Abstract
Anxiety disorders are prevalent and highly disabling mental disorders. In recent years, intensive efforts focused on the search for potential neuroimaging, genetic, and peripheral biomarkers in order to better understand the pathophysiology of these disorders, support their diagnosis, and characterize the treatment response. Of note, peripheral blood biomarkers, as surrogates for the central nervous system, represent a promising instrument to characterize psychiatric disorders, although their role has not been extensively applied to clinical practice. In this report, the state of the art on peripheral biomarkers of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) Anxiety Disorders is presented, in order to examine their role in the pathogenesis of these conditions and their potential application for diagnosis and treatment. Available data on the cerebrospinal fluid and blood-based biomarkers related to neurotransmitters, neuropeptides, the hypothalamic–pituitary–adrenal axis, neurotrophic factors, and the inflammation and immune system are reviewed. Despite the wide scientific literature and the promising results in the field, only a few of the proposed peripheral biomarkers have been defined as a specific diagnostic instrument or have been identified as a guide in the treatment response to DSM-5 Anxiety Disorders. Therefore, further investigations are needed to provide new biological insights into the pathogenesis of anxiety disorders, to help in their diagnosis, and to tailor a treatment.
Highlights
Anxiety disorders (ADs) are highly prevalent in the general population, often comorbid with psychiatric disorders and medical conditions [1,2], and associated with a negative impact on quality of life and a significant individual and economic burden [3]
The Serotonergic System: A study reported that platelet the 5-HT reuptake binding density was decreased in patients with GAD compared to healthy controls (HCs), even though this difference was reported in patients with major depressive disorder (MDD), dysthymia, and panic disorders with or without agoraphobia (PDA), not specific to GAD [23]
Cholecystokinin (CCK): A study by Brawman-Mintzer [97] reported that intravenous pentagastrin, a CCK-B receptor agonist, induced higher rates of panic attacks in patients with GAD compared with the controls, suggesting that CCK hypersensitivity could play a role in the pathophysiology of this disorder
Summary
Anxiety disorders (ADs) are highly prevalent in the general population, often comorbid with psychiatric disorders and medical conditions [1,2], and associated with a negative impact on quality of life and a significant individual and economic burden [3]. Biomarkers emerged as essential instruments in several clinical fields, in particular in cancer and cardiovascular medicine, guaranteeing an increased precision and individualization of diagnostic measures and treatments [8,9] Translating this approach to psychiatry seems a promising strategy. Different systems are involved in the pathogenesis of ADs, like the hypothalamic–pituitary–adrenal (HPA) axis [12] and the immune system [13], and the potential alterations underpinning these systems can be detected through peripheral sampling (e.g., through blood, saliva, urine, or hair) Considering this background, a better knowledge of peripheral biomarkers seems crucial for clinicians. Reference lists of the selected articles were screened for additional research We only included those articles published in English and that focused on the most investigated peripheral biomarkers related to neurotransmitters, neuropeptides, the HPA axis, neurotrophic factors, and the inflammation and immune system
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