Neuroimaging of anxiety disorders

2020 ◽  
pp. 938-947
Author(s):  
Gregor Leicht ◽  
Christoph Mulert
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Treatment Strategies ◽  
Panic Attacks ◽  
Anterior Cingulate ◽  
Therapeutic Interventions ◽  
Human Models ◽  
Neural Processes ◽  
Pathophysiological Role

Neuroimaging has extensively contributed to the identification of the neurobiological basis of anxiety and the pathophysiological mechanisms underlying anxiety disorders. Studies in human models of anxiety, as well as investigations in anxiety disorder patients, consistently demonstrated the pathophysiological role of a ‘fear network’ comprising the amygdala, insula, medial prefrontal cortex, and anterior cingulate cortex. This chapter reviews the main neuroimaging findings from human models of anxiety disorders such as fear conditioning, fear generalization, and pharmacologically induced panic attacks. Moreover, the chapter summarizes evidence from research in patients aiming to identify the neural processes underlying the pathophysiology of clinically relevant anxiety disorders. Finally, the chapter provides an overview on neurobiological aspects of successful therapeutic interventions, which might prospectively contribute to the refinement of existing approaches, the prediction of the success of certain treatment strategies in individual patients, and the development of more effective options for the treatment of anxiety disorders.

scholarly journals B Cells and Antibodies as Targets of Therapeutic Intervention in Neuromyelitis Optica Spectrum Disorders

2021 ◽  
Vol 14 (1) ◽  
pp. 37
Author(s):  
Jan Traub ◽  
Leila Husseini ◽  
Martin S. Weber
Keyword(s):  
B Cells ◽  
Neuromyelitis Optica ◽  
Plasma Cells ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Therapeutic Interventions ◽  
Complement Factor ◽  
Major Subset ◽  
Spectrum Disorders

The first description of neuromyelitis optica by Eugène Devic and Fernand Gault dates back to the 19th century, but only the discovery of aquaporin-4 autoantibodies in a major subset of affected patients in 2004 led to a fundamentally revised disease concept: Neuromyelits optica spectrum disorders (NMOSD) are now considered autoantibody-mediated autoimmune diseases, bringing the pivotal pathogenetic role of B cells and plasma cells into focus. Not long ago, there was no approved medication for this deleterious disease and off-label therapies were the only treatment options for affected patients. Within the last years, there has been a tremendous development of novel therapies with diverse treatment strategies: immunosuppression, B cell depletion, complement factor antagonism and interleukin-6 receptor blockage were shown to be effective and promising therapeutic interventions. This has led to the long-expected official approval of eculizumab in 2019 and inebilizumab in 2020. In this article, we review current pathogenetic concepts in NMOSD with a focus on the role of B cells and autoantibodies as major contributors to the propagation of these diseases. Lastly, by highlighting promising experimental and future treatment options, we aim to round up the current state of knowledge on the therapeutic arsenal in NMOSD.

Dimensional anxiety scales for DSM-5: Sensitivity to clinical severity

2013 ◽  
Vol 28 (7) ◽  
pp. 448-456 ◽  
Author(s):  
S. Knappe ◽  
J. Klotsche ◽  
A. Strobel ◽  
R.T. LeBeau ◽  
M.G. Craske ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Depressive Disorders ◽  
Specific Phobia ◽  
Panic Attacks ◽  
Clinical Severity ◽  
Global Functioning ◽  
Clinical Sensitivity ◽  
Dsm 5 ◽  
Wide Range

AbstractPurposePsychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.MethodsThe dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n= 83) and threshold anxiety disorders (n= 49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).ResultsIndividuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.ConclusionThe self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.

