Background

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.

Methods

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.

Results

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.

Limitations

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.

中文翻译：

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恐慌症及其亚型的情绪处理：使用情绪面孔的 fMRI 研究

背景

临床异质性可能导致恐慌症 (PD) 病理生理学的不一致结果。识别亚型可以增强对 PD 神经生物学底物的了解。

方法

在一组 PD 患者 (n=73) 和健康对照 (n=58) 中使用了情绪面孔 fMRI 范式。整个 PD 组进一步分为三个先前确定的亚型：认知自主（n = 22）、自主（n = 16）和非特异性（n = 35）亚型。针对六个感兴趣的区域，即杏仁核、腹内侧前额叶皮层、前扣带回、梭状回、舌回和岛叶，检查了组之间对情绪面部表情反应的大脑活动水平的差异。

结果

与健康对照组相比，PD 患者在面对愤怒的面孔时，其喙前扣带回的活动较低，这主要是由自主神经亚型驱动的。将 PD 患者与对照组进行比较或在 PD 亚型之间进行比较时，在其他大脑区域中没有发现显着差异。

限制

亚组的样本量相对较小

结论

这项研究强调了前扣带皮层在恐慌症中关键的情绪过程中的作用，并提供了使用亚型方法来推进我们对 PD 的神经生物学见解的证据，尽管它参与了自主内脏的评估-感觉症状。