group reporting the most severe symptoms. Moreover, anxiety sensitivity was related to suffocation fear only in the ED group. The heightened affective responses in the current study occurred in the absence of group differences in behavioral (breath hold duration, cold pressor duration) and physiological (end-tidal carbon dioxide, end-tidal oxygen, heart rate, skin conductance) responses. Against our expectations, there were no group differences in the response to cold pain stimulation. A matched-subgroup analysis focusing on individuals with anorexia nervosa (n = 30) produced similar results. These findings underscore the presence of abnormal respiratory interoception in MA and suggest that hyperreactivity to respiratory signals may be a potentially overlooked clinical feature of ED.


Assuntos
Anorexia Nervosa/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Dor Nociceptiva/fisiopatologia , Adolescente , Adulto , Afeto/fisiologia , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Asfixia/fisiopatologia , Asfixia/terapia , Comorbidade , Medo/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Masculino , Transtornos do Humor/complicações , Transtornos do Humor/epidemiologia , Transtornos do Humor/fisiopatologia , Dor Nociceptiva/complicações , Dor Nociceptiva/epidemiologia , Dor/complicações , Dor/epidemiologia , Dor/fisiopatologia , Sistema Respiratório/fisiopatologia
4.
Encephale ; 46(3S): S93-S98, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32507556

RESUMO

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pandemias , Transtorno de Pânico/psicologia , Pneumonia Viral/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Catastrofização , Comorbidade , Infecções por Coronavirus/epidemiologia , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Hipopotassemia/etiologia , Masculino , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/fisiopatologia , Pneumonia Viral/epidemiologia , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Sistema Renina-Angiotensina/fisiologia , Respiração/efeitos dos fármacos , Estresse Psicológico/etiologia , Estresse Psicológico/fisiopatologia , Terminologia como Assunto , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/etiologia
5.
PLoS One ; 15(4): e0230803, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298270

RESUMO

Anxiety has been implicated as one of the greatest influences on quality of life in Parkinson's disease (PD). The etiology of anxiety is unclear, although previous work suggests that anxiety may be linked to sensory deficits that cause uncertainty in movement. Thus, the current study examined whether focusing attention on sensory feedback during goal-based exercise has the potential to provide benefits to anxiety in PD. Thirty-five participants with PD were randomized to either a Sensory Attention Focused Exercise (SAFEx) (i.e. internal focus of attention, n = 18) or Sham Exercise control (i.e. external focus of attention, n = 17) and completed 33 one-hour attention-based exercise sessions over 11-weeks. Before and after the program (pre and post), participants completed the Parkinson Anxiety Scale (PAS) questionnaire. The PAS includes three anxiety sections: persistent, episodic, and avoidance. Changes in the total PAS score and within each section of the PAS were subjected to two-factor mixed repeated measures ANCOVA. Significant group by time interactions demonstrated that from pre to post, total PAS scores (p = 0.007) and episodic anxiety scores (p = 0.010) significantly decreased in the SAFEx group only (ΔTotal PAS = -5.2, F(1,27) = 5.41, p = 0.028, ηp2 = 0.17; ΔEpisodic Score = -1.8, F(1,27) = 6.89, p = 0.014, ηp2 = 0.20). In conclusion, focusing attention on sensory feedback while completing goal-based exercises may provide significant benefits to improving anxiety in PD. As such, sensory attention focused exercise may be a critical adjunct therapy for improving anxiety, and ultimately quality of life in people with PD.


Assuntos
Ansiedade/fisiopatologia , Exercício Físico/fisiologia , Retroalimentação Sensorial/fisiologia , Doença de Parkinson/fisiopatologia , Idoso , Transtornos de Ansiedade/fisiopatologia , Atenção/fisiologia , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Qualidade de Vida , Índice de Gravidade de Doença
6.
Am J Psychiatry ; 177(5): 454-463, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32252541

RESUMO

OBJECTIVE: Although both pediatric and adult patients with anxiety disorders exhibit similar neural responding to threats, age-related differences have been found in some functional MRI (fMRI) studies. To reconcile disparate findings, the authors compared brain function in youths and adults with and without anxiety disorders while rating fear and memory of ambiguous threats. METHODS: Two hundred medication-free individuals ages 8-50 were assessed, including 93 participants with an anxiety disorder. Participants underwent discriminative threat conditioning and extinction in the clinic. Approximately 3 weeks later, they completed an fMRI paradigm involving extinction recall, in which they rated their levels of fear evoked by, and their explicit memory for, morph stimuli with varying degrees of similarity to the extinguished threat cues. RESULTS: Age moderated two sets of anxiety disorder findings. First, as age increased, healthy subjects compared with participants with anxiety disorders exhibited greater amygdala-ventromedial prefrontal cortex (vmPFC) connectivity when processing threat-related cues. Second, age moderated diagnostic differences in activation in ways that varied with attention and brain regions. When rating fear, activation in the vmPFC differed between the anxiety and healthy groups at relatively older ages. In contrast, when rating memory for task stimuli, activation in the inferior temporal cortex differed between the anxiety and healthy groups at relatively younger ages. CONCLUSIONS: In contrast to previous studies that demonstrated age-related similarities in the biological correlates of anxiety disorders, this study identified age differences. These findings may reflect this study's focus on relatively late-maturing psychological processes, particularly the appraisal and explicit memory of ambiguous threat, and inform neurodevelopmental perspectives on anxiety.


