Neuroimaging findings related to panic disorder: A brief review

Year 2022, , 406 - 415, 26.12.2022

Dilara Kazancı Seren Saltoğlu Emel Erdoğdu

https://doi.org/10.5455/kpd.26024438m000082

Abstract

Panik bozukluk (PB), hastaların yaşam kalitesini olumsuz etkileyen, beklenmedik ve tekrarlayan panik ataklar ve kontrolü kaybetme kaygısıyla tanımlanmaktadır. Nörogörüntüleme teknikleri, beyinde panik bozuklukla ilişkili yapısal ve fonksiyonel değişimlerin altını çizerek PB ile ilgili mekanizmaların anlaşılmasında önemli araçlar haline gelmiştir. Güncel araştırmalar PB hastaları ve sağlıklı kontroller arasındaki önemli nöral farklılıkları MRI, PET, SPECT ve EEG gibi yöntemlerle aydınlatmaktadır. Ancak PB patolojisini çok boyutlu olarak anlayabilmek için gerçekleştirilen araştırmalardan elde edilen sonuçların tartışılmasına ihtiyaç vardır. Olası hedef bölgelerin tanımlanması ileride daha etkili tedavi ve müdahale stratejilerinin geliştirilmesine olanak verecektir. Bu makalede PB ile ilişkili nörogörüntüleme bulguları derlenmiştir. Alanyazın taramasına 2012 ve 2021 yılları arasında yayınlanmış ve 18 yaşından büyük katılımcıların yer aldığı PB ile ilişkili nörogörüntüleme çalışmalarının bulguları dahil edilmiştir. Araştırma PubMed, Web of Science ve PsycINFO’da nörogörüntüleme teknikleri için anahtar kelimeler (örn., fMRI, PET, EEG, fNIRS) ve “panik”, “anksiyete” ve "panik bozukluk” gibi PB ile ilişkili anahtar kelimelerin taranmasıyla gerçekleşmiştir. Komorbid durumları olan hastaları içeren (örn., depresyon ve panik bozukluk tanısı olan), 18 yaşından küçük ergen ve çocuklarla yapılmış, 2012 yılından öncesine ait çalışmalar araştırmaya dahil edilmemiştir. Derlemede toplamda içleme kriterlerini karşılayan 20 çalışmaya yer verilmiştir. Birçok çalışma, hipokampal ve talamik bölgeler, frontal, oksipital, temporal lop, amigdala, anterior singulat korteks ve insula ile ilişkili bölgelere işaret ettiği gibi, PB hastalarında ‘korku ağı modeli’ olarak sunulması önerilen beyin bölgelerinde anlamlı yapısal ve fonksiyonel değişikliklere işaret eden çalışmalar da bulunmaktadır. Sonuç olarak çalışmalardan elde edilen bulgular, çeşitli tedavilerin, hastaların yaşam kalitesini anlamlı ölçüde yükseltecek şekilde PB'den etkilenen bölgelerde faydalı olduğunu göstermiştir.

Keywords

panic disorder, neuroimaging, fMRI, PET, EEG, fNIRS, anxiety, panik bozukluk, nörogörüntüleme, anksiyete

Neuroimaging findings related to panic disorder: A brief review

Abstract

Panic disorder (PD) is defined by recurrent unanticipated panic attacks and anxiety of losing control, which negatively affects the patients’ quality of life. Various neuroimaging techniques allow to assess brain structure or function and therefore represent important tools to understand the mechanisms related to PD pathology. Current studies have highlighted neural differences between PD patients and healthy controls using MRI, PET, SPECT, or EEG. However, there is an urgent need to discuss findings from various investigations simultaneously in order to obtain a multidimensional understanding of PD pathology, which further allows identifying possible target regions for more effective treatment or prevention strategies. Therefore, the present work briefly reviewed PD related neuroimaging studies published between 2012 and 2021. Relevant articles were searched using a combination of keywords relevant to various neuroimaging techniques (e.g., MRI, MRS, PET, EEG, fNIRS) and to PD (e.g., panic, anxiety, panic disorder). Studies involving patients with comorbid conditions other than agoraphobia and participants aged under 18 were excluded. A total of 20 studies fulfilling inclusion criteria were considered in this review. Most of the reviewed studies point to structural and functional neural changes in regions of the proposed fear network mostly including the hippocampi, thalamic nuclei, amygdala, anterior cingulate corti, insulae and other frontal lobe regions. Such neural changes in PD are thought to result in a hypersensitive fear network affecting normal emotional processing. Finally, studies showed that different treatments can partly reverse these changes, which significantly improves the quality of life in PD patients.

Keywords

panic disorder, neuroimaging, fMRI, PET, EEG, fNIRS, anxie-ty, panik bozukluk, nörogörüntüleme, anksiyete

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