惊恐障碍患者血清脂质水平的初步研究

探讨惊恐障碍患者的血脂水平及明确高胆固醇 (Tch)水平是否仅伴发于惊恐障碍或与其他精神障碍有关。　　方法　采用酶法测定在性别、年龄上相匹配的 3 0例惊恐障碍患者、3 0例抑郁症患者及 3 0例正常对照者的血清脂质水平。　　结果　惊恐障碍男患者的血清Tch水平明显高于抑郁症患者和正常对照者 ,稳定内科疾病与高血清Tch水平无关 ;在抑郁症组中 ,焦虑障碍史者的血清Tch水平显著增高。　　结论　提示惊恐障碍男患者的血清高Tch水平 ,可能涉及去甲肾上腺素或 5-羟色胺活性增高假说机制     

惊恐障碍患者血清胆固醇水平及与抗惊恐治疗关系的

研究惊恐障碍患者中的血清胆固醇水平及其与药物之间的关系。方法对３０例惊恐障碍患者与３０例年龄，性别相匹配的正常人治疗前后的胆固醇水平进行对照比较。男性惊恐障碍患者的血清胆固醇水平明显高于男性正常对照者；男性惊恐障碍患者在抗惊恐治疗后的胆固醇水平下降最为显著。     

惊恐障碍患者的血脂浓度研究

血胆固醇(Tch)浓度过高是引起心血管疾病的主要危险因素之一,许多研究表明急性应激状态可使血清Tch和游离脂肪酸水平升高。Hayward等(1989)也发现,患惊恐障碍或广场恐怖症的女病人,其Tch值高于正常水平,在她们之中发生心血管疾病的危险性较大。为进一步研究惊恐障碍患者的血清脂质浓度,本文测定30例惊恐障碍患者的血脂浓度,并与正常对照者作一比较。     

惊恐障碍患者血清胆固醇水平及与抗惊恐治疗关系的研究

研究惊恐障碍患者中的血清胆固醇水平及其与药物之间的关系。方法对３０例惊恐障碍患者与３０例年龄、性别相匹配的正常人治疗前后的胆固醇水平进行对照比较。结果男性惊恐障碍患者的血清胆固醇水平明显高于男性正常对照者；男性惊恐障碍患者（尤其是阿普唑仑使用者）在抗惊恐治疗后的胆固醇水平下降最为显著。结论惊恐障碍患者的血清胆固醇水平升高可能与其内源性焦虑状态有关。     

惊恐障碍与心绞痛患者血清一氧化氮水平对照研究

目的:探讨惊恐障碍与心绞痛之间的关系.方法:检测并比较17例惊恐障碍(惊恐障碍组)与27例心绞痛(心绞痛组)及39名健康者(对照组)血清一氧化氮(NO)和一氧化氮合酶(NOS).结果:两患者组血清NO水平均显著低于对照组,惊恐障碍组与心绞痛组比较血清NO水平无显著差异;惊恐障碍组血清NOS水平与对照组比较无显著差异,心绞痛组血清NOS水平显著低于对照组,两患者组血清NOS水平无显著差异.结论:惊恐障碍与心绞痛症状相似可能与NO的下降有关.惊恐障碍成为心绞痛的危险因素由NO下降得到解释.     

惊恐障碍研究新进展

本文综述了近几年国外对惊恐障碍的流行病学、发病机制、治疗及社会问题四个方面的最新研究进展。     

惊恐障碍患者心率变异性的研究进展

惊恐障碍是一种常见的精神障碍,常伴有自主神经系统功能失调。心率变异性是评估自 主神经系统功能的重要指标,该指标降低被认为是自主神经系统功能异常的体现。本文总结了惊恐障 碍患者与健康人群、其他焦虑障碍患者和心血管疾病患者在心率变异性方面的差异,回顾了药物和心 理治疗对惊恐障碍患者心率变异性的影响,旨在为有效治疗惊恐障碍提供参考。     

