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Mussini E, Di Russo F. Reduction of anticipatory brain activity in anxious people and regulatory effect of response-related feedback. Psychophysiology 2023; 60:e14166. [PMID: 35975745 DOI: 10.1111/psyp.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 01/04/2023]
Abstract
Elevated anxiety levels degrade task performance, likely because of cognitive function reduction in the frontoparietal brain network. This study aimed to test whether anxiety could impact the frontal cortex anticipatory brain functions and to investigate the possible beneficial effect of response-related feedback on task performance. The electroencephalographic activity was recorded while participants performed two Go/No-go tasks: one with response-related feedback on errors (feedback task) and one task without feedback (standard task). We first tested whether anxiety levels could be associated with pre-stimulus ERP components such as the prefrontal negativity (pN), linked with top-down attentional control, and the Bereitschaftspotential (BP), related to motor preparation. Then, we assessed whether feedback could affect anxious people's brain preparation, reducing the state of uncertainty and improving performance. Results showed that the pN was almost absent and the BP was lower during a standard task in the high anxiety than in the low anxiety group. In the feedback task, these components increased in the high anxious, becoming comparable to the low anxious. Behavioral results showed that false alarms in the high anxiety group were larger than in the low anxiety group during the standard task but became comparable in the feedback task. Similarly, response time in the high anxiety group was slower in the standard task than in the feedback task, and high anxious people were faster in the feedback task than in the standard one. This study contributes to clarifying neural correlates of anxiety, showing brain activity reductions related to action preparation in frontal areas. In addition, response-related feedback tasks could be used to normalize task performance in high anxious people.
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Affiliation(s)
- Elena Mussini
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,Department of Neuroscience, Imaging, and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Di Russo
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, 00179
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2
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Maywald M, Pogarell O, Levai S, Paolini M, Tschentscher N, Rauchmann BS, Krause D, Stöcklein S, Goerigk S, Röll L, Ertl-Wagner B, Papazov B, Keeser D, Karch S, Chrobok A. Neurofunctional differences and similarities between persistent postural-perceptual dizziness and anxiety disorder. Neuroimage Clin 2023; 37:103330. [PMID: 36696807 PMCID: PMC9879992 DOI: 10.1016/j.nicl.2023.103330] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) share behavioural symptoms like anxiety, avoidance, social withdrawal, hyperarousal, or palpitation as well as neurological symptoms like vertigo, stance and gait disorders. Furthermore, previous studies have shown a bidirectional link between vestibulo-spatial and anxiety neural networks. So far, there have been no neuroimaging-studies comparing these groups. OBJECTIVES The aim of this explorative study was to investigate differences and similarities of neural correlates between these two patient groups and to compare their findings with a healthy control group. METHODS 63 participants, divided in two patient groups (ANX = 20 and PPPD = 14) and two sex and age matched healthy control groups (HC-A = 16, HC-P = 13) were included. Anxiety and dizziness related pictures were shown during fMRI-measurements in a block-design in order to induce emotional responses. All subjects filled in questionnaires regarding vertigo (VSS, VHQ), anxiety (STAI), depression (BDI-II), alexithymia (TAS), and illness-perception (IPQ). After modelling the BOLD response with a standard canonical HRF, voxel-wise t-tests between conditions (emotional-negative vs neutral stimuli) were used to generate statistical contrast maps and identify relevant brain areas (pFDR < 0.05, cluster size >30 voxels). ROI-analyses were performed for amygdala, cingulate gyrus, hippocampus, inferior frontal gyrus, insula, supramarginal gyrus and thalamus (p ≤ 0.05). RESULTS Patient groups differed from both HC groups regarding anxiety, dizziness, depression and alexithymia scores; ratings of the PPPD group and the ANX group did differ significantly only in the VSS subscale 'vertigo and related symptoms' (VSS-VER). The PPPD group showed increased neural responses in the vestibulo-spatial network, especially in the supramarginal gyrus (SMG), and superior temporal gyrus (STG), compared to ANX and HC-P group. The PPPD group showed increased neural responses compared to the HC-P group in the anxiety network including amygdala, insula, lentiform gyrus, hippocampus, inferior frontal gyrus (IFG) and brainstem. Neuronal responses were enhanced in visual structures, e.g. fusiform gyrus, middle occipital gyrus, and in the medial orbitofrontal cortex (mOFC) in healthy controls compared to patients with ANX and PPPD, and in the ANX group compared to the PPPD group. CONCLUSIONS These findings indicate that neuronal responses to emotional information in the PPPD and the ANX group are comparable in anxiety networks but not in vestibulo-spatial networks. Patients with PPPD revealed a stronger neuronal response especially in SMG and STG compared to the ANX and the HC group. These results might suggest higher sensitivity and poorer adaptation processes in the PPPD group to anxiety and dizziness related pictures. Stronger activation in visual processing areas in HC subjects might be due to less emotional and more visual processing strategies.
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Affiliation(s)
- Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Levai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Boris Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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3
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Brain activation elicited by acute stress: An ALE meta-analysis. Neurosci Biobehav Rev 2021; 132:706-724. [PMID: 34801579 DOI: 10.1016/j.neubiorev.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
Stress abounds in daily life and is closely related to psychiatric disease. Less is known about the neural basis for the gender differences in stress, and the common and specific neural mechanism for physiological and psychosocial stress. The current study obtained 141 stress-oriented neuroimaging experiments from 126 eligible articles and sorted them into nine types of neuroimaging datasets based on the combination of stress (general, physiological or psychosocial) and gender (overall, male or female). An activation likelihood estimation (ALE) meta-analysis was conducted on each dataset to detect the spatial convergence of activations. A hierarchical clustering analysis was also conducted to uncover the relationship between the stress-induced paradigms and spatial distribution of brain activations. We found that the physiological stress and psychosocial stress showed common activation in the bilateral anterior insula and brainstem, but different activation likelihood in the bilateral insula, thalami, middle cingulate cortex, left fusiform gyri, and left amygdala. Men were more likely to activate the bilateral thalami during physiological stress, whereas women were more likely to activate the left amygdala during psychosocial stress. The activation patterns are more consistent among different physiological stress paradigms than psychosocial stress paradigms. Our results suggest that physiological stress and psychosocial stress activate common brain regions for movement and attentional regulation but different brain regions for sensory and affective processing.
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Kunas SL, Hilbert K, Yang Y, Richter J, Hamm A, Wittmann A, Ströhle A, Pfleiderer B, Herrmann MJ, Lang T, Lotze M, Deckert J, Arolt V, Wittchen HU, Straube B, Kircher T, Gerlach AL, Lueken U. The modulating impact of cigarette smoking on brain structure in panic disorder: a voxel-based morphometry study. Soc Cogn Affect Neurosci 2021; 15:849-859. [PMID: 32734299 PMCID: PMC7543937 DOI: 10.1093/scan/nsaa103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
Cigarette smoking increases the likelihood of developing anxiety disorders, among them panic disorder (PD). While brain structures altered by smoking partly overlap with morphological changes identified in PD, the modulating impact of smoking as a potential confounder on structural alterations in PD has not yet been addressed. In total, 143 PD patients (71 smokers) and 178 healthy controls (62 smokers) participated in a multicenter magnetic resonance imaging (MRI) study. T1-weighted images were used to examine brain structural alterations using voxel-based morphometry in a priori defined regions of the defensive system network. PD was associated with gray matter volume reductions in the amygdala and hippocampus. This difference was driven by non-smokers and absent in smoking subjects. Bilateral amygdala volumes were reduced with increasing health burden (neither PD nor smoking > either PD or smoking > both PD and smoking). As smoking can narrow or diminish commonly observed structural abnormalities in PD, the effect of smoking should be considered in MRI studies focusing on patients with pathological forms of fear and anxiety. Future studies are needed to determine if smoking may increase the risk for subsequent psychopathology via brain functional or structural alterations.
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Affiliation(s)
- Stefanie L Kunas
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald 17489, Germany
| | - Alfons Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald 17489, Germany
| | - André Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, University of Münster, Münster 48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg 97080, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Bremen 28359, Germany.,Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg 20146, Germany
| | - Martin Lotze
- Functional Imaging Unit, Institute for Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald 17489, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg 97080, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster 48149, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden 01069, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Alexander L Gerlach
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany
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5
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Staudt MD, Telkes I, Pilitsis JG. Editorial. Achieving optimal outcomes with deep brain stimulation for posttraumatic stress disorder. J Neurosurg 2021; 134:1711-1713. [PMID: 32736351 DOI: 10.3171/2020.5.jns201127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Ilknur Telkes
- 2Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- Departments of1Neurosurgery and
- 2Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
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Pattyn T, Schmaal L, Van Den Eede F, Cassiers L, Penninx BW, Sabbe B, Veltman DJ. Emotional processing in panic disorder and its subtypes: An fMRI study using emotional faces. J Affect Disord 2021; 287:427-432. [PMID: 33845429 DOI: 10.1016/j.jad.2021.03.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inconsistent findings regarding the pathophysiology of panic disorder (PD) could result from clinical heterogeneity. Identifying subtypes could enhance insights into the neurobiological substrates of PD. METHODS An emotional faces fMRI paradigm was used in a group of PD patients (n = 73) and healthy controls (n = 58). The overall PD group was further divided into three previously identified subtypes: a cognitive-autonomic (n = 22), an autonomic (n = 16) and an aspecific (n = 35) subtype. Differences in brain activity levels in response to emotional facial expressions between groups were examined for six regions of interests, namely the amygdala, ventromedial prefrontal cortex, anterior cingulate, fusiform gyrus, lingual gyrus and insula. RESULTS PD patients showed lower activity in the rostral anterior cingulate in response to angry faces than healthy controls, which was mainly driven by the autonomic subtype. No significant differences were found in other brain regions when comparing PD patients with controls or when comparing across PD subtypes. LIMITATIONS Sample sizes in subgroups were relatively small CONCLUSIONS: The role of the rostral anterior cingulate cortex for emotional processes critical in panic disorder is highlighted by this study and provides, albeit preliminary, evidence for the use of a subtype approach to advance our neurobiological insights in PD considering its involvement in the appraisal of autonomic viscero-sensory symptoms.
