Disorder-Specific Neuroanatomical Correlates of Attentional Bias in Obsessive-compulsive Disorder, Panic Disorder, and Hypochondriasis

Heuvel, Odile A. van den; Veltman, Dick J.; Groenewegen, Henk J.; Witter, Menno P.; Merkelbach, J.; Cath, Daniëlle C.; Balkom, A.J.L.M. van; Oppen, Patricia van; Dyck, Richard van

doi:10.1001/archpsyc.62.8.922

Cited by 339 publications

(197 citation statements)

References 123 publications

(138 reference statements)

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“…In Obsessive Compulsive Disorder (OCD), color naming OCD-related, but not PD-related, words was found to correlate with increased activation of frontal-striatal and temporal regions. In contrast, an increased frontalstriatal involvement was found during color naming both OCD-related and panic-related words in Panic Disorder patients [86]. Baseline perfusion of the orbitofrontal cortex predicted panic attacks such that lower perfusion was associated with heightened anxiety in response to a pharmacological challenge [87].…”

Section: Anxiety Phenotypesmentioning

confidence: 96%

The role of neuroimaging for the diagnosis and treatment of anxiety disorders

Paulus

2008

Depress. Anxiety

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Neuroimaging comprises a set of tools, which include different types of magnetic resonance imaging such as fMRI, MRS, ASL, and radiotracer imaging such as PET and SPECT. The focus of this review is to address the question whether functional magnetic resonance imaging (fMRI) can contribute to the diagnosis and treatment of anxiety disorders. Key anxiety processes and neural substrates are reviewed. The main findings and shortcomings of fMRI in the context of anxiety are briefly summarized. Finally, the next stages of developing fMRI for diagnosis and treatment are highlighted. The main conclusion of this review is that fMRI could become a clinical tool for the diagnosis and treatment of anxiety disorders but neuroimaging groups will need to better develop its specificity and sensitivity so that fMRI results can be meaningful for an individual patient not just for groups of individuals. fMRI -what is it and what does it measure?Functional magnetic resonance imaging (fMRI) is a technique that enables one to map cognitive, affective, and experiential processes onto brain substrates. However, fMRI is not about increased or decreased activation in a certain part of the brain; rather it is a proxy measure about how complex cognitive, emotional, social and other experiential processes are implemented in different neural systems. For example, it is important to realize that it makes little sense to talk about hyperactivity in the amygdala in individuals with anxiety disorder without referencing the process, which is being measured during the amygdala hyperactivity, i.e. the task that individuals are engaged in while the functional images are obtained. Although the human brain comprises only about 2% of the body mass, it accounts for approximately 20% of its total oxygen consumption [1]. Deoxyhemoglobin has paramagnetic effects in the blood upon the nuclear magnetic resonance transverse relaxation times of nearby water protons in the tissue [2]. The fact that changes in the oxygen level in the blood can affect the fraction of hemoglobin in the deoxygenated state can be utilized as an image contrast and was termed as blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) [3]. Recent BOLD fMRI experiments in the awake Correspondence should be sent to: Martin P Paulus, Professor in Residence,

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Section: Anxiety Phenotypesmentioning

confidence: 96%

The role of neuroimaging for the diagnosis and treatment of anxiety disorders

Paulus

2008

Depress. Anxiety

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“…For example, low-frequency rTMS (1Hz) on the right dorsolateral prefrontal cortex seems to lessen the symptoms of panic in these patients 32 . There seems to be an activation asymmetry, so that, in PD patients, the right hemisphere appears to be more active than the left in the dorsolateral prefrontal cortex area 54 .…”

Section: Neuromodulation and Panic Disordermentioning

confidence: 97%

Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders

Iannone

Cruz

Brasil‐Neto

et al. 2016

Arq. Neuro-Psiquiatr.

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Transcranial magnetic stimulation (TMS) has recently been investigated as a possible adjuvant treatment for many neuropsychiatric disorders, and has already been approved for the treatment of drug-resistant depression in the United States and in Brazil, among other countries. Although its use in other neuropsychiatric disorders is still largely experimental, many physicians have been using it as an off-label add-on therapy for various disorders. More recently, another technique, transcranial direct current stimulation (tDCS), has also become available as a much cheaper and portable alternative to TMS, although its mechanisms of action are different from those of TMS. The use of off-label therapeutic TMS or tDCS tends to occur in the setting of diseases that are notoriously resistant to other treatment modalities. Here we discuss the case of anxiety disorders, namely panic and post-traumatic stress disorders, highlighting the uncertainties and potential problems and benefits of the clinical use of these neuromodulatory techniques at the current stage of knowledge.

