본문 바로가기
KERD
논문KCI 등재

공황장애의 신경생물학

Neurobiology of Panic Disorder

유범희|강은호
대한신경정신의학회 (Korean Neuropsychiatric Association)|2009.07|신경정신의학 (JOURNAL OF THE KOREAN NEUROPSYCHIATRIC ASSOCIATION)|제48권 제4호|pp. 207-212

0

조회

0

다운로드

1

인용

0

참고문헌

키워드

공황장애·불안·공포·신경생물학Panic disorder·Anxiety·Fear·Neurobiology.
주제분류정신과학

초록

공황장애가 단일 질환으로 분류되고 연구되기 시작한 지 는 불과 30년이 채 안 되었지만, 각종 신경생물학적 연구 기 법의 발전으로 공황장애의 병태생리 기전에 대한 구체적인 모 델들이 제시되었다. 신경해부학적 측면에서는 편도를 중심으 로 한 공포회로의 이상 가설이 제기되었으며, NE와 5-HT 를 비롯한 여러 신경전달 물질의 역할도 많이 밝혀진 상태 이다. 그러나 그럼에도 불구하고 아직 공황장애에서 신경전 달 물질의 역할에 대한 서로 상반된 의견이 팽팽한 상태이며, 신경내분비 계통이나 뇌영상 연구, 특히 유전학 분야에 대한 연구는 아직 많이 미흡한 실정이다. 따라서, 향후 이러한 부 분에 대한 추가적인 연구가 필요한 실정이며, 유전적 요인과 스트레스 같은 환경적 요인이 내부표현형(endophenotype) 으로 고려할 수 있는 신경생물학적 소견, 뇌영상 소견들과 어 떤 관련성을 보이는지에 대한 연구는 아직 초보적인 단계여 서 앞으로 이 분야에 대한 활발한 연구가 필요할 것으로 생 각된다.

Abstract

Panic disorder is a common mental disorder that causes considerable disability. However, the etiology of panic disorder remains unclear. Preclinical neuroanatomical and neurophysiological studies have provided clues to the neurobiological basis of panic disorder, and recent developments in neurobiological techniques in neurochemical research, brain imaging, and genetic research provide a further understanding of anxiety, fear, and panic disorder. In this article, we introduce a functional neuroanatomic model of fear and anxiety, and consider the implications of recent developments and debates in neurobiological findings with respect to panic disorder.

참고문헌 (54)

