Arousal and the attentional network in panic disorder

Abstract

Although a great deal of information about the neurobiology of panic disorder is now available, there is a need for an updated etiological model integrating recent findings on the neurobiology of the arousal system and its relationship with higher cortical functions in panic disorder. The current mini-review presents psychophysiological, molecular biological/genetic and functional neuroimaging evidence for dysfunction in major arousal systems of the brain. Such dysfunction may influence the development of panic disorder by precipitating autonomic bodily symptoms and at the same time increasing vigilance to these sensations by modulating cortical attentional networks. A multilevel model of arousal, attention and anxiety-including the norepinephrine, orexin, neuropeptide S and caffeine-related adenosine systems-may be useful in integrating a range of data available on the pathogenesis of panic disorder.

Brain responses to disorder‐related visual threat in panic disorder

“…Neurological and recent neurobiological findings support this broader network, and parallel pathways in PD [Geiger et al, 2014;Pannekoek et al, 2013]. Altered activation in these regions in PD patients has underlined the regions' role in the pathophysiology of the disorder.…”

The genetics of anxiety‐related negative valence system traits

“…The attentional network modulates cognitive resources in these domains, and patients with ADs have been shown to have altered functioning of this network. PD, for example, is associated with physiological hyperarousal and increased attention toward perceived or actual threats [Geiger et al, ], while hypervigiliance is a key symptom of PTSD. Although there is overlap with the RDoC “Cognitive Systems” domain, it is included in this review because of the relevance of attentional systems to core NVS elements (and AD correlates) like risk assessment, vigilance, and attentional biases.…”

“…The norepinephrine‐activated alerting network is of particular relevance to NVS as it relates to hypervigilance and attentiveness/attentional biases toward threat [Geiger et al, ]. Genes demonstrating an association with the activation or function of the alerting network include ADRA2A [Green et al, ], NET [Green et al, ], NPSR1 (rs324981) [Neufang et al, ], the NMDA receptor subunit GRIN2B (rs1806201) [Schulz et al, ], CACNA1C (rs1006737) [Thimm et al, ] and, at a trend level only, the dopamine transmitter DAT1 (rs6350) [Konrad et al, ].…”

A Genetic Animal Model of Alcoholism for Screening Medications to Treat Addiction

“…Moreover, there is a complex interaction between norepinephrine (NE) and corticotrophin releasing factor (CRF), a neuropeptide strongly associated with central autonomic and stress activity, receptors within the locus coeruleus (Reyes, Bangasser, Valentino, & Van Bockstaele, 2014). In addition to major projections to the frontal cortex, (NE) neurons project to the limbic system (Flavin & Winder, 2013), including amygdala, bed nucleus of the stria terminalis, hippocampus, and hypothalamus where it is implicated in addiction (Becker, 2012; Koob, 2013; Sofuoglu, Rosenheck, Petrakis, 2014; See also Al’ Absi, 2007), anxiety (Geiger, Neufang, Stein, & Domschke, 2014), attention (Geiger et al, 2014; Hegerl & Hensch, 2014), cognition (Chandler, Waterhouse, & Gao, 2014), memory, mood (Gold, 2015), pain (Elman, Borsook, & Volkow, 2013; Strobel, Hunt, Sullivan, Sun, & Sah, 2014), post-traumatic stress disorder (PTSD, Sofuoglu et al, 2014; Wimalawansa, 2014), sleep (Zeitzer, 2013), suicide (Elman et al, 2013), and associated physiological processes (Klimek, Rajkowska, Luker, Dilley, et al, 1999; Moret & Briley, 2011). …”