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“…Based on animal models of fear learning (3, 4), this hypothesis leads to the prediction that amygdalar dysfunction is common to a variety of anxiety disorders. Indeed, amygdalar hyperactivity has been observed during symptom provocation or negative emotional processing in patients with posttraumatic stress disorder (PTSD) (5-8), social anxiety disorder (9-14), specific phobia (15-18), panic disorder (19), and obsessive-compulsive disorder (OCD) (19,20). However, because of the low statistical power of individual studies Address correspondence and reprint requests to Dr. Etkin, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305; amitetkin@stanford.edu.…”

mentioning

confidence: 99%

Functional Neuroimaging of Anxiety: A Meta-Analysis of Emotional Processing in PTSD, Social Anxiety Disorder, and Specific Phobia

Etkin¹,

Wager²

2007

AJP

2,952

172

2,306

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Objective-The study of human anxiety disorders has benefited greatly from functional neuroimaging approaches. Individual studies, however, vary greatly in their findings. The authors searched for common and disorder-specific functional neurobiological deficits in several anxiety disorders. The authors also compared these deficits to the neural systems engaged during anticipatory anxiety in healthy subjects.Method-Functional magnetic resonance imaging and positron emission tomography studies of posttraumatic stress disorder (PTSD), social anxiety disorder, specific phobia, and fear conditioning in healthy individuals were compared by quantitative meta-analysis. Included studies compared negative emotional processing to baseline, neutral, or positive emotion conditions.Results-Patients with any of the three disorders consistently showed greater activity than matched comparison subjects in the amygdala and insula, structures linked to negative emotional responses. A similar pattern was observed during fear conditioning in healthy subjects. Hyperactivation in the amygdala and insula were, of interest, more frequently observed in social anxiety disorder and specific phobia than in PTSD. By contrast, only patients with PTSD showed hypoactivation in the dorsal and rostral anterior cingulate cortices and the ventromedial prefrontal cortex-structures linked to the experience and regulation of emotion.Conclusions-This meta-analysis allowed us to synthesize often disparate findings from individual studies and thereby provide neuroimaging evidence for common brain mechanisms in anxiety disorders and normal fear. Effects unique to PTSD furthermore suggested a mechanism for the emotional dysregulation symptoms in PTSD that extend beyond an exaggerated fear response. Therefore, these findings help refine our understanding of anxiety disorders and their interrelationships.Fear and avoidance of trigger cues are common to many anxiety disorders (1) and resemble the arousal and avoidance responses shown by normal subjects to conditioned fear cues (2). Thus, a common element of anxiety disorders may be an abnormally elevated fear response. Based on animal models of fear learning (3, 4), this hypothesis leads to the prediction that amygdalar dysfunction is common to a variety of anxiety disorders. Indeed, amygdalar hyperactivity has been observed during symptom provocation or negative emotional processing in patients with posttraumatic stress disorder (PTSD) (5-8), social anxiety disorder (9-14), specific phobia (15-18), panic disorder (19), and obsessive-compulsive disorder (OCD) (19,20). However, because of the low statistical power of individual studies Address correspondence and reprint requests to Dr. Etkin, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Stanford, CA 94305; amitetkin@stanford.edu. All authors report no competing interests. NIH Public Access Author ManuscriptAm J Psychiatry. Author manuscript; available in PMC 2012 April 4. NIH-PA Author Manuscr...

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Disorder-Specific Neuroanatomical Correlates of Attentional Bias in Obsessive-compulsive Disorder, Panic Disorder, and Hypochondriasis

Cited by 339 publications

References 123 publications

The role of neuroimaging for the diagnosis and treatment of anxiety disorders

The role of neuroimaging for the diagnosis and treatment of anxiety disorders

Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders

Functional Neuroimaging of Anxiety: A Meta-Analysis of Emotional Processing in PTSD, Social Anxiety Disorder, and Specific Phobia

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