Anxiety disorders and figural fluency: A measure of executive function

Gulpers, Bernice; Lugtenburg, Astrid; Zuidersma, Marij; Verhey, Frans R.J.; Voshaar, Richard C. Oude

doi:10.1016/j.jad.2018.02.038

Cited by 12 publications

(12 citation statements)

References 44 publications

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“…Deficits in executive functions have been found in anxiety disorders 12–14 . Acute anxiety impairs cognitive flexibility, the ability to adapt one’s behaviour in response to rapid changes in the environment 15 .…”

Section: Introductionmentioning

confidence: 99%

Acute anxiety and autonomic arousal induced by CO2 inhalation impairs prefrontal executive functions in healthy humans

et al. 2019

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Acute anxiety impacts cognitive performance. Inhalation of air enriched with carbon dioxide (CO2) in healthy humans provides a novel experimental model of generalised anxiety, but has not previously been used to assess cognition. We used inhalation of 7.5% CO2 to induce acute anxiety and autonomic arousal in healthy volunteers during neuropsychological tasks of cognitive flexibility, emotional processing and spatial working memory in a single-blind, placebo-controlled, randomized, crossover, within-subjects study. In Experiment 1 (n = 44), participants made significantly more extra-dimensional shift errors on the Cambridge Neuropsychological Test Automated Battery (CANTAB) Intra-Extra Dimensional Set Shift task under CO2 inhalation compared with ‘normal’ air. Participants also had slower latencies when responding to positive words and made significantly more omission errors for negative words on the CANTAB Affective Go/No-go task. In Experiment 2 (n = 28), participants made significantly more total errors and had poorer heuristic search strategy on the CANTAB Spatial Working Memory task. In both experiments, CO2 inhalation significantly increased negative affect; state anxiety and fear; symptoms of panic; and systolic blood pressure/heart rate. Overall, CO2 inhalation produced robust anxiogenic effects and impaired fronto-executive functions of cognitive flexibility and working memory. Effects on emotional processing suggested a mood-congruent slowing in processing speed in the absence of a negative attentional bias. State-dependent effects of anxiety on cognitive-emotional interactions in the prefrontal cortex warrant further investigation.

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Section: Introductionmentioning

confidence: 99%

Acute anxiety and autonomic arousal induced by CO2 inhalation impairs prefrontal executive functions in healthy humans

et al. 2019

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“…Lower design fluency scores have been shown in patients with comorbid clinical depression and anxiety [ 50 ]. However, absence of a dose-response relationship between number of comorbid anxiety disorders (as a measure of severity) and design fluency scores, after adjusting for comorbid depression, has also been reported in a large population-based sample of adults [ 24 ]. More research is clearly needed to investigate associations of EFs and severity of anxiety.…”

Section: Discussionmentioning

confidence: 99%

“…This result may be interpreted as patients with anxiety have better EF. There are sporadic reports of an association between anxiety disorders and “creativity” such as a creative occupation [ 24 ]. However, a more plausible explanation for our results may involve the normative sample for the design fluency test.…”

Section: Discussionmentioning

confidence: 99%

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Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study

et al. 2021

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Background Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders. Methods 189 Swedish patients aged 18–65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test. Results More severe anxiety was associated with lower digit span test scores (R2 = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests. Conclusions Severity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.

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“…EF is thought to be impaired in individuals with a range of mental health problems 1 , and there is evidence that it is also associated with substance use 2 . For example, poorer EF has been observed among individuals with schizophrenia 1,3–5 , major depressive disorder (MDD) 6,7 , and anxiety 8,9 , as well as in people who smoke both cigarettes 10,11 and cannabis 12,13 and consume alcohol 10,14 . The direction of association between EF and these phenotypes is unclear 1 , with some studies suggesting EF deficits prior to these 2 and others suggesting they occur after 3 .…”

Section: Introductionmentioning

confidence: 99%

Is there a causal relationship between executive function and liability to mental health and substance use? A Mendelian randomisation approach

Burton

Sallis

Hatoum

et al. 2022

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Background: Executive function consists of several cognitive control processes that are able to regulate lower level processes. Poorer performance in tasks designed to test executive function is associated with a range of psychopathologies such as schizophrenia, major depressive disorder (MDD) and anxiety, as well as with smoking and alcohol consumption. Despite these well-documented associations, whether they reflect causal relationships, and if so in what direction, remains unclear. We aimed to establish whether there is a causal relationship between a latent factor for performance on multiple executive function tasks - which we refer to as common executive function (cEF) - and liability to schizophrenia, MDD, anxiety, smoking initiation, alcohol consumption, alcohol dependence and cannabis use disorder (CUD), and the directionality of any relationship observed. Methods: We used a two-sample bidirectional Mendelian randomisation (MR) approach using genome-wide association study (GWAS) summary data from large cohorts (N=17,310 to 848,460) to examine whether causal relationships exist, and if so in which direction. Results: We found evidence of a causal effect of increased cEF on reduced schizophrenia liability (IVW: OR=0.10; 95% CI 0.05 to 0.19; p-value=3.43x10-12), reduced MDD liability (IVW: OR=0.52; 95% CI 0.38 to 0.72; p-value=5.23x10-05), decreased drinks per week (IVW: β=-0.06; 95% CI -0.10 to -0.02; p-value=0.003), and reduced CUD liability (IVW: OR=0.27; 95% CI 0.12 to 0.61; p-value=1.58x10-03). We also found evidence of a causal effect of increased schizophrenia liability on decreased cEF (IVW: β=-0.04; 95% CI -0.04 to -0.03; p-value=3.25x10-27), as well as smoking initiation on decreased cEF (IVW: β=-0.06; 95%CI -0.09 to -0.03; p-value=6.11x10-05). Conclusion: Our results indicate a potential bidirectional causal relationship between a latent factor measure of executive function (cEF) and schizophrenia liability, a possible causal effect of increased cEF on reduced MDD liability, CUD liability, and alcohol consumption, and a possible causal effect of smoking initiation on decreased cEF. These results suggest that executive function should be considered as a potential risk factor for some mental health and substance use outcomes, and may also be impacted by mental health (particularly schizophrenia). Further studies are required to improve our understanding of the underlying mechanisms of these effects, but our results suggest that executive function may be a promising intervention target. These results may therefore inform the prioritisation of experimental medicine studies (e.g., of executive function interventions), for both mental health and substance use outcomes, to improve the likelihood of successful translation.

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Anxiety disorders and figural fluency: A measure of executive function

Cited by 12 publications

References 44 publications

Acute anxiety and autonomic arousal induced by CO2 inhalation impairs prefrontal executive functions in healthy humans

Acute anxiety and autonomic arousal induced by CO2 inhalation impairs prefrontal executive functions in healthy humans

Anxiety severity and cognitive function in primary care patients with anxiety disorder: a cross-sectional study

Is there a causal relationship between executive function and liability to mental health and substance use? A Mendelian randomisation approach

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