Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder
Amygdala and ventrolateral prefrontal cortex activation to masked angry faces in children and adolescents with generalized anxiety disorder
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DOI：
10.1001/archpsyc.65.5.568
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发表时间：
2008-05-01
影响因子：
--
通讯作者：
Pine, Daniel S.
中科院分区：
文献类型：
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作者：
Monk, Christopher S.;Telzer, Eva H.;Pine, Daniel S.
背景：对威胁保持警惕是广泛性焦虑障碍（GAD）的一个关键特征。杏仁核和腹外侧前额叶皮层构成了一个神经回路，负责检测威胁。这些结构之间的相互作用受到干扰可能是儿童焦虑的基础。到目前为止，还没有研究选择性地检查了广泛性焦虑症或小儿焦虑症患者对短暂出现的威胁的反应。目的：探讨儿童广泛性焦虑症（GAD）中杏仁核和腹外侧前额叶皮层在短时威胁处理过程中的激活情况。设计：病例对照研究。单位：政府临床研究所。参与者：青年志愿者，17人患有广泛性焦虑症，12人没有精神病诊断。主要观察指标：我们使用功能性磁共振成像测量血氧水平依赖性信号。在成像过程中，受试者通过快速呈现（17毫秒）隐藏的情绪（愤怒或快乐）和中性面孔来完成注意力定向任务。结果：在观看蒙着面具的愤怒面孔时，广泛性焦虑症青少年的右侧杏仁核激活程度高于对照组，且与焦虑症严重程度呈正相关。此外，在功能连接（心理生理相互作用）分析中，右侧杏仁核和右侧腹外侧前额叶皮层表现出强烈的负耦合，特别是对隐藏的愤怒面孔。这种负耦合在患有广泛性焦虑症的青少年中往往比对照组弱。结论：青年广泛性焦虑症有杏仁核的过度激活，以短暂地呈现隐藏的威胁。右侧腹外侧前额叶皮层和杏仁核之间存在与威胁相关的负向连接，表明前额叶皮层调节杏仁核对威胁的反应。在儿童广泛性焦虑症中，杏仁核的高反应发生在腹侧前额皮质调节的代偿性增加缺失的情况下。
Context: Vigilance for threat is a key feature of generalized anxiety disorder (GAD). The amygdala and the ventrolateral prefrontal cortex constitute a neural circuit that is responsible for detection of threats. Disturbed interactions between these structures may underlie pediatric anxiety. To date, no study has selectively examined responses to briefly presented threats in GAD or in pediatric anxiety.Objective: To investigate amygdala and ventrolateral prefrontal cortex activation during processing of briefly presented threats in pediatric GAD.Design: Case-control study.Setting: Government clinical research institute.Participants: Youth volunteers, 17 with GAD and 12 without a psychiatric diagnosis.Main Outcome Measures: We used functional magnetic resonance imaging to measure blood oxygenation level-dependent signal. During imaging, subjects performed an attention-orienting task with rapidly presented (17 milliseconds) masked emotional (angry or happy) and neutral faces.Results: When viewing masked angry faces, youth with GAD relative to comparison subjects showed greater right amygdala activation that positively correlated with anxiety disorder severity. Moreover, in a functional connectivity (psychophysiological interaction) analysis, the right amygdala and the right ventrolateral prefrontal cortex showed strong negative coupling specifically to masked angry faces. This negative coupling tended to be weaker in youth with GAD than in comparison subjects.Conclusions: Youth with GAD have hyperactivation of the amygdala to briefly presented masked threats. The presence of threat-related negative connectivity between the right ventrolateral prefrontal cortex and the amygdala suggests that the prefrontal cortex modulates the amygdala response to threat. in pediatric GAD, amygdala hyperresponse occurs in the absence of a compensatory increase in modulation by the ventrolateral prefrontal cortex.