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4 results

  • Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review

  • Y. Noda, W. K. Silverstein, M. S. Barr, F. Vila-Rodriguez, J. Downar, T. K. Rajji, P. B. Fitzgerald, B. H. Mulsant, S. N. Vigod, Z. J. Daskalakis, D. M. Blumberger
  • Journal:
    Psychological Medicine / Volume 45 / Issue 16 / December 2015
    Published online by Cambridge University Press:
    09 September 2015, pp. 3411-3432

  • Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996–2014), Embase (1980–2014) and PsycINFO (1806–2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.

  • 27 - Childhood anxiety disorders: best treatment options and practice

  • from Section 4 - Treatment of anxiety: current status and controversial issues
  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book:
    Anxiety Disorders
    Published online:
    10 November 2010
    Print publication:
    26 August 2010, pp 306-322

  • Summary

    Anxiety disorders clearly have learned and non-learned components, suggesting that both types of animal models are of potential relevance. Defensive fear and anxiety behaviors have been extensively studied in rodents, using behavioral paradigms that test such behaviors in response to both learned and innately threatening stimuli. This chapter reviews these studies of learned fear and innate anxiety, detailing the latest advances in the understanding of neurobiological mechanisms and their implications for treatment. It also considers data from human studies to examine the relevance of these animal models of normative defensive behaviors to the pathological anxious behaviors seen in patients with anxiety disorders. Generalized anxiety disorder (GAD) offers perhaps the most compelling case for the relevance of innate anxiety, in that patients worry about numerous aspects of their lives without any logical rationale or previous experience.

  • 16 - Learned fear and innate anxiety in rodents and their relevance to human anxiety disorders

  • from Section 3 - Understanding the causes of anxiety
  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book:
    Anxiety Disorders
    Published online:
    10 November 2010
    Print publication:
    26 August 2010, pp 180-191

  • Summary

    This chapter identifies clinically meaningful subtypes of obsessive-compulsive disorder (OCD) including discrete categories based on age of onset and comorbidity with related disorders, and then describes efforts to understand obsessive-compulsive (OC) symptoms as dimensions. Both categorical and dimensional approaches have been applied in research on refining the phenotype of OCD. A strategy that has been successfully applied to other heterogeneous and complex psychiatric disorders is to identify intermediate phenotypes that are more closely related to neurobiological mechanisms than phenotypes. Modern neuroimaging techniques have allowed abnormalities in white-matter brain tissue to be investigated as potential OCD endophenotypes. Subtypes of OCD have been proposed, based on early age of onset, tic comorbidity, and obsessive-compulsive personality disorder (OCPD) comorbidity. Another approach to deconstructing the heterogeneity of OCD is the identification of vulnerability markers or endophenotypes. Integrating phenotypical and endophenotypical approaches may be fruitful in advancing the field.

  • 7 - Acute stress disorder and post-traumatic stress disorder in the disaster environment

  • from Part III - Clinical care and interventions
  • Edited by Robert J. Ursano, Uniformed Services University of the Health Sciences, Maryland, Carol S. Fullerton, Uniformed Services University of the Health Sciences, Maryland, Lars Weisaeth, Universitetet i Oslo, Beverley Raphael, University of Western Sydney
  • Book:
    Textbook of Disaster Psychiatry
    Published online:
    09 August 2009
    Print publication:
    01 November 2007, pp 140-163

  • Summary

    The chapter highlights the idea that many individuals exposed to significant trauma do not develop acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) and describes subgroups that may be at greater risk for these conditions in the aftermath of disaster. It reviews neurobiological mechanisms in normal and pathological traumatic stress responses. Traumatic experience results in both immediate and long-term endocrine changes that affect metabolism and neurophysiology. Some evidence exists to support the effectiveness of psychotherapeutic approaches immediately after trauma in preventing the development of ASD or PTSD. Cognitive-behavioral therapy (CBT) attempts to correct cognitive distortions and reduce the frequency and symptomatology associated with traumatic memories. Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication treatment for PTSD. The clinical interview remains the gold standard for the assessment of ASD or PTSD for several reasons. Future research should help to identify individual and group-specific risk factors or vulnerabilities.