Generalized anxiety disorder pathophysiology: Difference between revisions
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*Another area, the [[adjacent central nucleus]] of the amygdala, controls species-specific fear responses in its connections to the [[brainstem]], [[hypothalamus]] and [[cerebellum]] areas. | *Another area, the [[adjacent central nucleus]] of the amygdala, controls species-specific fear responses in its connections to the [[brainstem]], [[hypothalamus]] and [[cerebellum]] areas. | ||
*In those with generalized anxiety disorder, these connections seem less functionally distinct, and there is greater [[gray matter]] in the [[central nucleus]]. | *In those with generalized anxiety disorder, these connections seem less functionally distinct, and there is greater [[gray matter]] in the [[central nucleus]]. | ||
*Another difference is that the amygdala areas have decreased connectivity with the [[insula]] and [[cingulate areas]] that control general stimulus salience while having greater connectivity with the [[parietal cortex]] and [[prefrontal cortex]] circuits that underlie executive functions. | *Another difference is that the amygdala areas have decreased connectivity with the [[insula]] and [[cingulate areas]] that control general stimulus salience while having greater connectivity with the [[parietal cortex]] and [[prefrontal cortex]] circuits that underlie executive functions.<ref name="pmid22059936">{{cite journal| author=Baldwin DS, Allgulander C, Bandelow B, Ferre F, Pallanti S| title=An international survey of reported prescribing practice in the treatment of patients with generalised anxiety disorder. | journal=World J Biol Psychiatry | year= 2012 | volume= 13 | issue= 7 | pages= 510-6 | pmid=22059936 | doi=10.3109/15622975.2011.624548 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22059936 }} </ref> | ||
**The latter suggests a compensation strategy for dysfunctional [[amygdala]] processing of [[anxiety]]. | **The latter suggests a compensation strategy for dysfunctional [[amygdala]] processing of [[anxiety]]. | ||
**This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.<ref name="pmid16202187">{{cite journal| author=Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB et al.| title=Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. | journal=Psychol Med | year= 2005 | volume= 35 | issue= 12 | pages= 1747-59 | pmid=16202187 | doi=10.1017/S0033291705006069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16202187 }} </ref> | **This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.<ref name="pmid16202187">{{cite journal| author=Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB et al.| title=Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. | journal=Psychol Med | year= 2005 | volume= 35 | issue= 12 | pages= 1747-59 | pmid=16202187 | doi=10.1017/S0033291705006069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16202187 }} </ref> | ||
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Pathophysiology
- Generalized anxiety disorder has been linked to the disrupted functional connectivity of the amygdala and its processing of fear and anxiety.[1]
- Sensory information enters the amygdala through the nuclei of the basolateral complex (consisting of lateral, basal and accessory basal nuclei). The basolateral complex processes the sensory-related fear memories and communicates their threat importance to elsewhere in the brain, such as the medial prefrontal cortex and sensory cortices, along with:[2]
- Another area, the adjacent central nucleus of the amygdala, controls species-specific fear responses in its connections to the brainstem, hypothalamus and cerebellum areas.
- In those with generalized anxiety disorder, these connections seem less functionally distinct, and there is greater gray matter in the central nucleus.
- Another difference is that the amygdala areas have decreased connectivity with the insula and cingulate areas that control general stimulus salience while having greater connectivity with the parietal cortex and prefrontal cortex circuits that underlie executive functions.[3]
References
- ↑ Etkin A, Prater KE, Schatzberg AF, Menon V, Greicius MD (2009). "Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder". Arch Gen Psychiatry. 66 (12): 1361–72. doi:10.1001/archgenpsychiatry.2009.104. PMID 19996041.
- ↑ Kessler RC, Keller MB, Wittchen HU (2001). "The epidemiology of generalized anxiety disorder". Psychiatr Clin North Am. 24 (1): 19–39. PMID 11225507.
- ↑ Baldwin DS, Allgulander C, Bandelow B, Ferre F, Pallanti S (2012). "An international survey of reported prescribing practice in the treatment of patients with generalised anxiety disorder". World J Biol Psychiatry. 13 (7): 510–6. doi:10.3109/15622975.2011.624548. PMID 22059936.
- ↑ Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB; et al. (2005). "Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions". Psychol Med. 35 (12): 1747–59. doi:10.1017/S0033291705006069. PMID 16202187.