Tillfors Maria, Furmark Tomas, Marteinsdottir Ina, Fredrikson Mats
Department of Social Sciences, Orebro University, Orebro, Sweden.
Biol Psychiatry. 2002 Dec 1;52(11):1113-9. doi: 10.1016/s0006-3223(02)01396-3.
The aim was to examine the neural correlates of anxiety elicited by the anticipation of public speaking in individuals with social phobia. Positron emission tomography and (15)O-water was used to measure regional cerebral blood flow in subjects with DSM-IV defined social phobia during anxiety anticipation. Heart rate and subjective anxiety were also recorded. While being scanned, subjects were speaking alone either before or after speaking in public. To evaluate anticipatory anxiety we compared individuals speaking alone before they were speaking in front of an audience with those who did the reverse.
Heart rate and subjective anxiety measures confirmed anticipatory anxiety in social phobics who performed their private speech before their public. This was accompanied by enhanced cerebral blood flow in the right dorsolateral prefrontal cortex, left inferior temporal cortex, and in the left amygdaloid-hippocampal region. Brain blood flow was lower in the left temporal pole and bilaterally in the cerebellum in the anticipation group.
Brain regions with altered perfusion presumably reflect changes in neural activity associated with worry about anticipated public performance. We speculate that anticipatory anxiety in social phobics originates in an affect sensitive fear network encompassing the amygdaloid-hippocampal region, prefrontal, and temporal areas.
目的是研究社交恐惧症患者在预期公开演讲时引发焦虑的神经关联。采用正电子发射断层扫描和（15）O -水来测量符合《精神疾病诊断与统计手册》第四版（DSM - IV）定义的社交恐惧症患者在焦虑预期期间的局部脑血流量。同时记录心率和主观焦虑程度。在扫描过程中，受试者在公开演讲之前或之后独自讲话。为了评估预期焦虑，我们将在观众面前演讲之前独自讲话的个体与顺序相反的个体进行了比较。
心率和主观焦虑测量结果证实，先进行私下演讲再进行公开演讲的社交恐惧症患者存在预期焦虑。这伴随着右侧背外侧前额叶皮质、左侧颞下皮质以及左侧杏仁核 - 海马区脑血流量增加。预期组的左侧颞极和双侧小脑的脑血流量较低。
灌注改变的脑区可能反映了与担心预期公开表现相关的神经活动变化。我们推测社交恐惧症患者的预期焦虑源于一个情感敏感的恐惧网络，该网络包括杏仁核 - 海马区、前额叶和颞叶区域。
