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Objective: While adolescent anxiety disorders represent prevalent, debilitating conditions, few studies explore their brain physiology. Using event-related functional MRI (fMRI) and a behavioral measure of attention to angry faces, we evaluated differences in response between healthy adolescents and adolescents with generalized anxiety disorder (GAD).

Method: In the primary trials of interest, 18 adolescents with GAD and 15 comparisons of equivalent age/gender/IQ viewed angry/neutral face pairs during fMRI acquisition. Following the presentation of each face pair, subjects pressed a button to a probe that was either on the same (congruent) or opposite (incongruent) side as the angry face. Reaction time differences between congruent and incongruent face-trials provided a measure of attention bias to angry faces.

Results: Relative to controls, patients with GAD manifested greater right ventrolateral prefrontal cortex (VLPFC) activation to trials containing angry faces. Compared with controls, patients with GAD also showed greater attentional bias away from angry faces. VLPFC activation differences were independent of differences in attentional bias.

Conclusions: Adolescents with GAD show greater right VLPFC activation and attentional bias away from angry faces than controls. Enhanced VLPFC engagement may directly relate to anxiety, or may regulate abnormal functioning in another region.


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Monk, C.S., Nelson, E.E., McClure, E.B., Mogg, K., Bradley, B.P., Leibenluft, E., Blair, R.J.R., Chen, G., Charney, D.S., Ernst, M., Pine, D.S. (2006). Ventrolateral prefrontal cortex activation and attention bias in response to angry faces in adolescents with generalized anxiety disorder. American Journal of Psychiatry, 163(6), 1091-1097. DOI: 10.1176/appi.ajp.163.6.1091

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