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Affiliation(s)
- T Pattyn
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Department of Psychiatry, UPC KU Leuven, Belgium.
| | - L Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - F Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium
| | - L Cassiers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - B W Penninx
- Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Bcg Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium
| | - D J Veltman
- Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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7
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Min H. Abusive Relationship and Its Associated Factors Between Deployed and Un-Deployed Veterans in College. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:2227-2240. [PMID: 29502507 DOI: 10.1177/0886260518758331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study is to examine the effect of student veteran status on abusive relationships, namely, emotional, physical, and sexual abuse. In addition, this study divided student veterans into two groups, deployed and un-deployed veterans, to see whether two groups demonstrate different results on abusive relationships. Logistic regression models were employed as a statistical strategy using the 2011-2014 American College Health Association National College Health Assessment II (ACHA-NCHA-II) data. The results found that deployed veterans were more likely to experience physical abuse, while un-deployed veterans were more likely to experience emotional abuse. Student veterans did not show any significant relationship with sexual abuse regardless deployment experience. It would be appropriate to consider the results of this study to address abusive relationships among student veterans, which help them to not only adjust college life but also succeed in careers and have healthy family relationships.
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Affiliation(s)
- Hosik Min
- University of South Alabama, Mobile, USA
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8
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Harlé KM, Spadoni AD, Norman SB, Simmons AN. Neurocomputational Changes in Inhibitory Control Associated With Prolonged Exposure Therapy. J Trauma Stress 2020; 33:500-510. [PMID: 31765510 PMCID: PMC8567749 DOI: 10.1002/jts.22461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with inhibitory control dysfunction that extends beyond difficulties inhibiting trauma-related intrusions. Inhibitory learning has been proposed as a potential mechanism of change underlying the effectiveness of extinction-based therapies such as prolonged exposure (PE), a first-line treatment for PTSD. To identify neurocognitive markers of change in inhibitory learning associated with PE, we applied a Bayesian learning model to the analysis of neuroimaging data collected during an inhibitory control task, both before and after PE treatment. Veterans (N = 20) with combat-related PTSD completed a stop-signal task (SST) while undergoing fMRI at time points immediately before and after PE treatment. Participants exhibited a small, significant improvement in performance on the SST, as demonstrated by longer reaction times and improved inhibition accuracy. Amplitude of neural activation associated with a signed prediction error (SPE; i.e., the discrepancy between actual outcome and model-based expectation of needing to stop) in the right caudate decreased from baseline to posttreatment assessment. Change in model-based activation was modulated by performance accuracy, with a decrease in positive SPE activation observed on successful trials, d = 0.79, and a reduction in negative SPE activation on error trials, d = 0.74. The decrease in SPE-related activation on successful stop trials was correlated with PTSD symptom reduction. These results are consistent with the notion that PE may help broadly strengthen inhibitory learning and the development of more accurate model-based predictions, which may thus facilitate change in cognitions in response to trauma-related cues and help reduce PTSD symptoms.
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Affiliation(s)
- Katia M. Harlé
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Andrea D. Spadoni
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Alan N. Simmons
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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9
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Ridderbusch IC, Yang Y, Weber H, Reif A, Herterich S, Ströhle A, Pfleiderer B, Arolt V, Wittchen HU, Lueken U, Kircher T, Straube B. Neural correlates of NOS1 ex1f-VNTR allelic variation in panic disorder and agoraphobia during fear conditioning and extinction in fMRI. NEUROIMAGE-CLINICAL 2020; 27:102268. [PMID: 32361414 PMCID: PMC7200443 DOI: 10.1016/j.nicl.2020.102268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/04/2022]
Abstract
NOS1 ex1f-VNTR is associated with neural correlates during fear extinction learning. Differential effects are prominent in amygdala and hippocampus. Patients with panic disorder and agoraphobia differ from healthy controls. Genotype associated effects were not altered after cognitive behavioral therapy.
Neuronal nitric oxide synthase (NOS-I) impacts on fear/anxiety-like behavior in animals. In humans, the short (S) allele of a functional promotor polymorphism of NOS1 (NOS1 ex1f-VNTR) has been shown to be associated with higher anxiety and altered fear conditioning in healthy subjects in the amygdala and hippocampus (AMY/HIPP). Here, we explore the role of NOS1 ex1f-VNTR as a pathophysiological correlate of panic disorder and agoraphobia (PD/AG). In a sub-sample of a multicenter cognitive behavioral therapy (CBT) randomized controlled trial in patients with PD/AG (n = 48: S/S-genotype n=15, S/L-genotype n=21, L/L-genotype n=12) and healthy control subjects, HS (n = 34: S/S-genotype n=7, S/L-genotype n=17, L/L-genotype=10), a differential fear conditioning and extinction fMRI-paradigm was used to investigate how NOS1 ex1f-VNTR genotypes are associated with differential neural activation in AMY/HIPP. Prior to CBT, L/L-allele carriers showed higher activation than S/S-allele carriers in AMY/HIPP. A genotype × diagnosis interaction revealed that the S-allele in HS was associated with a pronounced deactivation in AMY/HIPP, while patients showed contrary effects. The interaction of genotype × stimulus type (CS+, conditioned stimulus associated with an aversive stimulus vs. CS-, unassociated) showed effects on differential learning in AMY/HIPP. All effects were predominately found during extinction. Genotype associated effects in patients were not altered after CBT. Low statistical power due to small sample size in each subgroup is a major limitation. However, our findings provide first preliminary evidence for dysfunctional neural fear conditioning/extinction associated with NOS1 ex1f-VNTR genotype in the context of PD/AG, shedding new light on the complex interaction between genetic risk, current psychopathology and treatment-related effects.
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Affiliation(s)
- Isabelle C Ridderbusch
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - CMBB, Philipps-Universität Marburg, Marburg, Germany.
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - CMBB, Philipps-Universität Marburg, Marburg, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sabine Herterich
- Clinical Chemistry and Laboratory Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bettina Pfleiderer
- Medical Faculty, University of Münster and Department Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität (LMU), München, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - CMBB, Philipps-Universität Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - CMBB, Philipps-Universität Marburg, Marburg, Germany
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Schwarzmeier H, Kleint NI, Wittchen HU, Ströhle A, Hamm AO, Lueken U. Characterizing the nature of emotional-associative learning deficits in panic disorder: An fMRI study on fear conditioning, extinction training and recall. Eur Neuropsychopharmacol 2019; 29:306-318. [PMID: 30497840 DOI: 10.1016/j.euroneuro.2018.11.1108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022]
Abstract
Emotional-associative learning represents a translational model for the development, maintenance and treatment of anxiety disorders such as panic disorder (PD). The exact nature of the underlying fear learning and extinction deficits however, remains under debate. Using a three-day paradigm to separate the distinct learning and consolidation processes, we aimed to gain insights into the neurofunctional substrates of altered fear conditioning, extinction training and recall in PD. In contrast to studies employing one-session fear conditioning paradigms, a differential fear conditioning and delayed extinction task was conducted for the purpose of disentangling neural networks involved in fear acquisition, extinction training and recall of extinction memories. Using functional magnetic resonance imaging (fMRI), quality-controlled datasets from 10 patients with PD and 10 healthy controls were available from three consecutive days (day 1: acquisition; day 2: extinction training; day 3: extinction recall) with neutral faces serving as CSs and an aversive auditory stimulus (panic scream) as US. PD patients showed heightened fear circuitry (e.g. right amygdala and left insula) activation during early acquisition and prolonged activation in the right insula, left inferior frontal operculum and left inferior frontal gyrus during extinction recall compared to healthy controls. Stronger neural activation in structures conferring defensive reactivity during early acquisition and extinction recall may indicate the accelerated acquisition of conditioned responses, while extinction recall may be attenuated as a function of PD pathophysiology. Future studies should investigate the predictive value of experimental measures of extinction recall for clinical relapse.
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Affiliation(s)
- H Schwarzmeier
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany.
| | - N I Kleint
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - H U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - A Ströhle
- Dept. of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - A O Hamm
- Dept. of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald , Germany
| | - U Lueken
- Center of Mental Health, Dept. of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Dept. of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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11
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McCurry KL, Frueh BC, Chiu PH, King-Casas B. Opponent Effects of Hyperarousal and Re-experiencing on Affective Habituation in Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:203-212. [PMID: 31759868 DOI: 10.1016/j.bpsc.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Aberrant emotion processing is a hallmark of posttraumatic stress disorder (PTSD), with neurobiological models suggesting both heightened neural reactivity and diminished habituation to aversive stimuli. However, empirical work suggests that these response patterns may be specific to subsets of those with PTSD. This study investigates the unique contributions of PTSD symptom clusters (re-experiencing, avoidance and numbing, and hyperarousal) to neural reactivity and habituation to negative stimuli in combat-exposed veterans. METHODS Ninety-five combat-exposed veterans (46 with PTSD) and 53 community volunteers underwent functional magnetic resonance imaging while viewing emotional images. This study examined the relationship between symptom cluster severity and hemodynamic responses to negative compared with neutral images (NEG>NEU). RESULTS Veterans exhibited comparable mean and habituation-related responses for NEG>NEU, relative to civilians. However, among veterans, habituation, but not mean response, was differentially related to PTSD symptom severity. Hyperarousal symptoms were related to decreased habituation for NEG>NEU in a network of regions, including superior and inferior frontal gyri, ventromedial prefrontal cortex, superior and middle temporal gyri, and anterior insula. In contrast, re-experiencing symptoms were associated with increased habituation in a similar network. Furthermore, re-experiencing severity was positively related to amygdalar functional connectivity with the left inferior frontal gyrus and dorsal anterior cingulate cortex for NEG>NEU. CONCLUSIONS These results indicate that hyperarousal symptoms in combat-related PTSD are associated with decreased neural habituation to aversive stimuli. These impairments are partially mitigated in the presence of re-experiencing symptoms, such that during exposure to negative stimuli, re-experiencing symptoms are positively associated with amygdalar connectivity to prefrontal regions implicated in affective suppression.
