scholarly journals Dorsal Anterior Cingulate Cortical Thickness Is Associated with Improvement in Worry Severity Following Treatment in Late-Life Generalized Anxiety Disorder

2019 ◽  
Author(s):  
Anusha Rangarajan ◽  
Helmet Talib Karim ◽  
Dana L. Tudorascu ◽  
Sarah Walker ◽  
Howard Aizensteina ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Cortical Thickness ◽  
Pearson Correlation ◽  
Late Life ◽  
Post Treatment ◽  
Anterior Cingulate ◽  
Generalized Anxiety ◽  
Pre Treatment

We recently showed that late-life participants with generalized anxiety disorder (GAD), compared with non-anxious elderly, had lower cortical thickness in the dorsal anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC). In this follow-up study, we investigated the association between cortical thickness and clinical markers of treatment response in a subgroup from that same sample. Twelve GAD participants were randomly selected and were included in an open label twelve-week treatment with citalopram and pre-/post-treatment magnetic resonance imaging (MRI). Cortical thickness measurements were obtained with Freesurfer. Six regions were selected based on previous results: left dorsal ACC, left rostral ACC, left and right medial orbitofrontal, right pars triangularis and right pars opercularis. A two-tailed paired t-test (non-parametric Wilcoxon Signed Rank test) was used to compare pre- and post-treatment for all clinical variables. For each region of interest (ROI), the Pearson correlation coefficient was estimated between pre-treatment cortical thickness and change in Penn State Worry Questionnaire (PSWQ) from pre- to post-treatment. Our results indicate that greater left pre-treatment dorsal ACC cortical thickness was associated with improvement in worry severity post-treatment. In late-life GAD, greater treatment response is associated with greater cortical thickness in areas pivotal for emotion regulation.

scholarly journals Anticipatory Activation in the Amygdala and Anterior Cingulate in Generalized Anxiety Disorder and Prediction of Treatment Response

2009 ◽  
Vol 166 (3) ◽  
pp. 302-310 ◽  
Author(s):  
Jack B. Nitschke ◽  
Issidoros Sarinopoulos ◽  
Desmond J. Oathes ◽  
Tom Johnstone ◽  
Paul J. Whalen ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Anterior Cingulate ◽  
Generalized Anxiety ◽  
Anticipatory Activation

Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire – Abbreviated (PSWQ-A)

2021 ◽  
pp. 1-13
Author(s):  
Carly Johnco ◽  
Viviana M. Wuthrich ◽  
Gretchen A. Brenes ◽  
Julie Loebach Wetherell ◽  
Jan Mohlman
Keyword(s):  
Older Adults ◽  
Treatment Outcome ◽  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Late Life ◽  
Generalized Anxiety ◽  
Penn State Worry Questionnaire ◽  
Penn State ◽  
State Worry

ABSTRACT Objective: The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). Design: Longitudinal assessment of GAD symptoms pre- and posttreatment. Participants: Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment. Intervention: Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. Measurements: Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. Results: Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. Conclusions: Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

scholarly journals Treatment Response for Late-Life Generalized Anxiety Disorder

2011 ◽  
Vol 199 (10) ◽  
pp. 811-814 ◽  
Author(s):  
Ashley S. Roseman ◽  
Jeffrey A. Cully ◽  
Mark E. Kunik ◽  
Diane M. Novy ◽  
Howard M. Rhoades ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Late Life ◽  
Generalized Anxiety

A Pilot Study of Anterior Cingulate Cortex Neurochemistry in Adolescents with Generalized Anxiety Disorder

2013 ◽  
Vol 67 (4) ◽  
pp. 224-229 ◽  
Author(s):  
Jeffrey R. Strawn ◽  
Wen-Jang Chu ◽  
Rachel M. Whitsel ◽  
Wade A. Weber ◽  
Matthew M. Norris ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Pilot Study ◽  
Anterior Cingulate Cortex ◽  
Generalized Anxiety Disorder ◽  
Cingulate Cortex ◽  
Anterior Cingulate ◽  
Generalized Anxiety

Measurement Invariant but Non-Normal Treatment Responses in Guided Internet Psychotherapies for Depressive and Generalized Anxiety Disorders

Assessment ◽  
2021 ◽  
pp. 107319112110625
Author(s):  
Tom H. Rosenström ◽  
Ville Ritola ◽  
Suoma Saarni ◽  
Grigori Joffe ◽  
Jan-Henry Stenberg
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Health Assessment ◽  
Psychotherapy Research ◽  
Self Report ◽  
Generalized Anxiety ◽  
Equivalence Testing ◽  
Sum Scores ◽  
Normally Distributed

Assessment of treatment response in psychotherapies can be undermined by lack of longitudinal measurement invariance (LMI) in symptom self-report inventories, by measurement error, and/or by wrong model assumptions. To understand and compare these threats to validity of outcome assessment in psychotherapy research, we studied LMI, sum scores, and Davidian Curve Item Response Theory models in a naturalistic guided internet psychotherapy treatment register of 2,218 generalized anxiety disorder (GAD) patients and 3,922 depressive disorder (DD) patients (aged ≥16 years). Symptoms were repeatedly assessed by Generalized Anxiety Disorder Assessment-7 (GAD-7) or Beck Depression Inventory. The symptom self-reports adhered to LMI under equivalence testing, suggesting sum scores are reasonable proxies for disorder status. However, the standard LMI assumption of normally distributed latent factors did not hold and inflated treatment response estimates by 0.2 to 0.3 standard deviation units compared with sum scores. Further methodological research on non-normally distributed latent constructs holds promise in advancing LMI and mental health assessment.

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

2021 ◽  
Vol 15 ◽  
Author(s):  
Yang Du ◽  
Hailong Li ◽  
Hongqi Xiao ◽  
Mei Wang ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Functional Connectivity ◽  
Generalized Anxiety Disorder ◽  
Trait Anxiety ◽  
Symptom Severity ◽  
Inferior Frontal Gyrus ◽  
Illness Severity ◽  
Anterior Cingulate ◽  
Generalized Anxiety ◽  
Significant Group

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.

scholarly journals Treating Late-Life Generalized Anxiety Disorder in Primary Care

2013 ◽  
Vol 201 (5) ◽  
pp. 414-420 ◽  
Author(s):  
Jessica S. Calleo ◽  
Amber L. Bush ◽  
Jeffrey A. Cully ◽  
Nancy L. Wilson ◽  
Cynthia Kraus-Schuman ◽  
...  
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Late Life ◽  
Generalized Anxiety
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