AIM To provide an overview of the current research in the functional neuroanatomy of panic disorder.METHODS Panic disorder(PD)is a frequent psychiatric disease.Gorman et al(1989;2000)proposed a comprehensive neuroanat...AIM To provide an overview of the current research in the functional neuroanatomy of panic disorder.METHODS Panic disorder(PD)is a frequent psychiatric disease.Gorman et al(1989;2000)proposed a comprehensive neuroanatomical model of PD,which suggested that fear-and anxiety-related responses are mediated by a so-called"fear network"which is centered in the amygdala and includes the hippocampus,thalamus,hypothalamus,periaqueductal gray region,locus coeruleus and other brainstem sites.We performed a systematic search by the electronic database PubMed.Thereby,the main focus was laid on recent neurofunctional,neurostructural,and neurochemical studies(from the period between January 2012 and April 2016).Within this frame,special attention was given to the emerging field of imaging genetics.RESULTS We noted that many neuroimaging studies have reinforced the role of the"fear network"regions in the pathophysiology of panic disorder.However,recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem,anterior and midcingulate cortex(ACC and MCC),insula,and lateral as well as medial parts of the prefrontal cortex.Interestingly,differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al(2000).Indeed,amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms,sample heterogeneity and size,as well as on limitations of neuroimaging techniques.Advanced neurochemical studies have substantiated the major role of serotonergic,noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD.However,alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable.A promising new research approach is"imaging genetics".Imaging genetic studies are designed to evaluate the impact of genetic variations(polymorphisms)on cerebral function in regions critical for PD.Most recently,imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor,CRH receptor,human TransM EMbrane protein(TMEM123D),and amiloride-sensitive cation channel 2(ACCN2)genes.CONCLUSION In light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.展开更多
Suicide is the 14^(th)leading cause of death worldwide.It is responsible for 1%-5%of all mortality.This article highlights the latest developments in universal,selective,and indicated prevention strategies.Concerning ...Suicide is the 14^(th)leading cause of death worldwide.It is responsible for 1%-5%of all mortality.This article highlights the latest developments in universal,selective,and indicated prevention strategies.Concerning universal suicide prevention,current research has shown that strategies such as restricting access to lethal means(e.g.,control of analgesics and hot-spots for suicide by jumping)and school-based awareness programs are most efficacious.Regarding selective prevention,substantial progress can be expected in psychological screening methods for suicidal behavior.The measurement of implicit cognition proved to be more valid in predicting future suicide attempts than classic clinical assessment.Latest developments are smartphone-based interventions and realtime monitoring of suicidal behavior.Great effort has been made to establish valid neurobiological screening methods(e.g.,genetic and epigenetic risk factors for suicide,hypothalamic-pituitary-adrenal axis)without yielding a major breakthrough.Potentially,multiple biomarkers rather than a single one are necessary to identify individuals at risk.With regard to indicated prevention in form of psychopharmacological treatment,recent pharmacoepidemiological studies and meta-analyses have supported a protective role of antidepressants,lithium,and clozapine.However,the data concerning a specific anti-suicidal effect of these drugs are currently not consistent.Promising results exist for ketamine in reducing suicidal ideation,independently of its antidepressant effect.Concerning psychotherapy,recent findings suggest that psychotherapeutic interventions specifically designed to prevent suicide re-attempts are most efficacious.Specifically,cognitive behavioral therapy and psychodynamic therapy approaches proved to decrease the number of suicide re-attempts significantly.展开更多
文摘AIM To provide an overview of the current research in the functional neuroanatomy of panic disorder.METHODS Panic disorder(PD)is a frequent psychiatric disease.Gorman et al(1989;2000)proposed a comprehensive neuroanatomical model of PD,which suggested that fear-and anxiety-related responses are mediated by a so-called"fear network"which is centered in the amygdala and includes the hippocampus,thalamus,hypothalamus,periaqueductal gray region,locus coeruleus and other brainstem sites.We performed a systematic search by the electronic database PubMed.Thereby,the main focus was laid on recent neurofunctional,neurostructural,and neurochemical studies(from the period between January 2012 and April 2016).Within this frame,special attention was given to the emerging field of imaging genetics.RESULTS We noted that many neuroimaging studies have reinforced the role of the"fear network"regions in the pathophysiology of panic disorder.However,recent functional studies suggest abnormal activation mainly in an extended fear network comprising brainstem,anterior and midcingulate cortex(ACC and MCC),insula,and lateral as well as medial parts of the prefrontal cortex.Interestingly,differences in the amygdala activation were not as consistently reported as one would predict from the hypothesis of Gorman et al(2000).Indeed,amygdala hyperactivation seems to strongly depend on stimuli and experimental paradigms,sample heterogeneity and size,as well as on limitations of neuroimaging techniques.Advanced neurochemical studies have substantiated the major role of serotonergic,noradrenergic and glutamatergic neurotransmission in the pathophysiology of PD.However,alterations of GABAergic function in PD are still a matter of debate and also their specificity remains questionable.A promising new research approach is"imaging genetics".Imaging genetic studies are designed to evaluate the impact of genetic variations(polymorphisms)on cerebral function in regions critical for PD.Most recently,imaging genetic studies have not only confirmed the importance of serotonergic and noradrenergic transmission in the etiology of PD but also indicated the significance of neuropeptide S receptor,CRH receptor,human TransM EMbrane protein(TMEM123D),and amiloride-sensitive cation channel 2(ACCN2)genes.CONCLUSION In light of these findings it is conceivable that in the near future this research will lead to the development of clinically useful tools like predictive biomarkers or novel treatment options.
文摘Suicide is the 14^(th)leading cause of death worldwide.It is responsible for 1%-5%of all mortality.This article highlights the latest developments in universal,selective,and indicated prevention strategies.Concerning universal suicide prevention,current research has shown that strategies such as restricting access to lethal means(e.g.,control of analgesics and hot-spots for suicide by jumping)and school-based awareness programs are most efficacious.Regarding selective prevention,substantial progress can be expected in psychological screening methods for suicidal behavior.The measurement of implicit cognition proved to be more valid in predicting future suicide attempts than classic clinical assessment.Latest developments are smartphone-based interventions and realtime monitoring of suicidal behavior.Great effort has been made to establish valid neurobiological screening methods(e.g.,genetic and epigenetic risk factors for suicide,hypothalamic-pituitary-adrenal axis)without yielding a major breakthrough.Potentially,multiple biomarkers rather than a single one are necessary to identify individuals at risk.With regard to indicated prevention in form of psychopharmacological treatment,recent pharmacoepidemiological studies and meta-analyses have supported a protective role of antidepressants,lithium,and clozapine.However,the data concerning a specific anti-suicidal effect of these drugs are currently not consistent.Promising results exist for ketamine in reducing suicidal ideation,independently of its antidepressant effect.Concerning psychotherapy,recent findings suggest that psychotherapeutic interventions specifically designed to prevent suicide re-attempts are most efficacious.Specifically,cognitive behavioral therapy and psychodynamic therapy approaches proved to decrease the number of suicide re-attempts significantly.
