Evidence map›Paper›PMID 40110375›Full record

SynthesisAlpha psychiatry2025

Neurocircuitry and Neuroanatomy in Panic Disorder: A Systematic Review.

Peter Kyriakoulis, Clarissa Wijaya, Laiana Quagliato, Rafael C Freire, Antonio E Nardi

Abstract readSystematic Review
In one paragraph

Synthesis in Alpha psychiatry, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Peter KyriakoulisSchool of Psychology, Faculty of Arts, Health and Design, Swinburne University of Technology, Melbourne, VIC 3122, Australia.ORCID https://orcid.org/0000-0002-6424-6179
Clarissa WijayaPositive Psychology Centre, Clinical Research, Melbourne, VIC 3166, Australia.
Laiana QuagliatoLaboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, 21941-617 Rio de Janeiro, Brazil.ORCID https://orcid.org/0000-0002-6928-5847
Rafael C FreireDepartment of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON K7L 3N6, Canada.ORCID https://orcid.org/0000-0003-3875-4601
Antonio E NardiLaboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, 21941-617 Rio de Janeiro, Brazil.ORCID https://orcid.org/0000-0002-2152-4669

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: This review updates our understanding of the neuroanatomical and neurocircuitry factors involved in panic disorder (PD). Many aspects remain undetermined. Methods: Clinical studies and a randomized controlled trial were identified via PubMed database and included in this review. Results: The search, following PRISMA guidelines, identified 13 human studies and 3 animal studies. Nine human studies compared brain activity and connectivity between regions in PD patients. Neural activity in the amygdala was highlighted in six studies. The hippocampus had higher activation in PD patients compared to those with social phobia, but generally showed less activity compared to healthy controls. The parahippocampal gyrus and thalamus exhibited greater activation in PD patients than healthy controls. Activity in the prefrontal cortices was also noted, particularly the ventromedial prefrontal cortex (vmPFC), ventrolateral prefrontal cortex (vlPFC), dorsomedial prefrontal cortex (dmPFC), and dorsolateral prefrontal cortex (dlPFC). Other regions involved included the dorsal midbrain, left brainstem (showing hyperactivation), S1, and right caudate, which showed increased activity in PD patients. The left intraparietal sulcus (IPS) exhibited hypoactivation in response to predictable cues compared to unpredictable or neutral cues within the default mode network (DMN). Three animal studies suggested that electrical and chemical activation of the dorsal periaqueductal gray (dPAG) in rats elicited fight-or-flight behaviors, providing a model for panic attacks. Conclusions: Neuroimaging studies suggest several key regions involved in PD pathophysiology, including the brainstem, amygdala, hippocampus, parahippocampal gyrus, thalamus, insula, and prefrontal and cingulate cortices. Hypersensitivity in the brainstem and amygdala plays a role in activating the fear network. Further prospective studies are needed to identify the neuroanatomical sites involved in PD and fear circuitry.

Indexed as

etiologyneuroanatomyneurocircuitrypanic disordersystematic review

Identifiers

PMID40110375
PMCPMC11916057

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.