G.D. Kotzalidis, R. Brugnoli, V. Orlandi, M. Donnini, A. Parmegiani,
P. Pancheri - Vol. 7, Settembre 2001, num.3
Testo
Immagini Bibliografia
Summary Riassunto Indice
Neurobiologia degli Attacchi di Panico
Neurobiology of panic attacks
Evidence for the neurobiology of panic attacks comes from positron emission
tomography (PET) and animal studies, which are difficult to interpret for various
reasons, as well as from challenge tests in the human, which are more likely
to induce panic in a panic disorder patient than in a healthy control. Such
studies suggest the presence of a circuitry which is vulnerable (labile) in
patients with panic disorder, being composed of various neuronal chains and
involving multiple neurotransmitters, such as serotonin, noradrenaline, acetylcholine,
probably dopamine, and amino acids (GABA, glutamate and/or aspartate), and neuromodulators,
such as neuropeptides (cholecystokinin, opiates, and CRF-like peptides), endogenous
cannabinoids and adenosine, and receiving multiple influences from other metabolic
substances, such as nitric oxide or carbon dioxide. Neuronal chains comprise
relay stations in the basolateral, but also in the central amygdala, in the
hippocampus, in the cerebral cortex (insular, cingulate and orbital prefrontal),
the locus coeruleus, the periaqueductal grey, the parabrachial and the solitary
nuclei. Collateral connections of these nuclei and areas may be recruited during
the attack and account for particular symptoms of the attack, spanning from
visceral and other somatic sensations to emotional perception and cognitive
working-through (which may give way to residual agoraphobia). The serotonin-noradrenaline
interplay taking place between the dorsal raphé, the periaqueductal grey,
and the locus coeruleus appears to be central to both somatic and higher brain
activity components; such interplay is regulated by GABAergic, glutamatergic,
adenosinergic, opioid and anandamidergic mediation. Conditioned fear appears
to be mediated through the raphé, whereas unconditioned fear (innate),
which is most strictly related to panic proper, appears to involve the periaqueductal
grey.
