Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T15:35:33.547Z Has data issue: false hasContentIssue false
  • English
  • Français

The contribution of brain imaging to the study of panic disorder

Published online by Cambridge University Press:  11 October 2011

Umberto Volpe ,
Eleonora Merlotti ,
Armida Mucci  and
Silvana Galderisi
Umberto Volpe*
Affiliation:
Diparlimento di Psichiatria, Università di Napoli SUN, Napoli
Eleonora Merlotti
Affiliation:
Diparlimento di Psichiatria, Università di Napoli SUN, Napoli
Armida Mucci
Affiliation:
Diparlimento di Psichiatria, Università di Napoli SUN, Napoli
Silvana Galderisi
Affiliation:
Diparlimento di Psichiatria, Università di Napoli SUN, Napoli
*
Address for correspondence: Dr. U. Volpe. Dipartimento di Psichiatria. Università di Napoli – SUN. Largo Madonna delle Grazie. 80138 Napoli (Italy). Fax: +39-081-566.6523 E-mail: umberto.volpe@unina2.it
Get access Rights & Permissions [Opens in a new window]

Summary

Aims — The present review is aimed to evaluate the recent contribution of brain imaging techniques to the definition of neuroanatomofunctional models of panic disorder (PD). Methods — Structural and functional brain imaging studies of PD, conducted from January 1993 to October 2003 and selected through a comprehensive Medline search (key-words: panic disorder, emotions, brain imaging, EEG, Event-Related Potentials, MRI, fMRI, PET, SPECT, TC) were included in the review. The Medline search has been complemented by bibliographic cross-referencing. Results — The majority of the reviewed studies suggests that a dysfunction of a neural circuit encompassing prefrontal and temporo-Iimbic cortices is present in PD. A right hemisphere preferential involvement in PD has been shown by several studies. Conclusions — Reviewed neuroimaging studies suggest a dysfunction of frontal and temporo-Iimbic circuitries in PD. However, those studies cannot be considered conclusive because of several methodological limitations. Longitudinal and multi-modal studies involving larger patient samples, possibly integrated with population-based and genetic studies, would provide more insight into pathophysiological mechanisms of PD.

Declaration of Interest: Authors declare that none of them had any known real, potential, or apparent conflict of interest and that there was no business or personal interest that might be relevant to the topic of this article.

Keywords

panic disorderemotionsbrain imagingEEGEvent-Related PotentialsMRIfMRIPETSPECTTC
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 13 , Issue 4 , December 2004 , pp. 237 - 248
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografia

Abraham, H.D. & Duffy, F.H. (1991). Computed EEG abnormalities in panic disorder with and without premorbid drug abuse. Biological Psychiatry 29. 687–690.CrossRefGoogle ScholarPubMed
Akiyoshi, J., Hieda, K., Aoki, Y. & Nagayama, H. (2003). Frontal brain hypoactivity as a biological substrate of anxiety in patients with panic disorders. Neuropsychobiologv 47. 165–170.CrossRefGoogle ScholarPubMed
Alemayehu, S., Bergey, G.K., Barry, E., Krumholz, A., Wolf, A., Fleming, C.P. & Frear, E.J. Jr. (1995). Panic attacks as ictal manifestations of parietal lobe seizures. Epilepsia 36. 824–830.CrossRefGoogle ScholarPubMed
