Functional Neuroimaging of Anxiety Disorders
Anxiety and fear are evolutionary beneficial emotions that help an organism to avoid danger and threat, but anxiety becomes pathological when it significantly impairs daily functioning. Anxiety disorders are among the most prevalent psychiatric disorders,
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Victor I. Spoormaker, Eric Vermetten, Michael Czisch, and Frank H. Wilhelm
Abbreviations BOLD CCK-4 CS− CS+ dACC dmPFC EMG ITC OCD vmPFC PTSD SCR SNRI
Blood oxygen level dependent Cholecystokinin tetrapeptide Safety stimulus Conditioned stimulus Dorsal anterior cingulate cortex Dorsomedial prefrontal cortex Electromyography Intercalated cells Obsessive-compulsive disorder Ventromedial prefrontal cortex Posttraumatic stress disorder Skin conductance response Serotonin-norepinephrine reuptake inhibitor
V.I. Spoormaker, PhD (*) • M. Czisch Max Planck Institute of Psychiatry, Munich, Germany e-mail: [email protected] E. Vermetten, MD, PhD Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands F.H. Wilhelm, PhD Clinical Psychology, Psychotherapy & Health Psychology, Institute for Psychology, University of Salzburg, Salzburg, Austria
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Introduction: Structural and Functional Imaging Tools of Anxiety Disorders
Anxiety disorders are the most prevalent group of psychiatric disorders with a 12-month prevalence of 14 %, affecting roughly 60 million people in the 27 countries of the European Union (Wittchen et al. 2011). Although the direct healthcare and indirect costs are lower in anxiety disorders compared to mood or psychotic disorders, the sheer amount of patients makes it one of the top five costliest brain disorders in Europe, surpassing an estimated 70 billion Euro a year (Gustavsson et al. 2011). Furthermore, prevalence estimates in the United States are comparable or even higher (Kessler et al. 2012). In this chapter, we will address the role of neuroimaging markers in anxiety disorders, with a specific focus on posttraumatic stress disorder (PTSD), panic disorder, specific phobias, and social anxiety disorder. Moreover, we will briefly discuss obsessive-compulsive disorder (OCD). The development of neuroimaging methodology for anxiety disorders can be illustrated by the progress made in PTSD, a disorder that may develop after exposure to a potentially traumatic event and is characterized by intrusive memories, avoidance behavior, numbing, and hyperarousal. Before the widespread availability of functional magnetic resonance imaging (fMRI), studies addressed structural differences between PTSD patients and controls and observed volumetric differences in hippocampus (Bremner et al. 1995, 1997). When fMRI was
C. Mulert, M.E. Shenton (eds.), MRI in Psychiatry, DOI 10.1007/978-3-642-54542-9_15, © Springer Berlin Heidelberg 2014
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technically suited to assess functional parameters of brain activity, the attention shifted from hippocampus to amygdala and the role of the prefrontal cortex. Research started to address the functioning of brain regions in PTSD by means of combining functional neuroimaging with symptom provocation tasks (e.g., with trauma scripts or stimuli), general affective tasks, and functional connectivity during the so-called resting state (Francati et al. 2007; Liberzon and Sripada 2008). These studies revealed intriguing altered functional pat
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