1
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Guan X, Cao P. Brain Mechanisms Underlying Panic Attack and Panic Disorder. Neurosci Bull 2024; 40:795-814. [PMID: 37477800 PMCID: PMC11178723 DOI: 10.1007/s12264-023-01088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/23/2023] [Indexed: 07/22/2023] Open
Abstract
Panic disorder is a psychiatric disorder characterized by recurrent panic attacks, with a prevalence of ~ 4% in the general population, causing heavy personal and socioeconomic burdens. The similarities of animal defense responses to clinical panic attack symptoms in humans make it possible to translate neuroanatomical pathways identified in animal studies to panic disorder in humans. Therefore, in this review we first present a basic overview of panic disorder in humans including the main subtypes, models commonly used to trigger panic attacks, related hypotheses, the neurotransmitter systems that may be involved, and the current clinical treatments to give the reader a comprehensive understanding of panic disorder. The animal section introduces the models that trigger panic-like behavior in animals and the brain regions that may be involved, providing insights for future elucidation of the neural circuit mechanisms behind panic attacks.
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Affiliation(s)
- Xuyan Guan
- Tsinghua Institute of Multidisciplinary Biomedical Research, Tsinghua University, Beijing, 102206, China.
- National Institute of Biological Sciences (NIBS), Beijing, 102206, China.
| | - Peng Cao
- Tsinghua Institute of Multidisciplinary Biomedical Research, Tsinghua University, Beijing, 102206, China
- National Institute of Biological Sciences (NIBS), Beijing, 102206, China
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2
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Wang X, Cheng B, Wang S, Lu F, Luo Y, Long X, Kong D. Distinct grey matter volume alterations in adult patients with panic disorder and social anxiety disorder: A systematic review and voxel-based morphometry meta-analysis. J Affect Disord 2021; 281:805-823. [PMID: 33243552 DOI: 10.1016/j.jad.2020.11.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/18/2020] [Accepted: 11/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The paradox of similar diagnostic criteria but potentially different neuropathologies in panic disorder (PD) and social anxiety disorder (SAD) needs to be clarified. METHODS We performed a qualitative systematic review and a quantitative whole-brain voxel-based morphometry (VBM) meta-analysis with an anisotropic effect-size version of seed-based D mapping (AES-SDM) to explore whether the alterations of grey matter volume (GMV) in PD are similar to or different from those in SAD, together with potential confounding factors. RESULTS A total of thirty-one studies were eligible for inclusion, eighteen of which were included in the meta-analysis. Compared to the respective healthy controls (HC), qualitative and quantitative analyses revealed smaller cortical-subcortical GMVs in PD patients in brain areas including the prefrontal and temporal-parietal cortices, striatum, thalamus and brainstem, predominantly right-lateralized regions, and larger GMVs in the prefrontal and temporal-parietal-occipital cortices, and smaller striatum and thalamus in SAD patients. Quantitatively, the right inferior frontal gyrus (IFG) deficit was specifically implicated in PD patients, whereas left striatum-thalamus deficits were specific to SAD patients, without shared GMV alterations in both disorders. Sex, the severity of clinical symptoms, psychiatric comorbidity, and concomitant medication use were negatively correlated with smaller regional GMV alterations in PD patients. CONCLUSION PD and SAD may represent different anxiety sub-entities at the neuroanatomical phenotypes level, with different specific neurostructural deficits in the right IFG of PD patients, and the left striatum and thalamus of SAD patients. This combination of differences and specificities can potentially be used to guide the development of diagnostic biomarkers for these disorders.
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Affiliation(s)
- Xiuli Wang
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China.