Benkelfat, C., Bradwejn, J., Meyer, E., Ellenbogen, M., Milot, S., Gjedde, A. & Evans, A. (1995). Functional neuroanatomy of CCK4-induced anxiety in normal healthy volunteers. American Journal ofPsvchiatry 152, 1180–1184.Google ScholarPubMed
Bisaga, A., Katz, J.L., Antonini, A., Wright, C.E., Margouleff, C.Gorman, J.M. & Eidelberg, D. (1998). Cerebral glucose metabolism in women with panic disorder. American Journal of Psychiatry 155. 1178–1183.CrossRefGoogle ScholarPubMed
Blair, R.J., Morris, J.S., Frith, C.D., Perrett, D.I. & Dolan, R.J. (1999). Dissociable neural responses to facial expressions of sadness and anger. Brain 122. 883–893.CrossRefGoogle ScholarPubMed
Boshuisen, M.L., Ter, Horst G.J., Paans, A.M., Reinders, A.A. & den Boer, J.A. (2002). rCBF differences between panic disorder patients and control subjects during anticipatory anxiety and rest. Biological Psychiatry 52. 126–135.CrossRefGoogle ScholarPubMed
Bremner, J.D., Innis, R.B., White, T., Fujita, M., Silbersweig, D., Goddard, A.W., Staib, L., Stern, E., Cappiello, A., Woods, S., Baldwin, R. & Charney, D.S. (2000). SPECT [I-123]iomazenil measurement of the bcnzodiazepine receptor in panic disorder. Biological Psychiatry 47. 96–106.CrossRefGoogle ScholarPubMed
Brenes, G.A. (2003). Anxiety and chronic obstructive pulmonary disease: prevalence, impact, and treatment. Psychosomatic Medicine 65. 963–970.CrossRefGoogle ScholarPubMed
Bystritsky, A., Pontillo, D., Powers, M., Sabb, F.W., Craske, M.G. & Bookheimer, S.Y. (2001). Functional MRI changes during panic anticipation and imagery exposure. Neuroreporl 12. 3953–3957.CrossRefGoogle ScholarPubMed
Capwell, R.R. & Carter, R. (1991). Organic anxiety syndrome secondary to metastatic brain tumor. Psychosomatics 32. 231–233.CrossRefGoogle ScholarPubMed
Clark, C.R., McFarlane, A.C., Weber, D.L. & Battersby, M. (1996). Enlarged frontal P300 to stimulus change in panic disorder. Biological Psychiatry 39. 845–856.CrossRefGoogle ScholarPubMed
Coplan, J.D. & Lydiard, R.B. (1998). Brain circuits in panic disorder. Biological Psychiatry 44. 1264–1276.CrossRefGoogle ScholarPubMed
Dager, S.R., Marro, K.I., Richards, T.L. & Metzger, G.D. (1994). Preliminary application of magnetic resonance spectroscopy to investigate lactate-induced panic. American Journal of Psychiatry 151. 57–63.Google ScholarPubMed
Dager, S.R., Richards, X.Strauss, W. & Artru, A. (1997). Single-voxel 1H-MRS investigation of brain metabolic changes during lactate-induced panic. Psychiatry Research 76. 89–99.CrossRefGoogle ScholarPubMed
Dager, S.R., Friedman, S.D., Heide, A., Layton, M.E., Richards, T., Artru, A., Strauss, W., Hayes, C. & Posse, S. (1999). Two-dimensional proton echo-planar spectroscopic imaging of brain metabolic changes during lactate-induced panic. Archives of General Psychiatry 56, 70–77.CrossRefGoogle ScholarPubMed
Dantendorfer, K., Prayer, D., Kramer, J., Amering, M., Baischer, W., Berger, P., Schoder, M., Steinberger, K., Windhaber, J., Imhof, H. & Katschnig, H. (1996). High frequency of EEG and MRI brain abnormalities in panic disorder. Psychiatry Research 68, 41–53.CrossRefGoogle ScholarPubMed
