Neural correlates of negative and disease-specific emotional stimuli in panic disorder: a functional magnetic resonance imaging study

Abstract

Objective: Decades of research have highlighted the involvement of the prefrontal cortex, anterior cingulated cortex, and limbic areas (amygdala) in panic disorder (PD). However, little attention has been given specifically to the inferior frontal gyrus. The current study aimed to investigate the neural substrates, including the inferior frontal gyrus, of both panic-related and negative conditions among individuals with PD and healthy controls. Methods: We examined 13 medication-free PD patients and 14 healthy controls with functional magnetic resonance imaging (fMRI) during exposure to negative and neutral pictures and a set of specific panic-related pictures. Results: Subtraction between the conditions indicated activation of the left amygdala region and the right inferior frontal gyrus in PD patients during the specific panic-related condition, whereas the left amygdalar region and left inferior frontal gyrus were activated during the negative condition in controls. Conclusion: These results suggest that in patients with PD, a prominent bottom-up process is involved in specific panic-related conditions, which might be associated with weak modulation of the left frontal area. These data add to our current understanding of the neural correlates of PD and can contribute to future clinical interventions targeting the functional reestablishment of these regions.

The alterations of degree centrality in the frontal lobe of patients with panic disorder

“…The panic-specific pictures will also induce greater activation in the IFG and limbic regions in PD patients [33]. The later study also replicated the findings of IFG in the responses to the panic-related pictures in PD patients [34]. The IFG-related inhibitory control and impacts to the fear network circuitry might be also associated with the panic response [35].…”

Breaking the Fear Barrier: Aberrant Activity of Fear Networks as a Prognostic Biomarker in Patients with Panic Disorder Normalized by Pharmacotherapy

“…Previous studies reported other abnormalities in the fronto-parietal areas of patients with PD relative to HCs, including reduced cortical gyrification [ 24 ], cortical thickness [ 48 ], resting-state FC [ 95 ], degree centrality [ 96 ], and nodal efficiency [ 97 ]. Additionally, task-based fMRI studies have identified aberrant activity in the fronto-parietal pathways of patients with PD during interoceptive [ 98 ], panic-motivated [ 50 , 99 ], or alerting tasks [ 30 ]. Jin, Zhang, Cui, Li, Li, Hu, Wang and Li [ 98 ] found increased activity in the bilateral superior parietal lobule of patients with PD relative to HCs during the heartbeat perception task.…”

“…Furthermore, in PD patients, left superior parietal lobule BOLD activity during the heartbeat perception task was positively correlated with heartbeat perception scores, suggesting the superior parietal lobule’s involvement in perceptive processing, particularly interoceptive awareness relevant to PD [ 98 ]. Lopes, Faria, Dias, Mallmann, Mendes, Horato, de-Melo-Neto, Veras, Magalhães, Malaspina and Nardi [ 50 ] and Kircher, et al [ 100 ] reported increased neural activation in the frontal gyrus of PD patients relative to HCs during panic-motivated tasks, indicating the frontal gyrus’s role in fear acquisition and conditioning. Neufang, Geiger, Homola, Mahr, Schiele, Gehrmann, Schmidt, Gajewska, Nowak and Meisenzahl-Lechner [ 30 ] reported reduced activation in the fronto-parietal pathways, including the middle frontal gyrus and superior parietal lobule, in patients with PD during the attention network task, which involves detecting targets and cues quickly.…”

“…Prior studies have indicated that individuals with PD exhibit varying degrees of depressive and anxiety symptoms, alongside prevalent deficits in social and cognitive capabilities [ 47 , 48 , 49 , 50 ]. These patients tend to adopt diverse coping mechanisms for managing daily life events and often display distinctive personality traits [ 51 , 52 ].…”

“…These patients tend to adopt diverse coping mechanisms for managing daily life events and often display distinctive personality traits [ 51 , 52 ]. Moreover, recent investigations have shown significant associations between emotional symptoms, social and cognitive impairments, personality traits, and corresponding patterns of brain activity in PD patients [ 48 , 49 , 50 ]. To assess anxiety and depressive symptoms in patients with PD, we used the Chinese version of the Hamilton Anxiety Rating Scale (HAMA, Cronbach’s alpha = 0.86) and the 17-item Hamilton Depression Rating Scale (HAMD, Cronbach’s alpha = 0.71), respectively [ 53 , 54 ].…”