Background: Affective disorders involve dysregulation of major biological stress systems (hypothalamic-pituitary adrenal (HPA)-axis, immune system, autonomic nervous system (ANS)).... Show moreBackground: Affective disorders involve dysregulation of major biological stress systems (hypothalamic-pituitary adrenal (HPA)-axis, immune system, autonomic nervous system (ANS)). Suchdysregulationshave rarely beensimultaneously examined across different stress systems.Methods: In the Netherlands Study of Depression and Anxiety (n=2789), we investigated whether current or remitted depressive and/or anxiety disorders (based on the CIDI semi-structured interview), including specific symptom profiles, were associated with separate markers and cumulative indexes of the HPA-axis (cortisol awakening response, evening cortisol, dexamethasone suppression test cortisol), immune system (C-reactive protein, interleukin-6, tumor necrosis factor-alpha), and ANS (heart rate, respiratory sinus arrhythmia, pre-ejection period).Results: Depressive andanxiety disorderswere significantlyassociated with changes in three biological stress systemsincluding HPA-axis hyperactivity, increased inflammatory activity, and a higher ANS tone, particularly for integrative and cumulative indexes of these stress systems (pFDR <.05) vs. controls. The strongest associations were seen with current disorders andcumulative indexes of the HPA-axis (13=.124, pFDR=.001), the immune system (13 =.057, pFDR=.032), and total cumulative index across stress systems (13=.102, pFDR=.004). Atypical, energy-related depression severity was linked to immune system markers (pFDR<0.001), melancholic depression severity to HPA-axis markers (pFDR=.032), and anxiety arousal severity to both HPA-axis and immune system markers (pFDR<0.05). Findings were partially explained by poorer lifestyle, more chronic diseases, or (especially for ANS-function) antidepressant use. Limitations: Cross-sectional analyses limit examination of temporal associations.Conclusion: Patients withdepressive and anxiety disorders showed consistent dysregulation across biological stress systems, particularly for current episodes.To understand stress system functionality in affective disorders, an integrated approach capturing cumulative stress indices within and across biological stress systems is important. Show less
Anxiety disorders as a group are the most prevalent psychiatric disorders. Although they have been studied extensively, previous research has focussed primarily on members of the general... Show moreAnxiety disorders as a group are the most prevalent psychiatric disorders. Although they have been studied extensively, previous research has focussed primarily on members of the general population, or on participants in clinical trials. As both groups may differ substantially from patients who are seen in clinical practice, it is unclear to what extent previous findings can be generalised to a clinical setting. In order to gain insight in the clinical epidemiology of anxiety, it is necessary to study outpatients. This thesis describes several studies in which naturalistic data, collected through Routine Outcome Monitoring, were used. Chapter two describes the age of onset of panic disorder, agoraphobia, social phobia and generalised anxiety disorder. Chapter three explores age related differences. In chapter four predictors of treatment response are identified and the fifth chapter describes patient characteristics that are associated with the course of suicidal ideation in anxiety and depression. In chapter seven a self-report measure of anxiety severity is compared with an observer rated measure and patient characteristics associated with discrepancies between both measures are identified. In the final chapter findings are discussed and recommendations for future research are made. Show less
Depressie en angststoornissen, zoals major depressive disorder, paniekstoornis, sociale angststoornis en gegeneraliseerde angststoornis, vallen onder de meest voorkomende psychiatrische... Show moreDepressie en angststoornissen, zoals major depressive disorder, paniekstoornis, sociale angststoornis en gegeneraliseerde angststoornis, vallen onder de meest voorkomende psychiatrische ziektebeelden. Door middel van neuroimaging onderzoek zoals structurele en functionele MRI (fMRI) is het mogelijk om op een non-invasieve manier de onderliggende neurobiologie van deze stoornissen in kaart te brengen. Op basis van dergelijk onderzoek werden ruim 15 jaar geleden enkele neurobiologische modellen opgesteld waarin werd voorgesteld dat het goed of juist niet goed hersengebieden een belangrijke bijdrage leverde aan het ontstaan en/of instandhouden van depressie en angst. In de loop der jaren zijn nieuwe MRI technieken ontwikkeld. Met behulp van structurele MRI en resting-state fMRI, waarmee connectiviteit tussen hersengebieden onderzocht kan worden, heb ik gekeken naar anatomische en functionele hersenafwijkingen bij volwassenen en jongeren met depressie en/of angststoornissen. Doel was te bepalen of de reeds bestaande neurobiologische modellen bevestigd danwel aangepast of aangevuld zouden kunnen worden met recent ontwikkelde onderzoeksmethoden. De resultaten van mijn studies bevestigden grotendeels de betrokkenheid van de hersengebieden in de modellen, maar wezen tevens op een rol voor uitgebreidere netwerken van hersengebieden dan in de modellen werd verondersteld. Show less
Muntingh, A.; Feltz-Cornelis, C. van der; Marwijk, H. van; Spinhoven, P.; Assendelft, W.; Waal, M. de; ... ; Balkom, A. van 2014
Diffusion tensor imaging (DTI) can be used to examine the structural integrity of regional white matter and to map white matter tracts. DTI studies have been performed in several psychiatric... Show moreDiffusion tensor imaging (DTI) can be used to examine the structural integrity of regional white matter and to map white matter tracts. DTI studies have been performed in several psychiatric disorders, especially in those for which a developmental or a neuropsychiatric component was postulated. Thus far, the use of DTI has been very limited in panic disorder, social anxiety disorder, and generalized anxiety disorder, and somewhat more extensive in post-traumatic stress disorder and obsessive-compulsive disorder. In most anxiety disorders, the results of DTI studies are in line with other structural and functional MRI findings and can be interpreted within the frameworks of existing models for the neurocircuitry of the various disorders. DTI findings could further enrich neurobiological models for anxiety disorders, although replication is often warranted, and studies in pediatric populations are lagging behind remarkably. Show less
