Relationship of urinary free cortisol levels in patients with panic disorder to symptoms of depression and agoraphobia

Kathol, Roger G.; Noyes, Russell; López, Ana Laura Solano; Reich, James

doi:10.1016/0165-1781(88)90064-9

Cited by 41 publications

(18 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Twenty-four hour urinary free cortisol (UFC) has been shown to be normal in panic disorder [Uhde et al, 1988], or elevated only in the presence of depression or agoraphobia [Kathol et al, 1988;Lopez et al, 1990]. Bandelow et al [1997Bandelow et al [ , 2000b, on the other hand, report elevated nocturnal urinary secretion of cortisol in patients with panic disorder over multiple nights measured at home, which seems unlikely to be impacted by reactivity to novelty or contextual variables.…”

Section: Discussionmentioning

confidence: 99%

“…No or inconsistent cortisol response with laboratoryinduced panic attacks Charney et al, 1985 (caffeine); Liebowitz et al, 1985;Levin et al, 1987;Seier et al, 1997;Peskind et al, 1998 (lactate); Sinha et al, 1999;van Duinen et al, 2004 Curtis et al, 1982;Lieberman et al, 1983;Sheehan et al, 1983;Goldstein et al, 1987 Elevated nonsuppression rate with repeat testing, linked to severity of depression Coryell et al, 1989 Basal studies Normal UFC (in uncomplicated panic) Uhde et al, 1988;Kathol et al, 1988 Elevated ACTH increased afternoon or nocturnal cortisol Brambilla et al, 1992Goldstein et al, 1987Bandelow et al, 1997;Bandelow et al, 2000b''Natural'' panic Increased cortisol Bandelow et al, 2000aInconsistent response Cameron et al, 1987Woods et al, 1987 …”

Section: Paradigmsmentioning

confidence: 99%

“…Elevations have been reported at ''baseline'' before a pharmacological challenge [Roy-Byrne et al, 1986], but levels appear normal when the baseline period is more extended [Holsboer et al, 1987]. Patients with uncomplicated panic have normal ''resting'' cortisol levels [Kathol et al, 1988;Uhde et al, 1988], but resting state elevations have also been reported [Goldstein et al, 1987]. In a 24-hour ''basal state'' study with frequent sampling, patients with panic disorder had normal daytime cortisol levels but some elevation overnight [Abelson and Curtis, 1996a].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

HPA axis activity in patients with panic disorder: review and synthesis of four studies

et al. 2006

View full text Add to dashboard Cite

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may play a role in panic disorder. HPA studies in patients with panic disorder, however, have produced inconsistent results. Seeking to understand the inconsistencies, we reexamined endocrine data from four studies of patients with panic disorder, in light of animal data highlighting the salience of novelty, control, and social support to HPA axis activity. Patients with panic disorder were studied (1) at rest over a full circadian cycle, (2) before and after activation by a panicogenic respiratory stimulant (doxapram) that does not directly stimulate the HPA axis, and (3) before and after a cholecystokinin B (CCK-B) agonist that is panicogenic and does directly stimulate the HPA axis. Patients with panic disorder had elevated overnight cortisol levels, which correlated with sleep disruption. ACTH and cortisol levels were higher in a challenge paradigm (doxapram) than in a resting state study, and paradigm-related ACTH secretion was exaggerated in patients with panic disorder. Panic itself could be elicited without HPA axis activation. Patients with panic disorder showed an exaggerated ACTH response to pentagastrin stimulation, but this response was normalized by prior exposure to the experimental context or psychological preparation to reduce novelty and enhance sense of control. Novelty is one of a number of contextual cues known from animal work to activate the HPA axis. The HPA axis abnormalities seen in patients with panic disorder in the four experiments reviewed here might all be due to exaggerated HPA axis reactivity to novelty cues. Most of the published panic/HPA literature is consistent with the hypothesis that HPA axis dysregulation in panic is due to hypersensitivity to contextual cues. This hypothesis requires experimental testing. Depression and Anxiety 24:66-76,

