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The Australian and New Zealand Journal... Sep 2022This review aimed to measure the degree of placebo response in panic disorder. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This review aimed to measure the degree of placebo response in panic disorder.
DATA SOURCES
We searched major databases up to 31 January 2021, for randomized pharmacotherapy trials published in English.
STUDY SELECTION
A total of 43 studies met inclusion criteria to be in the analysis (with 174 separate outcome measurements).
DATA EXTRACTION
Changes in outcome measures from baseline in the placebo group were used to estimate modified Cohen's effect size.
RESULTS
A total of 43 trials (2392 subjects, 174 outcomes using 27 rating scales) were included in the meta-analysis. Overall placebo effect size was 0.57 (95% confidence interval = [0.50, 0.64]), heterogeneity (: 96.3%). Higher placebo effect size was observed among clinician-rated scales compared to patient reports (0.75 vs 0.35) and among general symptom and anxiety scales compared to panic symptoms and depression scales (0.92 and 0.64 vs 0.56 and 0.54, respectively). There was an upward trend in effect size over the publication period ( = 0.02, = 0.002) that was only significant among clinician-rated scales ( = 0.02, = 0.011). There was no significant publication bias, Egger's test ( = 0.08).
CONCLUSION
We observed a substantial placebo effect size in panic disorder. This effect was more prominent for some aspects of panic disorder psychopathology than for others and was correlated with the source of the assessment and publication year. This finding has implications both for research design, to address the heterogeneity and diversity in placebo responses, and for clinical practice to ensure optimal quality of care.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO, CRD42019125979.
Topics: Humans; Outcome Assessment, Health Care; Panic Disorder; Placebo Effect; Publication Bias
PubMed: 34996304
DOI: 10.1177/00048674211068793 -
Frontiers in Physiology 2021Sweating, hot flushes, and blushing are symptoms frequently reported by individuals with anxiety disorders. They represent important reinforcers of anxiogenic... (Review)
Review
Sweating, hot flushes, and blushing are symptoms frequently reported by individuals with anxiety disorders. They represent important reinforcers of anxiogenic cognitions and behaviours. One system that may be involved in the manifestation of these symptoms is the thermosensory/thermoregulatory system. The aim of the present study was to investigate to what extent individuals with anxiety disorders are characterised by alterations in this system. PubMed and PsycINFO were systematically searched. Studies were eligible if they (i) assessed individuals with anxiety disorders, (ii) thermosensation or thermoregulatory effectors/outcomes, and (iii) used a case-control design. = 86 studies were identified. There was no evidence of altered thermosensation in individuals with anxiety disorders. Regarding thermoregulatory effectors, individuals with social anxiety disorder exhibited altered cutaneous vasodilation upon pharmacological challenge; individuals with specific phobia showed increased sweating upon confrontation with phobic stimuli; individuals with panic disorder showed increased daily sweating as well as increased sweating in response to non-phobic and phobic stimuli. Regarding thermoregulatory outcomes, there was evidence for altered skin temperature in all subtypes of anxiety. Whereas there was no evidence of altered thermoregulation in specific phobia, a subgroup of individuals with social anxiety and panic disorder appears to exhibit altered vasodilation and sweating, respectively. Longitudinal research is warranted to investigate whether this represents a vulnerability to anxiety/panic.
PubMed: 34938204
DOI: 10.3389/fphys.2021.784943 -
Heliyon Mar 2022The world has faced many disasters in recent years, but flood impacts have gained immense importance and attention due to their adverse effects. More than half of global... (Review)
Review
The world has faced many disasters in recent years, but flood impacts have gained immense importance and attention due to their adverse effects. More than half of global flood destruction and damages occur in the Asia region, which causes losses of life, damage infrastructure, and creates panic conditions among the communities. To provide a better understanding of flood hazard management, flood vulnerability assessment is the primary objective. In this case, vulnerability is the central construct in flood analysis and assessment. Many researchers have defined different approaches and methods to understand vulnerability assessment and how geographic information systems assess the flood vulnerability and their associated risk. Geographic information systems track and predict the disaster trend and mitigate the risk and damages. This study systematically reviews the methodologies used to measure floods and their vulnerabilities by integrating geographic information system. Articles on flood vulnerability from 2010 to 2020 were selected and reviewed. Through the systematic review methodology of five research engines, the researchers discovered a difference in flood vulnerability assessment tools and techniques that can be bridged by integrating high-resolution data with a multidimensional vulnerability methodology. The study reviewed several vulnerability components and directly examined the shortcomings in flood vulnerability approaches at different levels. The research contributed that the indicator-based approach gives a better understanding of vulnerability assessment. The geographic information system provides an effective environment for mapping and precise analysis to mitigate the flood disaster
PubMed: 35284686
DOI: 10.1016/j.heliyon.2022.e09075 -
Complex Psychiatry 2023Long interspersed nuclear elements (LINEs) are endogenous retrotransposable elements. A few studies have linked the methylation pattern of LINE-1 to different mental... (Review)
Review
INTRODUCTION
Long interspersed nuclear elements (LINEs) are endogenous retrotransposable elements. A few studies have linked the methylation pattern of LINE-1 to different mental disorders (e.g., post-traumatic stress disorder [PTSD], autism spectrum disorder [ASD], panic disorder [PD]). We sought to unify the existing knowledge in the field and provide a better understanding of the association between mental disorders and LINE-1 methylation.
