Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
South African Medical Research Council (SA-MRC) Unit on Child and Adolescent Health, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Mol Psychiatry. 2023 Mar;28(3):1079-1089. doi: 10.1038/s41380-022-01933-9. Epub 2023 Jan 19.
There is limited convergence in neuroimaging investigations into volumes of subcortical brain regions in social anxiety disorder (SAD). The inconsistent findings may arise from variations in methodological approaches across studies, including sample selection based on age and clinical characteristics. The ENIGMA-Anxiety Working Group initiated a global mega-analysis to determine whether differences in subcortical volumes can be detected in adults and adolescents with SAD relative to healthy controls. Volumetric data from 37 international samples with 1115 SAD patients and 2775 controls were obtained from ENIGMA-standardized protocols for image segmentation and quality assurance. Linear mixed-effects analyses were adjusted for comparisons across seven subcortical regions in each hemisphere using family-wise error (FWE)-correction. Mixed-effects d effect sizes were calculated. In the full sample, SAD patients showed smaller bilateral putamen volume than controls (left: d = -0.077, p = 0.037; right: d = -0.104, p = 0.001), and a significant interaction between SAD and age was found for the left putamen (r = -0.034, p = 0.045). Smaller bilateral putamen volumes (left: d = -0.141, p < 0.001; right: d = -0.158, p < 0.001) and larger bilateral pallidum volumes (left: d = 0.129, p = 0.006; right: d = 0.099, p = 0.046) were detected in adult SAD patients relative to controls, but no volumetric differences were apparent in adolescent SAD patients relative to controls. Comorbid anxiety disorders and age of SAD onset were additional determinants of SAD-related volumetric differences in subcortical regions. To conclude, subtle volumetric alterations in subcortical regions in SAD were detected. Heterogeneity in age and clinical characteristics may partly explain inconsistencies in previous findings. The association between alterations in subcortical volumes and SAD illness progression deserves further investigation, especially from adolescence into adulthood.
在社交焦虑障碍 (SAD) 的神经影像学研究中，皮质下脑区体积的研究结果存在一定局限性。这些不一致的发现可能源于研究之间方法学方法的差异，包括基于年龄和临床特征的样本选择。ENIGMA-焦虑工作组发起了一项全球大型分析，以确定相对于健康对照组，SAD 成人和青少年是否可以检测到皮质下体积的差异。从 ENIGMA 标准化协议中获得了 37 个国际样本的容积数据，这些样本包括 1115 名 SAD 患者和 2775 名对照者，用于图像分割和质量保证。使用全错误率 (FWE) 校正，对每个半球的七个皮质下区域进行了线性混合效应分析调整。计算了混合效应 d 效应大小。在全样本中，SAD 患者的双侧壳核体积小于对照组（左侧：d = -0.077，p = 0.037；右侧：d = -0.104，p = 0.001），并且在左侧壳核中发现了 SAD 和年龄之间的显著相互作用（r = -0.034，p = 0.045）。在成年 SAD 患者中还检测到双侧壳核体积较小（左侧：d = -0.141，p < 0.001；右侧：d = -0.158，p < 0.001）和双侧苍白球体积较大（左侧：d = 0.129，p = 0.006；右侧：d = 0.099，p = 0.046），而相对于对照组，青少年 SAD 患者中则没有发现体积差异。伴发的焦虑障碍和 SAD 发病年龄是皮质下区域 SAD 相关容积差异的其他决定因素。总之，在 SAD 中检测到皮质下区域的细微体积改变。年龄和临床特征的异质性可能部分解释了先前研究结果的不一致。皮质下体积改变与 SAD 疾病进展之间的关联值得进一步研究，尤其是从青少年到成年。
