Sapienza University of Rome, Italy, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Psychiatry Res. 2012 Jun 30;202(3):181-97. doi: 10.1016/j.pscychresns.2011.10.009. Epub 2012 Jul 16.
Specific phobias (SPs) are common, with lifetime prevalence estimates of 10%. Our current understanding of their pathophysiology owes much to neuroimaging studies, which enabled us to construct increasingly efficient models of the underlying neurocircuitry. We provide an updated, comprehensive review and analyze the relevant literature of functional neuroimaging studies in specific phobias. Findings are presented according to the functional neuroanatomy of patients with SPs. We performed a careful search of the major medical and psychological databases by crossing SP with each neuroimaging technique. Functional neuroimaging, mostly using symptom provocation paradigms, showed abnormal activations in brain areas involved in emotional perception and early amplification, mainly the amygdala, anterior cingulate cortex, thalamus, and insula. The insula, thalamus and other limbic/paralimbic structures are particularly involved in SPs with prominent autonomic arousal. Emotional modulation is also impaired after exposure to phobic stimuli, with abnormal activations reported for the prefrontal, orbitofrontal and visual cortices. Other cortices and the cerebellum also appear to be involved in the pathophysiology of this disorder. Functional neuroimaging identified neural substrates that differentiate SPs from other anxiety disorders and separate SP subtypes from one another; the results support current Diagnostic and Statistical Manual of Mental Disorders, 4th edition-Text Revision (DSM-IV-TR) diagnostic subtyping of SPs. Functional neuroimaging shows promise as a means of identifying treatment-response predictors. Improvement in these techniques may help in clarifying the neurocircuitry underlying SP, for both research and clinical-therapeutic purposes.
特定恐惧症（SPs）很常见，终生患病率估计为 10%。我们对其病理生理学的当前理解在很大程度上要归功于神经影像学研究，这些研究使我们能够构建越来越有效的基础神经回路模型。我们提供了一个更新的、全面的综述，并分析了特定恐惧症的功能神经影像学研究的相关文献。根据 SP 患者的功能神经解剖结构呈现发现结果。我们通过将 SP 与每种神经影像学技术交叉，仔细搜索了主要的医学和心理数据库。功能神经影像学，主要使用症状诱发范式，显示出与情绪感知和早期放大有关的大脑区域的异常激活，主要是杏仁核、前扣带皮层、丘脑和脑岛。脑岛、丘脑和其他边缘/旁边缘结构特别参与具有明显自主唤醒的 SP。暴露于恐惧刺激后，情绪调节也受到损害，据报道，前额叶、眶额皮质和视觉皮质的激活异常。其他皮质和小脑似乎也参与了这种疾病的病理生理学。功能神经影像学确定了将 SPs 与其他焦虑障碍区分开来的神经基础，并将 SP 亚型彼此区分开来；结果支持当前的《精神障碍诊断与统计手册》第 4 版-文本修订版（DSM-IV-TR）对 SPs 的诊断亚型。功能神经影像学有望成为识别治疗反应预测因子的一种手段。这些技术的改进可能有助于澄清 SP 背后的神经回路，无论是出于研究还是临床治疗目的。
