Nervenheilkunde 2019; 38(08): 528-536
DOI: 10.1055/a-0944-8687
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Angst und Panik

Funktionelle Netzwerke und therapeutische PerspektivenAnxiety and panic
Katharina Feldker
1   kbo-Inn-Salzach-Klinikum gemeinnützige GmbH, Fachkrankenhaus für Psychiatrie, Psychotherapie, Psychosomatische Medizin, Geriatrie und Neurologie
,
Swantje Notzon
2   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Münster, Albert-Schweitzer-Campus 1
› Author Affiliations
Further Information

Publication History

Publication Date:
01 August 2019 (online)

ZUSAMMENFASSUNG

Gegenstand und Ziel: Die Forschung zu den neuronalen Korrelaten von Angst und Panik hat sich im letzten Jahrzehnt weiterentwickelt. Seit 1989 Gormans Hypothese zur Neuroanatomie der Panikstörung erschien, wurden viele Studien in den Bereichen Bildgebung und Neurochemie durchgeführt.

Material und Methoden: Wir geben eine Übersicht über die Datenlage zu funktionellen Netzwerken bei Angst und Panik mit einem Schwerpunkt auf funktionellen Bildgebungsstudien.

Ergebnisse: Für das Verständnis der Panikstörung ist von einem komplexen Modell multipler neuronaler Netzwerke mit Beteiligung von weitaus mehr Hirnregionen als zunächst angenommen auszugehen. Ein mögliches erweitertes neuro­anatomisches Netzwerkmodell der Panikstörung umfasst den präfrontalen Kortex, den zingulären Kortex, Thalamus, Hypothalamus, Insel, Hirnstamm, Hippocampus, Amygdala und den Bed Nucleus der Stria Terminalis. Neurochemisch ist eine Vielzahl von Neurotransmittern an der Entstehung der Panikstörung beteiligt.

Schlussfolgerungen: Für das Verständnis der funktionellen Netzwerke bei Angst und Panik sind interdisziplinäre Forschung sowie eine dimensionale und transdiagnostische Herangehensweise essenziell.

ABSTRACT

Objective: Research on the neuronal correlates of anxiety and panic has significantly evolved in the last decade. A wide range of studies regarding neuroimaging and neurochemistry have been conducted since Gorman published his neuroanatomical hypothesis of panic disorder in 1989.

Materials and method: We will give an overview on data on functional networks in anxiety and panic. An emphasis is put on functional neuroimaging studies.

Results: A complex model of multiple neuronal networks is an approach to understanding anxiety disorders in general and panic disorder in particular. More regions than assumed earlier are involved in this multiple network model. A possible network model for understanding panic disorder includes the prefrontal cortex, the cingular cortex, thalamus, hypothalamus, insula, brainstem, amygdala and the bed nucleus striae terminalis. From a neurochemical perspective a multitude of neurotransmitters is involved in the genesis of panic disorder.

Conclusions: Interdisciplinary research as well as a dimensional and transdiagnostic perspective are essential to improve the understanding of neuronal correlates of anxiety and panic.

