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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Does panic disorder increase the risk of cardiovascular diseases in diabetics?: A nationwide population-based study. J Affect Disord 2023; 325:604-610. [PMID: 36681301 DOI: 10.1016/j.jad.2023.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several studies have suggested a link between panic disorder (PD) and cardiovascular disease (CVD). However, the extent to which PD confers risk for CVD is still unclear, particularly in diabetics, a group showing high risk for CVD. METHODS A nationwide population-based cohort of 1,624,718 patients with type 2 diabetes were selected from the National Health Screening Program database covering the years 2009 to 2012. The subjects were divided into two groups: those without panic disorder (non-PD group, n = 1,618,263) and those with newly diagnosed PD (PD-group, n = 6455). Follow-up of subjects for up to 10 years was conducted for evaluation of the incidences of myocardial infarction (MI), stroke, and death. RESULTS After adjusting for the baseline covariates and diabetes mellitus (DM)-related variables, no difference in the future risk of MI and stroke was observed between the non-PD group and the PD group. Compared with the non-PD group, the PD group showed an increase in the future risk of death. [adjusted hazard ratio (aHR) = 1.120, 95 % confidence interval (CI): 1.039-1.206]. In contrast to the population aged <40 and > 65 years, in the age group of 40-64 years a significantly higher risk of stroke was observed in the PD group compared with the non-PD group (aHR = 1.352, 95%CI: 1.136-1.610). LIMITATION The diagnoses were based on the diagnostic codes of the claim data. CONCLUSION The current findings suggested that PD might not contribute to the risk of future MI and stroke in diabetics who have already been at risk of various cardiovascular complications.
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Tremblay MA, Denis I, Turcotte S, DeGrâce M, Tully PJ, Foldes-Busque G. Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study. J Clin Psychol Med Settings 2022; 30:28-42. [PMID: 35543901 PMCID: PMC9093559 DOI: 10.1007/s10880-022-09876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
Abstract
Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials
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Affiliation(s)
- Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Stéphane Turcotte
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Michel DeGrâce
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Phillip J Tully
- Faculty of Health and Medical Sciences, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada. .,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada. .,Research Center of the Quebec Heart and Lung Institute, 2725, chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
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Chang HM, Pan CH, Chen PH, Chen YL, Su SS, Tsai SY, Chen CC, Kuo CJ. Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study. J Psychiatr Res 2022; 148:340-347. [PMID: 35202994 DOI: 10.1016/j.jpsychires.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD. METHODS We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities. RESULTS PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11-1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59-3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98-1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32-5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25-7.96]) than in men (MRR, 3.77 [99% CI, 3.14-4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59-4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29-17.85]) causes. CONCLUSION PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.
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Affiliation(s)
- Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Kim H, Jeong W, Kim SH, Seo JH, Ryu JS, Kim YS, Seok JH, Jang SI, Park EC. Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study. BMC Psychiatry 2022; 22:39. [PMID: 35031002 PMCID: PMC8759212 DOI: 10.1186/s12888-022-03689-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort. METHODS This retrospective cohort study assessed data from the 2002-2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia. RESULTS There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25-2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06-4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39-2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16-2.89). CONCLUSION This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.
