Correlates of therapeutic response in panic disorder presenting with palpitations: Heart rate variability, sleep, and placebo effect
Correlates of therapeutic response in panic disorder presenting with palpitations: Heart rate variability, sleep, and placebo effect
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DOI：
10.1177/070674370304800604
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发表时间：
2003-07-01
影响因子：
4
通讯作者：
Newman, D
中科院分区：
文献类型：
--
作者：
Baker, B;Khaykin, Y;Newman, D
目的：为了研究伴有心悸的惊恐障碍患者的治疗反应的相关性，我们假设治疗反应与心率变异性（HRV）和睡眠指标相关。经过一周的安慰剂洗脱后，27例无结构性心脏病且未服用强心药物的患者以双盲方式随机接受氯硝西泮治疗4周（已知的抗恐慌剂）或安慰剂。我们进行了标准的睡眠测量，并记录了基线和研究结束时24小时霍尔特采集的HRV。我们将治疗反应定义为汉密尔顿焦虑评定量表（HARS）评分改善50%，并通过问卷调查和乳酸钠输注反应证实。结果：有12例反应者和15例无反应者。与无应答者相比，在药物和安慰剂应答者（分别为P = 0.011和P = 0.05）和安慰剂单独应答者（分别为P = 0.006和P = 0.013）中观察到睡眠模式正常化（包括较少的1期和快速眼动[REM]睡眠）。安慰剂反应者更有可能表现出更少的抑郁，但即使在我们控制了抑郁之后，主要的睡眠影响仍然存在。与安慰剂组相比，氯硝西泮组HRV的时域和频域指标均下降（P < 0.05）。结论：以心悸为表现的惊恐障碍患者的治疗反应与中枢机制有关，但与HRV无直接相关性。更大规模和更长时间的研究可能会对惊恐障碍的安慰剂反应做出客观的解释。
Objective: To examine the correlates of therapeutic response of patients with panic disorder presenting with palpitations, we hypothesized that therapeutic response would correlate with heart rate variability (HRV) and sleep measures.Methods: After a I-week placebo washout, 27 patients free of structural heart disease and not on cardioactive drugs were randomized in a double-blinded fashion to 4 weeks of treatment with clonazepam (a known antipanic agent) or placebo. We performed standard sleep measures and recorded HRV from 24-hour Holter acquisitions at baseline and end of study. We defined response to therapy as a 50% improvement in the Hamilton Anxiety Rating Scale (HARS) score, confirmed by questionnaires and reaction to sodium lactate infusion.Results: There were 12 responders and 15 nonresponders. Normalization of sleep pattern (including less stage 1 and rapid eye movement [REM] sleep) was observed in both drug and placebo responders (P = 0.011 arid P = 0.05, respectively) and in placebo responders alone, compared with nonresponders (P = 0.006 and P = 0.013, respectively). Placebo responders were more likely to show less depression, but even after we controlled for depression, main sleep effects remained. None of the HRV measures correlated with response, but compared with placebo, clonazepam led to a decrease in all the time and frequency domain measures of HRV (all P < 0.05).Conclusions: Central mechanisms are related to the therapeutic response of patients with panic disorder presenting with palpitations, but this does not directly correlate with HRV. Larger and longer studies may allow objective explanations of placebo response in panic disorder.