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Affiliation(s)
- Katherine L McCurry
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia
| | - B Christopher Frueh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, University of Hawaii at Hilo, Hilo, Hawaii; Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston, Texas
| | - Pearl H Chiu
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia.
| | - Brooks King-Casas
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia; School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, Virginia.
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12
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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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13
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Terpou BA, Harricharan S, McKinnon MC, Frewen P, Jetly R, Lanius RA. The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray. J Neurosci Res 2019; 97:1110-1140. [PMID: 31254294 DOI: 10.1002/jnr.24447] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid- and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems.
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Affiliation(s)
- Braeden A Terpou
- Department of Neuroscience, Western University, London, Ontario, Canada
| | | | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Paul Frewen
- Department of Psychology, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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14
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Burkhardt A, Buff C, Brinkmann L, Feldker K, Gathmann B, Hofmann D, Straube T. Brain activation during disorder-related script-driven imagery in panic disorder: a pilot study. Sci Rep 2019; 9:2415. [PMID: 30787382 PMCID: PMC6382839 DOI: 10.1038/s41598-019-38990-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/14/2019] [Indexed: 01/02/2023] Open
Abstract
Despite considerable effort, the neural correlates of altered threat-related processing in panic disorder (PD) remain inconclusive. Mental imagery of disorder-specific situations proved to be a powerful tool to investigate dysfunctional threat processing in anxiety disorders. The current functional magnetic resonance imaging (fMRI) study aimed at investigating brain activation in PD patients during disorder-related script-driven imagery. Seventeen PD patients and seventeen healthy controls (HC) were exposed to newly developed disorder-related and neutral narrative scripts while brain activation was measured with fMRI. Participants were encouraged to imagine the narrative scripts as vividly as possible and they rated their script-induced emotional states after the scanning session. PD patients rated disorder-related scripts as more arousing, unpleasant and anxiety-inducing as compared to HC. Patients relative to HC showed elevated activity in the right amygdala and the brainstem as well as decreased activity in the rostral anterior cingulate cortex, and the medial and lateral prefrontal cortex to disorder-related vs. neutral scripts. The results suggest altered amygdala/ brainstem and prefrontal cortex engagement and point towards the recruitment of brain networks with opposed activation patterns in PD patients during script-driven imagery.
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Affiliation(s)
- Alexander Burkhardt
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany.
| | - Christine Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany
| | - Leonie Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany
| | - Katharina Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany
| | - David Hofmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, 48149, Muenster, Germany
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15
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Park SC, Kim YK. A Novel Bio-Psychosocial-Behavioral Treatment Model of Panic Disorder. Psychiatry Investig 2019; 16:4-15. [PMID: 30301303 PMCID: PMC6354044 DOI: 10.30773/pi.2018.08.21.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022] Open
Abstract
To conceptualize a novel bio-psychosocial-behavioral treatment model of panic disorder (PD), it is necessary to completely integrate behavioral, psychophysiological, neurobiological, and genetic data. Molecular genetic research on PD is specifically focused on neurotransmitters, including serotonin, neuropeptides, glucocorticoids, and neurotrophins. Although pharmacological interventions for PD are currently available, the need for more effective, faster-acting, and more tolerable pharmacological interventions is unmet. Thus, glutamatergic receptor modulators, orexin receptor antagonists, corticotrophin-releasing factor 1 receptor antagonists, and other novel mechanism-based anti-panic therapeutics have been proposed. Research on the neural correlates of PD is focused on the dysfunctional "cross-talk" between emotional drive (limbic structure) and cognitive inhibition (prefrontal cortex) and the fear circuit, which includes the amygdala-hippocampus-prefrontal axis. The neural perspective regarding PD supports the idea that cognitive-behavioral therapy normalizes alterations in top-down cognitive processing, including increased threat expectancy and attention to threat. Consistent with the concept of "personalized medicine," it is speculated that Research Domain Criteria can enlighten further treatments targeting dysfunctions underlying PD more precisely and provide us with better definitions of moderators used to identify subgroups according to different responses to treatment. Structuring of the "negative valence systems" domain, which includes fear/anxiety, is required to define PD. Therefore, targeting glutamate- and orexin-related molecular mechanisms associated with the fear circuit, which includes the amygdala-hippocampus-prefrontal cortex axis, is required to define a novel bio-psychosocial-behavioral treatment model of PD.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Ansan Hospital, Ansan, Republic of Korea
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16
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Zhao P, Yan R, Wang X, Geng J, Chattun MR, Wang Q, Yao Z, Lu Q. Reduced Resting State Neural Activity in the Right Orbital Part of Middle Frontal Gyrus in Anxious Depression. Front Psychiatry 2019; 10:994. [PMID: 32038329 PMCID: PMC6987425 DOI: 10.3389/fpsyt.2019.00994] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anxious depression (AD), which is generally recognized as a common clinical subtype of major depressive disorder (MDD), holds distinctive features compared with unanxious depression (UAD). However, the neural mechanism of AD still remains unrevealed. To give insight to it, we compared resting-state functional magnetic resonance amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) between AD and UAD patients. METHOD The data were collected from 60 AD patients, 38 UAD patients, and 60 matched healthy controls. The ALFF and seed-based FC were examined. Pearson correlations were computed between ALFF/FC and clinical measures. RESULTS In Comparison with the UAD group, the ALFF value of the right orbital part of middle frontal gyrus (RO-MFG) decreased in AD group. Specifically, the ALFF values of the RO-MFG were negatively correlated with retardation factor scores in AD group (r = -0.376, p = 0.003). CONCLUSIONS AD patients exhibited disturbed intrinsic brain function compared with UAD patients. The decreased activity of the RO-MFG is indicative of the alterations involved in the neural basis of AD.
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Affiliation(s)
- Peng Zhao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Department of Medical Psychology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Rui Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyi Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Jiting Geng
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Hangzhou Seventh People's Hospital, Hangzhou, China
| | - Mohammad Ridwan Chattun
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Department of Medical Psychology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China.,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
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17
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Asami T, Nakamura R, Takaishi M, Yoshida H, Yoshimi A, Whitford TJ, Hirayasu Y. Smaller volumes in the lateral and basal nuclei of the amygdala in patients with panic disorder. PLoS One 2018; 13:e0207163. [PMID: 30403747 PMCID: PMC6221356 DOI: 10.1371/journal.pone.0207163] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022] Open
Abstract
The amygdala plays an important functional role in fear and anxiety. Abnormalities in the amygdala are believed to be involved in the neurobiological basis of panic disorder (PD). Previous structural neuroimaging studies have found global volumetric and morphological abnormalities in the amygdala in patients with PD. Very few studies, however, have explored for structural abnormalities in various amygdala sub-regions, which consist of various sub-nuclei, each with different functions. This study aimed to evaluate for volumetric abnormalities in the amygdala sub-nuclei, in order to provide a better understanding neurobiological basis of PD. Thirty-eight patients with PD and 38 matched healthy control (HC) participants underwent structural MRI scanning. The volume of the whole amygdala, as well as its consistent sub-nuclei, were calculated using FreeSurfer software. Relative volumes of these amygdala sub-regions were compared between the two groups. Results showed significantly smaller volumes in the right lateral and basal nuclei in the patients with PD compared with the HC. Lateral and basal nuclei are thought to play crucial role for processing sensory information related with anxiety and fear. Our results suggest that these particular amygdala sub-regions play a role in the development of PD symptoms.
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Affiliation(s)
- Takeshi Asami
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- * E-mail:
| | - Ryota Nakamura
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masao Takaishi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Haruhisa Yoshida
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Asuka Yoshimi
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Thomas J. Whitford
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Yoshio Hirayasu
- Department of Psychiatry, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Heian Hospital, Okinawa, Japan
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18
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Martins BS, Cáceda R, Cisler JM, Kilts CD, James GA. The neural representation of the association between comorbid drug use disorders and childhood maltreatment. Drug Alcohol Depend 2018; 192:215-222. [PMID: 30268937 PMCID: PMC6375711 DOI: 10.1016/j.drugalcdep.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/19/2018] [Accepted: 08/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Comorbidity of drug use disorders (DUD) with other psychopathology is associated with worse functional and treatment outcomes than DUD alone. The present study sought to identify altered functional neural circuitry underlying DUD comorbidity with other psychiatric disorders, and model the relationship of these alterations to childhood trauma (Childhood Trauma Questionnaire) and negative self-beliefs (Beck Depression Inventory). METHODS A sample of adult men and women (mean = 36.8 years) with childhood maltreatment histories (n = 81) was allocated into the following groups based on psychiatric diagnoses and drug use history: no current or past psychiatric disorders (trauma control sample, n = 20), DUD only (n = 22), psychopathology only (n = 20), and DUD comorbid with other psychiatric illness (DCoP, n = 25). RESULTS Multiple regression of seed-based resting-state fMRI, controlling for age and sex, identified a functional connection between the right rostral anterior cingulate cortex (rACC) and left temporoparietal junction (TPJ) that was significantly increased in DCoP females, relative to the other clinical and control groups. Within the DCoP female sample, mediation analysis demonstrated that strength of connectivity between the subgenual cingulate cortex and both the right anterior insula and rostral lateral prefrontal cortex significantly mediated the relationship between increasing physical abuse and self-criticism with age as a moderator. CONCLUSIONS This study related sex-dependent alterations in functional organization of the prefrontal cortex with DCoP that are, in turn, related to magnitude of negative self-beliefs to childhood trauma exposure. Additionally, DCoP-selective alterations in rACC connectivity suggest that the neural correlates of DCoP do not represent linear additive contributions from two independent disorders.
