Advancing the defensive explanation for anxiety disorders: lorazepam effects on human defense are systematically modulated by personality and threat-type

Clinically effective drugs against human anxiety and fear systematically alter the innate defensive behavior of rodents, suggesting that in humans these emotions reflect defensive adaptations. Compelling experimental human evidence for this theory is yet to be obtained. We report the clearest test to date by investigating the effects of 1 and 2mg of the anti-anxiety drug lorazepam on the intensity of threat-avoidance behavior in 40 healthy adult volunteers (20 females). We found lorazepam modulated the intensity of participants’ threat-avoidance behavior in a dose-dependent manner. However, the pattern of effects depended upon two factors: type of threat-avoidance behavior and theoretically relevant measures of personality. In the case of flight behavior (one-way active avoidance), lorazepam increased intensity in low scorers on the Fear Survey Schedule tissuedamage fear but reduced it in high scorers. Conversely, in the case of risk-assessment behavior (two-way active avoidance), lorazepam reduced intensity in low scorers on the Spielberger trait anxiety but increased it in high scorers. Anti-anxiety drugs do not systematically affect rodent flight behavior; therefore, we interpret this new finding as suggesting that lorazepam has a broader effect on defense in humans than in rodents, perhaps by modulating general perceptions of threat intensity. The different patterning of lorazepam effects on the two behaviors implies that human perceptions of threat intensity are nevertheless distributed across two different neural streams, which influence effects observed on one-way or two-way active avoidance demanded by the situation

Prevalence, associated factors and predictors of anxiety: a community survey in Selangor, Malaysia

Background: Anxiety is the most common mental health disorders in the general population. This study aimed to determine the prevalence of anxiety, its associated factors and the predictors of anxiety among adults in the community of Selangor, Malaysia. Methods: A cross sectional study was carried out in three districts in Selangor, Malaysia. The inclusion criteria of this study were Malaysian citizens, adults aged 18 years and above, and living in the selected living quarters based on the list provided by the Department of Statistics Malaysia (DOS). Participants completed a set of questionnaires, including the validated Malay version of Generalized Anxiety Disorder 7 (GAD 7) to detect anxiety. Results: Of the 2512 participants who were approached, 1556 of them participated in the study (61.90 %). Based on the cut-off point of 8 and above in the GAD-7, the prevalence of anxiety was 8.2 %. Based on the initial multiple logistic regression analysis, the predictors of anxiety were depression, serious problems at work, domestic violence and high perceived stress. When reanalyzed again after removing depression, low self-esteem and high perceived stress, six predictors that were identified are cancer, serious problems at work, domestic violence, unhappy relationship with family, non-organizational religious activity and intrinsic religiosity. Conclusion: This study reports the prevalence of anxiety among adults in the community of Selangor, Malaysia and also the magnitude of the associations between various factors and anxiety

Anxiety disorders : From bench to Bedside and Beyond

© Springer International Publishing AG, part of Springer Nature 2019. The final publication is available at Springer via https://doi.org/10.1007/978-3-319-70554-5_2The anxiety disorders are prevalent, associated with high comorbidity and cause considerable disability. Despite efficacious treatment options, they are frequently misdiagnosed, and management is often suboptimal. With the recent publication of the DSM-5 and the imminent release of the ICD-11, there have been important debates about how best to categorize and conceptualize these disorders. In addition, their underlying neurobiology is being explored at multiple levels from systems neuroscience to molecular biology and genetics-an endeavour that is delivering insights with relevance to clinical practice. Furthermore, several international anxiety disorder treatment guidelines have recently been published, and large systematic reviews and meta-analyses have addressed important questions around clinical management. All of this indicates the need for an update on advances in this rapidly developing field, and this chapter therefore provides an overview of the epidemiology and classification, cognitive-affective neuroscience and clinical management of the anxiety disorders.Final Accepted Versio