惊恐障碍的临床研究进展

本文介绍了近年来国外有关惊恐障碍临床研究的一些进展 ,着重介绍了惊恐谱系障碍的概念以及诊断与鉴别诊断。     

惊恐障碍的临床研究进展

本介绍了近年来国外有关惊恐障碍临床研究的一些进展,着重介绍了惊恐谱系障碍的概念以及诊断与鉴别诊断。     

A 15-year follow-up study of patients with panic disorder

BACKGROUND: Panic disorder (PD) is generally regarded as a chronic condition with considerable variation in severity of symptoms. AIMS: To describe the long-term outcome of naturalistically treated PD. METHODS: Fifty-five outpatients with PD, who participated in a placebo-controlled drug trial of the efficacy of alprazolam and imipramine 15 years ago were reassessed with the same instruments used in the original study. RESULTS: Complete recovery (no panic attacks and no longer on medication during the last 10 years) was seen in 18% of patients, and an additional 13% recovered but were still on medication. Fifty-one percent experienced recurrent anxiety attacks whereas 18% still met diagnostic criteria for PD. The incidence of agoraphobia decreased from 69% to 20%. Patients with agoraphobia at admission tended to have a poorer long-term outcome according to daily functioning compared with patients without agoraphobia at admission, although both groups reported improved daily functioning at follow-up. Maintenance medication was common. No benzodiazepine abuse was reported. CONCLUSION: PD has a favourable outcome in a substantial proportion of patients. However, the illness is chronic and needs treatment. The short-term treatment given in the drug trial had no influence on the long-term outcome.     

Pre-treatment peripheral biomarkers associated with treatment response in panic symptoms in patients with major depressive disorder and panic disorder: A 12-week follow-up study

ObjectivePeripheral biomarkers have been studied to predict treatment response of panic symptoms. We hypothesized that depressive disorder (MDD) vs. panic disorder (PD) would exhibit different peripheral biomarkers, and their correlation with severity of panic attacks (PA) would also differ.MethodsForty-one MDD patients, 52 PD patients, and 59 healthy controls were followed for 12 weeks. We measured peripheral biomarkers along with the Panic Disorder Severity Scale (PDSS) at each visit—pre-treatment, 2, 4, 8, and 12 weeks on a regular schedule. Peripheral biomarkers including serum cytokines, plasma and serum brain-derived neurotrophic factor (BDNF), leptin, adiponectin, and C-reactive protein (CRP) were quantified using enzyme-linked immunosorbent assay (ELISA).ResultsPatients with MDD and PD demonstrated significantly higher levels of pre-treatment IL-6 compared to controls, but no differences were seen in plasma and serum BDNF, leptin, adiponectin, and CRP. Pre-treatment leptin showed a significant clinical correlation with reduction of panic symptoms in MDD patients at visit 5 (p = 0.011), whereas pre-treatment IL-6 showed a negative correlation with panic symptom reduction in PD patients (p = 0.022). An improvement in three panic-related items was observed to be positively correlated with pre-treatment leptin in MDD patients: distress during PA, anticipatory anxiety, and occupational interference.ConclusionHigher pre-treatment leptin was associated with better response to treatment regarding panic symptoms in patients with MDD, while higher IL-6 was associated with worse response regarding panic symptoms in PD patients. Different predictive peripheral biomarkers observed in MDD and PD suggest the need for establishing individualized predictive biomarkers, even in cases of similar symptoms observed in different disorders.     

惊恐障碍的遗传方式探讨

目的 :探讨惊恐障碍的遗传方式。　方法 :采用分离分析方法和多基因阈值理论对 75例惊恐障碍家系进行遗传方式探讨。　结果 :惊恐障碍的遗传方式符合常染色体隐性遗传 ,校正分离率为0 2 35同时也符合多基因遗传 ,一级亲属的加权平均遗传率为 (79 17± 4 39) %。　结论 :惊恐障碍是具有一个隐性主基因的多基因遗传病 ,但也存在不同的遗传背景。     

A 1-year follow-up study of chest-pain patients with and without panic disorder

OBJECTIVE: The aims of this study were to (a) study the persistence of panic disorder (PD); (b) investigate the association between PD at baseline and outcome [chest pain, psychiatric morbidity, health care utilization, suicidal thoughts, work impairment and health-related quality of life (HRQOL)]; (c) study the course of pain, distress, symptom attribution and HRQOL; and (d) describe treatment and perceived treatment needs of patients with PD. METHOD: A 1-year follow-up study of 199 chest-pain patients referred to cardiac outpatient investigation was completed. Assessments included Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), Short-Form McGill Pain Questionnaire, Symptom Checklist-90-Revised, the Illness Attitude Scales, the 36-item Short-Form Health Survey and a chest-pain questionnaire. RESULTS: At follow-up, 57 of the 153 patients reassessed with the SCID suffered from PD. Forty-three of the 55 patients (78%) who were diagnosed with PD at baseline still suffered from PD at follow-up. PD at baseline was associated with pain persistence, psychiatric morbidity (current major depression, pain disorder and simple phobia), significantly higher scores on psychological distress, hypochondriasis, negative outcome expectation, lower scores on seven of the eight dimensions of HRQOL and more general practitioner consultations. Only 6% of the patients with PD used effective treatment, and 3% reported a treatment need at follow-up. CONCLUSION: Despite chronic distress and impairment, we found significant undertreatment of PD, which needs to be addressed in future studies.     

