Departments of Psychiatry and Psychology, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Chicago, IL, 60608, USA.
Department of Psychology, University of Wisconsin - Milwaukee, Milwaukee, WI, USA.
Curr Psychiatry Rep. 2018 Aug 28;20(10):89. doi: 10.1007/s11920-018-0948-1.
Aberrant amygdala activity is implicated in the neurobiology of social anxiety disorder (SAD) and is, therefore, a treatment target. However, the extent to which amygdala predicts clinical improvement or is impacted by treatment has not been critically examined. This review highlights recent neuroimaging findings from clinical trials and research that test links between amygdala and mechanisms of action.
Neuropredictor studies largely comprised psychotherapy where improvement was foretold by amygdala activity and regions beyond amygdala such as frontal structures (e.g., anterior cingulate cortex, medial prefrontal cortex) and areas involved in visual processes (e.g., occipital regions, superior temporal gyrus). Pre-treatment functional connectivity between amygdala and frontal areas was also shown to predict improvement signifying circuits that support emotion processing and regulation interact with treatment. Pre-to-post studies revealed decreases in amygdala response and altered functional connectivity in amygdala pathways regardless of treatment modality. In analogue studies of fear exposure, greater reduction in anxiety was predicted by less amygdala response to a speech challenge and amygdala activity decreased following exposures. Yet, studies have also failed to detect amygdala effects reporting instead treatment-related changes in regions and functional systems that support sensory, emotion, and regulation processes. An array of regions in the corticolimbic subcircuits and extrastriate cortex appear to be viable sites of action. The amygdala and amygdala pathways predict treatment outcome and are altered following treatment. However, further study is needed to establish the role of the amygdala and other candidate regions and brain circuits as sites of action.
综述目的：杏仁核活动异常与社交焦虑障碍（SAD）的神经生物学有关，因此成为治疗靶点。然而，杏仁核对临床改善的预测程度或治疗的影响尚未得到严格检验。本综述强调了最近的神经影像学研究结果，这些研究检验了杏仁核与作用机制之间的联系。
最新发现：神经预测研究主要包括心理治疗，其中杏仁核活动以及杏仁核以外的区域（如额前结构，如前扣带皮层、内侧前额叶皮层）和涉及视觉过程的区域（如枕叶区域、颞上回）预测改善。治疗前杏仁核与额前区域之间的功能连接也被证明可以预测改善，表明支持情绪处理和调节的回路与治疗相互作用。在治疗前后的研究中，无论治疗方式如何，都发现杏仁核反应减少和杏仁核通路的功能连接改变。在恐惧暴露的模拟研究中，对言语挑战的杏仁核反应减少以及暴露后杏仁核活动减少，预示着焦虑程度更大的降低。然而，一些研究也未能检测到杏仁核的影响，而是报告了与支持感觉、情绪和调节过程的区域和功能系统相关的治疗相关变化。皮质边缘子电路和外纹状体的一系列区域似乎是可行的作用部位。杏仁核和杏仁核通路预测治疗效果，并在治疗后发生改变。然而，需要进一步的研究来确定杏仁核和其他候选区域和脑回路作为作用部位的作用。
