Pattyn T, Schmaal L, Van Den Eede F, Cassiers L, Penninx B W, Sabbe Bcg, Veltman D J
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; Department of Psychiatry, UPC KU Leuven, Belgium.
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
J Affect Disord. 2021 May 15;287:427-432. doi: 10.1016/j.jad.2021.03.069. Epub 2021 Mar 31.
Inconsistent findings regarding the pathophysiology of panic disorder (PD) could result from clinical heterogeneity. Identifying subtypes could enhance insights into the neurobiological substrates of PD.
An emotional faces fMRI paradigm was used in a group of PD patients (n = 73) and healthy controls (n = 58). The overall PD group was further divided into three previously identified subtypes: a cognitive-autonomic (n = 22), an autonomic (n = 16) and an aspecific (n = 35) subtype. Differences in brain activity levels in response to emotional facial expressions between groups were examined for six regions of interests, namely the amygdala, ventromedial prefrontal cortex, anterior cingulate, fusiform gyrus, lingual gyrus and insula.
PD patients showed lower activity in the rostral anterior cingulate in response to angry faces than healthy controls, which was mainly driven by the autonomic subtype. No significant differences were found in other brain regions when comparing PD patients with controls or when comparing across PD subtypes.
Sample sizes in subgroups were relatively small CONCLUSIONS: The role of the rostral anterior cingulate cortex for emotional processes critical in panic disorder is highlighted by this study and provides, albeit preliminary, evidence for the use of a subtype approach to advance our neurobiological insights in PD considering its involvement in the appraisal of autonomic viscero-sensory symptoms.
惊恐障碍（PD）病理生理学研究结果不一致可能是由临床异质性导致的。识别亚型有助于深入了解PD的神经生物学基础。
对一组惊恐障碍患者（n = 73）和健康对照者（n = 58）采用情绪面孔功能磁共振成像范式。将整个惊恐障碍组进一步分为先前确定的三个亚型：认知自主型（n = 22）、自主型（n = 16）和非特异性型（n = 35）。在六个感兴趣区域，即杏仁核、腹内侧前额叶皮质、前扣带回、梭状回、舌回和脑岛，检查各组对情绪面部表情反应的脑活动水平差异。
与健康对照者相比，惊恐障碍患者在面对愤怒面孔时，喙部前扣带回的活动较低，这主要由自主型亚型驱动。在将惊恐障碍患者与对照组进行比较或在各惊恐障碍亚型之间进行比较时，未发现其他脑区有显著差异。
亚组样本量相对较小。
本研究强调了喙部前扣带回皮质在惊恐障碍中对关键情绪过程的作用，尽管是初步的，但考虑到其参与自主内脏感觉症状的评估，为采用亚型方法推进我们对惊恐障碍的神经生物学认识提供了证据。
