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      Fear and panic in humans with bilateral amygdala damage

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          Abstract

          Decades of research have highlighted the amygdala’s influential role in fear. Surprisingly, we found that inhalation of 35% CO 2 evoked not only fear, but also panic attacks, in three rare patients with bilateral amygdala damage. These results indicate that the amygdala is not required for fear and panic, and make an important distinction between fear triggered by external threats from the environment versus fear triggered internally by CO 2.

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          Most cited references21

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          Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society.

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            Double dissociation of conditioning and declarative knowledge relative to the amygdala and hippocampus in humans.

            A patient with selective bilateral damage to the amygdala did not acquire conditioned autonomic responses to visual or auditory stimuli but did acquire the declarative facts about which visual or auditory stimuli were paired with the unconditioned stimulus. By contrast, a patient with selective bilateral damage to the hippocampus failed to acquire the facts but did acquire the conditioning. Finally, a patient with bilateral damage to both amygdala and hippocampal formation acquired neither the conditioning nor the facts. These findings demonstrate a double dissociation of conditioning and declarative knowledge relative to the human amygdala and hippocampus.
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              The pathways of interoceptive awareness

              A network of cortical brain regions including the insula and anterior cingulate cortex (ACC) has been proposed as the critical and sole substrate for interoceptive awareness. Combining lesion and pharmacological approaches in humans, we found the insula and ACC are not critical for awareness of heartbeat sensations. Rather, both somatosensory afferents from the skin and a network including the insula and ACC mediate it. Together these pathways enable the core human experience of the cardiovascular state of the body.
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                Author and article information

                Journal
                9809671
                21092
                Nat Neurosci
                Nat. Neurosci.
                Nature neuroscience
                1097-6256
                1546-1726
                2 August 2013
                03 February 2013
                March 2013
                01 September 2013
                : 16
                : 3
                : 270-272
                Affiliations
                [1 ]Department of Neurology, University of Iowa, Iowa City, Iowa, USA
                [2 ]Department of Psychology, University of Iowa, Iowa City, Iowa, USA
                [3 ]Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
                [4 ]Department of Psychiatry, University of Bonn, Bonn, Germany
                [5 ]Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
                [6 ]Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
                [7 ]Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA
                [8 ]Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa, USA
                [9 ]Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
                [10 ]Department of Veterans Affairs Medical Center, Iowa City, Iowa, USA
                Author notes
                Address Correspondence to: John A. Wemmie MD PhD, or Daniel Tranel PhD, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, Phone: 319-384-3173, Fax: 319-335-7623, john-wemmie@ 123456uiowa.edu , or daniel-tranel@ 123456uiowa.edu
                [*]

                These authors contributed equally to this work

                Article
                NIHMS433137
                10.1038/nn.3323
                3739474
                23377128
                20a2dcae-4d3b-42de-ac23-32bfb748c5f4

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                History
                Funding
                Funded by: National Institute of Mental Health : NIMH
                Award ID: R01 MH085724 || MH
                Funded by: National Institute of Neurological Disorders and Stroke : NINDS
                Award ID: P01 NS019632 || NS
                Categories
                Article

                Neurosciences
                co2,emotion,feeling,interoception,lesion
                Neurosciences
                co2, emotion, feeling, interoception, lesion

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