Psychophysiological response patterns in panic disorder

To determine whether panic disorder patients exhibit physiological hyperarousal during rest or during mild, non-panic-inducing stress, 18 patients who experienced frequent panic attacks were compared with nonanxious controls on a battery of physiological assessments. During baseline, patients with panic disorder exhibited higher forehead electromyographic activity, higher systolic blood pressure and higher heart rates than non-anxious volunteers. During psychological stress, heart rate and systolic blood pressure rose more in patients with panic disorder than in nonanxious controls. The skin conductance response, however, was greater and more variable in the nonanxious controls. The results suggest that panic disorder patients with frequent panic attacks exhibit heightened cardiovascular arousal and decreased electrodermal flexibility than nonanxious people, even in nonthreatening situations.     

Increased sympathetic response to standing in panic disorder

Although autonomic function has been investigated in panic disorder (PD), previous studies have not used non-invasive beat by beat blood pressure (BP) monitoring to assess the rapid dynamics of BP during autonomic reflex tests. The hypothesis of the current study was that patients with PD would show increased cardiovascular sympathetic reactivity compared with healthy or anxious controls, as assessed by the initial overshoot of diastolic BP during the immediate response to standing. Patients with PD (n=56), social phobia (n=28) and healthy volunteers (n=56) were tested using finger photoplethysmography during an orthostatic challenge. Panic disorder patients showed an increased BP overshoot compared with both control groups. Moreover, in a preliminary assessment of selective serotonin reuptake inhibitor treatment effects, the BP overshoot was significantly reduced towards normal values. These findings are consistent with recent evidence for increased sympathetic baroreflex function in PD and may be relevant to the pathophysiology of the disorder.     

Growth hormone response to clonidine in panic disorder patients

The growth hormone (GH) response to clonidine administration (2 micrograms/kg) was compared in three groups of subjects: seven panic disorder patients, seven depressed patients matched for age and sex, and seven normal controls. As previously reported, patients with affective disorders show a blunted GH response to clonidine. Only one panic disorder patient had a blunted GH response to clonidine, and this patient had recently received a tricyclic antidepressant.     

Prolactin response to TRH in patients with panic disorder

The effects of TRH administration (400 microg, i.v.) on the release of prolactin were examined in 15 patients who met DSM-III-R criteria for panic disorder and 15 normal control subjects. Four hundred micrograms TRH was given via IV route. Blood samples were taken before TRH administration (baseline values) and at 15, 30 and 60 min. The results demonstrate that prolactin responses to TRH did not differ between panic disorder patients and normal control subjects. When only women were evaluated, the findings indicate that women with PD tend to show excessive prolactin responses to TRH. The findings are discussed in view of findings from earlier reports.     

Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks

The therapeutic response to phenelzine sulfate was evaluated during 6 months' treatment of 35 outpatients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The possible influence of nonspecific predictors of drug efficacy and some biochemical parameters were investigated. Therapeutic response was assessed on standardized rating scales. Agoraphobic patients showed a significantly higher frequency of panic attacks when compared to the subjects with uncomplicated panic disorder. Phenelzine treatment blocked panic attacks in 100% of the patients with panic disorder and in 94.7% of the agoraphobics. Anticipatory anxiety and avoidant behavior improved markedly, although not statistically significantly, in 73.6% of the agoraphobics.     

Differential drug response of panic and agoraphobic avoidance in a case of panic disorder

A case is presented of a patient with severe panic disorder and agoraphobia in whom initial treatment with clomipramine resulted in complete elimination of panic attacks, with no improvement in agoraphobic avoidance. The addition of phenelzine to the pre-existing clomipramine treatment resulted in rapid and complete disappearance of the agoraphobic avoidance. The possible implications of this case for our understanding of the neurobiological relationship between panic attacks and agoraphobia are discussed.     

Patterns of response during placebo treatment of panic disorder

Data from the cross-national study of panic disorder are used for an analysis of response patterns. The main purpose of the study is a search for specific placebo patterns and a discussion of possible differences in patterns from patients treated with alprazolam, imipramine, and placebo. Four outcome measures were registered at baseline and weekly during the treatment period: the number of panic attacks, Physician's Global Evaluation of treatment effect, the Overall Phobia Score and the level on the Hamilton Rating Scale for Anxiety. Response patterns from the 3 treatment groups are described and compared, and subsequently categorized with regard to completeness and persistency. No specific placebo pattern is recognized. Some differences are found, however, as many placebo patients demonstrate an early and temporary remission. The variations in response patterns do not compromise the blindness of the study, and their predictive validity is low.     

