-
General Hospital Psychiatry 2022Caffeine has been purported to have anxiogenic and panicogenic properties, specifically salient in patients with panic disorder (PD). However, compilations of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Caffeine has been purported to have anxiogenic and panicogenic properties, specifically salient in patients with panic disorder (PD). However, compilations of the magnitude of the effect of caffeine on anxiety and panic attacks are lacking and potential dose-response relationships have not been examined.
OBJECTIVES
In the present systematic review and meta-analysis, we aimed to examine the acute effects of placebo-controlled caffeine challenge on occurrence of panic attacks and subjective anxiety in patients with PD and healthy controls (HC), including dose-response relationships.
METHODS
Systematic searches were performed in six databases. We included blinded placebo-controlled studies of acute caffeine challenge on panic attacks and/or subjective anxiety in adult patients with PD.
RESULTS
Of the 1893 identified articles, ten met our inclusion criteria. The 9 studies investigating panic attacks included 237 patients, of which 51.1% had a panic attack following caffeine, but none after placebo. Six of these studies compared 128 patients with 115 healthy controls (HC), finding that patients (53.9%) were more vulnerable than HC (1.7%) for panic attacks following caffeine (log RR: 3.47; 95% CI 2.06-4.87). Six studies investigated subjective anxiety in 121 patients and 111 HC following caffeine, with an overall effect indicating increased sensitivity to the anxiogenic effects of caffeine in the patient group (Hedges' g = 1.02 [95% CI: 0.09-1.96]). The restricted range of caffeine employed [400-750 mg] and few studies (3) not using 480 mg prevented any meaningful analysis of a dose-response relationship.
LIMITATIONS
Of the ten studies included, only 2 reported anxiety data for the placebo condition, precluding a proper meta-analysis comparing anxiogenic effects of caffeine and placebo. The restricted dose range used prevented assessment of dose-response relationships.
CONCLUSIONS
The results confirm that caffeine at doses roughly equivalent to 5 cups of coffee induces panic attacks in a large proportion of PD patients and highly discriminates this population from healthy adults. Caffeine also increases anxiety in PD patients as well as among healthy adults at these doses although the exact relationship between caffeine-induced anxiety and panic attacks remains uncertain. The results suggest that caffeine targets important mechanisms related to the pathophysiology of PD.
IMPLICATIONS
Future studies should employ a wider range of caffeine doses and investigate contributions of biological and psychological mechanisms underlying the anxiogenic and panicogenic effects of caffeine. In the clinic, patients with PD should be informed about the panicogenic and anxiogenic effects of caffeine, with the caveat that little is known regarding smaller doses than 480 mg. Registration. PROSPERO (www.crd.york.ac.uk/prospero) registration number CRD42019120220.
Topics: Adult; Anxiety; Anxiety Disorders; Caffeine; Humans; Panic Disorder
PubMed: 34871964
DOI: 10.1016/j.genhosppsych.2021.11.005 -
Indian Pediatrics May 1996
Review
Topics: Age of Onset; Anti-Anxiety Agents; Child; Diagnosis, Differential; Humans; India; Male; Panic Disorder; Propranolol
PubMed: 8979592
DOI: No ID Found -
Revue Medicale de Liege May 2004Panic attacks can occur unexpectedly and in almost any situation. The present article discusses the main features of anxiety states, the approach, the management and the... (Review)
Review
Panic attacks can occur unexpectedly and in almost any situation. The present article discusses the main features of anxiety states, the approach, the management and the practice guidelines for the treatment of panic disorder.
