Generalized Anxiety Disorder and Social Anxiety Disorder

在过去的12个月里，我们对广泛性焦虑症（GAD）和广泛性社交恐惧症（GSP）患者的一项特别工作脱颖而出。 病理性担忧是DSM中GAD的主要特征。 因此，了解广泛性焦虑症患者的神经功能障碍可能是一个重要的治疗目标。 然而，关于焦虑的神经基础以及它们如何在广泛性焦虑症患者中发生故障，使治疗进展复杂化，我们知之甚少。 人们对一种可能被视为与担忧相对应的结构了解得更多：乐观偏见（OB）。 OB是由大多数健康的人所表现出来的，并且涉及到与普通人相比，他们不太可能经历消极的生活事件，但更有可能经历积极的生活事件。 然而，在以前的行为研究中，我们发现GAD与OB减少有关（即，现实的观点（关于未来）。 特别是当我们要求参与者指出他们认为自己有多大可能经历积极的事情时（例如，具有很棒的发型;赢得彩票）或负面（例如，与普通人相比，患有广泛性焦虑症的患者不太可能乐观。 今年的一个目标是使用功能磁共振成像确定GAD中这种认知障碍的神经基础，并确定这种障碍是否是GAD特有的，而不是GSP。 与以前的工作一致，健康的参与者表现出显着的OB;他们认为自己不太可能经历未来的负面，但更有可能经历未来的积极事件相对于他人。 这一点也体现在普惠制中。 然而，GAD患者没有表现出明显的OB。 在神经水平，OB与内侧前额叶皮层（rmPFC）的调节显着更大的健康和GSP组相比，广泛性焦虑症组。 GAD组也与其他两组不同，表现出对低冲击的神经反应增加（例如，具有糟糕的发型）相对于高冲击（例如，心脏病发作）事件。广泛性焦虑症患者的这种神经功能障碍，特别是mPFC内的神经功能障碍，可能是导致该人群对日常事件的乐观情绪降低和担忧增加的神经基础。 此外，重要的是，GSP患者没有表现出这种功能障碍，表明疾病特异性和可能性，它可以代表一个重要的生物标志物治疗广泛性焦虑症。

Over the last 12 months, one particular strand of our work with patients with Generalized Anxiety Disorder (GAD) and Generalized Social Phobia (GSP) stands out. Pathological worry is the defining feature of GAD in DSM. Understanding the neural dysfunction underlying worry in GAD therefore likely represents an important treatment target. However very little is known about the neural underpinnings of worry or how they may malfunction in patients with GAD complicating treatment progress. More is known about a construct that may be viewed as a counterpoint to worry: optimistic bias (OB). OB is shown by most healthy individuals and involves thinking that compared to the average individual they are less likely to experience negative life events, but more likely to experience positive life events. However, in previous behavioral work we have found that GAD is associated with a reduced OB (i.e., realistic view) about the future. Specifically when we asked participants to indicate how likely they thought they were to experience something positive (e.g., having a great haircut; winning the lottery) or negative (e.g., having a bad haircut; having a heart attack) compared to the average individual, patients with GAD were much less likely to be optimistic. One goal this year was to determine the neural basis of this cognitive impairment in GAD using fMRI and to determine whether such impairment is specific to GAD and not GSP. In line with previous work, healthy participants showed significant OB; they considered themselves significantly less likely to experience future negative but significantly more likely to experience future positive events relative to others. This was also seen in GSP. However, GAD patients showed no significant OB. At the neural level, OB was associated with significantly greater modulation of medial prefrontal cortex (rmPFC) in the healthy and GSP groups compared to the GAD group. The GAD group also differed from the two other groups by showing increased neural responses to low impact (e.g., having a bad haircut) relative to high impact (e.g., having a heart attack) events. This neural dysfunction, particularly within mPFC, in patients with GAD may represent the neural substrate that underlies the reduced optimism and increased worry about everyday events in this population. Further and importantly, patients with GSP did not show such dysfunction, suggesting disorder-specificity and the possibility it could represent an important biomarker for treatment of GAD.