Generalized Anxiety Disorder Patients Research Articles

Dysfunction of Resting-State Functional Connectivity of Amygdala Subregions in Drug-Naïve Patients With Generalized Anxiety Disorder.

Objective: Although previous studies have reported on disrupted amygdala subregional functional connectivity in generalized anxiety disorder (GAD), most of these studies were conducted in GAD patients with comorbidities or with drug treatment. Besides, whether/how the amygdala subregional functional networks were associated with state and trait anxiety is still largely unknown.Methods: Resting-state functional connectivity of amygdala subregions, including basolateral amygdala (BLA) and centromedial amygdala (CMA) as seed, were mapped and compared between 37 drug-naïve, non-comorbidity GAD patients and 31 age- and sex-matched healthy controls (HCs). Relationships between amygdala subregional network dysfunctions and state/trait anxiety were examined using partial correlation analyses.Results: Relative to HCs, GAD patients showed weaker functional connectivity of the left BLA with anterior cingulate/medial prefrontal cortices. Significantly increased functional connectivity of right BLA and CMA with superior temporal gyrus and insula were also identified in GAD patients. Furthermore, these functional connectivities showed correlations with state and trait anxiety scores.Conclusions: These findings revealed abnormal functional coupling of amygdala subregions in GAD patients with regions involved in fear processing and emotion regulation, including anterior cingulate/medial prefrontal cortex and superior temporal gyrus, which provide the unique biological markers for GAD and facilitating the future accurate clinical diagnosis and target treatment.

Safety and efficacy of aviandr in patients with generalized anxiety disorder: A multicenter, randomized, double-blind, placebo-controlled, dose-finding, pilot study

Generalized anxiety disorder (GAD) is associated with an imbalance in the functioning of the stimulating neurotransmitter systems in human's brain. We studied the safety and therapeutic efficacy of aviandr, the new noradrenergic and specific serotonergic antidepressant, for GAD patients in the phase II, double-blind, placebo-controlled, randomized, multicenter, pilot trial at 17 clinical sites of the Russian Federation. 129 eligible patients were 18 years and older and met the criteria for GAD diagnosis. The patients were randomly assigned (1:1:1) to receive oral aviandr at daily dose of 40 mg (cohort 1, n = 41) or 60 mg (cohort 2, n = 43) or placebo (cohort 3, n = 43) for 8 weeks. The patients were assessed by the Hamilton anxiety scale (HAM-A), Hamilton Depression Scale (HAM-D), Clinical Global Impression Scale (CGI-S), Visual Analogue Scale and vital signs. At week 8, the decreases of the HAM-A score were achieved in 53∙7%, 47∙7% and 16∙3% in cohorts 1, 2 and 3, respectively. Changes of HAM-A, HAM-D, CGI-S, and CGI-I scores in aviandr-treated patients were superior to placebo (p < 0∙001). The psychic components of anxiety decreased on the first day, throughout the 8 weeks of treatment and on a follow-up week after aviandr discontinuation. Aviandr (40 mg daily dose) reduced drowsiness compared to baseline, was safe, well-tolerated and did not cause serious or severe adverse events or signs of withdrawal syndrome within one week after treatment completion. Aviandr at both 40 and 60 mg daily doses demonstrated therapeutic efficacy in GAD patients over placebo.

DIFFERENTIAL EXPRESSION OF MICRORNA IN GENERALIZED ANXIETY DISORDER AND ITS ASSOCIATION WITH SOCIAL SUPPORT

To explore the differential expression of microRNA (miRNA, miR-) and its correlation with social support and personality in Generalized Anxiety Disorder (GAD) patients. A total of 80 GAD patients and 80 control participants were selected from our serial study samples to be tested for microarray analysis, and real time quantitative Polymerase Chain Reaction (qRT-PCR) verification was carried out in both patient group and control group. Correlation between miRNA expression and social support were also carried out. According to microarray analysis, 6 miRNAs were differentially expressed between patient group and control group, with miR-4505, miR-4484, miR-4674, miR-501-3p and miR-663 up-regulated, and miR-1301 down-regulated; qPCR verification revealed that 5 miRNAs (miR-1301, miR-4484, miR-4674, miR-501-3p, miR-663, miR-4505) were significantly up-regulated and the expression of miRNA-1301 down-regulated; the expression of miRNA-1301 was significantly related to social support in GAD patients. In conclusions, comprehensive factors, including miRNA regulation, social support may be involved into the aetiology of GAD.

