Dialogues in Clinical Neuroscience最新文献

{"title":"The gut-brain axis and inflammatory mediators in suicide and mental disorders with high suicide rates: a review of current evidence.","authors":"Ahmad Shamabadi, Razman Arabzadeh Bahri, Melika Arab Bafrani, Hanie Karimi, Hassan Asadigandomani, Hamed Vahidi, Shahin Akhondzadeh","doi":"10.1080/19585969.2026.2636468","DOIUrl":"10.1080/19585969.2026.2636468","url":null,"abstract":"<p><p>The interplay between gastrointestinal microbiota and mental disorders has recently been spotlighted. This review investigated discrete evidence suggesting associations between the gastrointestinal microbiome and inflammation with suicide. Fusicatenibavter, Hungatella, Veillonella, and Megasphaera have positive associations, but Clostridium, Butyricicoccus, Desulfovibrio piger, and Parabacteroides merdae have negative associations with suicidality. Additionally, lower species uniformity index, higher intestinal fatty acid binding protein secretion, lower zonulin secretion, higher interleukin-6 in cerebrospinal fluid, and laxative abuse are associated with suicidality. As nearly 90% of suicides occur in patients with mental disorders, the interaction between the gut microbiota and inflammation with these disorders together was also documented. Regarding this, major depressive disorder, psychosis and schizophrenia, generalised anxiety disorder, and substance use disorder were investigated. Bacteroidetes and Firmicutes show prominent changes in most cases. In addition, gut bacterial and non-bacterial microbiome alterations and subsequent dysbiosis may contribute to inflammation, in which cytokines affect microglial activity. Meanwhile, impaired intestinal homeostasis may influence these disorders through the vagus nerve, the hypothalamus-pituitary-adrenal axis, and the kynurenine pathway. Beyond these, direct effects of the gut microbiome on immunity are being hypothesised. In conclusion, the gut microbiota imbalance may influence the nervous system environment from non-inflammatory to inflammatory caused by pro-inflammatory cytokine influx into the brain. Consequently, microbiota imbalances may be associated with mental disorders. Specifically, limited evidence indicated possible links between microbiome alterations and suicide, highlighting the need for further research clarifying these associations and underpinning mechanisms. Other factors, including genetic vulnerability, environmental influences, and neurochemical pathways, should also be considered.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"145-156"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prefrontal-limbic circuit modulation in anxiety disorders: Differential neural effects of psychotherapy versus pharmacotherapy revealed by ALE meta-analysis.","authors":"Juan Qiu, Junjie Ren, Jin Chang, Limin Huang, Xiaoming Li","doi":"10.1080/19585969.2026.2719522","DOIUrl":"10.1080/19585969.2026.2719522","url":null,"abstract":"<p><strong>Background: </strong>Anxiety disorders (ADs) involve dysregulation of prefrontal-limbic circuits, but the neural effects of psychotherapy and pharmacotherapy remain unclear.</p><p><strong>Methods: </strong>We conducted an activation likelihood estimation (ALE) meta-analysis of task-based fMRI studies reporting pre- and post-treatment whole-brain coordinates in ADs. Separate analyses were performed for psychotherapy and pharmacotherapy. A random-effects synthesis assessed changes in primary anxiety symptoms where extractable data were available.</p><p><strong>Results: </strong>27 studies involving 561 patients were included. Psychotherapy was associated mainly with decreased activation in prefrontal and striatal regions, including the medial, middle, and inferior frontal gyri and caudate nucleus, whereas pharmacotherapy showed more focal decreases in the right uncus. Subgroup analyses suggested heterogeneity across therapies, diagnoses, and tasks. 9 independent active-treatment cohorts (179 participants) showed a large pooled symptom reduction (Hedges' g = 1.44, 95% CI 0.99-1.90; I² = 75.1%).</p><p><strong>Conclusions: </strong>Psychotherapy and pharmacotherapy may engage partly distinct neural pathways in ADs, with broader prefrontal-striatal modulation after psychotherapy and more focal limbic effects after pharmacotherapy. Findings remain exploratory given the limited and heterogeneous evidence base.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"289-301"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of posttraumatic stress disorder (PTSD).","authors":"Borwin Bandelow","doi":"10.1080/19585969.2026.2680838","DOIUrl":"10.1080/19585969.2026.2680838","url":null,"abstract":"<p><p>The present review summarises recommendations for the management of posttraumatic stress disorder (PTSD) based on a consensus among international experts in the field.</p><p><p>Cognitive-behavioural therapy (CBT) has the best evidence base as a psychotherapy modality. Virtual reality exposure therapy appears to be an emerging treatment option for PTSD. Eye Movement Desensitisation and Reprocessing (EMDR) therapy and digital CBT-based interventions did not demonstrate superiority compared to controls. Controlled studies supporting the use of psychodynamic therapy are lacking. Early prophylactic psychotherapy for trauma victims is ineffective and may be harmful.