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Research Paper

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder

Katharina Feldker, Carina Yvonne Heitmann, Paula Neumeister, Leonie Brinkmann, Maximillan Bruchmann, Pienie Zwitserlood and Thomas Straube
J Psychiatry Neurosci January 01, 2018 43 (1) 26-36; DOI: https://doi.org/10.1503/jpn.160226
Katharina Feldker
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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  • For correspondence: [email protected]
Carina Yvonne Heitmann
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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Paula Neumeister
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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Leonie Brinkmann
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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Maximillan Bruchmann
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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Pienie Zwitserlood
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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Thomas Straube
From the Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany (Feldker, Heitmann, Neumeister, Brinkmann, Bruchmann, Straube); and the Institute for Psychology, University of Muenster, Muenster, Germany (Zwitserlood).
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  • Fig. 1
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    Fig. 1

    Schematic overview of a trial in the concurrent but distinct target–distractor task.

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    Fig. 2

    Mean postscanning scene ratings for valence, arousal and anxiety (disorder-related – neutral) for patients with panic disorder and healthy controls. Ratings were given on 9-point Likert scales as follows: valence, 1 = negative, 5 = neutral, 9 = positive; arousal, 1 = calm, 9 = intense; anxiety, 1 = low, 9 = high.

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    Fig. 3

    Differential brain activation for disorder-related compared with neutral distractor scenes in patients with panic disorder versus healthy controls in a priori–defined regions of interest (panic disorder > control, panic-related > neutral, all p < 0.005, uncorrected; p < 0.05, corrected; only selected effects are shown). ACC = anterior cingulate cortex; L = left; MCC = midcingulate cortex; R = right.

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    Fig. 4

    Correlation of panic disorder parameter estimates in the left insula (panic-related > neutral) and fear of cardiovascular symptoms as well as correlation of panic disorder parameter estimates in the brainstem (panic-related > neutral) and fear of respiratory symptoms. L = left.

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    Table 1

    Demographic and clinical characterization of patients with panic disorder and healthy controls

    CharacteristicGroup; mean ± SD*Statisticp value
    Panic disorderControl
    Sex, female:male20:619:7χ2 = 0.1030.75
    Age, (range) yr24.88 ± 6.12 (18–46)24.46 ± 2.79 (19–32)t = −0.3210.75
    Education, yr12.46 ± 0.9912.52 ± 1.05t = 0.2050.84
    Diagnosis, no.————
     Panic disorder13NA——
     Panic disorder with agoraphobia13NA——
    PAS score20.46 ± 7.05NA——
    ASI score
     Total45.92 ± 2.8810.12 ± 1.67t = −10.76< 0.001
     Cardiovascular symptoms9.58 ± 0.981.5 ± 0.40t = −7.63< 0.001
     Respiratory symptoms14.23 ± 1.252.69 ± 0.60t = −8.31< 0.001
     Publicly observable symptoms11.92 ± 1.034.65 ± 0.56t = −6.20< 0.001
     Loss of control10.19 ± 0.901.27 ± 0.39t = −9.10< 0.001
    BDI score14.23 ± 8.940.92± 2.08t = −7.39< 0.001
    Comorbidities, no.
     Mild depressive episode3———
     Generalized anxiety disorder4———
     Somatization disorder and hypochondria1———
     Social or specific phobia2———
     Bulimia nervosa1———
     OCD1———
    • ASI = Anxiety Sensitivity Scale; BDI = Beck Depression Inventory; NA = not applicable; OCD = obsessive–compulsive disorder; PAS = Panic and Agoraphobia Scale; SD = standard deviation.

    • ↵* Unless indicated otherwise.

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    Table 2

    Significant hyperactivations for disorder-related versus neutral scenes across all patients relative to healthy controls revealed by small volume–corrected analysis (p ≤ 0.05, corrected)

    RegionLateralizationTalairach coordinates of peak voxel (x, y, z)t maximumt averagek
    AmygdalaL−17, −7, −83.493.19617
    AmygdalaR23, 3, −143.2843.05915
    InsulaL−31, −1, 184.1663.31345
    InsulaL−45, 8, −84.3653.29884
    BrainstemL−3, −35, −84.3113.444134
    BrainstemL−7, −33, −284.0793.43137
    Thalamus, lat partL−15, −19, 64.5483.43341
    Anterior cingulate cortexL−3, 19, 343.9263.31421
    Anterior cingulate cortexL−3, 37, 163.4153.10822
    Midcingulate cortexL/R−1, −1, 303.8683.282100
    Midcingulate cortexL/R−5, 19, 384.263.41260
    • L = left; R = right.

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    Table 3

    Significant hyperactivations for disorder-related versus neutral scenes across all patients relative to healthy controls revealed by whole-brain analysis in 2 clusters (p ≤ 0.05, corrected)*

    RegionLateralizationTalairach coordinates of peak voxel (x, y, z)F maximumF averagek
    Cluster 1L/R1, −39, −24.383.40504
    CulmenR1, −39, −24.383.40378
    Posterior cingulate cortexR17, −43, 84.203.4868
    Brainstem/culmenL−10, −30, −74.033.3719
    Posterior cingulate cortexR24, −54, 103.553.1639
    Cluster 2L−47, 8, −34.513.28399
    Superior temporal gyrusL−47, 8, −34.513.26185
    InsulaL−38, −1, −74.113.3476
    Precentral gyrusL−61, 5, 134.013.2469
    Temporal lobeL−35, −8, −133.883.3630
    Inferior frontal gyrusL−48, 3, 173.743.2539
    • L = left ; R = right.

    • ↵* The watershed algorithm of Neuroelf (v0.9c; http://neuroelf.net/; i.e., the splitclustercoords function) was used to assess local maxima of clusters.

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Journal of Psychiatry and Neuroscience: 43 (1)
J Psychiatry Neurosci
Vol. 43, Issue 1
1 Jan 2018
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Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder
Katharina Feldker, Carina Yvonne Heitmann, Paula Neumeister, Leonie Brinkmann, Maximillan Bruchmann, Pienie Zwitserlood, Thomas Straube
J Psychiatry Neurosci Jan 2018, 43 (1) 26-36; DOI: 10.1503/jpn.160226

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Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder
Katharina Feldker, Carina Yvonne Heitmann, Paula Neumeister, Leonie Brinkmann, Maximillan Bruchmann, Pienie Zwitserlood, Thomas Straube
J Psychiatry Neurosci Jan 2018, 43 (1) 26-36; DOI: 10.1503/jpn.160226
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