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Brain structure and joint hypermobility: Relevance to the expression of psychiatric symptoms

  • J. A. Eccles (a1), F. D. C. Beacher (a2), M. A. Gray (a2), C. L. Jones (a2), L. Minati (a2), N. A. Harrison (a3) and H. D. Critchley (a3)...

Summary

Joint hypermobility is overrepresented among people with anxiety and can be associated with abnormal autonomic reactivity. We tested for associations between regional cerebral grey matter and hypermobility in 72 healthy volunteers using voxel-based morphometry of structural brain scans. Strikingly, bilateral amygdala volume distinguished those with from those without hypermobility. The hypermobility group scored higher for interoceptive sensitivity yet were not significantly more anxious. Our findings specifically link hypermobility to the structural integrity of a brain centre implicated in normal and abnormal emotions and physiological responses. Our observations endorse hypermobility as a multisystem phenotype and suggest potential mechanisms mediating clinical vulnerability to neuropsychiatric symptoms.

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Copyright

Royal College of Psychiatrists, This paper accords with the Wellcome Trust Open Access policy and is governed by the licence available at http://www.rcpsych.ac.uk/pdf/Wellcome%20Trust%20licence.pdf

Corresponding author

Dr Jessica Eccles, Psychiatry, Brighton and Sussex Medical School Brighton, BN1 9RR, UK. Email: J.Eccles@bsms.ac.uk

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Declaration of interest

None.

Footnotes

References

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Brain structure and joint hypermobility: Relevance to the expression of psychiatric symptoms

  • J. A. Eccles (a1), F. D. C. Beacher (a2), M. A. Gray (a2), C. L. Jones (a2), L. Minati (a2), N. A. Harrison (a3) and H. D. Critchley (a3)...

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Brain structure and joint hypermobility: Relevance to the expression of psychiatric symptoms

  • J. A. Eccles (a1), F. D. C. Beacher (a2), M. A. Gray (a2), C. L. Jones (a2), L. Minati (a2), N. A. Harrison (a3) and H. D. Critchley (a3)...
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eLetters

Joint Hypermobility and Psychiatry

Antonio Bulbena, Director
21 July 2012

We have read the original paper of Eccles et al. (2012) about the brain structure of the Joint Hypermobility (JH), which provides the first evidence of brain characteristics of subjects who suffer from this collagen condition. Authors claim that their findings may be relevant for the psychiatric symptoms and suggest that joint hypermobility might be a vulnerability factor for anxiety. However they are not fully aware of a series of papers describing the relationship of the joint hypermobility and psychiatric conditions, both in the clinical expression and also as a risk factor for anxiety. We had the opportunity of describing for the first time the strong link of the Joint hypermobility and Anxiety in 1988 (Bulbena et al 1988) and ever since, this association has been replicated several times both in clinical and also in non clinical samples. Although panic disorder, agoraphobia and social phobia are the associated psychiatric conditions most substantiated by evidence, schizophrenic patients with properly diagnosed comorbid anxiety disorders also score higher in joint hypermobility scales (Bulbena et al. 2007). Among non clinical samples, subjects JH subjects tend to score higher in fear scales, Spielberger Trait State inventory (STAI) but also in body perception and social anxiety scales (Baeza et al, 2011). Authors also suggest "vulnerability to stress and anxiety in individuals with hypermobility" and this has also been studied in an extensive 15 yearfollow up, in which subjects with properly diagnosed Joint hypermobility compared to those without this risk factor, showed a Relative Risk of 22.3for Panic/Agoraphobia, RR of 6.52 for Social Phobia and RR of 3.31 of Specific Phobia (Bulbena et al 2011). The contribution of the paper of Eccles et al. is very important for the progress of the understanding of anxiety disorders, both in their biological basis and their clinical expression (sometime named phenotype) which often remains unnoticed. This paper confirms that this collagen condition is not only a risk factor for anxiety (both in clinical and in non clinical samples) but also provide new bases to understand anxiety disorders as complex clinical conditions rather tan just psychiatric boundillness.

Institute Neuropsychiatry and Addictions. Hospital del Mar. Barcelona.Dep. Psychiatry. University Aut?noma Barcelona.

Eccles J, Beacher FD, Gray MA, et al (2012). Brain structure and joint hypermobility: relevance to the expression of psychiatric symptoms BJP 2012, 200:508-509.Bulbena A, Duro JC, Mateo A, et al. (1988) Joint hypermobility syndrome and anxiety disorders. Lancet. Sep 17;2(8612):694.Bulbena A, Sperry L, Anguiano B, et al. (2007). Joint Hypermobility in Schizophrenia: A Potential Marker for Co-Morbid Anxiety. The Open Psychiatry Journal, 1, 31-33.

Baeza-Velasco C, Gely-Nargeot, Bulbena A, et al (2011). Association between psychopathological factors and joint hypermobility syndrome in a group of undergraduates from a French university. Int J Psychiatry Med. 2011;41(2):187-201.

Bulbena A, Gago J, Pailhez G, et al. (2011) Joint hypermobility syndrome is a risk factor trait for anxiety disorders: a 15-year follow-upcohort study. Gen Hosp Psychiatry. Jul-Aug;33(4):363-70.

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Conflict of interest: None declared

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