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International Review of Psychiatry... Oct 2017The association between panic disorder (PD) and cardiovascular diseases (CVD) has been extensively studied in recent years and, although some studies have shown anxiety... (Review)
Review
The association between panic disorder (PD) and cardiovascular diseases (CVD) has been extensively studied in recent years and, although some studies have shown anxiety disorders co-existing or increasing the risk of heart disease, no causal hypothesis has been well established. Thus, a critical review was performed of the studies that evaluated the association between PD and cardiovascular diseases; synthesizing the evidence on the mechanisms mediators that theoretically would be the responsible for the causal pathway between PD and CVD, specifically. This overview shows epidemiological studies, and discusses biological mechanisms that could link PD to CVD, such as pleiotropy, heart rate variability, unhealthy lifestyle, atherosclerosis, mental stress, and myocardial perfusion defects. This study tried to provide a comprehensive narrative synthesis of previously published information regarding PD and CVD and open new possibilities of clinical management and pathophysiological understanding. Some epidemiological studies have indicated that PD could be a risk factor for CVD, raising morbidity and mortality in PD, suggesting an association between them. These studies argue that PD pathophysiology could cause or potentiate CVD. However, there is no evidence in favour of a causal relationship between PD and CVD. Therefore, PD patients with suspicions of cardiovascular symptoms need redoubled attention.
Topics: Cardiovascular Diseases; Heart Rate; Humans; Panic Disorder; Risk Factors
PubMed: 28893114
DOI: 10.1080/09540261.2017.1357540 -
Progress in Neuro-psychopharmacology &... Oct 2016Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our... (Review)
Review
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views.
Topics: Drug Resistance; Humans; Panic Disorder
PubMed: 26850787
DOI: 10.1016/j.pnpbp.2016.02.001 -
American Family Physician Aug 2022
Topics: Anxiety; Anxiety Disorders; Humans; Panic Disorder; Phobic Disorders
PubMed: 35977133
DOI: No ID Found -
Seizure Jul 2018Psychogenic Non-Epileptic Seizures (PNES) are events that appear epileptic but are instead thought to have a psychological origin. Increased rates of several psychiatric... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Psychogenic Non-Epileptic Seizures (PNES) are events that appear epileptic but are instead thought to have a psychological origin. Increased rates of several psychiatric disorders have been reported in PNES, including anxiety and panic disorders. Some theories suggest panic and/or hyperventilation have aetiological roles in PNES, though these remain unproven.
METHODS
We conducted a systematic review of associations of panic and hyperventilation with PNES using Ovid Medline and PubMed, and a meta-analysis where appropriate.
RESULTS
We found eighteen studies reporting rates of panic in PNES and eight studies reporting hyperventilation. The reported rate of panic attacks in PNES ranged from 17% to 83%, with physical symptoms more commonly reported, and affective symptoms less so. 'Dizziness or light-headedness' was found to be more prevalent than 'fear of dying' by random-effects meta-analysis (68% vs. 23%). A proportion meta-analysis found a weighted occurrence of 20% of panic disorder in PNES. A pooled meta-analytic rate of PNES events following voluntary hyperventilation induction was 30%, while the clinically observed rates of peri-ictal hyperventilation in PNES without induction varied from 15 to 46%.
CONCLUSIONS
Previous studies have reported moderate rates of association of panic in PNES, though the proportions varied considerably across the literature, with physical symptoms more commonly reported than affective. Hyperventilation is an effective inducer of PNES events in a minority, and can be observed occurring in a minority of patients without induction. These results support an important, albeit not essential, role for panic and hyperventilation in the pathogenesis of PNES events.
Topics: Humans; Hyperventilation; Panic Disorder; Psychophysiologic Disorders; Seizures
PubMed: 29787922
DOI: 10.1016/j.seizure.2018.05.007 -
Journal of Affective Disorders Mar 2020Computer simulations (CS) and virtual reality exposure are promising techniques for research and treatment of panic disorder with agoraphobia (PDA). The objective of...
