Exploring volumetric abnormalities in subcortical L-HPA axis structures in pediatric generalized anxiety disorder.

BACKGROUND: Pediatric generalized anxiety disorder (GAD) is debilitating and increasingly prevalent, yet its etiology remains unclear. Some believe the disorder to be propagated by chronic dysregulation of the limbic-hypothalamic-pituitary-adrenal (L-HPA) axis, but morphometric studies of implicated subcortical areas have been largely inconclusive. Recognizing that certain subcortical subdivisions are more directly involved in L-HPA axis functioning, this study aims to detect specific abnormalities in these critical areas. METHODS: Thirty-eight MRI scans of preschool children with (n = 15) and without (n = 23) GAD underwent segmentation and between-group volumetric comparisons of the basolateral amygdala (BLA), ventral hippocampal subiculum (vSC), and mediodorsal medial magnocellular (MDm) area of the thalamus. RESULTS: Children with GAD displayed significantly larger vSC compared to healthy peers, F(1, 31) = 6.50, pFDR = .048. On average, children with GAD presented with larger BLA and MDm, Fs(1, 31) ≥ 4.86, psFDR ≤ .054. Exploratory analyses revealed right-hemispheric lateralization of all measures, most notably the MDm, F(1, 31) = 8.13, pFDR = .024, the size of which scaled with symptom severity, r = .83, pFDR = .033. CONCLUSION: The BLA, vSC, and MDm are believed to be involved in the regulation of anxiety and stress, both individually and collectively through the excitation and inhibition of the L-HPA axis. All were found to be enlarged in children with GAD, perhaps reflecting hypertrophy related to hyperexcitability, or early neuronal overgrowth. Longitudinal studies should investigate the relationship between these early morphological differences and the long-term subcortical atrophy previously observed.

Grey matter alterations in generalized anxiety disorder: A voxel-wise meta-analysis of voxel-based morphometry studies.

OBJECTIVE: Grey matter, a crucial component of the brain, has been found altered in generalized anxiety disorder (GAD) of several voxel-based morphometry studies. The conclusive and consistent grey matter alterations in GAD have not been confirmed. METHOD: Eleven voxel-based morphometry studies of GAD patients were included in the current systematic review and meta-analysis. The linear model of anxiety severity scores was applied to explore the relationship of grey matter alterations and anxiety severity. The subgroup analysis of adult GAD and adolescent GAD was also performed. RESULTS: Significantly modest grey matter alterations in the left superior temporal gyrus of patients with GAD were found. The anxiety severity score was significantly correlated with grey matter alterations in the right insula, lenticular nucleus, putamen and striatum. The subgroup analysis of adult GAD and adolescent GAD all failed to show significant grey matter alterations. However, in the adult GAD subgroup, anxiety severity score was significantly correlated with grey matter alterations in the right insula. CONCLUSION: GAD might have the modest grey matter alterations in the left superior temporal gyrus. Anxiety severity might be related to the grey matter alterations in the limbic regions, such as the right insula, lenticular nucleus, putamen and striatum. This kind of correlation might be related to the effects of adult GAD. Future studies with adequate sample sizes and sophisticated GAD categories will be needed.

Grey matter structural alterations in anxiety disorders: a voxel-based meta-analysis.

Anxiety disorders (ADs) are a group of prevalent and destructive mental illnesses, but the current understanding of their underlying neuropathology is still unclear. Employing voxel-based morphometry (VBM), previous studies have demonstrated several common brain regions showing grey matter volume (GMV) abnormalities. However, contradictory results have been reported among these studies. Considering that different subtypes of ADs exhibit common core symptoms despite different diagnostic criteria, and previous meta-analyses have found common core GMV-altered brain regions in ADs, the present research aimed to combine the results of individual studies to identify common GMV abnormalities in ADs. Therefore, we first performed a systematic search in PubMed, Embase, and Web of Science on studies investigating GMV differences between patients with ADs and healthy controls (HCs). Then, the anisotropic effect-size signed differential mapping (AES-SDM) was applied in this meta-analysis. A total of 24 studies (including 25 data sets) were included in the current study, and 906 patients with ADs and 1003 HCs were included. Compared with the HCs, the patients with ADs showed increased GMV in the left superior parietal gyrus, right angular gyrus, left precentral gyrus, and right lingual gyrus, and decreased GMV in the bilateral insula, bilateral thalamus, left caudate, and right putamen. In conclusion, the current study has identified some abnormal GMV brain regions that are related to the pathological mechanisms of anxiety disorders. These findings could contribute to a better understanding of the underlying neuropathology of ADs.

The neurostructural consequences of glaucoma and their overlap with disorders exhibiting emotional dysregulations: A voxel-based meta-analysis and tripartite system model.

