NEWS
04.03.19: Aarhus, Dänemark: M. Lotze. Brain imaging studies on Brain imaging of sensorimotor integration in musicians and chill responses to music.16.02.19: New publication on fMRI of S1 and TMS of M1 in patients with CRPS from Pfannmöller J., Strauss S., Langner I., Usichenko T., Lotze M. (2019) Unilateral Altered Correlations in the Sensorimotor Cortex of Upper Limb CRPS I Patients in Restaurative Neurologie and Neuroscience, in press.
14.02.19: New publication on VBM of the brain and quality of life by Hahm S., Lotze M., Domin M., Schmidt S. (2019) The association of health-related quality of life and cerebral gray matter volume in the context of aging: A voxel-based morphometry study with a general population sample. NeuroImage, in press.
11.02.19: New Publication on somatotopic-functional parcellation of interhemispheric callosal primary motor fibres in "Brain Structure and Function" by Domin M. and Lotze M.: Parcellation of Motor Cortex associated Regions in the Human Corpus Callosum on the basis of Human Connectome Project data.
29.01.19: New Review on Plasticity in Neuroscience and Biobehavioral Reviews: Cerebral Plasticity as the Basis of Recovery following Brain Damage von Lotze M., Ladda A.M., Stephan K.M.
New article 28.01.19: Kohler M., Strauss S., Horn U., Langner I., Usichenko T., Neumann N., Lotze M. (2019) Differences in neuronal representation of mental rotation in CRPS patients and healthy controls. The Journal of Pain, in press.
New article 12/2018: in Scientific Reports: The Sexual Dimorphism of Local Gray Matter: Novel findings from 2,838 Adult Brains. from Lotze M., Domin M., Gerlach F.H., Gaser C., Luders E., Schmid C.O., Neumann N. doi.org/10.1038/s41598-018-38239-2
New article 11/2018: Frontiers in Neurology, section Stroke; Arm Ability Training (AAT) promotes dexterity recovery after a stroke – a review of its design, clinical effectiveness and the neurobiology of the actions; Thomas Platz and Martin Lotze
21.9.18: Lotze M., Roschka S., Domin M., Platz T. (2018) Predicting training gain for a three week period of arm ability training in the subacute stage after stroke. Frontiers Neurology/Stroke Front. Neurol. 9:854.
7.7.18: FENS Berlin: K. Klepzig, J. Dammann, E. Schenkenberger, B. Kordass, M. Lotze. Changes in trait anxiety in patients with craniomandibular disorder (CMD) are associated with decrease in anterior insula fMRI-activation during occlusion. Poster
17.6.18: OHBM Singapure: Pfannmöller J, Strauß S, Langner I, Usichenko T, Lotze M. Multi-Modal Investigation of the Reduced Sensorimotor Performance in Unilateral CRPS I Patients. Poster
12.6.18: Review on resting state biomarkers for pain chronification in Brain and Cognition:
Resting-State Biomarkers for Chronic Pain - A Network View; Authors: Jörg Pfannmöller and Martin Lotze
11.6.18: New article on DTI and iuvenile epilespsy: Domin M., Bartels S., Geithner J., Wang I., Runge U., Grothe M., Langner S., von Podewils F. (2018) Juvenile myoclonic epilepsy shows potential structural white matter abnormalities: a TBSS study. Front Neurol. doi: 10.3389/fneur.2018.00509
4.4.2018: New Publication on expertise research using VBM: Neumann N, Domin M, Erhardt K, Lotze, M (2018) Voxel-based morphometry in creative writers: Gray-matter increase in a prefronto-thalamic-cerebellar network. European Journal of Neuroscience, in press.
22.1.2018: Contribution for the ENIGMA-Project entitled "Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study" which just came out in BRAIN 2018: 141; 391–408.
3.1.2018: New article about cerebral representation of mental training of finger sequencing in HBM: Lebon F., Horn U., Domin M., Lotze M. (2018) Motor imagery training: kinesthetic imagery strategy and inferior parietal fMRI activation. Human Brain Mapping, in press.
9. December 2017: DGNR, Berlin: Biomarkers and longitudinal Arm Ability Training study in the subacute stage after stroke.
