Abstract
This study aimed to explore the role of the default mode network (DMN) and salience network (SN) in the assessment of pathophysiology of generalized anxiety disorder (GAD) through analyzing the characteristics of internal function connectivity (FC) and to investigate the relationship of FC with Hamilton anxiety (HAMA) scale scores in untreated GAD patients during a resting-state functional magnetic resonance imaging (rs-fMRI). Rs-fMRI and HAMA scale scoring were performed in 51 GAD patients (31 GAD patients with liver stagnation transforming into fire type and 20 GAD patients with stagnation of liver-Qi syndrome type) and 20 healthy controls. Spearman correlation analysis was performed to assess the association between HAMA scores and abnormal brain FC. Compared with healthy controls, the FC of the right medial prefrontal gyrus of the DMN and the right superior temporal gyrus of the SN increased significantly in the GAD patients (P < 0.001). However, the FC of the left middle frontal gyrus and bilateral medial superior frontal gyrus of the SN reduced significantly in the GAD patients with stagnation of liver-Qi syndrome type as compared with healthy controls and GAD patients with liver stagnation transforming into fire type (P < 0.001). There was no relationship between abnormal brain FC and HAMA scores. In conclusion, the FC of the DMN and SN may be abnormal in the GAD patients at the resting state. The aberrant FC of some crucial brain regions of these networks may contribute to the pathophysiology of GAD.
Highlights
Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry about a number of different things
GAD patients were recruited from the Department of Medical Neurology at Dongzhimen Hospital of Beijing University of Chinese Medicine between November 2015 and June 2017. e GAD was diagnosed by two experienced psychiatrists. e inclusion criteria were as follows: (1) GAD was diagnosed according to the diagnostic criteria from the American Diagnostic and Statistical Manual of Mental Disorders, 5th ed. [29]; (2) patients complained of uncontrollable anxiety and worries about everyday events and problems for at least 6 months; (3) patients were 20–40 years old; (4) all the participants were right-handed; and (5) GAD patients had the Hamilton anxiety (HAMA) score higher than 14
Our study investigated the brain functional connectivity in patients with different subtypes of GAD based on syndrome differentiation in the Traditional Chinese medicine (TCM) and the healthy controls, and our results confirmed that GAD patients had cerebral dysfunction at the resting state
Summary
Generalized anxiety disorder (GAD) is characterized by persistent and excessive worry about a number of different things. E main characteristics of GAD are chronic excessive anxiety and worry [2], which significantly reduce the work efficiency and increase the risk for other diseases. GAD has the highest prevalence and affects 4–6% of the general population [3]. Syndrome differentiation is one of the basic features of TCM, and the clinical treatment is usually based on the TCM syndrome which is a diagnostic classification of pathological changes of disease state according to the individual symptoms and signs, such as pulse and tongue. Us, TCM emphasizes the role of individual characteristics in clinical diagnosis and treatment [5]. Anxiety disorders are mainly caused by emotional discomfort, depression, and Qi stagnation according to TCM theory. “fire” symptoms will be turned out after long-term liver-Qi
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