Brain Circulation during Panic Attack: A Transcranial Doppler Study with Clomipramine Challenge.
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.
Psychiatry Unit, Careggi University Hospital, Largo Brambilla 3, 50100 Florence, Italy.
Francesco
0000-0001-6537-5880
F
Rotella
Neurology Unit, Careggi University Hospital, Largo Brambilla 3, 50100 Florence, Italy.
Marinella
M
Marinoni
Psychiatry Unit, Careggi University Hospital, Largo Brambilla 3, 50100 Florence, Italy.
Francesca
F
Lejeune
Neurology Unit, Careggi University Hospital, Largo Brambilla 3, 50100 Florence, Italy.
Fabiana
F
Alari
Psychiatry Unit, Careggi University Hospital, Largo Brambilla 3, 50100 Florence, Italy.
Daniela
D
Depinesi
Section of Psychology and Psychiatry, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
Fiammetta
0000-0002-5022-0488
F
Cosci
Section of Psychology and Psychiatry, Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
Carlo
C
Faravelli