Curtis G C, Abelson J L, Gold P W
University of Michigan Department of Psychiatry, Anxiety Disorders Program, Ann Arbor, USA.
Biol Psychiatry. 1997 Jan 1;41(1):76-85. doi: 10.1016/s0006-3223(95)00578-1.
This study applied the corticotropin-releasing hormone (CRH) stimulation test to patients with panic disorder, before and during treatment with alprazolam, and to control subjects. In contrast to some, but not all prior studies, untreated, nondepressed panic disorder patients failed to show blunted adrenocorticotropic hormone or cortisol responses to CRH. In fact, the responses were subtly enhanced in that they were more rapid than those of controls. After 12 weeks of alprazolam treatment, repeat testing gave results that were indistinguishable from those of controls. Inconsistency among reports of CRH testing in panic disorder may be related to interactions among illness mechanisms, concurrent subthreshold depressive symptoms, the chronic stress of the illness, and hyperresponsiveness of panic patients to the acute stress of experimental manipulations. Pretreatment abnormalities in hypothalamic-pituitary-adrenal axis function appear to resolve with alprazolam treatment. Preliminary observations suggest that pretreatment dysregulation of the hypothalamic-pituitary-adrenal system may predict a more difficult or less satisfactory treatment.
本研究对惊恐障碍患者在接受阿普唑仑治疗前、治疗期间以及对对照受试者应用促肾上腺皮质激素释放激素（CRH）刺激试验。与一些（但并非所有）先前研究不同，未经治疗的非抑郁惊恐障碍患者对CRH的促肾上腺皮质激素或皮质醇反应并未表现出迟钝。事实上，这些反应有轻微增强，因为它们比对照组的反应更快。阿普唑仑治疗12周后，重复测试得到的结果与对照组难以区分。惊恐障碍患者CRH测试报告之间的不一致可能与疾病机制、并发的阈下抑郁症状、疾病的慢性应激以及惊恐患者对实验操作急性应激的高反应性之间的相互作用有关。下丘脑 - 垂体 - 肾上腺轴功能的治疗前异常似乎随着阿普唑仑治疗而得到缓解。初步观察表明，下丘脑 - 垂体 - 肾上腺系统治疗前的失调可能预示着治疗更困难或效果不太令人满意。
