Robinaugh Donald J, Ward Meredith J, Toner Emma R, Brown Mackenzie L, Losiewicz Olivia M, Bui Eric, Orr Scott P
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Gen Psychiatr. 2019 Dec 23;32(6):e100140. doi: 10.1136/gpsych-2019-100140. eCollection 2019.
Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO inhalation) and their relation to subsequent panic attacks and panic disorder.
We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder.
We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder.
These findings provide support for the prediction derived from cognitive-behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development.
惊恐障碍的认知行为理论认为，惊恐发作源于与唤醒相关的身体感觉和感知到的威胁之间的正反馈回路。在最近开发的一个将这些惊恐发作理论形式化的计算模型中，观察到对模拟唤醒扰动的反应是易患惊恐发作和惊恐障碍的一个有力指标。在本综述中，我们评估这一观察结果是否在检验对生物挑战（如吸入一氧化碳）的反应及其与随后惊恐发作和惊恐障碍关系的实证文献中得到证实。
我们在PubMed、科学网和PsycINFO中进行搜索，使用表示激发剂（如乳酸钠）和程序（如输注）的关键词，并结合与惊恐障碍相关的关键词（如惊恐）。如果文章使用对生物挑战范式的反应来前瞻性地预测惊恐发作或惊恐障碍，则符合入选标准。
我们确定了四项符合条件的研究。合并效应量表明，生物挑战反应与随后的惊恐发作有中度的前瞻性关联，但与惊恐障碍没有前瞻性关系。
这些发现为认知行为理论得出的预测提供了支持，并有一些初步证据表明，对生物挑战的反应作为易患惊恐发作的标志物可能具有临床应用价值，有待进一步研究和开发。
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