Langhammer Till, Hilbert Kevin, Adolph Dirk, Arolt Volker, Bischoff Sophie, Böhnlein Joscha, Cwik Jan C, Dannlowski Udo, Deckert Jürgen, Domschke Katharina, Evens Ricarda, Fydrich Thomas, Gathmann Bettina, Hamm Alfons O, Heinig Ingmar, Herrmann Martin J, Hollandt Maike, Junghoefer Markus, Kircher Tilo, Koelkebeck Katja, Leehr Elisabeth J, Lotze Martin, Margraf Jürgen, Mumm Jennifer L M, Pittig Andre, Plag Jens, Richter Jan, Roesmann Kati, Ridderbusch Isabelle C, Schneider Silvia, Schwarzmeier Hanna, Seeger Fabian, Siminski Niklas, Straube Thomas, Ströhle Andreas, Szeska Christoph, Wittchen Hans-Ulrich, Wroblewski Adrian, Yang Yunbo, Straube Benjamin, Lueken Ulrike
Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Psychology, HMU Health and Medical University Erfurt, Erfurt, Germany.
Mol Psychiatry. 2025 Apr;30(4):1548-1557. doi: 10.1038/s41380-024-02768-2. Epub 2024 Oct 4.
Anxiety disorders (AD) are associated with altered connectivity in large-scale intrinsic brain networks. It remains uncertain how much these signatures overlap across different phenotypes due to a lack of well-powered cross-disorder comparisons. We used resting-state functional magnetic resonance imaging (rsfMRI) to investigate differences in functional connectivity (FC) in a cross-disorder sample of AD patients and healthy controls (HC). Before treatment, 439 patients from two German multicenter clinical trials at eight different sites fulfilling a primary diagnosis of panic disorder and/or agoraphobia (PD/AG, N = 154), social anxiety disorder (SAD, N = 95), or specific phobia (SP, N = 190) and 105 HC underwent an 8 min rsfMRI assessment. We performed categorical and dimensional regions of interest (ROI)-to-ROI analyses focusing on connectivity between regions of the defensive system and prefrontal regulation areas. AD patients showed increased connectivity between the insula and the thalamus compared to controls. This was mainly driven by PD/AG patients who showed increased (insula/hippocampus/amygdala-thalamus) and decreased (dorsomedial prefrontal cortex/periaqueductal gray-anterior cingulate cortex) positive connectivity between subcortical and cortical areas. In contrast, SAD patients showed decreased negative connectivity exclusively in cortical areas (insula-orbitofrontal cortex), whereas no differences were found in SP patients. State anxiety associated with the scanner environment did not explain the FC between these regions. Only PD/AG patients showed pronounced connectivity changes along a widespread subcortical-cortical network, including the midbrain. Dimensional analyses yielded no significant results. The results highlighting categorical differences between ADs at a systems neuroscience level are discussed within the context of personalized neuroscience-informed treatments. PROTECT-AD's registration at NIMH Protocol Registration System: 01EE1402A and German Register of Clinical Studies: DRKS00008743. SpiderVR's registration at ClinicalTrials.gov: NCT03208400.
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