</p><p><p>First-line pharmacotherapy includes selective serotonin reuptake inhibitors (SSRIs) and the serotonin-noradrenaline reuptake inhibitor (SNRI) venlafaxine. Several second- and third-line medications are available for treatment-refractory patients. Currently, no medications can be recommended for prophylactic use in trauma victims.</p><p><p>Although evidence is incomplete regarding combined psychotherapy and pharmacotherapy, available studies generally favour combination treatments over monotherapy. Repetitive transcranial magnetic stimulation (rTMS) showed efficacy in one study. In children and adolescents with PTSD, CBT demonstrated a medium effect size compared to active controls, while studies on SSRI treatment in this population yielded inconsistent results.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"229-239"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping topological abnormalities in cortical similarity networks to schizophrenia-associated gene expression.","authors":"Sung Woo Joo, Jungsun Lee","doi":"10.1080/19585969.2026.2682773","DOIUrl":"10.1080/19585969.2026.2682773","url":null,"abstract":"<p><strong>Introduction: </strong>Disrupted structural connectivity is recognized as a key pathophysiological feature of schizophrenia (SCZ). However, the relationship between cortical similarity network alterations and gene expression remains poorly understood.</p><p><strong>Methods: </strong>We applied the Morphometric INverse Divergence framework to T1-weighted MRI from 1,216 participants. Cortical similarity networks were constructed, and global and nodal metrics were computed. Case-control comparisons were performed using linear models. Partial least squares (PLS) regression identified genes associated with spatial patterns of network alterations using Allen Human Brain Atlas data.</p><p><strong>Results: </strong>Among global metrics, only the rich-club coefficient differed between groups, with a negligible effect size. Nodal metrics showed reduced eigenvector centrality and k-coreness centrality in left temporal/insular (somatomotor), lateral occipital (visual), anterior cingulate (salience/ventral attention), and posterior cingulate (default mode) regions. Participation coefficient was widely reduced in SCZ. For each nodal metric, we identified PLS2-positive and PLS2-negative gene sets. Across degree, eigenvector centrality, and k-coreness centrality, PLS2-negative genes were enriched for metal ion transport, linked to manic and nonorganic psychosis, and upregulated in adolescence and early adulthood. PLS2-positive genes were enriched for neuron projection development and learning or memory, but not psychotic disorders.</p><p><strong>Conclusions: </strong>These findings highlight synaptic and neurodevelopmental mechanisms underlying structural dysconnectivity in SCZ.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"240-249"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of neuroimaging studies of adults aged 35 and older with clinical, symptomatic and genetic risk for attention-deficit/hyperactivity disorder.","authors":"Natalia G Docteur, Hayley G P Huston, Avery A Krupa, Brandy L Callahan","doi":"10.1080/19585969.2026.2700984","DOIUrl":"10.1080/19585969.2026.2700984","url":null,"abstract":"<p><p>Attention-deficit/hyperactivity disorder (ADHD) affects 2.5% of adults and is associated with cognitive decline and dementia. The neurobiological mechanisms contributing to adverse outcomes in ADHD are poorly understood. ADHD-related brain alterations may persist into later life and interact with ageing-related processes, potentially increasing susceptibility to neuropathology. This preregistered systematic review synthesised neuroimaging findings in adults aged 35 years and older with clinical, symptomatic, or genetic risk for ADHD, and summarised cognitive and clinical correlates. A search of five databases produced 13 included studies. Risk of bias was assessed using the Newcastle-Ottawa Scale. Most studies (11/13) had low risk of bias. Compared to controls, ADHD groups exhibited alterations in fronto-striatal, fronto-parietal, and limbic systems implicated in executive control and attention. Middle-aged adults with clinical ADHD showed more widespread cortical structural differences, whereas older adults demonstrated abnormalities primarily in frontal regions, possibly reflecting attenuation of differences through ageing. Two functional studies in those with clinical ADHD reported frontal hypoactivation alongside parietal hyperactivation, consistent with compensatory recruitment. Among undiagnosed samples, there were interactions between genetic risk for ADHD and Alzheimer's disease-related pathology affecting brain and cognitive outcomes. Overall, ADHD-associated neurobiological alterations appear to persist into older age. Longitudinal investigations are needed to clarify these relationships.