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L'Encephale Jun 2020Although 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 epidemic 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 reduction. 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: Anxiety; Anxiety Disorders; Betacoronavirus; COVID-19; Catastrophization; Comorbidity; Coronavirus Infections; Dyspnea; Female; Humans; Hypokalemia; Male; Pandemics; Panic Disorder; Pneumonia, Viral; Psychotropic Drugs; Renin-Angiotensin System; Respiration; SARS-CoV-2; Stress, Psychological; Terminology as Topic; Torsades de Pointes
PubMed: 32507556
DOI: 10.1016/j.encep.2020.05.010 -
International Journal of Environmental... Dec 2022Allowing there to be an undersupply of medical resources and infection amid the social workforce, this paper proposes a theory to show how panic buying is induced and...
Allowing there to be an undersupply of medical resources and infection amid the social workforce, this paper proposes a theory to show how panic buying is induced and how bad the workforce status could be. By developing a novel general equilibrium model, we find that for any retail price that is higher than the buyer's reserve value, the buying competition will be induced and the medical resources supply will further be tightened. Moreover, if the transmission rate of COVID-19 surpasses the theoretical threshold that is proposed by this paper, the whole workforce in our simulated economy will inevitably be infected.
Topics: Humans; COVID-19; Panic; Marketing; Consumer Behavior; Workforce
PubMed: 36554773
DOI: 10.3390/ijerph192416891 -
General Psychiatry 2019Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived... (Review)
Review
Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder.
BACKGROUND
Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO inhalation) and their relation to subsequent panic attacks and panic disorder.
METHOD
We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder.
RESULTS
We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder.
CONCLUSIONS
These findings provide support for the prediction derived from cognitive-behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development.
TRIAL REGISTRATION NUMBER
135908.
PubMed: 31922089
DOI: 10.1136/gpsych-2019-100140 -
Dialogues in Clinical Neuroscience 2011Experimental neurochemical provocation of panic attacks in susceptible human subjects has considerably expanded our knowledge of the pathophysiology and... (Review)
Review
Experimental neurochemical provocation of panic attacks in susceptible human subjects has considerably expanded our knowledge of the pathophysiology and psychopharmacology of panic disorder. Some panicogens also elicit short-lived panic-like states in healthy man. This offers the opportunity to assess the anti-panic action of drugs in proof-of-concept studies. However, from current data it is still unclear whether experimental panic in healthy man is a valid translational model. Most such studies in healthy volunteers have been performed using a cholecystokinin tetrapeptide (CCK-4) challenge. While CCK-4 panic was blocked by alprazolam pretreatment, escitalopram showed negative results in healthy man. Preliminary findings on novel investigational drugs and a few problematic results will be reviewed. Small sample sizes in many panic provocation studies, lack of dose-response aspects, and still-insufficient knowledge about the biological underpinning of experimental and spontaneous panic limit the interpretation of existing findings and should inspire further research.
Topics: Alprazolam; Anti-Anxiety Agents; Clinical Trials as Topic; Drug Design; Humans; Panic Disorder; Tetragastrin; Translational Research, Biomedical
PubMed: 22275853
DOI: 10.31887/DCNS.2011.13.4/mkellner -
Yonsei Medical Journal Feb 2003Panic disorder (PD) in children and adolescents is a disabling and chronic condition, which is accompanied by psychosocial and academic difficulties both during... (Review)
Review
Panic disorder (PD) in children and adolescents is a disabling and chronic condition, which is accompanied by psychosocial and academic difficulties both during adolescence and into adulthood. In this article, the prevalence, clinical characteristics, risk factors, comorbid states, differential diagnosis, and treatment of PD are reviewed. Although PD was thought to be rare in children and adolescents, the prevalence of PD in community samples ranges between 0.5% and 5.0, and in pediatric psychiatric clinics from 0.2% to 10%. Panic attacks are reported to be equally prevalent in males and females. Clinical studies have shown that the majority of the PD pediatric patients receiving consultation in clinics are older adolescents, Caucasian, female, and middle class. Up to 90% of children and adolescents with PD have other anxiety disorders (generalized anxiety disorder/overanxious disorder, separation anxiety disorder, social phobia or agoraphobia), or mood disorders (major depressive disorder or bipolar disorder). PD patients can be misdiagnosed or having neurologic, cardiovascular, pulmonary, or gastrointestinal illness. Psychoeducation and psychosocial treatments are recommended, and it appears that selective serotonin reuptake inhibitors (SSRIs) are a safe and promising treatment for children and adolescents with PD. The clinical characteristics, long-term course, and treatment of PD in children and adolescents needs to be further assessed by well-designed studies.
Topics: Adolescent; Child; Comorbidity; Humans; Panic Disorder; Prevalence
PubMed: 12619196
DOI: 10.3349/ymj.2003.44.1.174 -
Neuroscience and Biobehavioral Reviews Oct 2014The Deakin/Graeff hypothesis proposes that different subpopulations of serotonergic neurons through topographically organized projections to forebrain and brainstem... (Review)
Review
The Deakin/Graeff hypothesis proposes that different subpopulations of serotonergic neurons through topographically organized projections to forebrain and brainstem structures modulate the response to acute and chronic stressors, and that dysfunction of these neurons increases vulnerability to affective and anxiety disorders, including panic disorder. We outline evidence supporting the existence of a serotonergic system originally discussed by Deakin/Graeff that is implicated in the inhibition of panic-like behavioral and physiological responses. Evidence supporting this panic inhibition system comes from the following observations: (1) serotonergic neurons located in the 'ventrolateral dorsal raphe nucleus' (DRVL) as well as the ventrolateral periaqueductal gray (VLPAG) inhibit dorsal periaqueductal gray-elicited panic-like responses; (2) chronic, but not acute, antidepressant treatment potentiates serotonin's panicolytic effect; (3) contextual fear activates a central nucleus of the amygdala-DRVL/VLPAG circuit implicated in mediating freezing and inhibiting panic-like escape behaviors; (4) DRVL/VLPAG serotonergic neurons are central chemoreceptors and modulate the behavioral and cardiorespiratory response to panicogenic agents such as sodium lactate and CO2. Implications of the panic inhibition system are discussed.
