-
Arquivos de Neuro-psiquiatria Sep 2002The panic-respiration connection has been presented with increasing evidences in the literature. We report three panic disorder patients with nocturnal panic attacks...
The panic-respiration connection has been presented with increasing evidences in the literature. We report three panic disorder patients with nocturnal panic attacks with prominent respiratory symptoms, the overlapping of the symptoms with the sleep apnea syndrome and a change of the diurnal panic attacks, from spontaneous to situational pattern. The implication of these findings and awareness to the distinct core of the nocturnal panic attacks symptoms may help to differentiate them from sleep disorders and the search for specific treatment.
Topics: Adrenergic Uptake Inhibitors; Adult; Circadian Rhythm; Dyspnea; Female; Humans; Male; Middle Aged; Nortriptyline; Panic Disorder; Polysomnography; Sleep Wake Disorders
PubMed: 12364936
DOI: 10.1590/s0004-282x2002000500006 -
CNS Neuroscience & Therapeutics 2009The current study investigates race-ethnic differences in rates of panic disorder, panic attacks and certain panic attack symptoms by jointly combining three major... (Comparative Study)
Comparative Study
The current study investigates race-ethnic differences in rates of panic disorder, panic attacks and certain panic attack symptoms by jointly combining three major national epidemiological databases. The compared groups were White, African American, Latino and Asian. The White group had significantly higher rates of panic disorder, and of many panic symptoms, including palpitations, as compared to the African American, Asian and Latino groups. Several expected race-ethnic differences were not found. An explanation for these findings are adduced, and suggestions are given for future studies so that possible ethnic-racial differences in panic disorder, panic attacks and panic attack symptoms can be investigated in a more rigorous manner.
Topics: Adult; Black or African American; Asian; Cooperative Behavior; Cross-Cultural Comparison; Cross-Sectional Studies; Ethnicity; Female; Health Surveys; Hispanic or Latino; Humans; Male; Middle Aged; Panic Disorder; Racial Groups; White People
PubMed: 19691544
DOI: 10.1111/j.1755-5949.2009.00092.x -
International Journal of Emergency... 2011Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic events--are predictive of later mental health status, including the...
Research suggests that perievent panic attacks--panic attacks in temporal proximity to traumatic events--are predictive of later mental health status, including the onset of depression. Using a community sample of New York City residents interviewed 1 year and 2 years after the World Trade Center Disaster, we estimated a structural equation model (SEM) using pre-disaster psychological status and post-disaster life events, together with psychosocial resources, to assess the relationship between perievent panic and later onset depression. Bivariate results revealed a significant association between perievent panic and both year-1 and year-2 depression. Results for the SEM, however showed that perievent panic was predictive of year-1 depression, but not year-2 depression, once potential confounders were controlled Year-2 stressors and year-2 psychosocial resources were the best predictors of year-2 depression onset. Pre-disaster psychological problems were directly implicated in year-1 depression, but not year-2 depression. We conclude that a conceptual model that includes pre- and post-disaster variables best explains the complex causal pathways between psychological status, stressor exposure, perievent panic attacks, and depression onset two years after the World Trade Center attacks.
Topics: Adjustment Disorders; Adult; Comorbidity; Cross-Sectional Studies; Female; Follow-Up Studies; Health Surveys; Humans; Life Change Events; Male; Models, Psychological; New York City; Panic Disorder; Prospective Studies; Risk Factors; September 11 Terrorist Attacks; Social Support
PubMed: 21957721
DOI: No ID Found -
Biological Psychiatry Dec 1998This paper reviews the pathophysiology of panic disorder (PD), within the context of newly described "fear circuitries," which have been well characterized in... (Review)
Review
This paper reviews the pathophysiology of panic disorder (PD), within the context of newly described "fear circuitries," which have been well characterized in preclinical models. Substantial advances in the neurosciences have made it possible for clinical neuroscientists to refine our understanding of the pathophysiology of PD and the mechanisms of currently effective treatment. These advances have in turn helped generate testable hypotheses for future neurobiological and psychopharmacologic research. Perturbation of mutual modulation ("cross talk") between key brain transmitter systems (serotonin, norepinephrine, gamma-aminobutyric acid, corticotropin-releasing factor, and others) may underlie the pathogenesis of panic-anxiety. Restoration of normal homeostasis may be an important therapeutic component of antipanic therapy and may provide information about underlying neurocircuits. Neuroimaging, an important new tool, has already begun to bridge the gap between the preclinical and clinical neurosciences through confirmation of hypothesized dysfunction of the complex human prefrontal cortex and its subcortical components. In higher species, such as humans, dysfunction of cortical inhibition or excessive cortical activation of caudal limbic structures is postulated to lead to activation of the phylogenetically conserved amygdalofugal pathways. Consistent with probable subtypes of PD, overlapping theoretical models of panic neurocircuitries are proposed, including ventilatory dysregulation, which is coupled with neurovascular instability in a critical area of the panic neurocircuitry--the amygdalohippocampus. Neuroimaging appears a critical tool in guiding further elaboration of the interaction of cortical and subcortical components of the panic neurocircuitry, whereas challenge studies appear crucial in gathering further information regarding brain stem dysfunction.
