Charney D S, Deutch A
Yale University School of Medicine, Department of Psychiatry, West Haven, Connecticut, USA.
Crit Rev Neurobiol. 1996;10(3-4):419-46. doi: 10.1615/critrevneurobiol.v10.i3-4.70.
This paper reviews the evidence that provides the basis for a functional neuroanatomy of anxiety and fear. The afferent arm of the anxiety circuit includes the exteroceptive sensory systems of the brain, which convey the sensory information contained in a fear- or anxiety-inducing stimulus to the dorsal thalamus. Visceral afferent pathways alter the function of the locus coeruleus and the amygdala. The thalamus relays sensory information to the primary sensory receptive areas of the cortex, which project to adjacent unimodal and polymodal cortical association areas. The cortical association areas send projections to the amygdala, entorhinal cortex, orbitofrontal cortex, and cingulate gyrus. A pivotal role for the amygdala in the transmission and interpretation of fear and anxiety is suggested by extensive afferents to the amygdala from thalamic and cortical exteroceptive systems, as well as by subcortical visceral afferent pathways. The neuronal interactions between the amygdala enable the individual to initiate adaptive behaviors to threat based upon the nature of the threat and prior experience. The efferent pathways involving the amygdala, locus coeruleus, hypothalamus, periaqueductal gray, and striatum mediate autonomic, neuroendocrine, and skeletal-motor responses associated with fear and anxiety. The proposed brain structures, neural mechanisms, and neural circuits related to anxiety provide a basis for increased understanding of the pathophysiology of anxiety disorders.
本文综述了为焦虑和恐惧的功能性神经解剖学提供基础的证据。焦虑回路的传入臂包括大脑的外感受感觉系统，该系统将恐惧或焦虑诱发刺激中包含的感觉信息传递至背侧丘脑。内脏传入通路改变蓝斑和杏仁核的功能。丘脑将感觉信息中继至皮质的主要感觉接收区域，这些区域投射至相邻的单峰和多峰皮质联合区域。皮质联合区域向杏仁核、内嗅皮质、眶额皮质和扣带回发出投射。丘脑和皮质外感受系统向杏仁核的广泛传入以及皮质下内脏传入通路表明杏仁核在恐惧和焦虑的传递及解读中起关键作用。杏仁核之间的神经元相互作用使个体能够根据威胁的性质和既往经验启动针对威胁的适应性行为。涉及杏仁核、蓝斑、下丘脑、导水管周围灰质和纹状体的传出通路介导与恐惧和焦虑相关的自主神经、神经内分泌和骨骼肌运动反应。所提出的与焦虑相关的脑结构、神经机制和神经回路为增进对焦虑症病理生理学的理解提供了基础。
