Interoceptive pathways to understand and treat mental health conditions

Trends in Cognitive Sciences, Journal Year: 2022, Volume and Issue: 26(6), P. 499 - 513

Published: April 21, 2022

Patients with neuropsychiatric disorders associated altered emotional or physical experiences show disruptions in interoception.Interoception may be an important target of both existing and novel mental health treatments.Antidepressants modulate aspects interoception specific psychological therapies interoceptive processes, particularly breathing.Medications for certain conditions are better health.Interoceptive measures could used to stratify patients treatment selection. An increasing recognition that brain body dynamically coupled has enriched our scientific understanding conditions. Peripheral signals interact centrally influence how we think feel, generating sense the internal condition body, a process known as interoception. Disruptions this system contribute clinical conditions, including anxiety, depression, psychosis. After reviewing nature disturbances review focuses on pathways putative treatments. Emerging interventions peripheral mechanisms. Future development requires forward- back-translation uncover processes elucidate their efficacy relative targeting other factors. Over century after introduction theories emotion (see Glossary) [1.Lange C.G. James W. The Emotions. Williams Wilkins Co., 1922Crossref Google Scholar], notion physiological is widely accepted [2.Barrett L.F. Are emotions natural kinds?.Perspect. Psychol. Sci. 2006; 1: 28-58Crossref PubMed Scopus (929) Scholar,3.Lindquist K.A. Barrett A functional architecture human brain: emerging insights from science emotion.Trends Cogn. 2012; 16: 533-540Abstract Full Text PDF (237) Scholar]. New techniques combine central driving rapid increase research detailing complex multifaceted ways which bodily state can cognition [4.Azzalini D. et al.Visceral shape dynamics cognition.Trends 2019; 23: 488-509Abstract (86) Recent work shows ranges moment-to-moment mapping, such discrete cardiac cycle effects [5.Garfinkel S.N. Critchley H.D. Threat body: heart supports fear processing.Trends 2016; 20: 34-46Abstract (113) long-term changes arising chronic alterations, immune [6.Dantzer R. al.From inflammation sickness depression: when subjugates brain.Nat. Rev. Neurosci. 2008; 9: 46-56Crossref (4415) Scholar,7.Hodes G.E. al.Individual differences promote resilience versus susceptibility social stress.Proc. Natl. Acad. 2014; 111: 16136-16141Crossref (0) ascribed two include bottom–up afferent signalling and/or top–down processing body. body-to-brain axis maps onto emotions, patterned relationship between particular states via neural representations signals. Higher-order paths represent someone's awareness – instance, accurately they interpret information likewise contributes experience. These also influenced by higher-order signals, example, appraisals given undifferentiated arousal Scholar,8.Scherer K.R. al.Appraisal Processes Emotion: Theory, Methods, Research. Oxford University Press, 2001Google Scholar] strong beliefs about might override veridical input [9.Koreki A. al.Trait abnormalities dissociation seizure frequency seizures.Epilepsia. 2020; 61: 1156-1165Crossref (21) role relevant disorders, today world's leading cause disability [10.Friedrich M.J. Depression around world.JAMA. 2017; 317: 1517Google efforts characterise disrupted mirror these pathways. In first, direct resultant modulation, vulnerability poor health. Alternatively additionally, sensing perception upregulated downregulated experience symptoms. Traditionally, correlates have been considered context diagnoses. More recently, it suggested instead 'transdiagnostic' mechanisms conferring common across multiple [11.Nord C.L. al.Disrupted dorsal mid-insula activation during psychiatric disorders.Am. J. Psychiatr. 2021; 178: 761-770Crossref (2) Similarly, range effective treatments alter physiology processes. Understanding path reveal routes render current effective, well pave way future designed explicitly disorders. Initial characterisation confined visceral organs [12.Sherrington C. Integrative Action Nervous System. CUP Archive, 1906Google although more recent definitions tend encompass broad set general feeling homeostatic control, needs, organ integrity [13.Craig A.D. How do you feel? Interoception: body.Nat. 2002; 3: 655Crossref Scholar,14.Critchley Garfinkel Interoception emotion.Curr. Opin. 17: 7-14Crossref (207) For review, adopt broader definition originating white paper health: namely, 'the stimuli nervous system' [15.Khalsa S.S. al.Interoception roadmap.Biol. Psychiatry Neuroimaging. 2018; 501-513Abstract (339) includes sensing, interpreting, integrating inside 'providing moment-by-moment mapping body's landscape conscious unconscious levels' This distinct exteroceptive proprioceptive information, does not describe per se, but rather information. But what counts 'internal' stimulus? Some sources heart, Others, system, controversial. references controversial provides table indicating each source 'interoceptive' (Figure 1). drive homeostasis means response glass water depends acutely whether thirsty not. Likewise, throughout profound responses experience? Classical models inference suggest autonomic (ANS) causes affects nonspecific processing. framework, ANS mobilised metabolic demands anticipate behaviours, resulting Scholar,16.Kreibig S.D. 