Audiovestibular functioning in patients with panic disorder

OBJECTIVE: The objective of this study was to investigate audiovestibular function in patients with panic disorder and healthy subjects by using vestibular and audiologic tests. METHODS: Thirty-four panic disorder patients and 20 healthy control subjects were assessed by using clinical otoneurological examination, pure tone audiometry, tympanometry, and electronystagmography (ENG). All patients were evaluated with the Panic and Agoraphobia Scale (PAS), the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the State-Trait Anxiety Inventory (STAI). RESULTS: On vestibular testing, abnormal responses were more prevalent in panic disorder patients compared to healthy controls. The presence of agoraphobia in panic disorder patients did not make a significant difference on vestibular test results. The only variable that may be a predictor of vestibular abnormalities in panic disorder patients was found to be dizziness between attacks. CONCLUSION: The results show that dizziness between panic attacks may warrant audiovestibular testing among other medical investigations.     

Phosphate levels as a possible state marker in panic disorder: preliminary study of a feasible laboratory measure for routine clinical practice

Objective

Low serum phosphate level is considered one of the metabolic adaptations to the respiratory alkalosis induced by hyperventilation associated with panic disorder. The aim of this study was to assess phosphatemia as a possible state marker for panic disorder.

Methods

Sixteen panic disorder patients underwent clinical assessment with a semi-structured interview, a set of rating scales and the self-rated State and Trait Anxiety Inventory (STAI), as well as extraction of venous blood samples at baseline and after 12 weeks of pharmacological treatment. Ten healthy volunteers of similar sex, age and educational level filled out the STAI and gave blood samples at baseline and 12 weeks later.

Results

The median (25th–75th percentiles) of phosphate levels (mg/dl) was 2.68 (2.22–3.18) among patients and 4.13 (3.74–4.70) among healthy volunteers respectively (P < 0.001). Seven (44%) patients and no healthy volunteers presented low serum phosphate (<2.50 mg/dl) at baseline; this patient abnormality was corrected in all cases after successful treatment. At baseline, the age-adjusted correlation between phosphate levels and state-anxiety was −0.66 (P < 0.001) among all 26 participants and −0.51 (P = 0.05) among the 16 panic disorder patients.

Conclusions

Measurement of phosphate levels could be easily introduced into clinical practice as a possible marker for chronic hyperventilation in panic disorder, although further investigations with larger sample sizes are necessary to characterize panic disorder patients with low versus normal phosphate levels.     

Body temperature in patients with panic disorder treated with escitalopram

The aim of the study was to investigate the influence of escitalopram on peripheral body temperature (PBT) in panic disorder. In a 4 week case–control study (N = 12 female patients; N = 12 matched healthy controls), the daytime PBT declined compared to night time PBT in patients. The prospective relationship between PBT and panic disorder shows a decline of daytime PBT compared to the night time PBT in panic disorder from week 2 of treatment with escitalopram onwards. The effect of escitalopram on daytime PBT may have occurred through an activation of the sympathetic system.     

Pre-morbid alexithymia in panic disorder: A cohort study

Whether alexithymia is a personality trait which increases the risk of Panic Disorder (PD) is still debated. In this prospective study, alexithymic levels were evaluated before, during and after an anxious episode. Therefore, the alexithymic levels, the presence of PD and the severity of anxious-depressive symptoms were evaluated, at intervals of about 1 month, in pregnant women, attending the Centers for Prenatal Care, using the Toronto Alexithymia Scale (TAS-20), the Primary Care Evaluation of Mental Disorders and the Hospital Anxiety and Depression Scale (HADS). Twenty-one women affected by PD and 256 healthy women (controls) were included in the study. Women who developed PD, compared to controls, showed similar TAS-20 and HADS scores during the pre-morbid phase, a significant increase of them during PD and a significant decrease after symptoms improvement, whereas no change was observed in controls. Our data suggest that in pregnant women alexithymia does not represent a personality trait that increases the risk of developing PD, and they support the hypothesis that alexithymia is a state dependent phenomenon in PD pregnant women.