Kang Yinzhi, Li Qingfeng, Liu Wenjing, Hu Yang, Liu Zhen, Xie Shuqi, Ma Changminghao, Zhang Lei, Zhang Xiaochen, Hu Zhishan, Ding Yue, Cheng Wenhong, Yang Zhi
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur Child Adolesc Psychiatry. 2025 Mar;34(3):1135-1148. doi: 10.1007/s00787-024-02548-x. Epub 2024 Aug 28.
Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.
社交焦虑障碍（SAD）是青少年中最常见的精神障碍之一。症状和病因的异质性是SAD治疗和预防困难的重要根源。本研究旨在基于病因相关的表型维度确定青少年SAD的亚型，并研究这些亚型的症状与大脑的关联。我们使用了一个对患有SAD的青少年（n = 196）和健康对照者（n = 109）进行深度表型分析的样本（来自13项测量的47个表型分量表）来提取与病因相关的风险因素，并据此确定SAD的亚型。我们比较了这些亚型在临床特征、脑形态计量学和功能连接方面的差异，并研究了风险因素、脑异常与临床特征之间的亚型特异性联系。我们确定了六个与病因相关的风险因素以及青少年SAD的两个亚型。一个亚型主要表现为消极情绪特质和应对方式升高，积极情绪特质和应对方式降低，而另一个亚型还具有显著较高的环境风险因素、更严重的社会功能损害以及脑结构和功能的显著异常。风险因素概况、脑异常与临床特征之间存在亚型特异性联系。这一发现提示了基于病因的青少年SAD的两个亚型，为病理途径的多样性和精准干预策略提供了新的见解。
