Stones A, Groome D, Perry D, Hucklebridge F, Evans P
Division of Psychology, University of Westminster, London, UK.
J Affect Disord. 1999 Jan-Mar;52(1-3):197-201. doi: 10.1016/s0165-0327(98)00058-5.
Various findings suggest the possibility of an abnormal cortisol response to CRH in panic disorder patients, which raises the question of whether such patients might also produce an abnormal cortisol response to stress. The purpose of the present study was to use salivary cortisol measurement in assessing differences in response to novelty/mild stress situations between panic disorder subjects and controls.
Subjects were recruited by means of posters and subsequently screened for suitability as controls or panic subjects. Twenty-four panic disorder (PD) sufferers and 15 panic-free control subjects were tested on a range of psychometric and physiological measures, at both the start and the end of the experiment. Subjects were tested at the beginning for state anxiety, salivary cortisol, heart rate, and blood pressure, and these tests were repeated at the end of the session (which had been designed to promote reassurance).
The state anxiety scores (STAI) showed a reduction in anxiety level over the test period, and there was a corresponding fall in both blood pressure and heart rate for both groups. Cortisol levels also fell over the course of the interview in the control group, but in the PD group cortisol levels showed no such reduction. In addition, there was a significant difference in the levels of cortisol at the start of the session between the two groups (PD group lower).
These data indicate a possible alteration in cortisol responsiveness to stress/novelty situations in PD subjects. This was considered to be consistent with previous suggestions of HPA axis dysregulation in PD patients, although our research indicates unresponsiveness rather than responsiveness to be a factor to be considered for future investigation.
Our results suggest that not all subjects suffering PD may benefit from stress reduction therapies as a first choice of treatment for their panic attacks. The existence of nocturnal panic attacks (considering sleep as a combination of mental and physical relaxation), in the absence of nightmares, as well as the induction of panic attacks during relaxation support this view.
Apart from the difficulty in accessing sufficient symptomatic subjects, the induction of higher levels of stress could be useful for confirmation of these results. However, this requires specialist support in case of subjects developing panic attacks during the experiments, which was not available during the present study.
Twenty-four panic disorder (PD) sufferers and 15 panic-free control subjects were tested on a range of psychometric and physiological measures, at both the start and the end of an experimental session. Subjects were tested at the beginning for state anxiety, salivary cortisol, heart rate, and blood pressure, and these tests were repeated at the end of the session. The state anxiety scores (STAI) showed a reduction in anxiety level over the test period for both groups, and there was a corresponding fall in both blood pressure and heart rate. Cortisol levels also fell over the course of the session in the control group, but in the PD group cortisol levels showed no such reduction. In addition, there was a significant difference in the levels of cortisol at the start of the session between the two groups (PD group lower). These data indicate a possible alteration in cortisol responsiveness to stress/novelty situations in PD subjects. This was considered to be consistent with previous suggestions of HPA axis dysregulation in PD patients, although our research indicates unresponsiveness rather than responsiveness to be a factor to be considered for future investigation.
多项研究结果表明惊恐障碍患者对促肾上腺皮质激素释放激素（CRH）可能存在皮质醇反应异常，这引发了一个问题，即这类患者对应激是否也会产生异常的皮质醇反应。本研究的目的是通过测量唾液皮质醇来评估惊恐障碍患者与对照组在应对新奇/轻度应激情况时的反应差异。
通过张贴海报招募受试者，随后筛选出适合作为对照组或惊恐障碍组的对象。24名惊恐障碍（PD）患者和15名无惊恐症状的对照受试者在实验开始和结束时接受了一系列心理测量和生理测量。在实验开始时对受试者进行状态焦虑、唾液皮质醇、心率和血压测试，并在实验结束时（实验设计旨在增强安心感）重复这些测试。
状态焦虑评分（STAI）显示在测试期间焦虑水平有所降低，两组的血压和心率也相应下降。对照组在访谈过程中皮质醇水平也下降，但PD组皮质醇水平未出现此类下降。此外，两组在实验开始时的皮质醇水平存在显著差异（PD组较低）。
这些数据表明PD患者对应激/新奇情况的皮质醇反应可能存在改变。这被认为与先前关于PD患者下丘脑-垂体-肾上腺（HPA）轴功能失调的观点一致，尽管我们的研究表明无反应性而非反应性是未来研究中需要考虑的一个因素。
我们的结果表明，并非所有PD患者作为惊恐发作的首选治疗方法都能从减压疗法中获益。夜间惊恐发作（将睡眠视为精神和身体放松相结合的状态）的存在，且无噩梦，以及在放松过程中诱发惊恐发作，都支持了这一观点。
除了难以招募到足够的有症状受试者外，诱导更高水平的应激可能有助于证实这些结果。然而，这需要专业支持以防受试者在实验过程中出现惊恐发作，而本研究期间无法提供此类支持。
24名惊恐障碍（PD）患者和15名无惊恐症状的对照受试者在实验开始和结束时接受了一系列心理测量和生理测量。在实验开始时对受试者进行状态焦虑、唾液皮质醇、心率和血压测试，并在实验结束时重复这些测试。两组的状态焦虑评分（STAI）显示在测试期间焦虑水平有所降低，血压和心率也相应下降。对照组在实验过程中皮质醇水平下降，但PD组皮质醇水平未出现此类下降。此外，两组在实验开始时的皮质醇水平存在显著差异（PD组较低）。这些数据表明PD患者对应激/新奇情况的皮质醇反应可能存在改变。这被认为与先前关于PD患者HPA轴功能失调的观点一致，尽管我们的研究表明无反应性而非反应性是未来研究中需要考虑的一个因素。
