Increased anxiety during anticipation of unpredictable but not predictable aversive stimuli as a psychophysiologic marker of panic disorder
Increased anxiety during anticipation of unpredictable but not predictable aversive stimuli as a psychophysiologic marker of panic disorder
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DOI：
10.1176/appi.ajp.2007.07101581
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发表时间：
2008-07-01
影响因子：
17.7
通讯作者：
Pine, Daniel S.
中科院分区：
文献类型：
--
作者：
Grillon, Christian;Lissek, Shmuel;Pine, Daniel S.
目的：可预测性是焦虑的一个基本调节因子，因为预测厌恶事件的能力减轻了焦虑反应。在惊恐障碍中，持续的焦虑症状是由对下一次无线索（不可预测）惊恐发作的预期引起的。作者测试的假设，即升高的焦虑反应，特别是对不可预测的厌恶事件，是一个心理生理相关的panic disorder.Method：参与者暴露于一个条件，其中可预测的厌恶刺激信号的线索，第二个条件，其中厌恶刺激管理不可预测的，和第三个条件，其中没有厌恶刺激的预期。惊吓被用来评估焦虑反应的线索和contextuals.Results：相对于健康的比较subjects，惊恐障碍患者表现出同等水平的恐惧增强惊吓的威胁cue.Conclusions：惊恐障碍患者是过度敏感的不可预测的厌恶事件的背景下，但提高惊吓增强。这种脆弱性可能是疾病的发病前特征标记，也可能是由无线索恐慌发作的经历引起的后天条件。作为一种病前特征，对不可预测性的脆弱性可能与惊恐障碍有关，因为它使个体对危险敏感，最终导致对轻微威胁的强烈恐惧/警报反应。作为一种获得性特征，这种脆弱性可能通过增加预期焦虑而导致惊恐障碍症状的维持和恶化。
Objective: Predictability is a fundamental modulator of anxiety in that the ability to predict aversive events mitigates anxious responses. In panic disorder, persistent symptoms of anxiety are caused by anticipation of the next uncued (unpredictable) panic attack. The authors tested the hypothesis that elevated anxious reactivity, specifically toward unpredictable aversive events, is a psychophysiological correlate of panic disorder.Method: Participants were exposed to one condition in which predictable aversive stimuli were signaled by a cue, a second condition in which aversive stimuli were administered unpredictably, and a third condition in which no aversive stimuli were anticipated. Startle was used to assess anxious responses to cues and contexts.Results: Relative to healthy comparison subjects, patients with panic disorder displayed equivalent levels of fear-potentiated startle to the threat cue but elevated startle potentiation in the context of the unpredictable condition.Conclusions: Patients with panic disorder are overly sensitive to unpredictable aversive events. This vulnerability could be either a premorbid trait marker of the disorder or an acquired condition caused by the experience of uncued panic attacks. As a premorbid trait, vulnerability to unpredictability could be etiologically related to panic disorder by sensitizing an individual to danger, ultimately leading to intense fear/alarm responses to mild threats. As an acquired characteristic, such vulnerability could contribute to the maintenance and worsening of panic disorder symptoms by increasing anticipatory anxiety.