Department of Psychiatry, Columbia University Medical Center, New York State PsychiatricInstitute, 1051 Riverside Drive, New York, NY 10032, USA.
Biol Psychiatry. 2013 Jan 1;73(1):75-84. doi: 10.1016/j.biopsych.2012.05.022. Epub 2012 Jun 29.
Despite increasing evidence that neuroanatomical abnormalities underlie pathological anxiety, social anxiety disorder (SAD)-although among the most common of anxiety disorders-has received little attention. With magnetic resonance imaging, we: 1) examined gray matter (GM) differences between generalized SAD and healthy control groups; 2) retested the findings in an independent clinical sample; and 3) tested for specificity by contrasting the SAD group to a separate group of panic disorder (PD) subjects.
The primary SAD group (n = 16) was required to meet DSM-IV criteria for SAD, with onset by age 30 years; control subjects (n = 20) had no lifetime history of anxiety. The replication sample included 17 generalized SAD and 17 control subjects. The PD comparison group (n = 16) was required to have no lifetime SAD. Images were acquired on a 1.5-Tesla GE Signa magnetic resonance imaging scanner with a three-dimensional T1-weighted spoiled gradient recalled pulse sequence. Morphological differences were determined with voxel-based morphometry, in SPM8.
After adjusting for age, gender, and total intracranial volume, SAD (as compared with control) subjects had greater GM in the left parahippocampal and middle occipital, and bilateral supramarginal and angular cortices, and left cerebellum; and lower GM in bilateral temporal poles and left lateral orbitofrontal cortex. Cerebellar, parahippocampal, and temporal pole differences were observed in both samples, survived whole brain corrections, and were not observed in the PD group, pointing to relative specificity to SAD.
These findings parallel the functional literature on SAD and suggest structural abnormalities underlying the functional disturbances.
尽管越来越多的证据表明神经解剖异常是病理性焦虑的基础，但社交焦虑障碍（SAD）——尽管是最常见的焦虑障碍之一——却很少受到关注。我们使用磁共振成像：1）比较广泛性 SAD 患者和健康对照组之间的灰质（GM）差异；2）在独立的临床样本中重复测试这些发现；3）通过将 SAD 组与单独的惊恐障碍（PD）组进行对比来测试特异性。
主要的 SAD 组（n = 16）必须符合 DSM-IV 中 SAD 的标准，发病年龄在 30 岁之前；对照组（n = 20）一生中没有焦虑史。复制样本包括 17 名广泛性 SAD 和 17 名对照组。PD 对照组（n = 16）一生中没有 SAD。图像是在 1.5T GE Signa 磁共振成像扫描仪上采集的，采用三维 T1 加权扰相梯度回波脉冲序列。形态学差异通过 SPM8 中的基于体素的形态测量学来确定。
在调整年龄、性别和总颅内体积后，SAD（与对照组相比）患者的左侧海马旁回和中枕叶、双侧缘上回和角回以及左侧小脑 GM 增加；双侧颞极和左侧外侧眶额皮层 GM 减少。小脑、海马旁回和颞极的差异在两个样本中都有观察到，在全脑校正后仍然存在，在 PD 组中没有观察到，表明其与 SAD 相对特异。
这些发现与 SAD 的功能文献相平行，表明结构性异常是功能障碍的基础。
