title: Neural response to eye contact and paroxetine treatment in generalized social anxiety disorder.
abstract: Generalized social anxiety disorder (GSAD) is characterized by excessive fears of scrutiny and negative evaluation, but neural circuitry related to scrutiny in GSAD has been little studied. In this study, 16 unmedicated adults with GSAD and 16 matched healthy comparison (HC) participants underwent functional magnetic resonance imaging to assess neural response to viewed images of faces simulating movement into eye contact versus away from eye contact. GSAD patients were then treated for 8 weeks with paroxetine, and 15 patients were re-imaged. At baseline, GSAD patients had elevated neural response to eye contact in parahippocampal cortex, inferior parietal lobule, supramarginal gyrus, posterior cingulate and middle occipital cortex. During paroxetine treatment, symptomatic improvement was associated with decreased neural response to eye contact in regions including inferior and middle frontal gyri, anterior cingulate, posterior cingulate, precuneus and inferior parietal lobule. Both the magnitude of GSAD symptom reduction with paroxetine treatment and the baseline comparison of GSAD vs. HCs were associated with neural processing of eye contact in distributed networks that included regions involved in self-referential processing. These findings demonstrate that eye contact in GSAD engages neurocircuitry consistent with the heightened self-conscious emotional states known to characterize GSAD patients during scrutiny.
authors: Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA. Electronic address: frs1@columbia.edu.
authors: Franklin R
authors: FR
authors: Schneier
authors: Department of Computer Science at the University of Massachusetts at Boston, Boston, MA, USA.
authors: Marc
authors: M
authors: Pomplun
authors: Program for Imaging and Cognitive Sciences, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neuroscience, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Psychology, Columbia University, New York, NY, USA.
authors: Melissa
authors: M
authors: Sy
authors: Program for Imaging and Cognitive Sciences, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neuroscience, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Psychology, Columbia University, New York, NY, USA.
authors: Joy
authors: J
authors: Hirsch
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001921:Brain / Q000098:blood supply / Q000187:drug effects*; D001931:Brain Mapping; D005133:Eye Movements / Q000187:drug effects*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D017374:Paroxetine / Q000627:therapeutic use*; D010698:Phobic Disorders / Q000188:drug therapy*; D010775:Photic Stimulation; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine; D010100:Oxygen