Abnormal brain hemodynamic responses during passive orthostatic challenge in panic disorder

Faravelli, Carlo; Marinoni, Marinella; Spiti, R.; Ginanneschi, A.; Serena, A.; Fabbri, Cecilia; Matteo, C. Di; Mastio, Monica Del; Inzitari, Domenico

doi:10.1176/ajp.154.3.378

Cited by 22 publications

(6 citation statements)

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“…In accordance with our findings, an exaggerated drop in cerebral blood flow has been reported in patients with panic disorder, similar to that observed in patients with VVS [25,36,37,38]. A predominant vagal activity has also been observed in patients with blood phobia [39].…”

Section: Discussionsupporting

confidence: 92%

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Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Leftheriotis

Michopoulos²,

Flevari³

et al. 2008

Psychother Psychosom

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Background: A high prevalence of minor psychiatric disorders (MPDs) has been reported in patients with vasovagal syncope (VVS). However, the relationship between the psychiatric substrate and syncope remains unclear. Methods: In order to test the hypothesis that MPDs may predispose to VVS, we assessed the prevalence of syncope, the response to head-up tilt test (HUTT) and the efficacy of psychiatric drug treatment in reducing syncopal episodes, in patients with recently diagnosed MPDs. The response to HUTT was compared with that in an equal number of matched (a) patients with VVS and (b) healthy controls. Results: A high rate of patients with MPDs (58%) had a positive HUTT. Additionally, 45% had a history of syncope; among them, the rate of positive HUTT was identical to that in the VVS group (83%). Following psychiatric drug treatment, the number of patients with syncope decreased in the MPD group (6/67 from 30/67, p < 0.01). Psychiatric symptoms and quality of life were also improved. The number of syncopal spells decreased equally in the MPD and VVS groups (0.6 ± 0.5 from 2.5 ± 1.4, p < 0.01, and 0.7 ± 0.5 from 2.7 ± 1.3, p < 0.01, respectively). Conclusion: A high proportion of patients with MPDs experience syncope, associated with a high rate of positive HUTT, comparable to that observed in VVS. Psychiatric treatment results in the improvement of syncopal and psychiatric symptoms. These findings suggest involvement of co-occurring MPDs in the pathogenesis of VVS. Therefore, the diagnosis and treatment of MPDs, when present, may be crucial for the effective therapy of vasovagal syndrome.

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Section: Discussionsupporting

confidence: 92%

“…Panic disorder has been associated with autonomic dysreactivity [25,26,27,28,29,30]. It has also been reported that panic symptoms reappear in 42% of patients after hyperventilation, a maneuver that has been associated with the vasovagal reflex [31,32,33,34].…”

Section: Discussionmentioning

confidence: 99%

Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Leftheriotis

Michopoulos²,

Flevari³

et al. 2008

Psychother Psychosom

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“…There is paucity of studies on biological markers of remitted patients with panic disorder [94, 95, 96, 97]. Six patients with panic disorder who had panicked during sodium lactate infusion were given cognitive-behavioral treatment.…”

Section: Subclinical Symptoms Of Panic Disordermentioning

confidence: 99%

Subclinical Symptoms of Panic Disorder: New Insights into Pathophysiology and Treatment

Fava

Mangelli²

1999

Psychother Psychosom

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The aim of this review was to survey the available literature on prodromal and residual symptoms of panic disorder. Both a computerized (Medline) and a manual search of the literature were performed. In a substantial proportion of patients with panic disorder with agoraphobia a prodromal phase can be identified. Most patients report residual symptoms despite successful treatment. Residual symptoms upon remission have a prognostic value. There appears to be a relationship between residual and prodromal symptomatology (the rollback phenomenon). Appraisal of subclinical symptomatology in panic disorder has important implications as to the pathophysiological model of disease, its conceptualization and treatment.

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“…Cardio-cerebrovascular modulation, which is related to responses of the autonomic nervous system, has the function of regulating cerebral blood flow [3–5]. Several studies, such as Alkin et al and Faravelli et al, have focused on cardio-cerebrovascular modulation in panic disorder and have found some significant results [6–8]; however the characteristics of cardio-cerebrovascular modulation in patients with GAD are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of cardio-Cerebrovascular modulation in patients with generalized anxiety disorder: an observational study

et al. 2017

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BackgroundGeneralized anxiety disorder (GAD) has been shown in previous studies to display abnormal cerebral blood flow velocity (CBFV); however, the characteristics of cardio-cerebrovascular modulation are unknown. We aimed to analyze cardio-cerebrovascular modulation using parameters from a supine-to-standing test.MethodsThere are 2 parts to this study; in Part 1, 125 participants with Hamilton Anxiety scale scores ≥14 were enrolled, and 33 age- and sex-matched medically and psychiatrically healthy volunteers were recruited as control participants. Patients were divided by score into mild, moderate, and severe anxiety groups. The cardio-cerebrovascular modulation using the parameters of dynamic changes of CBFV and heart rate in response to an orthostatic challenge were investigated. In Part 2, we followed up the severe GAD patients for 6 months and repeated the supine-to-standing test, and severe GAD patients were divided into recovery and non-recovery groups.ResultsIn part 1, the GAD group displayed more marked CBFV and heart rate changes than the healthy group, but there was no difference in the CBFV and heart rate changes from the supine to upright position in mild, moderate, and severe anxiety groups. In part 2, The recovery group demonstrated significant improvement in changes in the CBFV and heart rate values from the supine to the upright position after treatment compared with before treatment. In the non-recovery group, the CBFV and heart rate changes were significantly higher than the healthy group regardless of treatment.ConclusionsCardio-cerebrovascular modulation is compromised in patients with GAD, however, this impairment can be restored to normal after the disappearance of anxiety.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1428-6) contains supplementary material, which is available to authorized users.

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Abnormal brain hemodynamic responses during passive orthostatic challenge in panic disorder

Cited by 22 publications

References 50 publications

Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Minor Psychiatric Disorders and Syncope: The Role of Psychopathology in the Expression of Vasovagal Reflex

Subclinical Symptoms of Panic Disorder: New Insights into Pathophysiology and Treatment

Characteristics of cardio-Cerebrovascular modulation in patients with generalized anxiety disorder: an observational study

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