Category: Psychiatry

Unintentional overdose deaths in teens and adults have reached epidemic proportions in the U.S. In some 20 states in 2007 the number of unintentional drug poisoning deaths exceeded either motor vehicle crashes or suicides, two of the leading causes of injury death. Prescription opioid pain medications are driving this overdose epidemic. Opioid pain medications were also involved in about 36 percent of all poisoning suicides in the U.S. in 2007.

In a commentary article released ahead of the print version in the April 19, 2011 online issue of the Journal of Clinical Psychiatry, physicians affiliated with the U.S. Centers for Disease Control and Prevention (CDC), the University of North Carolina at Chapel Hill School of Medicine and Duke University Medical Center cite data noting that in 2007 unintentional deaths due to prescription opioid pain killers were involved in more overdose deaths than heroin and cocaine combined.

The new report was co-authored by CDC medical epidemiologist Leonard J. Paulozzi, MD, MPH; Richard H. Weisler, MD, adjunct professor of psychiatry at UNC and adjunct associate professor of psychiatry at Duke University Medical Center; and Ashwin A. Patkar, MD, associate professor in the psychiatry and behavioral sciences department at Duke University. More than describing the scope of unintentional prescription opioid overdose deaths, their report is aimed at helping doctors control the problem.

Approximately 27,500 people died from unintentional drug overdoses in 2007, driven to a large extent by prescription opioid overdoses. Dr. Weisler says that to put this in perspective, the number of 2007 U.S. unintentional drug poisoning deaths alone represents tragically about 4.6 times as many deaths as all U.S. fatalities in both Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan from the beginning of both wars through Feb 20, 2011.

Alternatively, the 2007 U.S. unintentional drug poisoning deaths would be equivalent to losing an airplane carrying 150 passengers and crew every day for six months, which clearly would be totally unacceptable from a public health perspective.

The CDC sounded alarms regarding the issue in several reports last year. In June 2010, for example, the agency announced that the 2009 National Youth Risk Behavior Survey (YRBS) found that 1 in 5 high school students in the United States have abused prescription drugs, including the opioid painkillers OxyContin, Percocet, and Vicodin. Opioids are synthetic versions of opium that are used to treat moderate and severe pain.

And in June last year the CDC reported that visits to hospital emergency departments involving nonmedical use of prescription narcotic pain relievers has more than doubled, rising 111 percent, between 2004 and 2008.

The authors note various reports citing some key factors linked to the problem: increased nonmedical use of opioids without a prescription "… solely for the feeling it causes" and that medical providers, psychiatrists and primary care physicians included, may fail to anticipate among their patients the extent of overlap between chronic pain, mental illness and substance abuse.

For example, 15 percent to 30 percent of people with unipolar, bipolar, anxiety, psychotic, non-psychotic, and attention deficit/hyperactivity disorders will also have substance abuse problems. Dr. Patkar said, "Similarly, people with substance abuse are more likely to have another mental illness and a significant number of patients with chronic pain will have mental illness or substance abuse problems."

Moreover, opioids, benzodiazepines, anti-depressants, and sleep aids "are frequently prescribed in combination despite their potentially harmful additive effects," the authors point out. And it's the combinations of these drugs that are frequently found in the toxicology reports of people dying of overdoses.

In their recommendations to physicians, the authors suggest that before prescribing opioids, doctors should try non-narcotic medications as well as, when possible, physical therapy, psychotherapy, exercise, and other non-medicinal methods. And that these methods are given "an adequate trial" before moving to opioids.

"It is very important to screen patients with chronic pain who may require opioid therapy for substance abuse and mental health problems, especially depression and other mood and anxiety disorders and address these problems adequately," they state.

