Grillon Christian, O'Connell Katherine, Lieberman Lynne, Alvarez Gabriella, Geraci Marilla, Pine Daniel S, Ernst Monique
National Institute of Mental Health, NIH, Bethesda, MD.
Now at Georgetown University, Washington, DC.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2017 Oct;2(7):575-581. doi: 10.1016/j.bpsc.2016.08.005.
Delineating specific clinical phenotypes of anxiety disorders is a crucial step toward better classification and understanding of these conditions. The present study sought to identify differential aversive responses to predictable and unpredictable threat of shock in healthy comparisons and in non-medicated anxiety patients with and without a history of panic attacks (PAs).
143 adults (72 healthy controls; 71 patients with generalized anxiety disorder (GAD) or/and social anxiety disorder (SAD), 24 with and 47 without PAs) were exposed to three conditions: 1) predictable shocks signaled by a cue, 2) unpredictable shocks, and 3) no shock. Startle magnitude was used to assess aversive responses.
Across disorders, a PA history was specifically associated with hypersensitivity to unpredictable threat. By disorder, SAD was associated with hypersensitivity to predictable threat, whereas GAD was associated with exaggerated baseline startle.
These results identified three physiological patterns. The first is hypersensitivity to unpredictable threat in individuals with PAs. The second is hypersensitivity to predictable threat, which characterizes SAD. The third is enhanced baseline startle in GAD, which may reflect propensity for self-generated anxious thoughts in the absence of imminent danger. These results inform current thinking by linking specific clinical features to particular physiology profiles.
描绘焦虑症的特定临床表型是更好地对这些病症进行分类和理解的关键一步。本研究旨在确定健康对照者以及有无惊恐发作（PA）病史的未用药焦虑症患者对可预测和不可预测电击威胁的不同厌恶反应。
143名成年人（72名健康对照者；71名患有广泛性焦虑症（GAD）或/和社交焦虑症（SAD）的患者，其中24名有PA病史，47名无PA病史）被暴露于三种情境：1）由提示信号表明的可预测电击；2）不可预测电击；3）无电击。惊吓幅度用于评估厌恶反应。
在所有病症中，PA病史与对不可预测威胁的超敏反应特别相关。按病症来看，SAD与对可预测威胁的超敏反应相关，而GAD与基线惊吓反应过度相关。
这些结果确定了三种生理模式。第一种是有PA病史的个体对不可预测威胁的超敏反应。第二种是SAD所特有的对可预测威胁的超敏反应。第三种是GAD中增强的基线惊吓反应，这可能反映了在没有迫在眉睫危险的情况下自我产生焦虑想法的倾向。这些结果通过将特定临床特征与特定生理特征联系起来，为当前的认识提供了依据。
