Anxiety Disorders: Helfinstein SM

Pine DS, Helfinstein SM, Bar-Haim Y, Nelson E, Fox NA. · Mood and Anxiety Disorders Program, Intramural Research Program, The National Institute of Mental Health, Bethesda, MD 20892-2670, USA. · Neuropsychopharmacology. · Pubmed #18754004 No free full text.

Abstract: Alterations in brain development may contribute to chronic mental disorders. Novel treatments targeted toward the early-childhood manifestations of such chronic disorders may provide unique therapeutic opportunities. However, attempts to develop and deliver novel treatments face many challenges. Work on pediatric anxiety disorders illustrates both the inherent challenges as well as the unusual opportunities for therapeutic advances. The present review summarizes three aspects of translational research on pediatric anxiety disorders as the work informs efforts to develop novel interventions. First, the review summarizes data on developmental conceptualizations of anxiety from both basic neuroscience and clinical perspectives. This summary is integrated with a discussion of the two best-established treatments, cognitive behavioral therapy and selective serotonin reuptake inhibitors. Second, the review summarizes work on attention bias to threat, considering implications for both novel treatments and translational research on neural circuitry functional development. This illustrates the manner in which clinical findings inform basic systems neuroscience research. Finally, the review summarizes work in basic science on fear learning, as studied in fear conditioning, consolidation, and extinction paradigms. This summary ends by describing potential novel treatments, illustrating the manner in which basic neuroscience informs therapeutics.

Reeb-Sutherland BC, Helfinstein SM, Degnan KA, Pérez-Edgar K, Henderson HA, Lissek S, Chronis-Tuscano A, Grillon C, Pine DS, Fox NA. · Department of Human Development, University of Maryland, 3304 Benjamin Building, College Park, MD 20742, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #19454917 No free full text.

Abstract: OBJECTIVE: Behaviorally inhibited children face increased risk for anxiety disorders, although factors that predict which children develop a disorder remain poorly specified. The current study examines whether the startle reflex response may be used to differentiate between behaviorally inhibited adolescents with and without a history of anxiety. METHOD: Participants were assessed for behavioral inhibition during toddlerhood and early childhood. They returned to the laboratory as adolescents and completed a fear-potentiated startle paradigm and a clinical diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). Magnitude of the startle reflex was examined at baseline and during cues associated with safety and threat. RESULTS: Only adolescents who showed high levels of behavioral inhibition and had a lifetime occurrence of anxiety disorders showed increased startle reactivity in the presence of safety cues. Neither behavioral inhibition nor diagnosis was related to startle reactivity during threat cues. CONCLUSIONS: These results suggest that neurobiological measures, such as the startle reflex, may be a potential risk marker for the development of anxiety disorders among behaviorally inhibited adolescents. These methods may enhance our ability to identify vulnerable individuals before the development of anxious psychopathology.

Helfinstein SM, White LK, Bar-Haim Y, Fox NA. · Child Development Laboratory, Department of Human Development, University of Maryland, College Park, MD 20742, USA. · Behav Res Ther. · Pubmed #18472088 links to  free full text

Abstract: Anxious individuals show an attention bias towards threatening information. However, under conditions of sustained environmental threat this otherwise-present attention bias disappears. It remains unclear whether this suppression of attention bias can be caused by a transient activation of the fear system. In the present experiment, high socially anxious and low socially anxious individuals (HSA group, n=12; LSA group, n=12) performed a modified dot-probe task in which they were shown either a neutral or socially threatening prime word prior to each trial. EEG was collected and ERP components to the prime and faces displays were computed. HSA individuals showed an attention bias to threat after a neutral prime, but no attention bias after a threatening prime, demonstrating that suppression of attention bias can occur after a transient activation of the fear system. LSA individuals showed an opposite pattern: no evidence of a bias to threat with neutral primes but induction of an attention bias to threat following threatening primes. ERP results suggested differential processing of the prime and faces displays by HSA and LSA individuals. However, no group by prime interaction was found for any of ERP components.