Generalized Anxiety Disorder and Social Anxiety Disorder

广泛性焦虑症和社交焦虑症

• 批准号: 9152108
• 负责人: james r blair
• 金额: $ 13.23万
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9152108
• 关键词: Affective; Alcohol abuse; Anxiety Disorders; Behavioral; Biological Markers; Diagnostic and Statistical Manual of Mental Disorders; Disease; Drug abuse; Event; Fright; Functional Magnetic Resonance Imaging; Functional disorder; Future; General Population; Generalized Anxiety Disorder; Goals; Impaired cognition; Impairment; Individual; Intervention; Life; Medial; Mental Depression; Myocardial Infarction; Neurobiology; Participant; Patients; Population; Prefrontal Cortex; Prevalence; Protocols documentation; Relative (related person); Social Anxiety Disorder; Social Phobia; Specificity; Suggestion; Suicide; Thinking; Work; base; cognitive neuroscience; economic cost; experience; high risk; neuromechanism; optimism; relating to nervous system; response; social; social situation; therapeutic target

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.

在过去 12 个月中，我们在针对广泛性焦虑症 (GAD) 和广泛性社交恐惧症 (GSP) 患者的工作中，有一个特别突出的部分。 病理性忧虑是 DSM 中广泛性焦虑症的定义特征。 因此，了解广泛性焦虑症担忧背后的神经功能障碍可能是一个重要的治疗目标。 然而，人们对焦虑的神经基础以及焦虑如何在广泛性焦虑症患者中导致治疗进展复杂化的机制知之甚少。 人们对一种可以被视为与担忧相对立的结构有了更多的了解：乐观偏见（OB）。 大多数健康人都会表现出OB，并认为与普通人相比，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，在之前的行为研究中，我们发现广泛性焦虑症与对未来的 OB（即现实看法）减少有关。 具体来说，当我们要求参与者表明与普通人相比，他们认为自己经历积极的事情（例如，剪一个漂亮的发型；中彩票）或消极的事情（例如，剪一个糟糕的发型；心脏病发作）的可能性有多大时，广泛性焦虑症患者不太可能保持乐观。 今年的一个目标是使用 fMRI 确定 GAD 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 特有的。 与之前的工作一致，健康参与者表现出显着的 OB；他们认为，与其他人相比，自己在未来经历负面事件的可能性要小得多，但在未来经历积极事件的可能性要大得多。 这在普惠制中也有所体现。 然而，GAD 患者没有表现出明显的 OB。 在神经水平上，与 GAD 组相比，健康组和 GSP 组的 OB 与内侧前额叶皮层 (rmPFC) 的调节显着增强相关。 GAD 组与其他两组的不同之处还在于，与高影响（例如心脏病发作）事件相比，GAD 组对低影响（例如理发不好）事件的神经反应增强。 GAD 患者的这种神经功能障碍，尤其是 mPFC 内的神经功能障碍，可能是导致该人群乐观情绪降低和对日常事件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，这表明疾病的特异性以及它可能代表广泛性焦虑症治疗的重要生物标志物的可能性。

项目成果

Cognitive control of attention is differentially affected in trauma-exposed individuals with and without post-traumatic stress disorder.

• DOI: 10.1017/s0033291712000840
• 发表时间: 2013-01
• 期刊: PSYCHOLOGICAL MEDICINE
• 影响因子: 6.9
• 作者: Blair, K. S.;Vythilingam, M.;Crowe, S. L.;McCaffrey, D. E.;Ng, P.;Wu, C. C.;Scaramozza, M.;Mondillo, K.;Pine, D. S.;Charney, D. S.;Blair, R. J. R.
• 通讯作者: Blair, R. J. R.

Stimulus-reinforcement-based decision making and anxiety: impairment in generalized anxiety disorder (GAD) but not in generalized social phobia (GSP).

• DOI: 10.1017/s003329170800487x
• 发表时间: 2009-07
• 期刊: PSYCHOLOGICAL MEDICINE
• 影响因子: 6.9
• 作者: DeVido, J.;Jones, M.;Geraci, M.;Hollon, N.;Blair, R. J. R.;Pine, D. S.;Blair, K.
• 通讯作者: Blair, K.