ROLE OF BHRAMARI PRANAYAMA IN GENERALISED ANXIETY DISORDER

Pranayama is a Yogic technique which ensure homeostasis between physical and mental health. Bhramari is one of the 8 types of Pranayama as explained by Sage Patanjali which is considered to be effective in maintaining mental health. The following article discusses the probable use of Bhramari in Generalised Anxiety Disorder (GAD). Various publications from Pubmed, Google Scholar, Scopus etc were reviewed to reinforce the hypothesis that Bhramari can be effective in GAD. It is worthwhile known that Bhramari is effective in various stressful conditions but its efficacy against GAD is not yet proven. Since GAD is one of the most common mental disorders, it is hypothesised that Bhramari acts good against GAD too. Hence, it can be concluded that it would be beneficial to conduct larger studies on GAD patients to ascertain the efficacy of Bhramari in their population.

S947 Risk of Generalized Anxiety Disorder and Its Impact on Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study

Introduction: There is a higher rate of co-morbid psychiatric illnesses in patients with inflammatory bowel disease (IBD) compared to the general population. The literature on the association and impact of generalized anxiety disorder (GAD) on IBD remains limited. The primary aim of our study was to assess the outcomes and the risk of complications in patients with IBD and GAD. Methods: We performed a retrospective analysis in the IBM Explorys database (1999-2021), a pooled, national, de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals. IBD patients were identified by a diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) who had a gastroenterology provider plus any one IBD medication. GAD patients were identified by the diagnosis code of GAD plus any anti-depressant medication or class. Exclusion criteria included the following: cerebrovascular accident, lupus, rheumatoid arthritis, myocardial infarction, multiple sclerosis, diabetes, psoriasis, malignancy, alcohol/substance abuse, epilepsy, hypo/hyperthyroidism and fibromyalgia. Control group included non-IBD patients who had GAD. IBD outcomes evaluated were as follows: disease flare, biologic therapy, colon cancer, strictures, fistula, pouchitis, osteoporosis, malnutrition, and IBD surgery. These outcomes were compared in IBD patients with GAD and those without GAD. Odds ratio with 95% CI were calculated to assess risk of GAD and complications in UC or CD compared to control cohort. Results: A total of 49,090 patients were identified with a diagnosis of UC, of which 2,070 (4.22%) also had GAD. 62,480 patients were identified with CD, of which 3,270 (4.22%) had GAD. Patients with CD (OR 3.34, 95% CI 3.22–3.46, P < 0.0001) and UC (2.69, 2.58–2.81) were at a higher risk of GAD compared to control cohort. Patients with UC and GAD were at a higher risk for disease flare (1.53, 1.41-1.65), pouchitis (1.31, 1.12-1.53), and malnutrition (1.75, 1.52-2.02) when compared to control cohort (Figure 1). Patients with CD and GAD were at a higher risk for disease flare (1.47, 1.38-1.56) and malnutrition (1.85, 1.67-2.05) compared to control cohort (Figure 1). Conclusion: A diagnosis of GAD is more commonly present with IBD, with increased risk of UC/CD flares and malnutrition when compared to the general IBD population. This study highlights the importance for gastroenterologists to screen and address GAD in their IBD clinics as it may significantly impact the natural course of the disease.Figure 1.: Odds ratios with 95% confidence intervals of inflammatory bowel disease (UC and CD) outcomes and complications in patients with and without generalized anxiety disorder (GAD).Table 1.: Comparing baseline demographics in Ulcerative Colitis (UC) and Crohn’s Disease (CD) patients with generalized anxiety disorder (GAD) to those without GAD

Neurophysiological and ultrasonographic comparative study of autonomous nervous system in patients suffering from fibromyalgia and generalized anxiety disorder.