  1. Kessler RC, "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication", Arch Gen Psychiatry, 62, pp.617~627 (2005)
  2. Kessler RC, "Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication", Arch Gen Psychiatry, 62, pp.593~602 (2005)
  3. Bruce SE, "Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study", Am J Psychiatry, 162, pp.1179~1187 (2005)
  4. Roy-Byrne PP, "Course and outcome in panic disorder: a review of recent follow-up studies", Anxiety, 1, pp.151~160 (1994)
  5. Goddard AW, "Toward an integrated neurobiology of panic disorder", J Clin Psychiatry, 58(2), pp.4~11 (1997)
  6. Paré D, "New vistas on amygdala networks in conditioned fear", J Neurophysiol, 92, pp.1~9 (2004)
  7. Rosen JB, "The neurobiology of conditioned and unconditioned fear: a neurobehavioral system analysis of the amygdala", Behav Cogn Neurosci Rev, 3, pp.23~41 (2004)
  8. Gorman JM, "Neuroanatomical hypothesis of panic disorder, revised", Am J Psychiatry, 157, pp.493~505 (2000)
  9. Reiman EM, "A focal brain abnormality in panic disorder, a severe form of anxiety", Nature, 310, pp.683~685 (1984)
  10. Sakai Y, "Cerebral glucose metabolism associated with a fear network in panic disorder", Neuroreport, 16, pp.927~931 (2005)
  11. Stewart RS, "Cerebral blood flow changes during sodium-lactate-induced panic attacks", Am J Psychiatry, 145, pp.442~449 (1988)
  12. Kent JM, "Prediction of panic response to a respiratory stimulant by reduced orbitofrontal cerebral blood flow in panic disorder", Am J Psychiatry, 162, pp.1379~1381 (2005)
  13. iomazenil measurement of the benzodiazepine receptor in panic disorder, "Biol Psychiatry", 2000, 96~106
  14. Malizia AL, "Decreased brain GABA (A)-benzodiazepine receptor binding in panic disorder: preliminary results from a quantitative PET study", Arch Gen Psychiatry, 55, pp.715~720 (1998)
  15. Goddard AW, "Reductions in occipital cortex GABA levels in panic disorder detected with 1h-magnetic resonance spectroscopy", Arch Gen Psychiatry, 58, pp.556~561 (2001)
  16. Uhde TW, "Blunted growth hormone response to clonidine in panic disorder patients", Biol Psychiatry, 21, pp.1081~1085 (1986)
  17. Cameron OG, "Anxious and depressive disorders and their comorbidity: effect on central nervous system noradrenergic function", Biol Psychiatry, 56, pp.875~883 (2004)
  18. Brown SL, "Lymphocyte beta-adrenergic receptor binding in panic disorder", Psychopharmacology, 94, pp.24~28 (1988)
  19. Nesse RM, "Adrenergic function in patients with panic anxiety", Arch Gen Psychiatry, 41, pp.771~776 (1984)
  20. Cohen H, "Autonomic dysregulation in panic disorder and in post-traumatic stress disorder: application of power spectrum analysis of heart rate variability at rest and in response to recollection of trauma or panic attacks", Psychiatry Res, 96, pp.1~13 (2000)
  21. Sullivan GM, "Effects of hyperventilation on heart rate and QT variability in panic disorder pre- and post-treatment", Psychiatry Res, 125, pp.29~39 (2004)
  22. Kawachi I, "Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study", Circu lation, 90, pp.2225~2229 (1994)
  23. Kawachi I, "Prospective study of phobic anxiety and risk of coronary heart disease in men", Circulation, 89, pp.1992~1997 (1994)
  24. Goodwin RD, "Mental disorders and cardiovascular disease among adults in the United States", J Psychiatr Res, 43, pp.239~246 (2009)
  25. Wilkinson DJ, "Sympathetic activity in patients with panic disorder at rest, under laboratory mental stress, and during panic attacks", Arch Gen Psychiatry, 55, pp.511~520 (1998)
  26. Maron E, "Serotonin function in panic disorder: important, but why?", Neuropsychopharmacology, 31, pp.1~11 (2006)
  27. Bell C, "Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine", J Psychopharmacol, 16, pp.5~14 (2002)
  28. Miller HE, "Effect of acute tryptophan depletion on CO2-induced anxiety in patients with panic disorder and normal volunteers", Br J Psychiatry, 176, pp.182~188 (2000)
  29. Klaassen T, "Effects of tryptophan depletion on anxiety and on panic provoked by carbon dioxide challenge", Psychiatry Res, 77, pp.167~174 (1998)
  30. Germine M, "Response to meta-chlorophenylpiperazine in panic disorder patients and healthy subjects: influence of reduction in intravenous dosage", Psychiatry Res, 54, pp.115~133 (1994)
  31. Kahn RS, "Behavioral indications for serotonin receptor hypersensitivity in panic disorder", Psychiatry Res, 25, pp.101~104 (1988)
  32. Coplan JD, "Serotonin related functions in panic-anxiety: a critical overview", Neuropsychopharmacology, 6, pp.189~200 (1992)
  33. Cutler NR, "phase II multicenter dosefinding, efficacy and safety trial of ipsapirone in outpatients with generalized anxiety disorder", Prog Neuropsychopharmacol Biol Psychiatry, 18, pp.447~463 (1994)
  34. Armbruster D, "Serotonin transporter gene variation and stressful life events impact processing of fear and anxiety", Int J Neuropsychopharmacol, pp.393~401 (2009)
  35. Wellman CL, "Impaired stress-coping and fear extinction and abnormal corticolimbic morphology in serotonin transporter knock-out mice", J Neurosci, 27, pp.684~691 (2007)
  36. Murphy DL, "Targeting the murine serotonin transporter: insights into human neurobiology", Nat Rev Neurosci, 9, pp.85~96 (2008)
  37. Murphy DL, "How the serotonin story is being rewritten by new gene-based discoveries principally related to SLC6A4, the serotonin transporter gene, which functions to influence all cellular serotonin systems", Neuropharmacology, 55, pp.932~960 (2008)
  38. Kang EH, "Platelet serotonin transporter function after short-term paroxetine treatment in patients with panic disorder", Psychiatry Res
  39. Aston-Jones G, "Serotonin selectively attenuates glutamate-evoked activation of noradrenergic locus coeruleus neurons", J Neurosci, 11, pp.760~769 (1991)
  40. Blier P, "Crosstalk between the norepinephrine and serotonin systems and its role in the antidepressant response", J Psychiatry Neurosci, 26, pp.S3~S10 (2001)
  41. Coplan JD, "Clinical improvement with fluoxetine therapy and noradrenergic function in patients with panic disorder", Arch Gen Psychiatry, 54, pp.643~648 (1997)
  42. Viana MB, "Kainate microinjection into the dorsal raphe nucleus induces 5-HT release in the amygdala and periaqueductal gray", Pharmacol Biochem Behav, 58, pp.167~172 (1997)
  43. Brady LS, "The antidepressants fluoxetine, idazoxan and phenelzine alter corticotropinreleasing hormone and tyrosine hydroxylase mRNA levels in rat brain: therapeutic implications", Brain Res, 572, pp.117~125 (1992)
  44. Stutzmann GE, "GABAergic antagonists block the inhibitory effects of serotonin in the lateral amygdala: a mechanism for modulation of sensory inputs related to fear conditioning", J Neurosci, 19, pp.RC8~ (1999)
  45. Hariri AR, "Serotonin transporter genetic variation and the response of the human amygdala", Science, 297, pp.400~403 (2002)
  46. Roy-Byrne PP, "Panic disorder", Lancet, 368, pp.1023~1032 (2006)
  47. Carroll BJ, "A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility", Arch Gen Psychiatry, 38, pp.15~22 (1981)
  48. Yehuda R, "Current status of cortisol findings in post-traumatic stress disorder", Psychiatr Clin North Am, 25, pp.341~368 (2002)
  49. Abelson JL, "axis activity in patients with panic disorder: review and synthesis of four studies", Depress Anxiety, 24, pp.66~76 (2007)
  50. Smoller JW, "The genetic basis of panic and phobic anxiety disorders", Am J Med Genet C Semin Med Genet, 148, pp.118~126 (2008)
  51. Goldstein RB, "Familial aggregation and phenomenology of 'early'-onset (at or before age 20 years) panic disorder", Arch Gen Psychiatry, 54, pp.271~278 (1997)
  52. Hettema JM, "A review and meta-analysis of the genetic epidemiology of anxiety disorders", Am J Psychiatry, 158, pp.1568~1578 (2001)
  53. Woo JM, "Catechol O-methyltransferase genetic polymorphism in panic disorder", Am J Psychiatry, 159, pp.1785~1787 (2002)
  54. Domschke K, "Meta-analysis of COMT val158met in panic disorder: ethnic heterogeneity and gender specificity", Am J Med Genet B Neuropsychiatr Genet, 144B, pp.667~673 (2007)

