Prefrontal dysfunction during emotion regulation in generalized anxiety and panic disorders.
Prefrontal dysfunction during emotion regulation in generalized anxiety and panic disorders.
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DOI：
10.1017/s0033291712002383
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发表时间：
2013-07
影响因子：
6.9
通讯作者：
Stein, M. B.
中科院分区：
文献类型：
--
作者：
Ball, T. Manber;Ramsawh, H. J.;Campbell-Sills, L.;Paulus, M. P.;Stein, M. B.
导致焦虑症情绪失调的机制尚不清楚。研究人员对广泛性焦虑症（GAD）和恐慌症（PD）这两种常见疾病进行了检查，以检验这两种疾病的特点是情绪调节过程中前额皮质（PFC）激活不足的假设。还评估了一个相互竞争的假设，即 GAD 的特点是情绪调节过程中 PFC 过度激活（反映过度活跃的自上而下控制）。 22 名未服用药物的健康对照 (HC)、23 名 GAD 和 18 名 PD 参与者在一项要求他们重新评估（即减少）或维持对负面图像的情绪反应的任务期间接受了功能磁共振成像 (fMRI)。 GAD 参与者报告日常生活中重新评估的使用最少，并且重新评估的使用与这些参与者的焦虑严重程度和功能障碍呈负相关。在功能磁共振成像期间，在重新评估和维持期间，HC 在对情绪调节重要的大脑区域（例如背外侧和背内侧 PFC）中表现出比 GAD 或 PD（两者没有差异）更大的激活。此外，在所有焦虑参与者中，重新评估背外侧和背内侧 PFC 期间的激活与焦虑严重程度和功能障碍呈负相关。 GAD 和 PD 的情绪失调可能是情绪调节期间 PFC 低激活的结果，与自上而下控制不足相一致。 PFC 低激活与功能障碍之间的关系表明，在情绪调节过程中未能参与 PFC 可能是从性格性高度焦虑到焦虑症的关键转变的一部分。
The mechanisms that contribute to emotion dysregulation in anxiety disorders are not well understood. Two common disorders, Generalized Anxiety Disorder (GAD) and Panic Disorder (PD), were examined to test the hypothesis that both disorders are characterized by hypo-activation in prefrontal cortex (PFC) during emotion regulation. A competing hypothesis that GAD in particular is characterized by PFC hyper-activation during emotion regulation (reflecting overactive top-down control) also was evaluated. Twenty-two medication-free Healthy Control (HC), 23 GAD, and 18 PD participants underwent functional magnetic resonance imaging (fMRI) during a task that required them to reappraise (i.e., reduce) or maintain emotional responses to negative images. GAD participants reported the least reappraisal use in daily life, and reappraisal use was inversely associated with anxiety severity and functional impairment in these participants. During fMRI, HC demonstrated greater activation during both reappraisal and maintenance than either GAD or PD (who did not differ) in brain areas important for emotion regulation (e.g., dorsolateral and dorsomedial PFC). Furthermore, across all anxious participants, activation during reappraisal in dorsolateral and dorsomedial PFC was inversely associated with anxiety severity and functional impairment. Emotion dysregulation in GAD and PD may be the consequence of PFC hypo-activation during emotion regulation, consistent with insufficient top-down control. The relationship between PFC hypo-activation and functional impairment suggests that the failure to engage PFC during emotion regulation may be part of the critical transition from dispositionally high anxiety to an anxiety disorder.