Amygdala on the Lookout.

Abstract

results present an explanatory challenge: why would the amygdala be hypoactive in paranoid individuals who exhibit heightened threat perception and elevated physiological arousal? To explain this paradoxical finding, some investigators hypothesized that reduced frontal control over the amygdala due to dysconnectivity of frontolimbic circuitry could lead to hypervigilanceand misattribution of fear to incoming signals (3). AnotherpossibilityisthatmethodologicallimitationsofBOLD fMRI have obstructed a more accurate quantification of amygdala activity. In this issue of the Journal, a new study conducted by Pinkham and colleagues (5) offers a methodological explanation for discrepant findings concerning aberrant amygdala activity in paranoid schizophrenia. The authors definitively demonstrate higher baseline amygdala activity in paranoid compared with nonparanoid patients with schizophrenia, by employing arterial spin labeling perfusion MRI. Arterial spin labeling allows for a noninvasive and quantitative measurement of regional cerebral blood flow (CBF) by using magneticallylabeledarterialbloodwaterasanendogenoustracer (asopposedtoexogenousradioactivetracersusedinpositron emission tomography) (6). There are both important methodological and conceptual advances here worthy of note. In addition to arterial spin labeling, the authors acquired BOLD fMRI data while participants rated photographs of faces for trustworthiness. By measuring resting state regional CBF and task-related BOLD activity in the same participants, the authors were able to examine group differences in baseline amygdala activity alongside differences in task-related fluctuations of amygdalaactivity.Suchcomparisonsareparticularlyrelevant to schizophrenia, as prior evidence of amygdala hypoactivation relied on BOLD contrasts blind to potential group differences in baseline activity. Indeed, Pinkham and colleagues found that acutely paranoid patients exhibited higher resting CBF in the bilateral amygdala compared with nonparanoid patients and healthy comparison subjects, who did not differ from each other. On the other hand, the BOLD fMRI task analysis revealed a general trend of amygdala hypoactivation in paranoid compared with nonparanoid participants. Thus, observed taskrelated amygdala hypoactivity likely reflects higher baseline amygdala activity that mitigates the stimulus-driven signal change detected by the BOLD contrast. Additional wholebrain group comparisons found greater CBF in the internal capsule, the corpus callosum, and portions of the inferior temporal and fusiform gyri in paranoid compared with nonparanoid patients. Overall, these results suggest that paranoia