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Journal Reference:

1. Leonard J. Paulozzi, Richard H. Weisler, Ashwin A. Patkar. A National Epidemic of Unintentional Prescription Opioid Overdose Deaths. The Journal of Clinical Psychiatry, 2011; DOI: 10.4088/JCP.10com06560

Scientists at the Fisher Center for Alzheimer's Disease Research at The Rockefeller University, led by Paul Greengard, Ph.D., and Jennifer Warner-Schmidt, Ph.D., have shown that anti-inflammatory drugs, which include ibuprofen, aspirin and naproxen, reduce the effectiveness of the most widely used class of antidepressant medications, the selective serotonin reuptake inhibitors, or SSRIs, taken for depression and obsessive-compulsive disorder and anxiety disorders.

This surprising discovery, published online in the Proceedings of the National Academy of Sciences, may explain why so many depressed patients taking SSRIs do not respond to antidepressant treatment and suggests that this lack of effectiveness may be preventable. The study may be especially significant in the case of Alzheimer's disease. Such patients commonly suffer from depression and unless this can be treated successfully, the course of the illness is likely to be more severe. Depression in the elderly is also a risk factor for developing Alzheimer's Disease and researchers have suggested that treating depression in the elderly might reduce the risk of developing the disease.

In the recent study, investigators treated mice with antidepressants in the presence or absence of anti-inflammatory drugs. They then examined how the mice behaved in tasks that are sensitive to antidepressant treatment. The behavioral responses to antidepressants were inhibited by anti-inflammatory/analgesic treatments. They then confirmed these effects in a human population. Depressed individuals who reported anti-inflammatory drug use were much less likely to have their symptoms relieved by an antidepressant than depressed patients who reported no anti-inflammatory drug use. The effect was rather dramatic since, in the absence of any anti-inflammatory or analgesic use, 54 percent of patients responded to the antidepressant, whereas success rates dropped to approximately 40 percent for those who reported using anti-inflammatory agents.

"The mechanism underlying these effects is not yet clear. Nevertheless, our results may have profound implications for patients, given the very high treatment resistance rates for depressed individuals taking SSRIs," notes Dr. Warner-Schmidt.

Dr. Greengard adds, "Many elderly individuals suffering from depression also have arthritic or related diseases and as a consequence are taking both antidepressant and anti-inflammatory medications. Our results suggest that physicians should carefully balance the advantages and disadvantages of continuing anti-inflammatory therapy in patients being treated with antidepressant medications."

This research was supported in part by grants from the National Institute of Mental Health and the National Institute on Aging, both parts of the federal government's National Institutes of Health and The Fisher Center for Alzheimer's Disease Foundation.

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Journal Reference:

1. Jennifer L. Warner-Schmidt, Kimberly E. Vanover, Emily Y. Chen, John J. Marshall, and Paul Greengard. Antidepressant effects of selective serotonin reuptake inhibitors (SSRIs) are attenuated by antiinflammatory drugs in mice and humans. Proceedings of the National Academy of Sciences, 2011; DOI: 10.1073/pnas.1104836108

— In the wake of several highly publicized suicides by gay teenagers, a new study finds that a negative social environment surrounding gay youth is associated with high rates of suicide attempts by lesbian, gay, and bisexual (LGB) youth.

The study appears in the April 18 issue of Pediatrics. It was conducted by by Robert Wood Johnson Foundation Health & Society Scholar Mark L. Hatzenbuehler at Columbia University's Mailman School of Public Health.

The study of nearly 32,000 11th-grade students in Oregon found that LGB youth were more than five times as likely to have attempted suicide in the previous 12 months, as their heterosexual peers (21.5 percent vs. 4.2 percent). Using a new tool designed to measure social environment, Hatzenbuehler found that LGB youth living in a social environment that was more supportive of gays and lesbians were 25 percent less likely to attempt suicide than LGB youth living in environments that were less supportive.

Overall, suicide is the third leading cause of death among youth ages 15 to 24, and LGB youth attempt suicide at significantly higher rates than heterosexuals. Few studies, however, have examined whether a young person's social environment contributes to the likelihood that he or she will attempt suicide.