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu 610041, China
| | - Song Wang
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Fengmei Lu
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China
| | - Ya Luo
- Mental Health Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xipeng Long
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Di Kong
- Department of Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China
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3
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He X, Jin C, Ma M, Zhou R, Wu S, Huang H, Li Y, Chen Q, Zhang M, Zhang H, Tian M. PET imaging on neurofunctional changes after optogenetic stimulation in a rat model of panic disorder. Front Med 2019; 13:602-609. [PMID: 31321611 DOI: 10.1007/s11684-019-0704-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022]
Abstract
Panic disorder (PD) is an acute paroxysmal anxiety disorder with poorly understood pathophysiology. The dorsal periaqueductal gray (dPAG) is involved in the genesis of PD. However, the downstream neurofunctional changes of the dPAG during panic attacks have yet to be evaluated in vivo. In this study, optogenetic stimulation to the dPAG was performed to induce panic-like behaviors, and in vivo positron emission tomography (PET) imaging with 18F-flurodeoxyglucose (18F-FDG) was conducted to evaluate neurofunctional changes before and after the optogenetic stimulation. Compared with the baseline, post-optogenetic stimulation PET imaging demonstrated that the glucose metabolism significantly increased (P < 0.001) in dPAG, the cuneiform nucleus, the cerebellar lobule, the cingulate cortex, the alveus of the hippocampus, the primary visual cortex, the septohypothalamic nucleus, and the retrosplenial granular cortex but significantly decreased (P < 0.001) in the basal ganglia, the frontal cortex, the forceps minor corpus callosum, the primary somatosensory cortex, the primary motor cortex, the secondary visual cortex, and the dorsal lateral geniculate nucleus. Taken together, these data indicated that in vivo PET imaging can successfully detect downstream neurofunctional changes involved in the panic attacks after optogenetic stimulation to the dPAG.
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Affiliation(s)
- Xiao He
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Chentao Jin
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Mindi Ma
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Rui Zhou
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Shuang Wu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Haoying Huang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Yuting Li
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China
| | - Qiaozhen Chen
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China.,Department of Psychiatry, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Mingrong Zhang
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, 263-8555, Japan.
| | - Hong Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China. .,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China.
| | - Mei Tian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, 310009, China. .,Institute of Nuclear Medicine and Molecular Imaging, Zhejiang University, Hangzhou, 310009, China.
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4
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Li XY, Wang XY. Effect of Zuogui Pill (左归丸) on monoamine neurotransmitters and sex hormones in climacteric rats with panic attack. Chin J Integr Med 2016; 23:190-195. [DOI: 10.1007/s11655-016-2095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Indexed: 11/24/2022]
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5
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Engel KR, Obst K, Bandelow B, Dechent P, Gruber O, Zerr I, Ulrich K, Wedekind D. Functional MRI activation in response to panic-specific, non-panic aversive, and neutral pictures in patients with panic disorder and healthy controls. Eur Arch Psychiatry Clin Neurosci 2016; 266:557-66. [PMID: 26585457 DOI: 10.1007/s00406-015-0653-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 11/09/2015] [Indexed: 01/04/2023]
Abstract
There is evidence that besides limbic brain structures, prefrontal and insular cortical activations and deactivations are involved in the pathophysiology of panic disorder. This study investigated activation response patterns to stimulation with individually selected panic-specific pictures in patients with panic disorder with agoraphobia (PDA) and healthy control subjects using functional magnetic resonance imaging (fMRI). Structures of interest were the prefrontal, cingulate, and insular cortex, and the amygdalo-hippocampal complex. Nineteen PDA subjects (10 females, 9 males) and 21 healthy matched controls were investigated using a Siemens 3-Tesla scanner. First, PDA subjects gave Self-Assessment Manikin (SAM) ratings on 120 pictures showing characteristic panic/agoraphobia situations, of which 20 pictures with the individually highest SAM ratings were selected. Twenty matched pictures showing aversive but not panic-specific stimuli and 80 neutral pictures from the International Affective Picture System were chosen for each subject as controls. Each picture was shown twice in each of four subsequent blocks. Anxiety and depression ratings were recorded before and after the experiment. Group comparisons revealed a significantly greater activation in PDA patients than control subjects in the insular cortices, left inferior frontal gyrus, dorsomedial prefrontal cortex, the left hippocampal formation, and left caudatum, when PA and N responses were compared. Comparisons for stimulation with unspecific aversive pictures showed activation of similar brain regions in both groups. Results indicate region-specific activations to panic-specific picture stimulation in PDA patients. They also imply dysfunctionality in the processing of interoceptive cues in PDA and the regulation of negative emotionality. Therefore, differences in the functional networks between PDA patients and control subjects should be further investigated.
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Affiliation(s)
- K R Engel
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany
| | - K Obst
- University clinik Schleswig-Holstein, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - B Bandelow
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany
| | - P Dechent
- Core Facility MR-Research in Neurology and Psychiatry, Department of Cognitive Neurology, University of Goettingen, Robert-Koch-Strasse 40, Goettingen, Germany
| | - O Gruber
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany.,Department of Systemic Neurosciences, University of Goettingen, von-Siebold-Strasse 5, Goettingen, Germany
| | - I Zerr
- Department of Neurology, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany
| | - K Ulrich
- Department of Neurology, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany
| | - D Wedekind
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany.