BACKGROUND: Glaucoma, a progressive neurodegenerative disorder leading to irreversible blindness, is associated with heightened rates of generalized anxiety and depression. This study aims to comprehensively investigate brain morphological changes in glaucoma patients, extending beyond visual processing areas, and explores overlaps with morphological alterations observed in anxiety and depression. METHODS: A comparative meta-analysis was conducted, using case-control studies of brain structural integrity in glaucoma patients. We aimed to identify regions with gray matter volume (GMV) changes, examine their role within distinct large-scale networks, and assess overlap with alterations in generalized anxiety disorder (GAD) and major depressive disorder (MDD). RESULTS: Glaucoma patients exhibited significant GMV reductions in visual processing regions (lingual gyrus, thalamus). Notably, volumetric reductions extended beyond visual systems, encompassing the left putamen and insula. Behavioral and functional network decoding revealed distinct large-scale networks, implicating visual, motivational, and affective domains. The insular region, linked to pain and affective processes, displayed reductions overlapping with alterations observed in GAD. LIMITATIONS: While the study identified significant morphological alterations, the number of studies from both the glaucoma and GAD cohorts remains limited due to the lack of independent studies meeting our inclusion criteria. CONCLUSION: The study proposes a tripartite brain model for glaucoma, with visual processing changes related to the lingual gyrus and additional alterations in the putamen and insular regions tied to emotional or motivational functions. These neuroanatomical changes extend beyond the visual system, implying broader implications for brain structure and potential pathological developments, providing insights into the overall neurological consequences of glaucoma.

The difference in volumetric alternations of the orbitofrontal-limbic-striatal system between major depressive disorder and anxiety disorders: A systematic review and voxel-based meta-analysis.

BACKGROUND: Major depressive disorder (MDD) and anxiety disorders (ANX) are psychiatric disorders with high mutual comorbidity rates that might indicate some shared neurobiological pathways between them, but they retain diverse phenotypes that characterize themselves specifically. However, no consistent evidence exists for common and disorder-specific gray matter volume (GMV) alternations between them. METHODS: A systematic review and meta-analysis on voxel-based morphometry studies of patients with MDD and ANX were performed. The effect of comorbidity was explicitly controlled during disorder-specific analysis and particularly investigated in patient with comorbidity. RESULTS: A total of 45 studies with 54 datasets comprising 2196 patients and 2055 healthy participants met the inclusion criteria. Deficits in the orbitofrontal cortex, striatum, and limbic regions were found in MDD and ANX. The disorder-specific analyses showed decreased GMV in the bilateral anterior cingulate cortex, right striatum, hippocampus, and cerebellum in MDD, while decreased GMV in the left striatum, amygdala, insula, and increased cerebellar volume in ANX. A totally different GMV alternation pattern was shown involving bilateral temporal and parietal gyri and left fusiform gyrus in patients with comorbidity. LIMITATIONS: Owing to the design of included studies, only partial patients in the comorbid group had a secondary comorbidity diagnosis. CONCLUSION: Patients with MDD and ANX shared a structural disruption in the orbitofrontal-limbic-striatal system. The disorder-specific effects manifested their greatest severity in distinct lateralization and directionality of these changes that differentiate MDD from ANX. The comorbid group showed a totally different GMV alternation pattern, possibly suggesting another illness subtype that requires further investigation.

Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis / Comorbilidades psiquiátricas en los trastornos del espectro autista: estudio comparativo entre los criterios DSM-IV-TR y DSM-5

Background/Objective: The heterogeneous clinical presentations of individuals with Autism Spectrum Disorders (ASD) pose a significant challenge for sample characterization. Therefore the main goal of DSM-5 must be to identify subgroups of ASD, including comorbidity disorders and severity. The main goal of this study is to explore the psychiatric comorbidities and the severity of symptoms that could be relevant for the phenotype characterization in ASD and also to compare these results according to the different classification criteria between the DSM-IV-TR and the DSM-5. Method: A comparative study of severity and psychiatric comorbidities was carried out between a sample of participants that only met criteria for Pervasive Developmental Disorder (PDD) according to the DSM-IV-TR and a sample of participants that also met ASD criteria according to DSM-5 classification. The recruitment of children was via educational (N=123). The psychiatric symptoms, comorbid disorders and severity of symptoms were assessed through The Nisonger Child Behavior Rating Form, clinical interview and The Inventory of Autism Spectrum Disorder, respectively. The psychiatric comorbidities considered were: anxiety, eating behavioural problems, self-aggressiveness, hetero-aggressiveness, self-harm, obsessive compulsive disorder and attention deficit and hyperactivity disorder. Results: Statistically significant differences between both groups were found regarding obsessive compulsive disorder, eating behavioural problems and severity. Conclusions: The results support the hypothesis that patients who meet the DSM-5 criteria have more severe symptoms, not only regarding the core autistic symptoms but also in relation with psychiatric comorbidities (AU)

