Common and specific amygdala-function perturbations in 2 depressed versus anxious adolescents

Context: Few studies directly compare amygdala function in depressive and anxiety disorders. 43 Data from longitudinal research emphasize the need for such studies in adolescents. 44 Objective: To compare amygdala response to varying attention and emotion conditions among 45 adolescents with Major Depressive Disorder (MDD) or anxiety disorders, relative to adolescents 46 with no psychopathology. 47 Design: Case-Control-Study. 48 Setting: Government Clinical Research Institute. 49 Participants: Eighty-seven adolescents matched on age, gender, intelligence, and social class: 26 50 with Major Depressive Disorder (MDD; 14 with and 12 without anxiety disorders), 16 with 51 anxiety disorders but no depression, and 45 with no psychopathology. 52 Main Outcome Measures: Blood oxygenated level dependent signal in the amygdala, measured 53 using event-related functional magnetic resonance imaging. During imaging, participants viewed 54 facial expressions (neutral, fearful, angry, happy) while attention was constrained (afraid, 55 hostility, nose width ratings) or unconstrained (passive-viewing). 56 Results: Left and right amygdala activation differed as a function of diagnosis, facial expression, 57 and attention-condition both when comorbid MDD/anxiety patients were included and excluded 58 (group-by-emotion-by-attention interactions: p-values≤.03). Focusing on fearful-face-viewing 59 events, anxiety and MDD patients both differed in amygdala responses from healthy participants 60 and from each other during passive-viewing. However, both MDD and anxiety patients, relative 61 to healthy participants, exhibited similar signs of amygdala hyper-activation to fearful faces when 62 rating subjectively experienced fear. 63 Conclusions: Adolescent MDD and anxiety disorders exhibit common and distinct functional 64 neural correlates during face processing. Attention modulates the degree to which common or 65 distinct amygdala perturbations manifest in these patient groups, relative to healthy peers

The Effect of Caregiver Posttraumatic Stress on Newly Diagnosed Pediatric Cancer Patients

Despite medical advances in the treatment of pediatric cancers, a pediatric cancer diagnosis remains associated with a threat to life and often precedes painful and potentially traumatic medical procedures. The current study examined posttraumatic stress, pain, and health-related quality of life in newly diagnosed pediatric cancer patients, as well as the associations between these constructs and caregiver posttraumatic stress. Participants were newly diagnosed pediatric cancer patients (n = 21, 6 to 23 years old) and their primary caregivers (n = 21). Patients completed self-report questionnaires rating their posttraumatic stress symptoms (PTSS), pain severity, use of pain coping strategies, and overall and cancer-related health-related quality of life (HRQOL). Caregivers also rated their own PTSS. Results revealed that although neither patients nor caregivers experienced elevated levels of PTSS compared to normative samples, patients did report poorer HRQOL relative to healthy control participants. Results also provided evidence of inverse relationships between patient PTSS and patient HRQOL, caregiver PTSS and patient HRQOL, and patient pain and patient HRQOL, as well as positive relationships between patient pain and both caregiver PTSS and seeking social support (a pain coping strategy). Results also provided preliminary evidence that caregiver PTSS may moderate the relationship between patient pain and patient PTSS. Theoretical findings are discussed in regards to previous studies, with particular emphasis on the potential impact of caregiver PTSS on patients’ psychological and physical functioning. Recommendations regarding important areas of assessment and potential prevention and intervention targets for pediatric cancer patients and their caregivers are also provided

Concreteness of Depressive Rumination and Trauma Recall in Individuals with Elevated Trait Rumination and/or Posttraumatic Stress Symptoms

The present study sought to compare the cognitive characteristics of depressive rumination and trauma recall in participants with high trait rumination and/or high levels of posttraumatic stress symptoms (PTSS), as well as in participants with normative levels of these variables. Specifically, we sought to compare the degree to which periods of depressive rumination and trauma recall were characterized by verbal-linguistic versus imagery-based activity and abstract versus concrete thought. We also explored whether these characteristics differed between participants with high trait rumination and/or high levels of PTSS, as well as participants with normative levels of trait rumination and PTSS. We found that for all participants, depressive rumination was characterized by increased verbal-linguistic activity, whereas trauma recall was characterized by increased imagery-based activity. We also found that individuals with both high trait rumination and high levels of PTSS evidenced lower levels of imagery-based activity during all repetitive thinking periods, as well as lower levels of concreteness during depressive rumination. Theoretical and clinical implications of these findings are discussed

Assessing gene–environment interactions on anxiety symptom subtypes across childhood and adolescence

Consistent evidence shows both genetic and stress-related risks on child and adolescent anxiety, yet few studies have considered the degree to which genetic effects are moderated by stress (gene–environment interaction). We used longitudinal data from both a child and adolescent sample of twins to examine three novel issues on the presence of gene–environment interaction on anxiety symptoms. First, we assessed moderation of genetic risks on anxiety symptoms by negative life events in each age group. Second, by distinguishing between “stable” and “age-specific” genetic factors, we explored the continuity of gene–environment interaction across time and/or its emergence at specific ages. Third, we compared the presence of gene–environment interaction across different symptom types (general, panic, social, and separation). Genetic effects on separation anxiety symptoms in childhood (mean age = 8 years, 6 months) and panic anxiety symptoms in adolescence (mean age = 15 years) increased across independent negative life events. Shared environmental effects on separation anxiety symptoms and nonshared environmental effects on general anxiety symptoms in adolescence were also moderated by negative life events. We interpret these preliminary findings tentatively in the context of gene–environment interaction on anxiety in general, and on early separation and later panic anxiety in particular

Common and distinct amygdala-function perturbations in depressed vs anxious adolescents

CONTEXT: Few studies directly compare amygdala function in depressive and anxiety disorders. Data from longitudinal research emphasize the need for such studies in adolescents. OBJECTIVE: To compare amygdala response to varying attention and emotion conditions among adolescents with major depressive disorder (MDD) or anxiety disorders, relative to adolescents with no psychopathology. DESIGN: Case-control study. SETTING: Government clinical research institute. PARTICIPANTS: Eighty-seven adolescents matched on age, sex, intelligence, and social class: 26 with MDD (14 with and 12 without anxiety disorders), 16 with anxiety disorders but no depression, and 45 without psychopathology. MAIN OUTCOME MEASURES: Blood oxygen level–dependent signal in the amygdala, measured by means of event-related functional magnetic resonance imaging. During imaging, participants viewed facial expressions (neutral, fearful, angry, and happy) while attention was constrained (afraid, hostility, and nose-width ratings) or unconstrained (passive viewing). RESULTS: Left and right amygdala activation differed as a function of diagnosis, facial expression, and attention condition both when patients with comorbid MDD and anxiety were included and when they were excluded (group × emotion × attention interactions, P≤.03). Focusing on fearful face–viewing events, patients with anxiety and those with MDD both differed in amygdala responses from healthy participants and from each other during passive viewing. However, both MDD and anxiety groups, relative to healthy participants, exhibited similar signs of amygdala hyperactivation to fearful faces when subjectively experienced fear was rated. CONCLUSIONS: Adolescent MDD and anxiety disorders exhibit common and distinct functional neural correlates during face processing. Attention modulates the degree to which common or distinct amygdala perturbations manifest in these patient groups, relative to healthy peers