Brühl Annette Beatrix, Delsignore Aba, Komossa Katja, Weidt Steffi
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland; Behavioural and Cognitive Neuroscience Institute, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland.
Neurosci Biobehav Rev. 2014 Nov;47:260-80. doi: 10.1016/j.neubiorev.2014.08.003. Epub 2014 Aug 11.
Social anxiety disorder (SAD) is one of the most frequent anxiety disorders. The landmark meta-analysis of functional neuroimaging studies by Etkin and Wager (2007) revealed primarily the typical fear circuit as overactive in SAD. Since then, new methodological developments such as functional connectivity and more standardized structural analyses of grey and white matter have been developed. We provide a comprehensive update and a meta-analysis of neuroimaging studies in SAD since 2007 and present a new model of the neurobiology of SAD. We confirmed the hyperactivation of the fear circuit (amygdala, insula, anterior cingulate and prefrontal cortex) in SAD. In addition, task-related functional studies revealed hyperactivation of medial parietal and occipital regions (posterior cingulate, precuneus, cuneus) in SAD and a reduced connectivity between parietal and limbic and executive network regions. Based on the result of this meta-analysis and review, we present an updated model of SAD adopting a network-based perspective. The disconnection of the medial parietal hub in SAD extends current frameworks for future research in anxiety disorders.
社交焦虑障碍（SAD）是最常见的焦虑障碍之一。埃特金和瓦格（2007年）对功能性神经影像学研究的里程碑式荟萃分析表明，社交焦虑障碍中主要是典型的恐惧回路过度活跃。从那时起，诸如功能连接以及对灰质和白质进行更标准化的结构分析等新的方法学得到了发展。我们对2007年以来社交焦虑障碍的神经影像学研究进行了全面更新和荟萃分析，并提出了社交焦虑障碍神经生物学的新模型。我们证实了社交焦虑障碍中恐惧回路（杏仁核、脑岛、前扣带回和前额叶皮质）的过度激活。此外，与任务相关的功能研究显示，社交焦虑障碍患者顶叶内侧和枕叶区域（后扣带回、楔前叶、楔叶）过度激活，且顶叶与边缘系统和执行网络区域之间的连接减少。基于这项荟萃分析和综述的结果，我们从基于网络的角度提出了社交焦虑障碍的更新模型。社交焦虑障碍中内侧顶叶枢纽的断开为未来焦虑障碍的研究扩展了当前框架。