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Affiliation(s)
- Bradford S Martins
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.
| | - Ricardo Cáceda
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA; Stony Brook University, Department of Psychiatry, Stony Brook, NY, 11794, USA
| | - Josh M Cisler
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA; University of Wisconsin-Madison, Department of Psychiatry, Madison, WI, 53706, USA
| | - Clinton D Kilts
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
| | - G Andrew James
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
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19
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Lucas EK, Clem RL. GABAergic interneurons: The orchestra or the conductor in fear learning and memory? Brain Res Bull 2018; 141:13-19. [PMID: 29197563 PMCID: PMC6178932 DOI: 10.1016/j.brainresbull.2017.11.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/15/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
Fear conditioning is a form of associative learning that is fundamental to survival and involves potentiation of activity in excitatory projection neurons (PNs). Current models stipulate that the mechanisms underlying this process involve plasticity of PN synapses, which exhibit strengthening in response to fear conditioning. However, excitatory PNs are extensively modulated by a diverse array of GABAergic interneurons whose contributions to acquisition, storage, and expression of fear memory remain poorly understood. Here we review emerging evidence that genetically-defined interneurons play important subtype-specific roles in processing of fear-related stimuli and that these dynamics shape PN firing through both inhibition and disinhibition. Furthermore, interneurons exhibit structural, molecular, and electrophysiological evidence of fear learning-induced synaptic plasticity. These studies warrant discarding the notion of interneurons as passive bystanders in long-term memory.
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Affiliation(s)
- Elizabeth K Lucas
- Fishberg Department of Neuroscience and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Roger L Clem
- Fishberg Department of Neuroscience and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States.
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20
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Feldker K, Heitmann CY, Neumeister P, Brinkmann L, Bruchmann M, Zwitserlood P, Straube T. Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder. J Psychiatry Neurosci 2018; 43. [PMID: 29252163 PMCID: PMC5747532 DOI: 10.1503/jpn.160226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. METHODS The present event-related functional MRI (fMRI) study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). RESULTS We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. LIMITATIONS The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. CONCLUSION Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.
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Affiliation(s)
- Katharina Feldker
- Correspondence to: K. Feldker, Institute of Medical Psychology and Systems Neuroscience, Von-Esmarch-Straße 52, D-48149 Muenster, Germany;
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21
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Feldker K, Heitmann CY, Neumeister P, Brinkmann L, Bruchmann M, Zwitserlood P, Straube T. Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder. J Psychiatry Neurosci 2018; 43:26-36. [PMID: 29252163 PMCID: PMC5747532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/30/2017] [Accepted: 05/01/2017] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. METHODS The present event-related functional MRI (fMRI) study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). RESULTS We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. LIMITATIONS The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. CONCLUSION Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.
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Affiliation(s)
- Katharina Feldker
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Carina Yvonne Heitmann
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Paula Neumeister
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Leonie Brinkmann
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Maximillan Bruchmann
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Pienie Zwitserlood
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
| | - Thomas Straube
- From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood)
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Brinkmann L, Buff C, Feldker K, Tupak SV, Becker MPI, Herrmann MJ, Straube T. Distinct phasic and sustained brain responses and connectivity of amygdala and bed nucleus of the stria terminalis during threat anticipation in panic disorder. Psychol Med 2017; 47:2675-2688. [PMID: 28485259 DOI: 10.1017/s0033291717001192] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Panic disorder (PD) patients are constantly concerned about future panic attacks and exhibit general hypersensitivity to unpredictable threat. We aimed to reveal phasic and sustained brain responses and functional connectivity of the amygdala and the bed nucleus of the stria terminalis (BNST) during threat anticipation in PD. METHODS Using functional magnetic resonance imaging (fMRI), we investigated 17 PD patients and 19 healthy controls (HC) during anticipation of temporally unpredictable aversive and neutral sounds. We used a phasic and sustained analysis model to disentangle temporally dissociable brain activations. RESULTS PD patients compared with HC showed phasic amygdala and sustained BNST responses during anticipation of aversive v. neutral stimuli. Furthermore, increased phasic activation was observed in anterior cingulate cortex (ACC), insula and prefrontal cortex (PFC). Insula and PFC also showed sustained activation. Functional connectivity analyses revealed partly distinct phasic and sustained networks. CONCLUSIONS We demonstrate a role for the BNST during unpredictable threat anticipation in PD and provide first evidence for dissociation between phasic amygdala and sustained BNST activation and their functional connectivity. In line with a hypersensitivity to uncertainty in PD, our results suggest time-dependent involvement of brain regions related to fear and anxiety.
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Affiliation(s)
- L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - C Buff
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - K Feldker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - S V Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - M P I Becker
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
| | - M J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy,Center of Mental Health, University Hospital Wuerzburg,Margarete-Hoeppel-Platz 1, Wuerzburg,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany
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Lueken U, Kuhn M, Yang Y, Straube B, Kircher T, Wittchen HU, Pfleiderer B, Arolt V, Wittmann A, Ströhle A, Weber H, Reif A, Domschke K, Deckert J, Lonsdorf TB. Modulation of defensive reactivity by GLRB allelic variation: converging evidence from an intermediate phenotype approach. Transl Psychiatry 2017; 7:e1227. [PMID: 28872638 PMCID: PMC5639239 DOI: 10.1038/tp.2017.186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 01/20/2023] Open
Abstract
Representing a phylogenetically old and very basic mechanism of inhibitory neurotransmission, glycine receptors have been implicated in the modulation of behavioral components underlying defensive responding toward threat. As one of the first findings being confirmed by genome-wide association studies for the phenotype of panic disorder and agoraphobia, allelic variation in a gene coding for the glycine receptor beta subunit (GLRB) has recently been associated with increased neural fear network activation and enhanced acoustic startle reflexes. On the basis of two independent healthy control samples, we here aimed to further explore the functional significance of the GLRB genotype (rs7688285) by employing an intermediate phenotype approach. We focused on the phenotype of defensive system reactivity across the levels of brain function, structure, and physiology. Converging evidence across both samples was found for increased neurofunctional activation in the (anterior) insular cortex in GLRB risk allele carriers and altered fear conditioning as a function of genotype. The robustness of GLRB effects is demonstrated by consistent findings across different experimental fear conditioning paradigms and recording sites. Altogether, findings provide translational evidence for glycine neurotransmission as a modulator of the brain's evolutionary old dynamic defensive system and provide further support for a strong, biologically plausible candidate intermediate phenotype of defensive reactivity. As such, glycine-dependent neurotransmission may open up new avenues for mechanistic research on the etiopathogenesis of fear and anxiety disorders.
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Affiliation(s)
- U Lueken
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - M Kuhn
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Yang
- Department of Psychiatry and Psychotherapy, Phillips-University Marburg, Marburg, Germany
| | - B Straube
- Department of Psychiatry and Psychotherapy, Phillips-University Marburg, Marburg, Germany
| | - T Kircher
- Department of Psychiatry and Psychotherapy, Phillips-University Marburg, Marburg, Germany
| | - H-U Wittchen
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - B Pfleiderer
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - V Arolt
- Department of Psychiatry, University Hospital Münster, Münster, Germany
| | - A Wittmann
- Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - A Ströhle
- Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Berlin, Germany
| | - H Weber
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - K Domschke
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - T B Lonsdorf
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sobanski T, Wagner G. Functional neuroanatomy in panic disorder: Status quo of the research. World J Psychiatry 2017; 7:12-33. [PMID: 28401046 PMCID: PMC5371170 DOI: 10.5498/wjp.v7.i1.12] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/16/2016] [Accepted: 01/14/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To provide an overview of the current research in the functional neuroanatomy of panic disorder.
METHODS Panic disorder (PD) is a frequent psychiatric disease. Gorman et al (1989; 2000) proposed a comprehensive neuroanatomical model of PD, which suggested that fear- and anxiety-related responses are mediated by a so-called “fear network” which is centered in the amygdala and includes the hippocampus, thalamus, hypothalamus, periaqueductal gray region, locus coeruleus and other brainstem sites. We performed a systematic search by the electronic database PubMed. Thereby, the main focus was laid on recent neurofunctional, neurostructural, and neurochemical studies (from the period between January 2012 and April 2016). Within this frame, special attention was given to the emerging field of imaging genetics.
RESULTS We noted that many neuroimaging studies have reinforced the role of the “fear network” regions in the pathophysiology of panic disorder. However, recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem, anterior and midcingulate cortex (ACC and MCC), insula, and lateral as well as medial parts of the prefrontal cortex. Interestingly, differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al (2000). Indeed, amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms, sample heterogeneity and size, as well as on limitations of neuroimaging techniques. Advanced neurochemical studies have substantiated the major role of serotonergic, noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD. However, alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable. A promising new research approach is “imaging genetics”. Imaging genetic studies are designed to evaluate the impact of genetic variations (polymorphisms) on cerebral function in regions critical for PD. Most recently, imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor, CRH receptor, human TransMEMbrane protein (TMEM123D), and amiloride-sensitive cation channel 2 (ACCN2) genes.
CONCLUSION In light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.
