Classification of anxiety disorders from a neuroscience perspective: Implications for the assessment and treatment and anxiety disorders

指导这项研究的假设是，焦虑障碍的诊断在恐惧/防御回路功能的连续体中有所不同。在连续统一体的一端是动机回路正常但反应性夸张的患者，其病理主要由恐惧反应目标的不适当性（即，它不是现实的威胁性）来定义-如单一诊断的特定恐惧症或局限性社交恐惧症；下一步是广泛性过度反应的障碍，其中恐惧反应是由多种刺激或不可预测的厌恶事件引起的，恐惧状态越来越持续；最后一个阶段出现在以长期功能障碍（障碍慢性性）、症状严重程度高、合并症高、“负性情绪”高为特征的焦虑患者。在后一组患者中，恐惧回路似乎受损，功能失调，无法调解通常发生在威胁背景下的防御反射（例如惊吓增强）。对这种基于情感和神经科学的精神病理学概念的研究是新颖的，突破了具有重要临床意义的重要新领域，超越了目前主要基于患者症状报告的诊断分类。尽管已经有许多关于焦虑患者惊吓增强到恐惧线索的研究，使用了各种范式，但其慢性、严重程度和合并症的问题仍未得到解决。本文提出的研究策略是检查全谱焦虑症（包括合并抑郁和多重焦虑合并症的患者）中多动/低动的反射和大脑测量，从而使用多重测量方法评估假设的恐惧/防御回路功能连续体的不同阶段。

The hypothesis guiding the proposed research is that anxiety disorder diagnoses vary along a continuum of fear/defense circuit function. At one end of the continuum are patients whose motivational circuitry is normal but exaggerated in reactivity for whom the pathology is mainly defined by the inappropriateness of the fear reaction´s target (i.e., it is not realistically minatory) – as in single-diagnosis specific phobia or circumscribed social phobia; the next step is to disorders in which the hyperreactivity is generalized, in which fear reactions are prompted by multiple stimuli or unpredictable aversive events and the fear state is increasingly sustained; the final step is found in anxiety patients characterized by long-enduring dysfunction (disorder chronicity), intense symptom severity, high comorbidity, and high “negative affectivity”. In this latter group of patients, the fear circuit appears to be compromised, functionally dysregulated, and fails to mediate defensive reflexes (e.g., startle potentiation) that normally occur in the context of threat. The proposed examination of this emotion and neuroscience based conception of psychopathology is novel and breaks important new ground of major clinical significance, going beyond current diagnostic categorizations that are mainly based on patient´s symptom reports. Although there have been many studies of startle potentiation to fear cues in anxiety patients, using a variety of paradigms, issues of chronicity, severity, and comorbidity remain unsresolved. The proposed research strategy is to examine reflex and brain measures of hyperactivity/hypoactivity in the full spectrum of anxiety disorders (including patients with comorbid depression and multiple anxiety comorbidities), thus assessing at different stages on the hypothesized continuum of fear/defense circuit function, using a multiple measurement approach.