26. November 2017: New study out on boostering motor training with intermittierend thetha-burst stimulation over M1: Platz T, Adler-Wiebe M., Roschka S., Lotze M. (2017) Enhancement of motor learning by focal intermittent theta burst stimulation (iTBS) of either the primary motor (M1) or somatosensory area (S1) in healthy human subjects. Restorative Neurology and Neuroscience, in press.
19. September 2017: Young Academics Price for Elischa Krause; International Society for the Advancement in Respiratory Psychophysiology (Annual Meeting in Lille, France) for his presentation: Don‘t panic: Brain and respiratory responses to increasing dyspnea in high and low suffocation fearful individuals
17. August 2017: Assoziation of heart rate variability and emotional recognition (Reading the Mind in the Eyes Test): Lischke A., Lemke D., Neubert J., Hamm AO.*, Lotze M.* (*equal contribution; 2017) Inter-individual differences in heart rate variability are associated with inter-individual differences in mind-reading; Scientific Reports, in press.
29. July 2017: Associations of classical acupuncture points and skin branches of the vagus nerve: Usichenko T., Hacker H, Lotze M. (2017) Transcutaneous auricular vagal nerve stimulation (taVNS) might be a mechanism behind the analgesic effects of auricular acupuncture. Brain Stimulation, in press.
2. July 2017: New Report from Biological Psychology: Wendt, J. Löw, A., Weymar, M., Lotze, M., Hamm, A.O. (2017)
Active Avoidance and Attentive Freezing in the Face of Approaching Threat. Neuroimage, in press.
31. May 2017: New Report on VBM in Multiple Sclerosis:
Grothe M., Lotze, M., Langner, S., Dressel A. (2017)
Impairments in walking ability, dexterity and cognitive function in multiple sclerosis are associated with
different regional cerebellar gray matter loss. Cerebellum, in press.
6. April 2017: Keynote Lecture: "Functional representation of long-term motor training in healthy individuals, in patients with chronic pain and after cerebral stroke" (Martin Lotze) on the 13. International Workshop on Functional Magnetic Resonance Imaging in the Neurosciences, Olomouc, Czech Republic.
21. March 2017: Cohort data on back pain, sleep duration and quality, polysomnography and grey matter loss of the human brain (Martin Lotze), Neura, Sydney, University of NSW.
17. March 2017: New article on long-term motor training and interhemispheric excitability balance: Grothe M, Doppl K, Roth C, Roschka S, Platz T, Lotze M. (2017) Changes in motor cortex excitability for the trained and non-trained hand after long-term unilateral motor training. Neuroscience Letters, in press.
3. January 2017: New case-control-study on altered processing of chill-response to musical and non-musical stimuliin "Frontiers Human Neuroscience": Grunkina V., Holtz K, Klepzig K., Neubert J., Horn U., Domin M., Hamm A., Lotze M. (2017) The anterior left insula as a monitor of bodily reaction and felt chill – a case-control functional imaging study.
23. October 2016: New publication on the functional representation of tactile finger stimulation in "Neuroscience": Pfannmöller J.P., Greiner, M., Balasubramanian M., Lotze M. (2016) Precise evaluation of primary functional somatosensory representation using high resolution fMRI. Neuroscience, in press.
5. October 2016: New article in "Brain Stimulation" about the effect of somatosensory stimulation of the finger tips on long-term hand motor training in healthy volunteers
Lotze, M., Ladda, A-M., Roschka, S., Platz, T., Dinse, H.R. (2016) Priming hand motor training with repetitive electric stimulation of the finger tips; performance gain and neural training effects, Brain Stimulation, in press.
Talk at the MPI Leipzig 20. September 2016: Funktional representation of long-term motor training in healthy individuals and after cerebral stroke; Martin Lotze
16. September 2016:Talk at the Jahreskongress Gesellschaft für Nervenheilkunde: Functional imaging of creativity and musical expertise; Martin Lotze
14. September 2016; Greifswald: Das Dentale. Zähne im Kontext; Bernd Kordass & Martin Lotze
Contributions for the TMS-meeting, Göttingen, 7th-9th September 2016:
-Effect of long term comprehensive training of the left hand in strongly right handed participants: reduction of interhemispheric asymmetry in intracortical facilitation (ICF);
Lotze M, Doppl K, Roschka S, Grothe M, Platz T
- Effects of inhibitory theta burst TMS to different brain sites involved in visuospatial attention – a combined neuronavigated cTBS and behavioural study;
Platz T, Schüttauf J, Aschenbach J, Mengdehl C, Lotze M
23.08.2016: New review on MRI-biomarker for monitoring and prognosis of upper limb motor outcome after stroke:
Horn U., Grothe M., Lotze M. (2016) MRI-Biomarkers for hand motor outcome-prediction and therapy-monitoring following stroke. Neural Plasticity, in press.
