SOMATIC SYMPTOMS AND THE PSYCHOBIOLOGY OF ANXIETY

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In anxiety disorders, the selection and assessment of treatment depend to a large extent on patient reports of somatic symptomatology. It is important, therefore, to obtain a better understanding of the relationships between patient reports and actual underlying physiological activity. In general, self reports and physiological measures do not correlate well. Among the possible reasons for this finding is that the physiological measures have been taken in laboratory settings rather than during patients' usual daily activities. An ambulatory monitoring device has been constructed which records skin conductance, heart rate, respiration, and activity levels while patients go about their daily activities. The past studies we have found that generalized anxiety disorder (CAD) patients who had comparable levels of psychic measures and the need for alprazolam. We also showed that panic disorder (PD) patients showed heightened autonomic arousal (skin conductance, heart rate) even during rest, while GAD patients as a group were comparable to nonanxious controls. Pilot studies with the monitor found GAD patients to have increased heart rate, but, paradoxically a decrease in skin conductance when feeling anxious. PD patients showed autonomic changes during panic attacks, but they were not always consistent with subjective experiences. We propose to: 1) compare GAD patients with high and low levels of cardiac symptoms and, 2) to compare GAD patients with PD patients and normal controls. Specifically, thirty-two GAD patients with and thirty-two without heart palpitations will wear the ambulatory monitoring device for eight hours of recording. They will rate their symptoms throughout the day and comparisons will be made between the physiological recordings and self reported symptoms during periods of stress and perceived stress. Similar recordings will be obtained in PD patients and normal controls. The data of the study will allow us to study physiological states of anxiety patients during everyday activities and, to determine whether patients who report different sets of symptoms differ in underlying physiological activity and whether self reports of somatic symptoms correlate with physiological measures during patients' everyday activities.