Scientific Research Symposium

The Interface of Anxiety Disorders and Medical Disorders: Pathophysiology and Treatment Implications

Friday, April 13
3:30 pm – 6:00 pm

Moderator

Charles Nemeroff, MD, PhD
University of Miami Leonard M. Miller School of Medicine

The theme for this Scientific Research Symposium is anxiety in medicine, exploring the increased medical vulnerability, and impact on outcomes when patients have stress, anxiety, and related disorders.

Epidemiology of Anxiety Disorders and Medical Disorders

Wayne J. Katon, MD
Department of Psychiatry
University of Washington Medical School

Anxiety and medical disorders have bidirectional interactions. Comorbid anxiety disorders in patients with chronic medical illness have been found to increase medical symptoms, lead to additive functional impairment, increase medical costs, and often lead to poor adherence to medical regiments. Anxiety disorders have also been associated with medically unexplained symptoms and syndromes such as irritable bowel and chronic fatigue syndromes, dizziness, chest pain and palpitations with negative cardiac testing, and migraine headaches. Research on methods to screen and treat patients with comorbid anxiety and chronic medical illnesses is necessary.

Stress, Anxiety, and Psychoimmune Function

Janice Kiecolt-Glaser, PhD
Department of Psychiatry
The Ohio State University College of Medicine

The field of psychoneuroimmunology, or PNI, is providing key mechanistic evidence about the ways that stressors and anxiety and depression, as well as other associated negative emotions, can get translated into physiological changes. Stressors can enhance susceptibility to infectious agents and influence the severity of infectious disease, diminish the strength of immune responses to vaccines, reactivate latent herpes viruses, and slow wound healing. Moreover, stressful events and can also substantially enhance the production of proinflammatory cytokines that are associated with a spectrum of age-related diseases. Accordingly, stress-related immune dysregulation may be one core mechanism behind a diverse set of health risks.

Impact of Cytokines on Brain and Behavior: Neurocircuits and Neurotransmitters

Andrew Miller, MD
Psychiatry and Behavioral Sciences
Emory University School of Medicine

Activation of the immune system and release of cytokines can lead to changes in behavior, including depression, anxiety, and fatigue. Such cytokine-induced behavioral changes may contribute to the high rate of depression, anxiety, and other behavioral alterations observed in medically ill and chronically stressed individuals. Using interferon (IFN)-alpha, the antiviral cytokine, our group and others have demonstrated that cytokines can access the brain and alter the function of the basal ganglia, key brain structures involved in regulating motor activity and motivation. Cytokines also appear to activate areas of the brain that are triggered in states of anxiety, arousal, and alarm.

From Cognitive Processes to Cellular Processes: How Anxiety Influences the Immune System and Increases Risk for Physical Disease

Aoife O'Donovan, PhD
School of Medicine
University of California, San Francisco

Research findings suggest that anxiety is associated with inflammatory activity independent of comorbid depressive symptoms. This session will highlight transcriptional control pathways by which anxiety disorders may lead to elevated inflammatory activity, which may also accelerate the rate of biological aging. Featured will be a comprehensive theoretical model suggesting that anxiety-related cognitive biases toward threatening information and associated activation of physiological stress responses may contribute to the increased inflammatory activity and accelerated rate of biological aging observed in anxious individuals.