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Association of generalized anxiety disorder with autonomic hypersensitivity and blunted ventromedial prefrontal cortex activity during peripheral adrenergic stimulation: A randomized clinical trial

JAMA Feb 05, 2022

Researchers examined if there are abnormal physiological, perceptual, or neural responses among individuals with generalized anxiety disorder (GAD) during peripheral β-adrenergic stimulation that may indicate interoceptive dysfunction.

  • In his crossover randomized clinical trial, researchers included 58 women with artifact-free data [29 with GAD (mean [SD] age, 26.9 [6.8] years) and 29 matched healthy comparators (mean [SD] age, 24.4 [5.0] years)].

  • Neural responses were assessed using functional magnetic resonance imaging during randomized intravenous bolus infusions of isoproterenol (0.5 and 2.0 μg) and saline, each administered twice in a double-blind fashion.

  • Relative to healthy participants, female patients with GAD showed hypersensitivity to adrenergic stimulation as well as greater interoceptive sensation and reduced ventromedial prefrontal cortex activity.

  • Findings overall support contribution of dysfunctional autonomic and central nervous system to the pathophysiology of GAD and suggest the possibility of the ventromedial prefrontal cortex to be a treatment target.

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