Anxiety Spectrum Research Articles

Pathological anxiety and function/dysfunction in the brain's fear/defense circuitry

Research from the University of Florida Center for the Study of Emotion and Attention aims to develop neurobiological measures that objectively discriminate among symptom patterns in patients with anxiety disorders. From this perspective, anxiety and mood pathologies are considered to be brain disorders, resulting from dysfunction and maladaptive plasticity in the neural circuits that determine fearful/defensive and appetitive/reward behavior (Insel et al., 2010). We review recent studies indicating that an enhanced probe startle reflex during the processing of fear memory cues (mediated by cortico-limbic circuitry and thus indicative of plastic brain changes), varies systematically in strength over a spectrum-wide dimension of anxiety pathology-across and within diagnoses-extending from strong focal fear reactions to a consistently blunted reaction in patients with more generalized anxiety and comorbid mood disorders. Preliminary studies with functional magnetic resonance imaging (fMRI) encourage the hypothesis that fear/defense circuit dysfunction covaries with this same dimension of psychopathology. Plans are described for an extended study of the brain's motivation circuitry in anxiety spectrum patients, with the aim of defining the specifics of circuit dysfunction in severe disorders. A sub-project explores the use of real-time fMRI feedback in circuit analysis and as a modality to up-regulate circuit function in the context of blunted affect.

EPA-1259 – Stressful life events history and mental disorders in behcet's disease

Introduction Behcet's disease (BD) is a heterogeneous, multisystemic, recurrent, inflammatory disorder with a chronic course and an unknown cause. Mental disorders (MD) occur quite often with BD. The influence of childhood experience, relations traumatic events with BD and MD, specificity of MD still have not investigated carefully. Methods 55 BD patients (44 male and 11 female mean age 33,1±10,1) were included. ICD-10 criteria were used for MD diagnostic. Severity levels of stress, anxiety, depression found by PSS, HAM-A, MADRS. Results Early traumatic childhood experiences observed in 29(52,7%) patients. Among this patients BD started before 18 years in 13(44,8%) cases whereas in patients without early traumatic childhood experiences in 7(26,3%). The severe stress factors were preceded first BD symptoms in 12(21,8%) cases, prolonged low-intensity stressors in 24(43,6%). Most patients 45(81,8%) self-reported connection between stressful life events and exacerbation of BD. MD were diagnosed in 47(86%) BD patients: dysthymia 19(34,5%), recurrent depressive disorder − 14 (25,4%), depressive episode (mild, moderate) − 8 (14,5%), generalized anxiety disorder − 4 (7,3%), adjustment disorder − 2 (3,6%). MD preceded BD in 20% cases. Depression scores showed a clinically normal level in 13 BD patients (23,6%), mild level in 34 (61,8%), and moderate level in 8 (14,5%). Mean severity levels of anxiety, stress were 14,3±5,4 and 16,1±5,9 accordingly. Conclusions The received data show, that individual history of stressful life events is important for the beginning of the rheumatic disease and MD in BD patients. Depression and anxiety spectrum disorders are the most common MD in BD patients.

QEEG related changes following the treatment of anxiety disorders: Case series

Patients with anxiety spectrum disorders are a highly heterogeneous group, requiring new therapeutic strategies and individualized treatment monitoring. Today, there is a growing interest for implementing biological approaches to clinical practice in psychiatry. Quantitative EEG is an excellent tool in this regard, though it has been widely underestimated when compared to recent neuroimaging techniques. In this case series, we presented four cases with a different anxiety spectrum disorder and evaluated their qEEG changes before and after the treatment. In addition, we also calculated the so-called EEG cordance values as an index of cerebral perfusion and cingulate cortex activity. According to the results, there appears to be an increase in the frontal beta and theta band in our cases, which has responded to treatment. In regards to the cordance values, we found that there was a reduction in the prefrontal regions up to %38 percent following the treatment. Based on previous studies, this may also indirectly suggest reduction in the cingulate cortex activity. The possible implications of these findings were discussed. Taken together, this case series highlighted the potential use of qEEG power values, normative z-scores and cordance values in anxiety spectrum disorders.