Topics: Animals; Brain; Humans; Inhibition, Psychological; Panic; Panic Disorder; Respiration Disorders; Serotonergic Neurons
PubMed: 24661986
DOI: 10.1016/j.neubiorev.2014.03.010 -
Annals of Palliative Medicine Sep 2023Episodic breathlessness is often accompanied by panic. A vicious cycle of breathlessness-panic-breathlessness leads to emergencies with severe breathlessness and/or fear...
BACKGROUND
Episodic breathlessness is often accompanied by panic. A vicious cycle of breathlessness-panic-breathlessness leads to emergencies with severe breathlessness and/or fear of dying. However, the interaction between episodic breathlessness and panic is poorly understood. Thus, the aim is a better understanding of the interaction between panic and episodic breathlessness to develop appropriate support for patients suffering from this symptom.
METHODS
Patients suffering from episodic breathlessness due to life-limiting diseases answered questions on the characteristics of episodic breathlessness and panic-spectrum psychopathology, including underlying mechanisms. Using the Patient Health Questionnaire and the Structured Clinical Interview for DSM-IV Diagnoses (SCID), patients were screened for panic disorder. An open-ended question captured the patients' descriptions of panic during breathlessness episodes.
RESULTS
Forty-six patients [52% women, mean age =66 years; standard deviation (SD) 7.3 years] provided information: 61% suffered from panic during the entire breathlessness episode, 39% experienced panic in every episode, and 25% were diagnosed with panic disorder. Exploratory data analysis was conducted. Patients with high scores in breathlessness catastrophizing thoughts experienced more panic in a breathlessness episode (P<0.001) and considered themselves more panic than low-scorers (P=0.024). There was a significant indirect effect of episodic breathlessness intensity on the panic experienced in an episode, and this effect was mediated by catastrophizing thoughts regarding breathlessness (b=0.164; 95% CI: 0.105, 0.222). Patients described in the open-ended question experiencing only panic or breathlessness, or a combination of both. Some patients managed to differentiate panic from episodic breathlessness, and used strategies to avoid panic in an episode.
CONCLUSIONS
Research on treatment options for episodic breathlessness should not only focus on panic in breathlessness episodes, but also on underlying mechanisms such as catastrophizing thoughts, as they aggravate the burden.
Topics: Humans; Female; Aged; Male; Cross-Sectional Studies; Dyspnea; Fear
PubMed: 37691331
DOI: 10.21037/apm-22-1304 -
Journal of the American Academy of... Jan 1992Childhood panic attacks and panic disorder were assessed retrospectively in adult anxiety clinic patients (N = 343) and their adult relatives (N = 560). Only nine (1%)...
Childhood panic attacks and panic disorder were assessed retrospectively in adult anxiety clinic patients (N = 343) and their adult relatives (N = 560). Only nine (1%) of the 903 subjects were judged to have experienced spontaneous panic attacks before age 13 by clinically trained interviewers. The narrative summaries of these cases were reviewed, and only three of nine provided convincing descriptions of spontaneous panic attacks in childhood. The authors conclude that prepubertal spontaneous panic attacks are rare, and that retrospective assessments of panic phenomena are difficult, even among adequately trained mental health professionals.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anxiety Disorders; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Panic; Panic Disorder; Personality Development; Phobic Disorders; Retrospective Studies
PubMed: 1537761
DOI: 10.1097/00004583-199201000-00017 -
American Family Physician Apr 2020
Review
Topics: Adult; Anti-Anxiety Agents; Arousal; Benzodiazepines; Humans; Panic; Panic Disorder; Treatment Outcome
PubMed: 32227829
DOI: No ID Found -
Neural Plasticity 2009Data from studies with humans have suggested that abnormalities of midbrain structures, including the periaqueductal gray matter (PAG), could be involved in the... (Review)
Review
Data from studies with humans have suggested that abnormalities of midbrain structures, including the periaqueductal gray matter (PAG), could be involved in the neurobiology of panic disorder (PD). The electrical stimulation of the PAG in neurosurgical patients induces panic-like symptoms and the effect of drugs that are effective in the treatment of PD in the simulation of public speaking model of anxiety is in agreement with data from animal models of PD. Structural neuroimaging studies have shown increases in gray matter volume of midbrain and pons of PD patients. There is also evidence of lower serotonin transporter and receptor binding, and increases of metabolism in the midbrain of PD patients. Nevertheless, these midbrain abnormalities can not be considered as specific findings, since neuroimaging data indicate that PD patients have abnormalities in other brain structures that process fear and anxiety.
Topics: Animals; Anxiety; Disease Models, Animal; Electric Stimulation; Humans; Models, Biological; Panic; Panic Disorder; Periaqueductal Gray; Serotonin
PubMed: 19283082
DOI: 10.1155/2009/108135