scholarly journals Neuroinflammation-Associated Alterations of the Brain as Potential Neural Biomarkers in Anxiety Disorders

2020 ◽  
Vol 21 (18) ◽  
pp. 6546
Author(s):  
Eunsoo Won ◽  
Yong-Ku Kim
Keyword(s):  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Chronic Stress ◽  
Preliminary Evidence ◽  
Generalized Anxiety ◽  
Limbic Structures ◽  
Neurobiological Substrates ◽  
The Brain

Stress-induced changes in the immune system, which lead to neuroinflammation and consequent brain alterations, have been suggested as possible neurobiological substrates of anxiety disorders, with previous literature predominantly focusing on panic disorder, agoraphobia, and generalized anxiety disorder, among the anxiety disorders. Anxiety disorders have frequently been associated with chronic stress, with chronically stressful situations being reported to precipitate the onset of anxiety disorders. Also, chronic stress has been reported to lead to hypothalamic–pituitary–adrenal axis and autonomic nervous system disruption, which may in turn induce systemic proinflammatory conditions. Preliminary evidence suggests anxiety disorders are also associated with increased inflammation. Systemic inflammation can access the brain, and enhance pro-inflammatory cytokine levels that have been shown to precipitate direct and indirect neurotoxic effects. Prefrontal and limbic structures are widely reported to be influenced by neuroinflammatory conditions. In concordance with these findings, various imaging studies on panic disorder, agoraphobia, and generalized anxiety disorder have reported alterations in structure, function, and connectivity of prefrontal and limbic structures. Further research is needed on the use of inflammatory markers and brain imaging in the early diagnosis of anxiety disorders, along with the possible efficacy of anti-inflammatory interventions on the prevention and treatment of anxiety disorders.

Clinical Management of Anxiety Disorders

2018 ◽  
Author(s):  
Shona Vas ◽  
Pooja N Dave
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Mood State ◽  
Behavioral Therapy ◽  
Skills Training ◽  
Generalized Anxiety

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

Clinical Management of Anxiety Disorders

2017 ◽  
Author(s):  
Shona Vas ◽  
Pooja N Dave
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Mood State ◽  
Behavioral Therapy ◽  
Skills Training ◽  
Generalized Anxiety

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

Aripiprazole as Augmentation Treatment of Refractory Generalized Anxiety Disorder and Panic Disorder

CNS Spectrums ◽  
2008 ◽  
Vol 13 (6) ◽  
pp. 522-525 ◽  
Author(s):  
Elizabeth A. Hoge ◽  
John J. Worthington ◽  
Rebecca E. Kaufman ◽  
Hannah R. Delong ◽  
Mark H. Pollack ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Panic Disorder ◽  
Generalized Anxiety Disorder ◽  
Antipsychotic Agent ◽  
Preliminary Evidence ◽  
Generalized Anxiety ◽  
Open Label ◽  
Pharmacologic Agent ◽  
Severity Scores ◽  
Augmentation Strategy

ABSTRACTIntroduction:Individuals with anxiety disorders often remain symptomatic despite treatment with a first-line pharmacologic agent. More research examining pharmacotherapy augmentation strategies to improve outcomes is needed.Methods:In an 8-week, open-label, prospective augmentation study, we examined the efficacy and tolerability of the novel antipsychotic agent aripiprazole for adult outpatients with generalized anxiety disorder (n=13) or panic disorder (n=10) who remained symptomatic despite treatment for at least 8 weeks with an adequate (or maximally tolerated) dose of typical pharmacotherapy.Results:Aripiprazole augmentation was associated with a significant reduction in Clinical Global Impressions-Severity scores (paired t=4.41, df=22, P<.001) in the intent-to-treat sample of 23 individuals. Three subjects (13%) discontinued due to sedation, chest discomfort, and restlessness, respectively.Conclusion:These data provide preliminary evidence that aripiprazole may be a useful augmentation strategy for individuals with generalized anxiety disorder or panic disorder who show a limited response to initial pharmacotherapy.

