title: Anticipating agoraphobic situations: the neural correlates of panic disorder with agoraphobia.
abstract: BACKGROUND
  Panic disorder with agoraphobia is characterized by panic attacks and anxiety in situations where escape might be difficult. However, neuroimaging studies specifically focusing on agoraphobia are rare. Here we used functional magnetic resonance imaging (fMRI) with disorder-specific stimuli to investigate the neural substrates of agoraphobia.
  
  
  METHODS
  We compared the neural activations of 72 patients suffering from panic disorder with agoraphobia with 72 matched healthy control subjects in a 3-T fMRI study. To isolate agoraphobia-specific alterations we tested the effects of the anticipation and perception of an agoraphobia-specific stimulus set. During fMRI, 48 agoraphobia-specific and 48 neutral pictures were randomly presented with and without anticipatory stimulus indicating the content of the subsequent pictures (Westphal paradigm).
  
  
  RESULTS
  During the anticipation of agoraphobia-specific pictures, stronger activations were found in the bilateral ventral striatum and left insula in patients compared with controls. There were no group differences during the perception phase of agoraphobia-specific pictures.
  
  
  CONCLUSIONS
  This study revealed stronger region-specific activations in patients suffering from panic disorder with agoraphobia in anticipation of agoraphobia-specific stimuli. Patients seem to process these stimuli more intensively based on individual salience. Hyperactivation of the ventral striatum and insula when anticipating agoraphobia-specific situations might be a central neurofunctional correlate of agoraphobia. Knowledge about the neural correlates of anticipatory and perceptual processes regarding agoraphobic situations will help to optimize and evaluate treatments, such as exposure therapy, in patients with panic disorder and agoraphobia.
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wittmann
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schlagenhauf
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy,University of Wuerzburg,Wuerzburg,Germany.
authors.forename: A
authors.initials: A
authors.lastname: Guhn
authors.affiliation: Institute of Clinical Psychology and Psychotherapy,Technische Universität Dresden,Dresden,Germany.
authors.forename: U
authors.initials: U
authors.lastname: Lueken
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: C
authors.initials: C
authors.lastname: Gaehlsdorf
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stoy
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: F
authors.initials: F
authors.lastname: Bermpohl
authors.affiliation: Institute of Psychology,Psychotherapy and Somatopsychology - Humboldt Universität zu Berlin,Germany.
authors.forename: T
authors.initials: T
authors.lastname: Fydrich
authors.affiliation: Department of Clinical Radiology,University of Münster,Münster,Germany.
authors.forename: B
authors.initials: B
authors.lastname: Pfleiderer
authors.affiliation: Department of Radiology,University of Jena,Jena,Germany.
authors.forename: H
authors.initials: H
authors.lastname: Bruhn
authors.affiliation: Department of Psychology,University of Cologne,Cologne,Germany.
authors.forename: A L
authors.initials: AL
authors.lastname: Gerlach
authors.affiliation: Department of Psychiatry and Psychotherapy,Philipps-University Marburg,Marburg,Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kircher
authors.affiliation: Department of Psychiatry and Psychotherapy,Philipps-University Marburg,Marburg,Germany.
authors.forename: B
authors.initials: B
authors.lastname: Straube
authors.affiliation: Institute of Clinical Psychology and Psychotherapy,Technische Universität Dresden,Dresden,Germany.
authors.forename: H-U
authors.initials: HU
authors.lastname: Wittchen
authors.affiliation: Department of Psychiatry,University of Münster,Münster,Germany.
authors.forename: V
authors.initials: V
authors.lastname: Arolt
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: A
authors.initials: A
authors.lastname: Heinz
authors.affiliation: Department of Psychiatry and Psychotherapy,Charité University Medicine Berlin,Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ströhle
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000453:epidemiology / Q000503:physiopathology*; D059031:Anticipation, Psychological / Q000502:physiology*; D002540:Cerebral Cortex / Q000503:physiopathology*; D015897:Comorbidity; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology / Q000503:physiopathology*; D066328:Ventral Striatum / Q000503:physiopathology*