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Affiliation(s)
- Hyunkyu Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Behavioral Science in Medicine, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonjeong Jeong
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Seung Hoon Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Jun Ho Seo
- grid.15444.300000 0004 0470 5454Institute of Behavioral Science in Medicine, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sun Ryu
- grid.15444.300000 0004 0470 5454Institute of Behavioral Science in Medicine, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - You-seok Kim
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jeong-Ho Seok
- grid.15444.300000 0004 0470 5454Institute of Behavioral Science in Medicine, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
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Xiong TW, Liu B, Wu Q, Xu YY, Liu P, Wang Y, Liu J, Shi JS. Beneficial effects of Dendrobium nobile Lindl. Alkaloids (DNLA) on anxiety and depression induced by chronic unpredictable stress in rats. Brain Res 2021; 1771:147647. [PMID: 34481787 DOI: 10.1016/j.brainres.2021.147647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022]
Abstract
Dendrobium nobile Lindl. alkaloid (DNLA) is effective against animal models of Alzheimer's disease. This study further examined its effect on anxiety and depression produced by chronic unpredictable stress (CUS). Rats were subjected to CUS for 42 days, followed by DNLA treatment (20 mg/kg/day, po) for 28 days. The behavioral tests, histopathology, neurotransmitters and RNA-Seq were examined. DNLA attenuated body weight loss and CUS-induced anxiety/depressive-like behaviors, as evidenced by the elevated-plus-maze test, open-field test and sucrose preference. DNLA alleviated neuronal damage and loss and increased Nissl bodies in the hippocampus CA2 region and cortex. DNLA decreased CUS-elevated 5-hydroxytryptamine, dopamine and monoamine oxidase and catechol-O-methyltransferase activities in the brain. DNLA attenuated HPA activation by decreasing adrenocorticotropic hormones and the expression of corticotropin-releasing hormone receptor-1, and increased the expression of glucocorticoid receptor in the brain. RNA-Seq revealed distinct gene expression patterns among groups. Gene ontology revealed the cell projection assembly, postsynapse and centrosome as top biological processes, and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment showed the cAMP, cGMP-PKG, glutamatergic synapse and circadian as major pathways for DNLA effects. Using DESeq2, CUS modulated 1700 differentially expressed genes (DEGs), which were prevented or attenuated by DNLA. CUS-induced DEGs were highly correlated with the Gene Expression Omnibus (GEO) database for anxiety and depression and were ameliorated by DNLA. Taken together, DNLA attenuated anxiety/depression-like behavior and neuronal damage induced by CUS in rats. The mechanisms could be related to regulation of the monoamine neurotransmitters and the HPA axis, and modulation of gene expression in the hippocampus.
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Affiliation(s)
- Ting-Wang Xiong
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China; Zunyi Medical and Pharmaceutical College, Zunyi, China.
| | - Bo Liu
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China.
| | - Qin Wu
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China.
| | - Yun-Yan Xu
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China.
| | - Ping Liu
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China; Department of Clinical Pharmacy, Zunyi Medical University, Zunyi, China.
| | - Yan Wang
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China.
| | - Jie Liu
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China.
| | - Jing-Shan Shi
- Key Lab for Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, China.
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Foldes-Busque G, Dionne CE, Turcotte S, Tully PJ, Tremblay MA, Poirier P, Denis I. Epidemiology and prognostic implications of panic disorder and generalized anxiety disorder in patients with coronary artery disease: rationale and design for a longitudinal cohort study. BMC Cardiovasc Disord 2021; 21:26. [PMID: 33435888 PMCID: PMC7801787 DOI: 10.1186/s12872-021-01848-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 01/25/2023] Open
Abstract
Background Anxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress. Design/Method This is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files. Discussion This study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada. .,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada. .,Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.
| | - Clermont E Dionne
- Hôpital du Saint-Sacrement, Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada.,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Paul Poirier
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.,Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada.,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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Alzahrani AS, Alqahtani A, Saleh A, Aloqalaa M, Abdulmajeed A, Nadhrah A, Alhazmi N. Prevalence of Psychiatric Disorders in Cardiac Outpatients. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200807-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Afsin A, Asoğlu R, Orum MH, Cicekci E. Evaluation of TP-E Interval and TP-E/QT Ratio in Panic Disorder. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E215. [PMID: 32353958 PMCID: PMC7279486 DOI: 10.3390/medicina56050215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: The autonomic nervous system (ANS) is involved in panic disorders. ANS dysfunction has been shown to be associated with ventricular arrhythmia and increased heterogeneity of ventricular repolarization. However, there remains limited evidence of the relationship between panic disorders and ventricular depolarization markers, including the Tp-e interval and Tp-e/QT ratio. This study aimed to evaluate ventricular repolarization parameters in patients with panic disorder. Materials and Methods: In total, 40 patients with panic disorder, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, were included in the study group. The control group comprised of 50 age- and sex-matched healthy individuals. A standard 12 lead electrocardiogram was recorded on all participants, and heart rate, QT interval, QRS duration, Tp-e interval, and Tp-e/QT ratio were measured. Results: QRS durations and QT intervals were similar in the study and control groups. Compared to the control group, QTd, Tp-e, and cTp-e intervals as well as Tp-e/QT and Tp-e/QTc ratios were significantly increased in patients with panic disorder (p < 0.05 for all). In the study group, the Severity Measure for Panic Disorder-Adult score had a significant positive correlation with the Tp-e interval (r = 0.369, p < 0001), cTp-e interval (r = 0.531, p < 0.001), Tp-e/QT ratio (r = 0.358, p = 0.001), and Tp-e/QTc ratio (r = 0.351, p = 0.001). Conclusion: These findings indicate that panic disorders are associated with increased ventricular repolarization heterogeneity, which may be attributed to ANS dysregulation.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, M.D, Kahta State Hospital, Adıyaman 02450, Turkey
| | - Ramazan Asoğlu
- Department of Cardiology, M.D, Adıyaman Training and Research Hospital, Adıyaman 02450, Turkey;
| | - Mehmet Hamdi Orum
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
| | - Elvan Cicekci
- Department of Psychiatry, M.D, Kahta State Hospital, Adıyaman 02450, Turkey; (M.H.O.); (E.C.)