Assuntos
Envelhecimento/psicologia , Transtornos de Ansiedade/fisiopatologia , Adolescente , Adulto , Transtornos de Ansiedade/psicologia , Criança , Condicionamento Psicológico , Extinção Psicológica , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise e Desempenho de Tarefas , Adulto Jovem
7.
Sci Rep ; 10(1): 4288, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152429

RESUMO

Great interest exists in maximizing exposure therapy efficacy in anxiety disorders. At the same time, reduced frequency and shortened duration of exposure sessions are required to meet the specific regularities in routine care settings. Extinction has emerged as the key mechanism of exposure treatment in anxiety disorders. Examining exposure treatment processes from the perspective of extinction learning might provide novel insights into variability in exposure treatment duration and outcome. The present study sought to examine the functional link between fear extinction, the ability to accomplish exposure in a predetermined time and exposure therapy outcome in specific phobia. Treatment-seeking individuals (N = 53) with spider phobia underwent a context-dependent fear conditioning paradigm prior to a standardized exposure. Spider-phobic participants who were able to complete exposure within the pre-determined time (i.e., completers) showed a more pronounced short- and long-term exposure therapy benefit. In the fear conditioning task, a more pronounced decline in CS-US contingency ratings during extinction (retrieval) was found in completers relative to non-completers. The failure to further extinguish US expectancy to the CSs in non-completers might offer a potential mechanistic explanation why non-completers have difficulties to accomplish all exposure steps in a fixed time and show less pronounced treatment gains. Our findings bear specific implications for the implementation of exposure treatment to routine care settings.


Assuntos
Transtornos de Ansiedade/terapia , Encéfalo/fisiopatologia , Condicionamento Clássico , Medo/psicologia , Terapia Implosiva/métodos , Transtornos Fóbicos/terapia , Aranhas/fisiologia , Adulto , Animais , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Feminino , Humanos , Masculino , Transtornos Fóbicos/fisiopatologia , Transtornos Fóbicos/psicologia , Adulto Jovem
8.
Am J Psychiatry ; 177(3): 214-222, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32114783

RESUMO

Anxiety and fear-related disorders are common and disabling, and they significantly increase risk for suicide and other causes of morbidity and mortality. However, there is tremendous potential for translational neuroscience to advance our understanding of these disorders, leading to novel and powerful interventions and even to preventing their initial development. This overview examines the general circuits and processes thought to underlie fear and anxiety, along with the promise of translational research. It then examines some of the data-driven "next-generation" approaches that are needed for discovery and understanding but that do not always fit neatly into established models. From one perspective, these disorders offer among the most tractable problems in psychiatry, with a great deal of accumulated understanding, across species, of neurocircuit, behavioral, and, increasingly, genetic mechanisms, of how dysregulation of fear and threat processes contributes to anxiety-related disorders. One example is the progressively sophisticated understanding of how extinction underlies the exposure therapy component of cognitive-behavioral therapy approaches, which are ubiquitously used across anxiety and fear-related disorders. However, it is also critical to examine gaps in our understanding between reasonably well-replicated examples of successful translation, areas of significant deficits in knowledge, and the role of large-scale data-driven approaches in future progress and discovery. Although a tremendous amount of progress is still needed, translational approaches to understanding, treating, and even preventing anxiety and fear-related disorders offer great opportunities for successfully bridging neuroscience discovery to clinical practice.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Encéfalo/fisiopatologia , Medo/fisiologia , Transtornos de Ansiedade/genética , Extinção Psicológica/fisiologia , Estudo de Associação Genômica Ampla , Humanos , Vias Neurais/fisiopatologia
9.
Sci Rep ; 10(1): 2962, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32139728

