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Physiological Aberrations in Panic Disorder

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Electrophysiology and Psychophysiology in Psychiatry and Psychopharmacology

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 21))

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Abstract

Panic disorder is a frequent and clinically relevant medical entity with a high lifetime prevalence and significant impact on psychosocial stability and function. Regarding the clinical presentation, there are obvious similarities in paroxysmal neurological disorders such as seizures and focal epilepsies. In this context, the detection of EEG abnormalities during the attacks or in asymptomatic intervals, continuously or rhythmical, is of significant interest. Likewise, isolated epileptic discharges (IEDs) are important components of epilepsy. On the other hand, IEDs are also common in non-epileptic psychiatric patients. It is not known exactly which role IEDs play in the genesis of behavioural aberrations. In this chapter, attention is directed towards this issue and its relevance to managing psychiatric patients suffering from panic disorder (PD), as well as understanding the complex relationship between IEDs and the pathophysiology of PD. Two main conclusions are being proposed. First, patients suffering from PD may show a higher rate of unspecific EEG abnormalities and increased beta power, pointing to a state of hyperarousal. Secondly, if first-line treatment of PD fails, the use of antiepileptic drugs (AEDs) should be considered. There is enough evidence to suggest that IEDs play a significant role in the genesis of PD and that this relationship is far from clear, warranting more research in this field. This article gives an overview of the current literature on the pathophysiology of PD, including studies on altered microstates, coherence imaging and alpha asymmetry.

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References

  • Adamaszek M, Olbrich S et al (2011) The diagnostic value of clinical EEG in detecting abnormal synchronicity in panic disorder. Clin EEG Neurosci 42(3):166–174

    Article  PubMed  Google Scholar 

  • Alvarez-Silva S, Alvarez-Rodriguez J et al (2006) Panic and epilepsy. J Anxiety Disord 20(3):353–362

    Article  CAS  PubMed  Google Scholar 

  • Asnaani A, Richey JA et al (2010) A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. J Nerv Ment Dis 198(8):551–555

    Article  PubMed Central  PubMed  Google Scholar 

  • Avoli M, Louvel J et al (2005) Cellular and molecular mechanisms of epilepsy in the human brain. Prog Neurobiol 77(3):166–200

    Article  CAS  PubMed  Google Scholar 

  • Bartolomei F, Trebuchon A et al (2005) Acute alteration of emotional behaviour in epileptic seizures is related to transient desynchrony in emotion-regulation networks. Clin Neurophysiol: Official J Int Fed Clin Neurophysiol 116(10):2473–2479

    Article  Google Scholar 

  • Beyenburg S, Mitchell AJ et al (2005) Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav: E&B 7(2):161–171

    Article  Google Scholar 

  • Boutros N (2009) Epileptiform discharges in psychiatric patients: a controversy in need of resurrection. Clin EEG Neurosci 40(4):239–244

    Article  PubMed  Google Scholar 

  • Boutros NN (2010) Interictal spikes in psychiatric patients: a controversy in need for resurrection. J Clin Neurophysiol: Official Publ Am Electroencephalogr Soc 27(6):484–485 (Author reply 485)

    Article  Google Scholar 

  • Boutros NN, Galloway MP et al (2013a) Abnormal coherence imaging in panic disorder: a magnetoencephalography investigation. NeuroReport 24(9):487–491

    Article  PubMed  Google Scholar 

  • Boutros NN, Gjini K et al (2013b) Panic versus epilepsy: a challenging differential diagnosis. Clin EEG Neurosci 44(4):313–318

    Article  PubMed  Google Scholar 

  • Boutros NN, Kirollos SB et al (2014) Predictive value of isolated epileptiform discharges for a favorable therapeutic response to antiepileptic drugs in nonepileptic psychiatric patients. J Clin Neurophysiol: Official Publ Am Electroencephalogr Soc 31(1):21–30

    Article  Google Scholar 

  • Britz J, Van De Ville D et al (2010) BOLD correlates of EEG topography reveal rapid resting-state network dynamics. Neuroimage 52(4):1162–1170

    Article  PubMed  Google Scholar 

  • Clark CR, Galletly CA et al (2009) Evidence-based medicine evaluation of electrophysiological studies of the anxiety disorders. Clin EEG Neurosci 40(2):84–112

    Article  PubMed  Google Scholar 

  • Coburn KL, Lauterbach EC et al (2006) The value of quantitative electroencephalography in clinical psychiatry: a report by the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 18(4):460–500

    Article  PubMed  Google Scholar 

  • Deutsch SI, Rosse RB et al (2009) Temporal lobe epilepsy confused with panic disorder: implications for treatment. Clin Neuropharmacol 32(3):160–162

