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Dissociation of Central From Peripheral and Subjective Measures

Joseph Zohar, MD; Thomas R. Insel, MD; Karen Faith Berman, MD; Edna B. Foa, PhD; James L. Hill, PhD; Daniel R. Weinberger, MD

Arch Gen Psychiatry. 1989;46(6):505-510.

Abstract
• To investigate the relationship between anxiety and regional cerebral blood flow, we administered behavioral challenges to 10 patients with obsessive-compulsive disorder while measuring regional cerebral blood flow with the xenon 133 inhalation technique. Each patient was studied under three conditions: relaxation, imaginal flooding, and in vivo (actual) exposure to the phobic stimulus. Subjective anxiety, obsessive-compulsive ratings, and autonomic measures (heart rate, blood pressure) increased significantly, but respiratory rate and Pco2 did not change across the three conditions. Regional cerebral blood flow increased slightly (in the temporal region) during imaginal flooding, but decreased markedly in several cortical regions during in vivo exposure, when anxiety was highest by subjective and peripheral autonomic measures. These results demonstrate that intense anxiety can be associated with decreased rather than increased cortical perfusion and that ostensibly related states of anxiety (eg, anticipatory and obsessional anxiety) may be associated with opposite effects on regional cerebral blood flow.

Author Affiliations
From the Laboratory of Clinical Science, National Institutes of Mental Health, Bethesda, Md (Drs Zohar, Insel, and Hill); Beer-Sheva (Israel) Mental Health Center, Ben-Gurion University (Dr Zohar); Clinical Brain Disorders Branch, National Institute of Mental Health, Saint Elizabeths Hospital, Washington, DC (Drs Berman and Weinberger); and Medical College of Pennsylvania, EPPI Conference Center, Philadelphia (Dr Foa).

Footnotes
Accepted for publication December 7, 1988.

Reprint requests to NIMH/NIHAC, PO Box 289, Poolesville, MD 20837 (Dr Insel).

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