Davidson, R.J., Abercrombie, H., Nitschke, J.B. & Putnam, K. (1999). Regional brain function, emotion and disorders of emotion. Current Opinions in Neurobiology 9. 228–234.CrossRefGoogle ScholarPubMed
De Cristofaro, M.T., Sessarego, A., Pupi, A., Biondi, F., & Faravelli, C. (1993). Brain perfusion abnormalities in drugnaive, Iactate-sensitive panic patients: a SPECT study. Biological Psychiatry 33, 505–512.CrossRefGoogle ScholarPubMed
Devinsky, O., Sato, S., Theodore, W.H. & Porter, R.J. (1989). Fear episodes due to limbic seizures with normal ictal scalp EEG: a subdural electrographic study. Journal of Clinical Psychiatry 50, 28–30.Google Scholar
Dietch, J.T. (1984). Cerebral tumor presenting with panic attacks. Psychosomatics 25. 861–863.CrossRefGoogle ScholarPubMed
Edlund, M.J., Swann, A.C. & Clothier, J. (1987). Patients with panic attacks and abnormal EEG results. American Journal of Psychiatry 144. 508–509.Google ScholarPubMed
Eren, I., Tukel, R., Polat, A., Karaman, R. & Unal, S. (2003). Evaluation of regional cerebral blood flow changes in panic disorder with Tc99mHMPAO SPECT. Psychiatry Research 123. 135–143.CrossRefGoogle ScholarPubMed
Faravelli, C.Marinoni, M., Spiti, R., Ginanneschi, A., Serena, A., Fabbri, C.Di Matteo, C., Del Mastio, M. & Inzitari, D. (1997). Abnormal brain hemodynamic responses during passive orthostatic challenge in panic disorder. American Journal of Psychiatry 154, 378–383.Google ScholarPubMed
Fischer, H., Andersson, J.L., Furmark, T. & Fredrikson, M. (1998). Brain correlates of an unexpected panic attack: a human positron emission tomographic study. Neuroscience Letters 251. 137–140.CrossRefGoogle ScholarPubMed
Fontaine, V, Breton, G., Dery, R., Fontaine, S. & Elie, R. (1990). Temporal lobe abnormalities in panic disorder: an MRI study. Biological Psychiatry 27. 304–310.CrossRefGoogle ScholarPubMed
Freeman, M.P., Freeman, S.A. & McElroy, S.L. (2002). The comorbidity of bipolar anxiety disorders: prevalence, psychobiology and treatment issues. Journal of Affective Disorders 68. 1–23.CrossRefGoogle ScholarPubMed
Galderisi, S., Bucci, P., Mucci, A., Bernardo, A., Koenig, T. & Maj, M. (2001). Brain electrical microstates in subjects with panic disorder. Brain Research Bulletin 54. 427–435.CrossRefGoogle ScholarPubMed
Garakani, A., Win, T., Virk, S., Gupta, S., Kaplan, D. & Masand, P.S. (2003). Comorbidity of irritable bowel syndrome in psychiatric patients: a review. American Journal of Therapeutics 10. 61–67.CrossRefGoogle ScholarPubMed
Ghadirian, A.M., Gauthier, S. & Bertrand, S. (1986). Anxiety attacks in a patient with a right temporal lobe meningioma. Journal of Clinical Psychiatry 47. 270–271.Google Scholar
Goddard, A.W., Mason, G.F., Almai, A., Rothman, D.L., Behar, K.L., Petroff, O.A., Charney, D.S. & Krystal, J.H. (2001). Reductions in occipital cortex GABA levels in panic disorder detected with lh-magnetic resonance spectroscopy. Archives of General Psychiatry 58. 556–561.CrossRefGoogle ScholarPubMed
Gorman, J.M., Kent, J.M., Suyllivan, G.M. & Coplan, J.D. (2000). Neuroanatomical hypothesis of panic disorder, revised. American Journal of Psychiatry 157. 493–505.CrossRefGoogle ScholarPubMed
Grove, G., Coplan, J.D. & Hollander, E. (1997). The neuroanatomy of 5-HT dysregulation and panic disorder. Neuropsychiatry and Clinical Neuroscience 9. 198–207.Google ScholarPubMed
