Angst Wetenschap

Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample.

J Behav Ther Exp Psychiatry. 2019 May 31;65:101492

Authors: Kesby A, Maguire S, Vartanian LR, Grisham JR

Abstract
BACKGROUND AND OBJECTIVES: Intolerance of uncertainty (IU) is a transdiagnostic process contributing to the maintenance of anxiety disorders, and is a potential target for treatment. Recent literature has investigated IU as a cognitive process underpinning pathological fear and anxiety in Anorexia Nervosa (AN). The current study was designed to examine trait and state IU, and their relationship to restrictive eating disorder symptoms, anxiety, worry, cognitive rigidity and eating behaviour.
METHODS: A sample of undergraduate women (N = 85) completed measures of eating disorder symptoms, IU, cognitive rigidity and worry. Participants were randomised to complete an eating task under one of two conditions: the "certain" condition received a high-calorie meal and nutritional information, while the "uncertain" condition received the meal alone. During the meal, state IU and state anxiety were examined at three time-points (baseline, pre-eating, post-eating).
RESULTS: Trait IU was correlated with cognitive rigidity, worry, global eating disorder symptoms, and, in particular, dietary restraint. No differences emerged between conditions with respect to eating-related anxiety, or amount of food eaten. Controlling for condition and eating disorder symptoms, state IU predicted pre-eating anxiety. Beyond the contribution of condition, BMI and eating disorder symptoms, state IU predicted consumption, specifically greater dietary restriction.
LIMITATIONS: The study employed a non-clinical sample.
CONCLUSIONS: IU may be implicated in a rigid cognitive style, the anxiety response to energy-dense food, and restrictive eating behaviour. Should these findings be replicated in a clinical sample, then IU might emerge as an adjunctive treatment target for AN.

PMID: 31202086 [PubMed - as supplied by publisher]

Fear-context association during memory retrieval requires input from granular to dysgranular retrosplenial cortex.

Neurobiol Learn Mem. 2019 Jun 12;:107036

Authors: Sigwald EL, Bignante EA, de Olmos S, Lorenzo A

Abstract
The contribution of the granular (area 29, A29) and dysgranular (area 30, A30) subdivisions of the retrosplenial cortex (RSC) to contextual fear memory (CFM) retrieval remains elusive. Here, intact and orchiectomized (ORC) male rats received an intraperitoneal (I.P.) injection of saline (control) or 5 mg/Kg MK801 after training and memory formation. In ORC, but not in intact males, this MK801 treatment selectively induces overt loss of neurons in layers IV-Va of A29 (A29MK801 neurons) (Sigwald et al., 2016). Compared to ORC-saline, ORC-MK801 rats showed impaired CFM retrieval in an A-B-A design for contextual fear conditioning (CFC), however context recognition was not affected. In ORC-MK801 rats, neither novel object recognition nor object-in-context discrimination were impaired, further indicating that A29MK801 neurons are not required for contextual recognition. Elevated plus maze test showed that anxiety-like behavior was not affected in ORC-MK801 animals, suggesting that loss of A29MK801 neurons does not affect the emotional state that could impair freezing during test. Importantly, in a sensory preconditioning test, higher order CFM retrieval was abolished in ORC-MK801, but not in male-MK801. Collectively, these observations indicate that A29MK801 neurons are critically required for retrieving fear-context association. For dissecting the anatomofunctional contribution of A29MK801 neurons to CFM retrieval, expression of c-Fos and Egr-1 was used to map brain-wide neuronal activity. In control male rats CFC and CFM retrieval was associated with significant enhancement of both proteins in limbic structures and A30, but not in A29, suggesting that neurons in A30 and limbic structures encode and store the associative experience. Notably, in ORC but not in intact males, MK801 impairs CFM retrieval and expression of c-Fos and Egr-1 proteins in A30, without affecting their expression in limbic structures. Thus, the loss of A29MK801 neurons after CFM formation precludes activation of associative neurons in A30, impairing CFM recall. FluoroGold retrograde track-tracing confirmed that A29MK801 neurons project to A30. Silver staining provide evidence that MK801 in ORC rats induces axonal deafferentation of A29MK801 neuron in A30. Collectively, our experiments provide the first evidence that A30 neurons participate in encoding and storing CFM while A29 is required for their activation during recall.

PMID: 31201928 [PubMed - as supplied by publisher]

Characterizing Anxiety at the First Encounter in women presenting to the urogynecology clinic: the CAFÉ Study.

Am J Obstet Gynecol. 2019 Jun 12;:

Authors: Pham TT, Chen YB, Adams W, Wolff B, Shannon M, Mueller ER

Abstract
BACKGROUND: Clinically based anxiety questionnaires measure 2 forms of anxiety known as state anxiety and trait anxiety. State anxiety is temporary and is sensitive to change, while trait anxiety is a generalized propensity to be anxious.
OBJECTIVE: Our study aims to characterize the reasons for anxiety among women presenting for an initial consultation for their pelvic floor disorders, to measure change in participant state anxiety after the visit, and to correlate improvement in anxiety with visit satisfaction.
STUDY DESIGN: All new patients presenting to our tertiary Urogynecology clinic were invited to participate. Following consent, participants completed pre- and post-visit questionnaires. Providers were blinded to pre and post-visit questionnaire responses. The pre-visit questionnaires included the Pelvic Floor Distress Inventory (PFDI), Generalized Anxiety Disorder-7 (GAD-7) and the 6 item short form of the Spielberg State Trait Anxiety Inventory (STAI-Y6). Participants were also asked to list their pre-visit anxieties. The post-visit questionnaires comprised of the STAI-Y6, patient global impression of improvement (PGI-I) of participant anxiety, patient satisfaction, and the participant's perception of whether her anxiety was address during the visit. The anxieties listed by participants were then reviewed independently by 2 of the authors and categorized. A separate panel arbitrated when there were disagreements among anxiety categories.
RESULTS: Fifty primarily Caucasian (66%) women with a median age of 53 years (IQR: 41-66) completed the study. The visit diagnoses included: stress urinary incontinence (54%), urge urinary incontinence (46%), myofascial pain (28%), pelvic organ prolapse (20%), and recurrent urinary tract infection (12%). Less than a quarter (22%) of participants had a history of anxiety diagnosis. The average pre-visit STAI-Y6 score was 42.9 (SD=11.98) which decreased by an average of 12.60 points post-visit (95% CI: -16.56 to -8.64, p<.001). Post-visit decreased anxiety was associated with improvements in the PGI-I anxiety (p<.001) and participants' perception that their anxiety symptoms were completely addressed (p=.045). The most reported causes for consultation related anxiety were: lack of knowledge of diagnosis and ramifications, personal or social issues, and fear of the physical exam. Participants reported that improvements in anxiety were related to patient education and reassurance, medical staff appreciation and acceptable treatment plan. Participants reporting complete satisfaction demonstrated a greater decrease in post-visit STAI scores compared to participants not reporting complete satisfaction (p=.045). Changes in the STAI-Y6 score were not associated with the PFDI (p=.35) or GAD-7 scores (p=.78).
CONCLUSION: Women with the highest satisfaction following their initial Urogynecology visit also demonstrate the largest decreases in anxiety following the visit. Changes in anxiety scores were not correlated with the PFDI or with measures of generalized anxiety (GAD-7). Recognizing and addressing patient anxiety may help physicians better treat their patients and improve overall patient satisfaction.

PMID: 31201810 [PubMed - as supplied by publisher]