Reduced Anterior Temporal and Hippocampal Functional Connectivity During Face Processing Discriminates Individuals with Social Anxiety Disorder from Healthy Controls and Panic Disorder, and Increases Following Treatment

Group functional magnetic resonance imaging (fMRI) studies suggest that anxiety disorders are associated with anomalous brain activation and functional connectivity (FC). However, brain-based features sensitive enough to discriminate individual subjects with a specific anxiety disorder and that track symptom severity longitudinally, desirable qualities for putative disorder-specific biomarkers, remain to be identified. Blood oxygen level-dependent (BOLD) fMRI during emotional face perceptual tasks and a new, large-scale and condition-dependent FC and machine learning approach were used to identify features (pair-wise correlations) that discriminated patients with social anxiety disorder (SAD, N = 16) from controls (N = 19). We assessed whether these features discriminated SAD from panic disorder (PD, N = 16), and SAD from controls in an independent replication sample that performed a similar task at baseline (N: SAD = 15, controls = 17) and following 8-weeks paroxetine treatment (N: SAD = 12, untreated controls = 7). High SAD vs HCs discrimination (area under the ROC curve, AUC, arithmetic mean of sensitivity and specificity) was achieved with two FC features during unattended neutral face perception (AUC = 0.88, P<0.05 corrected). These features also discriminated SAD vs PD (AUC = 0.82, P = 0.0001) and SAD vs HCs in the independent replication sample (FC during unattended angry face perception, AUC = 0.71, P = 0.01). The most informative FC was left hippocampus-left temporal pole, which was reduced in both SAD samples (replication sample P = 0.027), and this FC increased following the treatment (post>pre, t((11)) = 2.9, P = 0.007). In conclusion, SAD is associated with reduced FC between left temporal pole and left hippocampus during face perception, and results suggest promise for emerging FC-based biomarkers for SAD diagnosis and treatment effects.