PHYSIOLOGICAL MARKERS FOR ANXIETY DISORDER--PD AND GAD

焦虑症的生理标志——PD 和 GAD

• 批准号: 2675530
• 负责人: WALTON Thompson ROTH
• 金额: $ 22.69万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-05-15 至 2000-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2675530
• 关键词: agoraphobia; anxiety disorders; autonomic nervous system; avoidance behavior; behavior test; behavioral /social science research tag; biomarker; clinical research; human subject; hyperpnea; noise; panic disorder; psychophysiology; respiratory hypoxia; startle reaction; temporal lobe /cortex

DESCRIPTION (Adapted from applicant's abstract): The DSM-IV classification of anxiety disorders postulates a number of distinct diseases presumed to have different biological underpinnings. Although physiological symptoms such as rapid heart beat and breathlessness are important component criteria for both Panic Disorder (PD) with and without agoraphobia, and Generalized Anxiety Disorder (GAD), diagnosis is based on subjective report of physiological disturbance rather than its objective measurement. The clinical phenomenology of PD and GAD suggests different temporal patterns, e.g., abrupt surges of activation in panic attacks versus more sustained activation in phobic situations and in GAD. While primarily characterized by sustained activation, GAD patients may also show short spikes of activation associated with intrusive, worried thoughts. Biologic mechanisms proposed to account for the phenomenology of PD, with and without agoraphobia, include autonomic instability, hyperventilation, suffocation false alarm, and epileptic discharge. Ambulatory monitoring and laboratory tests (relaxation, habituation, breath holding, hyperventilation, concomitants of thought, and classical conditioning) developed specifically to assess these physiological mechanisms will be used in two separate studies. Study 1 will compare 30 GAD patients, 30 PD patients with agoraphobia, and 30 controls. Study 2 will compare 20 PD patients with agoraphobia, 20 PD patients without agoraphobia, and 20 controls. In Study 2, ambulatory monitoring will include a behavioral avoidance test in a shopping mall. Analysis will determine if: 1. PD patients manifest more spontaneous autonomic fluctuations coinciding with dips and/or peaks in end-tidal pCO2 and electroencephalography changes suggesting epileptic discharge, than controls and GAD patients. 2. PD patients respond with more exaggerated psychophysiological reactions to dips and peaks in end-tidal pCO2 produced respiratory maneuvers than GAD patients or controls. 3. GAD patients and PD patients with agoraphobia habituate more slowly to noise bursts than PD patients without agoraphobia or controls. 4. Emotional conditioning to noise bursts is acquired more quickly and is more resistant to extinction in PD patients with agoraphobia than PD patients without agoraphobia or controls. 5. Physiological activation is related to subjective report of anxiety and panic and specific anxiety symptoms.

描述（改编自申请人摘要）：DSM-IV分类 焦虑症的诊断假设了许多不同的疾病， 有不同的生物学基础。 虽然生理症状 例如快速心跳和呼吸困难是重要组成标准 对于伴有和不伴有广场恐怖症的惊恐障碍（PD）， 焦虑症（GAD），诊断是基于主观报告， 生理干扰，而不是其客观测量。 的 PD和GAD的临床现象学提示不同的时间模式， 例如，在一个实施例中，惊恐发作时的突然激活， 在恐惧症和广泛性焦虑症中的激活。 虽然主要特点是 通过持续的激活，GAD患者也可能表现出短暂的 与侵入性的、忧虑的想法有关的激活。 生物学机制 提出解释PD的现象学，有和没有 广场恐怖症，包括自主神经不稳定，换气过度，窒息 虚惊一场癫痫放电 动态监测和实验室 测试（放松，习惯，屏气，过度换气， 思想的伴随物，和经典条件作用） 为了评估这些生理机制，将在两个独立的 问题研究 研究1将比较30名GAD患者、30名PD患者和30名 广场恐怖症和30名对照。 研究2将比较20例PD患者， 广场恐怖症，20例PD患者无广场恐怖症，20名对照。 在自习 2、门诊监测将包括行为回避测试， 商场 分析将确定是否： 1. PD患者表现出更多的自发性自主神经波动， 潮气末pCO 2下降和/或达到峰值以及脑电图变化 提示癫痫样放电。 2. PD患者的心理生理反应更为夸张 对潮气末pCO 2的下降和峰值产生的呼吸动作比GAD 患者或对照组。 3. GAD患者和患有广场恐怖症的PD患者更慢地适应 噪声爆发比PD患者没有广场恐怖症或控制。 4. 对噪音爆发的情绪调节更快地获得， PD广场恐怖症患者比PD更难消退 无广场恐怖症的患者或对照组。 5. 生理激活与焦虑的主观报告有关， 恐慌和特定的焦虑症状。