Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA.
Curr Opin Psychiatry. 2021 Nov 1;34(6):617-623. doi: 10.1097/YCO.0000000000000743.
Anxiety disorders are some of the most common psychiatric diagnoses in children and adolescents, but attempts to improve outcome prediction and treatment have stalled. This review highlights recent findings on neural indices related to fear and anxiety that provide novel directions for attempts to create such improvements.
Stimuli capable of provoking fear engage many brain regions, including the amygdala, medial prefrontal cortex, hippocampus, and bed nucleus of the stria terminalis. Studies in rodents suggest that sustained, low-level threats are particularly likely to engage the bed nucleus of the stria terminalis, which appears to malfunction in anxiety disorders. However, anxiety disorders, like most mental illnesses, appear less likely to arise from alterations in isolated brain regions than in distributed brain circuitry. Findings from large-scale studies of brain connectivity may reveal signs of such broadly distributed dysfunction, though available studies report small effect sizes. Finally, we review novel approaches with promise for using such large-scale data to detect clinically relevant, broadly distributed circuitry dysfunction.
Recent work maps neural circuitry related to fear and anxiety. This circuitry may malfunction in anxiety disorders. Integrating findings from animal studies, big datasets, and novel analytical approaches may generate clinically relevant insights based on this recent work.
焦虑障碍是儿童和青少年中最常见的精神科诊断之一，但改善预后预测和治疗的尝试已经停滞不前。这篇综述强调了与恐惧和焦虑相关的神经指标的最新发现，为试图取得这些改善提供了新的方向。
能够引发恐惧的刺激会激活许多大脑区域，包括杏仁核、内侧前额叶皮层、海马体和终纹床核。啮齿动物研究表明，持续的低水平威胁特别可能涉及终纹床核，而终纹床核在焦虑障碍中似乎出现了功能障碍。然而，与大多数精神疾病一样，焦虑障碍似乎不太可能是由孤立的脑区改变引起的，而更可能是由分布广泛的脑回路异常引起的。对脑连接性进行大规模研究的结果可能揭示出这种广泛分布的功能障碍的迹象，尽管现有研究报告的效应量较小。最后，我们综述了使用这种大规模数据来检测临床上相关的、广泛分布的电路功能障碍的有前途的新方法。
最近的工作绘制了与恐惧和焦虑相关的神经回路图。该回路可能在焦虑障碍中出现功能障碍。整合来自动物研究、大数据集和新分析方法的发现，可能基于这项最近的工作产生临床上相关的见解。