The role of the ‘central’ cholecystokinin-B receptor in panic disorder

1996 ◽  
Vol 8 (4) ◽  
pp. 99-101
Author(s):  
H.J.G.M. Van Megen ◽  
H.G.M. Westenberg ◽  
J.A. Den Boer
Keyword(s):  
Anxiety Disorder ◽  
Panic Disorder ◽  
Animal Studies ◽  
Panic Attacks ◽  
Neuronal System ◽  
Receptor Agonists ◽  
Neuronal Systems ◽  
Cckb Receptor ◽  
Stimulation Of

SummaryResearch investigating the neurobiological underpinnings of anxiety disorder have mainly been focused on dysfunction of the GABA, noradrenergic and serotonergic (5-HT) neuronal systems. Just recently, in both animal and human studies, evidence has been found for a possible role of the cholecystokinin (CCK) neuronal system in the pathogenesis of anxiety disorder.Behaviorally, animal studies revealed anxiogenic-like properties for the ‘central’ CCKB receptor agonists, while CCKB receptor antagonists displayed intrinsic anxiolytic properties. Similarly, in man, CCKB receptor agonists, like pentagastrin and CCK4, were found to be able to elicited panic attacks in both panic disorder (PD) patients and healthy volunteers. These effects appear due to stimulation of the CCKB receptor. In addition, clinically effective panicolytic agents reduce the sensitivity to CCK4 in PD patients. Taken together, these findings may suggest a role for CCK in the neurobiology of PD. On the other hand, there is circumstantial evidence for involvement of several other neuronal systems, such as the serotonergic, noradrenergic and GABA-ergic system, in the regulation of anxiety. Interestingly, evidence has been found for an interaction between CCK and 5-HT and that this interaction plays a role in the mediation of anxiety.This presentation will critically discuss the evidence for the role of the CCKB receptor in anxiety and in addition, will focus on the putative evidence that the role of CCK in anxiety is mediated by its interaction with the serotonergic neuronal system.

scholarly journals Anxiety in Children with Selective Mutism: A Meta-analysis

2019 ◽  
Vol 51 (2) ◽  
pp. 330-341 ◽  
Author(s):  
Jim Driessen ◽  
Jan Dirk Blom ◽  
Peter Muris ◽  
Roger K. Blashfield ◽  
Marc L. Molendijk
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Meta Analysis ◽  
A Priori ◽  
Selective Mutism ◽  
Research Strategies ◽  
Prevalence Data ◽  
Systematic Assessment ◽  
Pooled Prevalence

Abstract This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). However, considerable heterogeneity was present, which remained unexplained by a priori specified moderators. The finding that SM is often diagnosed in combination with anxiety disorders, indicates that these disorders are not discrete, separable categories. Moreover, this finding does not help to elucidate the relation between SM and anxiety as an etiological mechanism or symptomatic feature. Broadening our research strategies regarding the assessment of anxiety is paramount to clarify the role of anxiety in SM, and allow for proper classification.

Anxiety disorders and the onset of depression among adults in the community

2002 ◽  
Vol 32 (6) ◽  
pp. 1121-1124 ◽  
Author(s):  
RENEE D. GOODWIN
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Anxiety Disorders ◽  
Panic Attack ◽  
Panic Attacks ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Sociodemographic Differences ◽  
Co Morbidity

Objective. To determine the association between anxiety disorders, panic attack and the risk of major depression among adults in the community.Method. Data were drawn from the Epidemiologic Catchment Area Program survey waves 1 (N = 20291) and 2 (N = 15849). Multivariate logistic regression analyses were used to determine the risk of incident major depression at 12-month follow-up (wave 2) associated with each anxiety disorder and panic attacks assessed at wave 1, adjusting for differences in sociodemographic characteristics, and then controlling simultaneously for all anxiety disorders, and other psychiatric co-morbidity.Results. Specific phobia (OR = 1.7 (1.6, 1.8)), agoraphobia (OR = 2.3 (2.2, 2.5)), obsessive–compulsive disorder (OR = 5.4 (5.0, 5.8)) and panic attack (OR = 1.9 (1.8, 2.1)) each made an independent contribution to the risk of major depression, which persisted after adjusting simultaneously for sociodemographic differences and other psychiatric co-morbidity. Conclusions. Each anxiety disorder and panic attacks appear to confer an independent risk for the onset of major depression within 12-months among adults in the community. Understanding the key role played by anxiety in depression onset is needed for prevention strategies.

