title: 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.
authors.affiliation: Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Feldker
authors.affiliation: Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany.
authors.forename: Carina Yvonne
authors.initials: CY
authors.lastname: Heitmann
authors.affiliation: Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany.
authors.forename: Paula
authors.initials: P
authors.lastname: Neumeister
authors.affiliation: Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bruchmann
authors.affiliation: Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Vibrans
authors.affiliation: University of Muenster, Muenster, Germany.
authors.forename: Pienie
authors.initials: P
authors.lastname: Zwitserlood
authors.affiliation: Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Straube
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D005239:Fear / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D009483:Neuropsychological Tests; D016584:Panic Disorder / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010364:Pattern Recognition, Visual / Q000502:physiology*; D055815:Young Adult
keywords: brainstem; disorder-related scenes; fMRI; panic disorder