Neuroimaging Predictors and Mechanisms of Treatment Response in Social Anxiety Disorder: an Overview of the Amygdala.
Neuroimaging Predictors and Mechanisms of Treatment Response in Social Anxiety Disorder: an Overview of the Amygdala.
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DOI：
10.1007/s11920-018-0948-1
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发表时间：
2018-08-28
影响因子：
6.7
通讯作者：
Fitzgerald, Jacklynn M.
中科院分区：
文献类型：
--
作者：
Klumpp, Heide;Fitzgerald, Jacklynn M.
异常的杏仁核活动与社交焦虑障碍（SAD）的神经生物学有关，因此是一个治疗靶点。然而，杏仁核预测临床改善或受治疗影响的程度尚未得到严格检查。这篇综述强调了最近从临床试验和研究中发现的杏仁核和作用机制之间的联系。神经预测因子研究主要包括心理治疗，其中通过杏仁核活动和杏仁核以外的区域如额叶结构（例如，前扣带皮层，内侧前额叶皮层）和涉及视觉过程的区域（例如，枕区、上级颞回）。杏仁核和额叶区域之间的治疗前功能连接也被证明可以预测改善，这意味着支持情绪处理和调节的回路与治疗相互作用。治疗前至治疗后的研究显示，无论治疗方式如何，杏仁核反应都会降低，杏仁核通路的功能连接也会改变。在恐惧暴露的模拟研究中，杏仁核对语言挑战的反应减少，焦虑减少，杏仁核活动减少。然而，研究也未能检测到杏仁核的影响，而是报告了支持感觉，情绪和调节过程的区域和功能系统的治疗相关变化。皮质边缘子回路和纹外皮质中的一系列区域似乎是可行的作用部位。杏仁核和杏仁核通路预测治疗结果，并在治疗后改变。然而，还需要进一步的研究来确定杏仁核和其他候选区域以及大脑回路作为作用部位的作用。
Aberrant amygdala activity is implicated in the neurobiology of social anxiety disorder (SAD) and is, therefore, a treatment target. However, the extent to which amygdala predicts clinical improvement or is impacted by treatment has not been critically examined. This review highlights recent neuroimaging findings from clinical trials and research that test links between amygdala and mechanisms of action. Neuropredictor studies largely comprised psychotherapy where improvement was foretold by amygdala activity and regions beyond amygdala such as frontal structures (e.g., anterior cingulate cortex, medial prefrontal cortex) and areas involved in visual processes (e.g., occipital regions, superior temporal gyrus). Pre-treatment functional connectivity between amygdala and frontal areas was also shown to predict improvement signifying circuits that support emotion processing and regulation interact with treatment. Pre-to-post studies revealed decreases in amygdala response and altered functional connectivity in amygdala pathways regardless of treatment modality. In analogue studies of fear exposure, greater reduction in anxiety was predicted by less amygdala response to a speech challenge and amygdala activity decreased following exposures. Yet, studies have also failed to detect amygdala effects reporting instead treatment-related changes in regions and functional systems that support sensory, emotion, and regulation processes. An array of regions in the corticolimbic subcircuits and extrastriate cortex appear to be viable sites of action. The amygdala and amygdala pathways predict treatment outcome and are altered following treatment. However, further study is needed to establish the role of the amygdala and other candidate regions and brain circuits as sites of action.
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