Asthma and depressive and anxiety disorders among young persons in the community

2004 ◽  
Vol 34 (8) ◽  
pp. 1465-1474 ◽  
Author(s):  
RENEE D. GOODWIN ◽  
DAVID M. FERGUSSON ◽  
L. JOHN HORWOOD
Keyword(s):  
Anxiety Disorder ◽  
Major Depression ◽  
Anxiety Disorders ◽  
Fixed Effects ◽  
Childhood Adversity ◽  
Causal Link ◽  
Panic Attacks ◽  
Future Research ◽  
Confounding Factors ◽  
Co Morbidity

Background. The objectives of the study were to examine linkages between asthma and depressive and anxiety disorders in a birth cohort of over 1000 young persons studied to the age of 21 years. Specifically, the study aimed to ascertain the extent to which associations between asthma and depressive and anxiety disorders could be explained by non-observed fixed confounding factors.Method. Asthma and depressive and anxiety disorders were measured prospectively over the course of a 21-year longitudinal study. Fixed effects logistic regression models were used to determine the relationship between asthma and depressive and anxiety disorders, adjusting for potentially confounding factors.Results. Asthma in adolescence and young adulthood was associated with increased likelihood of major depression (OR 1·7, 95% CI 1·3–2·3), panic attacks (OR 1·9, 95% CI 1·3–2·8), and any anxiety disorder (OR 1·6, 95% CI 1·2–2·2). Associations between asthma and depressive and anxiety disorders were adjusted for confounding factors using a fixed effects regression model which showed that, after control for fixed confounding factors, asthma was no longer significantly related to major depression (OR 1·1), panic attacks (OR 1·1), or any anxiety disorder (OR 1·2). Additional post hoc analyses suggested that exposure to childhood adversity or unexamined familial factors may account for some of the co-morbidity of asthma and depressive and anxiety disorders.Conclusions. These results confirm and extend previous findings by documenting elevated rates of depressive and anxiety disorders among young adults with asthma, compared with their counterparts without asthma, in the community. The weight of the evidence from this study suggests that associations between asthma and depressive and anxiety symptoms may reflect effects of common factors associated with both asthma and depressive and anxiety disorders, rather than a direct causal link. Future research is needed to identify the specific factors underlying these associations.

scholarly journals Microglia in Alzheimer’s Disease: A Target for Therapeutic Intervention

2021 ◽  
Vol 15 ◽  
Author(s):  
Guimei Zhang ◽  
Zicheng Wang ◽  
Huiling Hu ◽  
Meng Zhao ◽  
Li Sun
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Therapeutic Interventions ◽  
Tau Pathology ◽  
Age Related ◽  
Amyloid Accumulation ◽  
Pathophysiological Role ◽  
Inflammatory Drugs ◽  
Β Amyloid

Alzheimer’s disease (AD) is one of the most common types of age-related dementia worldwide. In addition to extracellular amyloid plaques and intracellular neurofibrillary tangles, dysregulated microglia also play deleterious roles in the AD pathogenesis. Numerous studies have demonstrated that unbridled microglial activity induces a chronic neuroinflammatory environment, promotes β-amyloid accumulation and tau pathology, and impairs microglia-associated mitophagy. Thus, targeting microglia may pave the way for new therapeutic interventions. This review provides a thorough overview of the pathophysiological role of the microglia in AD and illustrates the potential avenues for microglia-targeted therapies, including microglial modification, immunoreceptors, and anti-inflammatory drugs.

scholarly journals Bioluminescent Ross River Virus Allows Live Monitoring of Acute and Long-Term Alphaviral Infection by In Vivo Imaging

