Erhardt Angelika, Ising Marcus, Unschuld Paul Gerson, Kern Nikola, Lucae Susanne, Pütz Benno, Uhr Manfred, Binder Elisabeth B, Holsboer Florian, Keck Martin E
Max Planck Institute of Psychiatry, Munich, Germany.
Neuropsychopharmacology. 2006 Nov;31(11):2515-22. doi: 10.1038/sj.npp.1301168. Epub 2006 Jul 12.
Anxiety and depressive disorders are among the most common psychiatric disorders with a high number of hospital admissions and a lifetime prevalence of up to 25%. So far, the pathophysiological mechanisms for anxiety disorders remain to be found. Preclinical studies suggest that changes in hypothalamic-pituitary-adrenocortical (HPA) system function are causally related to the expression of anxiety-related behavior. The findings on HPA system function in patients with anxiety disorders are, however, heterogeneous. Both hypo- and hyperresponsiveness of HPA response in various anxiety disorders under different experimental conditions were found. In order to characterize putative case/control differences in HPA system function, we performed a Dex-CRH test, a widely used test to pick up changes in HPA system regulation with high sensitivity, in 30 patients with panic disorder, 35 patients with major depressive episode and in 30 controls individually matched for ethnicity, age and gender. The results indicate a similar dysregulation of the HPA system response in the Dex-CRH test in both patient groups. This finding further underlines the hypothesis that both, depression and panic disorder, share impaired HPA system regulation, supporting the notion that the impairment is involved in the pathophysiology of these clinical conditions. However, differences in the suppression effects and psychopathological correlation patterns between depressed and panic patients suggest different biological mechanisms of HPA system dysregulation in both disorders.
焦虑症和抑郁症是最常见的精神疾病，住院人数众多，终生患病率高达25%。到目前为止，焦虑症的病理生理机制仍有待发现。临床前研究表明，下丘脑-垂体-肾上腺皮质（HPA）系统功能的变化与焦虑相关行为的表达存在因果关系。然而，焦虑症患者HPA系统功能的研究结果并不一致。在不同实验条件下，各种焦虑症中均发现了HPA反应的低反应性和高反应性。为了描述HPA系统功能在病例/对照中的假定差异，我们对30名惊恐障碍患者、35名重度抑郁发作患者以及30名在种族、年龄和性别上与之匹配的对照个体进行了地塞米松-促肾上腺皮质激素释放激素（Dex-CRH）试验，这是一种广泛用于高灵敏度检测HPA系统调节变化的试验。结果表明，两组患者在Dex-CRH试验中HPA系统反应的失调情况相似。这一发现进一步强调了抑郁症和惊恐障碍均存在HPA系统调节受损的假说，支持了这种损伤参与这些临床病症病理生理学的观点。然而，抑郁患者和惊恐患者在抑制效应和心理病理相关模式上的差异表明，两种疾病中HPA系统失调的生物学机制不同。