Annual Meeting of the Organization for Human Brain mapping; Geneva 26.-30. June 2016
Contributions of our group:
- High resolution fMRI of CRPS associated reorganization in Brodmann Area 3b (Jörg Pfannmöller)
- Higher fractional anisotropy in the left pyramidal tract but no association with handedness in cohort data (Martin Domin)
- Motivational characteristics of expert performance (Nicola Neumann)
- Increase of motor gain and changes in neural representation after tactile primed hand training (Martin Lotze)
- Functional imaging correlates of recovered swallowing after dysphagia (Paul Glad Mihai)
- fMRI activation and connectivity of the ventral premotor cortex in a longitudinal stroke study (Ulrike Horn)
Summer School Neurorehabilitation 2016; Greifswald 15.-18. June 2016
www.wiko-greifswald.de/de/veranstaltung/article/summer-school-neurorehabilitation-2016.html
Open Talks at the Summer School at 7 p.m.:
Wednesday, 15. of June: A humanoid robot as 'therapist' in neurorehabilitation? (Fernando Fernández Rebollo)
Friday, 17. of June: Erholt sich das Gehirn, wenn ja, wie? (Martin Lotze)
27.5.2016: Prize for the best PHD-projects 2016 of the University Greifswald for Dr. Katharina Erhard and our work on neural correlates of creative writing
New article on the representation of chewing:
Lotze M., Domin M., Kordass B. (2016) Symmetry of fMRI activation in the primary sensorimotor cortex during unilateral chewing. Clinical Oral Investigations, in press.
New article about restitution of neurogenic dysphagia after stroke: Mihai, P.G., Otto, M., Domin, M., Platz, T., Hamdy, S., Lotze, M. (2016) Brain imaging correlates of recovered swallowing after dysphagic stroke: an fMRI and DWI study. Neuroimage Clinical, in press.
New article about restitution of hand motor function and representation of hand movements:
Horn, U., Roschka, S., Eyme, K., Walz, A.D., Platz, T., Lotze, M. (2016) Increased ventral premotor cortex recruitment after arm training in an fMRI study with subacute stroke patients. Behavioral Brain Research, in press.
International Symposium on Music Performance: Art and Neuroscience in Dialogue in Tübingen from 29.4. to 1.5.2016: ismp2016.de
Latest voxel-based-morphometry article on grey matter increase in professional singers in Neuroimage: Kleber, B., Veit, R. , Moll, C.V., Gaser, C., Birbaumer, N., Lotze, M. (2016) The brain of opera singers revisited: increased gray-matter density in right somatosensory and auditory regions revealed by voxel-based morphometry. Neuroimage, in press.
März 2016: New article on Prediction of motor outcome after subacute stroke in frontiers human neuroscience: Lindow, J., Domin, M., Grothe, M, Horn, U, Eickhoff, S.B., Byblow, W.D., Lotze, M. (2016) Connectivity-based predictions of hand motor outcome for mildly affected patients at the sub-acute stage after stroke. Frontiers Human Neuroscience, in press.
journal.frontiersin.org/article/10.3389/fnhum.2016.00101/full
February 2016: New article on theta-burst stimulation to induce a neglect in healthy volunteers: Platz, T., Schüttauf, J., Aschenbach, J., Mengdehl C., Lotze, M. (2016) Effects of neuronavigated cTBS to different brain sites involved in visuospatial attention. Rest. Neurol Neurosci., in press. www.ncbi.nlm.nih.gov/pubmed/26923615
New BIM-blog on our Pain-article entitled:“Anaesthetizing forearm decreases sensorimotor impairment and cortical excitability in CRPS"
www.bodyinmind.org/pain-physiology-crps
Title Journal of Pain
New publication of the acupuncture research team: Usichenko, T.*, Laqua, R.*, Leutzo, B., Lotze, M. (2015) Preliminary Findings of Cerebral Responses on Transcutaneous Vagal Nerve Stimulation on Experimental Heat Pain. Brain Imaging and Behavior, accepted. * equal contribution.
