Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
J Affect Disord. 2021 Mar 1;282:906-914. doi: 10.1016/j.jad.2020.12.085. Epub 2020 Dec 27.
Panic Disorder (PD) is mainly characterized by recurrent unexpected panic attacks. Although the presence of emotional functioning deficits in PD is well established, their neuronal bases are still less known. Therefore, in this review, we aim to summarize the available functional Magnetic Resonance Imaging (fMRI) studies investigating the neural correlates associated with the processing of facial emotional expressions in patients with PD.
A comprehensive search on PubMed was performed and 10 fMRI studies meeting our inclusion criteria were included in this review.
The majority of the studies reported selective deficits in key brain regions within the prefronto-limbic network in PD patients. Specifically, a mixed picture of hyperactivation and hypoactivation patterns were observed in limbic regions, including the amygdala and the anterior cingulate cortex (ACC), as well as in areas within the prefrontal cortex (PFC), either during negative or positive valenced stimuli, as compared to healthy controls (HC) or other anxiety disorders.
The limited number of studies and the clinical and methodological heterogeneity make it difficult to draw definite conclusions on the neural mechanism of emotional processing associated with PD.
Although the results of the available evidence suggest the presence of selective dysfunctions in regions within the cortico-limbic network in PD patients during processing of emotional stimuli, the direction of these abnormalities is still unclear. Therefore, future larger and more homogeneous studies are needed to elucidate the neural mechanisms underpinning the emotional processing dysfunctions often observed in PD patients.
惊恐障碍（PD）的主要特征是反复出现的意外惊恐发作。尽管 PD 患者存在情绪功能缺陷已经得到充分证实，但它们的神经基础仍知之甚少。因此，在这篇综述中，我们旨在总结目前已有的功能磁共振成像（fMRI）研究，这些研究探讨了与 PD 患者面部情绪表达处理相关的神经关联。
我们在 PubMed 上进行了全面检索，并纳入了 10 项符合我们纳入标准的 fMRI 研究。
大多数研究报告 PD 患者在prefronto-limbic 网络中的关键脑区存在选择性缺陷。具体来说，与健康对照组（HC）或其他焦虑障碍相比，PD 患者在处理负性或正性效价刺激时，在边缘区域（包括杏仁核和前扣带回皮质（ACC））以及前额叶皮层（PFC）内的区域，观察到混合的过度激活和低激活模式。
研究数量有限，临床和方法学的异质性使得很难对与 PD 相关的情绪处理的神经机制得出明确的结论。
尽管现有证据的结果表明 PD 患者在处理情绪刺激时，皮质边缘网络内的区域存在选择性功能障碍，但这些异常的方向仍不清楚。因此，需要进行更大、更同质的研究来阐明 PD 患者中经常观察到的情绪处理功能障碍的神经机制。
