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Distinct phasic and sustained brain responses and connectivity of amygdala and bed nucleus of the stria terminalis during threat anticipation in panic disorder

Published online by Cambridge University Press:  09 May 2017

L. Brinkmann ,
C. Buff ,
K. Feldker ,
S. V. Tupak ,
M. P. I. Becker ,
M. J. Herrmann  and
T. Straube
L. Brinkmann*
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, Germany
C. Buff
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, Germany
K. Feldker
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, Germany
S. V. Tupak
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, Germany
M. P. I. Becker
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, Germany
M. J. Herrmann
Affiliation:
Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, Germany
T. Straube
Affiliation:
Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, Muenster, Germany
*
*Address for correspondence: L. Brinkmann, Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Von-Esmarch-Str. 52, D-48149 Muenster, Germany. (Email: [email protected])
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Abstract

Background

Panic disorder (PD) patients are constantly concerned about future panic attacks and exhibit general hypersensitivity to unpredictable threat. We aimed to reveal phasic and sustained brain responses and functional connectivity of the amygdala and the bed nucleus of the stria terminalis (BNST) during threat anticipation in PD.

Methods

Using functional magnetic resonance imaging (fMRI), we investigated 17 PD patients and 19 healthy controls (HC) during anticipation of temporally unpredictable aversive and neutral sounds. We used a phasic and sustained analysis model to disentangle temporally dissociable brain activations.

Results

PD patients compared with HC showed phasic amygdala and sustained BNST responses during anticipation of aversive v. neutral stimuli. Furthermore, increased phasic activation was observed in anterior cingulate cortex (ACC), insula and prefrontal cortex (PFC). Insula and PFC also showed sustained activation. Functional connectivity analyses revealed partly distinct phasic and sustained networks.

Conclusions

We demonstrate a role for the BNST during unpredictable threat anticipation in PD and provide first evidence for dissociation between phasic amygdala and sustained BNST activation and their functional connectivity. In line with a hypersensitivity to uncertainty in PD, our results suggest time-dependent involvement of brain regions related to fear and anxiety.

Keywords

anterior cingulate cortex (ACC)anxietyfMRIinsulaprefrontal cortex (PFC)
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 15 , November 2017 , pp. 2675 - 2688
Copyright
Copyright © Cambridge University Press 2017 

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