Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior, such as pacing back and forth, somatic complaints, and rumination.

It is the subjectively unpleasant feelings of dread over anticipated events, such as the feeling of imminent death.

Anxiety is not the same as fear, which is a response to a real or perceived immediate threat; whereas anxiety is the expectation of future threat.

Anxiety is a feeling of fear, worry, and uneasiness, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.

It is often accompanied by muscular tension, restlessness, fatigue and problems in concentration. Anxiety can be appropriate, but when experienced regularly the individual may suffer from an anxiety disorder.

Diffuse axonal injury (DAI) patients are frequently accompanied by adverse sequelae and psychiatric disorders, such as anxiety, leading to a decreased quality of life, social isolation, and poor outcomes. However, the mechanisms regulating psychiatric disorders post-DAI are not well elucidated. Previous studies showed that endoplasmic reticulum stress functions as a pivotal factor in neurodegeneration disease. In a study, Huang et al., showed that DAI can trigger ER stress and unfolded protein response (UPR) activation in both the acute and chronic periods, leading to cell death and anxiety disorder. Treatment with 4-phenylbutyrate (4-PBA) is able to inhibit the UPR and cell apoptosis and relieve the anxiety disorder in our DAI model. However, later (14 days post-DAI) 4-PBA treatment can only restore the related gene expression of ER stress and UPR but not the psychiatric disorder. Therefore, the early (5 mins after DAI) administration of 4-PBA might be a therapeutic approach for blocking the ER stress/UPR-induced cell death and anxiety disorder after DAI 1).

Mood and anxiety disorders were more commonly seen in patients with lumbar disc herniation or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits 2).

Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction.

Anxiety symptoms during a vestibular stimulus may contribute to a priming effect that could explain worsening balance function 3).

Balance symptom severity, anxiety symptoms, and ambulant posture were significant contributors to disability and should be the focus of vestibular rehabilitation strategies 4).

Huang GH, Chen K, Sun YY, Zhu L, Sun ZL, Feng DF. 4-Phenylbutyrate ameliorates anxiety disorder by inhibiting endoplasmic reticulum stress following diffuse axonal injury. J Neurotrauma. 2018 Dec 22. doi: 10.1089/neu.2018.6048. [Epub ahead of print] PubMed PMID: 30582423.
Kayhan F, Albayrak Gezer İ, Kayhan A, Kitiş S, Gölen M. Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation. Int J Psychiatry Clin Pract. 2015 Nov 2:1-5. [Epub ahead of print] PubMed PMID: 26524007.
Saman Y, Mclellan L, Mckenna L, Dutia MB, Obholzer R, Libby G, Gleeson M, Bamiou DE. State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma. Front Neurol. 2016 Jul 13;7:101. eCollection 2016. PubMed PMID: 27468274.
Saman Y, Bamiou DE, Murdin L, Tsioulos K, Davies R, Dutia MB, Obholzer R, Gleeson M. Balance, falls risk, and related disability in untreated vestibular schwannoma patients. J Neurol Surg B Skull Base. 2014 Oct;75(5):332-8. doi: 10.1055/s-0034-1372469. Epub 2014 May 2. PubMed PMID: 25276598; PubMed Central PMCID: PMC4176536.
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