Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder

Maywald, Maximilian; Pogarell, Oliver; Levai, Susanne; Paolini, Marco; Tschentscher, Nadja; Rauchmann, Boris‐Stephan; Krause, Daniela; Stöcklein, Sophia; Goerigk, Stephan; Röll, Lukas; Ertl‐Wagner, Birgit; Papazov, Boris; Keeser, Daniel; Karch, Susanne; Chrobok, Agnieszka

doi:10.1016/j.nicl.2023.103330

Cited by 10 publications

(10 citation statements)

References 92 publications

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“…They are in accordance with other studies (Schiepek et al, 2013 ; Yu et al, 2022 ). The stronger activation of occipital regions for neutral pictures in ACS and INS is also in line with previous studies and seems to be a neuronal correlate of a less emotional involvement and stronger visual or “neutral” processing (Maywald et al, 2022a , b ).…”

Section: Discussionsupporting

confidence: 90%

“…Functional neuroimaging studies have linked activations of the insular cortex to various aspects including subjective disgust related information/emotional perception of emotional states (Craig et al, 2002 ), aversive valence of information (Anderson and Savage, 2004 ) and emotional tasks (Phan et al, 2002 ). In addition, insula plays an important role in a wide range of psychiatric disorders including obsessive-compulsive disorder (Avery et al, 2014 ; Buyukturkoglu et al, 2015 ; Maywald et al, 2022b ). A decreased neuronal response at T2 compared to T1 may indicate decreased emotional responses during the processing of OCD-relevant information.…”

Section: Limitationsmentioning

confidence: 99%

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Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder

Karch,

Maywald,

Schwartz

et al. 2024

Front. Psychol.

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IntroductionCognitive behaviour therapy with exposure and response prevention is efficient in treating patients with obsessive-compulsive disorder (OCD). Nevertheless, it would be helpful for many patients to complement the therapeutic treatment with acceptance strategies to further increase the therapeutic benefit. The aim of the present study was to examine neurobiological responses to acceptance and intensification strategies during symptom provocation alongside the psychotherapeutic process.MethodA total of 23 patients diagnosed with OCD (subtype: washing/contamination fear) was instructed to utilise either an acceptance strategy (ACS) or an intensification strategy (INS) to cope with their emotional and cognitive reactions to personalised symptom-triggering and neutral pictures. Fourteen patients participated twice: at the beginning [T1] and at the end [T2] of an inpatient multimodal treatment including cognitive behaviour therapy with response prevention to assess functional variations.ResultsFor the contrast of T1 and T2, ACS showed increased brain activity in the left inferior frontal gyrus (IFG), left caudate body, and posterior cingulate gyrus (PCC). They also showed decreased activity in the left anterior insula. INS showed decreased activation in right lingual gyrus and right caudate body. At T2, ACS showed increased activation compared to INS in the left cerebrum: IFG, caudate nucleus, middle and superior temporal gyrus, and PCC/cuneus. For the comparison of T1 and T2, the ACS revealed increased brain activity in the left IFG, left caudate body, and right inferior parietal lobe. It showed decreased activity in the left anterior insula. The INS revealed decreased activity in right lingual gyrus and right caudate body.The psychometric questionnaires suggested that patients were able to reduce obsession, compulsion, and depression symptoms. Furthermore, patients rated the ACS as more useful for themselves compared with the INS.ConclusionThe increased left IFG activity using ACS (T1 vs. T2) could be interpreted as a better inhibitory top-down process, while the increased PCC response might be due to a better reappraisal strategy after therapy. ACS seems to mobilise neuronal activations under therapy, especially in the left hemisphere. Both strategies showed reductions in emotional networks as a neuronal correlate of therapy success. Overall, ACS may be more efficient than INS, as rated by the patients and as in accordance with neurobiological findings.

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Section: Discussionsupporting

confidence: 90%

Section: Limitationsmentioning

confidence: 99%

Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder

Karch,

Maywald,

Schwartz

et al. 2024

Front. Psychol.

Self Cite

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“…There are ongoing discussions regarding whether these factors are causative or secondary to persistent dizziness [ 19 ]. The relationship is bidirectional, with anxiety potentially worsening dizziness symptoms and chronic dizziness contributing to heightened anxiety [ 20 ]. Anxiety disorders can manifest with persistent postural dizziness in various ways [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

“…The relationship is bidirectional, with anxiety potentially worsening dizziness symptoms and chronic dizziness contributing to heightened anxiety [ 20 ]. Anxiety disorders can manifest with persistent postural dizziness in various ways [ 20 ]. One manifestation involves triggering episodes of dizziness and unsteadiness crises [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

Persistent Challenges: A Comprehensive Review of Persistent Postural-Perceptual Dizziness, Controversies, and Clinical Complexities

Madrigal,

Herrón-Arango,

Bedoya

et al. 2024

Cureus

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Persistent postural-perceptual dizziness (PPPD) is a chronic and disabling disorder characterized by persistent dizziness, unsteadiness, and imbalance. It often arises without an identifiable cause and is exacerbated by upright posture, active or passive movement, and exposure to moving or complex visual stimuli. This complex pathophysiology and the psychological dimensions of its symptomatology pose a significant challenge to clinicians. PPPD presents diagnostic challenges and a lack of standardized treatment options, underscoring the need for multidisciplinary approaches encompassing pharmacotherapy, vestibular rehabilitation, and psychological interventions for effective management. Bridging the gaps in understanding PPPD requires collaborative efforts across disciplines, emphasizing integrated research approaches and patient support networks to enhance care and improve outcomes. This review explores the challenges, controversies, and clinical complexities of PPPD, highlighting the importance of a patientcentered approach.

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“…De manera especulativa, se puede proponer que las alteraciones espaciales de los pacientes con MPPP pueden repercutir en circuitos cerebrales del sistema límbico involucrado en fobias, miedo y ansiedad 10 . Adicionalmente, existe evidencia de que patologías como la agorafobia (miedo a lugares llenos de personas) comparten alteraciones estructurales de la corteza vestibular con el MPPP 11 .…”

Section: Sistema Vestibular Percepción Espacial Fobia Y Ansiedadunclassified

Miedo a las alturas en mareo postural perceptual persistente en ambientes arquitectónicos simulados por realidad virtual

Fuenzalida R.,

Rossi R.,

Wolff C.

et al. 2023

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder

Cited by 10 publications

References 92 publications

Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder

Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder

Persistent Challenges: A Comprehensive Review of Persistent Postural-Perceptual Dizziness, Controversies, and Clinical Complexities

Miedo a las alturas en mareo postural perceptual persistente en ambientes arquitectónicos simulados por realidad virtual

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