Alterations in Amygdala-Prefrontal Functional Connectivity Account for Excessive Worry and Autonomic Dysregulation in Generalized Anxiety Disorder
Alterations in Amygdala-Prefrontal Functional Connectivity Account for Excessive Worry and Autonomic Dysregulation in Generalized Anxiety Disorder
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DOI：
10.1016/j.biopsych.2015.10.013
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发表时间：
2016-11-15
影响因子：
10.6
通讯作者：
Ottaviani, Cristina
中科院分区：
文献类型：
--
作者：
Makovac, Elena;Meeten, Frances;Ottaviani, Cristina
背景：广泛性焦虑障碍（GAD）是以无法控制的忧虑为核心症状的一种焦虑障碍。功能性磁共振成像研究将这种症状与杏仁核和前额皮质之间的异常功能连接联系起来。广泛性焦虑症患者还表现出自主神经功能失调的特征。虽然额边缘回路与自主神经觉醒的调节有关，但据我们所知，以前没有研究将这些患者的功能磁共振成像与外周生理监测相结合，以验证GAD中担忧和自主神经失调的核心症状来自共同的潜在神经机制的假设。我们使用静息态功能磁共振成像和副交感神经自主神经功能的测量（心率变异性）在19例GAD患者和21名对照受试者，以确定神经相关的自主神经和认知反应之前和之后的诱导持续认知。种子为基础的分析进行量化的功能连接与右，左amygdala.RESULTS：诱导前，患者表现出相对较低的连接右杏仁核和右上级额回，右副扣带/前扣带皮层，右缘上回比对照组。诱导后，这种连接模式在GAD患者中增加，在对照组中减少，这些变化跟踪状态持续认知的增加。此外，左杏仁核和膝下扣带皮层之间以及右杏仁核和尾状核之间的功能连接性降低预测了诱导后心率变异性降低的幅度。我们的研究结果将焦虑和沉思背后的大脑功能机制与自主神经控制障碍联系起来，强调重叠的神经基板与认知和自主反应的诱导与广泛性焦虑症患者的持续认知。
BACKGROUND: Generalized anxiety disorder (GAD) is characterized by the core symptom of uncontrollable worry. Functional magnetic resonance imaging studies link this symptom to aberrant functional connectivity between the amygdala and prefrontal cortex. Patients with GAD also display a characteristic pattern of autonomic dysregulation. Although frontolimbic circuitry is implicated in the regulation of autonomic arousal, no previous study to our knowledge combined functional magnetic resonance imaging with peripheral physiologic monitoring in these patients to test the hypothesis that core symptoms of worry and autonomic dysregulation in GAD arise from a shared underlying neural mechanism.METHODS: We used resting-state functional magnetic resonance imaging and the measurement of parasympathetic autonomic function (heart rate variability) in 19 patients with GAD and 21 control subjects to define neural correlates of autonomic and cognitive responses before and after induction of perseverative cognition. Seed-based analyses were conducted to quantify brain changes in functional connectivity with the right and left amygdala.RESULTS: Before induction, patients showed relatively lower connectivity between the right amygdala and right superior frontal gyrus, right paracingulate/anterior cingulate cortex, and right supramarginal gyrus than control subjects. After induction, such connectivity patterns increased in patients with GAD and decreased in control subjects, and these changes tracked increases in state perseverative cognition. Moreover, decreases in functional connectivity between the left amygdala and subgenual cingulate cortex and between the right amygdala and caudate nucleus predicted the magnitude of reduction in heart rate variability after induction.CONCLUSIONS: Our results link functional brain mechanisms underlying worry and rumination to autonomic dyscontrol, highlighting overlapping neural substrates associated with cognitive and autonomic responses to the induction of perseverative cognitions in patients with GAD.