Handal, N.M., Masand, P. & Weilburg, J.B. (1995). Panic disorder and complex partial seizures. A truly complex relationship. Psychosomatics 36. 498–502.CrossRefGoogle ScholarPubMed
Hofmann, S.G. (1999). Relationship between panic and schizophrenia. Depression and Anxiety 9. 101–106.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Hoppe, K.D. & Bogen, J.E. (1977). Alexithymia in twelve commissurotomized patients. Psychotherapy and Psychosomatics 28.148–155.CrossRefGoogle ScholarPubMed
Hughes, J.R. (1996). A review of the usefulness of the standard EEG in psychiatry. Clinical Electroencephalography 27. 35–39.CrossRefGoogle ScholarPubMed
Jabourian, A.P., Erlich, M., Desvignes, C., El Hadjam, M. & Bitton, R. (1992). Panic attacks and 24-hour ambulatory EEG monitoring. Annales Medico-Psvchologiques, Revue Psvchiatrique 150. 240–244.Google ScholarPubMed
Javanmard, M., Shlik, J., Kennedy, S.H., Vaccarino, F.J., Houle, S. & Bradwejn, J. (1999). Neuroanatomic correlates of CCK-4-induced panic attacks in healthy humans: a comparison of two time points. Biological Psychiatry 45, 872–882.CrossRefGoogle ScholarPubMed
Kaufmann, J. & Charney, D. (2000). Comorbidity of mood and anxiety disorders. Depression and Anxiety 12, 69–76.3.0.CO;2-K>CrossRefGoogle Scholar
Knott, V., Lapierre, Y.D., Fraser, G. & Johnson, N. (1991). Auditory evoked potentials in panic disorder. Journal of Psychiatry and Neuroscience 16, 215–220.Google ScholarPubMed
Kaschka, W., Feistel, H. & Ebert, D. (1995). Reduced benzodiazepine receptor binding in panic disorders measured by iomazenil SPECT. Journal of Psychiatric Research 29, 427–434.CrossRefGoogle ScholarPubMed
Kuikka, J.T., Pitkanen, A., Lepola, U., Partanen, K., Vainio, P., Bergstrom, K.A., Wieler, H.J., Kaiser, K.P., Mittelbach, L. & Koponen, H. (1995). Abnormal regional benzodiazepine receptor uptake in the prefrontal cortex in patients with panic disorder. Nuclear Medicine Communications 16, 273–280.CrossRefGoogle ScholarPubMed
Langs, G., Fabisch, K. & Fabisch, H. (2000). A case of comorbidity between panic disorder and photosensitive epilepsy. Psychopathology 33. 271–274.CrossRefGoogle ScholarPubMed
Lauer, C.J., Krieg, J.C., Garcia-Borreguero, D., Ozdaglar, A. & Holsboer, F. (1992). Panic disorder and major depression: a comparative electroencephalographic sleep study. Psychiatry Research 44, 41–54.CrossRefGoogle ScholarPubMed
Layton, M.E., Friedman, S.D. & Dager, S.R. (2001). Brain metabolic changes during lactate-induced panic: effects of gabapentin treatment. Depression and Anxiety 14, 251–254.CrossRefGoogle ScholarPubMed
Lepola, U., Nousiainen, U., Puranen, M., Riekkinen, P., Rimon, R. (1990). EEG and CT findings in patients with panic disorder. Biological Psychiatry 28,721–727.CrossRefGoogle ScholarPubMed
Lucey, J.V., Costa, D.C., Adshead, G., Deahl, M., Busatto, G., Gacinovic, S., Travis, M., Pilowsky, L., Ell, P.J., Marks, I.M. & Kerwin, R.W. (1997). Brain blood flow in anxiety disorders. OCD, panic disorder with agoraphobia, and post-traumatic stress disorder on 99mTcHMPAO single photon emission tomography (SPET). British Journal of Psychiatiy 171, 346–350.CrossRefGoogle ScholarPubMed
