Panic comorbidity with bipolar disorder: what is the manic-panic connection?
Panic comorbidity with bipolar disorder: what is the manic-panic connection?
复制标题
躁郁症的恐慌共病：躁狂与恐慌有何联系？
DOI：
10.1111/j.1399-5618.2006.00356.x
复制
发表时间：
2006
影响因子：
5.4
通讯作者：
Rachel B. Zamoiski
中科院分区：
文献类型：
--
作者：
D. MacKinnon;Rachel B. Zamoiski
上下文
在临床、社区和家族样本中观察到双相/惊恐共病。由于两者都是情绪调节的发作性障碍，共同的病理生理机制可能涉及杏仁核介导的可塑性依赖性情绪调节的缺陷。
证据
神经元发生和突触重塑发生在杏仁核;双相情感障碍和惊恐障碍都与杏仁核和相关结构的异常有关，以及调节可塑性的分子，如血清素、去甲肾上腺素、脑源性神经营养因子（BDNF）和促肾上腺皮质激素释放因子（CRF）。这些生物因素参与了威胁和奖励的行为条件反射。
模型
惊恐发作类似于正常的急性恐惧反应，但与任何相关威胁异常分离。异常的奖赏寻求行为是躁狂症和抑郁症的核心。食欲可能会升高或降低;对动力的满足可能无法影响未来的行为。这些分离可能是不同杏仁核亚区内可塑性依赖性调节过程缺陷的结果。
结论
这种推测模型可能是一个有用的框架，连接分子，细胞，解剖和行为过程中的恐慌和双相情感障碍。主要的临床意义是，行为治疗可能是至关重要的，以恢复功能，在一些双相情感障碍患者谁只有部分响应药物。
CONTEXT
Bipolar/panic comorbidity has been observed in clinical, community and familial samples. As both are episodic disorders of affect regulation, the common pathophysiological mechanism is likely to involve deficits in amygdala-mediated, plasticity-dependent emotional conditioning.
EVIDENCE
Neuronal genesis and synaptic remodeling occur in the amygdala; bipolar and panic disorders have both been associated with abnormality in the amygdala and related structures, as well as in molecules that modulate plasticity, such as serotonin, norepinephrine, brain-derived neurotrophic factor (BDNF) and corticotrophin releasing factor (CRF). These biological elements are involved in behavioral conditioning to threat and reward.
MODEL
Panic attacks resemble the normal acute fear response, but are abnormally dissociated from any relevant threat. Abnormal reward-seeking behavior is central to both manic and depressive syndromes. Appetites can be elevated or depressed; satisfaction of a drive may fail to condition future behavior. These dissociations may be the result of deficits in plasticity-dependent processes of conditioning within different amygdala subregions.
CONCLUSIONS
This speculative model may be a useful framework with which to connect molecular, cellular, anatomic and behavioral processes in panic and bipolar disorders. The primary clinical implication is that behavioral treatment may be critical to restore function in some bipolar patients who respond only partially to medications.
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