    Article  PubMed  Google Scholar 

  • Dieler AC, Samann PG et al (2008) Independent component analysis applied to pharmacological magnetic resonance imaging (phMRI): new insights into the functional networks underlying panic attacks as induced by CCK-4. Curr Pharm Des 14(33):3492–3507

    Article  CAS  PubMed  Google Scholar 

  • Doyle A, Pollack MH (2004) Long-term management of panic disorder. J Clin Psychiatry 65(Suppl 5):24–28

    CAS  PubMed  Google Scholar 

  • Elisevich K, Shukla N et al (2011) An assessment of MEG coherence imaging in the study of temporal lobe epilepsy. Epilepsia 52(6):1110–1119

    Article  PubMed Central  PubMed  Google Scholar 

  • Engelbregt HJKD, Promes VHL, Verhagen-Schouten S, Deijen JB (2012) In vivo EEG changes during a panic attack in a patient with specific phobia. J Med Cases 3(1):34–38

    Google Scholar 

  • Gallinat J, Hegerl U (1999) Limbic ictus as a condition for anxiety attacks. Der Nervenarzt 70(3):206–215

    Article  CAS  PubMed  Google Scholar 

  • Gallinat J, Stotz-Ingenlath G et al (2003) Panic attacks, spike-wave activity, and limbic dysfunction. A case report. Pharmacopsychiatry 36(3):123–126

    Article  CAS  PubMed  Google Scholar 

  • Gelowitz DL, Kokkinidis L (1999) Enhanced amygdala kindling after electrical stimulation of the ventral tegmental area: implications for fear and anxiety. J Neurosci: Official J Soc Neurosci 19(22): RC41

    Google Scholar 

  • Gerez M, Sada A et al (2011) Amygdalar hyperactivity, a fear-related link between panic disorder and mesiotemporal epilepsy. Clin EEG Neurosci 42(1):29–39

    Article  CAS  PubMed  Google Scholar 

  • Gloor P, Olivier A et al (1982) The role of the limbic system in experiential phenomena of temporal lobe epilepsy. Ann Neurol 12(2):129–144

    Article  CAS  PubMed  Google Scholar 

  • Gordon E, Palmer DM et al (2010) EEG alpha asymmetry in schizophrenia, depression, PTSD, panic disorder, ADHD and conduct disorder. Clin EEG Neurosci 41(4):178–183

    Article  PubMed  Google Scholar 

  • Gorji A, Speckmann EJ (2009) Epileptiform EEG spikes and their functional significance. Clin EEG Neurosci 40(4):230–233

    Article  PubMed  Google Scholar 

  • Ham P, Waters DB et al (2005) Treatment of panic disorder. Am Fam Physician 71(4):733–739

    PubMed  Google Scholar 

  • Hirschfeld RM (1996) Panic disorder: diagnosis, epidemiology, and clinical course. J Clin Psychiatry 57(Suppl 10):3–8 (Discussion 9–10)

    Google Scholar 

  • Hurley RA, Fisher R et al (2006) Sudden onset panic: epileptic aura or panic disorder? J Neuropsychiatry Clin Neurosci 18(4):436–443

    Article  PubMed  Google Scholar 

  • Jabourian AP, Erlich M et al (1992) Panic attacks and 24-hour ambulatory EEG monitoring. Ann Med Psychol 150(2–3):240–244 (Discussion 245)

    Google Scholar 

  • Jacobi F, Wittchen HU et al (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34(4):597–611

    Article  CAS  PubMed  Google Scholar 

  • Jacobs J, Levan P et al (2009) Hemodynamic changes preceding the interictal EEG spike in patients with focal epilepsy investigated using simultaneous EEG-fMRI. Neuroimage 45(4):1220–1231

    Article  PubMed  Google Scholar 

  • Kalynchuk LE (2000) Long-term amygdala kindling in rats as a model for the study of interictal emotionality in temporal lobe epilepsy. Neurosci Biobehav Rev 24(7):691–704

    Article  CAS  PubMed  Google Scholar 

  • Kanner AM (2011) Ictal panic and interictal panic attacks: diagnostic and therapeutic principles. Neurol Clin 29(1):163–175 (ix)

    Google Scholar 

  • Keele NB (2005) The role of serotonin in impulsive and aggressive behaviors associated with epilepsy-like neuronal hyperexcitability in the amygdala. Epilepsy Behav: E&B 7(3):325–335

    Article  Google Scholar 

  • Kellett J, Kokkinidis L (2004) Extinction deficit and fear reinstatement after electrical stimulation of the amygdala: implications for kindling-associated fear and anxiety. Neuroscience 127(2):277–287

    Article  CAS  PubMed  Google Scholar 

  • Kikuchi M, Koenig T et al (2011) EEG microstate analysis in drug-naive patients with panic disorder. PLoS ONE 6(7):e22912