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6
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Yoon S, Kim JE, Kim GH, Kang HJ, Kim BR, Jeon S, Im JJ, Hyun H, Moon S, Lim SM, Lyoo IK. Subregional Shape Alterations in the Amygdala in Patients with Panic Disorder. PLoS One 2016; 11:e0157856. [PMID: 27336300 PMCID: PMC4919046 DOI: 10.1371/journal.pone.0157856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/06/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The amygdala has been known to play a pivotal role in mediating fear-related responses including panic attacks. Given the functionally distinct role of the amygdalar subregions, morphometric measurements of the amygdala may point to the pathophysiological mechanisms underlying panic disorder. The current study aimed to determine the global and local morphometric alterations of the amygdala related to panic disorder. METHODS Volumetric and surface-based morphometric approach to high-resolution three-dimensional T1-weighted images was used to examine the structural variations of the amygdala, with respect to extent and location, in 23 patients with panic disorder and 31 matched healthy individuals. RESULTS There were no significant differences in bilateral amygdalar volumes between patients with panic disorder and healthy individuals despite a trend-level right amygdalar volume reduction related to panic disorder (right, β = -0.23, p = 0.09, Cohen's d = 0.51; left, β = -0.18, p = 0.19, Cohen's d = 0.45). Amygdalar subregions were localized into three groups including the superficial, centromedial, and laterobasal groups based on the cytoarchitectonically defined probability map. Surface-based morphometric analysis revealed shape alterations in the laterobasal and centromedial groups of the right amygdala in patients with panic disorder (false discovery rate corrected p < 0.05). CONCLUSIONS The current findings suggest that subregion-specific shape alterations in the right amygdala may be involved in the development and maintenance of panic disorder, which may be attributed to the cause or effects of amygdalar hyperactivation.
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Affiliation(s)
- Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Geon Ha Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hee Jin Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Bori R. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Saerom Jeon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jooyeon Jamie Im
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Heejung Hyun
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Sohyeon Moon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
- * E-mail:
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7
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Heart rate and respiratory response to doxapram in patients with panic disorder. Psychiatry Res 2015; 227:32-8. [PMID: 25819170 PMCID: PMC4420657 DOI: 10.1016/j.psychres.2015.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 12/19/2022]
Abstract
Panic disorder (PD) is characterized by anticipatory anxiety and panic, both causing physiological arousal. We investigated the differential responses between anticipatory anxiety and panic in PD and healthy controls (HC). Subjects (15 PD and 30 HC) received an injection of a respiratory stimulant, doxapram, with a high rate of producing panic attacks in PD patients, or an injection of saline. PD subjects had significantly higher scores in anxiety and panic symptoms during both conditions. Analysis of heart rate variability (HRV) indices showed higher sympathetic activity (LF) during anticipatory anxiety and panic states, an increase in the ratio of LF/HF during the anticipatory and panic states and a decrease in parasympathetic (HF) component in PD patients. During doxapram PD subjects increased their LF/HF ratio while HC had a reduction in LF/HF. Parasympathetic component of HRV was lower during anticipatory anxiety in PD. In general, PD showed greater sympathetic and psychological responses related to anxiety and sensations of dyspnea, reduced parasympathetic responses during anticipatory and panic states, but no differences in respiratory response. This confirms previous studies showing that PD patients do not have an intrinsic respiratory abnormality (either heightened or dysregulated) at the level of the brain stem but rather an exaggerated fear response.
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8
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Vollmer LL, Strawn JR, Sah R. Acid-base dysregulation and chemosensory mechanisms in panic disorder: a translational update. Transl Psychiatry 2015; 5:e572. [PMID: 26080089 PMCID: PMC4471296 DOI: 10.1038/tp.2015.67] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/19/2015] [Accepted: 04/06/2015] [Indexed: 12/13/2022] Open
Abstract
Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with significant morbidity and an increased risk of suicide attempts and completed suicide. Recently however, neuroimaging and panic provocation challenge studies have provided insights into the pathoetiology of panic phenomena and have begun to elucidate potential neural mechanisms that may underlie panic attacks. In this regard, accumulating evidence suggests that acidosis may be a contributing factor in induction of panic. Challenge studies in patients with PD reveal that panic attacks may be reliably provoked by agents that lead to acid-base dysbalance such as CO2 inhalation and sodium lactate infusion. Chemosensory mechanisms that translate pH into panic-relevant fear, autonomic, and respiratory responses are therefore of high relevance to the understanding of panic pathophysiology. Herein, we provide a current update on clinical and preclinical studies supporting how acid-base imbalance and diverse chemosensory mechanisms may be associated with PD and discuss future implications of these findings.
