Blair Karina, Shaywitz Jonathan, Smith Bruce W, Rhodes Rebecca, Geraci Marilla, Jones Matthew, McCaffrey Daniel, Vythilingam Meena, Finger Elizabeth, Mondillo Krystal, Jacobs Madeline, Charney Dennis S, Blair R J R, Drevets Wayne C, Pine Daniel S
Mood and Anxiety Program, NIMH, NIH, 15K North Dr., MSC 2670, Bethesda, MD 20892, USA.
Am J Psychiatry. 2008 Sep;165(9):1193-202. doi: 10.1176/appi.ajp.2008.07071060. Epub 2008 May 15.
Generalized social phobia involves fear/avoidance, specifically of social situations, whereas generalized anxiety disorder involves intrusive worry about diverse circumstances. It remains unclear the degree to which these two, often comorbid, conditions represent distinct disorders or alternative presentations of a single, core underlying pathology. Functional magnetic resonance imaging assessed the neural response to facial expressions in generalized social phobia and generalized anxiety disorder.
Individuals matched on age, IQ, and gender with generalized social phobia without generalized anxiety disorder (N=17), generalized anxiety disorder (N=17), or no psychopathology (N=17) viewed neutral, fearful, and angry expressions while ostensibly making a simple gender judgment.
The patients with generalized social phobia without generalized anxiety disorder showed increased activation to fearful relative to neutral expressions in several regions, including the amygdala, compared to healthy individuals. This increased amygdala response related to self-reported anxiety in patients with generalized social phobia without generalized anxiety disorder. In contrast, patients with generalized anxiety disorder showed significantly less activation to fearful relative to neutral faces compared to the healthy individuals. They did show significantly increased response to angry expressions relative to healthy individuals in a lateral region of the middle frontal gyrus. This increased lateral frontal response related to self-reported anxiety in patients with generalized anxiety disorder.
These results suggest that neural circuitry dysfunctions differ in generalized social phobia and generalized anxiety disorder.
广泛性社交恐惧症涉及恐惧/回避，特别是对社交情境的恐惧/回避，而广泛性焦虑症则涉及对各种情况的侵入性担忧。目前尚不清楚这两种常常共病的情况在多大程度上代表不同的疾病，或者是单一核心潜在病理的不同表现形式。功能磁共振成像评估了广泛性社交恐惧症和广泛性焦虑症患者对面部表情的神经反应。
将年龄、智商和性别相匹配的个体分为三组，分别为无广泛性焦虑症的广泛性社交恐惧症患者（N = 17）、广泛性焦虑症患者（N = 17）或无精神病理学问题的个体（N = 17），他们在表面上进行简单的性别判断时观看中性、恐惧和愤怒的表情。
与健康个体相比，无广泛性焦虑症的广泛性社交恐惧症患者在包括杏仁核在内的几个区域对恐惧表情相对于中性表情的激活增加。这种杏仁核反应的增加与无广泛性焦虑症的广泛性社交恐惧症患者自我报告的焦虑有关。相比之下，广泛性焦虑症患者与健康个体相比，对恐惧表情相对于中性表情的激活明显减少。他们在额中回外侧区域对愤怒表情的反应相对于健康个体确实显著增加。这种额外侧反应的增加与广泛性焦虑症患者自我报告的焦虑有关。
这些结果表明，广泛性社交恐惧症和广泛性焦虑症的神经回路功能障碍有所不同。
