Kyriakoulis Peter, Wijaya Clarissa, Quagliato Laiana, Freire Rafael C, Nardi Antonio E
School of Psychology, Faculty of Arts, Health and Design, Swinburne University of Technology, Melbourne, VIC 3122, Australia.
Positive Psychology Centre, Clinical Research, Melbourne, VIC 3166, Australia.
Alpha Psychiatry. 2025 Feb 28;26(1):38756. doi: 10.31083/AP38756. eCollection 2025 Feb.
This review updates our understanding of the neuroanatomical and neurocircuitry factors involved in panic disorder (PD). Many aspects remain undetermined.
Clinical studies and a randomized controlled trial were identified via PubMed database and included in this review.
The search, following PRISMA guidelines, identified 13 human studies and 3 animal studies. Nine human studies compared brain activity and connectivity between regions in PD patients. Neural activity in the amygdala was highlighted in six studies. The hippocampus had higher activation in PD patients compared to those with social phobia, but generally showed less activity compared to healthy controls. The parahippocampal gyrus and thalamus exhibited greater activation in PD patients than healthy controls. Activity in the prefrontal cortices was also noted, particularly the ventromedial prefrontal cortex (vmPFC), ventrolateral prefrontal cortex (vlPFC), dorsomedial prefrontal cortex (dmPFC), and dorsolateral prefrontal cortex (dlPFC). Other regions involved included the dorsal midbrain, left brainstem (showing hyperactivation), S1, and right caudate, which showed increased activity in PD patients. The left intraparietal sulcus (IPS) exhibited hypoactivation in response to predictable cues compared to unpredictable or neutral cues within the default mode network (DMN). Three animal studies suggested that electrical and chemical activation of the dorsal periaqueductal gray (dPAG) in rats elicited fight-or-flight behaviors, providing a model for panic attacks.
Neuroimaging studies suggest several key regions involved in PD pathophysiology, including the brainstem, amygdala, hippocampus, parahippocampal gyrus, thalamus, insula, and prefrontal and cingulate cortices. Hypersensitivity in the brainstem and amygdala plays a role in activating the fear network. Further prospective studies are needed to identify the neuroanatomical sites involved in PD and fear circuitry.
本综述更新了我们对惊恐障碍（PD）所涉及的神经解剖学和神经回路因素的理解。许多方面仍未确定。
通过PubMed数据库识别临床研究和一项随机对照试验，并纳入本综述。
按照PRISMA指南进行检索，确定了13项人体研究和3项动物研究。9项人体研究比较了PD患者各区域之间的脑活动和连接性。6项研究突出了杏仁核中的神经活动。与社交恐惧症患者相比，PD患者海马体的激活程度更高，但与健康对照相比，总体活动较少。与健康对照相比，PD患者海马旁回和丘脑的激活程度更高。前额叶皮质的活动也被注意到，特别是腹内侧前额叶皮质（vmPFC）、腹外侧前额叶皮质（vlPFC）、背内侧前额叶皮质（dmPFC）和背外侧前额叶皮质（dlPFC）。其他涉及的区域包括中脑背侧、左侧脑干（显示激活增强）、初级体感皮层（S1）和右侧尾状核，PD患者这些区域的活动增加。与默认模式网络（DMN）内不可预测或中性线索相比，左侧顶内沟（IPS）对可预测线索的反应表现为激活减弱。3项动物研究表明，大鼠中脑导水管周围灰质背侧（dPAG）的电刺激和化学刺激引发了战斗或逃跑行为，为惊恐发作提供了一个模型。
神经影像学研究表明，PD病理生理学涉及几个关键区域，包括脑干、杏仁核、海马体、海马旁回、丘脑、脑岛以及前额叶和扣带回皮质。脑干和杏仁核的高敏性在激活恐惧网络中起作用。需要进一步的前瞻性研究来确定PD和恐惧回路中涉及的神经解剖部位。