Antecedentes/Objetivo: Los Trastornos del Espectro Autista (TEA) incluyen un grupo heterogéneo en cuanto a su presentación clínica, que supone un desafío a nivel de caracterización diagnóstica. Por consiguiente, el objetivo principal de la clasificación DSM-5 debería de ser identificar subgrupos de TEA incluyendo severidad y comorbilidades psiquiátricas. El objetivo principal de este estudio es explorar las comorbilidades diagnósticas que pueden ser relevantes como descriptores de fenotipos autistas así como la severidad de los síntomas de autismo y comparar los resultados de las diferentes criterios de clasificación entre el DSM-IV-TR y el DSM-5. Método: Se realiza un estudio comparativo de severidad y comorbilidades psiquiátricas entre una muestra con diagnóstico de Trastorno Generalizado del Desarrollo, según criterios DSM-IV-TR, y una muestra que cumplía también criterios para TEA según la clasificación DSM-5. La muestra fue obtenida en centros educativos (N=123). Las comorbilidades psiquiátricas y la severidad de los síntomas se evaluaron a través del The Nisonger Child Behavior Rating Form, entrevista clínica y el Inventario de Trastorno del Espectro Autista, respectivamente. Las comorbilidades estudiadas fueron ansiedad, alteraciones de la conducta alimentaria, auto-agresividad, hetero-agresividad, autolesiones, trastorno obsesivo-compulsivo y déficit de atención e hiperactividad. Resultados: Se encontraron diferencias estadísticamente significativas entre ambos grupos para trastorno obsesivo-compulsivo, alteraciones de la conducta alimentaria y severidad. Conclusiones: Se apoya la hipótesis de que los individuos que cumplen criterios diagnósticos según DSM-5 tienen mayor severidad sintomática, no sólo con respecto a los síntomas autistas centrales, sino también en relación con comorbilidades psiquiátricas (AU)

Influence of vulnerability factors in panic disorder severity / Influencia de factores de vulnerabilidad en la gravedad del trastorno de pánico

BACKGROUND: we studied herein the predictive value for panic severity of three well-based vulnerability factors: personality traits (neuroticism and extraversion; NEO-PI-R), anxiety sensitivity (ASI), and perceived control (ACQ-R). METHOD: the sample was composed of 52 participants diagnosed with panic disorder, with or without agoraphobia, according to DSM-IV-TR criteria. RESULTS: our results revealed that the anxiety facet is a better predictor of panic severity than neuroticism. Anxiety sensitivity increases the predictive value for panic severity and, finally, perception of control of emotions is the only perception control subscale that increases the predictive value for panic severity more than the anxiety facet and anxiety sensitivity. CONCLUSIONS: this finding supports the assumption of the importance of taking into account the assessment of the lower order dimensions of the vulnerability factors in the field of psychopathology studies. Furthermore, the predictive value of perception of control of emotions indicates the importance of this specific vulnerability factor in the etiology of panic disorder (with or without agoraphobia) and, thus, shows the necessity to include emotion regulation strategies in the psychological treatments

ANTECEDENTES: en este trabajo se estudia el valor predictivo sobre la gravedad del pánico de tres factores de vulnerabilidad bien establecidos: rasgos de personalidad (neuroticismo y extraversión; NEO-PI-R), sensibilidad a la ansiedad (ASI) y percepción de control (ACQ-R). MÉTODO: la muestra fue de 52 participantes con diagnóstico de trastorno de pánico, con o sin agorafobia, según criterios DSM-IV-TR.RESULTADOS: nuestros resultados revelan que la faceta de ansiedad es mejor predictor de la gravedad del pánico que el neuroticismo. La sensibilidad a la ansiedad aumenta el valor predictivo sobre la gravedad del pánico y, finalmente, la percepción de control de las emociones es la única subescala de la percepción de control que aumenta la capacidad predictiva más allá de la faceta de ansiedad y la sensibilidad a la ansiedad. CONCLUSIONES: estos resultados apoyan el supuesto sobre la importancia de evaluar las dimensiones de orden inferior de los factores de vulnerabilidad en los estudios psicopatológicos. Además, el valor predictivo de la percepción de control de las emociones indica la importancia de este factor específico de vulnerabilidad en la etiología del trastorno de pánico (con o sin agorafobia) lo que muestra la necesidad de incluir estrategias de regulación emocional en los tratamientos psicológicos

Mindfulness en perspectiva / Mindfulness into perspective

El Midfulness (Mf) es un tipo de psicoterapia basada en el budismo y que tiene un uso creciente en trastornos de ansiedad, afectivos y por dolor. Una de sus principales técnicas es la focalización de la atención en el momento presente. Al tener una fundamentación explícita en las prácticas espirituales budistas, y al proceder de un entorno cultural oriental, su aplicación clínica debe buscar mecanismos para facilitar su encaje. Se realiza una revisión narrativa con el objetivo de proporcionar la integración del Mf con otras técnicas de psicoterapia. Se clarifican concretamente: 1) los orígenes budistas comunes al Mf y a otras formas de psicoterapia y 2) la integración del conocimiento sobre los mecanismos neurobiológicos del Mf en los actuales modelos de neurociencia. Se concluye que el Mf puede integrarse con otros programas psicoterapéuticos y que sus postulados son falsables en el diálogo científico actual con la neurociencia clínica (AU)