METHODS
A systematic review was executed with 12 eligible articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
For psychotic disorders, PTSD, ASD, and PD, lower LINE-1 methylation levels were detected, whereas for mood disorders, the findings are controversial. The studies were conducted with subjects aged 18-80 years. Peripheral blood samples were utilized in 7/12 articles.
CONCLUSION
Although most studies have shown that LINE-1 hypomethylation was associated with mental disorders, there were still some divergences (i.e., hypermethylation associated with mental disorders). These studies suggest that LINE-1 methylation may be an important factor related to the development of mental disorders and highlight the need to better comprehend the biological mechanisms underlying the role of LINE-1 in mental disorders pathophysiology.
PubMed: 37404869
DOI: 10.1159/000530641 -
Journal of Experimental Pharmacology 2021Several effective pharmacological therapies for panic disorder (PD) are available, but they have some drawbacks, and unsatisfactory outcomes can occur. Expanding the... (Review)
Review
Several effective pharmacological therapies for panic disorder (PD) are available, but they have some drawbacks, and unsatisfactory outcomes can occur. Expanding the variety of anti-panic medications may allow for improving PD treatment. The authors performed an updated systematic review of preclinical and clinical (Phase I-III) pharmacological studies to look for advances made in the last six years concerning novel-mechanism-based anti-panic compounds or using medications approved for nonpsychiatric medical conditions to treat PD. The study included seven published articles presenting a series of preclinical studies, two Phase I clinical studies with orexin receptor (OXR) antagonists, and two clinical studies investigating the effects of D-cycloserine (DCS) and xenon gas in individuals with PD. The latest preclinical findings confirmed and expanded previous promising indications of OXR1 antagonists as novel-mechanism-based anti-panic compounds. Translating preclinical research into clinical applications remains in the early stages. However, limited clinical findings suggested the selective OXR1 antagonist JNJ-61393115 may exert anti-panic effects in humans. Overall, OXR1 antagonists displayed a favorable profile of short-term safety and tolerability. Very preliminary suggestions of possible anti-panic effects of xenon gas emerged but need confirmation with more rigorous methodology. DCS did not seem promising as an enhancer of cognitive-behavioral therapy in PD. Future studies, including objective panic-related physiological parameters, such as respiratory measures, and expanding the use of panic vulnerability biomarkers, such as hypersensitivity to CO panic provocation, may allow for more reliable conclusions about the anti-panic properties of new compounds.
PubMed: 33889031
DOI: 10.2147/JEP.S261403 -
Journal of Behavior Therapy and... Jun 2023Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally... (Review)
Review
BACKGROUND AND OBJECTIVES
Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, panic disorder is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. The objective of this article is to systematically identify and review the empirical literature on emotional management processes and strategies associated with panic disorder, with the aim of evaluating their role in the development and maintenance of panic disorder, in order to better understand the pathogenesis of the disorder and guide clinicians to improve their current treatments.
METHODS
Four databases were searched for studies which were based on self-reported questionnaires or a methodology based on an experimental procedure.
RESULTS
Of the 1719 articles identified, 61 referred to different aspects of emotional management. People living with PD are characterized by low emotional intelligence levels, excessive use of suppression, impaired cognitive reappraisal, high levels of alexithymia and maladaptive coping strategies.
LIMITATIONS
Most of the reviewed studies used measures of emotional management in cross-sectional models and were based on self-assessment reports.
CONCLUSIONS
Improving emotional intelligence levels is key to increasing emotion regulation flexibility for people living with PD. Automatic cognitive reappraisal impairment in these people indicates low importance of cognitive restructuring in psychotherapeutic treatment.
Topics: Humans; Panic Disorder; Affective Symptoms; Emotional Regulation; Cross-Sectional Studies; Emotions; Emotional Intelligence; Adaptation, Psychological
PubMed: 36680910
DOI: 10.1016/j.jbtep.2023.101835 -
The British Journal of Psychiatry : the... Sep 2022Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. (Meta-Analysis)
Meta-Analysis Review
Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.
BACKGROUND
Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence.
AIMS
To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis.
METHOD
We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258).
RESULTS
We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive-behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = -0.67, 95% CI -0.95 to -0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI -0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = -0.61, 95% CI -1.15 to -0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54-1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU.
CONCLUSIONS
CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.
