Brain Circulation during Panic Attack: A Transcranial Doppler Study with Clomipramine Challenge

Abstract

Introduction. Cerebral blood flow has been well studied in patients with panic disorder, but only few studies analyzed the mechanisms underlying the onset of a panic attack. The aim of the present study was to monitor the cerebral hemodynamics modifications during a panic attack. Materials and Methods. 10 panic disorder patients with recent onset, fully drug naïve, were compared to 13 patients with panic disorder with a previous history of treatment and to 14 controls. A continuous bilateral monitoring of mean flow velocities in right and left middle cerebral arteries was performed by transcranial Doppler. Clomipramine was chosen as challenge. Results. Eight out of 10 patients drug naïve and 6 control subjects out of 13 had a full blown panic attack during the test, whereas none of the patients with a history of treatment panicked. The occurrence of a panic attack was accompanied by a rapid decrease of flow velocities in both right and left middle cerebral arteries. Discussion. The bilateral acute decrease of mean flow velocity during a panic attack suggests the vasoconstriction of the microcirculation of deep brain structures perfused by middle cerebral arteries and involved in the so-called “fear circuitry,” thus suggesting that cerebral homeostatic dysfunctions seem to have a key role in the onset of a panic attack.

Psychiatric manifestations in moyamoya disease: more than a puff of smoke? a systematic review and a case-reports meta-analysis

“…These can lead to reduced carbon dioxide levels and vasoconstriction, which is more deleterious in the brain regions already significantly affected by MMD (8,13). A consequent transitory decrease in cerebral blood supply, especially in such vulnerable regions, may contribute to the development of panic (34,66) or even psychotic symptoms, which have been consistently associated with cerebral hypoperfusion (67). On the other hand, in post-stroke psychosis, the affected brain regions are permanently impaired, and the symptoms may result from more stable reorganization of brain networks or neurotransmitters imbalance.…”