Fibromyalgia (FM) and generalized anxiety disorder (GAD) share common clinical features: they both affect women more than men, their diagnosis is based solely on clinical criteria, and some of the symptoms such as anxiety, aches and muscle tension, sleep disorders, and cognitive dysfunction occur in both diseases. For both conditions, an underlying dysregulation of the autonomic nervous system (ANS) has been proposed. The aims of this study were to investigate ANS dysfunction in FM and GAD and compare them with controls. Sympathetic skin response (SSR) from palm and sole and cross-sectional area (CSA) of bilateral vagus nerves (VN) were measured in 28 healthy controls, 21 FM patients, and 24 GAD patients. CSA of VN was significantly smaller in FM patients (right: 1.97 ± 0.74mm2, left: 1.75 ± 0.65 mm2) and GAD patients (right: 2.12 ± 0.97mm2, left: 1.71 ± 0.86 mm2) compared to controls (right: 3.21 ± 0.75 mm2, left: 2.65 ± 1.13 mm2, p < 0.001, but did not differ between the two patient groups. SSR parameters were similar between patients and controls. SSR latency correlated to clinical scales (FM Widespread Pain Index) in the FM group (r = 0.515, p = 0.02 and r = 0.447, p = 0.05) for the upper and lower limbs respectively, but no other correlation between clinical and neurophysiological parameters was identified. This study confirms similar ANS abnormalities in FM and GAD that fairly distinguish them from controls and support the hypothesis of a common pathophysiological substrate underlying both conditions.

Investigating Principal Working Memory Features in Generalized, Panic, and Social Anxiety Spectrum Disorders.

Anxiety spectrum disorders are characterized by excessive and uncontrollable worrying about potential negative events in the short- and long-term future. Various reports linked anxiety spectrum disorders with working memory (WM) deficits despite conflicting results stemming from different study approaches. It remains unclear, however, how different anxiety spectrum disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD), differ in WM function. In this study, we utilized verbal, numerical, and sequential evaluations of WM to cover most possible facets of the WM data space. We used principal component analysis to extract the uncorrelated/whitened components of WM based on these measures. We evaluated medication-free patients with GAD, SAD, and PD patients as well as matched healthy individuals using a battery that measures WM duration and load. We found that patients with GAD and SAD, but not PD, exhibited poor performance only in the WM principal component that represents maintenance. There were no other significant differences between the four groups. Further, different WM components significantly predicted the severity of anxiety symptoms in the groups. We explored the clinical utility of WM components for differentiating patients with anxiety spectrum disorders from healthy individuals. By only using the WM components that represent maintenance and encoding, we managed to differentiate patients from controls in 84% of cases. For the first time, we present multiple novel approaches to examine cognitive function and design cognitive screening, and potentially diagnostics, for psychiatric disorders.

Application of PET Imaging in the Brain Regions of the Emotional Control Loop in Patients with Generalized Anxiety Disorder.

Objective This study uses PET imaging to observe the uptake and metabolism of 18F-fluorodeoxyglucose (18F-FDG) in the multibrain areas of the emotional control loop in patients with generalized anxiety disorder (GAD) and investigate the brain of GAD patient's functional abnormality mechanism. Methods The thesis clinically collected 20 GAD patients and 20 healthy subjects. Dynamic PET-CT scans were used. At the same time, 18F-FDG whole-brain uptake and metabolism data were collected. Image fusion and semiquantitative analysis were used to measure emotional control loops. The maximum standard uptake value (SUVmax) and dynamic uptake and metabolic changes of 11 time points in the brain area at 150 min were measured. Results Compared with the healthy control group, the peak uptake of the bilateral prefrontal cortex and the average uptake rate before the peak in GAD patients were significantly reduced (P < 0.05), and the average metabolic rate after the peak was significantly increased (P < 0.05). The peak uptake of the left striatum and the left hippocampus, the average uptake rate before the peak, and the average metabolic rate after the peak were all significantly reduced (P < 0.05); There were no obvious changes in the three indexes of the right striatum and the right hippocampus. Conclusion There are 18F-FDG uptake and metabolic disorders in multiple brain areas of the affective control loop of GAD patients. The abnormal peak and rate of uptake may be related to the pathogenesis of GAD.

Higher baseline serum adiponectin predicts better treatment remission in patients with generalized anxiety disorder treated with escitalopram.

