Treatment-resistant anxiety disorders

Bystritsky, Alexander

doi:10.1038/sj.mp.4001852

Cited by 233 publications

(192 citation statements)

References 67 publications

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“…Between one-third and two-thirds of anxiety patients are treatment-resistant or refractory (33), underscoring the need to develop more efficacious interventions. The present results highlight the potential utility of broad-spectrum (i.e., multisymptom) approaches.…”

Section: Discussionmentioning

confidence: 99%

Neural mechanisms underlying heterogeneity in the presentation of anxious temperament

Shackman

Fox

Oler

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

107

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Children with an anxious temperament (AT) are at risk for developing psychiatric disorders along the internalizing spectrum, including anxiety and depression. Like these disorders, AT is a multidimensional phenotype and children with extreme anxiety show varying mixtures of physiological, behavioral, and other symptoms. Using a well-validated juvenile monkey model of AT, we addressed the degree to which this phenotypic heterogeneity reflects fundamental differences or similarities in the underlying neurobiology. The rhesus macaque is optimal for studying AT because children and young monkeys express the anxious phenotype in similar ways and have similar neurobiology. Fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET) in 238 freely behaving monkeys identified brain regions where metabolism predicted variation in three dimensions of the AT phenotype: hypothalamic-pituitaryadrenal (HPA) activity, freezing behavior, and expressive vocalizations. We distinguished brain regions that predicted all three dimensions of the phenotype from those that selectively predicted a single dimension. Elevated activity in the central nucleus of the amygdala and the anterior hippocampus was consistently found across individuals with different presentations of AT. In contrast, elevated activity in the lateral anterior hippocampus was selective to individuals with high levels of HPA activity, and decreased activity in the motor cortex (M1) was selective to those with high levels of freezing behavior. Furthermore, activity in these phenotype-selective regions mediated relations between amygdala metabolism and different expressions of anxiety. These findings provide a framework for understanding the mechanisms that lead to heterogeneity in the clinical presentation of internalizing disorders and set the stage for developing improved interventions.affective neuroscience | behavioral inhibition | developmental psychopathology | emotion | functional neuroimaging

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Section: Discussionmentioning

confidence: 99%

Neural mechanisms underlying heterogeneity in the presentation of anxious temperament

Shackman

Fox

Oler

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

107

View full text Add to dashboard Cite

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“…Anxiety disorders, such as post-traumatic stress disorder, panic disorder, social phobia, specific phobia, and generalized anxiety disorder, comprise the most common psychiatric diseases in the United States (1). Mouse genetic studies have identified associations between glyoxalase 1 (Glo1) and anxiety-like behavior.…”

Section: Introductionmentioning

confidence: 99%

Glyoxalase 1 increases anxiety by reducing GABAA receptor agonist methylglyoxal

Distler¹,

Plant²,

Sokoloff³

et al. 2012

J. Clin. Invest.

132

214

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Glyoxalase 1 (Glo1) expression has previously been associated with anxiety in mice; however, its role in anxiety is controversial, and the underlying mechanism is unknown. Here, we demonstrate that GLO1 increases anxiety by reducing levels of methylglyoxal (MG), a GABA A receptor agonist. Mice overexpressing Glo1 on a Tg bacterial artificial chromosome displayed increased anxiety-like behavior and reduced brain MG concentrations. Treatment with low doses of MG reduced anxiety-like behavior, while higher doses caused locomotor depression, ataxia, and hypothermia, which are characteristic effects of GABA A receptor activation. Consistent with these data, we found that physiological concentrations of MG selectively activated GABA A receptors in primary neurons. These data indicate that GLO1 increases anxiety by reducing levels of MG, thereby decreasing GABA A receptor activation. More broadly, our findings potentially link metabolic state, neuronal inhibitory tone, and behavior. Finally, we demonstrated that pharmacological inhibition of GLO1 reduced anxiety, suggesting that GLO1 is a possible target for the treatment of anxiety disorders.

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“…O processamento cognitivo dos transtornos ansiosos envolve a vulnerabilidade, pois os indivíduos tendem a superestimar o perigo e subestimar os recursos pessoais para lidar com essas situações e, a partir do momento em que ocorre um reconhecimento do perigo, ficam propensos a desenvolver mais pensamentos que mantêm a ansiedade (Bystritsky, 2006). Os próprios sintomas de ansiedade podem transformar-se em uma nova ameaça percebida, uma vez que prejudicam o desempenho do indivíduo em situação perigosa (Frewen et al, 2013).…”

Section: Introductionunclassified

Importância das técnicas de relaxamento na terapia cognitiva para ansiedade

Willhelm

Andretta

Ungaretti

2015

ctc

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Resumo. Transtornos de ansiedade estão entre os transtornos mais comuns e se caracterizam por uma resposta de ansiedade exagerada e não adaptativa a algum estímulo. O tratamento com TCC para transtornos ansiosos sugere técnicas cognitivas de reestruturação e fl exibilização cognitiva e técnicas comportamentais como exposição, dessensibilização sistemática e técnicas de relaxamento corporal. Realizou-se uma investigação através de três estudos de caso, em que foram aplicadas técnicas de relaxamento, dentre elas o relaxamento progressivo, relaxamento passivo e respiração diafragmática. Para a análise da efi cácia da técnica de relaxamento, pediu-se que os pacientes indicassem um valor de ansiedade em uma escala de zero a dez antes e depois das técnicas. As técnicas de relaxamento tiveram sucesso nos três casos estudados e atingiram o objetivo de diminuição da ansiedade. Palavras-chave:Terapia Cognitiva, ansiedade, relaxamento.Abstract. Anxiety disorders are one of the most common disorders and are characterized by a maladaptive and exaggeratedly anxious response to some stimulus. The CBT treatment for anxiety disorders suggests cognitive techniques of restructuring and cognitive fl exibilization and behavioral techniques such as exposure, systematic desensitization and body relaxation techniques. An investigation was conducted through three case studies. Relaxation techniques were applied to all three patients, including progressive relaxation, passive relaxation and diaphragmatic breathing. To analyze the effi cacy of relaxation techniques the patients were asked to indicate their anxiety in a scale from zero to ten (zero is no anxiety and ten is high anxiety) before and after the techniques. Relaxation techniques have been successful in the three cases of this study and achieved the goal of decreasing anxiety, but it should be emphasized that the use of these techniques is not universal and depends on each patient. Keywords:Cognitive Therapy, anxiety, relaxation. Importância das técnicas de relaxamento na terapia cognitiva para ansiedadeImportance of relaxation techniques in cognitive therapy for anxiety

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Treatment-resistant anxiety disorders

Cited by 233 publications

References 67 publications

Neural mechanisms underlying heterogeneity in the presentation of anxious temperament

Neural mechanisms underlying heterogeneity in the presentation of anxious temperament

Glyoxalase 1 increases anxiety by reducing GABAA receptor agonist methylglyoxal

Importância das técnicas de relaxamento na terapia cognitiva para ansiedade

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