Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram

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Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram
Authors: Paul D. Carey, James Warwick, Dana J. H. Niehaus, Geoffrey van der Linden, Barend B. van Heerden, Brian H. Harvey, Soraya Seedat, Dan J. Stein
Citation: BMC Psychiatry 4 : 30. 2004
Database(s): PubMed (PMID/15482603)
DOI: 10.1186/1471-244X-4-30.
Link(s): http://www.biomedcentral.com/1471-244X/4/30
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Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram reports a single photon emission computed tomography study on patients with anxiety disorders undergoing treatment with citalopram.

Contents

[edit] Abstract from the BioMed Central CC-by article

[edit] Background

Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment.

[edit] Methods

Single photon emission computed tomography (SPECT) using Tc-99 m HMPAO to assess brain perfusion was performed on subjects with OCD, PTSD, and SAD before and after 8 weeks (SAD) and 12 weeks (OCD and PTSD) treatment with the SSRI citalopram. Statistical parametric mapping (SPM) was used to compare scans (pre- vs post-medication, and responders vs non-responders) in the combined group of subjects.

[edit] Results

Citalopram treatment resulted in significant deactivation (p = 0.001) for the entire group in the superior (t = 4.78) and anterior (t = 4.04) cingulate, right thalamus (t = 4.66) and left hippocampus (t = 3.96). Deactivation (p = 0.001) within the left precentral (t = 4.26), right mid-frontal (t = 4.03), right inferior frontal (t = 3.99), left prefrontal (3.81) and right precuneus (t= 3.85) was more marked in treatment responders. No pattern of baseline activation distinguished responders from non-responders to subsequent pharmacotherapy.

[edit] Conclusions

Although each of the anxiety disorders may be mediated by different neurocircuits, there is some overlap in the functional neuro-anatomy of their response to SSRI treatment. The current data are consistent with previous work demonstrating the importance of limbic circuits in this spectrum of disorders. These play a crucial role in cognitive-affective processing, are innervated by serotonergic neurons, and changes in their activity during serotonergic pharmacotherapy seem crucial.

[edit] Subjects

Subject group #1 (help)
Anxiety disorder patients
Subjects/♂/♀: 37 / 22 / 15
Age: 33.5 ±9.8 (–)
Nationality: define nationality
Approval: define approval
Databases:

Group 1 of 37 anxiety disorder patients with 22 males and 15 females were included in the study. The group had a mean age of 33.5.

Of the 37 patients with anxiety disorders 11 had obsessive-compulsive disorder, 15 had social anxiety disorder and 11 had post-traumatic stress disorder.

[edit] Results

Different statistical threshold were selected for different regions: P<0.001 uncorrected for cingulate, hippocampus, inferior frontal cortex and striatum, while P<0.05 corrected for the rest of the brain.

[edit] Deactivation following treatment for the combined group

Table 2 with four coordinates

Anatomy
BA
x
y
z
No. vox
t
z
Coordinate search
Plot
1 Superior cingulate -4 12 36 44 4.78 Brede Database Brede Wiki NeuroSynth SumsDB Not available
2 Right thalamus 24 -28 12 19 4.66 Brede Database Brede Wiki NeuroSynth SumsDB Not available
3 Anterior cingulate 0 48 8 10 4.04 Brede Database Brede Wiki NeuroSynth SumsDB Not available
4 Left hippocampus -24 -12 -20 7 3.96 Brede Database Brede Wiki NeuroSynth SumsDB Not available

[edit] Responders versus non-responders

Table 3 with 5 coordinates

Anatomy
BA
x
y
z
No. vox
t
z
Coordinate search
Plot
1 Left precentral -24 -20 56 21 4.26 Brede Database Brede Wiki NeuroSynth SumsDB Not available
2 Right mid-frontal 12 64 -8 33 4.03 Brede Database Brede Wiki NeuroSynth SumsDB Not available
3 Right inferior frontal cortex 36 32 -20 17 3.99 Brede Database Brede Wiki NeuroSynth SumsDB Not available
4 Right precuneus 8 -48 16 5 3.85 Brede Database Brede Wiki NeuroSynth SumsDB Not available
5 Left prefrontal -28 60 -8 18 3.81 Brede Database Brede Wiki NeuroSynth SumsDB Not available

[edit] Critique

  1. Different statistical threshold were selected for different regions: P<0.001 uncorrected for cingulate, hippocampus, inferior frontal cortex and striatum, while P<0.05 corrected for the rest of the brain.
  2. Spatial extent threshold on 5 was used.
  3. The SPECT images are not "quantitative", but normalized with "proportional scaling".
  4. The term "superior cingulate" is somewhat unusual.
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