Data was drawn from the 2006 and 2008 Oregon Healthy Teens survey, an annual survey of public school students in 8th and 11th grade in Oregon. Sexual orientation is assessed only in 11th grade; participants remain anonymous.

"The results of this study are pretty compelling," said Hatzenbuehler. "When communities support their gay young people, and schools adopt anti-bullying and anti-discrimination policies that specifically protect lesbian, gay, and bisexual youth, the risk of attempted suicide by all young people drops, especially for LGB youth."

Hatzenbuehler developed five measures of the social environment surrounding LGB youth on a county-wide level that included: 1) proportion of schools with anti-bullying policies specifically protecting LGB students; 2) proportion of schools with Gay-Straight Alliances (GSAs); 3) proportion of schools with anti-discrimination policies that included sexual orientation; 4) proportion of same-sex couples; and 5) proportion of Democrats in the county.

The study found that a more supportive social environment was associated with 20 percent fewer suicide attempts than an unsupportive environment. A supportive environment was also associated with a 9% lower rate of attempted suicide among heterosexual students.

Previous studies have documented risk factors for suicide attempts among LGB youth including depression, binge drinking, peer victimization, and physical abuse by an adult. Hatzenbuehler controlled for these individual risk factors in order to assess the influence of the social environment on suicide attempts above and beyond known risk factors for suicide attempts.

"The good news is that this study suggests a road map for how we can reduce suicide attempts among lesbian, gay and bisexual youth," Hatzenbuehler said. Unfortunately, he notes, some communities are heading in the wrong direction. He points to Utah, where school-based Gay-Straight Alliances — student groups that work toward increasing tolerance between homosexual and heterosexual youth — have come under attack.

"This study shows that the creation of school climates that are good for gay youth can lead to better health outcomes for all young people," said Hatzenbuehler.

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Journal Reference:

1. M. L. Hatzenbuehler. The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth. Pediatrics, 2011; DOI: 10.1542/peds.2010-3020

 — Forty-five percent of the 32,000 Americans who take their own lives each year visit their primary care provider within one month of their death. Ninety percent have a mental health or substance abuse disorder, or both. Yet only in the last decade has suicide been considered a preventable public health problem.

"In our society, we have separated mental health and physical health for quite some time," said Dr. Judith Salzer, Associate Dean for Strategic Management at the Georgia Health Sciences University College of Nursing. Salzer, a primary care pediatric nurse practitioner who has spent her career specializing in the care of vulnerable children, is one of a select group of experts participating in a Call to Action on Suicide Prevention in Primary Care Practice April 11-12 in Portland, Ore.

The meeting, sponsored by the Suicide Prevention Resource Center, the only federally funded center of its kind in the nation, and the American Association of Suicidology brings together physicians, social workers, nurses, researchers and government agencies to develop ideas and methods that would increase the capacity of primary care practices to assess and manage suicide risk.

"This hasn't been done before," Salzer said. "The most basic mental health occurs in primary care settings where practitioners have hands-on contact with patients. We want to set up a national network to let primary care providers know how critical their impact is and give them acceptable tools with which to identify patients at risk for suicide."

The group will identify ways for providers to better recognize and respond to patients' suicidal thoughts and behaviors and to develop organizational plans that incorporate suicide prevention activities into primary care practices.

"There aren't enough mental health professionals for everyone to get a mental health checkup," Salzer said. "We want to make sure primary care providers have a practical way to incorporate mental health awareness into their assessments. A quick, standardized screening will tell pretty quickly if someone is feeling like they may hurt themselves."

Low levels of household income are associated with several lifetime mental disorders and suicide attempts, and a decrease in income is associated with a higher risk for anxiety, substance use, and mood disorders, according to a report in the April issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"To date, findings on the relationship between income and mental illness have been mixed," the authors write as background information in the article. "Some studies have found that lower income is associated with mental illness, while other studies have not found this relationship."