Topics: Algorithms; Anti-Anxiety Agents; Antidepressive Agents; Cognitive Behavioral Therapy; Diagnosis, Differential; Humans; Panic Disorder
PubMed: 15264579
DOI: No ID Found -
Depression and Anxiety Jun 2014The recently published DSM-5 contains a number of changes pertinent to panic disorder and agoraphobia. These changes include separation of panic disorder and agoraphobia... (Review)
Review
The recently published DSM-5 contains a number of changes pertinent to panic disorder and agoraphobia. These changes include separation of panic disorder and agoraphobia into separate diagnoses, the addition of criteria and guidelines for distinguishing agoraphobia from specific phobia, the addition of a 6-month duration requirement for agoraphobia, the addition of panic attacks as a specifier to any DSM-5 diagnosis, changes to descriptors of panic attack types, as well as various changes to the descriptive text. It is crucial that clinicians and researchers working with individuals presenting with panic attacks and panic-like symptoms understand these changes. The purpose of the current paper is to provide a summary of the main changes, to critique the changes in the context of available empirical evidence, and to highlight clinical implications and potential impact on mental health service utilization. Several of the changes have the potential to improve access to evidence-based treatment; yet, although certain changes appear justified in that they were based on converging evidence from different empirical sources, other changes appear questionable, at least based on the information presented in the DSM-5 text and related publications. Ongoing research of DSM-5 panic disorder and agoraphobia as well as application of the new diagnostic criteria in clinical contexts is needed to further inform the strengths and limitations of DSM-5 conceptualizations of panic disorder and agoraphobia.
Topics: Agoraphobia; Diagnostic and Statistical Manual of Mental Disorders; Humans; Panic Disorder
PubMed: 24865357
DOI: 10.1002/da.22277 -
Annals of the Academy of Medicine,... Mar 2010The panic attack is able to mimic the clinical presentation of an acute coronary syndrome (ACS), to the point of being clinically indistinguishable without appropriate... (Review)
Review
The panic attack is able to mimic the clinical presentation of an acute coronary syndrome (ACS), to the point of being clinically indistinguishable without appropriate investigations. However, the literature actually demonstrates that the 2 conditions are more related than just being differential diagnoses. Through a review of the literature involving epidemiological studies, randomised controlled trials, systematic reviews and meta-analyses found on a Medline search, the relation between panic disorder and ACS is explored in greater depth. Panic disorder, a psychiatric condition with recurrent panic attacks, has been found to be an independent risk factor for subsequent coronary events. This has prognostic bearing and higher mortality rates. Through activation of the sympathetic system by differing upstream mechanisms, the 2 conditions have similar presentations. Another psychiatric differential diagnosis would be that of akathisia, as an adverse effect to antidepressant medications. An overview on the investigations, diagnostic process, treatment modalities and prognoses of the two conditions is presented. Panic disorders remain under-diagnosed, but various interviews are shown to allow physicians without psychiatric training to accurately pick up the condition. Comprehensive multidisciplinary approaches are needed to help patients with both coronary heart disease and anxiety disorder.
Topics: Acute Coronary Syndrome; Humans; Panic Disorder; Risk Factors
PubMed: 20372755
DOI: No ID Found -
Annual International Conference of the... Jul 2023Panic attacks are an impairing mental health problem that impacts more than one out of every 10 adults in the United States (US). Clinical guidelines suggest panic...
Panic attacks are an impairing mental health problem that impacts more than one out of every 10 adults in the United States (US). Clinical guidelines suggest panic attacks occur without warning and their unexpected nature worsens their impact on quality of life. Individuals who experience panic attacks would benefit from advance warning of when an attack is likely to occur so that appropriate steps could be taken to manage or prevent it. Our recent work suggests that an individual's likelihood of experiencing a panic attack can be predicted by self-reported mood and community-level Twitter-derived mood the previous day. Prior work also suggests that physiological markers may indicate a pending panic attack. However, the ability of objective physiological, behavioral, and environmental measures collected via consumer wearable sensors (referred to as digital biomarkers) to predict next-day panic attacks has not yet been explored. To address this question, we consider data from 38 individuals who regularly experienced panic attacks recruited from across the US. Participants responded to daily questions about their panic attacks for 28 days and provided access to data from their Apple Watches. Mixed Regressions, with an autoregressive covariance structure were used to estimate the prevalence of a next-day panic attack Results indicate that digital biomarkers of ambient noise (louder) and resting heart rate (higher) are indicative of experiencing a panic attack the next day. These preliminary results suggest, for the first time, that panic attacks may be predictable from digital biomarkers, opening the door to improvements in how panic attacks are managed and to the development of new preventative interventions.Clinical Relevance- Objective data from consumer wearables may predict when an individual is at high risk for experiencing a next-day panic attack. This information could guide treatment decisions, help individuals manage their panic, and inform the development of new preventative interventions.