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Zhang Y, Zhou B, Qiu J, Zhang L, Zou Z. Heart rate variability changes in patients with panic disorder. J Affect Disord 2020; 267:297-306. [PMID: 32217230 DOI: 10.1016/j.jad.2020.01.132] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This review aimed to evaluate whether patients with panic disorder (PD) exhibit different heart rate variability (HRV) compared to healthy controls and to determine whether HRV is different in patients with PD after treatment. METHODS Literature databases were searched for studies comparing resting-state HRV between drug-naïve patients with PD and healthy controls. Parameters from the short-term frequency-domain and long-term time domain were included. RESULTS In the low frequency (LF) analysis, no significant association was found between LF and PD (standardised mean difference [SMD] = -0.0443, 95% confidence interval [CI]: -0.1765 to 0.0879). In the high frequency (HF) analysis, no significant association was found between HF and PD (SMD = -0.1269, 95% CI: -0.2598 to 0.0059). In the LF/HF analysis, a significantly higher LF/HF ratio was found in cases than in controls, but the effect was moderate (SMD = 0.1390, 95% CI: 0.0180 to 0.2600). For the standard deviation of normal-to-normal intervals, a significantly lower value was observed in cases than in controls (SMD = -0.3133, 95% CI: -0.5459 to -0.0808). LIMITATIONS Limited sample size in the time-domain and treatment effect analyses. CONCLUSIONS Patients with PD had a higher short-term LF/HF ratio, indicating impaired sympathovagal balance. The LF/HF ratio findings were more consistent compared with LF and HF alone, making it a better parameter to interpret the LF and HF in conjunction. HRV may be a promising biomarker for predicting antidepressant response.
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Affiliation(s)
- Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, PR China
| | - Bo Zhou
- Psychosomatic department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, PR China
| | - Jian Qiu
- Psychosomatic department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, PR China
| | - Lijuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, PR China
| | - Zhili Zou
- Psychosomatic department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, PR China.
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11
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Anxiety Disorders in the Elderly. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:561-576. [DOI: 10.1007/978-981-32-9705-0_28] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Cosci F, Mansueto G. Biological and Clinical Markers to Differentiate the Type of Anxiety Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:197-218. [PMID: 32002931 DOI: 10.1007/978-981-32-9705-0_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present chapter is an overview of possible biomarkers which distinguish anxiety disorders as classified by the DSM-5. Structural or activity changes in the brain regions; changes in N-acetylaspartate/creatine, dopamine, serotonin, and oxytocin; hearth rate variability; hypothalamic-pituitary-adrenal axis activity; error-related negativity; respiratory regulation; and genetic variants are proposed. However, their clinical utility is questionable due to low specificity and sensitivity: the majority does not distinguish subjects with different anxiety disorders, and they might be influenced by stress, comorbidity, physical activity, and psychotropic medications. In this framework, the staging model, a clinimetric tool which allows to define the degree of progression of a disease at a point in time and where the patient is located on the continuum of the course of the disease, is proposed since several DSM anxiety disorders take place at different stages of the same syndrome according to the staging model. Thus, a stage-specific biomarker model for anxiety disorders is hypothesized and illustrated.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy. .,Maastricht University Medical Center, Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands.
