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Giampaolo Perna

Psicopatologia e fisiopatologia del panico: il tronco encefalico e l’omeostasi fisiopatologica. Giampaolo Perna Dipartimento di Neuroscienze Cliniche, Casa di Cura San Benedetto Menni , Albese con Cassano (Como) Centro Europeo per i Disturbi d’Ansia ed Emotivi (Milano).

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Giampaolo Perna

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  1. Psicopatologia e fisiopatologia del panico: il tronco encefalico e l’omeostasi fisiopatologica Giampaolo Perna Dipartimento di Neuroscienze Cliniche, Casa di Cura San Benedetto Menni, Albese con Cassano (Como) Centro Europeo per i Disturbi d’Ansia ed Emotivi (Milano)

  2. Defininga Panic Attack A Panic Attack is an acute episode of intense fear or discomfort which develop abruptly, usually lasts few minutes and is characterized by several neurovegetative and cognitive symptoms: Sensations of shortness of breath Feeling dizzy, unsteady Palpitations Trembling or shaking Sweating feeling of choking Nausea or abdominal distress • Feelings of unreality • Paresthesias • Chills or hot flushes • Chest pain or discomfort • Fear of dying • Fear of losing control or going crazy

  3. Panic Attacks and Panic Disorder 10-15% individuals from general population experience unexpected panic attacks during their lifetime 3-4% individuals from general population develop Panic Disorder

  4. Panic March UNEXPECTED PANIC ATTACKS Persistent pathologic fear of having a severe somatic disease HYPOCHONDRIA Persistent pathologic fear of having a panicattack ANTICIPATORY ANXIETY SITUATIONAL PANIC ATTACKS Severe discomfort or avoidanceofplaces and situation whereescaping or lookingfor help mightbedifficult PHOBIC AVOIDANCE DEPRESSION SUBSTANCE ABUSE

  5. Brainstem?………. whomatters?

  6. Brain……………………………… ………………………..…….. Body

  7. Whyhas the brainstembeenneglected? • Higherfunction in the brainattractincomingstudentsas a prime goal forscientificstudy • Untile recently the braistemwas hard toapproachexperimentally • Whenneurobiologyhasborn, biologyofrespiratory and cardiovascular system remained in the domain ofphysiologists

  8. Some cluesfromthis volume dedicatedto the brainstem…. • Brainstemregionscontrollingcardiovascular and respiratoryfunction are juxtaposed and intermingled. • Particularlyimportantoforrespiratorycontrolisserotonin…. As itsrole in reversingopiatemediatedrespiratorydepression…similarly, brainstemcardiovascularcontrol • Oneessential gene is Phox2b… providesanessential “drive tobreath” ……andisalsorequiredfor the embryologicaldevelopmentof the cardiovascular system and centralchemosensitivity.

  9. Perhaps, in the future, studentsof the nervous system Will discover the fascinationoftryingtounderstand How the brainstemperformsessentialhousekeeping Activitiesthatunderlieall the higherfunctions in the brain. John Nicholls & JulianPaton

  10. Emotionisinexorablyboundtoinstict • Emotion (Websters International Dictionary): physiologicaldeparturefromhomeostasiswhichissubjectivelyexperienced in strong feeling….. Sndbodilychangespreparatorytoevrtactswhichmay or maynotbeperformed • PrimordialEmotionsare geneticallyprogrammed and guard the physico-chemicalconstancyof the internalenvironmentof the body – the homeostaticprocess.

  11. ….. Panicattacks are frequent in the off- ofparkinsontreatment………….

  12. Panic in the Brainstemback to 1984……?

  13. Increasedbrainstem volume (ventral and dorsalmidbrain and rostralpons) Decreasedfrontal (orbitofrontal, right superiorfrontalgyrus)

  14. Increased volume of: • Insulasx • Temporalgyrussx • Brainstem

  15. Abnormalfunction: • PrefrontaCortex • ACC • Amygdala • Brainstem

  16. Panicas a PrimalEmotion • Evolutionhassuppliedorganismswith a wide collectionofmechanismstomantaininternalstability and defenceofbodilywellbeing. • Regulatoryphysiologicprocessestake placecontinuoslybeyondconsciousness and onlyoccasionally do they pervade the consciousawarenessas “primalemotions” (Damasio 1999)with the evolutionaryroleofsignalingthat the survivalof the organismisthreatened

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