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Anxiety Disorders - Brain Regions and their Dysfunctions

Anxiety Disorders

"Contemporary neurocircuitry models of anxiety disorders have primarily focused on amygdalo-cortical interactions. The amygdala is implicated in generating fear responses, whereas cortical regions, specifically the mOFC and the vmPFC, are implicated in fear extinction. In contrast to mOFC, anterolateral OFC (lOFC) has been associated with negative affects and obsessions and thus dysfunctional lOFC may underlie different aspects of certain anxiety disorders." S

"Several lines of evidence suggest specific neurotransmitter system alterations in social phobia, especially with regard to the serotoninergic, noradrenergic and dopaminergic systems." S

"A relative increase in gray matter volume was found in the left insula of PD (panic disorder) patients compared with controls. Additional structures showing differential increases were the left superior temporal gyrus, the midbrain, and the pons. A relative gray matter deficit was found in the right anterior cingulate cortex. The insula and anterior cingulate abnormalities may be relevant to the pathophysiology of PD, since these structures participate in the evaluation process that ascribes negative emotional meaning to potentially distressing cognitive and interoceptive sensory information." S
Affected Region Dysfunctions
Orbitofrontal Cortex Medial OFC is implicated in fear extinction; anterolateral OFC is associated with negative affects and obsessions S

Successful treatment of spider phobia is primarily accompanied by functional changes of the medial OFC, a region that is crucial for the self-regulation of emotions and the relearning of stimulus-reinforcement associations S
Medial PFC Ventromedial prefrontal cortex is implicated in fear extinction S

The VMPFC contributes to the pathophysiology of generalized social anxiety disorder S

Dysfunction in MPFC may play an important role in anxiety psychopathology S
Insular cortex "Lactate-induced panic (in patients with panic disorder) was associated with significant blood flow increases bilaterally in the temporal poles; bilaterally in insular cortex, claustrum, or lateral putamen; bilaterally in or near the superior colliculus; and in or near the left anterior cerebellar vermis." S
Amygdala The amygdala is implicated in generating fear responses S

"Hyperactivation in the amygdala and insula were, of interest, more frequently observed in social anxiety disorder and specific phobia than in PTSD." S
Posterior Cingulate Cortex Dysfunction in PCC may play an important role in anxiety psychopathology: Deactivation in PCC while listening to threat-related words alternating with emotionally neutral words S
Mammillary body Electrical stimulation of the mammillary body can be used to treat anxiety disorders S
Periaqueductal gray "Evidences from studies using electrical or chemical stimulation of the midbrain periaqueductal gray (PAG) suggest that whereas the dorsal PAG is critical for the regulation of panic-related defensive behaviors, the ventrolateral PAG (vlPAG) modulates generalized anxiety-related responses." S
Pons Differential increases in gray matter volume in the left superior temporal gyrus, the midbrain, and the pons in panic disorder S
Locus Caeruleus The LC is part of the anxiety circuitry S
Brain stem Electrophysiological brainstem abnormalities in anxiety disorders S

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