Viruses ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 584 ◽  
Author(s):  
Essia Belarbi ◽  
Vincent Legros ◽  
Justine Basset ◽  
Philippe Desprès ◽  
Pierre Roques ◽  
...  
Keyword(s):  
Immunosuppressive Treatment ◽  
Treatment Strategies ◽  
Chronic Phase ◽  
Therapeutic Interventions ◽  
In Vivo Evaluation ◽  
Viral Spread ◽  
Bioluminescent Signal

Arboviruses like chikungunya and Ross River (RRV) are responsible for massive outbreaks of viral polyarthritis. There is no effective treatment or vaccine available against these viruses that induce prolonged and disabling arthritis. To explore the physiopathological mechanisms of alphaviral arthritis, we engineered a recombinant RRV expressing a NanoLuc reporter (RRV-NLuc), which exhibited high stability, near native replication kinetics and allowed real time monitoring of viral spread in an albino mouse strain. During the acute phase of the disease, we observed a high bioluminescent signal reflecting viral replication and dissemination in the infected mice. Using Bindarit, an anti-inflammatory drug that inhibits monocyte recruitment, we observed a reduction in viral dissemination demonstrating the important role of monocytes in the propagation of the virus and the adaptation of this model to the in vivo evaluation of treatment strategies. After resolution of the acute symptoms, we observed an increase in the bioluminescent signal in mice subjected to an immunosuppressive treatment 30 days post infection, thus showing active in vivo replication of remnant virus. We show here that this novel reporter virus is suitable to study the alphaviral disease up to the chronic phase, opening new perspectives for the evaluation of therapeutic interventions.

Adverse childhood experiences in relation to mood and anxiety disorders in a population-based sample of active military personnel

2012 ◽  
Vol 43 (1) ◽  
pp. 73-84 ◽  
Author(s):  
J. Sareen ◽  
C. A. Henriksen ◽  
S.-L. Bolton ◽  
T. O. Afifi ◽  
M. B. Stein ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Military Personnel ◽  
Adverse Childhood Experiences ◽  
Mental Health Problems ◽  
Population Based ◽  
Panic Attacks ◽  
Childhood Experiences ◽  
Mood And Anxiety Disorders ◽  
Adverse Childhood

BackgroundAlthough it has been posited that exposure to adverse childhood experiences (ACEs) increases vulnerability to deployment stress, previous literature in this area has demonstrated conflicting results. Using a cross-sectional population-based sample of active military personnel, the present study examined the relationship between ACEs, deployment related stressors and mood and anxiety disorders.MethodData were analyzed from the 2002 Canadian Community Health Survey – Canadian Forces Supplement (CCHS-CFS; n = 8340, age 18–54 years, response rate 81%). The following ACEs were self-reported retrospectively: childhood physical abuse, childhood sexual abuse, economic deprivation, exposure to domestic violence, parental divorce/separation, parental substance abuse problems, hospitalization as a child, and apprehension by a child protection service. DSM-IV mood and anxiety disorders [major depressive disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic attacks/disorder and social phobia] were assessed using the Composite International Diagnostic Interview (CIDI).ResultsEven after adjusting for the effects of deployment-related traumatic exposures (DRTEs), exposure to ACEs was significantly associated with past-year mood or anxiety disorder among men [adjusted odds ratio (aOR) 1.34, 99% confidence interval (CI) 1.03–1.73, p < 0.01] and women [aOR 1.37, 99% CI 1.00–1.89, p = 0.01]. Participants exposed to both ACEs and DRTEs had the highest prevalence of past-year mood or anxiety disorder in comparison to those who were exposed to either ACEs alone, DRTEs alone, or no exposure.ConclusionsACEs are associated with several mood and anxiety disorders among active military personnel. Intervention strategies to prevent mental health problems should consider the utility of targeting soldiers with exposure to ACEs.

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