Mindfulnes (Mf) is a Buddhism based type of psychotherapy and has an increasing application in anxiety, affective and pain disorders. Focusing of attention in present moment is one of its mainly techniques. As it has an explicit foundation in Buddhist spiritual practice, and also proceed from an eastern cultural environment, implementation in the clinical practice should be provided. A narrative review is performed in order to facilitate Mf integration with other psychotherapy techniques. Manly to aspects are addressed: 1) Mf common Buddhist origins and other psychotherapy types and 2) inclusion of Mf neurobiological mechanism knowledge in present neuroscience models. We conclude that Mf can be integrated with other psychotherapy programs and that contain falsifiable assumptions on current scientific dialog with clinical neuroscience (AU)

Técnicas para el análisis de diseños de caso único en la práctica clínica: ejemplos de aplicación en el tratamiento de víctimas de atentados terroristas / Techniques for the analysis of single-case designs in clinical practice: Examples of application in the treatment of victims of terrorist attacks

En este trabajo se presentan dos técnicas para el análisis de datos de los diseños de caso único en la investigación de los tratamientos psicológicos: los índices de no solapamiento de datos para estimar el tamano del efecto del tratamiento (o magnitud del cambio terapéutico) y la aproximación estadística de Jacobson y Truax (1991) para estimar la significación clínica del efecto. A partir del caso de una víctima del terrorismo que sufría de trastorno por estrés postraumático, trastorno depresivo mayor y trastorno de angustia con agorafobia y que recibió terapia cognitivo conductual centrada en el trauma, se ejemplifica el cálculo y aplicación del porcentaje de datos no solapados (PND), el porcentaje de datos que exceden la mediana (PEM), el no solapamiento de todos los pares (NAP) y la aproximación estadística a la significación clínica y se discuten sus ventajas y limitaciones como complemento al análisis visual de los datos

This paper presents two techniques for the data analysis of single case designs in psychological treatment research: indices of data overlap between phases to estimate the size of treatment effect (or the magnitude of therapeutic change) and Jacobson and Truax’s (1991) statistical approach to estimate the clinical significance of treatment effect. Based on a case of a victim of terrorism who suffered from posttraumatic stress disorder, major depressive disorder and panic disorder with agoraphobia and received trauma-focused cognitive-behavioral therapy, this paper illustrates the computation and application of percentage of non-overlapping data (PND), percentage of data points exceeding the median (PEM), nonoverlap of all pairs (NAP), and statistical approach to clinical significance, and discusses their advantages and limitations as a complement of visual analysis of data

Attentional bias modulation by reappraisal in patients with generalized anxiety disorder: an event-related potential study

Affective states influence subsequent attention allocation. We evaluated emotional negativity bias modulation by reappraisal in patients with generalized anxiety disorder (GAD) relative to normal controls. Event-related potential (ERP) recordings were obtained, and changes in P200 and P300 amplitudes in response to negative or neutral words were noted after decreasing negative emotion or establishing a neutral condition. We found that in GAD patients only, the mean P200 amplitude after negative word presentation was much higher than after the presentation of neutral words. In normal controls, after downregulation of negative emotion, the mean P300 amplitude in response to negative words was much lower than after neutral words, and this was significant in both the left and right regions. In GAD patients, the negative bias remained prominent and was not affected by reappraisal at the early stage. Reappraisal was observed to have a lateralized effect at the late stage.

Alteraciones hipocampales y cambios cognitivos preceden al deposito de placas amiloides en un modelo murino de la enfermedad de Alzheimer

Existen múltiples evidencias de alteraciones neuronales y gliales en etapas avanzadas de la enfemedad de Alzheimer con abundantes depósitos cerebrales de beta amiloide, aunque hay pocos datos de cambios tempranos que podrían contribuir al desarrollo de la enfermedad. Evaluamos alteraciones morfológicas neuronales y gliales, y cambios cognitivos y emocionales tempranos en ratones transgénicos PDAPP-J20 (Tg), portadores del gen humano de APP (amyloid precursor protein) mutado, a los 5 meses de edad, aún sin depósitos amiloides en el hipocampo y con niveles bajos de péptidos amiloides cerebrales. Mediante inmunohistoquímica para NeuN, los Tg presentaron menor número de neuronas piramidales y granulares en el hipocampo, junto con un menor volumen de la estructura, en comparación con los controles no transgénicos. La neurogénesis se encontró afectada, evidenciada por reducido número de neuronas DCX+ en el giro dentado. En la región CA3, hubo una menor densidad de sinaptofisina sugiriendo alteraciones sinápticas entre neuronas granulares y piramidales, sin cambios en la densidad de espinas dendríticas en CA1. Utilizando microscopía confocal, observamos una disminución del número de astrocitos GFAP+ con una reducción de la complejidad celular, sugiriendo atrofia glial. Se detectó un déficit cognitivo (reconocimiento de localización novedosa de un objeto) y un aumento de la ansiedad (campo abierto) en los Tg, con aumento en los núcleos c-Fos+ en amígdala, evidenciando el papel de la emocionalidad en los inicios de la enfermedad. El estudio de las alteraciones iniciales en la enfermedad amiloide podría contribuir al desarrollo de métodos de diagnóstico temprano y de terapéutica preventiva.