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Respiratory phase (inspiration/expiration) alters Nasal inspiration, expiration, improves reaction times fearful (but surprising) faces, potentially due limbic regions [21.Zelano al.Nasal respiration entrains oscillations modulates cognitive function.J. 36: 12448-12467Crossref (158) entrainment amygdalar local field potential predicted identification performance one patient implanted intracranial electrodes Rate breathing valence processing: induced preferentially positive affect, while negative affect [22.Strigo I.A. Craig Interoception, sympathovagal balance.Phil. Trans. Soc. B. 37120160010Crossref (117) reduces heat pain unpleasantness, ameliorating [23.Zautra A.J. affective stimuli: experimental study.Pain. 149: 12-18Abstract (79) Slow influences respiratory, cardiovascular, Within domain, parasympathetic principle driver following involve deficit its downregulation By contrast, 'enhances' bronchiopulmonary vagal afferents, tone, reflected increased rate variability Scholar,24.Berntson G.G. al.Respiratory arrhythmia: origins, mechanisms, psychophysiological implications.Psychophysiology. 1993; 183-196Crossref (648) Slower useful intervention pain, potentially, regulate underpin number therapeutic applications regulation (discussed later). At much slower timescale, evoke motivational reorientation away positive- towards negative-valence [25.Harrison neurocomputational account enhances sensitivity punishments rewards.Biol. 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Cognitive reward, attention, impact (reviewed elsewhere, e.g., [29.Roiser J.P. Sahakian B.J. Hot cold depression.CNS spectrums. 2013; 18: 139-149Crossref (191) Scholar]), shaped dynamic Scholar,30.Critchley cognition.Curr. Behav. 19: 13-18Crossref (14) Even identical, highly differentiated precisely same subjective phenomena people. Therefore, only responses, individual capacity [31.Wiens S. al.Heartbeat detection emotions.Cognit. 2000; 417-427Crossref Quantifying key Perception state, core aspect [14.Critchley arises diverse Anatomically, ascend spinal laminar 1 spinothalamic tract unmyelinated lightly myelinated afferents subdivided into channels (for mechanoreceptor-derived ascending pathway), measured probing various dimensions interoception, accuracy insight (Box Each quantifying [32.Suksasilp Towards comprehensive assessment multi-dimensional framework.Biol. 2022; 168108262Crossref (1) Individual underlie variation population.Box 1Dimensions relevanceInteroception delineated Scholar,15.Khalsa Interoceptive differentially pharmacological, psychological, interventions. Here, provide illustrative examples affecting dimensions.Interoceptive attentionAnxiety self-focus, bias attention cues, sensations [113.Mansell al.Internal anxiety: investigation paradigm.Behav. Ther. 2003; 41: 555-572Crossref Scholar,114.Ewing D.L. al.Sleep linked experiential sleep quality anxiety depression.Biol. 127: 163-172Crossref Therapeutic strategies 'behavioural activation' engagement activities, attentional self.Interoceptive attributionAttribution varies conditions; catastrophic interpretations cardiovascular (such attack) panic disorder, somatoform reduced [115.Okur Güney Z.E. al.Emotion somatic symptom disorders: systematic review.PLoS One. 14e0217277Crossref suggesting disposition interpretations. Interventions therapy (CBT) incorporate attributions.Interoceptive insightInteroceptive (also termed metacognition [70.Garfinkel al.Knowing your own distinguishing awareness.Biol. 2015; 104: 65-74Crossref (576) operationalised confidence–accuracy correspondence tests assess accuracy, alignment FND Preliminary evidence suggests SSRIs [86.Livermore J.J. single oral dose citalopram increases healthy volunteers.Psychopharmacology (Berl). (Published online March 24, 2022. http://doi.org/10.1007/s00213-022-06115-7)Crossref Long-term meditation align self-report [104.Khalsa experienced meditators.Psychophysiology. 45: 671-677Crossref Scholar].Interoceptive self-reportInteroception assessed measures, questionnaires. Conditions autism tendency report being 'aware' [114.Ewing Scholar,116.Garfinkel al.Discrepancies autism: anxiety.Biol. 114: 117-126Crossref accuracyInteroceptive quantified axes, heartbeat resistance tests. alexithymia [117.Shah P. al.Alexithymia, autism, impaired interoception.Cortex. 81: 215-220Crossref (41) schizophrenia [118.Ardizzi M. symptoms schizophrenia.Front. Hum. 10: 379Crossref (26) accuracy. Enhancing aid reduction [106.Quadt L. training autistic adults (ADIE): single-center, superiority randomized controlled trial.EClinicalMedicine. 39101042Abstract (4) Scholar].Preconscious signalsBodily stimulus state) timescales heartbeat). effect heightened anxious individuals Blood pressure medications losartan) extinction memories [89.Marvar P.J. al.Angiotensin type receptor inhibition memory.Biol. 75: 864-872Abstract (67) Scholar].Neural interoceptionNeural areas subserves Disruption found Pharmacological interventions, SSRIs, insula [84.Simmons A.N. al.Subchronic SSRI anticipation volunteers.Int. Neuropsychopharmacol. 12: 1009-1020Crossref (56) Scholar].Afferent signalAutonomic signatures state. Afferent heartbeats frequency/intensity states. Medication, beta-adrenoreceptor blockers, dampen reducing [119.Tyrer Anxiolytics acting benzodiazepine receptor: beta blockers.Prog. Neuro-Psychopharmacol. 1992; 17-26Crossref dimensions. Anxiety

