The change of regional brain metabolism (18FDG PET) in panic disorder during the treatment with cognitive behavioral therapy or antidepressants.
BACKGROUND
The goal of our study was to identify brain structures in patients with panic disorder (PD) that show changes in 18FDG PET during the treatment with cognitive behavioral therapy (CBT) or antidepressants.


METHODS
Twelve patients suffering from panic disorder were studied with [18F]-2-fluoro-deoxyglucose positron emission tomography (18FDG PET) scanning during resting state (condition of random episodic silent thinking, REST). After PET examination patients were randomly assigned to either cognitive behavioral treatment group (6 patients) or antidepressants treatment group (6 patients). After a 3 month period 18FDG PET examination was repeated in both groups. Psychopathology was assessed using the rating scales HAMA, CGI and Panic Disorder Severity Scale (PDSS). Data were analysed using software for statistical parametric mapping (SPM99).


RESULTS
The scores of psychopathology rating scales (CGI, HAMA, PDSS) decreased in both groups. Changes of 18FDG uptake in the pharmacotherapy group: decreases were found in the a priori hypothesized regions in the right hemisphere, in the superior, middle, medial and inferior frontal gyrus, superior and middle temporal gyrus, and increases were detected in the a priori hypothesized regions, mainly in the left hemisphere in medial and middle frontal gyrus, superior, middle and transverse temporal gyrus. Changes of 18FDG uptake in the CBT group: decreases were found in the a priori hypothesized regions of the right hemisphere in the inferior temporal gyrus, superior and inferior frontal gyrus, and increases were detected in the a priori hypothesized region, mostly in the left hemisphere: inferior frontal gyrus, middle temporal gyrus and insula. We did not detect changes in 18FDG uptake in the limbic region (hippocampus, parahippocampal gyrus and amygdala).


CONCLUSIONS
Changes in brain metabolism (18FDG uptake) after the treatment either with CBT or with antidepressants were similar in number of brain areas, with prominent right-left difference. This is in concordance with the asymmetry of brain activity noted in patients with PD according to previous PET (and SPECT) studies.
Prasko
Ján
J
Prague Psychiatric Centre, 3rd Faculty of Medicine Charles University Prague, Centre of Neuropsychiatric Studies, Prague, Czech Republic. prasko@pcp.lf3.cuni.cz
Horácek
Jirí
J
Záleský
Richard
R
Kopecek
Miloslav
M
Novák
Tomás
T
Pasková
Beata
B
Skrdlantová
Lucie
L
Belohlávek
Otakar
O
Höschl
Cyril
C
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology; D015928:Cognitive Behavioral Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D007839:Functional Laterality; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D016584:Panic Disorder / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy*; D049268:Positron-Emission Tomography; D016896:Treatment Outcome
D000928:Antidepressive Agents; D019788:Fluorodeoxyglucose F18