Brain correlates of an unexpected panic attack: a human positron emission tomographic study.

Previous brain imaging studies on symptom provocation in panic anxiety have used either drug-infusions or sensory related stimulation to induce panic attacks. We here report positron emission tomographic measurements of regional cerebral blood flow (rCBF) during an unexpected panic attack in a healthy female volunteer participating in a fear conditioning study. During a first but not a second run with electric shock presentations the woman unexpectedly experienced a panic attack that fulfilled the DSM-IV criteria. Panic was associated with decreased rCBF in the right orbitofrontal (Brodmann area 11), prelimbic (area 25), anterior cingulate (area 32) and anterior temporal cortices (area 15). These findings suggest that neural activity in brain regions previously associated with symptom provocation in specific phobics and subjects with posttraumatic stress disorder also are involved during panic in healthy individuals.