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Affiliation(s)
- L L Vollmer
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - J R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, USA,Cincinnati Children's Hospital Medical Center, Department of Psychiatry, Cincinnati, OH, USA
| | - R Sah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, USA,Veterens' Affairs Medical Center, Cincinnati, OH, USA,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 2170 East Galbraith Road, Cincinnati, OH 45237, USA. E-mail:
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9
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Seo HJ, Choi YH, Chung YA, Rho W, Chae JH. Changes in cerebral blood flow after cognitive behavior therapy in patients with panic disorder: a SPECT study. Neuropsychiatr Dis Treat 2014; 10:661-9. [PMID: 24790449 PMCID: PMC4000241 DOI: 10.2147/ndt.s58660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM Inconsistent results continue to be reported in studies that examine the neural correlates of cognitive behavioral therapy (CBT) in patients with panic disorder. We examined the changes in regional cerebral blood flow (rCBF) associated with the alleviation of anxiety by CBT in panic patients. METHODS The change in rCBF and clinical symptoms before and after CBT were assessed using single photon emission computed tomography and various clinical measures were analyzed. RESULTS Fourteen subjects who completed CBT showed significant improvements in symptoms on clinical measures, including the Panic and Agoraphobic Scale and the Anxiety Sensitivity Index-Revised. After CBT, increased rCBF was detected in the left postcentral gyrus (BA 43), left precentral gyrus (BA 4), and left inferior frontal gyrus (BA 9 and BA 47), whereas decreased rCBF was detected in the left pons. Correlation analysis of the association between the changes in rCBF and changes in each clinical measure did not show significant results. CONCLUSION We found changes in the rCBF associated with the successful completion of CBT. The present findings may help clarify the effects of CBT on changes in brain activity in panic disorder.
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Affiliation(s)
- Ho-Jun Seo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Hee Choi
- Metta Institute of Cognitive Behavior Therapy, Seoul, South Korea
| | - Yong-An Chung
- Department of Radiology, Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Wangku Rho
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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10
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Ottaviani C, Cevolani D, Nucifora V, Borlimi R, Agati R, Leonardi M, De Plato G, Brighetti G. Amygdala responses to masked and low spatial frequency fearful faces: a preliminary fMRI study in panic disorder. Psychiatry Res 2012; 203:159-65. [PMID: 22944369 DOI: 10.1016/j.pscychresns.2011.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 12/13/2011] [Accepted: 12/18/2011] [Indexed: 01/04/2023]
Abstract
Previous studies have demonstrated amygdala activation in response to fearful faces even if presented below the threshold of conscious visual perception. It has also been proposed that subcortical regions are selectively sensitive to low spatial frequency (LSF) information. However, chronic hyperarousal may reduce amygdala activation in panic disorder (PD). Our aim was to establish whether the amygdala is engaged by masked and LSF fearful faces in PD as compared to healthy subjects. Neutral faces were used as the mask stimulus. Thirteen PD patients (seven females, six males; mean age=29.1 (S.D: 5.9)) and 15 healthy volunteers (seven females, eight males; mean age=27.9 (S.D. 4.5)) underwent two passive viewing tasks during a 3T functional magnetic resonance imaging (fMRI) as follows: 1) presentation of faces with fearful versus neutral expressions (17ms) using a backward masking procedure and 2) presentation of the same faces whose spatial frequency contents had been manipulated by low-pass filtering. Level of awareness was confirmed by a forced choice fear-detection task. Whereas controls showed bilateral activation to fearful masked faces versus neutral faces, patients failed to show activation within the amygdala. LSF stimuli did not elicit amygdala response in either group, contrary to the view that LSF information plays a crucial role in the processing of facial expressions in the amygdala. Findings suggest maladaptive amygdala responses to potentially threatening visual stimuli in PD patients.