Anxiety Has Specific Syndromal Profiles in Parkinson Disease: A Data-Driven Approach

Anxiety symptoms are common in Parkinson disease (PD). Recent evidence suggests that anxiety syndromes as encountered in clinical practice may not correspond to the DSM-IV classification of anxiety disorders. To examine the syndromal pattern of the anxiety spectrum in a large series of patients with PD, as determined with a data-driven approach using latent class analysis (LCA). 342 patients with PD were recruited from referrals to movement disorders or psychiatry clinics at six tertiary centers. Participants were assessed with a structured psychiatric interview and specific scales rating the severity of anxiety, depression, cognition and parkinsonism. The main outcome measure was classes of patients with a specific syndromal profile of anxiety symptoms based on LCA. LCA identified four classes that were interpreted as "no anxiety or depression", "episodic anxiety without depression", "persistent anxiety with depression", and "both persistent and episodic anxiety with depression". Symptoms of persistent anxiety were almost invariably associated with symptoms of depression. There were significant differences between classes in terms of history of depression and anxiety, use of psychoactive medication, and on the Mentation and Complications sections of the Unified Parkinson Disease Rating Scale. Patients with PD show different syndromic profiles of anxiety that do not align with the symptom profiles represented by DSM-IV anxiety disorders and major depression. Accordingly, DSM-IV criteria for anxiety disorders may not be clinically useful in PD. The different classes identified here provide empirically validated phenotypes for future research.

A translational neuroscience framework for the development of socioemotional functioning in health and psychopathology

The development of socioemotional functioning is a complex process that occurs over a protracted time period and requires coordinating affective, cognitive, and social faculties. At many points in development, the trajectory of socioemotional development can be deleteriously altered due to a combination of environmental insults and individual vulnerabilities. The result can be psychopathology. However, researchers are just beginning to understand the neural and genetic mechanisms involved in the development of healthy and disordered socioemotional functioning. We propose a translational developmental neuroscience framework to understand the transactional process that results in socioemotional functioning in both healthy and disordered populations. We then apply this framework to healthy socioemotional development, pediatric anxiety, pediatric depression, and autism spectrum disorder, selectively reviewing current literature in light of the framework. Finally, we examine ways that the framework can help to frame future directions of research on socioemotional development and translational implications for intervention.

Is post-event processing a social anxiety specific or transdiagnostic cognitive process in the anxiety spectrum?

Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.

Community perceptions of mental distress in a post-conflict setting: A qualitative study in Burundi

There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.

Urban insecurity and fear of crime in people suffering from mental disorders: a study in 24 Mental Health Centers in Italy

To assess in a sample of people with mental disorders: 1) fear of crime and perceived insecurity; 2) the association between fear of crime and insecurity; 3) the incidence of crimes. Twenty-four Italian mental health centres have been invited to participate in the study from the network of the Early Career Psychiatrists' Committee of the Italian Psychiatric Association. In each participating centre, the first 20 patients consecutively accessing the mental health centre between February and April 2011 have been recruited. All patients have been assessed using validated assessment tools. The final sample consists of 426 patients. They are mostly female (70.1%), with a mean age of 45 years (± 13.5), and with a good level of education. Fifty-two percent of patients have a diagnosis of mood disorders, and 37.8% on anxiety spectrum disorders. About half of the sample declares that the most prominent feeling toward life is uncertainty. Almost all patients report to have at least one big fear, with the most frequently report being: 1) loss or death of a loved one (41.2%); 2) financial constraint (28.4%); 3) physical or mental health problems (26.5%). Our results show the presence of a common sense of uncertainty among patients, probably as a result of the historical moment we are facing. It is reasonable that this attitude toward life can have a detrimental impact on patients' psychological and physical wellbeing, contributing to high levels of distress. Further studies are needed in order to clarify the possible relationship between fears, uncertainty and mental disorders.