BACKGROUND
Computer simulations (CS) and virtual reality exposure are promising techniques for research and treatment of panic disorder with agoraphobia (PDA). The objective of this study was to ascertain whether a given CS was a stimulus capable of producing panic attacks (PAs), anxiety and psychophysiological changes in patients with PDA.
METHODS
Thirty PDA patients and 30 healthy subjects were recruited for this study. Subjects were exposed to a 3-min CS of a situation relevant to agoraphobic patients. Anxiety, panic symptoms, PAs, heart rate, skin conductance and respiration were recorded before, during and after the CS exposure.
RESULTS
The CS effectively induced anxiety, hyperventilation and electrodermal responses in PDA patients but not in healthy subjects. Forty percent of PDA patients had a PA while none of the control subjects had a PA. A subgroup of patients who were less sensitive to the CS than the other subgroup of PDA patients and did not present full-blown PAs still had more panic symptoms, higher anxiety levels and more respiratory irregularities than the controls.
LIMITATIONS
Low immersion and low sense of presence, lack of interaction with the environment.
CONCLUSIONS
Exposure to the CS produced effects similar to in vivo exposure, respiratory and caffeine challenges. Subsequent studies should: make direct comparisons between CS and other challenges for PDA; investigate if CS can be a tool for predicting effects of medication; determine the potential of CS as a desensitization technique for situational PAs.
Topics: Agoraphobia; Anxiety Disorders; Computer Simulation; Humans; Panic; Panic Disorder
PubMed: 31786029
DOI: 10.1016/j.jad.2019.11.081 -
FP Essentials Apr 2023Anxiety disorders are characterized by excessive fear and worry. Generalized anxiety disorder (GAD) and panic disorder (PD) are two of the most common anxiety disorders...
Anxiety disorders are characterized by excessive fear and worry. Generalized anxiety disorder (GAD) and panic disorder (PD) are two of the most common anxiety disorders in the United States. GAD is defined as excessive worry and anxiety that occur on most days for at least 6 months that affect daily functioning. PD is defined by recurrent unexpected panic attacks. Patients with symptoms of GAD or PD should be assessed for conditions such as hyperthyroidism, hyperparathyroidism, and cardiac arrhythmia before confirmation of an anxiety disorder diagnosis. A U.S. Preventive Services Task Force (USPSTF) draft statement recommends screening for anxiety in adults 64 years and younger, including pregnant and postpartum women. A final statement recommends screening for anxiety in children and adolescents ages 8 to 18 years. Multiple self-report tools have been validated for GAD and PD screening. The 7-item Generalized Anxiety Disorder (GAD-7) scale is an option for screening for GAD. The Panic Disorder Severity Scale (PDSS) is a 7-item tool with excellent sensitivity and specificity in screening for PD. Management with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors in combination with psychotherapy has been shown to be effective for GAD and PD. Research on alternative treatments, such as psychedelic-assisted psychotherapy, is ongoing.
Topics: Adult; Pregnancy; Adolescent; Child; Humans; Female; Anxiety Disorders; Panic Disorder; Anxiety; Selective Serotonin Reuptake Inhibitors; Psychotherapy
PubMed: 37036769
DOI: No ID Found -
Neuroscience and Biobehavioral Reviews Oct 2014Panic disorder is twice a common in women than in men. In women, susceptibility to panic increases during the late luteal (premenstrual) phase of the menstrual cycle,... (Review)
Review
Panic disorder is twice a common in women than in men. In women, susceptibility to panic increases during the late luteal (premenstrual) phase of the menstrual cycle, when progesterone secretion is in rapid decline. This article considers the evidence for the midbrain periaqueductal grey (PAG) as a locus for panic and for the use of PAG stimulation as an animal model of panic in both sexes. We show in females how a rapid fall in progesterone secretion, such as occurs during the late dioestrus phase of the ovarian cycle in rats (similar to the late luteal phase in women), triggers a neuronal withdrawal response during which the excitability of the midbrain panic circuitry increases as a result of upregulation of extrasynaptic GABAA receptors on inhibitory interneurones in the PAG. The withdrawal effect is due not to the native hormone but to its neuroactive metabolite allopregnanolone. Differences in the kinetics of allopregnanolone metabolism may contribute to individual differences in susceptibility to panic in women.