Jitender Sareen, M.D., FRCPC, of the University of Manitoba, Winnipeg, Canada, and colleagues analyzed data from the U.S. National Epidemiologic Survey of Alcohol and Related Conditions — the largest longitudinal, population-based mental health survey — to examine the relationship between income, mental disorders, and suicide attempts. A total of 34,653 non-institutionalized U.S. adults, age 20 years and older, were interviewed twice, three years apart.

"Participants with household income of less than $20,000 per year were at increased risk of incident mood disorders during the three-year follow-up period in comparison with those with income of $70,000 or more per year," the authors report.

"A decrease in household income during the two time points was also associated with an increased risk of incident mood, anxiety, or substance use disorders in comparison with respondents with no change in income," they write.

An increase in income during the follow-up period was not associated with any increase or decrease in the risk of developing mental disorders.

The authors believe their study findings have important public health implications.

"Most important, the findings suggest that income below $20,000 per year is associated with substantial psychopathologic characteristics and that there is a need for targeted interventions to treat and prevent mental illness in this low-income sector of the population," they conclude. "The findings also suggest that adults with reduction in income are at increased risk of mood and substance use disorders."

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Journal Reference:

1. J. Sareen, T. O. Afifi, K. A. McMillan, G. J. G. Asmundson. Relationship Between Household Income and Mental Disorders: Findings From a Population-Based Longitudinal Study. Archives of General Psychiatry, 2011; 68 (4): 419 DOI: 10.1001/archgenpsychiatry.2011.15

Although thousands of people commit suicide worldwide each year, researchers and doctors do not have any method for evaluating a person's likelihood of thinking about or trying to commit suicide. An international group of scientists, in which the Hospital del Mar Research Institute (IMIM) has participated, has devised the first risk index in order to prevent suicides.

"It is of key importance to identify suicidal thoughts among people at increased risk. The most important contribution that our study has made is an international risk index to estimate the likelihood of a person moving on from these thoughts to any one of the following behaviours — planning or trying to commit suicide," Jordi Alonso, head of the IMIM Healthcare Services Research Group, said.

The data used in the study, which also involved Josep M. Haro, a researcher at the Sant Joan de Déu Healthcare Park, and which has been published in the Journal of Clinical Psychiatry, come from the World Health Organisation (WHO) survey World Mental Health Surveys between 2001 and 2007, in which 108,705 adults from 21 countries responded to the Composite International Diagnostic Interview.

The study looks at suicidal behaviour rather than suicides that result in death, since it is based on interviews carried out with adults. The factors associated with such behaviour are — being female, younger age groups, lower levels of education, not living with a partner, being unemployed, suffering from certain mental illnesses, having experienced troubles during childhood, and mental illnesses among parents.

We are all at the same risk

Suicidal behaviour rates are similar in both developed and developing countries. In addition, "all the risk factors are similar for both these sets of countries, so the index used to determine the risk of suicidal behaviour is valid in both cases," the expert explains.

However, in terms of mortality as a result of suicide, there are significant variations around the world. For example, countries in eastern Europe and the former Soviet Union have the highest rates (Lithuania, Belarus, the Russian Federation), and a large number of those who die from suicide suffer from mental illnesses.

Other decisive factors involved in suicides being enacted include religion (meaning there are very low suicide rates in Muslim countries), social support and access to weapons or lethal substances.

Below the average but on the rise

In Spain, a country with a traditional Catholic culture with extended families, a relatively low prevalence of mental illnesses and significant restrictions on the use of weapons, suicide rates are low, at half the European average.

"However, this rate is on the rise, while in countries with higher rates it is falling," the researcher warns. In places such as the United States, for every death from suicide there are between three and four hospitalisations resulting from failed suicide attempts, and between 15 and 20 emergency room visits for the same reason.

"Our index for evaluating multiple risks could help to predict suicidal planning and attempts with a fairly high level of precision and help medical specialists to foresee such behaviour," concludes Alonso.