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Lanteaume L, Khalfa S et al (2007) Emotion induction after direct intracerebral stimulations of human amygdala. Cereb Cortex 17(6):1307–1313

    Article  PubMed  Google Scholar 

  • Lewine JD, Andrews R et al (1999) Magnetoencephalographic patterns of epileptiform activity in children with regressive autism spectrum disorders. Pediatrics 104(3 Pt 1):405–418

    Article  CAS  PubMed  Google Scholar 

  • Lin YY, Shih YH et al (2003) Magnetoencephalographic yield of interictal spikes in temporal lobe epilepsy. Comparison with scalp EEG recordings. Neuroimage 19(3):1115–1126

    Article  CAS  PubMed  Google Scholar 

  • Meletti S, Tassi L et al (2006) Emotions induced by intracerebral electrical stimulation of the temporal lobe. Epilepsia 47(Suppl 5):47–51

    Article  PubMed  Google Scholar 

  • Mintzer S, Lopez F (2002) Comorbidity of ictal fear and panic disorder. Epilepsy Behav: E&B 3(4):330–337

    Article  Google Scholar 

  • Nguyen DK, Nguyen DB et al (2009) Insular cortex epilepsy: an overview. Can J Neurol Sci (Le journal canadien des sciences neurologiques) 36(Suppl 2):S58–S562

    Google Scholar 

  • Ray A, Tao JX et al (2007) Localizing value of scalp EEG spikes: a simultaneous scalp and intracranial study. Clin Neurophysiol: Official J Int Fed Clin Neurophysiol 118(1):69–79

    Article  Google Scholar 

  • Sazgar M, Carlen PL et al (2003) Panic attack semiology in right temporal lobe epilepsy. Epileptic Dis: Int Epilepsy J Videotape 5(2):93–100

    Google Scholar 

  • Skapinakis P, Lewis G et al (2011) Panic disorder and subthreshold panic in the UK general population: epidemiology, comorbidity and functional limitation. Eur Psychiatry: J Assoc Eur Psychiatrists 26(6):354–362

    Article  CAS  Google Scholar 

  • Toni C, Cassano GB et al (1996) Psychosensorial and related phenomena in panic disorder and in temporal lobe epilepsy. Compr Psychiatry 37(2):125–133

    Article  CAS  PubMed  Google Scholar 

  • Towle VL, Carder RK et al (1999) Electrocorticographic coherence patterns. J Clin Neurophysiol: Official Publ Am Electroencephalogr Soc 16(6):528–547

    Article  CAS  Google Scholar 

  • Vaaler AE, Morken G et al (2009) Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department. BMC Psychiatry 9:63

    Article  PubMed Central  PubMed  Google Scholar 

  • Van de Ville D, Britz J et al (2010) EEG microstate sequences in healthy humans at rest reveal scale-free dynamics. Proc Natl Acad Sci USA 107(42):18179–18184

    Article  PubMed  Google Scholar 

  • Weilburg JB, Schachter S et al (1993) Focal paroxysmal EEG changes during atypical panic attacks. J Neuropsychiatry Clin Neurosci 5(1):50–55

    CAS  PubMed  Google Scholar 

  • Weilburg JB, Schachter S et al (1995) EEG abnormalities in patients with atypical panic attacks. J Clin Psychiatry 56(8):358–362

    CAS  PubMed  Google Scholar 

  • Wieser HG (1983) Depth recorded limbic seizures and psychopathology. Neurosci Biobehav Rev 7(3):427–440

    Article  CAS  PubMed  Google Scholar 

  • Young GB, Chandarana PC et al (1995) Mesial temporal lobe seizures presenting as anxiety disorders. J Neuropsychiatry Clin Neurosci 7(3):352–357

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Munich, Nussbaumstr. 7, 80336, Munich, Germany

    Wenzel Schicho & Oliver Pogarell

Authors
  1. Wenzel Schicho
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  2. Oliver Pogarell
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Correspondence to Wenzel Schicho .

Editor information

Editors and Affiliations

  1. Department of Psychology,, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom

    Veena Kumari

  2. Center for Neuropsych Research of Traumatic Stress, Charles University Department of Psychiatry, Prague, Czech Republic

    Petr Bob

  3. Department of Psychiatry and Neurosciences, Department of Psychiatry and Neurosciences, University of Missouri Kansas City (UMKC), Kansas City, Missouri, USA

    Nash N. Boutros

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Schicho, W., Pogarell, O. (2014). Physiological Aberrations in Panic Disorder. In: Kumari, V., Bob, P., Boutros, N. (eds) Electrophysiology and Psychophysiology in Psychiatry and Psychopharmacology. Current Topics in Behavioral Neurosciences, vol 21. Springer, Cham. https://doi.org/10.1007/7854_2014_347

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