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Revise the revised? New dimensions of the neuroanatomical hypothesis of panic disorder

  • Biological Psychiatry - Review article
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Abstract

In 2000, Gorman et al. published a widely acknowledged revised version of their 1989 neuroanatomical hypothesis of panic disorder (PD). Herein, a ‘fear network’ was suggested to mediate fear- and anxiety-related responses: panic attacks result from a dysfunctional coordination of ‘upstream’ (cortical) and ‘downstream’ (brainstem) sensory information leading to heightened amygdala activity with subsequent behavioral, autonomic and neuroendocrine activation. Given the emergence of novel imaging methods such as fMRI and the publication of numerous neuroimaging studies regarding PD since 2000, a comprehensive literature search was performed regarding structural (CT, MRI), metabolic (PET, SPECT, MRS) and functional (fMRI, NIRS, EEG) studies on PD, which will be reviewed and critically discussed in relation to the neuroanatomical hypothesis of PD. Recent findings support structural and functional alterations in limbic and cortical structures in PD. Novel insights regarding structural volume increase or reduction, hyper- or hypoactivity, laterality and task-specificity of neural activation patterns emerged. The assumption of a generally hyperactive amygdala in PD seems to apply more to state than trait characteristics of PD, and involvement of further areas in the fear circuit, such as anterior cingulate and insula, is suggested. Furthermore, genetic risk variants have been proposed to partly drive fear network activity. Thus, the present state of knowledge generally supports limbic and cortical prefrontal involvement as originally proposed in the neuroanatomical hypothesis. Some modifications might be suggested regarding a potential extension of the fear circuit, genetic factors shaping neural network activity and neuroanatomically informed clinical subtypes of PD potentially guiding future treatment decisions.

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Notes

  1. As this study—apart from abstract and figures—is only available in Chinese, methodology could not be sufficiently assessed. Therefore, it is not presented in the tables, but is mentioned for completeness.

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Acknowledgments

The present work has been supported by the Deutsche Forschungsgemeinschaft [SFB-TRR-58, projects C2 (K.D., J.D.), C4 (A.J.F., A.C.E., J.D., M.H., T.D., A.G., S.V.T.) and Z2 (J.D.)].

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  1. Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr. 14, 72076, Tübingen, Germany

    Thomas Dresler, Ann-Christine Ehlis & Andreas J. Fallgatter

  2. Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Würzburg, Germany

    Thomas Dresler, Anne Guhn, Sara V. Tupak, Martin J. Herrmann, Jürgen Deckert & Katharina Domschke

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  1. Thomas Dresler
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Dresler, T., Guhn, A., Tupak, S.V. et al. Revise the revised? New dimensions of the neuroanatomical hypothesis of panic disorder. J Neural Transm 120, 3–29 (2013). https://doi.org/10.1007/s00702-012-0811-1

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