2012年9月7日 訊 /生物谷BIOON/ --近日，麻省理工學(xué)院的神經(jīng)科學(xué)家發(fā)現(xiàn)，對社交恐懼癥患者進(jìn)行大腦掃描可以幫助判斷認(rèn)知行為治療（cognitive behavioral therapy）是否對其有效。
社交恐懼癥（social anxiety disorder）的治療方法有認(rèn)知行為治療和藥物治療。然而，對于某一病人來說哪種治療方法更好尚無法判斷,。研究表明，患者觀察面部表情不同的照片時的大腦活動可告訴我們答案,。相關(guān)論文發(fā)表在新一期的Archives of General Psychiatry雜志上,。
社交恐懼癥又名社交焦慮癥，是一種對任何社交或公開場合感到強(qiáng)烈恐懼或憂慮的精神疾病,?；颊邔τ谠谀吧嗣媲盎蚩赡鼙粍e人仔細(xì)觀察的社交或表演場合，有一種顯著且持久的恐懼,，害怕自己的行為或緊張的表現(xiàn)會引起羞辱或難堪,。有些患者對參加聚會、打電話,、到商店購物,、或詢問權(quán)威人士都感到困難。
認(rèn)知行為治療的目的是改變導(dǎo)致恐懼的想法和行為,，患者需要通過學(xué)習(xí)改變他人在注視或評價自己的想法,。
目前醫(yī)生通常根據(jù)藥物的副作用、患者的保險(xiǎn)等因素決定治療方法,。論文作者Gabrieli說,，"從科學(xué)角度來說，基本無證據(jù)可以表明患者采用哪種治療方法更好,。"
此項(xiàng)研究中,，在治療前和治療后，研究者在患者觀察面部表情生氣或平靜的照片時對患者大腦進(jìn)行功能性核磁共振成像（fMRI,，functional magnetic resonance imaging）,。在12周的認(rèn)知行為治療之后，檢測患者的社交恐懼水平,。結(jié)果發(fā)現(xiàn)，認(rèn)知行為治療可明顯改善觀察照片時大腦高層視覺處理區(qū)（high-level visual processing areas）活動有顯著變化的患者,。
Gabrieli說,，尚不清楚為何與視覺處理有關(guān)的大腦區(qū)域會做出這一指示,，或許能夠區(qū)分不同經(jīng)歷的患者更能從認(rèn)知行為治療中獲益。（生物谷Bioon.com）
編譯自Predicting How Patients Respond to Therapy: Brain Scans Could Help Doctors Choose Treatments for People With Social Anxiety Disorder
doi:10.1001/2013.jamapsychiatry.5
PMC:
PMID:
Predicting Treatment Response in Social Anxiety Disorder From Functional Magnetic Resonance Imaging
Oliver Doehrmann, PhD; Satrajit S. Ghosh, PhD; Frida E. Polli, PhD; Gretchen O. Reynolds, BA; Franziska Horn, BSc; Anisha Keshavan, BSc; Christina Triantafyllou, PhD; Zeynep M. Saygin, PhD; Susan Whitfield-Gabrieli, PhD; Stefan G. Hofmann, PhD; Mark Pollack, MD; John D. Gabrieli, PhD
Context Current behavioral measures poorly predict treatment outcome in social anxiety disorder (SAD). To our knowledge, this is the first study to examine neuroimaging-based treatment prediction in SAD.
Objective To measure brain activation in patients with SAD as a biomarker to predict subsequent response to cognitive behavioral therapy (CBT).
Design Functional magnetic resonance imaging (fMRI) data were collected prior to CBT intervention. Changes in clinical status were regressed on brain responses and tested for selectivity for social stimuli.
Setting Patients were treated with protocol-based CBT at anxiety disorder programs at Boston University or Massachusetts General Hospital and underwent neuroimaging data collection at Massachusetts Institute of Technology.
Patients Thirty-nine medication-free patients meeting DSM-IV criteria for the generalized subtype of SAD.
Interventions Brain responses to angry vs neutral faces or emotional vs neutral scenes were examined with fMRI prior to initiation of CBT.
Main Outcome Measures Whole-brain regression analyses with differential fMRI responses for angry vs neutral faces and changes in Liebowitz Social Anxiety Scale score as the treatment outcome measure.
Results Pretreatment responses significantly predicted subsequent treatment outcome of patients selectively for social stimuli and particularly in regions of higher-order visual cortex. Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline.
Conclusions The results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient.
