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The Orbitofrontal Cortex$
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David Zald and Scott Rauch

Print publication date: 2006

Print ISBN-13: 9780198565741

Published to Oxford Scholarship Online: February 2010

DOI: 10.1093/acprof:oso/9780198565741.001.0001

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The orbitofrontal cortex and anxiety disorders

The orbitofrontal cortex and anxiety disorders

(p.523) Chapter 20 The orbitofrontal cortex and anxiety disorders
The Orbitofrontal Cortex

Mohammed R. Milad

Scott L. Rauch

Oxford University Press

This chapter reviews contemporary neurocircuitry models of anxiety disorders, with a focus on the role of the orbitofrontal cortex (OFC). In addition to human neuroimaging studies, findings from animal research are also considered, with emphasis on fear conditioning and extinction paradigms. The anatomical distinction between medial and lateral OFC is highlighted; medial OFC has been implicated in rewards and conditioned fear extinction recall, whereas reciprocally the lateral OFC has been implicated in evaluating punishers and mediating negative affects. As similarities and differences across the anxiety disorders are explored, the distinction is made between: 1) exaggerated ‘bottom-up’ amygdala responses; 2) failure of ‘top-down’ control by the medial OFC; and 3) excessive lateral OFC activity in concert with striatum. In this way, the clinical phenomena associated with the various anxiety disorders are linked to sub-territories of OFC, and understood in terms of their anatomical connections and the normal functions these neural circuits subserve.

Keywords:   anxiety disorders, fear conditioning, extinction, amygdale responses, PTSD, phobia

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