Changes in Cerebrovascular Modulation in Anxiety before and after Treatment

Abstract

Abstract:

【Abstract】 Objective To study cerebral blood flow regulation features in patients with anxiety before and after treatment. Methods Subjects with Hamilton anxiety scale scores ≥14 were enrolled, and the dynamic changes in their cerebral blood flow velocity (CBFV) in response to an orthostatic challenge were investigated using transcranial Doppler. Next, we provided the patients with treatment, and then they were followed-up for a period of 6 months. The dynamic changes in their CBFV values were then re-recorded. Results The CBFV changes from supine to upright differed between the anxious and the healthy groups. Anxious subjects showed more pronounced decreases in CBFV with abrupt standing (P <0.001). In the recovery group, the changes in the mean CBFV values from the supine to the upright position were significantly improved after treatment (P <0.001), and can restore to the healthy group level. Conclusion Our results indicate that cerebral blood flow regulation is compromised in anxiety; however, it can restore to normal after the disappearance of anxiety.

Key words: Anxiety; Cerebral blood flow regulation; Transcranial Doppler

摘要：

【摘要】目的分析焦虑症患者临床治愈前后脑血流调节的变化。方法应用经颅多普勒超声（transcranial Doppler，TCD）卧-立位脑血流检测方法分析50例焦虑症患者在体位变化时脑血流速度的变化特点并与健康对照组比较，然后随访6个月，观察焦虑症治愈组与未愈组TCD卧-立位脑血流变化。结果焦虑症组较对照组立位时脑血流速度下降（P <0.001），卧-立位脑血流差值大于对照组（P <0.001）；随访发现，焦虑症治愈组治疗后较治疗前卧-立位脑血流差值减小（P <0.001），可恢复到对照组水平；焦虑症未愈组治疗后卧-立位脑血流差值仍大于对照组（P =0.007）；治疗后治愈组卧-立位脑血流差值较未愈组减小（P =0.003）。结论 TCD卧-立位脑血流检测显示，焦虑症患者存在脑血流调节的异常，而且在焦虑症临床治愈后，脑血流调节可恢复正常。

关键词: 焦虑症; 脑血流调节功能; 经颅多普勒超声

XING Ying-Qi*, GUO Zhen-Ni, YANG Le, YAN Shuo, YANG Yi.. Changes in Cerebrovascular Modulation in Anxiety before and after Treatment[J]. Chinese Journal of Stroke, 2014, 9(03): 183-187.

邢英琦1，郭珍妮1，杨乐2，闫硕2，杨弋2. 焦虑症患者临床治愈前后脑血流调节的变化[J]. 中国卒中杂志, 2014, 9(03): 183-187.

References

1 江开达. 精神病学[M]. 北京:人民卫生出版社, 2006:127.

2 Bowen RC, Senthilselvan A, Barale A. Physical

illness as an outcome of chronic anxiety disorders[J].

Can J Psychiatry, 2000, 45:459-464.

3 Lan CC, Yu HS, Li WC, et al. Anxiety contributes

to the development of cerebrovascular disease in

Taiwanese patients with psoriasis:a population-based

study[J]. Eur J Dermatol, 2013, 23:290-292.

4 Rutledge T, Linke SE, Krantz DS, et al. Comorbid

depression and anxiety symptoms as predictors

of cardiovascular events:results from the NHLBI

sponsored Women's Ischemia Syndrome Evaluation

(WISE) study[J]. Psychosom Med, 2009, 71:958-964.

5 Gur RC, Gur RE, Resnick SM, et al. The effect

of anxiety on cor tical cerebral blood f low and

metabolism[J]. J Cereb Blood Flow Metab, 1987,

7:173-177.

6 Giardino ND, Friedman SD, Dager SR. Anxiety,

respiration, and cerebral blood flow:implications for

functional brain imaging[J]. Compr Psychiatry, 2007,48:103-112.

7 Faravelli C, Marinoni M, Spiti R, et al. Abnormal

brain hemodynamic responses dur ing passive

orthostatic challenge in panic disorder[J]. Am J

Psychiatry, 1997, 154:378-383.

8 郭珍妮, 邢英琦, 杨乐, 等. 焦虑症患者卧立位脑血流

调节研究初探[J]. 中风与神经疾病杂志, 2011, 28:50-

52.

9 Hamilton M. The assessment of anxiety states by

rating[J]. Br J Med Psychol, 1959, 32:50-55.

10 Zhang HL, Guo ZN, Yang G, et al. Compromised

c e r e b r o v a s c u l a r mo d u l a t i o n i n c h r o n i c

anxiety:evidence from cerebral blood flow velocity

measured by transcranial Doppler sonography[J].

Neurosci Bull, 2012, 28:723-728.

11 Stoll M, Hamann GF, Mangold R, et al. Emotionally

evoked changes in cerebral hemodynamics measured

by transcranial Doppler sonography[J]. J Neurol, 1999,

246:127-133.

12 Gibbs DM. Hyperventilation-induced cerebral

ischemia in panic disorder and effect of nimodipine[J].

Am J Psychiatry, 1992, 149:1589-1591.

13 Xu WH, Wang H, Wang B, et al. Disparate cardiocerebral

vascular modulation during standing in

multiple system atrophy and Parkinson disease[J]. J

Neurol Sci, 2009, 276:84-87.

14 Grubb BP. Neurocardiogenic syncope and related

disorders of orthostatic intolerance[J]. Circulation,

2005, 111:2997-3006.

15 Smith JJ, Porth CM, Erickson M. Hemodynamic

response to the upright posture[J]. J Clin Pharmacol,

1994, 34:375-386.

16 Brys M, Brown CM, Marthol H, et al. Dynamic

cerebral autoregulation remains stable during physical

challenge in healthy persons[J]. Am J Physiol Heart

Circ Physiol, 2003, 285:H1048-H1054.

17 Edvinsson L, Owman C, Siesjo B. Physiological

role of cerebrovascular sympathetic nerves in the

autoregulation of cerebral blood flow[J]. Brain Res,

1976, 117:519-523.

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