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BACKGROUND: Functional magnetic resonance imaging (fMRI) holds promise as a noninvasive means of identifying neural responses that can be used to predict treatment response before beginning a drug trial. Imaging paradigms employing facial expressions as presented stimuli have been shown to activate the amygdala and anterior cingulate cortex (ACC). Here, we sought to determine whether pretreatment amygdala and rostral ACC (rACC) reactivity to facial expressions could predict treatment outcomes in patients with generalized anxiety disorder (GAD). METHODS: Fifteen subjects (12 female subjects) with GAD participated in an open-label venlafaxine treatment trial. Functional magnetic resonance imaging responses to facial expressions of emotion collected before subjects began treatment were compared with changes in anxiety following 8 weeks of venlafaxine administration. In addition, the magnitude of fMRI responses of subjects with GAD were compared with that of 15 control subjects (12 female subjects) who did not have GAD and did not receive venlafaxine treatment. RESULTS: The magnitude of treatment response was predicted by greater pretreatment reactivity to fearful faces in rACC and lesser reactivity in the amygdala. These individual differences in pretreatment rACC and amygdala reactivity within the GAD group were observed despite the fact that 1) the overall magnitude of pretreatment rACC and amygdala reactivity did not differ between subjects with GAD and control subjects and 2) there was no main effect of treatment on rACC-amygdala reactivity in the GAD group. CONCLUSIONS: These findings show that this pattern of rACC-amygdala responsivity could prove useful as a predictor of venlafaxine treatment response in patients with GAD.
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The capacity to self-generate mental content that is unrelated to the current environment is a fundamental characteristic of the mind, and the current experiment explored how this experience is related to the decisions that people make in daily life. We examined how task-unrelated thought (TUT) varies with the length of time participants are willing to wait for an economic reward, as measured using an inter-temporal discounting task. When participants performed a task requiring minimal attention, the greater the amount of time spent engaged in TUT the longer the individual was prepared to wait for an economic reward. These data indicate that self-generated thought engages processes associated with the successful management of long-term goals. Although immersion in the here and now is undeniably advantageous, under appropriate conditions the capacity to let go of the present and consider more pertinent personal goals may have its own rewards.
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