Facial emotion processing in patients with social anxiety disorder and Williams–Beuren syndrome: an fMRI study

Facial emotion processing in patients with social anxiety disorder and Williams–Beuren syndrome: an fMRI study

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J Psychiatry Neurosci 2016;41(3):182-191

Cynthia Binelli, PhD; Armando Muñiz, MD; Susana Subira, MD, PhD;
Ricard Navines, MD, PhD; Laura Blanco-Hinojo, MSc; Debora Perez-Garcia, BSc; Jose Crippa, MD, PhD; Magi Farré, MD, PhD; Luis Pérez Jurado, MD, PhD; Jesus Pujol, MD, PhD; Rocio Martin-Santos, MD, PhD

Abstract

Background: Social anxiety disorder (SAD) and Williams–Beuren syndrome (WBS) are 2 conditions with major differences in terms of genetics, development and cognitive profiles. Both conditions are associated with compromised abilities in overlapping areas, including social approach, processing of social emotional cues and gaze behaviour, and to some extent they are associated with opposite behaviours in these domains. We examined common and distinct patterns of brain activation during a facial emotion processing paradigm in patients with SAD and WBS.

Methods: We examined patients with SAD and WBS and healthy controls matched by age and laterality using functional MRI during the processing of happy, fearful and angry faces.

Results: We included 20 patients with SAD and 20 with WBS as well as 20 matched controls in our study. Patients with SAD and WBS did not differ in the pattern of limbic activation. We observed differences in early visual areas of the face processing network in patients with WBS and differences in the cortical prefrontal regions involved in the top– down regulation of anxiety and in the fusiform gyrus for patients with SAD. Compared with those in the SAD and control groups, participants in the WBS group did not activate the right lateral inferior occipital cortex. In addition, compared with controls, patients with WBS hypoactivated the posterior primary visual cortex and showed significantly less deactivation in the right temporal operculum. Participants in the SAD group showed decreased prefrontal activation compared with those in the WBS and control groups. In addition, compared with controls, participants with SAD showed decreased fusiform activation. Participants with SAD and WBS also differed in the pattern of activation in the superior temporal gyrus, a region that has been linked to gaze processing.

Limitations: The results observed in the WBS group are limited by the IQ of the WBS sample; however, the specificity of findings suggests that the pattern of brain activation observed for WBS is more likely to reflect a neurobiological substrate rather than intellectual impairment per se.

Conclusion: Patients with SAD and WBS showed common and specific patterns of brain activation. Our results highlight the role of cortical regions during facial emotion processing in individuals with SAD and WBS.


Submitted Dec. 17, 2014; Revised May 31, 2015; Accepted July 19, 2015; Early-released Dec. 1, 2015

Acknowledgements: This study was performed in part with grants: Instituto de Carlos III (ISCIII) – FIS: PI14/01411 (R. Martín-Santos), ISCIII-G03/184 (R. Martín-Santos), and the support of Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement: SGR2009/1435 and SGR2014/1411 (R. Martín-Santos).

Affiliations: From the Department of Psychiatry and Psychology, Hospital Clínic, Institut d’Investigacions Biomèdicas August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM) G25, Barcelona, Spain (Binelli, Muñiz, Navinés, Martín-Santos); the Department of Clinical and Health Psychology. Universitat Autònoma de Barcelona, Bellaterra, Spain ( Binelli, Subirà); the Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain (Muñiz, Martín-Santos); the MRI Research Unit, Hospital del Mar, CIBERSAM G21, Barcelona, Spain (Blanco-Hinojo, Pujol); the Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, SP, Brazil (Crippa); the Human Pharmacology and Clinical Neurosciences Research Group, Neurosciences Research Programme, IMIM-Hospital del Mar Medical Research Institute and Universitat Autònoma Barcelona, (UDIMAS-UAB), Barcelona, Spain (Pérez-García, Farré, Pérez-Jurado); and the Unitat de Genètica, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona (PRBB), and Centro de Investigación en Red en Enfermedades Raras (CIBERER), Barcelona, Spain (Pérez-Jurado).

Competing interests: None declared.

Contributors: M. Farré, L. Pérez-Jurado, J. Pujol and R. Martin-Santos designed the study. C. Binelli, A. Muñiz, S. Subira, R. Navines, L. Blanco-Hinojo, D. Perez-Garcia, M. Farré, L. Pérez-Jurado and J. Pujol acquired the data, which C. Binelli, L. Blanco-Hinojo, J. Crippa, J. Pujol and R. Martin-Santos analyzed. C. Binelli and R. Martin-Santos wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.140384

Correspondence to: R. Martin-Santos, Department of Psychiatry and Psychology, Hospital Clínic, Institut d’Investigacions Biomèdicas August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Villarroel, 170, 08036-Barcelona, Spain; rmsantos@clinic.ub.es