Language: Английский

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Exiting the Anthropocene: Achieving personal and planetary health in the 21st century

Allergy, Journal Year: 2022, Volume and Issue: 77(12), P. 3498 - 3512

Published: June 24, 2022

Planetary health provides a perspective of ecological interdependence that connects the and vitality individuals, communities, Earth's natural systems. It includes social, political, economic ecosystems influence both individuals whole societies. In an era interconnected grand challenges threatening all systems at scales, planetary framework for cross-sectoral collaboration unified approaches to solutions. The field allergy is forefront these efforts. Allergic conditions are sentinel measure environmental impact on human in early life-illuminating how changes affect immune development predispose wider range inflammatory noncommunicable diseases (NCDs). This shows adverse macroscale ecology Anthropocene penetrates molecular level personal microscale ecology, including microbial foundations ecosystems. basis more integrated efforts address widespread degradation effects maladaptive urbanization, food systems, lifestyle behaviors, socioeconomic disadvantage. Nature-based solutions improve nature-relatedness crucial restoring symbiosis, balance, mutualism every sense, recognizing choices collective structural actions needed tandem. Ultimately, meaningful will depend placing greater emphasis psychological cultural dimensions such as mindfulness, values, moral wisdom ensure sustainable resilient future.

Language: Английский

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Automatic segmentation of the choroid plexuses: Method and validation in controls and patients with multiple sclerosis

NeuroImage Clinical, Journal Year: 2023, Volume and Issue: 38, P. 103368 - 103368

Published: Jan. 1, 2023

Choroid Plexuses (ChP) are structures located in the ventricles that produce cerebrospinal fluid (CSF) central nervous system. They also a key component of blood-CSF barrier. Recent studies have described clinically relevant ChP volumetric changes several neurological diseases including Alzheimer's, Parkinson's disease, and multiple sclerosis (MS). Therefore, reliable automated tool for segmentation on images derived from magnetic resonance imaging (MRI) is crucial need large attempting to elucidate their role disorders. Here, we propose novel automatic method datasets. The approach based 2-step 3D U-Net keep preprocessing steps minimum ease use lower memory requirements. models trained validated first research cohort people with MS healthy subjects. A second validation performed pre-symptomatic patients having acquired MRIs routine clinical practice. Our reaches an average Dice coefficient 0.72 ± 0.01 ground truth volume correlation 0.86 while outperforming FreeSurfer FastSurfer-based segmentations. On dataset originating practice, 0.67 (being close inter-rater agreement 0.64 0.02) 0.84. These results demonstrate this suitable robust both