Psychophysiological arousal and biased perception of bodily anxiety symptoms in socially anxious children and adolescents: a systematic review

Cognitive models of social anxiety [Clark and Wells, Social phobia: Diagnosis, assessment, and treatment, Guilford Press, New York, 1995], diagnostic criteria and studies on adult samples suggest that both an overestimation of bodily anxiety symptoms and psychophysiological abnormalities play an important role in social anxiety. To date, less is known about such a perception bias and physiological characteristics in children and adolescents with social anxiety. We performed a systematic review of the literature in the electronic databases Medline, PsycINFO, and PSYNDEX. Additional studies were identified by hand search using the ancestry approach. We identified 1,461 studies, screened their titles and abstracts, viewed 94 papers, and included 28 of these. Study samples were heterogeneous and consisted of socially phobic, high socially anxious, shy and test anxious children and adolescents. Regarding a biased perception, most studies in the review suggest that bodily symptoms of anxiety were overestimated by children and adolescents across the social anxiety spectrum when compared with control groups. An elevated psychophysiological reactivity to social stress was present in samples of high social anxiety, shyness, and test anxiety. In clinical samples with social phobia, by contrast, no differences or an even lower physiological responding compared with healthy control groups were reported. In addition, some evidence for a chronic psychophysiological hyperarousal was found across all sample types. The results are discussed with regard to current models of social anxiety, psychophysiological theories, and treatment implications.

Proinflammatory cytokines and depression in rheumatoid arthritis

Система комплексной поддержки и сопровождения научного журнала Elpub позволяет запустить двуязычный сайт журнала со встроенной системой электронной редакции в соответствии с лучшими издательскими практиками, а так же предусматривает техническую и методическую поддержку со стороны специалистов НЭИКОН.

Social Anxiety and Autism Spectrum Disorders in Duchenne and Becker Muscular Dystrophy

Social Anxiety and Autism Spectrum Disorders in Duchenne and Becker Muscular Dystrophy

Postnatal maturation of GABAergic transmission in the rat basolateral amygdala.

Many psychiatric disorders, including anxiety and autism spectrum disorders, have early ages of onset and high incidence in juveniles. To better treat and prevent these disorders, it is important to first understand normal development of brain circuits that process emotion. Healthy and maladaptive emotional processing involve the basolateral amygdala (BLA), dysfunction of which has been implicated in numerous psychiatric disorders. Normal function of the adult BLA relies on a fine balance of glutamatergic excitation and GABAergic inhibition. Elsewhere in the brain GABAergic transmission changes throughout development, but little is known about the maturation of GABAergic transmission in the BLA. Here we used whole cell patch-clamp recording and single-cell RT-PCR to study GABAergic transmission in rat BLA principal neurons at postnatal day (P)7, P14, P21, P28, and P35. GABAA currents exhibited a significant twofold reduction in rise time and nearly 25% reduction in decay time constant between P7 and P28. This corresponded with a shift in expression of GABAA receptor subunit mRNA from the α2- to the α1-subunit. The reversal potential for GABAA receptors transitioned from depolarizing to hyperpolarizing with age, from around -55 mV at P7 to -70 mV by P21. There was a corresponding shift in expression of opposing chloride pumps that influence the reversal, from NKCC1 to KCC2. Finally, we observed short-term depression of GABAA postsynaptic currents in immature neurons that was significantly and gradually abolished by P28. These findings reveal that in the developing BLA GABAergic transmission is highly dynamic, reaching maturity at the end of the first postnatal month.

