title: Functional MRI activation in response to panic-specific, non-panic aversive, and neutral pictures in patients with panic disorder and healthy controls.
abstract: There is evidence that besides limbic brain structures, prefrontal and insular cortical activations and deactivations are involved in the pathophysiology of panic disorder. This study investigated activation response patterns to stimulation with individually selected panic-specific pictures in patients with panic disorder with agoraphobia (PDA) and healthy control subjects using functional magnetic resonance imaging (fMRI). Structures of interest were the prefrontal, cingulate, and insular cortex, and the amygdalo-hippocampal complex. Nineteen PDA subjects (10 females, 9 males) and 21 healthy matched controls were investigated using a Siemens 3-Tesla scanner. First, PDA subjects gave Self-Assessment Manikin (SAM) ratings on 120 pictures showing characteristic panic/agoraphobia situations, of which 20 pictures with the individually highest SAM ratings were selected. Twenty matched pictures showing aversive but not panic-specific stimuli and 80 neutral pictures from the International Affective Picture System were chosen for each subject as controls. Each picture was shown twice in each of four subsequent blocks. Anxiety and depression ratings were recorded before and after the experiment. Group comparisons revealed a significantly greater activation in PDA patients than control subjects in the insular cortices, left inferior frontal gyrus, dorsomedial prefrontal cortex, the left hippocampal formation, and left caudatum, when PA and N responses were compared. Comparisons for stimulation with unspecific aversive pictures showed activation of similar brain regions in both groups. Results indicate region-specific activations to panic-specific picture stimulation in PDA patients. They also imply dysfunctionality in the processing of interoceptive cues in PDA and the regulation of negative emotionality. Therefore, differences in the functional networks between PDA patients and control subjects should be further investigated.
authors.affiliation: Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany.
authors.forename: K R
authors.initials: KR
authors.lastname: Engel
authors.affiliation: University clinik Schleswig-Holstein, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23538, Luebeck, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Obst
authors.affiliation: Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Bandelow
authors.affiliation: Core Facility MR-Research in Neurology and Psychiatry, Department of Cognitive Neurology, University of Goettingen, Robert-Koch-Strasse 40, Goettingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Dechent
authors.affiliation: Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany.|Department of Systemic Neurosciences, University of Goettingen, von-Siebold-Strasse 5, Goettingen, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Gruber
authors.affiliation: Department of Neurology, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Zerr
authors.affiliation: Department of Neurology, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Ulrich
authors.affiliation: Department of Psychiatry and Psychotherapy, Anxiety Research Unit, University of Goettingen, Von-Siebold-Strasse 5, 37075, Goettingen, Germany. dirk.wedekind@med.uni-goettingen.de.
authors.forename: D
authors.initials: D
authors.lastname: Wedekind
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000150:complications / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D004644:Emotions / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology; D010775:Photic Stimulation; D012647:Self-Assessment
keywords: Insular cortex; Panic disorder; Prefrontal cortex; Visual stimuli; fMRI