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Maastricht University Medical Center, Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
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13
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Caldirola D, Perna G. Toward a personalized therapy for panic disorder: preliminary considerations from a work in progress. Neuropsychiatr Dis Treat 2019; 15:1957-1970. [PMID: 31371969 PMCID: PMC6628946 DOI: 10.2147/ndt.s174433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022] Open
Abstract
Although several treatment options for panic disorder (PD) are available, the best intervention for each individual patient remains uncertain and the use of a more personalized therapeutic approach in PD is required. In clinical practice, clinicians combine general scientific information and personal experience in the decision-making process to choose a tailored treatment for each patient. In this sense, clinicians already use a somehow personalized medicine strategy. However, the influence of their interpretative personal models may lead to bias related to personal convictions, not sufficiently grounded on scientific evidence. Hence, an effort to give some advice based on the science of personalized medicine could have positive effects on clinicians' decisions. Based on a narrative review of meta-analyses, systematic reviews, and experimental studies, we proposed a first-step attempt of evidence-based personalized therapy for PD. We focused on some phenomenological profiles, encompassing symptoms during/outside panic attacks, related patterns of physiological functions, and some aspects of physical health, which might be worth considering when developing treatment plans for patients with PD. We considered respiratory, cardiac, vestibular, and derealization/depersonalization profiles, with related implications for treatment. Given the extensiveness of the topic, we considered only medications and some somatic interventions. Our proposal should be considered neither exhaustive nor conclusive, as it is meant as a very preliminary step toward a future, robust evidence-based personalized therapy for PD. Clearly much more work is needed to achieve this goal, and recent technological advances, such as wearable devices, big data platforms, and the application of machine learning techniques, may help obtain reliable findings. We believe that combining the efforts of different research groups in this work in progress can lead to largely shared conclusions in the near future.
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Affiliation(s)
- Daniela Caldirola
- Humanitas University, 20090 Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy
| | - Giampaolo Perna
- Humanitas University, 20090 Pieve Emanuele, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, 22032 Albese Con Cassano, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, FL 33136 -1015, USA
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14
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Cosci F, Mansueto G. Biological and Clinical Markers in Panic Disorder. Psychiatry Investig 2019; 16:27-36. [PMID: 30184613 PMCID: PMC6354043 DOI: 10.30773/pi.2018.07.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/26/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Classifying mental disorders on the basis of objective makers might clarify their aetiology, help in making the diagnosis, identify "at risk" individuals, determine the severity of mental illness, and predict the course of the disorder. This study aims to review biological and clinical markers of panic disorder (PD). METHODS A computerized search was carried out in PubMed and Science Direct using the key words: "marker/biomarker/clinical marker/neurobiology/staging" combined using Boolean AND operator with "panic." In addition, the reference lists from existing reviews and from the articles retrieved were inspected. Only English language papers published in peer-reviewed journals were included. RESULTS Structural changes in the amygdala, hippocampus, cerebral blood level in the left occipital cortex, serotonin 5-TH and noradrenergic systems activation, aberrant respiratory regulation, hearth rate variability, blood cells and peripheral blood stem cells, hypothalamic-pituitary-adrenal axis dysregulation were identified as potential candidate biomarkers of PD. Staging was identified as clinical marker of PD. According to the staging model, PD is described as follows: prodromal phase (stage 1); acute phase (stage 2); panic attacks (stage 3); chronic phase (stage 4). CONCLUSION The clinical utility, sensitivity, specificity, and the predictive value of biomarkers for PD is still questionable. The staging model of PD might be a valid susceptibility, diagnostic, prognostic, and predictive marker of PD. A possible longitudinal model of biological and clinical markers of PD is proposed.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Maastricht University Medical Center, Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, the Netherlands
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy.,Maastricht University Medical Center, Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, the Netherlands
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15
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Sancassiani F, Carta MG, Montisci R, Preti A, Machado S, Moro MF, Marchetti MF, Meloni L. Takotsubo Syndrome is Associated with Mood Disorders and Antidepressants Use, not with Anxiety and Impairment of Quality of Life Due to the Psychiatric Disorder. Clin Pract Epidemiol Ment Health 2018; 14:26-32. [PMID: 29541148 PMCID: PMC5838620 DOI: 10.2174/1745017901814010026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/14/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim was to study the association between mood and anxiety disorders and the Tako-Tsubo Syndrome (TTS) and to determine the role of antidepressants and the impairment of quality of life due the comorbid psychiatric disorder. METHODS Case-control study: 19 consecutive patients (17 female) with TTS compared to 76 controls without TTS, were randomly selected from the database of a nationwide epidemiological study after matching (gender, age and residence) by controls. Psychiatric diagnoses were carried out according to the ICD-10 using semi-structured interview tools (ANTAS-SCID) administered by clinical staff. Quality of Life (Qol) was assessed by means of SF-12. RESULTS Only Major Depressive Disorders (MDD) showed higher frequencies in cases with statistical significance difference (p=0.014) as well as at least one Mood Disorder Diagnosis [MDD or BD] (p=0.002). The lifetime prevalence of at least one anxiety disorder with no comorbid mood disorder did not show a higher frequency in cases (p=0.57).The score at SF-12 in the TTS group was similar to those of controls (p=0.71)In the TTS group, the score at SF-12 in people with one mood or anxiety diagnosis (N=7) was similar to those without mood or anxiety diagnosis (p=0.75). The use of antidepressants was higher in TTS group (15.79% vs 1.31%; p=0.030). CONCLUSION The study shows an association between TTS with depressive disorders and antidepressants use and does not confirm the association with anxiety syndromes. The study suggests the need to investigate the possible interactions between antidepressants use and mood disorders in studies with appropriate design and sample size.
