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Table 5 Chemical neuroimaging findings in panic disorder [magnetic resonance spectroscopy]

From: The role of the amygdala in the pathophysiology of panic disorder: evidence from neuroimaging studies

Study Subjects No. of subjects (female) Mean age (SD) Clinical state Comorbid Depression Comorbid Agora-phobia Medication status Field strength (Tesla) Imaging method Study paradigm Amygdala Hippocampus Ventromedial Prefrontal cortex Other brain regions
Induced Panic Attack
Friedman, 2006 [29] PD 9 (4) 42.7 (15.3) API 7.39 (7.19) Anxiety ratings 1.56 (1.33) Panic ratings 2.33 (1.94) None   Fluoxetine, n = 8; Gabapentin, n = 1 1.5 31P-MRS Regulated hyperventilation     Blunted pH response in PD
HC 11 (8) 31.5 (9.6) API 1.63 (2.06) Anxiety ratings 0.09 (0.30) Panic ratings 0 (0)    
Layton, 2001 [30] PD 6 (3)   API 20.3 (5.2) Panic severity 6.7 (2.4) Anxiety severity 2.8 (1.5)     1.5 PEPSI Panic induced by initial intravenous sodium lactate infusion/second infusion with gabapentin responders, n = 4; placebo responders, n = 2     No significant difference in Lactate/NAA levels between conditions (although gabapentin reduced clinical response to infusion)
Dager, 1999 [31] PD 15 (8) 33.1 (11.7) API 8.9 (8.2) Panic Severity 2.4 (3.0) Anxiety Severity 2.1 (1.3) None   Free for 1 month 1.5 PEPSI Panic induced by intravenous sodium lactate infusion (Panickers, n = 12)     Panickers: Earlier global Lactate/NAA▲
HC 10 (6) 32.7 (7.4) API 1.5 (1.8) Panic Severity 0.2 (0.4) Anxiety Severity 0.5 (0.9)    
Dager, 1997 [32] PD 13 (8) 36.2 (9.1) API 25.7 (9.7) Panic Severity 8.0 (1.9) None   Free for 1 month 1.5 1 H-MRS Panic induced by intravenous sodium lactate infusion (Panickers, n = 10)     PD patients: Insular cortex Lactate/NAA▲
HC 10 (6) 37.7 (7.5) API 4.5 (2.5)    
Dager, 1994 [33] PD 8 (4) 38.6 (7.2)   None   Fluoxetine, n = 3; Fluoxetine + alprazolam, n = 1; Imipramine, n = 1 1.5 1 H-MRS Panic induced by intravenous sodium lactate infusion
(Panickers, n = 3)
    Panickers: Insular cortex Lactate/NAA▲
HC 8 (2) 36.0 (6.8)    
Others
Trzesniak, 2010 [34] PD 25 (19) 39.2 (9.9)   History, n = 13 Current, n = 10 SSRI, n = 8 Clorimipramine, n = 2 BZD, n = 3 BZD + SSRI, n = 3 1.5 1 H-MRS -   Left hippocampus NAA/Cr   
HC       
Hasler, 2009 [35] PD 17 (12) 34.2 (10.1) PD onset 22 (8.9) yrs PD duration 21 (31) mts PDSS 7.5 (3.0); PSS 18 (5.4) HAM-A 9.6 (6.2) HAM-D 9.6 (7.4) Current MDD, n = 7 Current, n = 7 Medication naive, n = 9; Free for 3 months, n = 8 3.0 1 H-MRS -    No significant difference GABA, Glx, CHO, NAA No significant difference in DM/DALPFC GABA, Glx, CHO, NAA
HC 17 (12) 35.1 (11.8)     
Maddock, 2009 [36] PD 15 (10) 37.5 (9.2) STAI-S 41.3 (10.6) API 2.1 (2.7) PAS 22.7 (10.5) ASI 36.9 (14) Past MDD, n = 1 Current, n = 14 Untreated, n = 15 1.5 1 H-MRS Vigilance task with visual stimuli     Visual cortex Lactate/NAA▲
HC 15 (10) 37.1 (6.9) STAI-S 25.4 (9.8) API 0.3 (1.0)    
Ham, 2007 [37] PD 24 (10) 31.9 (6.8) PDSS 9.5 (6.4) HAM-D 4.7 (5.0) Not current   Combination of antidepressants and anxiolytics 3.0 1 H-MRS     GABA Lactate▲ Cho▲ Basal ganglia GABA
HC 24 (10) 30.5 (5.2) HAM-D 5.2 (4.1)    
Goddard, 2004 [38] PD 10 (5) 36 (11)   None With/Without Medication naive, n = 5; Free for 3 months, n = 2; BDZ until 1 week before, n = 3 2.1 1 H-MRS Acute oral, open-label BDZ (clonazepam) administration     Occipital cortex GABA
HC 10 (5) 31.5 (9.6)     
Massana, 2002 [39] PD 11 (6) 34.27 (6.92)   None All with some degree All were antidepressant-naive and medication-free for 2 weeks 1.5 1 H-MRS -    No significant difference in medial frontal cortex Right medial temporal lobe Cr + PCr ;
  HC 11 (6) 34.55 (6.95)            
Goddard, 2001 [40] PD 14 (8) 37 (10) PDSS 13 (4), n = 13HAM-A 17 (8) 25-item HAM-D 20 (10) 17-item HAM-D 14 (6)CRAS 31 (16) None With/Without Medication naive, n = 9; Free for 3 months, n = 2; BDZ until 1 week before, n = 3 2.1 1 H-MRS -     Occipital cortex GABA , significant in Female Panickers
HC 14 (8) 31.5 (9.6)     
Shioiri, 1996 [41] PD 18 (10) 35.9 (9.1) HAM-A 9.8 (6.3) None   All on BDZ 1.5 31P-MRS -     Frontal lobe slight Pi ; Frontal lobe PCr L > R asymmetry
HC 18 (10) 35.3 (11.4)     
  1. Abbreviations: API, Acute Panic Inventory; ASI, Anxiety Sensitivity Index; BDZ, benzodiazepine; Cho, choline; Cr, creatine; CRAS, Clinician-Rated Anxiety Scale; DM/DALPFC, dorsomedial/dorsal anteromedial prefrontal cortex; GABA, gamma-aminobutyric acid; Glx, glutamte + glutamine; HAM-A, Hamilton Anxiety Rating Scale; HAM-D, Hamilton Depression Rating Scale; HC, healthy control; NAA, N-acetyl aspartate; PAS, Panic and Agoraphobia Scale; PCr, phosphocreatine; PD, panic disorder; PDSS, Panic Disorder Severity scale; PEPSI, proton echo-planar spectroscopic imaging; Pi, inorganic phosphate; SD, standard deviation; SSRI, selective serotonin reuptake inhibitor; STAI-S, State Trait Anxiety Index-State version.