Anxiety and Other Distressing Symptoms

2021 ◽  
pp. 97-111
Author(s):  
John C. Markowitz
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Psychiatric Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Generalized Anxiety ◽  
Risk And Uncertainty ◽  
Case Examples

This omnibus chapter covers anxiety disorders and other psychiatric disorders that may arise or be aggravated by the pandemic. Some anxiety is of course warranted in the midst of a crisis of ongoing risk and uncertainty; therapist and patient must try to separate appropriate from symptomatic anxiety. The chapter includes a discussion of prior IPT research for these disorders, appropriate IPT adaptations, and extended, detailed case examples illustrating the application of IPT to panic disorder, generalized anxiety disorder, and social anxiety disorder. It also addresses how the pandemic may trigger or exacerbate other diagnoses for which IPT has shown benefit.

Anxiety disorders in primary care

2017 ◽  
Author(s):  
Markus Dold ◽  
Siegfried Kasper
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Pharmacological Treatment ◽  
Treatment Options ◽  
Specific Phobia ◽  
Generalized Anxiety

Chapter 7 summarizes the epidemiology, clinical characteristics, and evidence for pharmacological treatment options of generalized anxiety disorder, panic disorder, agoraphobia, specific phobia, and social anxiety disorder. With regard to the pharmacological management, serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) represent the well-established first-line medication for generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social anxiety disorder. In GAD, also the calcium channel modulator pregabalin can be regarded as evidence-based treatment option. In simple cases of specific phobia, however, the initiation of a pharmacotherapy is not recognized as standard treatment according to international treatment guidelines and psychotherapeutic interventions should be preferred. Besides illustrating the pharmacological treatment options, we described the actualized diagnostic criteria for anxiety disorders established in the newly introduced fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Clinical Management of Anxiety Disorders

2018 ◽  
Author(s):  
Shona Vas ◽  
Pooja N Dave
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Mood State ◽  
Behavioral Therapy ◽  
Skills Training ◽  
Generalized Anxiety

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

scholarly journals Anxiety in middle adulthood: effects of age and time on the 14-year course of panic disorder, social phobia and generalized anxiety disorder

2008 ◽  
Vol 39 (4) ◽  
pp. 615-624 ◽  
Author(s):  
H. J. Ramsawh ◽  
S. D. Raffa ◽  
M. Orlando Edelen ◽  
R. Rende ◽  
M. B. Keller
Keyword(s):  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Social Phobia ◽  
Generalized Anxiety Disorder ◽  
Short Interval ◽  
Outcome Variable ◽  
Generalized Anxiety ◽  
Over Time

BackgroundMuch about the long-term course of anxiety disorders is unknown. The present study utilizes a naturalistic, longitudinal, short-interval follow-up design to elucidate the course of anxiety disorders over 14 years in a largely middle-aged adult sample recruited from out-patient psychiatry and primary care facilities.MethodThe sample consisted of 453 participants with a diagnosis of panic disorder (PD), social phobia (SP) and/or generalized anxiety disorder (GAD). Anxiety symptom ratings were tracked using weekly psychiatric status ratings (PSRs). Controlling for demographic and clinical variables, the course of PD, GAD and SP were examined using longitudinal growth models, with the most severe PSR at each follow-up point as the main outcome variable.ResultsPSRs significantly decreased in severity over time in each of the three disorders. In the interaction effects models, age×time had a significant effect on course for PD and GAD, but not for SP, in that older age was associated with lower PSRs over time.ConclusionsThe present findings suggest that the severity of anxiety disorders declines over time, although this decline is modest and depends on the specific disorder being assessed. Older individuals with PD and GAD have a better prognosis than their younger counterparts, as their course is characterized by a steeper decline in severity. The present findings provide important information about the course of anxiety disorders in mid-life.

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