Somatic Symptoms and Physiologic Responses in Generalized Anxiety Disorderand Panic Disorder

Hoehn‐Saric, Rudolf; McLeod, Daniel R.; Funderburk, Frank R.; Kowalski, Pamela

doi:10.1001/archpsyc.61.9.913

Cited by 203 publications

(178 citation statements)

References 69 publications

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“…The patients with stable coronary heart disease have higher levels of anxiety than the general population, with prevalence rates ranging from 16% to 42 % (15). This finding is further an evidence of the pervasive nature of anxiety in coronary heart disease patients (16)(17)(18). Research on anxiety among ACS patients has been conducted quite extensively in other countries.…”

Section: Introductionsupporting

confidence: 55%

Associated Factors of Anxiety among Acute Coronary Syndrome Patients in Kelantan and Terengganu

et al. 2017

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Background and purpose: Anxiety is a common condition among acute coronary syndrome (ACS) patients. This syndrome often goes unrecognised and can persist for months to years, while impacting substantially the quality of life. Therefore, this study aimed to identify the associated factor of anxiety among ACS patients in Hospital Universiti Sains Malaysia (USM) and Hospital Sultanah Nur Zahirah (HSNZ). Materials and Methods:This cross-sectional study involved ACS patients admitted to Hospital USM, Kelantan and HSNZ, Terengganu between August 2014 and May 2015. A standardised questionnaire was developed to interview the respondents. The questionnaire was separated into two sections. The first section comprised the socio-demographic details of the patients. The second section was the validated Depression Anxiety Stress Scale 21 (DASS-21) questionnaire. Simple and multiple logistic regressions were used for analysing the collected data. Results: The mean (standard deviation (SD)) age of ACS patients was 60.4 (11.3) years and 61.2 (10.4) years in Hospital USM and HSNZ respectively. The majority of ACS patients who experienced anxiety were male (86.3%) with 84.9% of them Malay ethnicity and 85.9% of them married. The factor associated with anxiety among ACS patients was having a history of ischemic heart disease (adjusted odd ratio (OR): 2.20, as well as confidence interval (CI): 1.19, 4.10, p=0.013). Conclusion: It was concluded that anxiety had myriad effects on cardiovascular physiology, which plays an important role in the increased incidence of ischemic events in patients. A screening tool should be created to refine and identify the psychological status of ACS patients, so that early treatment could be given.

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Section: Introductionsupporting

confidence: 55%

Associated Factors of Anxiety among Acute Coronary Syndrome Patients in Kelantan and Terengganu

et al. 2017

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“…Panic disorder involves fear of specific stimuli (for example, somatic experiences), whereas GAD is characterized by more diffuse anxiety. More importantly, whereas high arousal could be associated with PD, decreased arousal seems to characterize GAD (Hoehn-Saric, McLeod, & Zimmerli, 1989;Hoehn-Saric, McLeod, Funderburk, & Kowalski, 2004). Previous studies suggest that fear sensitization (i.e., an enhanced fear response after experiencing intense fear) plays an important role in conditioned fear-generalization (Dunsmoor, Mitroff, & LaBar, 2009).…”

Section: Discussionmentioning

confidence: 98%

Conditioned Fear Acquisition and Generalization in Generalized Anxiety Disorder

et al. 2015

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Abnormal fear conditioning processes (including fear acquisition and conditioned fear-generalization) have been implicated in the pathogenesis of anxiety disorders. Previous research has shown that individuals with panic disorder present enhanced conditioned fear-generalization in comparison to healthy controls. Enhanced conditioned fear-generalization could also characterize generalized anxiety disorder (GAD), but research so far is inconclusive. An important confounding factor in previous research is comorbidity. The present study examined conditioned fear-acquisition and fear-generalization in 28 patients with GAD and 30 healthy controls using a recently developed fear acquisition and generalization paradigm assessing fear-potentiated startle and online expectancies of the unconditioned stimulus. Analyses focused on GAD patients without comorbidity but included also patients with comorbid anxiety disorders. Patients and controls did not differ as regards fear acquisition. However, contrary to our hypothesis, both groups did not differ either in most indexes of conditioned fear-generalization.Moreover, dimensional measures of GAD symptoms were not correlated with conditioned fear-generalization indexes. Similar results were obtained for patients with comorbidity.These results suggest that conditioned fear-generalization is not enhanced in GAD. Results are discussed with special attention to the possible effects of comorbidity on fear learning abnormalities.

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“…The initial pathology in these patients appears to be an alteration somewhere in the central neural pathways regulating normal panic responses, thus rendering the patients susceptible to unprovoked panic symptoms when exposed to ordinarily mild interoceptive stressors (Vickers and McNally, 2005). This is supported by findings that panic disorder patients, but not healthy controls, are hyperresponsive to normal interoceptive cues (Hoehn-Saric et al, 2004;Pollock et al, 2006), and are also susceptible to induction of panic attacks by interoceptive stimuli such as intravenous (i.v.) 0.5 M sodium lactate infusions and 7.5% CO 2 inhalations (Liebowitz et al, 1986;Gorman et al, 1994).…”

Section: Introductionmentioning

confidence: 89%

Neural Pathways Underlying Lactate-Induced Panic

Johnson

Truitt

Fitz

et al. 2007

Neuropsychopharmacol

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Panic disorder is a severe anxiety disorder characterized by susceptibility to induction of panic attacks by subthreshold interoceptive stimuli such as 0.5 M sodium lactate infusions. Although studied for four decades, the mechanism of lactate sensitivity in panic disorder has not been understood. The dorsomedial hypothalamus/perifornical region (DMH/PeF) coordinates rapid mobilization of behavioral, autonomic, respiratory and endocrine responses to stress, and rats with disrupted GABA inhibition in the DMH/PeF exhibit panic-like responses to lactate, similar to panic disorder patients. Utilizing a variety of anatomical and pharmacological methods, we provide evidence that lactate, via osmosensitive periventricular pathways, activates neurons in the compromised DMH/PeF, which relays this signal to forebrain limbic structures such as the bed nucleus of the stria terminalis to mediate anxiety responses, and specific brainstem sympathetic and parasympathetic pathways to mediate the respiratory and cardiovascular components of the panic-like response. Acutely restoring local GABAergic tone in the DMH/PeF blocked lactate-induced panic-like responses. Autonomic panic-like responses appear to be a result of DMH/PeF-mediated mobilization of sympathetic responses (verified with atenolol) and resetting of the parasympathetically mediated baroreflex. Based on our findings, DMH/PeF efferent targets such as the C1 adrenergic neurons, paraventricular hypothalamus, and the central amygdala are implicated in sympathetic mobilization; the nucleus of the solitary tract is implicated in baroreflex resetting; and the parabrachial nucleus is implicated in respiratory responses. These results elucidate neural circuits underlying lactate-induced panic-like responses and the involvement of both sympathetic and parasympathetic systems.

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Somatic Symptoms and Physiologic Responses in Generalized Anxiety Disorderand Panic Disorder

Cited by 203 publications

References 69 publications

Associated Factors of Anxiety among Acute Coronary Syndrome Patients in Kelantan and Terengganu

Associated Factors of Anxiety among Acute Coronary Syndrome Patients in Kelantan and Terengganu

Conditioned Fear Acquisition and Generalization in Generalized Anxiety Disorder

Neural Pathways Underlying Lactate-Induced Panic

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