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11
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Revise the revised? New dimensions of the neuroanatomical hypothesis of panic disorder. J Neural Transm (Vienna) 2012; 120:3-29. [PMID: 22692647 DOI: 10.1007/s00702-012-0811-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/16/2012] [Indexed: 12/14/2022]
Abstract
In 2000, Gorman et al. published a widely acknowledged revised version of their 1989 neuroanatomical hypothesis of panic disorder (PD). Herein, a 'fear network' was suggested to mediate fear- and anxiety-related responses: panic attacks result from a dysfunctional coordination of 'upstream' (cortical) and 'downstream' (brainstem) sensory information leading to heightened amygdala activity with subsequent behavioral, autonomic and neuroendocrine activation. Given the emergence of novel imaging methods such as fMRI and the publication of numerous neuroimaging studies regarding PD since 2000, a comprehensive literature search was performed regarding structural (CT, MRI), metabolic (PET, SPECT, MRS) and functional (fMRI, NIRS, EEG) studies on PD, which will be reviewed and critically discussed in relation to the neuroanatomical hypothesis of PD. Recent findings support structural and functional alterations in limbic and cortical structures in PD. Novel insights regarding structural volume increase or reduction, hyper- or hypoactivity, laterality and task-specificity of neural activation patterns emerged. The assumption of a generally hyperactive amygdala in PD seems to apply more to state than trait characteristics of PD, and involvement of further areas in the fear circuit, such as anterior cingulate and insula, is suggested. Furthermore, genetic risk variants have been proposed to partly drive fear network activity. Thus, the present state of knowledge generally supports limbic and cortical prefrontal involvement as originally proposed in the neuroanatomical hypothesis. Some modifications might be suggested regarding a potential extension of the fear circuit, genetic factors shaping neural network activity and neuroanatomically informed clinical subtypes of PD potentially guiding future treatment decisions.
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12
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Vickers K. Hypersensitivity to hypercapnia: definition/(s). Psychiatry Res 2012; 197:7-12. [PMID: 22401967 DOI: 10.1016/j.psychres.2011.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/29/2011] [Accepted: 11/08/2011] [Indexed: 10/28/2022]
Abstract
Empirical evidence indicates that panic disorder (PD) patients experience hypersensitivity to hypercapnia, a condition in which the blood level of carbon dioxide exceeds the normal value. The importance of this research line is substantial and indeed, hypercapnic hypersensitivity has been advanced as a possible endophenotype of panic. Definitions of "hypersensitivity," however, have varied. The purpose of this brief review is to delineate and critique different definitions of hypercapnic hypersensitivity. Several definitions - panic attack rate, panic symptoms including dyspnea, subjective anxiety, and respiratory disturbance - are explored. The review concludes that although no ideal definition has emerged, marked anxiety post-hypercapnia has substantial support as a putative trait marker of PD. The term "subjective hypersensitivity" (Coryell et al., 2001) is re-introduced to denote pronounced anxiety post-hypercapnia and recommended for use along with its previous definition: increased self-reported anxiety measured on a continuous visual analog scale, already widely in use. Due to the well-established link between panic and respiration, definitional candidates focusing on aberrant respiratory response - less investigated as trait markers of PD in high risk studies - warrant scrutiny as well. Several reasons why definitional clarity might be beneficial are presented, along with ideas for future research.
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Affiliation(s)
- Kristin Vickers
- Department of Psychology, Ryerson University, Toronto, ON, Canada.
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13
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Wan L, Stans L, Bogaerts K, Decramer M, Van den Bergh O. Sensitization in Medically Unexplained Dyspnea. Chest 2012; 141:989-995. [DOI: 10.1378/chest.11-1423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Dresler T, Hahn T, Plichta MM, Ernst LH, Tupak SV, Ehlis AC, Warrings B, Deckert J, Fallgatter AJ. Neural correlates of spontaneous panic attacks. J Neural Transm (Vienna) 2011; 118:263-9. [DOI: 10.1007/s00702-010-0540-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022]
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Klein S, Nicolas LB, Lopez-Lopez C, Jacobson LH, McArthur SG, Grundschober C, Prinssen EP. Examining face and construct validity of a noninvasive model of panic disorder in Lister-hooded rats. Psychopharmacology (Berl) 2010; 211:197-208. [PMID: 20514481 DOI: 10.1007/s00213-010-1882-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE Increasing evidence suggests that defensive escape behavior in Lister-hooded (LH) rats induced by ultrasound application may be an animal model of panic disorder. OBJECTIVE The objectives of this study were to further explore the face and construct validity of ultrasound-induced escape behavior by characterizing the autonomic and neuroendocrine response to ultrasound, and to examine the underlying neuronal structures by comparing the effects of the anxiolytic with panicolytic properties, diazepam, with a preclinical anxiolytic without panicolytic-like activity, the NOP agonist Ro 64-6198. MATERIALS AND METHODS LH rats were implanted with telemetry transmitters to monitor heart rate and core body temperature before, during, and after ultrasound application. Blood samples were taken after ultrasound application for corticosterone analysis. Ultrasound-induced c-Fos expression was measured in different periaqueductal gray (PAG) and amygdala subregions after treatment with diazepam or Ro 64-6198. RESULTS Ultrasound application increased heart rate and body temperature, but did not alter plasma corticosterone levels. Ultrasound application increased c-Fos expression in the dorsal and dorsolateral PAG (dPAG, dlPAG) and amygdaloid subregions. Diazepam, but not Ro 64-6198, reduced c-Fos expression in the dPAG/dlPAG, while Ro 64-6198, but not diazepam, reduced c-Fos expression in the central amygdala. CONCLUSIONS Similar to human panic attacks, ultrasound application to LH rats activated the autonomic, but not the neuroendocrine, stress system. Also, like in humans, the current data confirm and extend that the dPAG/dlPAG plays a key role in ultrasound-induced escape behavior. These observations suggest that ultrasound-induced escape behaviors in LH rats have face and construct validity for panic disorders.