Lydiard, R.B. (2001). Irritable bowel syndrome, anxiety and depression: what are the links? Journal of Clinical Psychiatiy 62. 38–45.Google ScholarPubMed
MacLean, P.D. (1977). The triune brain in conflict. Psychotherapy and Psychosomatics 28, 207–221.CrossRefGoogle ScholarPubMed
Maddock, R.J., Buonocore, M.H., Kile, S.J. & Garrett, A.S. (2003). Brain regions showing increased activation by threat-related words in panic disorder. Neuroreporl 14. 325–328.CrossRefGoogle ScholarPubMed
Malizia, A.L., Cunningham, V.J., Bell, C.J., Liddle, P.F., Jones, T. & Nutt, D.J. (1998). Decreased brain GABA(A)-benzodiazepine receptor binding in panic disorder: preliminary results from a quantitative PET study. Archives of General Psychiatry 55. 715–720.CrossRefGoogle ScholarPubMed
Malizia, A.L. (2002). Receptor binding and drug modulation in anxiety. European Neuropsvchopharmacology 12. 567–574.CrossRefGoogle ScholarPubMed
Maricle, R.A., Sennhauser, S. & Burry, M. (1991). Panic disorder associated with right parahippocampal infarction. Journal of Nervous and Mental Disorders 179. 374–375.CrossRefGoogle ScholarPubMed
Markowitz, J.S., Weissman, M.M., Ouellette, R., Lish, J.D. & Klerman, G.L. (1989). Quality of life in panic disorder. Archives of General Psychiatry 46. 984–992.CrossRefGoogle ScholarPubMed
Massana, G., Gasto, C.Junque, C.Mercader, J.M., Gomez, B., Massana, J., Torres, X. & Salamero, M. (2002). Reduced levels of creatine in the right medial temporal lobe region of panic disorder patients detected with (1)H magnetic resonance spectroscopy. Neuroimage 6. 836–842.CrossRefGoogle Scholar
Massana, G., Serra-Grabulosa, J.M., Salgado-Pineda, P., Gasto, C.Junque, C.Massana, J., Mercader, J.M., Gomez, B., Tobena, A. & Salamero, M. (2003a). Amygdalar atrophy in panic disorder patients detected by volumetric magnetic resonance imaging. Neuroimage 19. 80–90.CrossRefGoogle ScholarPubMed
Massana, G., Serra-Grabulosa, J.M., Salgado-Pineda, P., Gasto, C.Junque, CMassana, J. & Mercader, J.M. (2003b). Parahippocampal gray matter density in panic disorder: a voxel-based morphometric study. American Journal of Psychiatry 160. 566–568.CrossRefGoogle ScholarPubMed
Mayer, E.A., Craske, M. & Naliboff, B.D. (2001). Depression, anxiety and the gastrointestinal system. Journal of Clinical Psychiatry 62. 28–36.Google ScholarPubMed
McLachlan, R.S. & Blume, W.T. (1980). Isolated fear in complex partial status epilepticus. Annals of Neurology 8, 639–641.CrossRefGoogle ScholarPubMed
Meyer, M.A., Zimmerman, A.W. & Miller, C.A. (2000). Temporal lobe epilepsy presenting as panic attacks: detection of interictal hypometabolism with positron emission tomography. Journal of Neuroimaging 10, 120–122.CrossRefGoogle ScholarPubMed
Mucci, A., Merlotti, E., Forte, A. & Galderisi, S. (2003). P300 topography and emotional processing in panic disorder. Brain Topography 15, 186.Google Scholar
Nakamura, K., Kawashima, R., Ito, K., Sugiura, M., Kato, T., Nakamura, A., Hatano, K., Nagumo, S., Kubota, K., Fukuda, H. & Kojima, S. (1999). Activation of the right inferior frontal cortex during assessment of facial emotion. Journal of Neurophysiology 82. 1610–1614.CrossRefGoogle ScholarPubMed
