Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China.
Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu 610041, China.
J Affect Disord. 2021 Feb 15;281:805-823. doi: 10.1016/j.jad.2020.11.057. Epub 2020 Nov 13.
The paradox of similar diagnostic criteria but potentially different neuropathologies in panic disorder (PD) and social anxiety disorder (SAD) needs to be clarified.
We performed a qualitative systematic review and a quantitative whole-brain voxel-based morphometry (VBM) meta-analysis with an anisotropic effect-size version of seed-based D mapping (AES-SDM) to explore whether the alterations of grey matter volume (GMV) in PD are similar to or different from those in SAD, together with potential confounding factors.
A total of thirty-one studies were eligible for inclusion, eighteen of which were included in the meta-analysis. Compared to the respective healthy controls (HC), qualitative and quantitative analyses revealed smaller cortical-subcortical GMVs in PD patients in brain areas including the prefrontal and temporal-parietal cortices, striatum, thalamus and brainstem, predominantly right-lateralized regions, and larger GMVs in the prefrontal and temporal-parietal-occipital cortices, and smaller striatum and thalamus in SAD patients. Quantitatively, the right inferior frontal gyrus (IFG) deficit was specifically implicated in PD patients, whereas left striatum-thalamus deficits were specific to SAD patients, without shared GMV alterations in both disorders. Sex, the severity of clinical symptoms, psychiatric comorbidity, and concomitant medication use were negatively correlated with smaller regional GMV alterations in PD patients.
PD and SAD may represent different anxiety sub-entities at the neuroanatomical phenotypes level, with different specific neurostructural deficits in the right IFG of PD patients, and the left striatum and thalamus of SAD patients. This combination of differences and specificities can potentially be used to guide the development of diagnostic biomarkers for these disorders.
惊恐障碍 (PD) 和社交焦虑障碍 (SAD) 具有相似的诊断标准，但潜在的神经病理学可能不同，这种矛盾需要加以阐明。
我们进行了定性系统评价和基于种子的弥散张量成像 (DTI) 各向异性效应量版本（AES-SDM）的全脑基于体素形态学 (VBM) 定量荟萃分析，以探讨 PD 患者的灰质体积 (GMV) 改变是否与 SAD 相似或不同，同时考虑了潜在的混杂因素。
共有 31 项研究符合纳入标准，其中 18 项研究纳入荟萃分析。与各自的健康对照组 (HC) 相比，定性和定量分析显示 PD 患者大脑区域包括前额叶和颞顶叶皮质、纹状体、丘脑和脑干的皮质下 GMV 较小，主要为右侧偏侧化区域，SAD 患者的前额叶和颞顶叶-枕叶皮质 GMV 较大，纹状体和丘脑 GMV 较小。定量分析显示，右侧额下回 (IFG) 缺陷与 PD 患者具体相关，而左侧纹状体-丘脑缺陷与 SAD 患者具体相关，两种疾病均无共同的 GMV 改变。患者的性别、临床症状严重程度、精神共病和伴随用药与 PD 患者的 GMV 改变呈负相关。
PD 和 SAD 可能代表神经解剖表型水平上不同的焦虑亚实体，PD 患者右侧 IFG 存在不同的特定神经结构缺陷，SAD 患者左侧纹状体和丘脑存在不同的特定神经结构缺陷。这些差异和特异性的结合可能有助于为这些疾病开发诊断生物标志物。
