Differential activity of subgenual cingulate and brainstem in panic disorder and PTSD
Research highlights
▶ Panic disorder (PD) and posttraumatic stress disorder (PTSD) share similar symptoms and both are thought of disorders of fear learning. ▶ Directly comparing neural correlates of fear learning of both disorders. ▶ PD patients show abnormal (inverse) activity in key fear regions. ▶ PTSD patients lack habituation in key fear regions.
Section snippets
Participants
Participants were 8 subjects meeting DSM-IV criteria for PD (mean age = 37 years, range = 24–50); 8 subjects meeting DSM-IV criteria for PTSD (mean age = 42 years, range = 37–50); and 8 healthy comparison subjects (mean age = 35 years, range = 24–49). PTSD and comparison subjects were a matched subset of larger groups. Each group consisted of 4 female and 4 male right-handed subjects. Among the patients, there were current secondary diagnoses of generalized anxiety disorder, social phobia, specific phobia,
Results
During debriefing all subjects indicated that they had expected to receive an electrodermal stimulation during the presentation of the Threat stimulus and that this expectation was associated with the feeling of fear which decreased with repeated presentations over time.
In healthy control subjects significant activation was exhibited in the contrast of Threat versus Safety in bilateral anterior insula, bilateral basal ganglia and thalamus, bilateral dorsal anterior cingulate and bilateral
Discussion
Using cognitively instructed fear, this study demonstrates significantly less activation to threat cues and increased activity to safety cues in the subgenual cingulate, ventral striatum, extended amygdala and midbrain periaquaeductal grey in PD patients, suggesting abnormal reactivity in these regions for fear expression. PTSD subjects, in comparison, failed to show the temporal pattern of activity decrease found in control subjects.
Considering the role of these regions in the regulation of
Conclusion
These findings contribute to the growing literature examining the potentially unique neurocircuitry subserving distinct anxiety disorders. Key findings in the present study may suggest a heightened sensitivity to internally generated, viscerosomatic threat in PD versus heightened sensitivity to external threat in PTSD, as well as to impaired discrimination learning in PD versus impaired extinction learning in PTSD on the behavioral level. Neuroimaging studies contributing to the
Acknowledgement
Funding for this study was provided by the NIMH Grant P50 MH58911-S1.
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Both authors contributed equally to this work.