Indicated prevention of mental disorders in subjects with initial panic symptomatology: effectiveness and underlying mechanisms of action

对具有初始恐慌症状的受试者进行精神障碍的预防：有效性和潜在的作用机制

• 批准号: 346183077
• 负责人: Professorin Dr. Katja Beesdo-Baum, since 11/2017
• 金额: --
• 依托单位: Department of Psychology
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2023-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/346183077?language=en
• 关键词: Indicated; prevention; mental; disorders; subjects

Mental disorders are common and associated with considerable individual and societal burden. Thus, increased research efforts are necessary to not only treat but also prevent psychopathology. Previous research has demonstrated that subjects with panic attacks (PA) and their milder forms, fearful spells (FS), are at increased risk for several types of psychopathology including panic but also other mental disorders (e.g., anxiety, depression, substance use). Additional findings suggest that FS/PA may constitute phenotypical indicators of underlying dysfunctions in brain circuits associated with fear/ anxiety (especially excessive threat responsivity) and may thus be useful as target points in prevention research. However, although early intervention in subjects with PA or subthreshold/ mild panic disorder has been shown to effectively reduce panic severity and associated adversity, it is unclear so far whether intervening at initial signs of panic (FS/PA) can prevent a further symptom progression towards panic disorder and various other types of psychopathology. This randomized controlled trial in high-risk subjects with initial panic symptomatology (FS/PA) but no full-threshold mental disorder aims to test whether a brief CBT-based panic-related preventive intervention can effectively reduce current psychopathological symptoms (intervention efficacy) and prospectively prevent the onset of full-threshold mental disorders (prevention efficacy). To identify central mechanisms of action, experimental paradigms (conditioning, NPU threat test and threat-looming test) will be applied examining whether intervention and prevention efficacy are mediated by favorable changes in defensive responsivity to acute threat and potential harm.

精神障碍很常见，并与相当大的个人和社会负担相关。因此，有必要加大研究力度，不仅可以治疗精神病理学，还可以预防精神病理学。先前的研究表明，患有惊恐发作（PA）及其较轻微形式的恐惧发作（FS）的受试者患多种类型精神病理学的风险增加，包括惊恐以及其他精神障碍（例如焦虑、抑郁、药物滥用）。其他研究结果表明，FS/PA 可能构成与恐惧/焦虑（尤其是过度威胁反应）相关的大脑回路潜在功能障碍的表型指标，因此可能可用作预防研究的目标点。然而，尽管对 PA 或阈下/轻度惊恐障碍受试者的早期干预已被证明可以有效降低惊恐严重程度和相关逆境，但目前尚不清楚在惊恐最初迹象（FS/PA）进行干预是否可以防止症状进一步进展为惊恐障碍和各种其他类型的精神病理学。这项随机对照试验针对具有初始恐慌症状（FS/PA）但无全阈值精神障碍的高危受试者，旨在测试基于 CBT 的简短恐慌相关预防干预是否可以有效减轻当前的精神病理症状（干预功效）并前瞻性预防全阈值精神障碍的发作（预防功效）。为了确定作用的中心机制，将应用实验范式（调节、NPU 威胁测试和威胁迫在眉睫测试）来检查干预和预防效果是否是通过对急性威胁和潜在伤害的防御反应的有利变化来调节的。