New VBM-study on chronic back pain:Fritz, H.C., McAuley, J.H., Wittfeld, K., Hegenscheid, K., Schmidt, C.O., Langner, S., Lotze, M. (2015) Chronic back pain is associated with decreased prefrontal and anterior insular gray matter. Results from a population-based cohort study. Journal of Pain, in press.
New ALE-Review on the expertise topic: Neumann, N., Lotze, M., Eickhoff, S.B. (2015) Cognitive expertise: an ALE meta-analysis. Human Brain Mapping, in press.
Workshop 3rd to 6th October 2015 in Berlin and Greifswald
AvH Research Linkage and DFG Speed vs. Accuracy Projects
New publication on chronic neuropathic pain in Pain: Strauß S, Grothe M, Usichenko T, Neumann N, Byblow WD, Lotze M. (2015) Inhibition of the primary sensorimotor cortex by topical anesthesia of the forearm in patients with CRPS (www.ncbi.nlm.nih.gov/pubmed/?term=CRPS+Pain+M1+Strauss).
"Future in Plasma Science“ at the Leibniz Institute Greifswald: Free-your-mind session
14th of July 2015; 5pm; Train your brain -plasticity in the motor and cognitive system; Martin Lotze
After Work Summer Garden Party of the Lab; June 2015
Defense of Magali Fernández-Salazar
on the 25th of June 2015
at the Sorbonne/Paris
with her work entitled:
"LA DIMENSION ÉMOTIONNELLE DE LA DOULEUR CHRONIQUE.
PERSPECTIVES NEUROPHILOSOPHIQUES SUR LA DOULEUR DU MEMBRE FANTÔME"
www.paris-sorbonne.fr/Mme-MARIA-MAGALI-FERNANDEZ-SALAZAR
22-27.6.2015:
International young academics meeting on „Data evaluation in cohort studies” in the Alfried Krupp Kolleg, Greifswald
www.wiko-greifswald.de/de/veranstaltung/article/datenauswertung-in-kohortenstudien.html
Professor Paul Thompson
Alfried Krupp Kolleg; 23. Juni 2015 • 19:00 Uhr
"Cohort Studies in Brain Disease"
www.wiko-greifswald.de/de/veranstaltung/article/cohort-studies-in-brain-disease.html
Prof. Dr. Simon B. Eickhoff
Alfried Krupp Kolleg; 22. Juni 2015 • 19:00 Uhr
"Evaluating BIG DATA of the human brain – approaches in Jülich"
www.wiko-greifswald.de/de/veranstaltung/article/evaluating-big-data-of-the-human-brain-approaches-in-juelich.html
Johannes C. Eichstaedt.
Alfried Krupp Kolleg; 22. Juni 2015 • 08:30 Uhr
"Measuring Psychological States through Social Media"
www.wiko-greifswald.de/de/veranstaltung/article/soziale-medien-als-quelle-psychologischer-erkenntnisse.html
Lecture from Dr. James Mc Auley from NEURA in Sydney on
"Reassurance Strategies on Back Pain Therapy" at 18th of June 2015
Defense Paul Glad Mihai; "Funktional Imaging of cerebral representation of swallowing " at the 10th of June 2015
Defense Katharina Erhard; fMRI-measurements of verbal creativity" at the 3rd of June 2015
Posterprice (500€) for: Connectivity-based predictions of hand motor outcome at the sub-acute stage after stroke
New article on high-resolution mapping of the somatosensory cortex in JMRI:
Pfannmöller J, Schweitzer, R, Lotze M. (2015) An Automated Analysis Protocol for high resolution BOLD-fMRI Mapping of the Fingertip Somatotopy in Brodmann Area 3b. Journal of Magnetic Resonance Imaging, in press.
Latest article on swallowing and aging
Windel AS*, Mihai PG*, Lotze M. (2015) Neuroimaging of swallowing in the elderly, Behavioral Brain Research, in press.
Latest article on motor training: Walz A., Doppl K., Kaza E., Roschka S., Platz T., Lotze M. (2014) Changes in cortical, cerebellar and basal ganglia representation after comprehensive long term unilateral hand motor training. Behavioral Brain Research, in press.