Topics: Animals; Brain; Fear; Humans; Neural Pathways; Neurotransmitter Agents; Panic Disorder
PubMed: 9861469
DOI: 10.1016/s0006-3223(98)00300-x -
Revista Brasileira de Psiquiatria (Sao... May 2007This article focuses on the differential activation of the hypothalamic-pituitary-adrenal axis in generalized anxiety disorder and panic disorder. (Review)
Review
OBJECTIVE
This article focuses on the differential activation of the hypothalamic-pituitary-adrenal axis in generalized anxiety disorder and panic disorder.
METHOD
The results of recently reported reviews of the literature are summarized and discussed.
RESULTS
The results of experimental studies that assayed adrenocorticotropic hormone, cortisol and prolactin show 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 axis. Agonists of the cholecystokinin receptor B such as the cholecystokinin-4 peptide and pentagastrin increase stress hormones regardless of the occurrence of a panic attack and, thus, seem to activate the hypothalamic-pituitary-adrenal axis directly. The benzodiazepine antagonist flumazenil does not increase stress hormones, but this agent does not reliably induce panic attacks. Pharmacological agents that increase anxiety in both normal people and panic patients (caffeine, yohimbine, serotonergic agonists) raise stress hormone levels.
CONCLUSIONS
In addition to the differences in symptomatology and pharmacological response, generalized anxiety disorder and panic disorder affect stress hormones in distinct ways. While anticipatory anxiety and generalized anxiety disorder activate both the hypothalamic-pituitary-adrenal and the sympathoadrenal axes, panic attack causes major sympathetic activation, but has little effect on the hypothalamic-pituitary-adrenal axis.
Topics: Adrenocorticotropic Hormone; Animals; Carbon Dioxide; Disease Models, Animal; Humans; Hypothalamo-Hypophyseal System; Lactic Acid; Panic Disorder; Pituitary-Adrenal System; Prolactin; Stress, Psychological
PubMed: 17546345
DOI: 10.1590/s1516-44462007000500002 -
Medicine Jul 2020Agoraphobia is frequently accompanied by panic disorder and causes considerable suffering. The aim of this study was to compare clinical features and treatment courses... (Observational Study)
Observational Study
Agoraphobia is frequently accompanied by panic disorder and causes considerable suffering. The aim of this study was to compare clinical features and treatment courses between patients with and without agoraphobia in panic disorder.In this retrospective study, 87 patients with panic disorder were divided into two groups depending on the presence of agoraphobia: patients with agoraphobia (PDA, nā=ā41) and patients without agoraphobia (PD, nā=ā46). Agoraphobia subscale score of the Albany Panic and Phobia Questionnaire was used to identify correlations between agoraphobia and panic and affective symptoms.The PDA group showed more severe panic and affective symptoms than the PD group. Patients with PDA were more likely to be younger at the age of onset, take benzodiazepines for longer durations, and be treated with antipsychotics augmentation. Agoraphobia subscale was associated with panic symptoms, depression, anxiety, and the duration of benzodiazepines use.The findings suggest that patients with PDA experienced more severe panic symptoms, more profound psychiatric comorbidity, and worse illness progression than those with PD.
Topics: Adult; Agoraphobia; Benzodiazepines; Female; Humans; Male; Middle Aged; Panic Disorder; Retrospective Studies; Young Adult
PubMed: 32791758
DOI: 10.1097/MD.0000000000021414 -
Nature Neuroscience Feb 2013Post-traumatic stress disorder, panic disorder and phobia manifest in ways that are consistent with an uncontrollable state of fear. Their development involves heredity,... (Review)
Review
Post-traumatic stress disorder, panic disorder and phobia manifest in ways that are consistent with an uncontrollable state of fear. Their development involves heredity, previous sensitizing experiences, association of aversive events with previous neutral stimuli, and inability to inhibit or extinguish fear after it is chronic and disabling. We highlight recent progress in fear learning and memory, differential susceptibility to disorders of fear, and how these findings are being applied to the understanding, treatment and possible prevention of fear disorders. Promising advances are being translated from basic science to the clinic, including approaches to distinguish risk versus resilience before trauma exposure, methods to interfere with fear development during memory consolidation after a trauma, and techniques to inhibit fear reconsolidation and to enhance extinction of chronic fear. It is hoped that this new knowledge will translate to more successful, neuroscientifically informed and rationally designed approaches to disorders of fear regulation.
Topics: Animals; Brain; Extinction, Psychological; Fear; Humans; Learning; Memory; Nerve Net; Neural Pathways; Panic Disorder; Phobic Disorders; Stress Disorders, Post-Traumatic
PubMed: 23354388
DOI: 10.1038/nn.3296 -
Journal of Affective Disorders Oct 2015While current theories on perception of interoceptive signals suggest impaired interoceptive processing in psychiatric disorders such as panic disorder or depression,...