Integration of Pediatric Mental Health Care: An Evidence-Based Workshop for Primary Care Providers

IntroductionPediatric primary care providers (PCPs) are being asked to care for children with mental health (MH) disorders but cite inadequate training as a barrier. An intensive workshop may improve the PCPs’ level of knowledge and lead to an increase in quality care for children with MH disorders. We compared pediatric PCPs’ knowledge, comfort, and practice in the evaluation and management of pediatric patients with attention deficit–hyperactivity disorder, depression, anxiety, and autism spectrum disorders before and after a 2-day educational workshop. MethodStudy participants (n = 30) were recruited from rural areas of Pennsylvania. A pre- and posttest design was used. A 15-question multiple choice knowledge test and a 19-question survey of comfort and practice were administered before and after the workshop. ResultsThe mean knowledge test number correct increased from 9.19 before the workshop to 12.23 after the workshop (p < .0001). Survey scores increased from 34.6 before the workshop to 44.14 after the workshop (p < .0001). DiscussionIntensive workshops may be an effective method of training PCPs on provision of MH care in pediatric primary care practice.

Behavioral effects of SQSTM1/p62 overexpression in mice: Support for a mitochondrial role in depression and anxiety

Affective spectrum and anxiety disorders have come to be recognized as the most prevalently diagnosed psychiatric disorders. Among a suite of potential causes, changes in mitochondrial energy metabolism and function have been associated with such disorders. Thus, proteins that specifically change mitochondrial functionality could be identified as molecular targets for drugs related to treatment for affective spectrum disorders. Here, we report generation of transgenic mice overexpressing the scaffolding and mitophagy related protein Sequestosome1 (SQSTM1/p62) or a single point mutant (P392L) in the UBA domain of SQSTM1/p62. We show that overexpression of SQSTM1/p62 increases mitochondrial energy output and improves transcription factor import into the mitochondrial matrix. These elevated levels of mitochondrial functionality correlate directly with discernible improvements in mouse behaviors related to affective spectrum and anxiety disorders. We also describe how overexpression of SQSTM1/p62 improves spatial learning and long term memory formation in these transgenic mice. These results suggest that SQSTM1/p62 provides an attractive target for therapeutic agents potentially suitable for the treatment of anxiety and affective spectrum disorders.

Meeting report: “Depression and Anxiety Spectrum disorders: from basic science to the clinic and back”

In March, 2012 we held the first Mideast conference on “Depression and Anxiety Spectrum disorders: from basic science to the clinic and back”, at the University of Amman, Jordan. This event brought together both clinical and basic scientists with expertise in depression and anxiety spectrum disorders. The meeting took place in a large lecture hall at the University of Jordan Medical School. The audience included faculty, residents, and students. The Dean of the Medical School opened the meeting, welcoming the guest speakers and participants.

A Study Of Psychiatric Morbidty Amongst Children Attending A Child Guidance Clinic At A Tertiary Level Teaching Hospital In Nepal

Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence. It is a challenging all over the world to determine the epidemiology of childhood mental disorders. Objective: The aim of this study is to sort out the prevalence and predominance of mental illness and their onset of age and sex among the child and adolescent who attended in the child guidance clinic in TUTH. Methodology: A retrospective study of a total of 539 consecutive cases of child and adolescent attended in Child Guidance Clinic TUTH. Diagnosis was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. Result: The cases from the age of 0.4 year to 21 years with mean age 8.85±4.08 years. Significantly majority were boys (n=343, 63.6%) and most of from out of the Kathmandu valley (n=300, 53.2%). Significantly most case referred from ENT OPD of TUTH (n=97, 18%) and mental retardation was the commonest (n=81, 15%) followed by conversion disorder (n=77, 14.3%) and anxiety spectrum disorder (n=63, 11.7%) Conclusion: Boys are common in mental illness among child and adolescents. The common diagnoses among child and adolescent are mental retardation, conversion disorder, anxiety spectrum disorders and Autism spectrum disorder. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 55-63 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7677

