Ehlers A, Breuer P
Department of Psychiatry, University of Oxford, Warneford Hospital, UK.
Biol Psychol. 1996 Jan 5;42(1-2):165-82. doi: 10.1016/0301-0511(95)05153-8.
Palpitations are among the most common symptoms of panic attacks. The present review addresses the question of whether systematic differences in heartbeat perception exist between patients with panic disorder and control subjects. Paradigms involving the comparison of heartbeat sensations with external signals such as discrimination task have failed to find group differences. Recent improvements in methodology may give clearer results in future studies. The majority of studies using the mental tracking paradigm have shown that panic disorder patients show a better heartbeat perception than controls. Discrepant results are probably related to different instructions and differences in sample characteristics such as the inclusion of patients on medication affecting the cardiovascular system. More accurate heartbeat perception, may, however, be restricted to those patients who show agoraphobic avoidance behavior. It is also conceivable that group differences in the mental tracking paradigm are due to attentional biases or a tendency to interpret weak sensations as heartbeats rather than differences in perceptual sensitivity. More ambulatory studies are needed to test whether the results can be generalized to the patients' natural environment. So far ambulatory studies have established superior heartbeat perception only in the subgroup of panic disorder patients with cardiac neurosis. A 1-year prospective study showed that heartbeat perception as assessed with the mental tracking paradigm predicted maintenance of panic attacks. This supports the clinical significance of the findings. Increased cardiac awareness may increase the probability of anxiety-inducing bodily sensations triggering the vicious cycle of panic. Laboratory and ambulatory monitoring studies showed that panic disorder patients respond with anxiety when they think that their heart rate has accelerated. Increased cardiac awareness may also contribute to the maintenance of the disorder by motivating the patients to avoid situations in which these sensations occur.
心悸是惊恐发作最常见的症状之一。本综述探讨了惊恐障碍患者与对照组在心跳感知方面是否存在系统性差异的问题。涉及将心跳感觉与外部信号（如辨别任务）进行比较的范式未能发现组间差异。方法学上的最新改进可能会在未来研究中给出更清晰的结果。大多数使用心理追踪范式的研究表明，惊恐障碍患者比对照组表现出更好的心跳感知。结果不一致可能与不同的指导语以及样本特征的差异有关，比如纳入了服用影响心血管系统药物的患者。然而，更准确的心跳感知可能仅限于那些表现出广场恐怖症回避行为的患者。也可以想象，心理追踪范式中的组间差异是由于注意力偏差或倾向于将微弱感觉解释为心跳，而非感知敏感性的差异。需要更多的动态研究来测试这些结果是否能推广到患者的自然环境中。到目前为止，动态研究仅在患有心脏神经症的惊恐障碍患者亚组中证实了卓越的心跳感知。一项为期1年的前瞻性研究表明，用心理追踪范式评估的心跳感知可预测惊恐发作的持续情况。这支持了这些发现的临床意义。心脏意识增强可能会增加诱发焦虑的身体感觉触发惊恐恶性循环的可能性。实验室和动态监测研究表明，当惊恐障碍患者认为自己的心率加快时会产生焦虑反应。心脏意识增强也可能通过促使患者避免出现这些感觉的情境而导致该障碍持续存在。
