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We provide evidence that GAD is associated with disrupted white-matter coherence of posterior right hemisphere regions, which may partly sustain the impaired cognitive regulation of anxiety. Future diffusion imaging investigations are expected to better elucidate the communication between the parietal cortex and other right hemisphere regions in sustaining the cognitive processing of social and emotional stimuli in patients with GAD.

Background: It is possible to find an organic cause just for 1/3 of patients admitted to hospital with chest pain [1]. For the other 2/3 we are dealing with Unexplained Chest Pain [2]. Many studies demonstrated that in a high percentage of people that suffer of UCP there are mental disorders and unfavourable social and psychological factors [3,4,5]. Aim: The aim of this study was to estimate prevalence and to outline the psychological, social, anxious, depressive and somatoform state of patients admitted to emergency ward. Method: We recruited 319 patients, 169 treated in Udine´s Emergency ward for chest pain and a control group of 150 patients that went to their family doctor with other symptoms. Each of them completed self-administered tests searching socio-demographic characteristics, anxiety, depression, somatization, alexithymia, stress factors and child abuse. After 3 months we selected, using the hospitals database, patients that had confirmed diagnosis of UCP. Results: Prevalence of UCP in patients treated in Udine's emergency room was 45,5% (n77). We found a statistically significant difference between patients with UCP and control healthy group in the somatization subscale of SCL90 (χ2=18,2; p< 0,0001) and anxiety subscale of HADS (χ2=21,5; p< 0,0001). Conclusions: A high percentage of hospitalized patients in the emergency ward for chest pain did not receive diagnosis of an organic pathology. It's possible to find in these patients a greater tendency to somatization and presence of anxiety symptoms. This data is in line with what recent literature shows.

IntroductionLittle is known about the structural abnormalities underlying generalized anxiety disorder (GAD). However, there is evidence of larger volumes of dorsomedial prefrontal cortex (Schienle et al, 2011). Also, increased n-acetyl-aspartate in right dorsolateral prefrontal cortex (DLPFC) (Mathew et al, 2004), and hyperactivation in right middle frontal to negative stimuli have been shown in GAD (Blair et al, 2008).ObjectivesTo investigate variations in cortical thickness (CT) in GAD patients versus healthy controls (HCs).AimsGAD patients and matched HCs underwent a 3T magnetic resonance imaging (MRI) session.MethodsStructural MRI was acquired from 24 DSM-IV GAD patients (age=41±13.9) and 23 HCs (age=39±13.4). CT was estimated using Freesurfer5.3 (Fischl and Dale, 2000). Results were manually corrected if necessary. We considered 21 regions of interest (ROIs) per hemisphere (4 cingulate, 6 frontal, 3 parietal, 5 temporal, 1 occipital, entorhinal, insula), for each of which a mean CT value was calculated. A t-test was performed for each region, correcting results for multiple comparisons.ResultsThe groups were statistically homogeneous in terms of age, gender, handedness, and IQ (p>0.05). Though ROI volumes were preserved in GAD (p>0,05; Bonferroni corrected), a significantly reduced CT was found in right caudal middle (t(46)=3.621, p=0.015) and right superior frontal (t(46)=3.215, p=0.049) regions.ConclusionsThe found decreased CT in GAD patients compared to HCs in superior frontal and caudal middle areas (right side) sustains prior neuroimaging findings showing abnormalities in prefrontal cortex. Reduced right frontal CT may be involved in cognitive dysfunction and symptomatology of the disorder.