Topics: Adult; Humans; United States; Panic Disorder; Quality of Life; Self Report; Affect; Wearable Electronic Devices
PubMed: 38083448
DOI: 10.1109/EMBC40787.2023.10339982 -
Anais Da Academia Brasileira de Ciencias Sep 2005A bibliographic search has been performed in MEDLINE using cortisol and panic as key-words, occurring in the title and/or in the abstract. Human studies were selected,... (Review)
Review
A bibliographic search has been performed in MEDLINE using cortisol and panic as key-words, occurring in the title and/or in the abstract. Human studies were selected, with no time limit. The following publications were excluded: review articles, case reports, panic attacks in disorders other than panic disorder, and studies on changes that occurred in-between panic attacks. The results showed that real-life panic attacks as well as those induced by selective panicogenic agents such as lactate and carbon dioxide do not activate the hypothalamic-pituitary-adrenal (HPA) axis. Agonists of the colecystokinin receptor B, such as the colecystokinin-4 peptide and pentagastrin, increase stress hormones regardless of the occurrence of a panic attack and thus, seem to activate the HPA axis directly. The benzodiazepine antagonist flumazenil does not increase stress hormones, but this agent does not reliably induce panic attacks. Pharmacological agents that increased anxiety in both normal subjects and panic patients raised stress hormone levels; among them are the alpha2-adrenergic antagonist yohimbine, the serotonergic agents 1-(m-chlorophenyl) piperazine (mCPP) and fenfluramine, as well as the psychostimulant agent caffeine. Therefore, the panic attack does not seem to activate the HPAaxis, in contrast to anticipatory anxiety.
Topics: Anxiety; Cholecystokinin; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Panic Disorder; Pituitary-Adrenal System
PubMed: 16127553
DOI: 10.1590/s0001-37652005000300009 -
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 -
Journal of Psychosomatic Research Jul 2021Somatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with...
OBJECTIVE
Somatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with and without panic attack in somatoform disorder.
METHODS
In this cross-sectional study, 341 patients with somatoform disorder according to the MINI-International Neuropsychiatric Interview (M.I.N·I.) were divided into two groups depending on with or without comorbidity of a panic attack, somatoform disorder with a panic attack (SPA, n = 88) and those without panic attack (SNPA, n = 253). Patient Health Questionnaire (PHQ-15), Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) scale was used to identify correlations between SPA group and SNPA group, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on somatic, depressive and anxiety symptoms separately.
RESULTS
The SPA group's PHQ-15, PHQ-9 and GAD-7 scores were significantly higher than those of the SNPA group. Multiple linear regression analyses revealed that the associated factors for PHQ-15 were gender and panic disorder. PHQ-9 was just significantly associated with panic disorder. GAD-7 was significantly associated with education degree and panic disorder.
CONCLUSIONS
Our results suggest that somatoform disorder patients with panic attack suffered more severe clinical symptoms than those without a panic attack.
Topics: China; Cross-Sectional Studies; Humans; Panic Disorder; Somatoform Disorders; Surveys and Questionnaires
PubMed: 33984592
DOI: 10.1016/j.jpsychores.2021.110509 -
AAOHN Journal : Official Journal of the... Jun 2010Panic attack symptoms mimic other serious health problems and have implications for the occupational health nurse. In the workplace, the results of panic disorder may...
Panic attack symptoms mimic other serious health problems and have implications for the occupational health nurse. In the workplace, the results of panic disorder may lead to poor job performance and affect the morale and effectiveness of the entire workplace.
Topics: Humans; Nurse's Role; Occupational Health; Occupational Health Nursing; Panic Disorder; Workplace
PubMed: 20677723
DOI: 10.3928/08910162-20100526-07