Photosensitivity in panic disorder

Background: The objective of this study is to evaluate abnormal light‐related behavior in patients with panic disorder (PD). Methods: We administered the Photosensitivity Assessment Questionnaire to 30 subjects with PD and to 40 healthy subjects. The Photosensitivity Assessment Questionnaire is a self‐report questionnaire that evaluates two dimensions of photosensitivity: photophilia and photophobia. Results: Compared to healthy controls, PD subjects reported significantly higher scores on the photophobia (P<.003) and significantly lower scores on the photophilia (P<.001) questions. Conclusions: Subjects with PD indicated that they tolerate and seek light to a significantly lower degree than normal controls. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Fluoxetine in panic disorder

This paper presents the cases of two patients who suffered from panic disorder with agoraphobia and depression. One had been refractory to alprazolam and tricyclics and to behaviour therapy; she had responded to phenelzine, but due to a weight gain of 50 lbs, had discontinued treatment and she relapsed. The second patient, who also suffered from post-traumatic stress disorder, did not respond to alprazolam, imipramine or to phenelzine, but gained weight (33 lbs) on phenelzine. Both patients responded to fluoxetine 80 mg per day without concomitant weight gain.     

Medical illness and response to treatment in primary care panic disorder

OBJECTIVE: Although studies have suggested that comorbid medical illness can affect the outcome of patients with depression, little is known about whether medical illness comorbidity affects treatment outcome in patients with anxiety. METHOD: Primary care patients with panic disorder (n=232), participating in a randomized collaborative care intervention of CBT and pharmacology, were divided into those above (n=125) and below (n=107) the median for burden of chronic medical illness and assessed at 3, 6, 9 and 12 months. RESULTS: Subjects with a greater burden of medical illness were more psychiatrically ill at baseline, with greater anxiety symptom severity, greater disability and more psychiatric comorbidity. The intervention produced significant and similar increases in amount of evidence-based care, and reductions in clinical symptoms and disability that were comparable in the more and less medically ill groups. CONCLUSIONS: The comparable response of individuals with more severe medical illness suggests that CBT and pharmacotherapy for panic disorder work equally well regardless of medical illness comorbidity. However, the more severe psychiatric illness both at baseline and follow-up in these same individuals suggest that treatment programs may need to be extended in time to optimize treatment outcome.     

Cortisol response during different anxiogenic challenges in panic disorder patients.

The present study assessed the relation of cortisol response to anxiogenic reactivity during intravenous lactate infusion and oral fenfluramine in 12 panic disorder (PD) patients who responded positively to both challenges and in eight non-reactive control subjects. There was no significant cortisol response difference between the PD patients and the controls during lactate infusion, but there was s significant difference at 120 min during the fenfluramine challenge. These findings are consistent with the possibility that these challenges stimulate different neurobiologic mechanisms and that fenfluramine-precipitated anxiety is more akin to anticipatory or generalized anxiety than to true panic anxiety.     

惊恐障碍患者杏仁核对情绪图片反应模式的研究

目的 探讨惊恐障碍患者对情感刺激相关的杏仁核时程反应.方法 13例首次发病、未经治疗的惊恐障碍患者(惊恐障碍组)和13名健康个体(对照组)在被动注视任务下行功能磁共振成像(fMRI);采用感兴趣区分析方法,比较2组被试的杏仁核在正性、中性和负性情绪图片任务下组块间的血氧依赖信号时间反应特征,并对情绪图片愉悦度等评分.结果 (1)对正性任务,左侧杏仁核存在“组×时间”交互作用[F(4,96) =4.89,P＜0.01],右侧杏仁核表现时间效应[F(4,96)=4.85,P＜0.01],2组均呈激活强度显著降低形式;(2)对负性图片被动注视任务,右侧杏仁核表现显著的组间差异[F(1,24) =9.01,P＜0.01],惊恐障碍组强于对照组;(3)中性图片被动注视任务条件下,惊恐障碍组和对照组双侧杏仁核在组水平、时间水平和组×时间交互作用的差异无统计学意义(均P＞ 0.05).结论 惊恐障碍患者表现为杏仁核对正性和负性情绪图片反应敏感、增强,从fMRI方面支持惊恐障碍患者情绪反应敏感的假设.