title: Neurocircuitry of generalized anxiety disorder in adolescents: a pilot functional neuroimaging and functional connectivity study.
abstract: BACKGROUND
  Dysfunction of neural systems responsible for the processing of emotional stimuli is hypothesized to be involved in the pathophysiology of generalized anxiety disorder (GAD) in adolescents. We used standard fMRI and functional connectivity analyses to examine the functional neurocircuitry of GAD in adolescents.
  
  
  METHODS
  Ten adolescents with GAD and 10 healthy comparison subjects underwent fMRI while performing a continuous performance task with emotional and neutral distractors. Standard event-related voxel-wise fMRI and steady-state functional connectivity analyses were performed.
  
  
  RESULTS
  Increased activation was observed in the left medial prefrontal cortex and right ventrolateral prefrontal cortex (VLPFC) in response to emotional images compared to neutral imagines in youth with GAD. Connectivity analyses using the right VLPFC seed region suggested decreased connectivity between this region and the bilateral medial prefrontal cortex. Connectivity analyses using the right amygdala seed region revealed decreased correlation with the posterior cingulate cortex in adolescents with GAD. The left amygdala seed region demonstrated increased connectivity with the ipsilateral precuneus in youth with GAD compared to healthy subjects.
  
  
  CONCLUSIONS
  In addition to increased activation of the medial prefrontal cortex and right VLPFC, we observed altered connectivity between the amygdala or VLPFC and regions, which subserve mentalization (e.g. posterior cingulate cortex, precuneus, and medial prefrontal cortex). This suggests that structures that regulate emotion and affect interact abnormally with key structures that are involved in mentalization, a process known to be disrupted in GAD.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience College of Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0559, USA. strawnjr@uc.edu
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Strawn
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Bitter
authors.forename: Wade A
authors.initials: WA
authors.lastname: Weber
authors.forename: Wen-Jang
authors.initials: WJ
authors.lastname: Chu
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Whitsel
authors.forename: Caleb
authors.initials: C
authors.lastname: Adler
authors.forename: Michel A
authors.initials: MA
authors.lastname: Cerullo
authors.forename: James
authors.initials: J
authors.lastname: Eliassen
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Strakowski
authors.forename: Melissa P
authors.initials: MP
authors.lastname: DelBello
mesh_terms: D000293:Adolescent; D000339:Affect; D000679:Amygdala / Q000503:physiopathology; D001008:Anxiety Disorders / Q000503:physiopathology*; D001921:Brain / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D004644:Emotions; D005260:Female; D059907:Functional Neuroimaging; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology*; D010296:Parietal Lobe / Q000503:physiopathology; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000503:physiopathology