RESUMO

Behaviour problems and anxieties in dogs decrease their quality of life and may lead to relinquishment or euthanasia. Considering the large number of pet dogs and the commonness of these problematic behaviours, a better understanding of the epidemiology and related molecular and environmental factors is needed. We have here studied the prevalence, comorbidity, and breed specificity of seven canine anxiety-like traits: noise sensitivity, fearfulness, fear of surfaces and heights, inattention/impulsivity, compulsion, separation related behaviour and aggression with an online behaviour questionnaire answered by dog owners. Our results show that noise sensitivity is the most common anxiety-related trait with a prevalence of 32% in 13,700 Finnish pet dogs. Due to the high prevalence of noise sensitivity and fear, they were the most common comorbidities. However, when comparing the relative risk, the largest risk ratios were seen between hyperactivity/inattention, separation related behaviour and compulsion, and between fear and aggression. Furthermore, dog breeds showed large differences in prevalence of all anxiety-related traits, suggesting a strong genetic contribution. As a result, selective breeding focusing on behaviour may reduce the prevalence of canine anxieties. Anxious animals may suffer from chronic stress and thus, modified breeding policies could improve the welfare of our companion dogs.


Assuntos
Agressão/psicologia , Transtornos de Ansiedade/epidemiologia , Comportamento Animal , Comportamento Compulsivo/epidemiologia , Doenças do Cão/epidemiologia , Animais , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Comorbidade , Comportamento Compulsivo/fisiopatologia , Comportamento Compulsivo/psicologia , Doenças do Cão/fisiopatologia , Doenças do Cão/psicologia , Cães , Medo/psicologia , Feminino , Finlândia/epidemiologia , Humanos , Comportamento Impulsivo , Masculino , Animais de Estimação/psicologia , Prevalência , Qualidade de Vida , Especificidade da Espécie , Inquéritos e Questionários
10.
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
11.
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
12.
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
13.
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
14.
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
15.
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
16.
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
17.
J Abnorm Psychol ; 129(3): 237-247, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32077707

RESUMO

The valine66methionine (Val66Met) polymorphism (rs6265) of the brain-derived neurotrophic factor (BDNF) gene has been shown to influence autonomic arousal pathways, which in turn predict elevated syndromal anxiety in healthy humans. We examined whether the BDNF variant is associated with an increased risk of generalized anxiety disorder (GAD), one of the most prevalent anxiety disorders, through altering parasympathetic stress/relaxation reactivity. A total of 2,250 Han Chinese adults (750 GAD patients and 1,500 healthy controls) were included in the genotyping. High-frequency heart rate variability, an index of vagal (parasympathetic) activity, was measured during the supine-standing-supine test (5 min in each position); vagal withdrawal and vagal activation were calculated as baseline supine minus standing and recovery supine minus standing, respectively. Analysis of healthy participants indicated that Val/Val homozygotes displayed significantly blunted vagal withdrawal and vagal activation compared with Met allele carriers. After analyzing the entire sample, these effects remained significant. Furthermore, both attenuated vagal response patterns were found to be significantly associated with a higher incidence of GAD. Lastly, the path analysis identified a significant indirect effect of BDNF on the risk of GAD via diminishing vagal response to either orthostatic stress or supine relaxation. Even when further testing the subsample comprising only comorbidity- and medication-free GAD patients and healthy controls to minimize the confounding bias, the results still remained. Our findings demonstrate that individuals carrying the BDNF Val/Val genotype, compared to Met-carriers, may be at higher risk of GAD due to blunted vagal reactivity in response to both stress and relaxation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/genética , Ansiedade/genética , Fator Neurotrófico Derivado do Encéfalo/genética , Genótipo , Sistema Nervoso Parassimpático/fisiopatologia , Polimorfismo de Nucleotídeo Único , Adulto , Alelos , Ansiedade/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Nível de Alerta/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Vago/fisiopatologia
18.
Trials ; 21(1): 17, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907032

RESUMO

BACKGROUND: Only 40-60% of patients with generalized anxiety disorder experience long-lasting improvement with gold standard psychosocial interventions. Identifying neurobehavioral factors that predict treatment success might provide specific targets for more individualized interventions, fostering more optimal outcomes and bringing us closer to the goal of "personalized medicine." Research suggests that reward and threat processing (approach/avoidance behavior) and cognitive control may be important for understanding anxiety and comorbid depressive disorders and may have relevance to treatment outcomes. This study was designed to determine whether approach-avoidance behaviors and associated neural responses moderate treatment response to exposure-based versus behavioral activation therapy for generalized anxiety disorder. METHODS/DESIGN: We are conducting a randomized controlled trial involving two 10-week group-based interventions: exposure-based therapy or behavioral activation therapy. These interventions focus on specific and unique aspects of threat and reward processing, respectively. Prior to and after treatment, participants are interviewed and undergo behavioral, biomarker, and neuroimaging assessments, with a focus on approach and avoidance processing and decision-making. Primary analyses will use mixed models to examine whether hypothesized approach, avoidance, and conflict arbitration behaviors and associated neural responses at baseline moderate symptom change with treatment, as assessed using the Generalized Anxiety Disorder-7 item scale. Exploratory analyses will examine additional potential treatment moderators and use data reduction and machine learning methods. DISCUSSION: This protocol provides a framework for how studies may be designed to move the field toward neuroscience-informed and personalized psychosocial treatments. The results of this trial will have implications for approach-avoidance processing in generalized anxiety disorder, relationships between levels of analysis (i.e., behavioral, neural), and predictors of behavioral therapy outcome. TRIAL REGISTRATION: The study was retrospectively registered within 21 days of first participant enrollment in accordance with FDAAA 801 with ClinicalTrials.gov, NCT02807480. Registered on June 21, 2016, before results.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Encéfalo/diagnóstico por imagem , Terapia Cognitivo-Comportamental , Terapia Implosiva , Adulto , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Aprendizagem da Esquiva/fisiologia , Encéfalo/fisiopatologia , Tomada de Decisões/fisiologia , Eletroencefalografia , Feminino , Previsões/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Autorrelato , Resultado do Tratamento , Adulto Jovem
19.
Horm Behav ; 118: 104667, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31899259

