Electrocortical evidence for an early abnormal processing of panic-related words in panic disorder patients

Panic patients are hypothesized to have particularly elaborated cortical networks for panic-related stimuli, and this characteristic should be associated with an abnormal automatic processing of these stimuli. Panic-related and neutral words were presented to 25 panic patients and 25 matched healthy controls either at individually determined perception thresholds (threshold condition) or for 1000 ms (above threshold condition). Word recognition for words presented at perception threshold (threshold words), and event-related brain potentials (ERPs) triggered by threshold and above threshold words were analyzed. In the threshold condition, both panic patients and control participants correctly recognized more panic-related than neutral words. An additional analysis restricted to participants who used an intuitive strategy for word identification revealed an enhanced frequency of correctly identified panic-related words in panic patients. In the ERPs, only panic patients exhibited enhanced positive potentials during early time windows (200-400 ms after stimulus presentation) triggered by panic-related compared to neutral threshold words. In late (400-600 ms) and very late (600-1000 ms) time windows, both groups showed a greater ERP positivity for panic-related than for neutral words. These data suggest that panic patients are characterized by an early automatic and elaborated processing of disorder-relevant stimuli.