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Review
. 2011;13(4):453-61.
doi: 10.31887/DCNS.2011.13.4/kholzschneider.

Neuroimaging in anxiety disorders

Kathrin Holzschneider  1 , Christoph Mulert
Affiliations
Review

Neuroimaging in anxiety disorders

Kathrin Holzschneider et al. Dialogues Clin Neurosci. 2011.

Abstract
in English, Spanish, French

Over the last few years, neuroimaging techniques have contributed greatly to the identification of the structural and functional neuroanatomy of anxiety disorders. The amygdala seems to be a crucial structure for fear and anxiety, and has consistently been found to be activated in anxiety-provoking situations. Apart from the amygdala, the insula and anterior cinguiate cortex seem to be critical, and ail three have been referred to as the "fear network." In the present article, we review the main findings from three major lines of research. First, we examine human models of anxiety disorders, including fear conditioning studies and investigations of experimentally induced panic attacks. Then we turn to research in patients with anxiety disorders and take a dose look at post-traumatic stress disorder and obsessive-compulsive disorder. Finally, we review neuroimaging studies investigating neural correlates of successful treatment of anxiety, focusing on exposure-based therapy and several pharmacological treatment options, as well as combinations of both.

Durante los últimos años las técnicas de neuroimágenes han contribuido de manera importante a la identificación de la neuroanatomía estructural y funcional de los trastornos ansiosos. La amígdala parece ser una estructura crucial para el miedo y la ansiedad, y constantemente se ha encontrado activada en situaciones que provocan ansiedad, Además de la amígdala, la ínsula y la corieza cingulada anterior también parecen ser muy importantes y las tres se han denominado “el circuito del miedo”. En este artículo se revisan los principales hallazgos de tres importantes líneas de investigation. Primero se examinan modelos humanos de los trastornos ansiosos, incluyendo estudios de miedo condicionado e investigaciones de ataques de pánico inducidos experimenialmente. Luego se aborda la investigación en patientes con trastornos ansiosos con especial énfasis en el trastorno por estrés postraumático y el trastorno obsesivo compulsivo. Finalmente se revisan los estudios de neuroimágenes que investigan los correlatos neurales de tratamientos ansiolíticos exitosos, enfocándose en terapias basadas en la exposición y en algunas alternativas psicofarmacológicas, como también en combinaciones de ambas.

Ces dernières années, les techniques de neuro-imagerie ont largement contribué à l'identification de la neuroanatomie structurale et fonctionnelle des troubles anxieux. Les amygdales, structures capitales pour la peur et l'anxiété, sont régulièrement activées dans des situations pourvoyeuses d'anxiété, À côté des amygdales, l'insula et le cortex cingulaire antérieur semblent d'une importance cruciale, ces trois structures ayant été qualifiées de « réseau de la peur ». Dans cet article, nous passons en revue les principaux résultats de trois axes majeurs de recherche. Tout d'abord, nous examinons des modèles humains de troubles anxieux, à l'aide d'études sur le conditionnement de la peur et d'enquêtes sur les attaques de panique induites expérimentalement. Puis nous nous consacrons à la recherche chez les patients atteints de troubles anxieux et nous examinons de près l'état de stress post-traumatique et les troubles obsessionnels compulsifs. Enfin, nous analysons des études de neuroimagerie sur les corrélations neurales du traitement efficace de l'anxiété, en nous concentrant sur un traitement basé sur l'exposition (au stimulus anxiogène) et sur plusieurs traitements pharmacologiques, comme sur l'association des deux.

Keywords: amygdala; anxiety disorder; functional magnetic resonance imaging; neuroimaging; treatment.

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Figures

Figure 1.
Figure 1.. Activation in the left anterior cingulate cortex (top) and left anterior insula (bottom) during presentation of conditioned (vs neutral) faces. Reproduced from ref 5: Buchel C, Morris J, Dolan RJ, Friston KJ. Brain systems mediating aversive conditioning: an event-related fMRI study. Neuron. 1998;20:947-957. Copyright © Elsevier, 1998
Figure 2.
Figure 2.. Activation in the right amygdala is enhanced in post-traumatic stress disorder (PTSD) patients compared with trauma-exposed non-PTSD participants (TENP) during the presentation of emotionally negative pictures. Fix, fixation baseline; Neg, negative; Neut, neutral. Reprinted from ref 43: Brohawn KH, Offringa R, Pfaff DL, Hughes KC, Shin LM. The neural correlates of emotional memory in posttraumatic stress disorder. Biol Psychiatry. 2010;68:1023-1030. Copyright © Elsevier, 2010
Figure 3.
Figure 3.. Amygdala activation during presentation of pictures of spiders (vs neutral pictures) in spider phobic subjects before and after successful treatment, and in non-phobic control subjects. Reprinted from ref 59: Goossens L, Sunaert S, Peeters R, Griez EJ, Schruers KR. Amygdala hyperfunction in phobic fear normalizes after exposure. Biol Psychiatry. 2007;62:1119-1125. Copyright © Elsevier, 2007
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