Language: Английский

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Recognizing depression as an inflammatory disease: The search for endotypes

AJP Cell Physiology, Journal Year: 2024, Volume and Issue: 327(1), P. C205 - C212

Published: June 3, 2024

Major depressive disorder (MDD) affects millions of individuals worldwide, leading to considerable social and economic costs. Despite advancements in pharmacological treatments, achieving remission remains a key challenge, with substantial number patients showing resistance existing therapies. This is often associated elevated levels proinflammatory cytokines, suggesting connection between inflammation, MDD pathophysiology, treatment efficacy. The observation increased immune activation about quarter resulted the distinction inflammatory noninflammatory endotypes. Although anti-inflammatory treatments show promise alleviating depression-like symptoms, responses are heterogeneous, thus highlighting importance identifying distinct endotypes tailor effective therapeutic strategies. intestinal microbiome emerges as crucial modulator mental health, mediating its effects partially through different pathways. Microbiota-derived short-chain fatty acids (SCFAs) significantly impact innate adaptive cells, regulating their differentiation, function, cellular response. Furthermore, gut-educated cells reach border regions central nervous system (CNS), glial cell functions. CNS modulates via efferent parts vagus nerve, afferent tracts concurrently transport information on peripheral inflammation back brain. bidirectional communication particularly relevant depression, allowing for stimulation nerve context depression In this review, we explore intricate relationship discuss how signals translated into depressive-like highlight immune-modulating avenues.

Language: Английский

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Choroid plexus volume as a novel candidate neuroimaging marker of the Alzheimer’s continuum

Alzheimer s Research & Therapy, Journal Year: 2024, Volume and Issue: 16(1)

Published: July 3, 2024

Enlarged choroid plexus (ChP) volume has been reported in patients with Alzheimer's disease (AD) and inversely correlated cognitive performance. However, its clinical diagnostic predictive value, mechanisms by which ChP impacts the AD continuum remain unclear.

Language: Английский

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Deconstructing the functional neuroanatomy of the choroid plexus: an ontogenetic perspective for studying neurodevelopmental and neuropsychiatric disorders

Molecular Psychiatry, Journal Year: 2022, Volume and Issue: 27(9), P. 3573 - 3582

Published: May 26, 2022

Abstract The choroid plexus (CP) is a delicate and highly vascularized structure in the brain comprised of dense network fenestrated capillary loops that help synthesis, secretion circulation cerebrospinal fluid (CSF). This unique neuroanatomical arachnoid villi stemming from frond-like surface projections—that protrude into lumen four cerebral ventricles—providing key source nutrients to parenchyma addition serving as ‘sink’ for central nervous system metabolic waste. In fact, functions CP are often described being analogous those liver kidney. Beyond forming barrier/interface between blood CSF compartments, has been identified modulator leukocyte trafficking, inflammation, cognition, circadian rhythm gut brain-axis. recent years, advances molecular biology techniques neuroimaging along with use sophisticated animal models have played an integral role shaping our understanding how CP–CSF changes relation maturation neural circuits during critical periods development. this article we provide ontogenetic perspective review experimental evidence implicating pathophysiology neurodevelopmental neuropsychiatric disorders.

Language: Английский

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The Gut–Immune–Brain Axis: An Important Route for Neuropsychiatric Morbidity in Inflammatory Bowel Disease

International Journal of Molecular Sciences, Journal Year: 2022, Volume and Issue: 23(19), P. 11111 - 11111

Published: Sept. 21, 2022

Inflammatory bowel disease (IBD) comprises Crohn's (CD) and ulcerative colitis (UC) is associated with neuropsychiatric symptoms like anxiety depression. Both conditions strongly worsen IBD burden. In the present review, we summarize current understanding of pathogenesis depression in IBD. We a stepwise cascade along gut-immune-brain axis initiated by evasion chronic intestinal inflammation to pass epithelial vascular barrier gut cause systemic inflammation. then different anatomical transmission routes gut-derived peripheral into central nervous system (CNS) highlight knowledge on neuroinflammatory changes CNS preclinical mouse models focus microglia, brain-resident macrophages. Subsequently, discuss how neuroinflammation can alter neuronal circuitry trigger anxiety. Finally, role microbiota will be reviewed. A more comprehensive interaction between gastrointestinal tract, immune accounting for similarities differences UC CD pave path improved prediction treatment comorbidities other inflammatory diseases.