Nordahl, T.E., Semple, W.E., Gross, M., Mellman, T.A., Stein, M.B., Goyer, P., King, A.C., Uhde, T.W. & Cohen, R.M. (1990). Cerebral glucose metabolic differences in patients with panic disorder. Neuropsychopharmacology 3. 261–272.Google ScholarPubMed
Nordahl, T.E., Stein, M.B., Benkelfat, C.Semple, W.E., Andreason, P., Zametkin, A., Uhde, T.W. & Cohen, R.M. (1998). Regional cerebral metabolic asymmetries replicated in an independent group of patients with panic disorders. Biological Psychiatry 44. 998–1006.CrossRefGoogle Scholar
Ontiveros, A., Fontaine, R., Breton, G., Elie, R., Fontaine, S. & Dery, R. (1989). Correlation of severity of panic disorder and neuroanatomical changes on magnetic resonance imaging. Journal of Neuropsychiatrx and Clinical Neuroscience 1, 404–408.Google ScholarPubMed
Parker, J.D.A., Taylor, G.J., Bagby, R.M. & Acklin, M.W. (1993). Alexithymia in panic disorder and simple phobia: A comparative study. American Journal of Psychiatry 150. 1105–1107.Google ScholarPubMed
Phan, K.L., Wager, T., Taylor, S.F., Liberzon, I. (2002). Functional neuroanatomy of emotion: a meta-analysis of emotion activation studies in PET and fMRI. Neuroimage 16. 331–348.CrossRefGoogle ScholarPubMed
Perugi, G., Tomi, C. & Akiskal, H.S. (1999). Anxious-bipolar comorbidity. Diagnostic and treatment challenges. Psychiatric Clinics of North America 22. 565–583.CrossRefGoogle ScholarPubMed
Ponto, L.L., Kathol, R.G., Kettelkamp, R., Watkins, G.L., Richmond, J.C., Clark, J. & Hichwa, R.D. (2002). Global cerebral blood flow after CO2 inhalation in normal subjects and patients with panic disorder determined with [150]water and PET. Journal of Anxiety Disorders 16. 247–258.CrossRefGoogle ScholarPubMed
Reiman, E.M., Raichle, M.E., Butler, F.K., Herscovitch, P. & Robins, E. (1984). A focal brain abnormality in panic disorder, a severe form of anxiety. Nature 310. 683–685.CrossRefGoogle ScholarPubMed
Reiman, E.M., Raichle, M.E., Robins, E., Butler, F.K., Herscovitch, P., Fox, P. & Perlmutter, J. (1986). The application of positron emission tomography to the study of panic disorder. American Journal of Psychiatry 143. 469–477.Google Scholar
Reiman, E.M., Lane, R.D., Ahern, G.L., Schwartz, G.E., Davidson, R.J., Friston, K.J., Yun, L.S. & Chen, K. (1997). Neuroanatomical correlates of externally and internally generated human emotion. American Journal of Psychiatry 154. 918–925.Google ScholarPubMed
Roth, M. & Harper, M. (1962). Temporal lobe epilepsy and the phobic anxiety-depersonalization syndrome. II. Practical and theoretical considerations. Comprehensive Psychiatry 3. 215–226.CrossRefGoogle ScholarPubMed
Sazgar, M., Carlen, P.L. & Wennberg, R. (2003). Panic attack semiology in right temporal lobe epilepsy. Epileptic Disorders 5. 93–100.Google ScholarPubMed
Shioiri, T., Kato, T., Murashita, J., Hamakawa, H., Inubushi, T. & Takahashi, S. (1996). High-energy phosphate metabolism in the frontal lobes of patients with panic disorder detected by phase-encoded 3 IPMRS. Biological Psychiatry 40. 785–793.CrossRefGoogle Scholar
Stein, M.B. & Uhde, T.W. (1989). Infrequent occurrence of EEG abnormalities in panic disorder. American Journal of Psychiatry 146. 517–520.Google ScholarPubMed
Stewart, R.S., Devous, M.D. Sr., Rush, A.J., Lane, L. & Bonte, F.J. (1988)., Cerebral blood flow changes during sodium-lactate-induced panic attacks. American Journal of Psychiatry 145, 442–449.Google ScholarPubMed
