Institute of Medical Psychology and Systems Neuroscience, University of Muenster,Von-Esmarch-Str. 52, Muenster,Germany.
Department of Psychiatry, Psychosomatics and Psychotherapy,Center of Mental Health, University Hospital Wuerzburg,Margarete-Hoeppel-Platz 1, Wuerzburg,Germany.
Psychol Med. 2017 Nov;47(15):2675-2688. doi: 10.1017/S0033291717001192. Epub 2017 May 9.
Panic disorder (PD) patients are constantly concerned about future panic attacks and exhibit general hypersensitivity to unpredictable threat. We aimed to reveal phasic and sustained brain responses and functional connectivity of the amygdala and the bed nucleus of the stria terminalis (BNST) during threat anticipation in PD.
Using functional magnetic resonance imaging (fMRI), we investigated 17 PD patients and 19 healthy controls (HC) during anticipation of temporally unpredictable aversive and neutral sounds. We used a phasic and sustained analysis model to disentangle temporally dissociable brain activations.
PD patients compared with HC showed phasic amygdala and sustained BNST responses during anticipation of aversive v. neutral stimuli. Furthermore, increased phasic activation was observed in anterior cingulate cortex (ACC), insula and prefrontal cortex (PFC). Insula and PFC also showed sustained activation. Functional connectivity analyses revealed partly distinct phasic and sustained networks.
We demonstrate a role for the BNST during unpredictable threat anticipation in PD and provide first evidence for dissociation between phasic amygdala and sustained BNST activation and their functional connectivity. In line with a hypersensitivity to uncertainty in PD, our results suggest time-dependent involvement of brain regions related to fear and anxiety.
惊恐障碍（PD）患者一直担心未来的惊恐发作，并对不可预测的威胁表现出普遍的过度敏感。我们旨在揭示 PD 患者在威胁预期期间杏仁核和终纹床核（BNST）的相位和持续脑反应和功能连接。
使用功能磁共振成像（fMRI），我们在预期时间不可预测的厌恶和中性声音期间研究了 17 名 PD 患者和 19 名健康对照（HC）。我们使用了一个相位和持续分析模型来分离时间上可分离的大脑激活。
与 HC 相比，PD 患者在预期厌恶刺激与中性刺激时表现出相位杏仁核和持续 BNST 反应。此外，在前扣带皮层（ACC）、岛叶和前额叶皮层（PFC）中观察到了相位激活增加。岛叶和 PFC 也表现出持续的激活。功能连接分析显示出部分不同的相位和持续网络。
我们证明了 BNST 在 PD 中不可预测的威胁预期期间的作用，并提供了相位杏仁核和持续 BNST 激活及其功能连接分离的初步证据。与 PD 中对不确定性的过度敏感一致，我们的结果表明与恐惧和焦虑相关的大脑区域的时间依赖性参与。
