Brain responses to disorder‐related visual threat in panic disorder

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.

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder

“…Panic-related scenes display symptoms related to panic attacks (e.g., shortness of breath, hyperventilation, heart palpitations, chest pain, trembling or shaking, dizziness, fainting), fears (e.g., having a heart attack) and agoraphobia-related situ ations (e.g., crowded bus, dark tunnel, glass elevator). 22 …”

Functional neuroanatomy in panic disorder: Status quo of the research

“…For example, panic-related pictures are presented to people suffering from PD to study the neural underpinnings of threat processing in this group[29]. …”

“…In a very recent fMRI study, Feldker et al[29] presented panic-related and neutral visual scenes to 26 PD patients to study the neural underpinnings of threat processing. Similarly to the results found by Engel et al[32], patients showed hyperactivation in an extended fear network comprising the brainstem, insula, thalamus, ACC, midcingulate cortex and DMPFC for disorder-related vs neutral scenes, compared to 26 healthy controls.…”

“…Interestingly, differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al[11]. Feldker et al[29] stated that, given the role of the amygdala proposed for the pathophysiology of PD, it seems surprising that amygdala hyperactivation only reached marginal significance. In the same tenor, Etkin et al[138] concluded that “in PD, amygdala hyperactivity appears to be the exception, rather than the rule”.…”

“…Interestingly, two very recent studies using clear panic-related pictorial stimuli and relatively large sample sizes have put strong emphasis on a specific role of the insula and dACC in the pathophysiology of PD[29,32]. There is growing evidence that the insula, the dACC as well as subcortical structures, such as the amygdala, play a crucial role in salience processing across multiple sensory and cognitive domains by integrating external sensory information with internal emotional and bodily state signals[142].…”