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Journal Reference:

1. Guilherme Borges, Matthew K. Nock, Josep M. Haro Abad, Irving Hwang, Nancy A. Sampson, Jordi Alonso, Laura Helena Andrade, Matthias C. Angermeyer, Annette Beautrais, Evelyn Bromet, Ronny Bruffaerts, Giovanni de Girolamo, Silvia Florescu, Oye Gureje, Chiyi Hu, Elie G. Karam, Viviane Kovess-Masfety, Sing Lee, Daphna Levinson, Maria Elena Medina-Mora, Johan Ormel, Jose Posada-Villa, Rajesh Sagar, Toma Tomov, Hidenori Uda, David R. Williams, Ronald C. Kessler. Twelve-Month Prevalence of and Risk Factors for Suicide Attempts in the World Health Organization World Mental Health Surveys. The Journal of Clinical Psychiatry, 2010; 71 (12): 1617 DOI: 10.4088/JCP.08m04967blu

Most "locked-in syndrome" patients say they are happy, and many of the factors reported by those who say they are unhappy can be improved, suggest the results of the largest survey of its kind, published in the launch issue of the new online journal BMJ Open.

The findings are likely to challenge the perception that these patients can no longer enjoy quality of life and are candidates for euthanasia or assisted suicide, say the authors.

The research team quizzed 168 members of the French Association for Locked in Syndrome on their medical history and emotional state, and their views on end of life issues, using validated questionnaires.

Locked-in syndrome describes a condition in which a person is fully conscious, but cannot move or communicate, save through eye movements or blinking. The syndrome is caused by brain stem injury, and those affected can survive for decades.

In all, 91 people replied, giving a response rate of 54%. Around two thirds had a partner and lived at home, and most (70%) had religious beliefs.

There were no obvious differences between those who expressed happiness or unhappiness, but not unexpectedly, depression, suicidal thoughts, and a desire not to be resuscitated, should the need arise, or for euthanasia were more common among those who said they were unhappy.

Over half the respondents acknowledged severe restrictions on their ability to reintegrate back into the community and lead a normal life. Only one in five were able to partake in everyday activities they considered important.

Nevertheless, most (72%) said they were happy.

Only four of the 59 people (7%) who responded to the question asking whether they wanted to opt for euthanasia, said they wished to do so.

Among the 28% who said they were unhappy, difficulties getting around, restrictions on recreational/social activities, and coping with life events were the sources of their unhappiness.

But a shorter period in the syndrome — under a year — feeling anxious, and not recovering speech were also associated with unhappiness.

A greater focus on rehabilitation and more aggressive treatment of anxiety could therefore make a big difference, say the authors, who emphasise that it can take these patients a year or more to adapt to this huge change in their circumstances.

"Our data show that, whatever the physical devastation and mental distress of [these] patients during the acute phase of the condition, optimal life sustaining care and revalidation can have major long term benefit," they write. "We suggest that patients recently struck by [the syndrome] should be informed that, given proper care, they have a considerable chance of regaining a happy life," they add.

And they conclude: "In our view, shortening of life requests … are valid only when the patients have been give a chance to attain a steady state of subjective wellbeing."

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Journal Reference:

1. Marie-Aurélie Bruno, Jan L Bernheim, Didier Ledoux, Frédéric Pellas, Athena Demertzi, Steven Laureys. A Survey on Self-Assessed Well-Being in a Cohort of Chronic Locked-In Syndrome Patients: Happy Majority, Miserable Minority. BMJ Open, 23 February 2011 DOI: 10.1136/bmjopen-2010-000039

People found incompetent to stand trial are more likely to be unemployed, have been previously diagnosed with a psychotic disorder or have had psychiatric hospitalization, according to an analysis of 50 years of research, published by the American Psychological Association.

"Competency to stand trial evaluations have been regarded as the most significant mental health inquiry pursued in the system of criminal law," said the paper's lead author, Gianni Pirelli, PhD, who conducted the research at John Jay College of Criminal Justice, City University of New York and is presently on staff at Greystone Park Psychiatric Hospital in New Jersey.

