Generalized Anxiety Disorder and Social Anxiety Disorder:

广泛性焦虑症和社交焦虑症：

• 批准号: 8745722
• 负责人: james r blair
• 金额: $ 14.39万
• 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/8745722
• 关键词: Affective; Alcohol abuse; Amygdaloid structure; Anxiety Disorders; Decision Making; Development; Disease; Drug abuse; Emotional; Event; Fright; Functional Magnetic Resonance Imaging; Functional disorder; General Population; Generalized Anxiety Disorder; Impairment; Individual; Intervention; Learning; Life; Maintenance; Medial; Mental Depression; Nature; Neurobiology; Pathology; Patients; Phobic anxiety disorder; Population; Prefrontal Cortex; Prevalence; Probability; Process; Reaction; Role; Social Environment; Social Phobia; Stimulus; Suggestion; Suicide; Work; base; cognitive neuroscience; economic cost; emotional reaction; frontal lobe; functional disability; high risk; neuromechanism; relating to nervous system; response; showing emotion; social; therapeutic target

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.

我们与GSP和GAD患者的工作有三个重要的链接： 这些链中的第一个是确定GAD中看到的病理与GSP中看到的病理的程度。在以前的工作中，我们是第一个证明GSP和GAD患者对情绪表达刺激的反应性不同的人。具体而言，我们表明，在GAD患者中未见杏仁核对GSP中可怕表达的反应增强。确实，它们显示出表现不佳的迹象。在过去的一年中，我们以两种重要方式扩展了这些结果：（a）只有GAD而不是患有GSP的患者显示出降低的乐观偏见。这似乎反映了鼻内侧额叶皮质在比较过程中的作用中的功能障碍。 （b）在社会参考的背景下，只有患有GSP而不是患有GAD的患者出现功能障碍。社会引用是指个人通过见证他人对它们的反应来了解对象和行动的价值的过程。 第二链涉及在GSP中看到的功能障碍的特定性质。在以前的工作中，我们已经表明，GSP不仅代表了对社会威胁的杏仁核的增强反应。取而代之的是，似乎还有非典型的社会信息自我参考处理。简而言之，我们较早的工作表明，不仅是杏仁核，而且对GSP中的内侧前额叶皮层（MPFC一个至关重要的区域）的重要作用。今年，我们通过表明GSP患者在参与社交参考时（观看另一个对物体表现出对物体的情感反应）的杏仁核和内侧前额叶皮层反应的增强来扩展这项工作。 此外，患有GSP的患者对与他人情绪表现相关的对象的杏仁核反应增强。 重要的是，人们认为社会参考对于恐惧症的发展和维持很重要，而障碍可能有助于这种疾病的持续存在。 第三组工作涉及GAD中看到的功能障碍的特定性质。特别是，我们一直在研究我们在与这种疾病患者的初步工作中观察到的情感反应中的一些问题可能在决策任务上遇到困难。从以前的结果开始，我们制定了适合fMRI的乐观偏见任务。乐观的偏见是指健康个体的趋势认为，与统计学上的可能性相比，他们更有可能发生美好事物，而坏事发生在他们身上的可能性更低。在抑郁症中看到了降低的乐观偏见，我们表明它在GAD中也可以看出，但没有GSP。重要的是，我们确定了可能支持GAD损伤的神经计算障碍。具体而言，Rostral内侧额叶在VANCED事件概率的比较中的作用似乎在GAD中被破坏。