Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
Psychiatric Genetics Laboratory, Biotherapy State Key Laboratory, West China Hospital of Sichuan University, Chengdu, China.
J Clin Psychiatry. 2016 Nov;77(11):e1429-e1438. doi: 10.4088/JCP.15r10226.
We conducted a meta-analysis of the literature reporting neuroimaging in patients undergoing psychotherapy and pharmacotherapy for social anxiety disorder (SAD).
Using PubMed, MEDLINE, and Embase, we searched for English-language studies published between January 2000 and February 2015 with terms related to SAD, therapy, and neuroimaging.
Twelve studies were included with a total of 295 subjects with SAD before and after therapy from January 2000 to February 2015.
We extracted peak coordinates of clusters of significant group differences and performed a meta-analysis using effect-size signed differential mapping to analyze the peak coordinates of clusters and thresholds.
Therapy significantly reduced activity in the left inferior parietal gyrus (Z = 1.441; P < .001), right postcentral gyrus (Z = 1.711; P < .001), and right precuneus (Z = 1.352; P < .01) and increased activity in the left inferior frontal gyrus/insula (Z = 1.939; P < .001) and bilateral middle cingulate gyrus (Z = 1.836; P < .001). Psychotherapy significantly increased activity in the bilateral precuneus (Z = 2.259; P < .001) and left inferior parietal gyrus (Z = 1.786; P < .001) and decreased activity in the left anterior cingulate gyrus (Z = 1.707; P < .001), left middle frontal gyrus (Z = 1.584; P < .001), and right cerebellum (Z = 1.424; P < .01). Pharmacotherapy increased activity in the right postcentral gyrus (Z = 1.215; P < .01), left middle occipital gyrus (Z = 1.269; P < .01), and right medial orbital frontal gyrus (Z = 1.250; P < .01) and reduced activity in the bilateral insula (Z = 2.172; P < .001; Z = 1.608; P < .01) and left medial cingula (Z = 1.479; P < .01). The improvement in social anxiety symptoms was positively associated with hyperactivity of the bilateral precuneus, left inferior partial gyrus, right medial cingulate, and right postcentral gyrus but negatively associated with hypoactivity of the bilateral insula and right medial cingulate (P < .01). We did not find any difference of amygdala among these 3 groups.
Previous reports of brain imaging suggest that pharmacotherapy and psychotherapy impact different brain regions in adult patients with SAD.
我们对报告社交焦虑障碍（SAD）患者接受心理治疗和药物治疗的神经影像学研究进行了荟萃分析。
我们使用 PubMed、MEDLINE 和 Embase 检索了 2000 年 1 月至 2015 年 2 月间以 SAD、治疗和神经影像学为关键词的英文文献。
共纳入 12 项研究，总计 295 例 SAD 患者，这些患者在 2000 年 1 月至 2015 年 2 月期间接受了治疗。
我们提取了组间差异显著的聚类的峰值坐标，并使用效应大小差异映射进行荟萃分析，以分析聚类和阈值的峰值坐标。
治疗显著降低了左侧顶下小叶（Z = 1.441；P <.001）、右侧中央后回（Z = 1.711；P <.001）和右侧楔前叶（Z = 1.352；P <.01）的活性，增加了左侧额下回/岛叶（Z = 1.939；P <.001）和双侧扣带回中部（Z = 1.836；P <.001）的活性。心理治疗显著增加了双侧楔前叶（Z = 2.259；P <.001）和左侧顶下小叶（Z = 1.786；P <.001）的活性，降低了左侧前扣带回（Z = 1.707；P <.001）、左侧额中回（Z = 1.584；P <.001）和右侧小脑（Z = 1.424；P <.01）的活性。药物治疗增加了右侧中央后回（Z = 1.215；P <.01）、左侧中枕叶（Z = 1.269；P <.01）和右侧内侧眶额回（Z = 1.250；P <.01）的活性，降低了双侧岛叶（Z = 2.172；P <.001；Z = 1.608；P <.01）和左侧内侧扣带（Z = 1.479；P <.01）的活性。社交焦虑症状的改善与双侧楔前叶、左侧顶下小叶、右侧扣带回和右侧中央后回的过度活跃呈正相关，与双侧岛叶和右侧扣带的过度活跃呈负相关（P <.01）。我们在这 3 组之间没有发现杏仁核的任何差异。
先前的脑影像学报告表明，药物治疗和心理治疗对成年 SAD 患者的不同脑区产生影响。