Although there is strong evidence about neuronal and glial disturbances at advanced stages of Alzheimer’s disease, less attention has been directed to early, pre-amyloid changes that could contribute to the progression of the disease. We evaluated neuronal and glial morphological changes and behavioral disturbances in PDAPP-J20 transgenic (Tg) mice, carrying mutated human APP gene (amyloid precursor protein), at 5 months of age, before brain amyloid deposition occurs. Using NeuN immunohistochemistry we found decreased numbers of pyramidal and granular neurons in the hippocampus associated with a reduction of hippocampal volume in Tg mice compared with controls. Neurogenesis was impaired, evidenced by means of DCX immunohistochemistry in the dentate gyrus. In the CA3 region we found a decreased density of synaptophysin, suggesting synaptic disturbance, but no changes were found in CA1 synaptic spine density. Using confocal microscopy we observed decreased number and cell complexity of GFAP+ astrocytes, indicating potential glial atrophy. Cognitive impairment (novel location recognition test) and increased anxiety (open field) were detected in Tg mice, associated with more c-Fos+ nuclei in the amygdala, possibly indicating a role for emotionality in early stages of the disease. The study of early alterations in the course of amyloid pathology could contribute to the development of diagnostic and preventive strategies.

Altered Activity and Functional Connectivity of Superior Temporal Gyri in Anxiety Disorders: A Functional Magnetic Resonance Imaging Study

OBJECTIVE: The prior functional MRI studies have demonstrated significantly abnormal activity in the bilateral superior temporal gyrus (STG) of anxiety patients. The purpose of the current investigation was to determine whether the abnormal activity in these regions was related to a loss of functional connectivity between these regions. MATERIALS AND METHODS: Ten healthy controls and 10 anxiety patients underwent noninvasive fMRI while actively listening to emotionally neutral words alternated by silence (Task 1) or threat-related words (Task 2). The participants were instructed to silently make a judgment of each word's valence (i.e., unpleasant, pleasant, or neutral). A coherence analysis was applied to the functional MRI data to examine the functional connectivity between the left and the right STG, which was selected as the primary region of interest on the basis of our prior results. RESULTS: The data demonstrated that the anxiety patients exhibited significantly increased activation in the bilateral STG than the normal controls. The functional connectivity analysis indicated that the patient group showed significantly decreased degree of connectivity between the bilateral STG during processing Task 2 compared to Task 1 (t = 2.588, p = 0.029). In addition, a significantly decreased connectivity was also observed in the patient group compared to the control group during processing Task 2 (t = 2.810, p = 0.012). CONCLUSION: Anxiety patients may exhibit increased activity of the STG but decreased functional connectivity between the left and right STG, which may reflect the underlying neural abnormality of anxiety disorder, and this will provide new insights into this disease.

What friends tell you about justice: The influence of peer communication on applicant reactions / Lo que te dicen los amigos sobre la justicia: influencia de la comunicación entre iguales en la reacción de los aspirantes

This study examined the influence of peer communication concerning a selection procedure on the levels of anxiety among applicants taking a test and test motivation regarding a similar selection procedure, through the formation of interpersonal and distributive justice expectations. The hypotheses were addressed in a randomized four-group experiment. The results of the mediated hierarchical regression analyses showed significant mediating effects. Specifically, peer communication about interpersonal justice shaped applicants’ interpersonal justice expectations, which in turn related negatively to applicants’ levels of test anxiety. Peer communication about distributive justice shaped applicants’ distributive justice expectations, which in turn related positively to applicants’ test motivation(AU)

Este estudio examinó la influencia de la comunicación entre iguales en un proceso de selección sobre los niveles de ansiedad en aspirantes que realizan un test y su motivación para realizarlo en un proceso de selección similar, a través de la formación de expectativas de justicia distributiva e interpersonal. Las hipótesis se pusieron a prueba mediante un diseño aleatorizado de cuatro grupos. Los resultados de los análisis de regresión jerárquica mediada mostraron efectos mediadores significativos. Especialmente la comunicación entre iguales sobre la justicia interpersonal configuró las expectativas sobre justicia interpersonal de los solicitantes, las cuales a su vez se relacionaron negativamente con los niveles de ansiedad de exámenes de los solicitantes. La comunicación entre iguales acerca de la justicia distributiva configuró las expectativas de justicia distributiva, que a su vez se relacionaron positivamente con la motivación para realizar exámenes de los solicitantes(AU)

Manual para diagnóstico y tratamiento de trastornos ansiosos / Manual for diagnosis and treatment of anxiety disorders

