Generalized Anxiety Disorder and Social Anxiety Disorder:

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。在之前的工作中，我们首次证明了GSP和GAD患者对情绪表达刺激的反应不同。具体地说，我们发现在GAD患者中没有看到GSP对恐惧表达的杏仁核反应增强。事实上，它们显示出反应迟钝的迹象。在过去的一年里，我们在两个重要方面推广了这些结果：(A)只有GAD患者而不是GSP患者表现出更少的乐观偏见。这似乎反映了吻侧额叶内侧皮质在比较过程中的功能障碍；以及(B)只有GSP患者而不是GAD患者在社会参照的背景下表现出功能障碍。社会参照是指个体通过观察他人对事物和行为的反应来了解它们的价值的过程。 第二条线索涉及普惠制中所见的功能损害的具体性质。在以前的工作中，我们已经表明，GSP不仅仅代表杏仁核对社会威胁的高度反应。相反，似乎还有一种非典型的社会信息自我参照加工。简而言之，我们早期的工作表明，不仅杏仁核，而且内侧前额叶皮质(MPFC，自我参照加工的关键区域)在GSP中起着重要作用。今年，我们扩展了这项工作，表明GSP患者在参与社会参照(观看另一个人对对象的情绪反应)时，杏仁核和内侧前额叶皮质的反应比对照人群高。此外，GSP患者对与另一个人相关的物体的杏仁核反应增强，表现出情绪表现。重要的是，社会参照被认为对恐惧症的发展和维持很重要，这种损害可能有助于这种障碍的持续。 第三项工作涉及GAD中所见的功能障碍的具体性质。特别是，我们一直在研究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。在前人研究的基础上，我们开发了一种适用于功能磁共振成像的乐观偏向任务。乐观偏见指的是，健康的人倾向于认为，比起统计上的可能性，好事更有可能发生，坏事发生的可能性更小。在抑郁症中可以看到减少的乐观偏见，我们发现它也出现在GAD中，但GSP中没有。重要的是，我们确定了神经计算损伤，这可能是广泛性AD损伤的基础。具体地说，吻侧额叶内侧皮质在配价事件概率比较中的作用在广泛性AD中似乎被破坏了。

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 previous work, we were the first to demonstrate that patients with GSP and GAD differ in their responsiveness to emotional expression stimuli. Specifically, we showed that the heightened amygdala response to fearful expressions seen in GSP is not seen in patients with GAD. Indeed, they show indications of hypo-responsiveness. Over the past year, we have extended these results in two important ways: (a) only patients with GAD and not those with GSP show reduced optimistic bias. This appears to reflect dysfunction in the role of rostral medial frontal cortex in comparison processes; and (b) only patients with GSP and not those with GAD show dysfunction in the context of social referencing. Social referencing refers to the process by which an individual learns the value of objects and actions by witnessing another's reactions to them. The second strand concerns the specific nature of the functional impairment seen in GSP. In previous work, we have shown that GSP does not simply represent a heightened amygdala response to social threats. Instead, there appears additionally to be atypical self referential processing of social information. In short, our earlier work had indicated an important role for not only the amygdala but also medial prefrontal cortex (MPFC a region critical for self referential processing) in GSP. This year, we extended this work by showing that patients with GSP show heightened amygdala and medial prefrontal cortex responses when engaged in social referencing (watching another show an emotional reaction to an object) than comparison populations. In addition, patients with GSP show heightened amygdala responses to objects associated with another individuals emotional displays. Importantly, social referencing is thought to be important for the development and maintenance of phobias and the impairment may contribute to the persistence of this disorder. The third strand of work concerns the specific nature of the functional impairment seen in GAD. In particular, we have been examining 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. Following on from our previous results, we developed an optimistic bias task suitable for fMRI. Optimistic bias refers to the tendency of healthy individuals to consider that good things are more likely to occur to them, and bad things less likely to occur to them, than is statistically probable. Reduced optimistic bias is seen in depression and we showed that it is also seen in GAD but not GSP. Importantly, we identified the neuro-computational impairment that may underpin the impairment in GAD. Specifically, the role of rostral medial frontal cortex in the comparison of valenced event probabilities appears to be disrupted in GAD.