Strakowski, S.M., DelBello, M.P., Adler, C.Cecil, K.M. & Sax, K.W. (2000). Neuroimaging in bipolar disorder. Bipolar Disorders 2, 148–164.CrossRefGoogle ScholarPubMed
Thomas, K.M., Drevets, W.C., Dahl, R.E., Ryan, N.D., Birmaher, B., Eccard, C.H., Axelson, D., Whalen, P.J. & Casey, B.J. (2001). Amygdala response to fearful faces in anxious and depressed children. Archives of General Psychiatry 58. 1057–1063.CrossRefGoogle ScholarPubMed
Turnbull, G. & Bebbington, P. (2001). Anxiety and the schizophrenic process: clinical and epidemiological evidence. Social Psychiatry and Psychiatric Epidemiology 36. 235–243.CrossRefGoogle ScholarPubMed
Uhde, T.W. & Kellner, C.H. (1987). Cerebral ventricular size in panic dis-order. Journal of Affective Disorder 12, 175–178.CrossRefGoogle Scholar
Vythilingam, M., Anderson, E.R., Goddard, A., Woods, S.W., Staib, L.H., Charney, D.S. & Bremner, J.D. (2000). Temporal lobe volume in panic disorder–a quantitative magnetic resonance imaging study. Psychiatry Research 99, 75–82.CrossRefGoogle ScholarPubMed
Wall, M., Tuchman, M. & Mielke, D. (1985). Panic attacks and temporal lobe seizures associated with a right temporal lobe arteriovenous malformation: case report. Journal of Clinical Psychiatry 46. 143–145.Google ScholarPubMed
Wall, M., Mielke, D. & Luther, J.S. (1986). Panic attacks and psychomotor seizures following right temporal Iobectomy. Journal of Clinical Psychiatry 41. 219.Google Scholar
Weilburg, J.B., Schachter, S., Sachs, G.S., Worth, J., Pollack, M.H., Ives, J.R. & Schomer, D.L. (1993). Focal paroxysmal EEG changes during atypical panic attacks. Journal of Neuropsychialry and Clinical Neuroscience 5, 50–55.Google ScholarPubMed
Weilburg, J.B., Schachter, S., Worth, J., Pollack, M.H., Sachs, G.S., Ives, J.R. & Schomer, D.L. (1995). EEG abnormalities in patients with atypical panic attacks. Journal of Clinical Psychiatry 56, 358–362.Google ScholarPubMed
Weissman, M.M., Bland, R.C., Canino, G.J., Faravelli, C.Greenwald, S., Hwu, H.G., Joyce, P.R., Karam, E.G., Lee, C.K., Lellouch, J., Lepine, J.P., Newman, S.C., Oakley-Browne, M.A., Rubio-Stipec, M., Wells, J.E., Wickramaratne, P.J., Wittchen, H.U. & Yeh, E.K. (1997). The cross-national epidemiology of panic disorder. Archives of General Psychiatiy 54. 305–309.CrossRefGoogle ScholarPubMed
Wiedemann, G., Pauli, P., Dengler, W., Lutzenberger, W., Birbaumer, N. & Buchkremer, G. (1999). Frontal brain asymmetry as a biological substrate of emotions in patients with panic disorders. Archives of General Psychiatiy 56. 78–84.CrossRefGoogle ScholarPubMed
Wilcox, J.A. (1991). Pituitary microadenoma presenting as panic attacks. British Journal of Psychiatry 158, 426–427.CrossRefGoogle ScholarPubMed
Woods, S.W., Koster, K., Krystal, J.K., Smith, E.O., Zubal, I.G., Hoffer, P.B. & Charney, D.S. (1988). Yohimbine alters regional cerebral blood flow in panic disorder. Lancet 2, 678.CrossRefGoogle ScholarPubMed
Wurthmann, C.Bogerts, B., Gregor, J., Baumann, B., Effenberger, O. & Dohring, W. (1997). Frontal CSF enlargement in panic disorder: a qualitative CT-scan study. Psychiatry Research 76. 83–87.CrossRefGoogle ScholarPubMed