Topics: Animals; Disease Models, Animal; Female; Humans; Male; Panic Disorder; Periaqueductal Gray; Progesterone; Receptors, GABA-A; Sex Characteristics
PubMed: 24704571
DOI: 10.1016/j.neubiorev.2014.03.006 -
L'Encephale Feb 2021Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific... (Review)
Review
Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence, given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 pandemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe; thus, caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety relief. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).
Topics: COVID-19; Humans; Pandemics; Panic Disorder
PubMed: 33221039
DOI: 10.1016/j.encep.2020.08.001 -
Translational Psychiatry May 2015Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with... (Review)
Review
Panic disorder (PD), a complex anxiety disorder characterized by recurrent panic attacks, represents a poorly understood psychiatric condition which is associated with significant morbidity and an increased risk of suicide attempts and completed suicide. Recently however, neuroimaging and panic provocation challenge studies have provided insights into the pathoetiology of panic phenomena and have begun to elucidate potential neural mechanisms that may underlie panic attacks. In this regard, accumulating evidence suggests that acidosis may be a contributing factor in induction of panic. Challenge studies in patients with PD reveal that panic attacks may be reliably provoked by agents that lead to acid-base dysbalance such as CO2 inhalation and sodium lactate infusion. Chemosensory mechanisms that translate pH into panic-relevant fear, autonomic, and respiratory responses are therefore of high relevance to the understanding of panic pathophysiology. Herein, we provide a current update on clinical and preclinical studies supporting how acid-base imbalance and diverse chemosensory mechanisms may be associated with PD and discuss future implications of these findings.
Topics: Acid-Base Imbalance; Acidosis; Autonomic Nervous System; Chemoreceptor Cells; Humans; Hydrogen-Ion Concentration; Hyperventilation; Panic Disorder
PubMed: 26080089
DOI: 10.1038/tp.2015.67 -
Journal of Clinical Neuroscience :... Nov 2020Anxiety is commonly observed together with skin diseases and can aggravate them, while skin diseases can increase anxiety. The relationship of skin diseases observed in...
OBJECTIVE
Anxiety is commonly observed together with skin diseases and can aggravate them, while skin diseases can increase anxiety. The relationship of skin diseases observed in panic disorder with quantitative electroencephalography (QEEG) findings has not been investigated yet. The aim of this study is to compare the absolute alpha and delta power of panic disorder patients with and without skin disease.
METHODS
246 panic disorder patients, 19 of whom had skin disease and 227 of whom did not have skin disease, were included in the study. Panic disorder severity scale (PDSS) scores of patients were recorded, and QEEG recording was performed. Absolute alpha and delta power and PDSS scores were compared between the two groups.
RESULTS
It was found that the absolute delta power in the left hemisphere was lower and PDSS scores were higher in the patients with skin diseases compared to the control group. In the patients with skin disease, decreased delta power in the left hemisphere may cause impairment in the processing of positive emotions and may cause trait anxiety.
CONCLUSION
Trait anxiety may increase susceptibility to skin diseases by disrupting cutaneous homeostasis resulting from the prolonged sympathetic nervous system activation.
Topics: Adult; Brain Waves; Case-Control Studies; Dominance, Cerebral; Electroencephalography; Female; Humans; Male; Panic Disorder; Psychiatric Status Rating Scales; Severity of Illness Index; Skin Diseases
PubMed: 33222937
DOI: 10.1016/j.jocn.2020.09.071