Background Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. Methods A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. Results A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. Conclusion The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/410326/ioi60000.pdf

A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7

Attachment--and loss.

Microglial cells are the resident macrophages in the central nervous system. These cells of mesodermal/mesenchymal origin migrate into all regions of the central nervous system, disseminate through the brain parenchyma, and acquire a specific ramified morphological phenotype termed "resting microglia." Recent studies indicate that even in the normal brain, microglia have highly motile processes by which they scan their territorial domains. By a large number of signaling pathways they can communicate with macroglial cells and neurons and with cells of the immune system. Likewise, microglial cells express receptors classically described for brain-specific communication such as neurotransmitter receptors and those first discovered as immune cell-specific such as for cytokines. Microglial cells are considered the most susceptible sensors of brain pathology. Upon any detection of signs for brain lesions or nervous system dysfunction, microglial cells undergo a complex, multistage activation process that converts them into the "activated microglial cell." This cell form has the capacity to release a large number of substances that can act detrimental or beneficial for the surrounding cells. Activated microglial cells can migrate to the site of injury, proliferate, and phagocytose cells and cellular compartments.

Physiology of Microglia

Here we provide a review of the animal and human literature concerning the role of the amygdala in fear conditioning, considering its potential influence over autonomic and hormonal changes, motor behavior and attentional processes. A stimulus that predicts an aversive outcome will change neural transmission in the amygdala to produce the somatic, autonomic and endocrine signs of fear, as well as increased attention to that stimulus. It is now clear that the amygdala is also involved in learning about positively valenced stimuli as well as spatial and motor learning and this review strives to integrate this additional information. A review of available studies examining the human amygdala covers both lesion and electrical stimulation studies as well as the most recent functional neuroimaging studies. Where appropriate, we attempt to integrate basic information on normal amygdala function with our current understanding of psychiatric disorders, including pathological anxiety.

The amygdala: vigilance and emotion

Descartes’ Error: Emotion, Reason and the Human Brain

Meditation is a conscious mental process that induces a set of integrated physiologic changes termed the relaxation response. Functional magnetic resonance imaging (fMRI) was used to identify and characterize the brain regions that are active during a simple form of meditation. Significant (p < 10 7 ) signal increases were observed in the group-averaged data in the dorsolateral prefrontal and parietal cortices, hippocampus/ parahippocampus, temporal lobe, pregenual anterior cingulate cortex, striatum, and pre- and post-central gyri during meditation. Global fMRI signal decreases were also noted, although these were probably secondary to cardiorespiratory changes that often accompany meditation. The results indicate that the practice of meditation activates neural structures involved in attention and control of the autonomic nervous system.

Functional brain mapping of the relaxation response and meditation.

Activation of bone marrow hematopoietic stem cells by chronic stress raises circulating leukocyte levels and increases atherosclerotic plaque inflammation.

/pdf/chronic-variable-stress-activates-hematopoietic-stem-cells-25k6us05jy.pdf

Chronic variable stress activates hematopoietic stem cells

Background Mindfulness-based therapies are being used in a wide range of common chronic conditions in both treatment and prevention despite lack of consensus about their effectiveness in different patient categories. Objective To systematically review the evidence of effectiveness MBSR and MBCT in different patient categories. Methods A systematic review and meta-analysis of systematic reviews of RCTs, using the standardized MBSR or MBCT programs. We used PRISMA guidelines to assess the quality of the included reviews and performed a random effects meta-analysis with main outcome measure Cohen's d. All types of participants were considered. Results The search produced 187 reviews: 23 were included, covering 115 unique RCTs and 8,683 unique individuals with various conditions. Compared to wait list control and compared to treatment as usual, MBSR and MBCT significantly improved depressive symptoms (d=0.37; 95%CI 0.28 to 0.45, based on 5 reviews, N=2814), anxiety (d=0.49; 95%CI 0.37 to 0.61, based on 4 reviews, N=2525), stress (d=0.51; 95%CI 0.36 to 0.67, based on 2 reviews, N=1570), quality of life (d=0.39; 95%CI 0.08 to 0.70, based on 2 reviews, N=511) and physical functioning (d=0.27; 95%CI 0.12 to 0.42, based on 3 reviews, N=1015). Limitations include heterogeneity within patient categories, risk of publication bias and limited long-term follow-up in several studies. Conclusion The evidence supports the use of MBSR and MBCT to alleviate symptoms, both mental and physical, in the adjunct treatment of cancer, cardiovascular disease, chronic pain, depression, anxiety disorders and in prevention in healthy adults and children.

/pdf/standardised-mindfulness-based-interventions-in-healthcare-3tbysjyjuz.pdf

Standardised mindfulness-based interventions in healthcare: An overview of systematic reviews and meta-analyses of RCTs

OBJECTIVE: Evidence for a connection between stress and selected neurodegenerative diseases as well as mental disorders is analyzed Does stress cause or exacerbate related pathophysiological disease processes? METHOD: The stress phenomenon is illustrated and the impact of stress on the nervous system, neurodegenerative diseases, and mental disorders is examined The connection between stress and the hippocampus - and its association with memory functions - is described In particular, the pathophysiological significance of stress in Alzheimer's disease, multiple sclerosis, anxiety, depression, posttraumatic stress disorder, and schizophrenia is investigated RESULTS: Stress plays a major role in various (patho)physiological processes associated with neurodegenerative diseases and mental disorders In principle, stress has the potency to exert either ameliorating or detrimental effects The specific outcome depends on multiple variables However, the amount of stress experienced in relation to activated physiological processes that aim at successful coping and positive adjustments (ie, stress response) most often is overwhelming - and may thus become detrimental in the long-term Moreover, the hippocampus is sensitive to stress, and its involvement in neurodegeneration - in the course of stress-related disease processes - may account for severe clinical disabilities (eg, memory loss) DISCUSSION/CONCLUSION: Stress has a major impact upon neurodegenerative diseases and mental disorders It plays a significant role in susceptibility, progress, and actual outcome Also, subjective or individual differences have to be taken into account However, stress - especially 'adequate' acute stress (stress that is not overwhelming) - may even improve performance/biological functions and be beneficial in certain cases

Gregory L. Fricchione

Papers

Descartes’ Error: Emotion, Reason and the Human Brain

Functional brain mapping of the relaxation response and meditation.

Chronic variable stress activates hematopoietic stem cells

Standardised mindfulness-based interventions in healthcare: An overview of systematic reviews and meta-analyses of RCTs

The role of stress in neurodegenerative diseases and mental disorders.