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Affiliation(s)
- F. Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program - Salgado de Oliveira University, Niterói, Brazil
| | - Maria F. Moro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria F. Marchetti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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16
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Kotianova A, Kotian M, Slepecky M, Chupacova M, Prasko J, Tonhajzerova I. The differences between patients with panic disorder and healthy controls in psychophysiological stress profile. Neuropsychiatr Dis Treat 2018; 14:435-441. [PMID: 29445280 PMCID: PMC5808685 DOI: 10.2147/ndt.s153005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Alarming somatic symptoms, in particular, cardiovascular symptoms, are the characteristic feature of panic attacks. Increased cardiac mortality and morbidity have been found in these patients. Power spectral analysis of electrocardiogram R-R intervals is known to be a particularly successful tool in the detection of autonomic instabilities in various clinical disorders. Our study aimed to compare patients with panic disorder and healthy controls in heart rate variation (HRV) parameters (very-low-frequency [VLF], low-frequency [LF], and high-frequency [HF] band components of R-R interval) in baseline and during the response to the mental task. SUBJECTS AND METHODS We assessed psychophysiological variables in 33 patients with panic disorder (10 men, 23 women; mean age 35.9±10.7 years) and 33 age- and gender-matched healthy controls (10 men, 23 women; mean age 35.8±12.1 years). Patients were treatment naïve. Heart rate, blood pressure, muscle tension, and HRV in basal conditions and after the psychological task were assessed. Power spectrum was computed for VLF (0.003-0.04 Hz), LF (0.04-0.15 Hz), and HF (0.15-0.40 Hz) bands using fast Fourier transformation. RESULTS In the baseline period, the VLF band was significantly lower in panic disorder group compared to controls (p<0.005). In the period of mental task, the LF/HF ratio was significantly higher in panic disorder patients compared to controls (p<0.05). No significant differences were found in the remaining parameters. There was a significant difference in ΔHF and ΔLF/HF ratio between patients and controls, with Δ increasing in patients and decreasing in controls. CONCLUSION These findings revealed that patients suffering from panic disorder were characterized by relative sympathetic dominance (reactivity) in response to mental stress compared with healthy controls.
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Affiliation(s)
- Antonia Kotianova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic
| | - Michal Kotian
- Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic
| | | | - Jan Prasko
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, Czech Republic
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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17
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Carta MG, Patten S, Nardi AE, Bhugra D. Mental health and chronic diseases: a challenge to be faced from a new perspective. Int Rev Psychiatry 2017; 29:373-376. [PMID: 28911265 DOI: 10.1080/09540261.2017.1364885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mauro Giovanni Carta
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Scott Patten
- b Department of Community Health Sciences , University of Calgary , Calgary , AB , Canada
| | - António E Nardi
- c Faculdade de Medicina , Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brasil.,d Academia Nacional de Medicina , Rio de Janeiro , Brasil
| | - Dinesh Bhugra
- e Emeritus Professor of Mental Health and Cultural Diversity, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK.,f World Psychiatric Association , Geneva , Switzerland
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