Spectrum of Anxiety Disorders: Diagnosis and Pharmacologic Treatment

Karsnitz, Deborah; Ward, Sheila

doi:10.1111/j.1542-2011.2011.00045.x

Cited by 13 publications

(10 citation statements)

References 68 publications

(147 reference statements)

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“…According to the current Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), anxiety disorders are categorized into generalized anxiety disorder (GAD), panic disorder with or without agoraphobia, agoraphobia without history of panic disorder, posttraumatic stress disorder (PTSD), acute stress disorder, obsessive–compulsive disorder, social anxiety disorder (social phobia), anxiety secondary to a medical condition, substance-induced anxiety disorder, and stimulus-specific phobias [16, 189]. For this review, GAD, panic disorder, PTSD, and to a certain extent, acute stress disorder are of particular relevance because acute, repeated, or chronic stress exposures are common triggers for these psychiatric disorders [273, 286], because women may have an inherently increased stress vulnerability, and because key symptoms of these disorders have been successfully modeled in animals.…”

Section: Human Gender Differences In Anxiety and Emotional Disordersmentioning

confidence: 99%

Sex differences in anxiety and emotional behavior

Donner

Lowry

2013

Pflugers Arch - Eur J Physiol

310

168

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Research has elucidated causal links between stress exposure and the development of anxiety disorders, but due to the limited use of female or sex-comparative animal models, little is known about the mechanisms underlying sex differences in those disorders. This is despite an overwhelming wealth of evidence from the clinical literature that the prevalence of anxiety disorders is about twice as high in women compared to men, in addition to gender differences in severity and treatment efficacy. We here review human gender differences in generalized anxiety disorder, panic disorder, posttraumatic stress disorder and anxiety-relevant biological functions, discuss the limitations of classic conflict anxiety tests to measure naturally occurring sex differences in anxiety-like behaviors, describe sex-dependent manifestation of anxiety states after gestational, neonatal, or adolescent stressors, and present animal models of chronic anxiety states induced by acute or chronic stressors during adulthood. Potential mechanisms underlying sex differences in stress-related anxiety states include emerging evidence supporting the existence of two anatomically and functionally distinct serotonergic circuits that are related to the modulation of conflict anxiety and panic-like anxiety, respectively. We discuss how these serotonergic circuits may be controlled by reproductive steroid hormone-dependent modulation of crfr1 and crfr2 expression in the midbrain dorsal raphe nucleus and by estrous stage-dependent alterations of γ-aminobutyric acid (GABAergic) neurotransmission in the periaqueductal gray, ultimately leading to sex differences in emotional behavior.

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Section: Human Gender Differences In Anxiety and Emotional Disordersmentioning

confidence: 99%

Sex differences in anxiety and emotional behavior

Donner

Lowry

2013

Pflugers Arch - Eur J Physiol

310

168

View full text Add to dashboard Cite

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“…Anxiety disorders, including social anxiety disorder and panic disorder, are common emotional disorders, significantly impair overall quality of life, and affect about 19% of the male, and 30% of the female population at some point during life . The neural mechanisms underlying the manifestation of anxiety disorders are complex.…”

Section: Introductionmentioning

confidence: 99%

“…Anxiety disorders, including social anxiety disorder [1] and panic disorder, [2] are common emotional disorders, significantly impair overall quality of life, and affect about 19% of the male, and 30% of the female population at some point during life. [3][4][5] The neural mechanisms underlying the manifestation of anxiety disorders are complex. However, two interconnected neural systems commonly dysregulated in patients with anxiety disorders are the extended amygdala [6,7] and midbrain serotonergic systems.…”

