title: The common traits of the ACC and PFC in anxiety disorders in the DSM-5: meta-analysis of voxel-based morphometry studies.
abstract: BACKGROUND
  The core domains of social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder (PD) with and without agoraphobia (GA), and specific phobia (SP) are cognitive and physical symptoms that are related to the experience of fear and anxiety. It remains unclear whether these highly comorbid conditions that constitute the anxiety disorder subgroups of the Diagnostic and Statistical Manual for Mental Disorders--Fifth Edition (DSM-5) represent distinct disorders or alternative presentations of a single underlying pathology.
  
  
  METHODS
  A systematic search of voxel-based morphometry (VBM) studies of SAD, GAD, PD, GA, and SP was performed with an effect-size signed differential mapping (ES-SDM) meta-analysis to estimate the clusters of significant gray matter differences between patients and controls.
  
  
  RESULTS
  Twenty-four studies were eligible for inclusion in the meta-analysis. Reductions in the right anterior cingulate gyrus and the left inferior frontal gyrus gray matter volumes (GMVs) were noted in patients with anxiety disorders when potential confounders, such as comorbid major depressive disorder (MDD), age, and antidepressant use were controlled for. We also demonstrated increased GMVs in the right dorsolateral prefrontal cortex (DLPFC) in comorbid depression-anxiety (CDA), drug-naïve and adult patients. Furthermore, we identified a reduced left middle temporal gyrus and right precentral gyrus in anxiety patients without comorbid MDD.
  
  
  CONCLUSIONS
  Our findings indicate that a reduced volume of the right ventral anterior cingulate gyrus and left inferior frontal gyrus is common in anxiety disorders and is independent of comorbid depression, medication use, and age. This generic effect supports the notion that the four types of anxiety disorders have a clear degree of overlap that may reflect shared etiological mechanisms. The results are consistent with neuroanatomical DLPFC models of physiological responses, such as worry and fear, and the importance of the ventral anterior cingulate (ACC)/medial prefrontal cortex (mPFC) in mediating anxiety symptoms.
authors.affiliation: Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Shang
authors.affiliation: Radiology Department of the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China.
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Ren
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
authors.forename: Mingying
authors.initials: M
authors.lastname: Du
authors.affiliation: Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
authors.forename: Qiyong
authors.initials: Q
authors.lastname: Gong
authors.affiliation: Radiology Department of the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China; Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
authors.forename: Su
authors.initials: S
authors.lastname: Lui
authors.affiliation: Mental Health Center, Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000379:Agoraphobia / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D001008:Anxiety Disorders / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D001931:Brain Mapping; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D066128:Gray Matter / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D006179:Gyrus Cinguli / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D011619:Psychotropic Drugs / Q000627:therapeutic use
chemical_list: D011619:Psychotropic Drugs