Some blogs and discussions about the NeuroImage article on creative writing:
1. thewritelife.com/writing-well-new-study
2. www.thegamesmenplay.com/blog/2014/6/24/creative-writing-and-the-voice-and-movie-in-my-head
3. www.farces.com/the-neuroscience-of-creative-writing
4. ptbertram.wordpress.com/tag/neuroscience-of-creative-writing
5. www.sciencealert.com.au/features/20141107-25864-2.html
6. nikkimalbert.com/2014/07/14/neuroscience-of-creative-writing
7. broadviews.wordpress.com/2014/06/22/this-is-your-brain-on-writing
8. www.themunicheye.com/news/Wired-for-imagination-2906
9. www.zmescience.com/medicine/mind-and-brain/fmri-writers-neuroscience-24062014
10. www.howtobeabetterwriter.com/the-write-stuff
20.6.14: Report in the recent New York Times about our article on creative writing:
www.nytimes.com/2014/06/19/science/researching-the-brain-of-writers.html?action=click&contentCollection=Science®ion=Footer&module=MoreInSection&pgtype=article
Latest Publications; 2014:
Erhard, K., Kessler, F., Neumann, N., Ortheil H.-J., Lotze, M. (2014) Professional training in creative writing is associated with enhanced fronto-striatal activity in a literary text continuation task. Neuroimage, in press.
von Bohlen und Halbach O, Lotze M, Pfannmöller JP (2014) Post-mortem magnetic resonance microscopy (MRM) of the murine brain at 7 Tesla results in a gain of resolution as compared to in-vivo MRM. Frontiers in Neuroanatomy. in press.
Domin M., Langner S., Hosten N., Lotze M. (2014) Comparison of parameter threshold combinations for diffusion tensor tractography in chronic stroke patients and healthy subjects. PlosOne, in press.
Fritz H.C., Wittfeld K, Schmidt C O, Domin M, Grabe H J, Hegenscheid K, Hosten N, Lotze M (2014) Current smoking and reduced gray matter volume – a voxel-based morphometry study. Neuropsychopharmacology, in press.
Ladda AM., Pfannmöller JP., Kalisch T., Roschka S., Platz T., Dinse HR., Lotze M. (2013) Effects of combining 2 weeks of passive sensory stimulation with active hand motor training in healthy adults. PlosOne 9(1):e84402.
Usichenko TI, Wesolowski T, Lotze M (2014) Verum and sham acupuncture exert distinct cerebral activation in pain processing areas: a crossover fMRI investigation in healthy volunteers, Brain Imaging and Behavior, in press.
Fernández-Salazar M. (2014) Cortical plasticity related to chronic pain in a continuous interaction of neuronal and mental processes. Cognitive Critique. Vol. 8.
Music Medicine and Music Physiology Award 2013 for our study: "Encoding and recall of finger sequences in experienced pianists compared with musically naïve controls: A combined behavioral and functional imaging study".
Posteraward, iSAMS Congress, Karolinska Institute, Stockholm 2013: "Auricular stimulation reduces BOLD signal in insular cortex of responders exposed to thermal pain – an fMRI crossover investigation", Laqua R, Lotze M, Leutzow B, Usichenko TI.
Award of our project: „Prevention of obesity in childhood“ (Lauffer, Hamm and Lotze) with one of the prevention awards of the German Adipositas Society on the 3rd of October 2013 in Hannover.
Defence Benjamin Gebel 12.09.2013. Title: "Instrument specific activation maps in musicians".
Lecture: Prof. Dr. Winston Byblow (Movement Neuroscience Laboratory, Department of Sport & Exercise Science, Centre for Brain Research, The University of Auckland), 11.9.2013 at 9.30 a.m. Neurology meeting room:
"Two perspectives of motor recovery after stroke’"
Report about our study on instrument-specific plasticity: www.bodyinmind.org/it-is-the-instrument-that-shapes-your-brain-and-not-only-the-time-you-spend-with-it
Greifswald Cityrun;
Flavia Di Pietro (Sydney) after running the 10 km distance (7th best of more than 100 women participating)
Science Price of the Medical Association, Greifswald:
Gebel B., Braun Ch., Kaza E., Altenmüller E., Lotze M. (2013) Instrument specific brain activation in sensorimotor and auditory representation in musicians. Neuroimage, 74:37-44.