Topics: Agoraphobia; Cognitive Behavioral Therapy; Humans; Network Meta-Analysis; Panic Disorder; Psychotherapy; Psychotherapy, Psychodynamic; Randomized Controlled Trials as Topic
PubMed: 35049483
DOI: 10.1192/bjp.2021.148 -
Translational Psychiatry Apr 2021Maternal immune activation (MIA) during pregnancy is recognized as an etiological risk factor for various psychiatric disorders, such as schizophrenia, major depressive... (Meta-Analysis)
Meta-Analysis Review
Maternal immune activation (MIA) during pregnancy is recognized as an etiological risk factor for various psychiatric disorders, such as schizophrenia, major depressive disorder, and autism. Prenatal immune challenge may serve as a "disease primer" for alteration of the trajectory of fetal brain development that, in combination with other genetic and environmental factors, may ultimately result in the emergence of different psychiatric conditions. However, the association between MIA and an offspring's chance of developing anxiety disorders is less clear. To evaluate the effect of MIA on offspring anxiety, a systematic review and meta-analysis of the preclinical literature was conducted. We performed a systematic search of the PubMed, Web of Science, PsycINFO, and Cochrane Library electronic databases using the PRISMA and World Health Organization (WHO) methodologies for systematic reviews. Studies that investigated whether MIA during pregnancy could cause anxiety symptoms in rodent offspring were included. Overall, the meta-analysis showed that MIA induced anxiety behavior in offspring. The studies provide strong evidence that prenatal immune activation impacts specific molecular targets and synapse formation and function and induces an imbalance in neurotransmission that could be related to the generation of anxiety in offspring. Future research should further explore the role of MIA in anxiety endophenotypes. According to this meta-analysis, MIA plays an important role in the pathophysiological mechanisms of anxiety disorders and is a promising therapeutic target.
Topics: Animals; Anxiety; Anxiety Disorders; Behavior, Animal; Depressive Disorder, Major; Disease Models, Animal; Female; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 33903587
DOI: 10.1038/s41398-021-01361-3 -
Expert Review of Neurotherapeutics 2023Recommendations for treating panic disorder (PD) in older patients are scarce. The authors have systematically reviewed whether several recommended medications are... (Review)
Review
INTRODUCTION
Recommendations for treating panic disorder (PD) in older patients are scarce. The authors have systematically reviewed whether several recommended medications are superior to others and their optimal doses in this age group.
METHODS
A database search of studies involving patients with PD with/without agoraphobia aged ≥ 60 years was carried out using PubMed, PsycINFO, Embase, and Clinical Trials.gov, from their inception dates to 1 March 2023. Only four (published from 2002 to 2010) of the 1292 records screened were included. A risk of bias assessment was provided. This systematic review was performed using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
RESULTS
Two studies were randomized clinical trials, whereas two were open-label, including paroxetine, citalopram, escitalopram, and sertraline; three studies reported short-term evaluations, whereas one study included a 26-week follow-up. Medications provided benefits, with good tolerability. Preliminary results suggested greater benefits of paroxetine in reducing panic attacks vs. cognitive - behavioral therapy, and an earlier decrease in PAs with escitalopram vs. citalopram. Risk of bias was considerable.
CONCLUSIONS
The pharmacological management of PD in older patients has received no attention. Findings are scant, dated, and affected by methodological flaws; thus, they do not provide significant advances.
Topics: Humans; Aged; Panic Disorder; Paroxetine; Citalopram; Selective Serotonin Reuptake Inhibitors; Escitalopram; Randomized Controlled Trials as Topic
PubMed: 37676054
DOI: 10.1080/14737175.2023.2254938 -
Journal of Affective Disorders Jun 2023Heart rate variability (HRV) in patients with emotional disorders and healthy controls (HCs) has been investigated in many studies but the difference between these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Heart rate variability (HRV) in patients with emotional disorders and healthy controls (HCs) has been investigated in many studies but the difference between these emotional disorders was unclear.
METHODS
The PubMed, Embase, Medline and Web of Science databases were systematically searched for studies published in English that compared HCs with generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD) patients in HRV. We conducted a network meta-analysis to compare HRV in patients with GAD, MDD, PD and HCs. HRV outcomes, including time domain indices (the standard deviation of NN intervals (SDNN) and the root mean square of the successive differences between normal heartbeats (RMSSD)), and frequency domain indices (High-frequency (HF), Low-frequency (LF) and the ratio of LF to HF (LF/HF)) were obtained. A total of 4008 participants from 42 studies were included.
RESULTS
The results of pairwise meta-analysis showed that compared with controls, GAD, PD and MDD patients exhibited significantly reduced HRV. Similar findings were also confirmed in network meta-analysis. The most important finding from network meta-analysis was that GAD patients had significantly lower SDNN than PD patients (SMD = -0.60, 95 % CI [-1.09, -0.11]).
CONCLUSION
Our findings provided a potential objective biological marker to distinguish between GAD and PD. In the future, a large sample of research is needed to directly compare HRV of various mental disorders, which is crucial for finding biomarkers to distinguish them.
Topics: Humans; Panic Disorder; Depressive Disorder, Major; Heart Rate; Network Meta-Analysis; Anxiety Disorders
PubMed: 36914118
DOI: 10.1016/j.jad.2023.03.018