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Klahn AL, Klinkenberg IA, Lueken U, Notzon S, Arolt V, Pantev C, Zwanzger P, Junghoefer M. Commonalities and differences in the neural substrates of threat predictability in panic disorder and specific phobia. NEUROIMAGE-CLINICAL 2017; 14:530-537. [PMID: 28331799 PMCID: PMC5345973 DOI: 10.1016/j.nicl.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/15/2017] [Accepted: 02/16/2017] [Indexed: 10/27/2022]
Abstract
Different degrees of threat predictability are thought to induce either phasic fear or sustained anxiety. Maladaptive, sustained anxious apprehension is thought to result in overgeneralization of anxiety and thereby to contribute to the development of anxiety disorders. Therefore, differences in threat predictability have been associated with pathological states of anxiety with specific phobia (SP) representing phasic fear as heightened response to predictable threat, while panic disorder (PD) is characterized by sustained anxiety (unpredictable threat) and, as a consequence, overgeneralization of fear. The present study aimed to delineate commonalities and differences in the neural substrates of the impact of threat predictability on affective processing in these two anxiety disorders. Twenty PD patients, 20 SP patients and 20 non-anxious control subjects were investigated with an adapted NPU-design (no, predictable, unpredictable threat) using whole-head magnetoencephalography (MEG). Group independent neural activity in the right dlPFC increased with decreasing threat predictability. PD patients showed a sustained hyperactivation of the vmPFC under threat and safety conditions. The magnitude of hyperactivation was inversely correlated with PDs subjective arousal and anxiety sensitivity. Both PD and SP patients revealed decreased parietal processing of affective stimuli. Findings indicate overgeneralization between threat and safety conditions and increased need for emotion regulation via the vmPFC in PD, but not SP patients. Both anxiety disorders showed decreased activation in parietal networks possibly indicating attentional avoidance of affective stimuli. Present results complement findings from fear conditioning studies and underline overgeneralization of fear, particularly in PD.
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Affiliation(s)
- Anna Luisa Klahn
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | | | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Germany
| | - Swantje Notzon
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany
| | - Christo Pantev
- Institute for Biogmagnetism and Biosignalanalysis, University of Muenster, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University Hospital Muenster, Germany; kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Germany
| | - Markus Junghoefer
- Institute for Biogmagnetism and Biosignalanalysis, University of Muenster, Germany
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Persistent amygdala novelty response is associated with less anterior cingulum integrity in trauma-exposed women. NEUROIMAGE-CLINICAL 2017; 14:250-259. [PMID: 28203528 PMCID: PMC5292758 DOI: 10.1016/j.nicl.2017.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/06/2017] [Accepted: 01/15/2017] [Indexed: 12/14/2022]
Abstract
Objectives We investigated the potential role of cingulum and uncinate fasciculus integrity in trauma-related neural hypervigilance, indexed by less discrimination between amygdala activation to novel and familiar affective images. Participants 22 women (mean age 21.7 ± 3.9 years) with a history of trauma, and 20 no-trauma controls (mean age 21.9 ± 4.8 years). Measures Trauma exposure and trauma-related symptoms were assessed during structured clinical interview. White matter integrity in the anterior cingulum, parahippocampal cingulum, and uncinate fasciculus was measured using diffusion weighted imaging. Amygdala response to novel and familiar affective scenes was measured with functional magnetic resonance imaging. Results Trauma-exposed women showed less discrimination between novel and familiar negative images in the amygdala compared to no-trauma controls. In trauma-exposed women, less amygdala discrimination between novel and familiar affective images was associated with less structural integrity in the anterior cingulum, but was not associated with structural integrity of the parahippocampal cingulum or the uncinate fasciculus. Conclusions The anterior cingulum might play an important role in impaired novelty discrimination for affective information in the amygdala. This impairment is potentially driven by inefficient habituation and could contribute to persistent behavioral hypervigilance following trauma exposure. Trauma-exposed women showed impaired amygdala novelty discrimination for negative images. Less novelty discrimination in the amygdala was associated with less anterior cingulum integrity. The anterior cingulum might play a role in trauma-related behavioral hypervigilance.
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Modeling the development of panic disorder with interoceptive conditioning. Eur Neuropsychopharmacol 2017; 27:59-69. [PMID: 27887860 DOI: 10.1016/j.euroneuro.2016.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 05/28/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
Abstract
Panic disorder is characterized by the paroxysmal occurrence and fear of bodily symptoms. In recent years it has been proposed that patients "learn" to fear cardiorespiratory sensations through interoceptive conditioning. This study sought to model the initial stage of this process in healthy volunteers (N=44) using mild cardiac sensations. An additional aim was to explore whether anxiety sensitivity - a known risk factor for panic disorder - modulates such interoceptive learning. Infusions of pentagastrin and saline were used to manipulate the presence versus absence of cardiac sensations, respectively, and served as conditioned stimuli in a differential interoceptive conditioning paradigm. Inhalation of 35% CO2-enriched air served as the panicogenic, unconditioned stimulus (UCS). In half of the participants ("prepared" condition), cardiac sensations caused by pentagastrin were followed by inhalation of CO2-enriched air (penta CS+), whereas the absence of such sensations (saline) was followed by room air (saline CS-). The reversed combination ("unprepared" condition) was used in the other half of the participants. Conditioning effects showed up for self-reported UCS-expectancy, but not for skin conductance and anxiety ratings. Only participants from the prepared group learned to expect the UCS, and differential learning was impaired with higher scores on anxiety sensitivity. Expectancy learning was more easily established towards the presence compared to the absence of cardiac sensations, whereas the reverse effect was observed for safety learning. Modeling impaired discriminatory learning and the moderating effect of anxiety sensitivity provides new insight in the development of panic disorder.
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Feldker K, Heitmann CY, Neumeister P, Bruchmann M, Vibrans L, Zwitserlood P, Straube T. Brain responses to disorder-related visual threat in panic disorder. Hum Brain Mapp 2016; 37:4439-4453. [PMID: 27436308 PMCID: PMC6867252 DOI: 10.1002/hbm.23320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/13/2016] [Accepted: 07/11/2016] [Indexed: 12/17/2022] Open
Abstract
Panic disorder (PD) patients show aberrant neural responses to threatening stimuli in an extended fear network, but results are only partially comparable, and studies implementing disorder-related visual scenes are lacking as stimuli. The neural responses and functional connectivity to a newly developed set of disorder-related, ecologically valid scenes as compared with matched neutral visual scenes, using event-related functional magnetic resonance imaging (fMRI) in 26 PD patients and 26 healthy controls (HC) were investigated. PD patients versus HC showed hyperactivation in an extended fear network comprising brainstem, insula, thalamus, anterior, and mid-cingulate cortex and (dorso-)medial prefrontal cortex for disorder-related versus neutral scenes. Amygdala differences between groups failed significance. Subjective levels of anxiety significantly correlated with brainstem activation in PD patients. Analysis of functional connectivity by means of beta series correlation revealed no emotion-specific alterations in connectivity in PD patients versus HC. The results suggest that subjective anxiety evoked by external stimuli is directly related to altered activation in the homeostatic alarm system in PD. With novel disorder-related stimuli, the study sheds new light on the neural underpinnings of pathological threat processing in PD. Hum Brain Mapp 37:4439-4453, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katharina Feldker
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Carina Yvonne Heitmann
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Paula Neumeister
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Maximilian Bruchmann
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | - Laura Vibrans
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
| | | | - Thomas Straube
- Institute of Medical Psychology and Systems NeuroscienceUniversity of MuensterMuensterGermany
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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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Classical conditioning in borderline personality disorder: an fMRI study. Eur Arch Psychiatry Clin Neurosci 2016; 266:291-305. [PMID: 25814470 DOI: 10.1007/s00406-015-0593-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
Previous research suggests disturbed emotional learning and memory in borderline personality disorder (BPD). Studies investigating the neural correlates of aversive differential delay conditioning in BPD are currently lacking. We aimed to investigate acquisition, within-session extinction, between-session extinction recall, and reacquisition. We expected increased activation in the insula, amygdala, and anterior cingulate, and decreased prefrontal activation in BPD patients. During functional magnetic resonance imaging, 27 medication-free female BPD patients and 26 female healthy controls (HC) performed a differential delay aversive conditioning paradigm. An electric shock served as unconditioned stimulus, two neutral pictures as conditioned stimuli (CS+/CS-). Dependent variables were blood-oxygen-level-dependent response, skin conductance response (SCR), and subjective ratings (valence, arousal). No significant between-group differences in brain activation were found [all p(FDR) > 0.05]. Within-group comparisons for CS+unpaired > CS- revealed increased insula activity in BPD patients but not in HC during early acquisition; during late acquisition, both groups recruited fronto-parietal areas [p(FDR) < 0.05]. During extinction, BPD patients rated both CS+ and CS- as significantly more arousing and aversive than HC and activated the amygdala in response to CS+. In contrast, HC showed increased prefrontal activity in response to CS+ > CS during extinction. During extinction recall, there was a trend for stronger SCR to CS+ > CS in BPD patients. Amygdala habituation to CS+paired (CS+ in temporal contingency with the aversive event) during acquisition was found in HC but not in patients. Our findings suggest altered temporal response patterns in terms of increased vigilance already during early acquisition and delayed extinction processes in individuals with BPD.
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Greco JA, Liberzon I. Neuroimaging of Fear-Associated Learning. Neuropsychopharmacology 2016; 41:320-34. [PMID: 26294108 PMCID: PMC4677141 DOI: 10.1038/npp.2015.255] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/14/2015] [Accepted: 08/16/2015] [Indexed: 01/08/2023]
Abstract
Fear conditioning has been commonly used as a model of emotional learning in animals and, with the introduction of functional neuroimaging techniques, has proven useful in establishing the neurocircuitry of emotional learning in humans. Studies of fear acquisition suggest that regions such as amygdala, insula, anterior cingulate cortex, and hippocampus play an important role in acquisition of fear, whereas studies of fear extinction suggest that the amygdala is also crucial for safety learning. Extinction retention testing points to the ventromedial prefrontal cortex as an essential region in the recall of the safety trace, and explicit learning of fear and safety associations recruits additional cortical and subcortical regions. Importantly, many of these findings have implications in our understanding of the pathophysiology of psychiatric disease. Recent studies using clinical populations have lent insight into the changes in regional activity in specific disorders, and treatment studies have shown how pharmaceutical and other therapeutic interventions modulate brain activation during emotional learning. Finally, research investigating individual differences in neurotransmitter receptor genotypes has highlighted the contribution of these systems in fear-associated learning.