 
  • Literatur

  • 1 American Psychiatric Association.. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition.. Arlington, VA: American Psychiatric Association; 2013
  • 2 American Psychiatric Association.. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th edition. text revision Washington, DC: American Psychiatric Association; 2000
  • 3 Notzon S. Klinische Erscheinungsformen. In: Zwanzger P. (Hrsg.). Angst Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2018: 100-116
  • 4 Baxter AJ, Vos T, Scott KM. et al The global burden of anxiety disorders in 2010. Psychol Med 2014; 44: 2363-2374
  • 5 Jacobi F, Höfler M, Strehle J. et al Psychische Störungen in der Allgemeinbevölkerung. Nervenarzt 2014; 85: 77-87
  • 6 Jacobi F, Wittchen H-U. Holting et al Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 2004; 34: 597-611
  • 7 Kessler RC, Chiu WT, Jin R. et al The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006; 63: 415-424
  • 8 Gorman JM, Liebowitz MR, Fyer AJ. et al A neuroanatomical hypothesis for panic disorder. Am J Psychiatry 1989; 146: 148-161
  • 9 Gorman JM. Neuroanatomical Hypothesis of Panic Disorder, Revised. Am J Psychiatry 2000; 157: 493-505
  • 10 Bouton ME, Mineka S, Barlow DH. A modern learning theory perspective on the etiology of panic disorder. Psychol Rev 2001; 108: 4-32
  • 11 Pape HC, Pare D. Plastic synaptic networks of the amygdala for the acquisition, expression, and extinction of conditioned fear. Physiol Rev 2010; 90: 419-463
  • 12 LeDoux J. Coming to terms with fear. Proc Natl Acad Sci 2014; 111: 2871-2878
  • 13 LeDoux JE, Pine DS. Using Neuroscience to Help Understand Fear and Anxiety: A Two-System Framework. Am J Psychiatry 2016; 173: 1083-1093
  • 14 LeDoux J. Emotion circuits in the brain. Annu Rev Neurosci 2000; 23: 155-184
  • 15 de Carvalho MR, Dias GP, Cosci F. et al Current findings of fMRI in panic disorder: contributions for the fear neurocircuitry and CBT effects. Expert Rev Neurother 2010; 10: 291-303
  • 16 Dresler T, Guhn A, Tupak SV. et al Revise the revised? New dimensions of the neuroanatomical hypothesis of panic disorder. J Neural Transm 2013; 120: 3-29
  • 17 Pfleiderer B, Zinkirciran S, Arolt V. et al fMRI amygdala activation during a spontaneous panic attack in a patient with panic disorder. World J Biol Psychiatry 2007; 8: 269-272
  • 18 Dresler T, Hahn T, Plichta MM. et al Neural correlates of spontaneous panic attacks. J Neural Transm 2011; 118: 263-269
  • 19 Lai CH. Fear Network Model in Panic Disorder: The Past and the Future. Psychiatry Investig 2019; 16: 16-26
  • 20 Brinkmann L, Buff C, Feldker K. et al Distinct phasic and sustained brain responses and connectivity of amygdala and bed nucleus of the stria terminalis during threat anticipation in panic disorder. Psychol Med 2017; 47: 2675-2688
  • 21 Bystritsky A, Pontillo D, Powers M. et al Functional MRI changes during panic anticipation and imagery exposure. Neuroreport 2001; 12: 3953-3957
  • 22 Maddock RJ, Buonocore MH, Kile S. et al Brain regions showing increased activation by threat-related words in panic disorder. Neuroreport 2003; 14: 325-328
  • 23 van den Heuvel OA, Veltman D, Groenewegen H. Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis. Arch Gen Psychiatry 2005; 62: 922-933
  • 24 Pillay SS, Gruber SA, Rogowska J. et al fMRI of fearful facial affect recognition in panic disorder: The cingulate gyrus-amygdala connection. J Affect Disord 2006; 94: 173-181
  • 25 Pillay SS, Rogowska J, Gruber SA. et al Recognition of happy facial affect in panic disorder: An fMRI study. J Anxiety Disord 2007; 21: 381-393
  • 26 Chechko N, Wehrle R, Erhardt A. et al Unstable Prefrontal Response to Emotional Conflict and Activation of Lower Limbic Structures and Brainstem in Remitted Panic Disorder. PLoS ONE 2009; 4: 1-11
  • 27 Tuescher O, Protopopescu X, Pan H. et al Differential activity of rostral cingulate and brainstem in Panic Disorder and PTSD. J Anxiety Disord 2011; 25: 251-257
  • 28 van den Heuvel OA, Mataix-Cols D, Zwitser G. et al Common limbic and frontal-striatal disturbances in patients with obsessive compulsive disorder, panic disorder and hypochondriasis. Psychol Med 2011; 41: 2399-2410
  • 29 Ottaviani C, Cevolani D, Nucifora V. et al Amygdala responses to masked and low spatial frequency fearful faces: a preliminary fMRI study in panic disorder. Psychiatry Res Neuroimaging 2012; 203: 159-165
  • 30 Dresler T, Attar CH, Spitzer C. et al Neural correlates of the emotional Stroop task in panic disorder patients: An event-related fMRI study. J Psychiatr Res 2012; 46: 1627-1634
  • 31 Demenescu LR, Kortekaas R, Cremers HR. et al Amygdala activation and its functional connectivity during perception of emotional faces in social phobia and panic disorder. J Psychiatr Res 2013; 47: 1024-1031
  • 32 Wittmann A, Schlagenhauf F, Guhn A. et al Anticipating agoraphobic situations: the neural correlates of panic disorder with agoraphobia. Psychol Med 2014 FirstView: 1-12