Section: Introductionmentioning

confidence: 99%

ELEVATED tph2 mRNA EXPRESSION IN A RAT MODEL OF CHRONIC ANXIETY

et al. 2012

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Background Allelic variations in TPH2, the gene encoding tryptophan hydroxylase 2, the rate-limiting enzyme for brain serotonin (5-HT) biosynthesis, may be genetic predictors of panic disorder and panic responses to panicogenic challenges in healthy volunteers. To test the hypothesis that tph2 mRNA is altered in chronic anxiety states, we measured tph2 expression in an established rat model of panic disorder. Methods We implanted 16 adult, male rats with bilateral guide cannulae and then primed them with daily injections of the corticotropin-releasing factor (CRF) receptor agonist, urocortin 1 (UCN1, 6 fmoles/100 nl per side, n = 8) or vehicle (n = 8) into the basolateral amygdaloid complex (BL) for 5 consecutive days. Anxiety-like behavior was assessed, 24 hr prior to and 48 hr following priming, in the social interaction (SI) test. A third group (n = 7) served as undisturbed home cage controls. All rats were killed 3 days after the last intra-BL injection to analyze tph2 and slc6a4 (gene encoding the serotonin transporter, SERT) mRNA expression in the dorsal raphe nucleus (DR), the main source of serotonergic projections to anxiety-related brain regions, using in situ hybridization histochemistry. Results UCN1 priming increased anxiety-related behavior in the SI test compared to vehicle-injected controls and elevated tph2, but not slc6a4, mRNA expression in DR subregions, including the ventrolateral DR/ventrolateral periaqueductal gray (DRVL/VLPAG), a subregion previously implicated in control of panic-related physiologic responses. Tph2 mRNA expression in the DRVL/VLPAG was correlated with increased anxiety-related behavior. Conclusion Our data support the hypothesis that chronic anxiety states are associated with dysregulated tph2 expression.

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“…GAD has a lifetime prevalence of 5.7%1 and if left untreated can become a chronic disorder with low rates of remission 2,3. Risk factors of GAD include family history, an increase in situational stressors and (or) stressful life events,4,5 and a history of physical or emotional trauma 3,6. Many people with GAD report heightened anxiety beginning in childhood,4 with clinically significant anxiety symptoms emerging during the late teens through to the late twenties 7…”

mentioning

confidence: 99%

Comparative Efficacy of the Generalized Anxiety Disorder 7-Item Scale and the Edinburgh Postnatal Depression Scale as Screening Tools for Generalized Anxiety Disorder in Pregnancy and the Postpartum Period

et al. 2014

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Objective:About 24.1% of pregnant women suffer from at least 1 anxiety disorder, 8.5% of whom suffer specifically from generalized anxiety disorder (GAD). GAD is often associated with major depressive disorder (MDD). During the perinatal period, the presence of physical and somatic symptoms often makes differentiation between depression and anxiety more challenging. To date, no screening tools have been developed to detect GAD in the perinatal population. We investigated the psychometric properties of the GAD 7-item Scale (GAD-7) as a screening tool for GAD in pregnant and postpartum women.Methods:Two hundred and forty perinatal women (n = 155 pregnant and n = 85 postpartum) referred for psychiatric consultation were enrolled. On the day of initial assessment, all women completed the GAD-7 and the Edinburgh Postnatal Depression Scale (EPDS). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–based diagnoses were made by experienced psychiatrists. Scores from the GAD-7 and EPDS were compared with the clinical diagnoses to evaluate the psychometric properties of the GAD-7 and EPDS when used as a screening tool for GAD.Results:The GAD-7 yielded a sensitivity of 61.3% and specificity of 72.7% at an optimal cut-off score of 13. Compared with the EPDS and the EPDS-3A subscale, the GAD-7 displayed greater accuracy and specificity over a greater range of cut-off scores and more accurately identified GAD in patients with comorbid MDD.Conclusion:Our findings suggest that the GAD-7 represents a clinically useful scale for the detection of GAD in perinatal women.

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Spectrum of Anxiety Disorders: Diagnosis and Pharmacologic Treatment

Cited by 13 publications

References 68 publications

Sex differences in anxiety and emotional behavior

Sex differences in anxiety and emotional behavior

ELEVATED tph2 mRNA EXPRESSION IN A RAT MODEL OF CHRONIC ANXIETY

Comparative Efficacy of the Generalized Anxiety Disorder 7-Item Scale and the Edinburgh Postnatal Depression Scale as Screening Tools for Generalized Anxiety Disorder in Pregnancy and the Postpartum Period

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