PROSPECTIVE STUDY OF RELAPSE PREDICTORS IN PANIC DISORDER

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。恐慌症的病因仍不清楚。然而，神经科学研究中有关恐惧的数据和临床研究中有关焦虑的数据的融合表明，恐慌症可能是由大脑恐惧通路的遗传决定的敏感性和应激性生活事件的影响共同决定的。动物和人类研究也有大量证据表明，应激性生活事件会影响大脑恐惧通路的功能，并与恐慌症的发展、发病和复发有关。我们之前已经在恐慌症患者的心血管和呼吸功能指标上显示出显著的异常。心脏和肺的控制受到大脑中参与压力反应和焦虑发展的区域的影响。我们现在计划调查应激性生活事件、大脑对心血管和呼吸功能的控制以及成功治疗恐慌症后复发的可能性之间的关系。使用非侵入性方法，我们将获得对惊恐障碍患者的心血管和呼吸功能的测量，以及对应激性生活事件的严格历史评估。然后，我们将结合使用认知行为疗法和抗抑郁剂舍曲林，这两种药物对治疗恐慌症都有很好的疗效，并在治疗期间和之后进行反复的应激、心血管和呼吸测量。急性治疗阶段为3个月，维持治疗阶段为3个月，随访、未治疗阶段为12个月。这项调查将使我们能够测试惊恐障碍患者是否容易受到应激性生活事件的影响，以及在治疗前、治疗中和治疗后与心血管和呼吸功能以及惊恐复发的关系。这些关系可能为指导治疗方法和允许临床医生测试恐慌症的易感性提供重要数据。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The etiology of panic disorder remains unknown. Yet a convergence of data from neuroscience research on fear and clinical research on anxiety suggests panic disorder may be explained by a combination of genetically determined hypersensitivity of the brains fear pathways and the influence of stressful life events. There is also abundant evidence from both animal and human studies that stressful life events can impact on functioning of the brain's fear pathways and are associated with development, onset, and relapse of panic disorder. We have previously demonstrated significant abnormalities in cardiovascular and respiratory function measures in individuals with panic disorder. The control of the heart and lungs is affected by regions of the brain involved in the response to stress and the development of anxiety. We now plan to investigate the relationships of stressful life events, the brain's control of cardiovascular and respiratory function, and the potential for relapse after successful treatment of panic disorder. Using non-invasive methods, we will obtain measures of cardiovascular and respiratory function in panic disorder patients along with a rigorous historical assessment of stressful life events. We will then use a combination of cognitive behavioral therapy and the antidepressant sertraline, both with well-validated efficacy for the treatment of panic disorder, and obtain repeated stress, cardiovascular, and respiratory measures during and after such treatment. The acute treatment phase is 3 months, the maintenance treatment phase is another 3 months, and the follow-up, no-treatment phase is 12 months. This investigation will enable us to test whether patients with panic disorder are vulnerable to the impact of stressful life events and what are the relationships with cardiovascular and respiratory function and panic relapse before, during, and after treatment. These relationships may offer important data for directing treatment approaches and allowing clinicians to test for vulnerability to panic disorder.