  • 33 Kircher T, Arolt V, Jansen A. et al Effect of Cognitive-Behavioral Therapy on Neural Correlates of Fear Conditioning in Panic Disorder. Biol Psychiatry 2013; 73: 93-101
  • 34 Killgore WDS, Britton JC, Schwab ZJ. et al Cortico-Limbic Responses to Masked Affective Faces Across PTSD, Panic Disorder, and Specific Phobia. Depress Anxiety 2014; 31: 150-159
  • 35 Lueken U, Straube B, Reinhardt I. et al Altered top-down and bottom-up processing of fear conditioning in panic disorder with agoraphobia. Psychol Med 2014; 44: 381-394
  • 36 Engel K, Obst K, Bandelow B. et al Functional MRI activation in response to panic-specific, non-panic aversive, and neutral pictures in patients with panic disorder and healthy controls. Eur Arch Psychiatry Clin Neurosci 2015: 1-10
  • 37 Pattyn T, Schmaal L, Filip VDE. et al Emotional processing in panic disorder and its subtypes: An fMRI study using the emotional faces paradigm. Eur Psychiatry 2016; 33: 460
  • 38 Feldker K, Heitmann CY, Neumeister P. et al Brain responses to disorder-related visual threat in panic disorder. Hum Brain Mapp 2016; 37: 4439-4453
  • 39 Feldker K, Heitmann CY, Neumeister P. et al Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder. J Psychiatry Neurosci 2018; 43: 26-36
  • 40 Craig AD. How do you feel — now? The anterior insula and human awareness. Nat Rev Neurosci 2009; 10: 59-70
  • 41 Critchley HD, Wiens S Rotshtein. et al Neural systems supporting interoceptive awareness. Nat Neurosci 2004; 7: 189-195
  • 42 Gasquoine PG. Contributions of the Insula to Cognition and Emotion. Neuropsychol Rev 2014; 24: 77-87
  • 43 Arolt V, Zwanzger P, Zwanziger P. et al (The research network PANIC-NET: improving the treatment of panic disorder – from a better understanding of fear circuit mechanisms to more effective psychological treatment and routine care). Psychother Psychosom Med Psychol 2009; 59: 124-131
  • 44 Beutel ME, Stark R, Pan H. et al Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: An fMRI study of panic disorder patients. Psychiatry Res Neuroimaging 2010; 184: 96-104
  • 45 Straube B, Lueken U, Jansen A. et al Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study. Psychother Psychosom 2014; 83: 222-233
  • 46 Yang Y, Kircher T, Straube B. The neural correlates of cognitive behavioral therapy: Recent progress in the investigation of patients with panic disorder. Behav Res Ther 2014; 62: 88-96
  • 47 Liebscher C, Wittmann A, Gechter J. et al Facing the fear – clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia. Eur Neuropsychopharmacol 2016; 26: 431-444
  • 48 Wittmann A, Schlagenhauf F Guhn. et al Effects of Cognitive Behavioral Therapy on Neural Processing of Agoraphobia-Specific Stimuli in Panic Disorder and Agoraphobia. Psychother Psychosom 2018; 87: 350-365
  • 49 Kunas SL, Yang Y, Straube B. et al The impact of depressive comorbidity on neural plasticity following cognitive-behavioral therapy in panic disorder with agoraphobia. J Affect Disord 2019; 245: 451-460
  • 50 Hofmann SG, Smits JAJ. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008; 69: 621-632
  • 51 Carl E, Stein AT, Levihn-Coon A. et al Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord 2019; 61: 27-36
  • 52 Olthuis JV, Watt MC, Bailey K. et al Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 2016
  • 53 Pompoli A, Furukawa TA, Imai H. et al Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database Syst Rev 2016
  • 54 Ströhle A, Fydrich T. Angsterkrankungen: Welche Psychotherapie für wen? Nervenarzt. 2018; 89: 271
  • 55 Lueken U, Zierhut KC, Hahn T. et al Neurobiological markers predicting treatment response in anxiety disorders: A systematic review and implications for clinical application. Neurosci Biobehav Rev 2016; 66: 143-162
  • 56 Sobanski T, Wagner G. Functional neuroanatomy in panic disorder: Status quo of the research. World J Psychiatry 2017; 7: 12-33
  • 57 Zwanzger P, Zavorotnyy M, Gencheva E. et al Acute shift in glutamate concentrations following experimentally induced panic with cholecystokinin tetrapeptide–a 3T-MRS study in healthy subjects. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol 2013; 38: 1648-1654
  • 58 Lambert JJ, Cooper MA, Simmons R. et al Neurosteroids: Endogenous allosteric modulators of GABAA receptors. Psychoneuroendocrinology 2009; 34: 48-58
  • 59 Nothdurfter C, Rammes G, Baghai TC. et al Translocator protein (18 kDa) as a target for novel anxiolytics with a favourable side-effect profile. J Neuroendocrinol 2012; 24: 82-92
  • 60 Perna G, Schruers K, Alciati A. et al Novel investigational therapeutics for panic disorder. Expert Opin Investig Drugs 2015; 24: 491-505
  • 61 Comer JS, Mojtabai R, Olfson M. National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders. Am J Psychiatry 2011; 168: 1057-1065
  • 62 Perna G, Alciati A, Riva A. et al Long-Term Pharmacological Treatments of Anxiety Disorders: An Updated Systematic Review. Curr Psychiatry Rep 2016; 18: 23
  • 63 Pignon B, Tezenas du Montcel C. et al The Place of Antipsychotics in the Therapy of Anxiety Disorders and Obsessive-Compulsive Disorders. Curr Psychiatry Rep 2017; 19: 103