Neurovisceral phenotypes in the expression of psychiatric symptoms

Eccles, Jessica A, Owens, Andrew P, Mathias, Christopher J, Umeda, Satoshi and Critchley, Hugo D (2015) Neurovisceral phenotypes in the expression of psychiatric symptoms. Frontiers in Neuroscience, 9. ISSN 1662-453X

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Abstract

This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brainbody mechanisms underlie individual differences in psychophysiological reactivity that can be important for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in 'emotional' brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity during postural change and as recently recognised factors causing vasodilatation (as noted post prandially, post exertion and with heat) is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/blood phobia), are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms, notably anxiety.

Item Type: Article
Keywords: postural tachycardia syndrome, joint hypermobility, vasovagal syncope, anxiety, psychiatry
Schools and Departments: Brighton and Sussex Medical School > Neuroscience
Subjects: R Medicine > RC Internal medicine > RC0321 Neurosciences. Biological psychiatry. Neuropsychiatry
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Depositing User: Christina Lee
Date Deposited: 06 Mar 2015 16:23
Last Modified: 27 Jul 2017 19:59
URI: http://sro.sussex.ac.uk/id/eprint/53260

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Project NameSussex Project NumberFunderFunder Ref
Hypermobility and autonomic hyperactivity: Relevance for the expression of psychiatric symptomsG0930MRC-MEDICAL RESEARCH COUNCILMR/K002643/1