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Affiliation(s)
- Steffen Klein
- Brain Research Institute, University of Bremen, Cognium-Raum 2140, Hochschulring 18, 28359, Bremen, Germany
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Evans KC. Cortico-limbic circuitry and the airways: insights from functional neuroimaging of respiratory afferents and efferents. Biol Psychol 2010; 84:13-25. [PMID: 20211221 PMCID: PMC2908728 DOI: 10.1016/j.biopsycho.2010.02.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 02/01/2010] [Accepted: 02/11/2010] [Indexed: 01/25/2023]
Abstract
After nearly two decades of active research, functional neuroimaging has demonstrated utility in the identification of cortical, limbic, and paralimbic (cortico-limbic) brain regions involved in respiratory control and respiratory perception. Before the recent boon of human neuroimaging studies, the location of the principal components of respiratory-related cortico-limbic circuitry had been unknown and their function had been poorly understood. Emerging neuroimaging evidence in both healthy and patient populations suggests that cognitive and emotional/affective processing within cortico-limbic circuitry modulates respiratory control and respiratory perception. This paper will review functional neuroimaging studies of respiration with a focus on whole brain investigations of sensorimotor pathways that have identified respiratory-related neural circuitry known to overlap emotional/affective cortico-limbic circuitry. To aid the interpretation of present and future findings, the complexities and challenges underlying neuroimaging methodologies will also be reviewed as applied to the study of respiration physiology.
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Affiliation(s)
- Karleyton C Evans
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 13th Street, Charlestown, MA 02129, USA.
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Engel K, Bandelow B, Gruber O, Wedekind D. Neuroimaging in anxiety disorders. J Neural Transm (Vienna) 2009; 116:703-16. [PMID: 18568288 PMCID: PMC2694920 DOI: 10.1007/s00702-008-0077-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 06/01/2008] [Indexed: 11/15/2022]
Abstract
Neuroimaging studies have gained increasing importance in validating neurobiological network hypotheses for anxiety disorders. Functional imaging procedures and radioligand binding studies in healthy subjects and in patients with anxiety disorders provide growing evidence of the existence of a complex anxiety network, including limbic, brainstem, temporal, and prefrontal cortical regions. Obviously, "normal anxiety" does not equal "pathological anxiety" although many phenomena are evident in healthy subjects, however to a lower extent. Differential effects of distinct brain regions and lateralization phenomena in different anxiety disorders are mentioned. An overview of neuroimaging investigations in anxiety disorders is given after a brief summary of results from healthy volunteers. Concluding implications for future research are made by the authors.
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Affiliation(s)
- Kirsten Engel
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, von-Siebold-Strasse 5, 37075 Goettingen, Germany
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, von-Siebold-Strasse 5, 37075 Goettingen, Germany
| | - Oliver Gruber
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, von-Siebold-Strasse 5, 37075 Goettingen, Germany
| | - Dirk Wedekind
- Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, von-Siebold-Strasse 5, 37075 Goettingen, Germany
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Abstract
Panic disorder seems to be mediated by the neuronal circuitry and neurochemical systems that have evolved to respond to external threatening stimuli. Distant threats activate prefrontal cortex (involved in complex planning of avoidance strategies), while immediate threats activate midbrain structures (involved in fast reflexive behaviors). Panic disorder may, however, also involve more specific interoceptive mechanisms. For example, the association between respiratory dysfunction and panic disorder has bolstered a false suffocation alarm hypothesis. Genetic and environmental contributors to panic disorder are beginning to be delineated. Effective pharmacotherapy and psychotherapy are able to normalize the relevant psychobiology.
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