The paper, published in the APA journal Psychology, Public Policy and Law, examined results of 68 studies from 1967 to 2008 to help determine which variables are most closely related to findings of incompetency, as well as which measures are best to use in competency evaluations. Combined, the studies' participants totaled 26,139 individuals, with 6,428 found incompetent and 19,711 found competent. Only approximately half of the studies included female participants.

The current legal standard for competency to stand trial is based on a 1960 Supreme Court ruling in Dusky v. United States that determined a defendant is competent if "he has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding — and whether he has a rational as well as factual understanding of the proceedings against him," the article states.

The paper analyzed comparisons among demographic, psychiatric and criminal variables for competent and incompetent defendants. It found that defendants diagnosed with a psychotic disorder were approximately eight times more likely to be found incompetent, and unemployed defendants were twice as likely to be found incompetent. The likelihood of being found incompetent was also double for defendants with a previous psychiatric hospitalization.

Additionally, in contrast to a competent defendant, those found to be incompetent were slightly older, predominantly non-white and unmarried, the research showed. Regarding similarities between competent and incompetent defendants, the study found the majority were male, had a prior arrest history, a current violent criminal charge and an average of about 10 years of education.

Competency test data "must be integrated with information obtained from clinical interviews, other relevant test data and observation/reports from collateral sources," the authors wrote. They emphasized the importance of competency evaluations and the risks if these evaluations are conducted poorly, including allowing an incompetent defendant to stand trial or violating a defendant's civil rights by temporarily committing him or her to a psychiatric facility.

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Journal Reference:

1. Gianni Pirelli et al. A Meta-Analytic Review of Competency to Stand Trial Research. Psychology, Public Policy, & Law, Vol. 17, Issue 1

 When psychotherapy is helping someone get better, what does that change look like in the brain? This was the question a team of Canadian psychological scientists set out to investigate in patients suffering from social anxiety disorder. Their findings are published in Psychological Science, a journal of the Association of Psychological Science.

Social anxiety is a common disorder, marked by overwhelming fears of interacting with others and expectations of being harshly judged. Medication and psychotherapy both help people with the disorder. But research on the neurological effects of psychotherapy has lagged far behind that on medication-induced changes in the brain.

"We wanted to track the brain changes while people were going through psychotherapy," says McMaster University Ph.D. candidate Vladimir Miskovic, the study's lead author.

To do so, the team — led by David Moscovitch of the University of Waterloo, collaborating with McMaster's Louis Schmidt, Diane Santesso, and Randi McCabe; and Martin Antony of Ryerson University — used electroencephalograms, or EEGs, which measure brain electrical interactions in real time. They focused on the amount of "delta-beta coupling," which elevates with rising anxiety.

The study recruited 25 adults with social anxiety disorder from a Hamilton, Ontario clinic. The patients participated in 12 weekly sessions of group cognitive behavior therapy, a structured method that helps people identify — and challenge — the thinking patterns that perpetuate their painful and self-destructive behaviors.

Two control groups — students who tested extremely high or low for symptoms of social anxiety — underwent no psychotherapy.

The patients were given four EEGs — two before treatment, one halfway through, and one two weeks after the final session. The researchers collected EEG measures of the participants at rest, and then during a stressful exercise: a short preparation for an impromptu speech on a hot topic, such as capital punishment or same-sex marriage; participants were told the speech would be presented before two people and videotaped. In addition, comprehensive assessments were made of patients' fear and anxiety.

When the patients' pre- and post-therapy EEGs were compared with the control groups', the results were revealing: Before therapy, the clinical group's delta-beta correlations were similar to those of the high-anxiety control group and far higher than the low-anxiety group's. Midway through, improvements in the patients' brains paralleled clinicians' and patients' own reports of easing symptoms. And at the end, the patients' tests resembled those of the low-anxiety control group.

"We can't quite claim that psychotherapy is changing the brain," cautions Miskovic. For one thing, some of the patients were taking medication, and that could confound the results. But the study, funded by the Ontario Mental Health Foundation, is "an important first step" in that direction — and toward understanding the biology of anxiety and developing better treatments.

