Anxiety disorders are a leading source of human misery, morbidity, and premature mortality. Existing treatments are far from curative for many, underscoring the need to clarify the underlying neural mechanisms. Although many brain regions contribute, the amygdala has received the most intense scientific attention. Over the past several decades, this scrutiny has yielded a detailed understanding of amygdala function, but it has failed to produce new clinical assays, biomarkers, or cures. Rising to this urgent public health challenge demands an honest reckoning with the functional-neuroanatomical complexity of the amygdala and a shift from theories anchored on "the amygdala" to models centered on specific amygdala nuclei and cell types. This review begins by examining evidence from studies of rodents, monkeys, and humans for the "canonical model," the idea that the amygdala plays a central role in fear- and anxiety-related states, traits, and disorders. Next, the authors selectively highlight work indicating that the canonical model, while true, is overly simplistic and fails to adequately capture the actual state of the evidentiary record, the breadth of amygdala-associated functions and illnesses, or the complexity of the amygdala's functional architecture. The authors describe the implications of these facts for basic and clinical neuroimaging research. The review concludes with some general recommendations for grappling with the complexity of the amygdala and accelerating efforts to understand and more effectively treat amygdala-related psychopathology.

中文翻译：

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诚实地清算杏仁核和精神疾病。


焦虑症是人类痛苦、发病率和过早死亡的主要原因。现有的治疗方法对许多人来说远非治愈性，这凸显了阐明潜在神经机制的必要性。尽管许多大脑区域都有贡献，但杏仁核受到了最强烈的科学关注。在过去的几十年里，这种审查产生了对杏仁核功能的详细理解，但它未能产生新的临床检测、生物标志物或治疗方法。应对这一紧迫的公共卫生挑战需要诚实地考虑杏仁核的功能神经解剖学复杂性，并从以“杏仁核”为基础的理论转变为以特定杏仁核和细胞类型为中心的模型。本综述首先检查了啮齿动物、猴子和人类研究中“规范模型”的证据，即杏仁核在与恐惧和焦虑相关的状态、特征和障碍中起着核心作用。接下来，作者有选择地强调了表明规范模型虽然正确，但过于简单化，未能充分捕捉证据记录的实际状态、杏仁核相关功能和疾病的广度或杏仁核功能结构的复杂性。作者描述了这些事实对基础和临床神经影像学研究的影响。本综述总结了一些一般性建议，以应对杏仁核的复杂性，并加快理解和更有效地治疗杏仁核相关精神病理学的努力。