Johnson Philip L, Federici Lauren M, Shekhar Anantha
Department of Anatomy & Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, USA; Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Anatomy & Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
Neurosci Biobehav Rev. 2014 Oct;46 Pt 3:429-54. doi: 10.1016/j.neubiorev.2014.07.027. Epub 2014 Aug 15.
Panic disorder (PD) is a severe anxiety disorder that is characterized by recurrent panic attacks (PA), which can be unexpected (uPA, i.e., no clear identifiable trigger) or expected (ePA). Panic typically involves an abrupt feeling of catastrophic fear or distress accompanied by physiological symptoms such as palpitations, racing heart, thermal sensations, and sweating. Recurrent uPA and ePA can also lead to agoraphobia, where subjects with PD avoid situations that were associated with PA. Here we will review recent developments in our understanding of PD, which includes discussions on: symptoms and signs associated with uPA and ePAs; Diagnosis of PD and the new DSM-V; biological etiology such as heritability and gene×environment and gene×hormonal development interactions; comparisons between laboratory and naturally occurring uPAs and ePAs; neurochemical systems that are associated with clinical PAs (e.g. gene associations; targets for triggering or treating PAs), adaptive fear and panic response concepts in the context of new NIH RDoc approach; and finally strengths and weaknesses of translational animal models of adaptive and pathological panic states.
惊恐障碍（PD）是一种严重的焦虑症，其特征为反复发作的惊恐发作（PA），惊恐发作可以是不可预期的（uPA，即没有明确可识别的触发因素）或可预期的（ePA）。惊恐通常涉及一种突然的灾难性恐惧或痛苦感，并伴有心悸、心跳加速、潮热感和出汗等生理症状。反复发作的uPA和ePA还可导致广场恐惧症，患有惊恐障碍的个体往往会回避与惊恐发作相关的情境。在此，我们将综述近期在惊恐障碍认识方面的进展，包括以下方面的讨论：与不可预期和可预期惊恐发作相关的症状和体征；惊恐障碍的诊断及新版《精神疾病诊断与统计手册》（DSM-V）；生物学病因，如遗传性、基因×环境以及基因×激素发育相互作用；实验室诱导的与自然发生的不可预期和可预期惊恐发作之间的比较；与临床惊恐发作相关的神经化学系统（如基因关联；引发或治疗惊恐发作的靶点）；在国立卫生研究院（NIH）新的研究领域标准（RDoc）方法背景下的适应性恐惧和惊恐反应概念；最后是适应性和病理性惊恐状态的转化动物模型的优缺点。