1303 – Depression, anxiety and multiple sclerosis-serbian experience

It is well known that patients with multiple sclerosis (MS) have frequently affective and anxiety spectrum disorders.The aim of our study was to assesss the links between anxious and depressive symptoms on one hand and the quality of life (QOL) and daily activities and abilities on the other, in patients diagnosed with MS. We measured the intensity of depression using HAMD-17 item., and the intensity of anxiety using HAM-A scale. We also measured the expanded disability status scale (EDSS) score for each patient. Our batch was composed of 98 patients diagnosed with different forms of multiple sclerosis. The patients with relapsing remitting MS were free of acute neurological deficits during the examination. For every patient we performed neurological examination (EDSS) and the assessment of depression, of anxiety, of daily activities (activities of daily living-ADL and instrumental activities of daily living-IADL) and of the quality of life-score and grade (QOL score and QOL grade). First we found strong correlations between neurological deficit (measured by EDSS) and HAM-A, HAM-D, ADL, IADL,QOL score and QOL grade (using Pearson method: p= 0.0001 for each. For different levels of EDSS score we tried to correlate HAM-A and HAm-D with ADL, IADL, QOL (score and grade). The correlations were all valid with a stronger connection in the groups with a higher EDSS score. Anxiety and depression levels grow together with the EDSS score. Anxiety and depression spectrums are interrelated by increasing each other;s level regardless of MS severity.

734 – “You say so, who knows if it is true” effects of speaker's social hierarchy on the sentence comprehension

Social hierarchies modulate cognitive processes. Nevertheless, the study of the influence of social hierarchy on sentence comprehension is scarce. We presented sentences with different levels of plausibility uttered by speakers with different hierarchical status (as previously established through a hierarchical video game) and measured the modulations of the N400 component. Participants heard three subsets of sentences with different plausibility value, depending on the last word (high, intermediate and low-plausibility). Sentences could be spoken by a superior or by an inferior status player. When listening to the superior player, the modulation of the N400 component followed the expected pattern (inverse relationship between amplitudes and sentence plausibility). However, when participants heard the Inferior speaker the amplitude of the N400 in high plausible sentences matched that of intermediate plausibility (increased). This result indicated that participants’ did not trust low rank speakers, even if sentences were high-plausible. We have observed specific personality traits modulating these hierarchical influences. The present research sets the ground for future studies exploring the influence of social hierarchies in other cognitive domains, specifically in relevant mental disorders where the social cognition is a nuclear field of symptoms such as the anxiety and other obssesive compulsive spectrum disorders.

2860 – Reappraisal mediates the link between 5-HTTLPR and social anxiety symptoms

Mounting evidence suggests that social anxiety symptoms are related to (1) polymorphisms in the serotonin transporter gene promoter region ( 5-HTTLPR ) and (2) reduced use of adaptive forms of emotion regulation such as reappraisal. It is not known, however, whether reappraisal mediates the link between 5-HTTLPR and social anxiety. Participants to this study were unselected community volunteers, all Caucasians from a circumscribed geographical area. They were genetically tested for 5-HTTLPR status, and self-report measures of social anxiety symptoms and reappraisal use were obtained. The results indicated that participants with one or two low-expressing alleles displayed increased social anxiety symptoms and reduced levels of cognitive reappraisal. Cognitive reappraisal significantly mediated the influence of 5-HTTLPR on social anxiety symptoms, and this effect was evident on two different measures of reappraisal. Therefore, this study shows that cognitive reappraisal is a major intermediate phenotype of the social anxiety spectrum. Our correlational results suggest that individuals with low-expressing 5-HTTLPR genotypes may benefit the most from cognitive-behavioral psychotherapy because they do not appear to engage as frequently as others in reappraisal.

845 – Dual diagnosis of anxiety disorders and substance abuse: the need for awareness

Background The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly Anxiety disorders patients. As a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis. Method 683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I module for Anxiety disorders, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines. Results 22% of the sample fulfill the diagnosis of dual diagnosis. 19.3% of the sample were schizophrenic, 17.42% among the later were fulfilling diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses. No difference among anxiety spectrum disorders regarding rate of dual diagnosis. Conclusion Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.