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Affiliation(s)
- John A Greco
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Israel Liberzon
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Todd RM, MacDonald MJ, Sedge P, Robertson A, Jetly R, Taylor MJ, Pang EW. Soldiers With Posttraumatic Stress Disorder See a World Full of Threat: Magnetoencephalography Reveals Enhanced Tuning to Combat-Related Cues. Biol Psychiatry 2015; 78:821-9. [PMID: 26094019 DOI: 10.1016/j.biopsych.2015.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is linked to elevated arousal and alterations in cognitive processes. Yet, whether a traumatic experience is linked to neural and behavioral differences in selective attentional tuning to traumatic stimuli is not known. The present study examined selective awareness of threat stimuli and underlying temporal-spatial patterns of brain activation associated with PTSD. METHODS Participants were 44 soldiers from the Canadian Armed Forces, 22 with PTSD and 22 without. All completed neuropsychological tests and clinical assessments. Magnetoencephalography data were collected while participants identified two targets in a rapidly presented stream of words. The first target was a number and the second target was either a combat-related or neutral word. The difference in accuracy for combat-related versus neutral words was used as a measure of attentional bias. RESULTS All soldiers showed a bias for combat-related words. This bias was enhanced in the PTSD group, and behavioral differences were associated with distinct patterns of brain activity. At early latencies, non-PTSD soldiers showed activation of midline frontal regions associated with fear regulation (90-340 ms after the second target presentation), whereas those with PTSD showed greater visual cortex activation linked to enhanced visual processing of trauma stimuli (200-300 ms). CONCLUSIONS These findings suggest that attentional biases in PTSD are linked to deficits in very rapid regulatory activation observed in healthy control subjects. Thus, sufferers with PTSD may literally see a world more populated by traumatic cues, contributing to a positive feedback loop that perpetuates the effects of trauma.
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Affiliation(s)
- Rebecca M Todd
- Department of Psychology, University of British Columbia, Vancouver, British Columbia.
| | - Matt J MacDonald
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto
| | - Paul Sedge
- Operational Stress Injury Clinic, The Royal Ottawa Mental Health Center, Ottawa; The Saint Lawrence Valley Correctional Treatment Center, Brockville
| | - Amanda Robertson
- Neurosciences and Mental Health Research Institute, Hospital for Sick Children, Toronto
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto; Neurosciences and Mental Health Research Institute, Hospital for Sick Children, Toronto; Department of Medical Imaging, University of Toronto, Toronto; Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth W Pang
- Neurosciences and Mental Health Research Institute, Hospital for Sick Children, Toronto; Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
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Weisholtz DS, Root JC, Butler T, Tüscher O, Epstein J, Pan H, Protopopescu X, Goldstein M, Isenberg N, Brendel G, LeDoux J, Silbersweig DA, Stern E. Beyond the amygdala: Linguistic threat modulates peri-sylvian semantic access cortices. BRAIN AND LANGUAGE 2015; 151:12-22. [PMID: 26575986 PMCID: PMC4743641 DOI: 10.1016/j.bandl.2015.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 10/16/2015] [Accepted: 10/24/2015] [Indexed: 06/05/2023]
Abstract
In this study, healthy volunteers were scanned using functional magnetic resonance imaging (fMRI) to investigate the neural systems involved in processing the threatening content conveyed via visually presented "threat words." The neural responses elicited by these words were compared to those elicited by matched neutral control words. The results demonstrate that linguistic threat, when presented in written form, can selectively engage areas of lateral temporal and inferior frontal cortex, distinct from the core language areas implicated in aphasia. Additionally, linguistic threat modulates neural activity in visceral/emotional systems (amygdala, parahippocampal gyrus and periaqueductal gray), and at earlier stages of the visual-linguistic processing stream involved in visual word form representations (ventral occipitotemporal cortex). We propose a model whereby limbic activation modulates activity at multiple nodes along the visual-linguistic-semantic processing stream, including a perisylvian "semantic access network" involved in decoding word meaning, suggesting a dynamic interplay between feedforward and feedback processes.
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Affiliation(s)
- Daniel S Weisholtz
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
| | - James C Root
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States; Department of Psychiatry, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, United States
| | - Tracy Butler
- Department of Neurology, New York University Langone Medical Center, 223 East 34th Street, New York, NY 10016, United States; Department of Psychiatry, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, United States
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, Johannes-Gutenberg University Mainz, Langenbeck Street 1, D-55131 Mainz, Germany
| | - Jane Epstein
- Department of Psychiatry, VA Boston Healthcare System/Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, United States
| | - Hong Pan
- Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
| | | | - Martin Goldstein
- Mount Sinai School of Medicine, Department of Neurology, 5 East 98th Street, 7th Floor, New York, NY 10029, United States
| | - Nancy Isenberg
- Neuroscience Institute, Virginia Mason Medical Center, 1100 Ninth Ave., Seattle, WA 98101, United States
| | - Gary Brendel
- Department of Psychiatry, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, United States
| | - Joseph LeDoux
- Center for Neural Science, New York University, 4 Washington Place, Room 809, New York, NY 10003, United States
| | - David A Silbersweig
- Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
| | - Emily Stern
- Department of Radiology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, United States; Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
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Nees F, Heinrich A, Flor H. A mechanism-oriented approach to psychopathology: The role of Pavlovian conditioning. Int J Psychophysiol 2015; 98:351-364. [DOI: 10.1016/j.ijpsycho.2015.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/01/2015] [Accepted: 05/06/2015] [Indexed: 01/19/2023]
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Perez DL, Pan H, Weisholtz DS, Root JC, Tuescher O, Fischer DB, Butler T, Vago DR, Isenberg N, Epstein J, Landa Y, Smith TE, Savitz AJ, Silbersweig DA, Stern E. Altered threat and safety neural processing linked to persecutory delusions in schizophrenia: a two-task fMRI study. Psychiatry Res 2015; 233. [PMID: 26208746 PMCID: PMC5003172 DOI: 10.1016/j.pscychresns.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Persecutory delusions are a clinically important symptom in schizophrenia associated with social avoidance and increased violence. Few studies have investigated the neurobiology of persecutory delusions, which is a prerequisite for developing novel treatments. The aim of this two-paradigm functional magnetic resonance imaging (fMRI) study is to characterize social "real world" and linguistic threat brain activations linked to persecutory delusions in schizophrenia (n=26) using instructed-fear/safety and emotional word paradigms. Instructed-fear/safety activations correlated to persecutory delusion severity demonstrated significant increased lateral orbitofrontal cortex and visual association cortex activations for the instructed-fear vs. safety and instructed-fear vs. baseline contrasts; decreased lateral orbitofrontal cortex and ventral occipital-temporal cortex activations were observed for the instructed-safety stimuli vs. baseline contrast. The salience network also showed divergent fear and safety cued activations correlated to persecutory delusions. Emotional word paradigm analyses showed positive correlations between persecutory delusion severity and left-lateralized linguistic and hippocampal-parahippocampal activations for the threat vs. neutral word contrast. Visual word form area activations correlated positively with persecutory delusions for both threat and neutral word vs. baseline contrasts. This study links persecutory delusions to enhanced neural processing of threatening stimuli and decreased processing of safety cues, and helps elucidate systems-level activations associated with persecutory delusions in schizophrenia.
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Affiliation(s)
- David L. Perez
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Hong Pan
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Daniel S. Weisholtz
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Neurology, Boston, MA, USA
| | - James C. Root
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA
| | - Oliver Tuescher
- University Medical Center Freiburg, Department of Neurology, Freiburg im Breisgau, Germany,University Medical Centre Mainz, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - David B. Fischer
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Tracy Butler
- Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - David R. Vago
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Nancy Isenberg
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Yulia Landa
- Weill Cornell Medical Center, Department of Psychiatry, New York, NY, USA
| | - Thomas E. Smith
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Adam J. Savitz
- Weill Cornell Medical Center, Department of Psychiatry, New York, NY, USA
| | - David A. Silbersweig
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Neurology, Boston, MA, USA
| | - Emily Stern
- Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Department of Psychiatry, 824 Boylston Street, Chestnut Hill, MA 02467, USA; Brigham and Women's Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA.
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Lueken U, Straube B, Yang Y, Hahn T, Beesdo-Baum K, Wittchen HU, Konrad C, Ströhle A, Wittmann A, Gerlach AL, Pfleiderer B, Arolt V, Kircher T. Separating depressive comorbidity from panic disorder: A combined functional magnetic resonance imaging and machine learning approach. J Affect Disord 2015; 184:182-92. [PMID: 26093832 DOI: 10.1016/j.jad.2015.05.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/11/2015] [Accepted: 05/29/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Depression is frequent in panic disorder (PD); yet, little is known about its influence on the neural substrates of PD. Difficulties in fear inhibition during safety signal processing have been reported as a pathophysiological feature of PD that is attenuated by depression. We investigated the impact of comorbid depression in PD with agoraphobia (AG) on the neural correlates of fear conditioning and the potential of machine learning to predict comorbidity status on the individual patient level based on neural characteristics. METHODS Fifty-nine PD/AG patients including 26 (44%) with a comorbid depressive disorder (PD/AG+DEP) underwent functional magnetic resonance imaging (fMRI). Comorbidity status was predicted using a random undersampling tree ensemble in a leave-one-out cross-validation framework. RESULTS PD/AG-DEP patients showed altered neural activation during safety signal processing, while +DEP patients exhibited generally decreased dorsolateral prefrontal and insular activation. Comorbidity status was correctly predicted in 79% of patients (sensitivity: 73%; specificity: 85%) based on brain activation during fear conditioning (corrected for potential confounders: accuracy: 73%; sensitivity: 77%; specificity: 70%). LIMITATIONS No primary depressed patients were available; only medication-free patients were included. Major depression and dysthymia were collapsed (power considerations). CONCLUSIONS Neurofunctional activation during safety signal processing differed between patients with or without comorbid depression, a finding which may explain heterogeneous results across previous studies. These findings demonstrate the relevance of comorbidity when investigating neurofunctional substrates of anxiety disorders. Predicting individual comorbidity status may translate neurofunctional data into clinically relevant information which might aid in planning individualized treatment. The study was registered with the ISRCTN ISRCTN80046034.