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"259-276"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self‑harm ideation in perinatal women: Prevalence across gestational and postpartum windows and general risk and protective factors.","authors":"Alberto Stefana, Fiorino Mirabella, Antonella Gigantesco, Gemma Calamandrei, Laura Camoni","doi":"10.1080/19585969.2026.2719514","DOIUrl":"10.1080/19585969.2026.2719514","url":null,"abstract":"<p><strong>Introduction: </strong>The perinatal period is marked by heightened vulnerability to mental health difficulties, including the onset of self-harm ideation (SHI). We aimed to (a) estimate the prevalence of self-harm ideation among perinatal women, (b) explore sociodemographic, clinical, and psychosocial correlates of SHI.</p><p><strong>Methods: </strong>This is a cross-sectional study involving pregnant (<i>n</i> = 5,087) and postpartum women (<i>n</i> = 6,550). SHI was measured using item 10 of the Edinburgh Postnatal Depression Scale (EPDS), depressive symptoms using the remaining 9 EPDS items (EPDS-9), and anxiety symptoms using the Generalised Anxiety Disorder-7. Prespecified multivariable logistic models were fitted separately for pregnancy and postpartum.</p><p><strong>Results: </strong>SHI prevalence was 2.3% during pregnancy and 1.1% postpartum. In pregnancy, risk was independently associated with depressive symptom severity (OR = 1.27, 95%CI [1.21-1.33], <i>p</i><.001) and immigrant status (OR = 2.08, 95%CI [1.15-3.75], <i>p</i>=.015), whereas better economic conditions were protective (OR = 0.53 per category increase, 95%CI [0.36-0.78], <i>p</i>=.001). In the postpartum period, depressive symptoms remained strongly associated with SHI (OR = 1.32, 95%CI [1.24-1.40], <i>p</i><.001), and stable paid employment was protective (OR = 0.41, 95%CI [0.23-0.74], <i>p</i>=.003). Phase-specific models showed good to excellent discrimination (AUC_pregnancy=.86; AUC_postpartum=.91) and acceptable calibration. No clinically meaningful EPDS-9 × phase interaction emerged.</p><p><strong>Conclusions: </strong>A portion of perinatal women experience SHI and report it when asked directly (i.e. through the EPDS self-harm item). Routine screening should include explicit questions about self-harm thoughts and should continue through the first postpartum year. Combining mood screening with assessment of socioeconomic adversity may further improve the identification of individuals who could benefit from additional support.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"314-326"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance use involvement moderates the effect of cortisol response on white-matter microstructure longitudinally.","authors":"Chelsea E Smith, Charlotte B Luster, Sarah E Kimmel, Maureen D Reynolds, Marc N Potenza, Zu Wei Zhai","doi":"10.1080/19585969.2026.2719512","DOIUrl":"10.1080/19585969.2026.2719512","url":null,"abstract":"<p><strong>Introduction: </strong>Stress contributes to substance use (SU) involvement (SUI) and differences in brain white matter (WM). However, longitudinal relationships involving SUI, stress hormones, and WM are not well understood. This study examined the moderating role of SUI on the prospective association between cortisol response (CR) and WM microstructure.</p><p><strong>Methods: </strong>Data were drawn from a larger longitudinal study on SU disorder (SUD) aetiology. Participants were enrolled at ages 10-12 years when salivary cortisol was assayed. The Drug Use Chart assessed cumulative involvement with 10 substance categories by age 18 years. Diffusion-weighted data were acquired from sixty-nine participants after reaching age 18 years and were used to compute crossing-fibre measures. Analyses were conducted in <i>a priori</i> regions of interest linked to SU and stress.</p><p><strong>Results: </strong>CR levels were related to secondary- and tertiary-fibre anisotropy in the cingulum. SUI moderated associations between CR and right cingulum secondary-fibre anisotropy wherein CR levels associated with greater anisotropy at heightened SUI levels.</p><p><strong>Conclusions: </strong>This study identified stress-linked differences in distinct cingulum WM fibres among individuals with greater SUI. Involvement with SU overall, may modulate stress effects and enhance WM anisotropy in region- and fibre-specific manners. Potential biomarkers associated with SUI in WM among vulnerable stress-exposed youth require further investigation with respect to SUD aetiology.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"302-313"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polarisation of brain dynamics in mania and depression.","authors":"Matteo Martino, Paola Magioncalda, Benedetta Conio, Mario Amore, Zirui Huang","doi":"10.1080/19585969.2026.2663032","DOIUrl":"10.1080/19585969.2026.2663032","url":null,"abstract":"<p><strong>Introduction: </strong>This work investigated brain dynamics underlying manic and depressive states in bipolar disorder.</p><p><strong>Methods: </strong>Resting-state fMRI data were obtained from 69 bipolar patients-34 manic, 35 depressed<i>-</i>and 73 healthy controls. Intrinsic brain activity was modelled as a temporal sequence of discrete quasi-stationary states (co-activation patterns), which were compared between groups and related to symptomatology.