Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging.
Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging.
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DOI：
10.1001/2013.jamapsychiatry.5
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发表时间：
2013-01
期刊：
影响因子：
25.8
通讯作者：
Gabrieli, John D.
中科院分区：
文献类型：
--
作者：
Doehrmann, Oliver;Ghosh, Satrajit S.;Polli, Frida E.;Reynolds, Gretchen O.;Horn, Franziska;Keshavan, Anisha;Triantafyllou, Christina;Saygin, Zeynep M.;Whitfield-Gabrieli, Susan;Hofmann, Stefan G.;Pollack, Mark;Gabrieli, John D.
当前的行为测量方法对社交焦虑障碍（SAD）的治疗结果预测效果不佳。据我们所知，这是第一项在社交焦虑障碍中研究基于神经影像学的治疗预测的研究。
测量社交焦虑障碍患者的大脑激活情况作为一种生物标志物，以预测其对认知行为疗法（CBT）的后续反应。
在认知行为疗法干预之前收集功能性磁共振成像（fMRI）数据。将临床状态的变化与大脑反应进行回归分析，并测试对社会刺激的选择性。
患者在波士顿大学或麻省总医院的焦虑障碍项目中接受基于方案的认知行为疗法治疗，并在麻省理工学院进行神经影像学数据收集。
39名符合《精神疾病诊断与统计手册》第四版（DSM - IV）中广泛性社交焦虑障碍亚型标准且未服用药物的患者。
在认知行为疗法开始之前，利用功能性磁共振成像检查患者对愤怒与中性面孔或情绪化与中性场景的大脑反应。
以愤怒与中性面孔的功能性磁共振成像差异反应以及利博维茨社交焦虑量表得分的变化作为治疗结果的衡量指标，进行全脑回归分析。
治疗前的反应能够选择性地针对社会刺激显著预测患者随后的治疗结果，尤其是在高级视觉皮层区域。将大脑测量结果与临床严重程度信息相结合，能够解释治疗反应中超过40%的方差，大大超过了基于基线临床测量的预测。预测的成功不受对潜在混杂因素（如基线时的抑郁严重程度）检验的影响。
研究结果表明，大脑成像能够提供生物标志物，极大地提高对认知行为干预成功的预测，并且更普遍地表明，此类生物标志物可能为患者在治疗方案中进行最佳选择提供基于证据的个性化医疗方法。
Current behavioral measures poorly predict treatment outcome in social anxiety disorder (SAD). To our knowledge, this is the first study to examine neuroimaging-based treatment prediction in SAD. To measure brain activation in patients with SAD as a biomarker to predict subsequent response to cognitive behavioral therapy (CBT). Functional magnetic resonance imaging (fMRI) data were collected prior to CBT intervention. Changes in clinical status were regressed on brain responses and tested for selectivity for social stimuli. Patients were treated with protocol-based CBT at anxiety disorder programs at Boston University or Massachusetts General Hospital and underwent neuroimaging data collection at Massachusetts Institute of Technology. Thirty-nine medication-free patients meeting DSM-IV criteria for the generalized subtype of SAD. Brain responses to angry vs neutral faces or emotional vs neutral scenes were examined with fMRI prior to initiation of CBT. Whole-brain regression analyses with differential fMRI responses for angry vs neutral faces and changes in Liebowitz Social Anxiety Scale score as the treatment outcome measure. Pretreatment responses significantly predicted subsequent treatment outcome of patients selectively for social stimuli and particularly in regions of higher-order visual cortex. Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline. The results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient.
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影响因子：
3.5
作者：
Gorgolewski K;Burns CD;Madison C;Clark D;Halchenko YO;Waskom ML;Ghosh SS
通讯作者：
Ghosh SS
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
DWASS, M
通讯作者：
DWASS, M
影响因子：
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作者：
Hofmann, SG;Meuret, AE;Otto, MW
通讯作者：
Otto, MW