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Affiliation(s)
- Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Würzburg, Füchsleinstr. 15, D-97080 Würzburg, Germany; Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany.
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Tim Hahn
- Department of Cognitive Psychology II, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-University Medicine Berlin, Berlin, Germany
| | - André Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-University Medicine Berlin, Berlin, Germany
| | | | - Bettina Pfleiderer
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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Poletti S, Radaelli D, Cucchi M, Ricci L, Vai B, Smeraldi E, Benedetti F. Neural correlates of anxiety sensitivity in panic disorder: A functional magnetic resonance imaging study. Psychiatry Res 2015; 233:95-101. [PMID: 26071623 DOI: 10.1016/j.pscychresns.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/01/2014] [Accepted: 05/22/2015] [Indexed: 12/22/2022]
Abstract
Panic disorder has been associated with dysfunctional neuropsychological dimensions, including anxiety sensitivity. Brain-imaging studies of the neural correlates of emotional processing have identified a network of structures that constitute the neural circuitry for emotions. The anterior cingulate cortex (ACC), medial prefrontal cortex (mPFC) and insula, which are part of this network, are also involved in the processing of threat-related stimuli. The aim of the study was to investigate if neural activity in response to emotional stimuli in the cortico-limbic network is associated to anxiety sensitivity in panic disorder. In a sample of 18 outpatients with panic disorder, we studied neural correlates of implicit emotional processing of facial affect expressions with a face-matching paradigm; correlational analyses were performed between brain activations and anxiety sensitivity. The correlational analyses performed showed a positive correlation between anxiety sensitivity and brain activity during emotional processing in regions encompassing the PFC, ACC and insula. Our data seem to confirm that anxiety sensitivity is an important component of panic disorder. Accordingly, the neural underpinnings of anxiety sensitivity could be an interesting focus for treatment and further research.
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Affiliation(s)
- Sara Poletti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy.
| | - Daniele Radaelli
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Michele Cucchi
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Liana Ricci
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Benedetta Vai
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Enrico Smeraldi
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
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Straube B, Lueken U, Jansen A, Konrad C, Gloster AT, Gerlach AL, Ströhle A, Wittmann A, Pfleiderer B, Gauggel S, Wittchen U, Arolt V, Kircher T. Neural correlates of procedural variants in cognitive-behavioral therapy: a randomized, controlled multicenter FMRI study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 83:222-33. [PMID: 24970601 DOI: 10.1159/000359955] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus self-guided (T-) exposure on the neural correlates of fear conditioning in PD/AG. METHOD In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T-, n = 20). RESULTS The interaction of diagnosis (PD/AG, HS), treatment group (T+, T-), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2). CONCLUSION After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.
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Affiliation(s)
- Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps University Marburg, Marburg, Germany
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Santos M, D'Amico D, Dierssen M. From neural to genetic substrates of panic disorder: Insights from human and mouse studies. Eur J Pharmacol 2015; 759:127-41. [PMID: 25818748 DOI: 10.1016/j.ejphar.2015.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 01/15/2015] [Accepted: 03/12/2015] [Indexed: 01/30/2023]
Abstract
Fear is an ancestral emotion, an intrinsic defensive response present in every organism. Although fear is an evolutionarily advantageous emotion, under certain pathologies such as panic disorder it might become exaggerated and non-adaptive. Clinical and preclinical work pinpoints that changes in cognitive processes, such as perception and interpretation of environmental stimuli that rely on brain regions responsible for high-level function, are essential for the development of fear-related disorders. This review focuses on the involvement of cognitive function to fear circuitry disorders. Moreover, we address how animal models are contributing to understand the involvement of human candidate genes to pathological fear and helping achieve progress in this field. Multidisciplinary approaches that integrate human genetic findings with state of the art genetic mouse models will allow to elucidate the mechanisms underlying pathology and to develop new strategies for therapeutic targeting.
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Affiliation(s)
- Mónica Santos
- Cellular & Systems Neurobiology, Systems Biology Program, Center for Genomic Regulation (CRG), E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), E-08003 Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), E-08003 Barcelona, Spain; Institute of Biology, Otto-von-Guericke University, 39120 Magdeburg, Germany.
| | - Davide D'Amico
- Cellular & Systems Neurobiology, Systems Biology Program, Center for Genomic Regulation (CRG), E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), E-08003 Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), E-08003 Barcelona, Spain; ZeClinics SL, E-08001 Barcelona, Spain.
| | - Mara Dierssen
- Cellular & Systems Neurobiology, Systems Biology Program, Center for Genomic Regulation (CRG), E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), E-08003 Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), E-08003 Barcelona, Spain.
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Milad MR, Rosenbaum BL, Simon NM. Neuroscience of fear extinction: Implications for assessment and treatment of fear-based and anxiety related disorders. Behav Res Ther 2014; 62:17-23. [DOI: 10.1016/j.brat.2014.08.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 01/06/2023]
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The role of serotonin in reward, punishment and behavioural inhibition in humans: insights from studies with acute tryptophan depletion. Neurosci Biobehav Rev 2014; 46 Pt 3:365-78. [PMID: 25195164 DOI: 10.1016/j.neubiorev.2014.07.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/19/2014] [Accepted: 07/28/2014] [Indexed: 01/06/2023]
Abstract
Deakin and Graeff proposed that forebrain 5-hydroxytryptamine (5-HT) projections are activated by aversive events and mediate anticipatory coping responses including avoidance learning and suppression of the fight-flight escape/panic response. Other theories proposed 5-HT mediates aspects of behavioural inhibition or reward. Most of the evidence comes from rodent studies. We review 36 experimental studies in humans in which the technique of acute tryptophan depletion (ATD) was used to explicitly address the role of 5-HT in response inhibition, punishment and reward. ATD did not cause disinhibition of responding in the absence of rewards or punishments (9 studies). A major role for 5-HT in reward processing is unlikely but further tests are warranted by some ATD findings. Remarkably, ATD lessened the ability of punishments (losing points or notional money) to restrain behaviour without affecting reward processing in 7 studies. Two of these studies strongly indicate that ATD blocks 5-HT mediated aversively conditioned Pavlovian inhibition and this can explain a number of the behavioural effects of ATD.
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Characterization of post-traumatic stress disorder using resting-state fMRI with a multi-level parametric classification approach. Brain Topogr 2014; 28:221-37. [PMID: 25078561 DOI: 10.1007/s10548-014-0386-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
Functional neuroimaging studies have found intra-regional activity and inter-regional connectivity alterations in patients with post-traumatic stress disorder (PTSD). However, the results of these studies are based on group-level statistics and therefore it is unclear whether PTSD can be discriminated at single-subject level, for instance using the machine learning approach. Here, we proposed a novel framework to identify PTSD using multi-level measures derived from resting-state functional MRI (fMRI). Specifically, three levels of measures were extracted as classification features: (1) regional amplitude of low-frequency fluctuations (univariate feature), which represents local spontaneous synchronous neural activity; (2) temporal functional connectivity (bivariate feature), which represents the extent of similarity of local activity between two regions, and (3) spatial functional connectivity (multivariate feature), which represents the extent of similarity of temporal correlation maps between two regions. Our method was evaluated on 20 PTSD patients and 20 demographically matched healthy controls. The experimental results showed that the features of each level could successfully discriminate PTSD patients from healthy controls. Furthermore, the combination of multi-level features using multi-kernel learning can further improve the classification performance. Specifically, the classification accuracy obtained by the proposed framework was 92.5 %, which was an increase of at least 5 and 17.5 % from the two-level and single-level feature based methods, respectively. Particularly, the limbic structure and prefrontal cortex provided the most discriminant features for classification, consistent with results reported in previous studies. Together, this study demonstrated for the first time that patients with PTSD can be identified at the individual level using resting-state fMRI data. The promising classification results indicated that this method may provide a complementary approach for improving the clinical diagnosis of PTSD.
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Maier SJ, Szalkowski A, Kamphausen S, Feige B, Perlov E, Kalisch R, Jacob GA, Philipsen A, Tüscher O, Tebartz van Elst L. Altered cingulate and amygdala response towards threat and safe cues in attention deficit hyperactivity disorder. Psychol Med 2014; 44:85-98. [PMID: 23510549 DOI: 10.1017/s0033291713000469] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Emotional dysregulation is becoming increasingly recognized as an important feature of attention deficit hyperactivity disorder (ADHD). In this study, two experiments were conducted investigating the neural response to either verbally instructed fear (IF) or uninstructed (classically conditioned) fear (UF) using the skin conductance response (SCR) and functional magnetic resonance imaging (fMRI). METHOD In the conditioning phase of the UF experiment (17 ADHD and 17 healthy controls), subjects experienced an unconditioned stimulus (UCS, unpleasant electrodermal stimulation) paired with a former neutral conditioned stimulus (CS+), whereas a control stimulus (CS-) was never paired with the UCS. In the subsequent test phase, only the CS+ and the CS- were presented. In the IF experiment (13 ADHD and 17 healthy controls), subjects were only told that an independently experienced UCS might occur together with the CS+ but not the CS- during testing. No UCS was presented. RESULTS Groups did not detectably differ in SCR or neural responses to UF. In IF, ADHD patients showed a trend-line decreased SCR and significantly decreased activation of the dorsal anterior cingulate cortex (dACC), a region prominently involved in fear responding, to the CS+. This was accompanied by higher amygdala activation to the CS-. CONCLUSIONS During IF, ADHD patients showed deficits in regions centrally involved in fear learning and expression in terms of diminished CS+-related dACC and increased CS--related amygdala signals. This suggests an impaired processing of verbally transmitted aversive information, which is central for conveying fear information in social contexts. This result extends the growing literature on emotional alterations in ADHD.