</p><p><strong>Results: </strong>Mania was associated with increased occurrence of a co-activation pattern encompassing sensorimotor network areas, which positively correlated with manic symptomatology (hyperactivity and mood elevation) and manic polarity, and negatively correlated with depressive symptomatology (retardation and apathy). Depression was associated with increased occurrence of a co-activation pattern encompassing default-mode network areas, negatively correlating with manic symptomatology (hyperactivity and mood elevation).</p><p><strong>Conclusions: </strong>These findings suggest that polarisation of brain dynamics towards low-order sensorimotor/insular systems-subserving perception and modulation of the outer and inner/body environments-may reshape subjective experience and behaviour promoting immediate interaction with the environment, manifesting as mania. Conversely, polarisation towards high-order associative systems-subserving stimulus-independent associative processing-may reshape experience and behaviour favouring detachment from the environment, manifesting as depression. This framework illustrates how changes in the functional brain architecture may alter the structure of phenomenal experience and behaviour in physiology and psychopathology.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"10-20"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current potential biomarkers for Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis: review of literature.","authors":"Jiaman Peng, Ting Fan, Junling Wang, Youqing Deng, Renshi Xu","doi":"10.1080/19585969.2026.2622722","DOIUrl":"10.1080/19585969.2026.2622722","url":null,"abstract":"<p><strong>Introduction: </strong>Alzheimer's disease (AD), Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) are several common neurodegenerative diseases (NDs). At present, is the lack of effective diagnosis, progression, prognosis and therapeutic biomarkers. it is a urgent demand to search the relevant confident biomarkers.</p><p><strong>Area covered: </strong>This review systematically analysed the potential biomarkers of blood, cerebrospinal fluid, neuroimaing and emerging non-invasive indicators, and synthesises current evidences on the biomarkers of AD, PD and ALS about diagnosis, progression, prognosis and therapeutic, especially diagnosis biomarkers.</p><p><strong>Expert commentary: </strong>In this review, we focus on discussing relevant diagnosis, progression, prognosis and therapeutic biomarkers for AD, PD and ALS in recent years, and prospecting the possible future directions of relevant biomarkers.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"17-39"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, genetics, neuroimaging, clinical features, and treatment between overall and performance-only social anxiety disorder: a narrative review.","authors":"Lisa Okamura, Yuki Ueji, Tamae Izumi, Daisuke Fujikane, Tatsuhide Ukisu, Hiroki Murakami, Toshiki Shioiri, Kazutaka Ohi","doi":"10.1080/19585969.2026.2661986","DOIUrl":"10.1080/19585969.2026.2661986","url":null,"abstract":"<p><p>Social anxiety disorder (SAD) is a common psychiatric condition marked by a significant fear of social evaluation. To better identify a meaningful subgroup, the DSM-5 introduced a \"performance-only\" specifier, replacing the generalised specifier in the DSM-IV. We conducted a narrative review comparing overall SAD (including generalised and performance-only forms) and performance-only SAD across epidemiology, genetics, neuroimaging, clinical characteristics, and treatment. Overall SAD affects 5-13% of the population, whereas performance-only SAD has been reported in about 0.3-0.7%. Overall SAD typically emerges in early adolescence and is more prevalent among females, whereas performance-only SAD tends to begin in mid-adolescence and is relatively more prevalent among males. Family studies indicate stronger familial aggregation in overall SAD, suggesting greater genetic contribution compared with performance-only SAD, although direct heritability estimates for the latter remain limited. Neuroimaging studies of overall SAD reveal alterations in fronto-limbic and default mode networks, whereas neurobiological data on performance-only SAD are limited and suggest more localised, context-dependent neural responses. Clinically, performance-only SAD is linked to fewer psychiatric comorbidities, less functional impairment, and higher socioeconomic status. Treatments for overall SAD typically include CBT and pharmacotherapy, such as SSRIs or SNRIs. In contrast, performance-only SAD is commonly managed with exposure-based CBT and, in some cases, beta-blockers for situational symptom relief. These findings suggest that performance-only SAD may represent a distinct subtype within the SAD spectrum, although empirical research on this specifier remains limited.</p>","PeriodicalId":54343,"journal":{"name":"Dialogues in Clinical Neuroscience","volume":"28 1","pages":"188-196"},"PeriodicalIF":5.1,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}