Seminar with Prof. Simon Eickhoff and Professor Silke Anders; 9. und 10.5.2013; Advanced-User-Seminar: ANATOMY, ALE, Connectivity analyses.
Our main topic:
The fact that the brain is changing continuously is one of the most challenging results from brain research of the last two decades. These adaptation processes can be documented by electrophysiological parameters (e.g. evoked potentials in response to a stimulus), with secondary parameters to energy consumption in the brain (e.g. blood oxygenation level dependent (BOLD) effect), with changes in neurotransmitters (e.g. NMDA, glutamate) but also morphological changes (e.g. axional sprouting, changes in synapses, changes of cortical thickness, rewiring of white matter etc.). All these changes have been documented after repetitive training in a physiologic condition in animal and men. However, adaptation of the brain to a changing environment or a differential interaction of the body with the environment is not only positive. There are maladaptive processes in response to changes which are at least associated with pathology. For instance for pain processing a repetitive nociceptive stimulus does not only result in changes in the neural transmission but also in brain changes as for instance in changes of cortical representation of the hurting body part and over long periods to changes of the morphology (cortical and subcortical atrophy). Maladaptive changes are difficult to stop and as longer they last as less restitution can be achieved. With respect to our understanding of therapy on chronic pain these findings have deeply changed our understanding and treatment concepts for chronic pain.
With respect to restitution of function after cerebral damage comparable processes have been described which hamper relearning and beneficial reorganization. For instance there is an imbalance between the affected and the non-affected hemisphere which reduces training affects of the affected limb after motor impairment due to stroke. New therapy approaches reduce these imbalances to facilitate training and knowledge about these non-beneficial processes individualizes training in neurorehabilitation.
Most of our work has been concentrated on these issues.
We currently perform the following studies:
1) Neuropathic pain is associated with cortical and behavioral changes which might not all be based on impaired usage of the limb. One aspect is a neglect-like symptom for the affected hand. We use functional imaging and TMS to learn mote about the interaction of body representation and sensorimotor control of the affected and the unaffected limb. This work is currently performed in a tight interaction wit Lorimer Moseley’s group in Australia (Adelaide and Sydney) and Winston Byblow’s group in New Zealand (Auckland).
2) We are working on the interaction of arts, repetitive training and creativity.
One direction of these studies is centered on musicians, the other on expert versus creative performance and associated brain representation networks. The studies on musicians are centered on comparisons of expert instrumentalists and expert singers during performance of musical performance in the fMRI-scanner. We therefore use cutting-edge technology to allow musical performance in the scanner. We modulate sensory feedback (somatosensory anesthesia, auditory feedback) to learn more about sensorimotor interaction associated with expertise.
Another direction is associated with verbal creativity. In a cooperation project with the University of Hildesheim we investigate neural correlates of creative verbal processes in expert writers in comparisons to non-experts. We identified a fronto-striatal network associated with verbal creativity and writing experience.
In a third study we investigate the ability of drawers to detect characteristic items of the human face during drawing a portrait. This study is performed in a cooperation of the Institute for Fine Arts at the University of Greifswald (Caspar David Friedrich Institute).
3) Another large field of research is the imaging of plastic changes of the brain.
These includes A) basic concepts of brain plasticity B) precise identification of different plasticity processes C) identification of these processes and their role for pathologic symptoms D) development of strategies for increasing beneficial plastic processes and decrease or avoid maladaptive plasticity.
We build on different approaches for the investigation of these issues: we use the Brucker 7 Tesla ClinScan in our department to cooperate with groups investigating basic principles in the animal model (e.g. research on dementia together with Stephan Teipel, Rostock). Additionally, we investigate repetitive training processes in healthy participants using functional magnetic resonance imaging -fMRI, voxel based morphology -VBM, diffusion tensor imaging –DTI and transcranial magnetic stimulation /TMS.
Thirdly, in cooperation with the clinicians of the University Hospital, we investigate patients suffering form brain damage (Neurology, BDH-Rehabilitation Hospital), chronic neuropathic pain (Taras Usichenko; pain ambulance; Bernd Kordass; dental hospital) and psychological diseases (e.g. cooperation projects with the groupof Alfons Hamm, Psychology, studies on the understanding of panic disorder).