RESUMO

Subjective, disabling fatigue is a common complaint and a key feature of numerous medical conditions, and is a transdiagnostic feature of psychiatric disorders. Despite physical and mental fatigue being associated with functional impairment and reduced quality of life, little is understood about its underlying mechanisms or modulating factors. Women commonly experience exacerbation of other (non-fatigue related) psychiatric symptoms during the luteal phase of the menstrual cycle, and report greater fatigue prevalence compared to men. It is therefore plausible that subjective fatigue may similarly fluctuate across the menstrual cycle. Here we compared physical and mental fatigue in the early-follicular (lower ovarian hormones) and mid-luteal (higher ovarian hormones) phases of a single menstrual cycle, while controlling for sleep disruption, in women with (n = 18) and without (non-anxious; n = 20) generalised anxiety disorder (GAD). As expected, women with GAD reported greater physical and mental fatigue than healthy women. Further, although there were no changes in physical fatigue from the early-follicular to mid-luteal phases in both groups, mental fatigue in non-anxious women increased to levels equivalent to those experienced by their GAD counterparts in the mid-luteal phase. Although salivary levels of estradiol and progesterone increased from the early-follicular to mid-luteal phase, hormones did not significantly predict fatigue in either phase. These findings are consistent with the exacerbations of state anxiety and mood disturbance recognised to occur in the luteal phase of the menstrual cycle. We speculate that increased mental fatigue in the luteal phase may represent a vulnerable period for the development and maintenance of psychiatric disorders, potentially via compromised emotional regulation.


Assuntos
Transtornos de Ansiedade/epidemiologia , Fadiga/epidemiologia , Ciclo Menstrual/psicologia , Fadiga Mental/epidemiologia , Adolescente , Adulto , Transtornos de Ansiedade/sangue , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/fisiopatologia , Estudos de Casos e Controles , Regulação Emocional/fisiologia , Estradiol/sangue , Fadiga/sangue , Fadiga/complicações , Feminino , Humanos , Ciclo Menstrual/sangue , Fadiga Mental/sangue , Fadiga Mental/complicações , Progesterona/sangue , Qualidade de Vida , Adulto Jovem
20.
J Clin Neurosci ; 74: 25-31, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31982276

RESUMO

OBJECTIVE: This study wants to test whether the heart rate variability (HRV) analysis using sphygmomanometers can effectively reflect the physical and emotional distress of somatic symptom disorder (SSD) cases and assist in further health management. METHODS: This study includes 66 female SSD cases and 32 male SSD cases. All cases received a 200-second blood pressure (BP) measurement, after which the numerical figure for the heart rate was obtained from the BP signal for HRV analysis. All cases also filled out Patient Health Questionnaire-15 (PHQ-15), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI) to understand the extent of their somatic distress, depression, and anxiety. The relationship between psychological conditions and HRV indicators are examined statistically. Receiver operating characteristic (ROC) curve analysis was used to understand whether HRV indicators can assist in the determination of psychosomatic problems. RESULTS: Considering all and female SSD cases, low-frequency power (LF) and PHQ-15 in the HRV index have the most significant correlations. In male SSD cases, root mean square of successive NN interval differences (RMSSD) and BDI-II have the highest correlations. The results of ROC curve analysis indicate that LF is useful to judge the severity of female SSD cases, while RMSSD has reference value in determining whether male patients of SSD cases have depression or not. In addition, physical stress index (PSI) can also help determine the degree of depression in male SSD cases. CONCLUSION: The use of BP in HRV analysis can help in the monitoring of somatic distress and depression issues in SSD cases. LF, RMSSD, PSI are potential physiological indicators.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Determinação da Pressão Arterial , Frequência Cardíaca/fisiologia , Sintomas Inexplicáveis , Adulto , Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo/fisiopatologia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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