La ansiedad es la más común y universal de las emociones, es una sensación o un estado emocional normal ante determinadas situaciones y que constituye una respuesta habitual a diferentes situaciones cotidianas estresantes. Tan solo cuando sobrepasa cierta intensidad o supera la capacidad adaptativa de la persona, es cuando la ansiedad se convierte en patológica y provoca malestar significativo con síntomas que afectan tanto al plano físico, como al psicológico y conductual. Los trastornos de ansiedad son más frecuentes que cualquier otro tipo de alteración psiquiátrica. No obstante, a menudo pasan desapercibidos y, por tanto, no se tratan. Se realiza este manual con el objetivo de brindar a los médicos de la atención primaria de salud recursos que le permitan establecer el diagnóstico de los trastornos ansiosos, así como indicar una terapéutica adecuada, mediante la utilización de algoritmos diagnósticos, que permiten identificar las manifestaciones psicopatológicas de cada forma clínica y su conducta farmacológica psicológica(AU)

Anxiety is the most common and universal of all emotions. It is a feeling or a normal emotional state in certain situations and that is a common response to everyday stressful situations. Only when it exceeds certain intensity or the adaptive capacity of the person, it becomes pathological and causes significant discomfort with symptoms that affect both the physical and psychological behavioral spheres. Anxiety disorders are more common than any other psychiatric disorder. However, they are often unnoticed and therefore untreated. This manual has been conformed in order to provide physicians in primary health care resources to enable the diagnosis of anxiety disorders and the indication of the appropriate therapy, using diagnostic algorithms, which identify the psychopathology of each clinical presentation and its pharmacological and psychological conducts(AU)

Transtorno do pânico / Panic disorder

Objetivos: Revisar o transtorno do pânico (TP), considerando seus aspectos clínicos, epidemiológicos, diagnósticos e etiológicos, bem como os avanços no tratamento, uma vez que o TP é uma entidade nosológica acompanhada de importante prejuízo psíquico e funcional. Método: Foi realizada uma revisão narrativa da literatura nas principais bases de dados existentes (MEDLINE, PsychINFO e SciELO) e em livros textos atualizados. Resultados: Devido à sintomatologia predominantemente física desse transtorno, os pacientes geralmente procuram vários atendimentos clínicos até que o diagnóstico seja feito. Em função desses aspectos e da sua cronicidade, o TP está associado a elevados custos econômicos. O tratamento do TP pode ser feito com psicoterapia e/ou psicofármacos. As diversas abordagens terapêuticas são apresentadas com o nível de evidência de cada recomendação. Em virtude da cronicidade e morbidade do TP, pesquisas têm se voltado para o estudo de estratégias de prevenção já na infância. Conclusões: O TP é um transtorno crônico e com baixas taxas de remissão dos sintomas em longo prazo. Sendo assim, sugere-se que sejam delineados novos estudos para tratamento precoce dos transtornos de ansiedade ou mesmo para prevenção em crianças de risco.

Objective: To review panic disorder (PD) considering its clinical, epidemiological, diagnostic, and etiologic aspects, as well as the advances in its treatment, since PD is a nosologic entity characterized by important psychiatric and functional impairment. Method: A review of the literature was carried out using the main databases available (MEDLINE, PsychINFO and SciELO) and up-to-date textbooks. Results: Due to the prevalence of physical symptoms in this disorder, patients usually have to seek clinical care for several times before the diagnosis is established. As a result of these aspects and because of its chronicity, PD is associated with high economic costs. PD treatment may include psychotherapy and/or use of psychotropic drugs. In this review, we present several different therapeutic approaches, as well as the levels of evidence of each recommendation. Due to PD chronicity and morbidity, researches have been focused on the study of strategies to prevent PD since childhood. Conclusions: PD is a chronic disorder with low long-term remission rates. Therefore, we suggest that new studies should be designed concerning the early treatment of anxiety disorders or even the prevention of this disorder in children at risk.

Structural magnetic ressonance imaging in anxiety disorders: an update of research findings: [review] / Ressonância magnética estrutural em transtornos de ansiedade: atualização dos achados de pesquisa: [revisão]

OBJECTIVE: The aim of the present report is to present a systematic and critical review of the more recent literature data about structural abnormalities detected by magnetic ressonance in anxiety disorders. METHOD: A review of the literature in the last five years was conducted by a search of the Medline, Lilacs and SciELO indexing services using the following key words: "anxiety", "panic", "agoraphobia", "social anxiety", "posttraumatic" and "obsessive-compulsive", crossed one by one with "magnetic resonance", "voxel-based", "ROI" and "morphometry". RESULTS: We selected 134 articles and 41 of them were included in our review. Recent studies have shown significant morphological abnormalities in various brain regions of patients with anxiety disorders and healthy controls. Despite some apparently contradictory findings, perhaps reflecting the variability and limitations of the methodologies used, certain brain regions appear to be altered in a consistent and relatively specific manner in some anxiety disorders. These include the hippocampus and the anterior cingulate cortex in posttraumatic stress disorder and the orbitofrontal cortex in obsessive-compulsive disorder. CONCLUSIONS: The present review indicates that structural neuroimaging has contributed to a better understanding of the neurobiology of anxiety disorders. Further development of neuroimaging techniques, better sample standardization and the integration of data across neuroimaging modalities may extend progress in this area.