Generalized anxiety disorder (GAD) is partly attibuted to the dysregulation of nuero-inflammation which can be mediated by adiponectin. We conducted this study was to explore the characteristics of peripheral adiponectin and its role in predicting treatment outcome in patients with generalized anxiety disorder (GAD) treated by escitalopram or venlafaxine. A total of 70 untreated GAD inpatients who met the diagnosis criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) were enrolled and randomly selected for treatment with escitalopram (n=36) or venlafaxine (n=34) for 8 weeks. The serum adiponectin level of GAD and healthy controls (HCs) was measured by enzyme-linked immunosorbent assay (ELISA) before treatment. Hamilton Anxiety Rating Scale (HAM-A) assessment was conducted at baseline and at 1, 2, 4, and 8 weeks after treatment respectively. Serum adiponectin levels were compared between GAD patients and HCs, as well as between remission and nonremission cases; the correlation between baseline adiponectin level and HAM-A reduction rate were also analyzed. The serum adiponectin levels were higher in GAD patients compared to HCs (t=2.304; P=0.023), the serum adiponectin levels were higher in remission cases compared to nonremission cases (t=2.255, P=0.027), and the receiver operating characteristic (ROC) area in predicting treatment remission was 0.652±0.066 (P=0.029). The correlation between baseline adiponectin level and HAM-A reduction rate of GAD cases treated with escitalopram and venlafaxine in the endpoint was 0.362 (P=0.030) and -0.026 (P=0.883), respectively, and the ROC area of baseline adiponectin level in predicting treatment remission was 0.72±0.086 (P=0.024) and 0.473±0.102 (P=0.469), respectively. Peripheral adiponectin is upregulated in GAD, and it seems higher baseline adiponectin level predicts a better treatment remission treated by escitalopram but not with venlafaxine, which suggests adiponectin maybe a potential key biomarker in Chinese GAD.

The effectiveness of sandplay therapy in treating generalized anxiety disorder patients with childhood trauma using magnetic resonance spectroscopy to examine choline level in the dorsolateral prefrontal cortex and centrum semiovale.

The effectiveness of sandplay therapy in treating generalized anxiety disorder patients with childhood trauma using magnetic resonance spectroscopy to examine choline level in the dorsolateral prefrontal cortex and centrum semiovale.

A Real-World, Prospective, Multicenter, Single-Arm Observational Study of Duloxetine in Patients With Major Depressive Disorder or Generalized Anxiety Disorder.

Background: Suboptimal treatment response during anti-depressive treatment is fairly common with the first antidepressant (AD) choice, followed by switching to another agent in the majority of cases. However, the efficacy of this strategy over continuation of the original agent is less solidly documented in real-life studies. The aim of our present study was to ascertain the effects of switching to duloxetine following inadequate response to prior ADs on general illness severity, pain, and health-related quality of life in a large sample of major depressive disorder (MDD) and generalized anxiety disorder (GAD) patients in a prospective, real-world, multicenter, observational study.Methods: A total of 578 participants with MDD or GAD were enrolled in 58 outpatient sites in an 8-week, single-arm, open-label, flexible-dose trial with duloxetine. Severity of symptoms [with Clinical Global Impression-Severity (CGI-S) and Clinical Global Impression-Improvement (CGI-I)], severity of pain (with a Visual Analog Scale), satisfaction with current treatment, and health-related quality of life [with the three-level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L)] measures were recorded at baseline and at follow-up visits 4 and 8 weeks after initiation of treatment. Data were analyzed using ANOVA and mixed linear models.Results: 565 patients completed the study and comprised the analyzed dataset. Results indicated that severity of illness significantly decreased over the 8 weeks of the study and already at 4 weeks in both patient groups. Overall quality of life and all of its subindicators also significantly improved in both patient groups and so did subjective experience of pain. Satisfaction with current treatment also significantly increased during the study period. Frequency of side effects was low. In both GAD and MDD groups, two patients dropped out of the study due to adverse effects, leading to treatment termination in four cases (0.7%).Conclusions: This 8-week, multicenter, flexible-dosing, single-arm, open-label, observational real-life study in MDD and GAD patients switched to duloxetine after inadequate response or low tolerability to other ADs showed a significant positive effect on all outcome measures, including a significant decrease in illness severity as well as significant overall symptomatic improvement, with good tolerability.

Shared Decision-Making and Information Needs among People with Generalized Anxiety Disorder.

