Unstable prefrontal response to emotional conflict and activation of lower limbic structures and brainstem in remitted panic disorder.
Unstable prefrontal response to emotional conflict and activation of lower limbic structures and brainstem in remitted panic disorder.
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DOI：
10.1371/journal.pone.0005537
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发表时间：
2009-05-20
期刊：
影响因子：
3.7
通讯作者：
Sämann PG
中科院分区：
文献类型：
--
作者：
Chechko N;Wehrle R;Erhardt A;Holsboer F;Czisch M;Sämann PG
惊恐障碍(PD)的神经机制还不完全清楚。患者对非特定恐惧线索的敏感度更高，与条件性恐惧的相似之处表明，低位边缘和脑干结构受累。我们调查了缓解期帕金森病患者的情绪知觉是否发生了改变。我们使用血氧水平依赖(BOLD)功能磁共振成像(FMRI)研究了18名缓解期PD患者和18名健康受试者对情绪冲突范式的神经和行为反应，这种范式基于情绪上一致和不一致的面孔/单词对的呈现。我们观察到，患者表现出更强的行为干扰和对干扰冲突的较低适应。患者的总体表现较慢，但准确性并未降低。在之前一致的背景下，患者在冲突检测时发现更强的背侧前扣带回(DACC)激活。在先前不一致的情况下，控制扩大了dACC的活动，并成功地减少了行为干扰。相比之下，患者表现出dACC和背内侧前额叶皮质(DmPFC)招募的缺失，但下缘区域(包括右侧杏仁核)和脑干激活。本研究提供的证据表明，情绪刺激呈现的刺激顺序对缓解期帕金森病患者的大脑反应的影响明显大于对照组，导致dACC/dmPFC以及下缘结构(包括杏仁核)和脑干的异常反应。尽管临床症状有所缓解，但帕金森病患者对非惊恐相关情绪刺激的处理受到干扰。
The neural mechanisms of panic disorder (PD) are only incompletely understood. Higher sensitivity of patients to unspecific fear cues and similarities to conditioned fear suggest involvement of lower limbic and brainstem structures. We investigated if emotion perception is altered in remitted PD as a trait feature. We used blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to study neural and behavioural responses of 18 remitted PD patients and 18 healthy subjects to the emotional conflict paradigm that is based on the presentation of emotionally congruent and incongruent face/word pairs. We observed that patients showed stronger behavioural interference and lower adaptation to interference conflict. Overall performance in patients was slower but not less accurate. In the context of preceding congruence, stronger dorsal anterior cingulate cortex (dACC) activation during conflict detection was found in patients. In the context of preceding incongruence, controls expanded dACC activity and succeeded in reducing behavioural interference. In contrast, patients demonstrated a dropout of dACC and dorsomedial prefrontal cortex (dmPFC) recruitment but activation of the lower limbic areas (including right amygdala) and brainstem. This study provides evidence that stimulus order in the presentation of emotional stimuli has a markedly larger influence on the brain's response in remitted PD than in controls, leading to abnormal responses of the dACC/dmPFC and lower limbic structures (including the amygdala) and brainstem. Processing of non-panic related emotional stimuli is disturbed in PD patients despite clinical remission.
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