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Paradigmsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

HPA axis activity in patients with panic disorder: review and synthesis of four studies

et al. 2006

View full text Add to dashboard Cite

show abstract

“…In fact, during a resting state, both normal [74,75] and elevated cortisol levels have been reported [76][77][78] . On the other hand, a clear escape or hypersuppression after Dex administration has not been demonstrated [76,79] , but some DST abnormalities exist and predict risk of relapse and long term disability in panic disordered subjects [30,80,81] .…”

Section: Childhood Stressful Events Hpa Axis and Pdmentioning

confidence: 99%

Childhood stressful events, HPA axis and anxiety disorders

Faravelli

Sauro²,

Godini³

et al. 2012

WJP

129

View full text Add to dashboard Cite

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyperresponsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

show abstract

“…Therefore, one reason for the differences may be that some studies may have measured free cortisol levels whereas others have measured total cortisol values. Another cause of inconsistency in the results may be the difference in severity of associated depressive symptoms (28) and anxiety levels (31). Another reason why the results are inconsistent may be that the measurement times are different.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of hypothalamo-pituitary-adrenal axis activity by using dexamethasone suppression test in patients with panic disorder and generalized anxiety disorder

Hacımusalar¹,

Eşel²

2017

Dusunen Adam

View full text Add to dashboard Cite

Evaluation of hypothalamo-pituitary-adrenal axis activity by using dexamethasone suppression test in patients with panic disorder and generalized anxiety disorderObjective: The aim of this study was to investigate the role of hypothalamo-pituitary-adrenal (HPA) axis activity on the pathophysiology of anxiety disorders by examining the HPA axis activity in patients with panic disorder (PD) and generalized anxiety disorder (GAD).Method: Baseline and post dexamethasone suppression test (DST) serum concentrations of cortisol and dehydroepiandrosterone-sulfate (DHEA-S) were measured in patients with PD (n=24), GAD (n=21) and in healthy controls (n=20). Results:The baseline cortisol levels in GAD group were found lower than those of the patients with PD and healthy controls. Cortisol suppression by dexamethasone in GAD group was found to be lower than PD patients and healthy controls. Baseline and post-DST DHEA-S levels in the patients with PD and GAD were similar to those of the healthy controls. Yöntem: PB (n=24) ve YAB (n=21) olan hastalarda ve sağlıklı kontrollerde (n=20) bazal ve deksametazon baskılama testi (DST) uygulaması sonrasında kortizol ve dehidroepiandrosteron-sülfat (DHEA-S) değerleri ölçüldü.Bulgular: YAB grubunun bazal kortizol düzeyleri kontrol ve PB grubuna göre düşük bulundu. Ayrıca YAB grubunda deksametazonun kortizolu baskılaması kontrol ve PB grubuna göre düşük bulundu. PB ve YAB hastalarında bazal ve DST sonu DHEA-S düzeyleri kontrol grubuna benzer bulundu.Sonuç: YAB hastalarında bazal kortizol düzeyinin düşük olması ve DST'de kortizol baskılanmasının yetersiz oluşu bu hastalarda hem kortikotropin salgılatıcı hormon reseptörlerinde, hem de glukokortikoid reseptörlerinde bir aşağı ayarlama (down-regulation) olduğunu akla getirmektedir.Anahtar kelimeler: Dehidroepiandrosteron, deksametazon, yaygın anksiyete bozukluğu, panik bozukluğu

show abstract

Relationship of urinary free cortisol levels in patients with panic disorder to symptoms of depression and agoraphobia

Cited by 41 publications

References 33 publications

HPA axis activity in patients with panic disorder: review and synthesis of four studies

HPA axis activity in patients with panic disorder: review and synthesis of four studies

Childhood stressful events, HPA axis and anxiety disorders

Evaluation of hypothalamo-pituitary-adrenal axis activity by using dexamethasone suppression test in patients with panic disorder and generalized anxiety disorder

Contact Info

Product

Resources

About