Generalized anxiety disorder (GAD) is closely associated with emotional dysregulation. Patients with GAD tend to overreact to emotional stimuli and are impaired in emotional regulation. Using emotional regulation task, studies have found hypo-activation in prefrontal cortex (PFC) of GAD patients and concluded with inadequate top-down control. However, results remain inconsistent concerning PFC and limbic area’s reactivity to emotional stimuli. What’s more, only a few studies aim to identify how limbic area interacts with PFC in GAD patients. The current study aims to identify the difference in PFC-limbic circuitry response to emotional stimuli between GAD patients and healthy controls (HCs) from the perspective of brain network. Through brain network analysis, it revealed the connectivity between limbic area and PFC, and moreover, the orientation of connectivity, all of which gave a better test of inadequate top-down control hypothesis. During fMRI scanning, participants were required to complete an emotional face identification task (fearful, neutral, happy facial expression). 30 participants (16 GAD patients, 14 HCs) were included in the formal analysis. A Bayesian-network based method was used to identify the brain network consisting of several pre-hypothesized regions of interest (ROIs) under each condition (negative, positive, neutral). In total, six graphs were obtained. Each of them represented the brain network that was common to the group under corresponding condition. Results revealed that GAD patients showed more bottom-up connection but less top-down connection regardless of condition, relative to HCs. Also, the insula was more connected but the amygdala was less connected regardless of condition, relative to HCs. the results also revealed a very different brain network response between GAD patients and HCs even under neutral condition. More bottom-up connection but less top-down connection may indicate that GAD patients are insufficient in top-down control, in keeping with inadequate top-down control hypothesis. The more connected insula may indicate GAD patients’ abnormality in interoception processing. Relative to HCs, distinct brain network response pattern in GAD patients under neutral condition suggests GAD patients’ abnormality in distinguishing safety from threat and intolerance of uncertainty.

中文翻译：

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广泛性焦虑症中与情绪反应相关的脑网络分析：一项功能性fMRI研究。

广泛性焦虑症（GAD）与情绪失调密切相关。GAD患者倾向于对情绪刺激反应过度，并且情绪调节能力受损。使用情绪调节任务，研究发现GAD患者的前额叶皮层（PFC）激活不足，并得出自上而下的控制不足的结论。但是，关于PFC和边缘区域对情绪刺激的反应性，结果仍然不一致。此外，只有少数研究旨在确定GAD患者的边缘区如何与PFC相互作用。当前的研究旨在从大脑网络的角度识别GAD患者与健康对照（HCs）之间的PFC-limbic电路对情绪刺激的反应差异。通过脑网络分析，它揭示了边缘区和PFC之间的连通性，此外，连通性的方向，所有这些都更好地检验了自上而下的控制假设不足。在fMRI扫描过程中，要求参与者完成情绪面部识别任务（恐惧，中立，快乐的面部表情）。正式分析包括30名参与者（16名GAD患者，14名HC）。基于贝叶斯网络的方法用于识别在每种条件（负，正，中性）下由几个预先假设的感兴趣区域（ROI）组成的大脑网络。总共获得了六张图。他们每个人都代表了在相应条件下该组所共有的大脑网络。结果显示，相对于HCs，GAD患者显示出更多的自下而上的联系，而较少的自上而下的联系。也，相对于HCs，与条件无关，岛状岛的连接程度较高，而杏仁核的连接程度较低。结果还表明，即使在中性条件下，GAD患者和HC的大脑网络反应也大不相同。自下而上的联系更多，但自上而下的联系较少，这可能表明GAD患者在自上而下的控制方面不足，这与自上而下的控制假设不足有关。岛状连接的更多可能表明GAD患者在受精过程中异常。相对于HCs，GAD患者在中性条件下的独特脑网络反应模式表明GAD患者在区分安全性与不确定性的威胁性和不耐受性方面存在异常。结果还表明，即使在中性条件下，GAD患者和HC的大脑网络反应也大不相同。自下而上的联系更多，但自上而下的联系较少，这可能表明GAD患者在自上而下的控制方面不足，这与自上而下的控制假设不足有关。岛状体之间的连接更多可能表明GAD患者在受精过程中异常。相对于HC，在中性条件下GAD患者中独特的脑网络反应模式表明GAD患者在区分安全性与不确定性的威胁性和不耐受性方面存在异常。结果还表明，即使在中性条件下，GAD患者和HC的大脑网络反应也大不相同。自下而上的联系更多，但自上而下的联系较少，这可能表明GAD患者在自上而下的控制方面不足，这与自上而下的控制假设不足有关。岛状体之间的连接更多可能表明GAD患者在受精过程中异常。相对于HC，在中性条件下GAD患者中独特的脑网络反应模式表明GAD患者在区分安全性与不确定性的威胁性和不耐受性方面存在异常。岛状体之间的连接更多可能表明GAD患者在受精过程中异常。相对于HCs，GAD患者在中性条件下的独特脑网络反应模式表明GAD患者在区分安全性与不确定性的威胁性和不耐受性方面存在异常。岛状体之间的连接更多可能表明GAD患者在受精过程中异常。相对于HC，在中性条件下GAD患者中独特的脑网络反应模式表明GAD患者在区分安全性与不确定性的威胁性和不耐受性方面存在异常。