Multimodal MRI of fear network in panic disorder / 中华行为医学与脑科学杂志

The etiology and pathological mechanism of panic disorder (PD) are still unclear, which hinders the development of clinical diagnosis and treatment. In order to clarify the pathogenesis, biological diagnostic markers, curative effect prediction of PD, and ultimately provide a basis for individualized treatment, this article reviews the magnetic resonance imaging (MRI) research on PD in the past 5 years in conjunction with the hypothesis of the " fear network model" . It is found that the brain function and structural abnormalities of PD patients are not limited to the classic " fear network model" , but also a wider range of brain areas such as the cingulate gyrus, fronto-temporal cortex, insula, striatum, thalamus, sensorimotor related brain regions and cerebellum, together with classic brain regions such as the amygdala, form an expanded fear network. Among them, the amygdala, insula, medial prefrontal lobe, somato-motor network (SMN) and cerebellum are specific brain areas that differentiate PD from other anxiety disorders. The changes in the activity of the frontal lobe-limbic loop included in the fear network model can predict the treatment outcome of different methods for PD. This article improved the fear network hypothesis of PD, and more accurately identifies the biological indicators that can be used for accurate diagnosis and efficacy prediction of PD, which lays the foundation for the ultimate realization of personalized diagnosis and treatment of PD.

Fear Network Model in Panic Disorder: The Past and the Future

The core concept for pathophysiology in panic disorder (PD) is the fear network model (FNM). The alterations in FNM might be linked with disturbances in the autonomic nervous system (ANS), which is a common phenomenon in PD. The traditional FNM included the frontal and limbic regions, which were dysregulated in the feedback mechanism for cognitive control of frontal lobe over the primitive response of limbic system. The exaggerated responses of limbic system are also associated with dysregulation in the neurotransmitter system. The neuroimaging studies also corresponded to FNM concept. However, more extended areas of FNM have been discovered in recent imaging studies, such as sensory regions of occipital, parietal cortex and temporal cortex and insula. The insula might integrate the filtered sensory information via thalamus from the visuospatial and other sensory modalities related to occipital, parietal and temporal lobes. In this review article, the traditional and advanced FNM would be discussed. I would also focus on the current evidences of insula, temporal, parietal and occipital lobes in the pathophysiology. In addition, the white matter and functional connectome studies would be reviewed to support the concept of advanced FNM. An emerging dysregulation model of fronto-limbic-insula and temporooccipito-parietal areas might be revealed according to the combined results of recent neuroimaging studies. The future delineation of advanced FNM model can be beneficial from more extensive and advanced studies focusing on the additional sensory regions of occipital, parietal and temporal cortex to confirm the role of advanced FNM in the pathophysiology of PD.

Neuroimaging in patients with panic disorder / 上海交通大学学报（医学版）

Panic disorder (PD) is characterized by recurrent unexpected panic attacks and fear of dying or losing control, which negatively influences the social functioning and life quality of the patients. The neurobiological mechanisms underlying PD have not been clearly understood. Previous opinion held that hyperactivity of the fear network which included amygdala, hypothalamus, hippocampus, brain stem and so on and dysfunction of prefrontal cortex underlay PD. Summarizing recent advances on magnetic resonance imaging studies in PD, this review focuses on the functional, structural and metabolic neuroanatomical alterations in the specific population. There is evidence to show that the hyperactivity of fear network, prefrontal and occipital cortex may be involved in the pathophysiology of PD and it is necessary to revise models of anxiety disorder.

Neuroimaging in patients with panic disorder / 上海交通大学学报（医学版）

Panic disorder (PD) is characterized by recurrent unexpected panic attacks and fear of dying or losing control,which negatively influences the social functioning and life quality of the patients.The neurobiological mechanisms underlying PD have not been clearly understood.Previous opinion held that hyperactivity of the fear network which included amygdala,hypothalamus,hippocampus,brain stem and so on and dysfunction of prefrontal cortex underlay PD.Summarizing recent advances on magnetic resonance imaging studies in PD,this review focuses on the functional,structural and metabolic neuroanatomical alterations in the specific population.There is evidence to show that the hyperactivity of fear network,prefrontal and occipital cortex may be involved in the pathophysiology of PD and it is necessary to revise models of anxiety disorder.