OBJETIVO: Apresentar uma revisão sistemática e crítica dos achados mais recentes da literatura em relação a alterações estruturais avaliados por ressonância magnética nos transtornos de ansiedade. MÉTODO: Uma revisão da literatura dos últimos cinco anos foi realizada utilizando uma busca nos indexadores Medline, Lilacs e SciELO utilizando as seguintes palavras-chave: "anxiety", "panic", "agoraphobia", "social anxiety", "posttraumatic" e "obsessive-compulsive" cruzadas uma a uma com "magnetic ressonance", "voxel-based", "ROI" e "morphometry". RESULTADOS: Foram selecionados 134 artigos, sendo 41 foram incluídos nesta revisão. Estudos recentes mostram alterações morfológicas significativas entre os pacientes com transtorno de ansiedade e os controles saudáveis em várias regiões cerebrais. Apesar de achados contraditórios, sobretudo devido à variabilidade e às limitações nas metodologias utilizadas, algumas estruturas aparecem alteradas de forma mais consistente e relativamente específica em alguns transtornos de ansiedade, como o hipocampo e o córtex cingulado anterior no transtorno de estresse pós-traumático e o córtex orbitofrontal no transtorno obsessivo-compulsivo. CONCLUSÕES: A presente revisão aponta que a neuroimagem estrutural pode ser utilizada na busca de uma maior compreensão da neurobiologia dos transtornos de ansiedade. É possível que o rápido avanço das técnicas de neuroimagem, uma maior padronização das amostras e a associação de dados de diferentes modalidades permitam um maior entendimento deste cenário.

Cerebellum and psychiatric disorders / O cerebelo e os transtornos psiquiátricos

OBJECTIVE: The objective of this update article is to report structural and functional neuroimaging studies exploring the potential role of cerebellum in the pathophysiology of psychiatric disorders. METHOD: A non-systematic literature review was conducted by means of Medline using the following terms as a parameter: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" and "attention deficit hyperactivity disorder". The electronic search was done up to April 2008. DISCUSSION: Structural and functional cerebellar abnormalities have been reported in many psychiatric disorders, namely schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, dementia and attention deficit hyperactivity disorder. Structural magnetic resonance imaging studies have reported smaller total cerebellar and vermal volumes in schizophrenia, mood disorders and attention deficit hyperactivity disorder. Functional magnetic resonance imaging studies using cognitive paradigms have shown alterations in cerebellar activity in schizophrenia, anxiety disorders and attention deficit hyperactivity disorder. In dementia, the cerebellum is affected in later stages of the disease. CONCLUSION: Contrasting with early theories, cerebellum appears to play a major role in different brain functions other than balance and motor control, including emotional regulation and cognition. Future studies are clearly needed to further elucidate the role of cerebellum in both normal and pathological behavior, mood regulation, and cognitive functioning.

OBJETIVO: Este artigo de atualização tem como objetivo avaliar estudos em neuroimagem estrutural e funcional a fim de explorar o papel do cerebelo na patofisiologia dos transtornos psiquiátricos. MÉTODO: Uma revisão não sistemática foi realizada através do Medline utilizando-se como parâmetro os seguintes termos: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" e "attention deficit hyperactivity disorder". A busca eletrônica foi feita até abril de 2008. DISCUSSÃO: Anormalidades cerebelares estruturais e funcionais têm sido relatadas em muitos transtornos psiquiátricos, entre eles a esquizofrenia, transtorno bipolar, transtorno depressivo, transtornos ansiosos, demências e transtorno de déficit de atenção e hiperatividade. Estudos utilizando imagem por ressonância magnética estrutural relataram a diminuição do volume total do cerebelo e do vermis cerebelar na esquizofrenia, transtornos do humor e transtorno de falta de atenção com hiperatividade. Estudos utilizando ressonância magnética funcional e paradigmas cognitivos têm demonstrado alterações na atividade cerebelar na esquizofrenia, transtornos ansiosos e transtorno de falta de atenção com hiperatividade. Nas demências, o cerebelo é afetado nos estágios mais avançados dessas doenças. CONCLUSÃO: Contrastando com as primeiras teorias, o cerebelo parece apresentar um papel mais importante em diferentes funções cerebrais além do controle motor e do equilíbrio, incluindo a regulação emocional e cognição. Futuros estudos são necessários para melhor elucidar o papel do cerebelo em ambos os comportamentos, normal e patológico, na regulação do humor e nas funções cognitivas.

