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Panic disorderAetiology
What happens in the brain?The areas of the brain implicated are the forebrain The forebrain is the area most affected in people with anxiety disorders, including panic disorder (PD). The limbic system is involved in storing memories and creating emotions and is thought to play a central role in processing all anxiety-related information. Both the locus coeruleus Neurochemical involvementMost researchers have emphasised the role of noradrenergic mechanisms in PD. However, serotonin-related findings in PD, such as the documented antipanic potential of SSRIs, are lending support to there also being a serotonergic dysfunction occurring (Humble et al., 1989; Humble and Wistedt, 1992; DeVane, 1997). The three neurochemical pathways that have been most studied are those related to benzodiazepines (BZD) and g-amino-butyric acid (GABA) function, noradrenergic function, and serotonergic function. There seems to be evidence of serotonin involvement in the GABA-BZD and the noradrenergic systems (Kahn et al., 1990). Serotonin may influence the GABA system in the raphe nuclei and median raphe sites in the brainstem Further evidence for the involvement of serotonin in PD derives from the abnormal cerebrospinal fluid levels of 5-hydroxyindoleacetic acid (5-HIAA) (Eriksson et al., 1991), and anxiety induced by the serotonin receptor The role of GABA has been supported by the initial effects of BZDs on panic, and the subsequent rebound effect and panic exacerbation on withdrawal of the BZD. |
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