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Anticipating agoraphobic situations: the neural correlates of panic disorder with agoraphobia

Published online by Cambridge University Press:  07 January 2014

A. Wittmann ,
F. Schlagenhauf ,
A. Guhn ,
U. Lueken ,
C. Gaehlsdorf ,
M. Stoy ,
F. Bermpohl ,
T. Fydrich ,
B. Pfleiderer  and
H. Bruhn
...Show all authors
A. Wittmann*
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
F. Schlagenhauf
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany Max Planck Institute for Human Cognitive and Brain Science, Leipzig, Germany
A. Guhn
Affiliation:
Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
U. Lueken
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
C. Gaehlsdorf
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
M. Stoy
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
F. Bermpohl
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany Berlin School of Mind and Brain, Berlin, Germany
T. Fydrich
Affiliation:
Institute of Psychology, Psychotherapy and Somatopsychology – Humboldt Universität zu Berlin, Germany
B. Pfleiderer
Affiliation:
Department of Clinical Radiology, University of Münster, Münster, Germany
H. Bruhn
Affiliation:
Department of Radiology, University of Jena, Jena, Germany
A. L. Gerlach
Affiliation:
Department of Psychology, University of Cologne, Cologne, Germany
T. Kircher
Affiliation:
Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
B. Straube
Affiliation:
Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
H.-U. Wittchen
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
V. Arolt
Affiliation:
Department of Psychiatry, University of Münster, Münster, Germany
A. Heinz
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
A. Ströhle
Affiliation:
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
*
*Address for correspondence: Mr A. Wittmann, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. (Email: Andre.Wittmann@charite.de)
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Abstract

Background

Panic disorder with agoraphobia is characterized by panic attacks and anxiety in situations where escape might be difficult. However, neuroimaging studies specifically focusing on agoraphobia are rare. Here we used functional magnetic resonance imaging (fMRI) with disorder-specific stimuli to investigate the neural substrates of agoraphobia.

Method

We compared the neural activations of 72 patients suffering from panic disorder with agoraphobia with 72 matched healthy control subjects in a 3-T fMRI study. To isolate agoraphobia-specific alterations we tested the effects of the anticipation and perception of an agoraphobia-specific stimulus set. During fMRI, 48 agoraphobia-specific and 48 neutral pictures were randomly presented with and without anticipatory stimulus indicating the content of the subsequent pictures (Westphal paradigm).

Results

During the anticipation of agoraphobia-specific pictures, stronger activations were found in the bilateral ventral striatum and left insula in patients compared with controls. There were no group differences during the perception phase of agoraphobia-specific pictures.

Conclusions

This study revealed stronger region-specific activations in patients suffering from panic disorder with agoraphobia in anticipation of agoraphobia-specific stimuli. Patients seem to process these stimuli more intensively based on individual salience. Hyperactivation of the ventral striatum and insula when anticipating agoraphobia-specific situations might be a central neurofunctional correlate of agoraphobia. Knowledge about the neural correlates of anticipatory and perceptual processes regarding agoraphobic situations will help to optimize and evaluate treatments, such as exposure therapy, in patients with panic disorder and agoraphobia.

Keywords

Agoraphobiaanticipationfunctional magnetic resonance imaginginsulapanicventral striatumWestphal paradigm
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 11 , August 2014 , pp. 2385 - 2396
Copyright
Copyright © Cambridge University Press 2014 

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