The work might also alter perceptions of therapy. "Laypeople tend to think that talk therapy is not 'real,' while they associate medications with hard science, and physiologic change," says Miskovic. "But at the end of the day, the effectiveness of any program must be mediated by the brain and the nervous system. If the brain does not change, there won't be a change in behavior or emotion."

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Journal Reference:

1. V. Miskovic, D. A. Moscovitch, D. L. Santesso, R. E. McCabe, M. M. Antony, L. A. Schmidt. Changes in EEG Cross-Frequency Coupling During Cognitive Behavioral Therapy for Social Anxiety Disorder. Psychological Science, 2011; DOI: 10.1177/0956797611400914

Why do some people fret over the most trivial matters while others remain calm in the face of calamity? Researchers at the University of California, Berkeley, have identified two different chinks in our brain circuitry that explain why some of us are more prone to anxiety.

Their findings, published Feb. 10 in the journal Neuron may pave the way for more targeted treatment of chronic fear and anxiety disorders. Such conditions affect at least 25 million Americans and include panic attacks, social phobias, obsessive-compulsive behavior and post-traumatic stress disorder.

In the brain imaging study, researchers from UC Berkeley and Cambridge University discovered two distinct neural pathways that play a role in whether we develop and overcome fears. The first involves an overactive amygdala, which is home to the brain's primal fight-or-flight reflex and plays a role in developing specific phobias.

The second involves activity in the ventral prefrontal cortex, a neural region that helps us to overcome our fears and worries. Some participants were able to mobilize their ventral prefrontal cortex to reduce their fear responses even while negative events were still occurring, the study found.

"This finding is important because it suggests some people may be able to use this ventral frontal part of the brain to regulate their fear responses — even in situations where stressful or dangerous events are ongoing," said UC Berkeley psychologist Sonia Bishop, lead author of the paper.

"If we can train those individuals who are not naturally good at this to be able to do this, we may be able to help chronically anxious individuals as well as those who live in situations where they are exposed to dangerous or stressful situations over a long time frame," Bishop added.

Bishop and her team used functional Magnetic Resonance Imaging (fMRI) to examine the brains of 23 healthy adults. As their brains were scanned, participants viewed various scenarios in which a virtual figure was seen in a computerized room. In one room, the figure would place his hands over his ears before a loud scream was sounded. But in another room, the gesture did not predict when the scream would occur. This placed volunteers in a sustained state of anticipation.

Participants who showed overactivity in the amygdala developed much stronger fear responses to gestures that predicted screams. A second entirely separate risk factor turned out to be failure to activate the ventral prefrontal cortex. Researchers found that participants who were able to activate this region were much more capable of decreasing their fear responses, even before the screams stopped.

The discovery that there is not one, but two routes in the brain circuitry that lead to heightened fear or anxiety is a key finding, the researchers said, and it offers hope for new targeted treatment approaches.

"Some individuals with anxiety disorders are helped more by cognitive therapies, while others are helped more by drug treatments," Bishop said. "If we know which of these neural vulnerabilities a patient has, we may be able to predict what treatment is most likely to be of help."

In addition to Bishop, coauthors of the study are Anwar O. Nunez Elizalde at UC Berkeley; Iole Indovina of the Neuroimaging Laboratory of the Santa Lucia Foundation in Rome, Italy; Trevor Robbins at Cambridge University in the United Kingdom; and Barney Dunn at the MRC Cognition and Brain Sciences Unit in Cambridge, U.K.

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Journal Reference:

1. Iole Indovina, Trevor W. Robbins, Anwar O. Núñez-Elizalde, Barnaby D. Dunn, Sonia J. Bishop. Fear-Conditioning Mechanisms Associated with Trait Vulnerability to Anxiety in Humans. Neuron, 2011; 69 (3): 563 DOI: 10.1016/j.neuron.2010.12.034