Shared decision making (SDM) aims to involve patients in the decisions about their care, considering their preferences, values and concerns about the different treatment options. However, research shows that people with mental health problems have considerable unmet information needs about their condition. This community-based cross-sectional study explores the SDM process and information needs among people with Generalized Anxiety Disorder (GAD), as an initial step in the design and development of a Patient Decision Aid for this population. Seventy participants completed an online survey with the Control Preference Scale, and questions about the perceived difficulty of past treatment decisions and the use of the Internet for searching for GAD-related information. Most participants preferred an active (42.9%) or collaborative role (41.4%) in the SDM process, and 53% did not perceive their preferred role. Information provided by healthcare professionals was considered insufficient by 28% of the sample, and over 30% reported using the Internet to look for GAD-related information at least once a week or more. The most relevant GAD-related information needs were general information (71.4%), information on self-help groups (65.7%), recommendations on how to face this disorder (61.4%) and information on treatment options (50%). Exploratory analyses showed that patients who perceived an active participation were more likely to search for information frequently (p = 0.038), and those who felt more involved than desired tended to search for more themes (p = 0.049). In summary, the study showed that a considerable percentage of GAD patients have unmet needs related to decision-making participation and information.

Rapid screening for generalized anxiety disorder in patients with migraine

Background: Generalized anxiety disorder (GAD) often remains undiagnosed in patients with migraine, while comorbidity of GAD with migraine is associated with increased dysfunction and risk of chronic migraine. Generalized Anxiety Disorder Scale 7-item (GAD-7) and Generalized Anxiety Disorder Scale 2-item (GAD-2) are the commonly employed screening measures for generalized anxiety symptoms in different patient groups. The present study aimed to evaluate psychometric properties of the Persian version of GAD-7 and GAD-2 in migraine. Methods: In this cross-sectional study, patients were diagnosed with migraine headaches according to the International Classification of Headache Disorders, 3rd edition (ICHD-3); then they participated in the psychiatric diagnostic interview, and filled out GAD-7, GAD-2, Beck Anxiety Inventory (BAI), Headache Impact Test-6 (HIT-6), and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1). The psychometric properties of GAD-7 and GAD-2 were examined using SPSS and LISREL. Results: Final samples were 186 patients with migraine that 83 patients received a diagnosis of GAD. Confirmatory factor analysis (CFA) indicated that the one-factor model of GAD-7 fit the data well. Internal consistency, test-retest, and Guttman split-half reliability of GAD-7 and GAD-2 were good. Significant correlation results, average variance extracted (AVE), and composite reliability (CR) supported the construct validity of the GAD-7. A score of ≥ 10 in GAD-7 and ≥ 3 in GAD-2 achieved satisfactory sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (GAD-7: 92%, 90%, 88%, and 93%, respectively; GAD-2: 79%, 88%, 71%, and 91%, respectively). Conclusion: Our findings supported GAD-7 and GAD-2 for assessing GAD in patients with migraine. It seems that GAD-7 and GAD-2 accurately diagnosed GAD in this group of patients.

Illness Severity Moderated Association Between Trait Anxiety and Amygdala-Based Functional Connectivity in Generalized Anxiety Disorder.

Trait anxiety is considered a vulnerability factor for the development of generalized anxiety disorder (GAD). The amygdala is related to both trait anxiety and GAD. Thus, we investigated amygdala-based functional connectivity (FC) in drug-naive non-comorbid GAD patients and explored its associations with personality, symptoms, and illness severity. FC analyses using the bilateral amygdala as seeds were performed with resting-state functional MRI data from 38 GAD patients and 20 matched healthy controls (HCs). Clinical characteristics were correlated with FC Z-scores from regions showing significant group differences. Furthermore, moderation analyses were used to explore the conditional effect of illness severity measured by the Clinical Global Impression–Severity (CGI-S) scale on the relationship between FC and trait anxiety. Relative to HCs, GAD patients showed hypoconnectivity between the amygdala and the rostral anterior cingulate cortex (rACC), inferior frontal gyrus (IFG), parahippocampal gyrus, and cerebellum and hyperconnectivity between the amygdala and the superior temporal gyrus (STG), insula, and postcentral gyrus. In GAD patients, amygdala–rACC connectivity was negatively associated with symptom severity and trait anxiety, and amygdala–IFG connectivity was positively associated with symptom severity. Moreover, CGI-S scores moderated the negative correlation between trait anxiety and amygdala–rACC FC. We demonstrate that there is extensive amygdala-based network dysfunction in patients with GAD. More importantly, amygdala–rACC connectivity plays a key role in the neural pathology of trait anxiety. Finally, the more severe the illness, the stronger the negative association between trait anxiety and amygdala–rACC FC. Our results emphasize the importance of personalized intervention in GAD.

Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial

Introduction: Evidence favoring homeopathy in generalized anxiety disorder (GAD) remains scarce. The objective of this pilot trial was to test feasibility of a definitive trial in future. We also experimented whether individualized homeopathic medicines (IH) plus psychological counseling (PC) can produce significantly different effects beyond placebo plus PC in the treatment of GAD. Methods: A double-blind, randomized, placebo-controlled, parallel arm, pilot trial was conducted on 62 GAD patients at the National Institute of Homoeopathy, India. GAD-7 questionnaire and Hamilton Anxiety Scale (HAM-A) were used as the primary and secondary outcomes, respectively, measured at baseline and 3 months. Patients received either IH plus PC (n = 31) or identical-looking placebo plus PC (n = 31). Intention-to-treat sample was analyzed to detect group differences using unpaired t tests. Results: Recruitment and retention rates were 56 and 90%, respectively. Mean age was 31.5 years; 56.5% were male. GAD-7 reductions were non-significantly higher in IH than placebo (p = 0.122). Group differences on HAM-A favored IH significantly (p = 0.018). Effect sizes were small to medium. Calcarea carbonica was the most frequently indicated medicine. No serious adverse events happened. Conclusions: A small but positive direction of anxiolytic effect was observed favoring homeopathy over placebo. A definitive trial appeared feasible in future.

Disruption of functional and structural networks in first-episode, drug-naïve adolescents with generalized anxiety disorder

BackgroundIndividuals with generalized anxiety disorder (GAD) tend to worry exaggeratedly and uncontrollably about various daily routines. Previous studies have demonstrated that the GAD patients exhibited widespread alternations in both functional networks (FN) and structural networks (SN). However, the simultaneous alternations of the topological organization of FN, SN, as well as their couplings in GAD still remain unknown. MethodsUsing multimodal approach, we constructed FN from resting-state functional magnetic imaging (R-fMRI) data and SN from diffusion magnetic resonance imaging (dMRI) data of 32 adolescent GAD patients and 25 healthy controls (HC). Graph theory analysis was employed to investigate the topological properties of FN, SN, and FN-SN coupling. ResultsCompared to HC, the GAD patients showed disruptions in global (i.e., decreased clustering coefficient, global, and local efficiency) and subnetwork (i.e., reduced intermodular connections, rich club, and feeder connections) levels in FN. Abnormal global level properties (i.e., increased characteristic path length and reduced global efficiency) were also observed in SN. Altered FN-SN couplings in normalized characteristic path length and feeder connections were identified in the GAD patients. The identified network measures were correlated with anxiety severity in the GAD patients. LimitationsThe sample size of the current study is small and the cross-sectional nature can not infer causal relationship. ConclusionsOur findings identified GAD-related topological alternations in both FN and SN, together with the couplings between FN and SN, providing us with a novel perspective for understanding the pathophysiological mechanisms of GAD.

Verbal and practical intelligence in general anxiety, obsessive compulsive and major depression disorders

IntroductionPrevious researches have shown that anxiety symptoms are negatively associated with measures of intelligence. However, recent findings indicate possible positive relationships between Generalized Anxiety Disorders (GAD) and intelligence. Also, Obsessive Compulsive Disorder (OCD) is associated with a moderate degree of underperformance on cognitive tests, including deficient processing. There are inconsistent results to present the relationship between Major Depression Disorder (MDD) and IQ. The present study has three main aims. The first aim of this study is to investigate the difference between IQ in individuals with GAD, OCD and major depressive disorder, and normal group. The second purpose is to perform a comparative study between the GAD, OCD and MDD groups on verbal and non-verbal intelligence. The third aim of this study is to examine the relationships between GAD, OCD and MDD as well as their underlying cognitive processes, including worry, rumination, and post-event processing, with verbal and non-verbal intelligence. ObjectiveThe present study is performed on four groups of participants including those with GAD, OCD, MDD and Healthy Volunteer (HV) group consisting of individuals without psychiatric disorders. MethodThe number of 50 healthy volunteers as the control group, 45 patients with GAD, 20 patients with OCD and 25 patients with MDD (n=140) were selected as the case-referent groups. The present study was a cross-sectional type and the research was performed based on the causal-comparative method. Verbal and non-verbal intelligence was measured with the Wechsler Adult Intelligence Scale-3rd edition (WAIS-III). Rumination and post-event processing were measured by PSWQ, RRS-BR, and PEPQ, respectively. ResultsThe results indicate that Verbal Intelligence and Verbal Comprehension Index in GAD patients have significant differences in comparison to the OCD, MDD and control groups. While, the value of the Working Memory Index (WMI) in the normal group is higher than the value of the same index in the GAD, OCD and MDD groups. Also, the values of the Processing Speed Index (PSI) in normal and GAD groups are higher than the OCD and MDD groups. The worry, rumination, and post-event processing in patients with GAD are positively correlated with general and verbal intelligence. But, verbal and non-verbal intelligence had a negative correlation with worry, rumination and post-event processing in healthy volunteers. ConclusionInvestigation of the possible connections between intelligence and the cognitive processes underlying emotional disorders can provide therapeutic strategies for smart individuals who are at risk for GAD.