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Affiliation(s)
- S J Maier
- Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Germany
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MAOA and mechanisms of panic disorder revisited: from bench to molecular psychotherapy. Mol Psychiatry 2014; 19:122-8. [PMID: 23319006 DOI: 10.1038/mp.2012.172] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 10/01/2012] [Accepted: 10/09/2012] [Indexed: 12/17/2022]
Abstract
Panic disorder with agoraphobia (PD/AG) is a prevalent mental disorder featuring a substantial complex genetic component. At present, only a few established risk genes exist. Among these, the gene encoding monoamine oxidase A (MAOA) is noteworthy given that genetic variation has been demonstrated to influence gene expression and monoamine levels. Long alleles of the MAOA-uVNTR promoter polymorphism are associated with PD/AG and correspond with increased enzyme activity. Here, we have thus investigated the impact of MAOA-uVNTR on therapy response, behavioral avoidance and brain activity in fear conditioning in a large controlled and randomized multicenter study on cognitive behavioral therapy (CBT) in PD/AG. The study consisted of 369 PD/AG patients, and genetic information was available for 283 patients. Carriers of the risk allele had significantly worse outcome as measured by the Hamilton Anxiety scale (46% responders vs 67%, P=0.017). This was accompanied by elevated heart rate and increased fear during an anxiety-provoking situation, that is, the behavioral avoidance task. All but one panic attack that happened during this task occurred in risk allele carriers and, furthermore, risk allele carriers did not habituate to the situation during repetitive exposure. Finally, functional neuroimaging during a classical fear conditioning paradigm evidenced that the protective allele is associated with increased activation of the anterior cingulate cortex upon presentation of the CS+ during acquisition of fear. Further differentiation between high- and low-risk subjects after treatment was observed in the inferior parietal lobes, suggesting differential brain activation patterns upon CBT. Taken together, we established that a genetic risk factor for PD/AG is associated with worse response to CBT and identify potential underlying neural mechanisms. These findings might govern how psychotherapy can include genetic information to tailor individualized treatment approaches.
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Lueken U, Straube B, Reinhardt I, Maslowski NI, Wittchen HU, Ströhle A, Wittmann A, Pfleiderer B, Konrad C, Ewert A, Uhlmann C, Arolt V, Jansen A, Kircher T. Altered top-down and bottom-up processing of fear conditioning in panic disorder with agoraphobia. Psychol Med 2014; 44:381-394. [PMID: 23611156 DOI: 10.1017/s0033291713000792] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although several neurophysiological models have been proposed for panic disorder with agoraphobia (PD/AG), there is limited evidence from functional magnetic resonance imaging (fMRI) studies on key neural networks in PD/AG. Fear conditioning has been proposed to represent a central pathway for the development and maintenance of this disorder; however, its neural substrates remain elusive. The present study aimed to investigate the neural correlates of fear conditioning in PD/AG patients. METHOD The blood oxygen level-dependent (BOLD) response was measured using fMRI during a fear conditioning task. Indicators of differential conditioning, simple conditioning and safety signal processing were investigated in 60 PD/AG patients and 60 matched healthy controls. RESULTS Differential conditioning was associated with enhanced activation of the bilateral dorsal inferior frontal gyrus (IFG) whereas simple conditioning and safety signal processing were related to increased midbrain activation in PD/AG patients versus controls. Anxiety sensitivity was associated positively with the magnitude of midbrain activation. CONCLUSIONS The results suggest changes in top-down and bottom-up processes during fear conditioning in PD/AG that can be interpreted within a neural framework of defensive reactions mediating threat through distal (forebrain) versus proximal (midbrain) brain structures. Evidence is accumulating that this network plays a key role in the aetiopathogenesis of panic disorder.
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Affiliation(s)
- U Lueken
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - B Straube
- Department of Psychiatry and Psychotherapy, Philipps University Marburg, Germany
| | - I Reinhardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - N I Maslowski
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - A Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - A Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - B Pfleiderer
- Department of Clinical Radiology, University of Münster, Germany
| | - C Konrad
- Department of Psychiatry and Psychotherapy, Philipps University Marburg, Germany
| | - A Ewert
- Department of Clinical Radiology, University of Münster, Germany
| | - C Uhlmann
- Department of Psychiatry and Psychotherapy, University of Münster, Germany
| | - V Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Germany
| | - A Jansen
- Department of Psychiatry and Psychotherapy, Philipps University Marburg, Germany
| | - T Kircher
- Department of Psychiatry and Psychotherapy, Philipps University Marburg, Germany
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Hippocampal network connectivity and activation differentiates post-traumatic stress disorder from generalized anxiety disorder. Neuropsychopharmacology 2013; 38:1889-98. [PMID: 23673864 PMCID: PMC3746693 DOI: 10.1038/npp.2013.122] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/02/2013] [Accepted: 05/11/2013] [Indexed: 01/19/2023]
Abstract
Anxiety disorders are a diverse group of clinical states. Post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD), eg, share elevated anxiety symptoms, but differ with respect to fear-related memory dysregulation. As the hippocampus is implicated in both general anxiety and fear memory, it may be an important brain locus for mapping the similarities and differences among anxiety disorders. Anxiety and fear also functionally associate with different subdivisions of the hippocampus along its longitudinal axis: the human posterior (rodent dorsal) hippocampus is involved in memory, through connectivity with the medial prefrontal-medial parietal default-mode network, whereas the anterior (rodent ventral) hippocampus is involved in anxiety, through connectivity with limbic-prefrontal circuits. We examined whether differential hippocampal network functioning may help account for similarities and differences in symptoms in PTSD and GAD. Network-sensitive functional magnetic resonance imaging-based resting-state intrinsic connectivity methods, along with task-based assessment of posterior hippocampal/default-mode network function, were used. As predicted, in healthy subjects resting-state connectivity dissociated between posterior hippocampal connectivity with the default-mode network, and anterior hippocampal connectivity to limbic-prefrontal circuitry. The posterior hippocampus and the associated default-mode network, across both resting-state connectivity and task-based measures, were perturbed in PTSD relative to each of the other groups. By contrast, we found only modest support for similarly blunted anterior hippocampal connectivity across both patient groups. These findings provide new insights into the neural circuit-level dysfunctions that account for similar vs different features of two major anxiety disorders, through a translational framework built on animal work and carefully selected clinical disorders.
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Kircher T, Arolt V, Jansen A, Pyka M, Reinhardt I, Kellermann T, Konrad C, Lueken U, Gloster AT, Gerlach AL, Ströhle A, Wittmann A, Pfleiderer B, Wittchen HU, Straube B. Effect of cognitive-behavioral therapy on neural correlates of fear conditioning in panic disorder. Biol Psychiatry 2013; 73:93-101. [PMID: 22921454 DOI: 10.1016/j.biopsych.2012.07.026] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 06/30/2012] [Accepted: 07/02/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Learning by conditioning is a key ability of animals and humans for acquiring novel behavior necessary for survival in a changing environment. Aberrant conditioning has been considered a crucial factor in the etiology and maintenance of panic disorder with agoraphobia (PD/A). Cognitive-behavioral therapy (CBT) is an effective treatment for PD/A. However, the neural mechanisms underlying the effects of CBT on conditioning processes in PD/A are unknown. METHODS In a randomized, controlled, multicenter clinical trial in medication-free patients with PD/A who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before and after CBT. Quality-controlled fMRI data from 42 patients and 42 healthy subjects were obtained. RESULTS After CBT, patients compared to control subjects revealed reduced activation for the conditioned response (CS+ > CS-) in the left inferior frontal gyrus (IFG). This activation reduction was correlated with reduction in agoraphobic symptoms from t1 to t2. Patients compared to control subjects also demonstrated increased connectivity between the IFG and regions of the "fear network" (amygdalae, insulae, anterior cingulate cortex) across time. CONCLUSIONS This study demonstrates the link between cerebral correlates of cognitive (IFG) and emotional ("fear network") processing during symptom improvement across time in PD/A. Further research along this line has promising potential to support the development and further optimization of targeted treatments.
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Affiliation(s)
- Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Rudolf-Bultmann-Straße 8, Marburg, Germany.
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Kim JE, Dager SR, Lyoo IK. The role of the amygdala in the pathophysiology of panic disorder: evidence from neuroimaging studies. BIOLOGY OF MOOD & ANXIETY DISORDERS 2012; 2:20. [PMID: 23168129 PMCID: PMC3598964 DOI: 10.1186/2045-5380-2-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 09/19/2012] [Indexed: 01/04/2023]
Abstract
Although the neurobiological mechanisms underlying panic disorder (PD) are not yet clearly understood, increasing amount of evidence from animal and human studies suggests that the amygdala, which plays a pivotal role in neural network of fear and anxiety, has an important role in the pathogenesis of PD. This article aims to (1) review the findings of structural, chemical, and functional neuroimaging studies on PD, (2) relate the amygdala to panic attacks and PD development, (3) discuss the possible causes of amygdalar abnormalities in PD, (4) and suggest directions for future research.
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Affiliation(s)
- Jieun E Kim
- Department of Radiology, School of Medicine, University of Washington, 1100 NE 45th St, Ste 555, WA 98105, Seattle, USA.
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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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