Generalized Anxiety Disorder and Social Anxiety Disorder:

广泛性焦虑症和社交焦虑症：

• 批准号: 8158126
• 负责人: james r blair
• 金额: $ 10.2万
• 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/8158126
• 关键词: Anxiety Disorders; Generalized Anxiety Disorder; social

There are three important strands to our work with patients with GSP and GAD. The first of these strands is determining the degree to which the pathology seen in GAD differs from that seen in GSP. In the first study of its kind, we presented patients with GSP, patients with GAD, patients with both GSP and GAD and no pathology individuals with angry, fearful, and neutral facial expression stimuli. We demonstrated clear differences in the pathology of GAD and GSP. Patients with GSP showed significantly increased activation to fearful relative to neutral expressions in several regions, including the amygdala. In contrast, patients with GAD showed significantly reduced activation to fearful relative to neutral faces compared to healthy individuals and patients with GSP but this was coupled with anomalously and significantly increased responses in a lateral region of prefrontal cortex. Patients with comorbid GAD/GSP appeared to present with the pathology associated with the GAD, but not the GSP. Our on-going work has continued to follow this approach. Specifically, we have been examining differences in automatic and controlled emotional regulation across these patient groups. The second strand concerns the specific nature of the functional impairment seen in GSP. Patients with GSP show increased amygdala responses to socially threatening stimuli such as fearful and angry expressions. We followed this work up by examining the neural responses to receipt of praise or criticism in GSP. Participants were presented with positive, negative, and neutral statements (e.g., You are beautiful/ ugly/ human) that could be either about highly relevant and about themselves or less relevant about somebody else (e.g., He is beautiful). The results of this study indicated an important role for not only the amygdala but also medial prefrontal cortex (MPFC) in GSP. MPFC plays an important role in self-referential processing and it now appears that GSP reflects a particular sensitivity to self-referential information. Our on-going work has followed up on these results. In particular, we have been examining the specific nature of this sensitivity to self-referential information in patients with GSP. The third strand of work concerns the specific nature of the functional impairment seen in GAD. It was this third strand that has been the specific focus for the past 12 months. In particular, we wished to examine whether some of the problems in emotional responding in GAD that we observed in our preliminary work with patients with this disorder might manifest in difficulties on decision making tasks. Using several decision making paradigms where successful performance is based on the appropriate representation of reward and punishment expectances, we observed significant impairment in patients with GAD (Devido et al., 2009). Notably, such impairments were not seen in patients with GSP. Our on-going work is following up these results and using functional magnetic resonance imaging to determine their neural basis.

我们对GSP和GAD患者的工作有三个重要方面。这些线索中的第一条是确定在GAD中看到的病理与在GSP中看到的不同程度。在第一个此类研究中，我们向GSP患者、GAD患者、GSP和GAD患者以及没有病理改变的人提供愤怒、恐惧和中性的面部表情刺激。我们在GAD和GSP的病理上表现出明显的区别。GSP患者在包括杏仁核在内的几个区域显示，相对于中性表达，恐惧的激活显著增加。相比之下，与健康人和GSP患者相比，GAD患者表现出相对于中性面孔的恐惧激活显著减少，但这与前额叶皮质外侧区域的异常反应显著增加有关。GAD/GSP并存的患者似乎出现了与GAD相关的病理，而不是GSP。我们正在进行的工作继续遵循这一方针。具体地说，我们一直在检查这些患者群体在自动和控制情绪调节方面的差异。 第二条线索涉及普惠制中所见的功能损害的具体性质。GSP患者表现出对社会威胁刺激的杏仁核反应增强，如恐惧和愤怒的表情。我们进一步研究了普通话水平受试者对表扬或批评的神经反应。参与者得到了正面、负面和中性的陈述(例如，你很漂亮/丑陋/人类)，这些陈述可能是高度相关的，也可能是关于自己的，也可能是与他人无关的(例如，他很漂亮)。本研究结果表明，杏仁核和内侧前额叶皮质在GSP中起着重要作用。MPFC在自我参照加工中起着重要作用，现在看来，GSP反映了一种对自我参照信息的特殊敏感性。我们正在进行的工作已经跟进了这些结果。特别是，我们一直在研究GSP患者对自我参照信息的敏感性的特殊性。 第三项工作涉及GAD中所见的功能障碍的具体性质。过去12个月来，这第三条线索一直是特别关注的焦点。特别是，我们希望检查我们在对患有这种疾病的患者的初步工作中观察到的GAD在情绪反应方面的一些问题是否可能表现为决策任务中的困难。使用几种决策范例，其中成功的绩效基于奖惩期望的适当表示，我们观察到GAD患者的显著损害(DeVido等人，2009年)。值得注意的是，这种损害在GSP患者中未见。我们正在进行的工作是跟踪这些结果，并使用功能磁共振成像来确定它们的神经基础。