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