Neural correlates of self-referential processing and their clinical implications in social anxiety disorder
Hyung-Jun Yoon 1, Eun Hyun Seo 2, Jae-Jin Kim 3, IL Han Choo 1*
1Department of Neuropsychiatry, College of Medicine, Chosun University/Chosun University Hospital, Gwangju, Republic of Korea, 2Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea, 3Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Received: January 3, 2018; Revised: March 14, 2018; Accepted: April 27, 2018; Published online: April 27, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Social anxiety disorder (SAD) is associated with aberrant self-referential processing (SRP) such as increased self-focused attention. Aberrant SRP is one of the core features of SAD and is also related to therapeutic interventions. Understanding of the underlying neural correlates of SRP in SAD is important for identifying specific brain regions as treatment targets. We reviewed functional magnetic resonance imaging (fMRI) studies to clarify the neural correlates of SRP and their clinical implications for SAD. Task-based and resting fMRI studies have reported the cortical midline structures (CMS) including the default mode network (DMN), theory of mind-related regions of the temporo-parietal junction and temporal pole, and the insula as significant neural correlates of aberrant SRP in SAD patients. Also, these neural correlates are related to clinical improvement on pharmacological and cognitive-behavioral treatments. Furthermore, these could be candidates for the development of novel SAD treatments. This review supports that neural correlates of SAD may be significant biomarkers for future pathophysiology based treatment.
Keywords: social anxiety disorder, self-referential processing, functional magnetic resonance imaging, cortical midline structures


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