관련 논문AI추천

공황장애의 감정 인식 및 조절 메커니즘김유라, 이경욱대한불안의학회 · 대한불안의학회지2011 · 제7권 제1호불안 관련 장애의 신경생물학적 이해김경민, 김민경, 이상혁대한생물정신의학회 · 생물정신의학2014 · 제21권 제4호신경생물학 및 고전적 조건화 이론을 이용한 공황장애의 정신분석적 접근김민재, 김채리, 노양호, 박진완, 우성일, 이연정, 한상우, 황재욱한국정신분석학회 · 정신분석2015 · 제26권 제3호[123I]-Iomazenil SPECT를 이용한 공황장애 환자에서 대뇌 벤조다이아제핀 수용체 결합 이상김영기, 김찬형, 노대영, 류영훈, 박경민, 이상민대한신경정신의학회 · 신경정신의학2010 · 제49권 제2호A Novel Bio-Psychosocial-Behavioral Treatment Model of Panic DisorderSeon-Cheol Park, Yong-Ku Kim대한신경정신의학회 · PSYCHIATRY INVESTIGATION2019 · 제16권 제1호외상 후 스트레스 장애의 이해에 있어서 유전학 및 뇌영상 연구의 기여김지은, 류인균, 이유상, 전찬수대한생물정신의학회 · 생물정신의학2010 · 제17권 제4호

이 간행물의 다른 논문 (12건)

우울증 환자의 혈액에서 측정되는 BDNF 농도 변화와 그 의미이분희, 김용구pp. 203-206중독성 질환으로서의 흡연김대진, 조근호pp. 213-219기억상실성 경도인지장애 환자의 신경정신 증상김도관, 안인숙pp. 220-224정신분열병에서 강제입원과 자의입원 환자군의 3년 추적관찰을 통한 비교 분석강민희, 이정섭, 최혜진, 김철응, 김원형, 배재남, 이명지, 정승호pp. 225-231양극성 장애에서 1형과 2형 환자 간의 임상 양상 비교최정미, 박해정, 박동연, 백지현, 최지선, 노지혜, 이동수, 홍경수pp. 232-239
원문 보기