Language: Английский

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Association between choroid plexus volume and cognition in Parkinson disease

European Journal of Neurology, Journal Year: 2023, Volume and Issue: 30(10), P. 3114 - 3123

Published: July 27, 2023

Abstract Background and purpose The choroid plexus (CP) clears harmful metabolites from the central nervous system as part of glymphatic system. We investigated association CP volume (CPV) with baseline longitudinal cognitive decline in patients Parkinson disease (PD). Methods retrospectively reviewed medical records 240 newly diagnosed PD who had undergone detailed neuropsychological tests high‐resolution T1‐weighted structural magnetic resonance imaging during initial assessment. CPV each patient was automatically segmented, intracranial ratio used subsequent analyses. relationship between composite scores domain assessed using multivariate linear regression A Cox proportional hazards model to compare risk dementia conversion CPV. Results negatively correlated frontal/executive function (β = −0.375, p 0.002) after adjusting for age, sex, years education, parkinsonian symptom duration. revealed that a larger associated higher (hazard [HR] 1.509, 0.038), which no longer significant domain. mediation analysis demonstrated effect on completely mediated by (direct effect: HR 1.203, 0.396; indirect 1.400, 0.015). Conclusions Baseline is function, subsequently influences PD.

Language: Английский

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Choroid plexus volume is enlarged in clinically isolated syndrome patients with optic neuritis

Multiple Sclerosis Journal, Journal Year: 2023, Volume and Issue: 29(4-5), P. 540 - 548

Published: March 6, 2023

Objectives: We investigated choroid plexus (CP) volume in patients presenting with optic neuritis (ON) as a clinically isolated syndrome (CIS), compared to cohort established relapsing–remitting multiple sclerosis (RRMS) and healthy controls (HCs). Methods: Three-dimensional (3D) T1, T2-FLAIR diffusion-weighted sequences were acquired from 44 ON CIS at baseline, 1, 3, 6 12 months after the onset of ON. Fifty RRMS 50 HCs also included for comparison. Results: CP volumes was larger both groups HCs, but not significantly different between (analysis covariance (ANCOVA) adjusted comparisons). Twenty-three who converted definite MS (MS) demonstrated similar patients, HCs. In this sub-group, associated severity nerve inflammation or long-term axonal loss, brain lesion load. A transient increase observed following an occurrence new lesions on magnetic resonance imaging (MRI). Interpretation: Enlarged can be very early disease. It transiently reacts acute inflammation, degree tissue destruction.

Language: Английский

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Cerebral blood flow changes and their genetic mechanisms in major depressive disorder: a combined neuroimaging and transcriptome study

Psychological Medicine, Journal Year: 2023, Volume and Issue: 53(14), P. 6468 - 6480

Published: Jan. 5, 2023

Abstract Background Extensive research has shown abnormal cerebral blood flow (CBF) in patients with major depressive disorder (MDD) that is a heritable disease. The objective of this study was to investigate the genetic mechanisms CBF abnormalities MDD. Methods To achieve more thorough characterization changes MDD, we performed comprehensive neuroimaging meta-analysis previous literature as well examined group differences an independent sample 133 MDD and controls. In combination Allen Human Brain Atlas, transcriptome-neuroimaging spatial association analyses were conducted identify genes whose expression correlated followed by set gene functional feature analyses. Results We found increased reward circuitry default-mode network decreased visual system patients. Moreover, these spatially associated 1532 genes, which enriched for important molecular functions, biological processes, cellular components cortex several common mental disorders. Concurrently, specifically expressed brain tissue, immune cells neurons, during nearly all developmental stages. Regarding behavioral relevance, domains involving emotion sensation. addition, could construct protein-protein interaction supported 60 putative hub significance. Conclusions Our findings suggest perfusion redistribution may be consequence complex interactions wide range diverse features.

Language: Английский

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