Aspectos cognitivos en la depresión / Cognitive Aspects of Depression

La depresión mayor (DM) es una de las afecciones más frecuentes en salud mental, esperándose un incremento de esta para el año 2020 (WHO). Se ha efectuado una revisión de los estudios recientes existentes acerca de las alteraciones cognitivas en pacientes con depresión mayor, concluyéndose en varios estudios, incluido un metanálisis, que los pacientes con DM tienen alteraciones en las funciones ejecutivas, comparados con sujetos sanos. Este hecho se ha observado tanto en pacientes con reiterados episodios de depresión mayor como en aquellos con el primer episodio. Esta alteración cognitiva puede llevar a dificultades en el rendimiento laboral, escolar, social, etc. Por ello, surge la necesidad de profundizar el estudio de este aspecto poco analizado de la depresión, así como capacitar a los profesionales de la salud en su detección y reconocimiento precoz, ya que podría constituir un síntoma trazador de la evolución de la enfermedad depresiva

Major depression (MD) is one of the most frequent diseases of mental health; this disorder is expected to increase by 2020 (WHO). The author does a revision of recent existing studies on cognitive alterations in patients with major depression, many of which, including a meta-analysis, conclude that such patients display alterations in their execuive functions, as compared with healthy subjects. This has been observed both in patients with repeated episodes of major depression, as well as in patients with a first episode. This congnitive alteration may lead to difficulties in work, school, social, etc. performance. Therefore, it becomes necessary to delve into the study of this poorly analyzed aspect of depression, and train health care professionals in its prompt detection and identification, since it might be a revealing symptom of the progression of the depressive disorder

Aspectos cognitivos en la depresión / Cognitive Aspects of Depression

La depresión mayor (DM) es una de las afecciones más frecuentes en salud mental, esperándose un incremento de esta para el año 2020 (WHO). Se ha efectuado una revisión de los estudios recientes existentes acerca de las alteraciones cognitivas en pacientes con depresión mayor, concluyéndose en varios estudios, incluido un metanálisis, que los pacientes con DM tienen alteraciones en las funciones ejecutivas, comparados con sujetos sanos. Este hecho se ha observado tanto en pacientes con reiterados episodios de depresión mayor como en aquellos con el primer episodio. Esta alteración cognitiva puede llevar a dificultades en el rendimiento laboral, escolar, social, etc. Por ello, surge la necesidad de profundizar el estudio de este aspecto poco analizado de la depresión, así como capacitar a los profesionales de la salud en su detección y reconocimiento precoz, ya que podría constituir un síntoma trazador de la evolución de la enfermedad depresiva (AU)

Major depression (MD) is one of the most frequent diseases of mental health; this disorder is expected to increase by 2020 (WHO). The author does a revision of recent existing studies on cognitive alterations in patients with major depression, many of which, including a meta-analysis, conclude that such patients display alterations in their execuive functions, as compared with healthy subjects. This has been observed both in patients with repeated episodes of major depression, as well as in patients with a first episode. This congnitive alteration may lead to difficulties in work, school, social, etc. performance. Therefore, it becomes necessary to delve into the study of this poorly analyzed aspect of depression, and train health care professionals in its prompt detection and identification, since it might be a revealing symptom of the progression of the depressive disorder (AU)

Mecanismos neuronales en el modelo cognitivo de depresión de Beck / Neural Mechanisms in Becks Cognitive Model of Depression

El modelo cognitivo de la depresión que fuera formulado por Beck hace más de 40 años se fundamentaba en procesamientos sesgados de la atención, memoria y el pensamiento, con rumiación y desvíos hacia los llamados ôpensamientos negativos repetitivosö, como jugando roles primarios en el desarrollo y mantenimiento de la depresión. En 2011, el propio Beck y sus colaboradores hacen un resumen de los hallazgos referentes a los mecanismos neurales que subyacen a los aspectos cognitivos de la depresión. Sin embargo, sólo se consideran aquellos aspectos referentes al procesamiento cognitivo sin hacer lo mismo con el procesamiento emocional que es el endofenotipo nuclear del trastorno depresivo y se refleja en la lectura de las emociones por el cerebro emocional y la corteza de la ínsula según el esquema de Damasio actualizado por Craig (14), que deberá tenerse en cuenta como la base fundamental de las terapias cognitivo/conductuales y las cognitivo/emocionales junto al necesario tratamiento farmacológico, adecuadamente complementados en tiempo y forma (AU)

The cognitive model of depression, which was formulated by Beck more than 40 years ago, was grounded on biased processings of attention, memory and thought, with rumination and deviations towards the so-called "negative repetitive thoughts", as playing primry roles in the development and maintenance of depression. In 2011, Beck himself, as well as his collaborators, summarized the findings concerning the neural mechanisms underlying the cognitive aspects of depression. However, only those aspects relating to the cognitive processing are considered and not the emotional processing that is the nuclear endophenotype of depressive disorder and is reflected in the reading of emotions by the brain and the insular cortex, according to Damasios scheme updated by Craig (14), which should be considered the fundamental basis of cognitive/behavioral therapies and cognitive/emotional therapies together with the necessary pharmacological treatment, adequately complimented in due time and forma (AU)