ABSTRACT
Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders. OBJECTIVES: The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field. RESULTS: Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. CONCLUSION: It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.
A ansiedade é um componente importante da psicopatologia do transtorno obsessivo-compulsivo (TOC). Até o momento, a maioria das intervenções que provaram ser eficazes para o tratamento de TOC é semelhante àquelas desenvolvidas para outros transtornos de ansiedade. No entanto, estudos que investigaram a neurobiologia do TOC chegaram a conclusões que nem sempre são compatíveis com aquelas anteriormente associadas aos demais transtornos de ansiedade. OBJETIVOS: Neste artigo, revisamos o grau de sobreposição entre as características do TOC e a fenomenologia e fisiopatologia dos demais transtornos de ansiedade com o intuito de dar suporte ao racional que orienta a pesquisa nesse campo. RESULTADOS: Alguns dados sobre os neurocircuitos envolvidos na manifestação dos transtornos de ansiedade foram obtidos a partir do estudo de modelos animais de ansiedade, e da neuroimagem estrutural e funcional em humanos. Esses trabalhos sugerem que no TOC, além da disfunção das vias corticoestriatais, o funcionamento do circuito amigdalocortical, essencial para a apresentação da resposta de medo e processos de extinção dessa resposta, também pode estar prejudicado. CONCLUSÃO: É provável que a ansiedade seja uma dimensão relevante do TOC, com impacto em outras características desse transtorno. Consequentemente, estudos futuros podem se beneficiar da investigação dos fenômenos de medo e ansiedade e de suas relações com os tipos de obsessões e compulsões, idade de início do TOC, comorbidades e padrões de resposta ao tratamento.
Subject(s)
Animals , Humans , Anxiety/physiopathology , Fear/physiology , Obsessive-Compulsive Disorder/physiopathology , Anxiety/epidemiology , Anxiety/psychology , Comorbidity , Disease Models, Animal , Fear/psychology , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/psychologyABSTRACT
The fact that the dorsal periaqueductal gray (dPAG) and inferior colliculus (IC), together with superior colliculus, medial hypothalamus and amygdala, constitute the brain aversion system has been well-established. Stepwise increases in the intensity of electrical stimulation of dPAG or IC cause freezing and escape responses, which are followed by a freezing behavior that lasts after the interruption of the stimulation. Freezing and escape are unconditioned defensive behaviors derived from the stimulation of the output centers for the defense reaction, whereas the post-stimulation freezing is the behavioral counterpart of the processing of aversive information. Although GABA-A mechanisms of the midbrain tectum exert a tonic inhibitory influence on the neural substrates of unconditioned fear, their influence on the processing of aversive information is not completely understood. Thus, the present study examines the effects of injections of the GABA-A receptor agonist muscimol (1 and 2 nmol/0.2 µL) or the glutamic acid decarboxylase blocker semicarbazide (5 and 7.5 µg/0.2 µL) into dPAG or IC of Wistar rats on freezing and escape thresholds determined by electrical stimulation of these same structures and on post-stimulation freezing. Intra-dPAG injections of muscimol increased and semicarbazide decreased the freezing and escape thresholds of electrical stimulation of the dPAG. Only semicarbazide enhanced the dPAG post-stimulation freezing. Intra-IC injections of muscimol significantly increased aversive thresholds, while having no effect on IC post-stimulation freezing. Intra-IC injections of semicarbazide had no significant effects. These findings suggest that GABAergic mechanisms are important regulators of the expression of unconditioned fear in dPAG and IC, whereas only in dPAG GABA appears to play a role on the sensory gating towards aversive information during post-stimulation freezing.