BACKGROUND
While current theories on perception of interoceptive signals suggest impaired interoceptive processing in psychiatric disorders such as panic disorder or depression, heart-rate (HR) interoceptive accuracy (IAc) of panic patients under resting conditions is superior to that of healthy controls. Thus, in this study, we chose to assess further physiological parameters and comorbid depression in order to get information on how these potentially conflicting findings are linked together.
DESIGN
We used a quasi-experimental laboratory design which included multi-parametric physiological data collection of 40 panic subjects and 53 matched no-panic controls, as well as experimental induction of stress and relaxation over a time-course.
METHODS
Stress reactivity, interoceptive awareness (IAw; from the Body Perception Questionnaire (BPQ)) and IAc (as correlation between self-estimation and physiological data) were major outcome variables. Self-estimation of bioparametrical change was measured via numeric rating scales.
RESULT
Panic subjects had stronger HR-reaction and more accurate HR-interoception. Concurrently, though, their IAc of skin conductance level, pulse amplitude and breathing amplitude was significantly lower than that of the control group. Interestingly, comorbid depression was found to be associated with increased IAw but attenuated IAc.
LIMITATIONS
Demand characteristics and a categorical approach to panic confine the results.
CONCLUSION
The potentially conflicting findings coalesce, as panic was associated with an increase of the ability to perceive the fear-related parameter and a simultaneous decrease of the ability to perceive other parameters. The superordinate integration of afferent signals might be impaired.
Topics: Adult; Awareness; Case-Control Studies; Comorbidity; Depression; Depressive Disorder; Fear; Female; Heart Rate; Humans; Interoception; Male; Middle Aged; Panic; Panic Disorder; Stress, Psychological
PubMed: 26186533
DOI: 10.1016/j.jad.2015.07.010 -
Clinical and Experimental Rheumatology Jun 2022Fibromyalgia (FM) is a syndrome of unknown aetiology characterised by chronic widespread musculoskeletal pain and associated with high rates of psychiatric...
OBJECTIVES
Fibromyalgia (FM) is a syndrome of unknown aetiology characterised by chronic widespread musculoskeletal pain and associated with high rates of psychiatric comorbidities, mainly mood and anxiety disorders.This study aims to determine the age at onset (AAO) and temporal sequencing patterns of FM and its frequent and distinguishable psychiatric comorbidities, the major depressive episode/s (MDE), and panic disorder (PD).
METHODS
Diagnosis of MDE and PD were assigned using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV). The AAO of FM, MDE, and PD was defined using the event history calendar. All patients completed a sociodemographic data form, self-report questionnaires measuring FM-related symptoms and function, and the Childhood Trauma Questionnaire-28 (CTQ-28).
RESULTS
98 (83%) of the 118 recruited patients with FM had at least one psychiatric comorbidity. Two main temporal patterns were identified among the 83 patients (70.3 %) who could reliably report the age at onset of FM and psychiatric comorbidities. In the concurrent comorbidity pattern (CCP), MDE and/or PD co-occurred with the onset of FM. In the sequential pattern (SP), the patients first developed PD, then MDE, and finally FM. FM patients with SP are overweight and younger than those with a CCP (FM concurrent with MDE and PD) and reported more childhood adversities, mainly sexual abuse. AAO of psychiatric comorbidities significantly differed between the two patterns.
CONCLUSIONS
The presence of different temporal comorbidity patterns may suggest prevention/early treatment interventions, especially in patients with childhood adversities and early-onset PD.
Topics: Comorbidity; Depression; Depressive Disorder, Major; Fibromyalgia; Humans; Panic Disorder
PubMed: 35699055
DOI: 10.55563/clinexprheumatol/ryp027 -
Comprehensive Psychiatry 1991We report the analyses of daily journal descriptions of 790 self-defined panic attacks from 59 patients meeting DSM-III criteria for panic disorder or agoraphobia with...
We report the analyses of daily journal descriptions of 790 self-defined panic attacks from 59 patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The DSM-III-R specified symptoms occurred with frequencies ranging from choking (17% of attacks) to palpitations (63% of attacks). The mean weekly panic attack severity correlated significantly with the number of symptoms per attack, but not their weekly frequency. Within a given person, situational and spontaneous panic attacks did not significantly differ over a number of characteristics, including severity, duration, frequency per week, diurnal distribution, and the number of symptoms per attack. Limited symptom attacks were less severe, but were otherwise similar to panic attacks. Also, panic attacks during sleep were less frequent than panic attacks in the awake state, but did not significantly differ on other descriptive characteristics. These data support the validity of the symptoms specified for panic attacks by DSM-III-R. They also suggest that within an individual, panic attacks of various subtypes may be descriptively similar, despite the differing contexts in which they arise. In addition, these data question the diagnostic significance of the limited symptom attack-panic attack distinction.
Topics: Adult; Agoraphobia; Arousal; Female; Humans; Male; Panic; Panic Disorder; Psychiatric Status Rating Scales; Psychometrics; Sleep Stages; Sleep Wake Disorders; Social Environment; Wakefulness
PubMed: 1778074
DOI: 10.1016/0010-440x(91)90026-9