Impact of self-designed Ningxin Anshen Decoction on the resting-state network functional connectivity in patients with mild to moderate generalized anxiety disorders.

Generalized anxiety disorder (GAD) is a persistent chronic excessive anxiety that is hard to control. Our previous study indicated that self-designed Ningxin Anshen Formula (NXAS) was effective to treat mild to moderate GAD patients. This study is a randomized controlled clinical trial and aimed to investigate the imapct of self-designed NXAS on the resting-state functional connectivity (rsFC) in patients with mild to moderate GAD and explore the potential mechanisms. A total of 61 patients diagnosed with mild to moderate GAD were recruited and divided into two groups randomly: NXAS group (n=31) and placebo group (n=30). Before and after treatment, the rsFC was examined by resting-state functional MRI (rs-fMRI), the anxiety was assessed with HAMA, and the independent component analysis (ICA) was used to analyze the resting-state functional connectivity (rsFC). The correlation between HAMA score and abnormal rsFC was further evaluated. The default mode network (DMN) showed evident rsFC interaction in the PCUN in both groups before and after therapy. The salience network (SN) showed obvious rsFC interaction in the bilateral gyrus frontalis inferiors and bilateral gyri temporalis superiors before and after therapy. In the NXAS group, the rsFC interction reduced significantly in the left gyrus frontalis inferior, but remained unchanged in the right gyrus frontalis inferior and bilateral gyri temporalis superiors after therapy. In the control group, the rsFC interaction increased dramatically after treatment. In addition, the abnormal rsFC had no relationship with HAMA score. The self-designed NXAS can increase the rsFC in the PUCN on DMN and reduce rsFC in the orbIFG.L on SN to exert anti-anxiety effect.

Epidemiology and prognostic implications of panic disorder and generalized anxiety disorder in patients with coronary artery disease: rationale and design for a longitudinal cohort study

BackgroundAnxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress.Design/MethodThis is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files.DiscussionThis study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.

Cholinergic modulation of disorder-relevant human defensive behaviour in generalised anxiety disorder

Drugs that are clinically effective against anxiety disorders modulate the innate defensive behaviour of rodents, suggesting these illnesses reflect altered functioning in brain systems that process threat. This hypothesis is supported in humans by the discovery that the intensity of threat-avoidance behaviour is altered by the benzodiazepine anxiolytic lorazepam. However, these studies used healthy human participants, raising questions as to their validity in anxiety disorder patients, as well as their generalisability beyond GABAergic benzodiazepine drugs. BNC210 is a novel negative allosteric modulator of the alpha 7 nicotinic acetylcholine receptor and we recently used functional Magnetic Resonance Imaging to show it reduced amygdala responses to fearful faces in generalised anxiety disorder patients. Here we report the effect of BNC210 on the intensity of threat-avoidance behaviour in 21 female GAD patients from the same cohort. We used the Joystick Operated Runway Task as our behavioural measure, which is a computerised human translation of the Mouse Defense Test Battery, and the Spielberger state anxiety inventory as our measure of state affect. Using a repeated-measures, within-subjects design we assessed the effect of BNC210 at two dose levels versus placebo (300 mg and 2000 mg) upon two types of threat-avoidance behaviour (Flight Intensity and Risk Assessment Intensity). We also tested the effects of 1.5 mg of the benzodiazepine lorazepam as an active control. BNC210 significantly reduced Flight Intensity relative to placebo and the low dose of BNC210 also significantly reduced self-reported state anxiety. Risk Assessment Intensity was not significantly affected. Results show both human defensive behaviour and state anxiety are influenced by cholinergic neurotransmission and there provide converging evidence that this system has potential as a novel target for anxiolytic pharmacotherapy.