Maron Eduard, Lan Chen-Chia, Nutt David
Neuropsychopharmacology Unit, Centre for Academic Psychiatry, Division of Brain Sciences, Imperial College London, London, UK.
Department of Psychiatry, University of Tartu, Tartu, Estonia.
Curr Top Behav Neurosci. 2018;40:219-292. doi: 10.1007/7854_2018_49.
Anxiety disorders are the most common mental health problem in the world and also claim the highest health care cost among various neuropsychiatric disorders. Anxiety disorders have a chronic and recurrent course and cause significantly negative impacts on patients' social, personal, and occupational functioning as well as quality of life. Despite their high prevalence rates, anxiety disorders have often been under-diagnosed or misdiagnosed, and consequently under-treated. Even with the correct diagnosis, anxiety disorders are known to be difficult to treat successfully. In order to implement better strategies in diagnosis, prognosis, treatment decision, and early prevention for anxiety disorders, tremendous efforts have been put into studies using genetic and neuroimaging techniques to advance our understandings of the underlying biological mechanisms. In addition to anxiety disorders including panic disorder, generalised anxiety disorder (GAD), specific phobias, social anxiety disorders (SAD), due to overlapping symptom dimensions, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) (which were removed from the anxiety disorder category in DSM-5 to become separate categories) are also included for review of relevant genetic and neuroimaging findings. Although the number of genetic or neuroimaging studies focusing on anxiety disorders is relatively small compare to other psychiatric disorders such as psychotic disorders or mood disorders, various structural abnormalities in the grey or white matter, functional alterations of activity during resting-state or task conditions, molecular changes of neurotransmitter receptors or transporters, and genetic associations have all been reported. With continuing effort, further genetic and neuroimaging research may potentially lead to clinically useful biomarkers for the prevention, diagnosis, and management of these disorders.
焦虑症是世界上最常见的心理健康问题，在各种神经精神疾病中，其医疗费用也最高。焦虑症病程慢性且反复发作，对患者的社交、个人和职业功能以及生活质量产生显著负面影响。尽管患病率很高，但焦虑症常常未得到充分诊断或误诊，因此治疗不足。即使诊断正确，焦虑症也已知难以成功治疗。为了在焦虑症的诊断、预后、治疗决策和早期预防方面实施更好的策略，人们已经投入了巨大努力，运用基因和神经影像学技术进行研究，以增进我们对潜在生物学机制的理解。除了包括惊恐障碍、广泛性焦虑症（GAD）、特定恐惧症、社交焦虑症（SAD）在内的焦虑症外，由于症状维度重叠，强迫症（OCD）和创伤后应激障碍（PTSD）（在《精神疾病诊断与统计手册》第5版中从焦虑症类别中移除，成为单独类别）也被纳入，以回顾相关的基因和神经影像学研究结果。尽管与精神分裂症或情绪障碍等其他精神疾病相比，专注于焦虑症的基因或神经影像学研究数量相对较少，但已经报道了灰质或白质的各种结构异常、静息状态或任务状态下活动的功能改变、神经递质受体或转运体的分子变化以及基因关联。随着持续的努力，进一步的基因和神经影像学研究可能会为这些疾病的预防、诊断和管理带来临床上有用的生物标志物。
