Association between uncinate fasciculus integrity and agoraphobia symptoms in female patients with panic disorder
Sung Eun Kim 1, Minji Bang 1, Eunsoo Won 1, Sang-Hyuk Lee 1, 2*
1Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea, 2Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
Received: January 20, 2020; Revised: May 6, 2020; Accepted: May 6, 2020; Published online: May 6, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective: Although neural correlates of sub-clinical agoraphobia symptoms have been previously suggested, only a few studies evaluating the structural changes of the brain have been conducted in agoraphobic patients with panic disorder (PD). We investigated and compared the white matter (WM) micro-structural alterations between PD patients with agoraphobia (PD+AG) and those without agoraphobia (PD-AG).
Methods: Our study included 56 female PD patients, of which 25 were diagnosed with agoraphobia and 31 were diagnosed without agoraphobia. Diffusion tensor imaging was performed to investigate the micro-structural changes in the WM tracts related to fronto-temporo-occipital areas (uncinate fasciculus, cingulum bundle, inferior longitudinal/fronto-occipital fasciculus, fornix column and body, and fornix/stria terminalis). All participants were subjected to the Anxiety Sensitivity Inventory-Revised (ASI-R), Beck Depression Inventory (BDI), and Albany Panic and Phobia questionnaires.
Results: The fractional anisotropy values of the right uncinate fasciculus in the PD+AG group were significantly lower than that of the PD-AG group and showed significant correlations with the BDI and ASI-R total scores. Mean diffusivity and radial diffusivity values of the right uncinate fasciculus were significantly higher in PD+ AG as compared to PD-AG.
Conclusions: Our findings suggested that the uncinate fasciculus could be associated with PD+AG, possibly through demyelination. Our findings could contribute to the neurobiological evidence regarding the association between agoraphobia and the WM structural changes in PD.
Keywords: Panic disorder, Agoraphobia, White matter, Neuroimaging


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