Anxiety Sensitivity, Menstrual Cycle Phase, and Panic-Relevant Responding

描述（由申请人提供）：惊恐障碍是一种以反复发作、意外惊恐发作为特征的衰弱性心理健康问题，女性的患病率是男性的2倍。然而，对这种性别差异的潜在解释的研究有限。焦虑敏感性（AS;即，对焦虑症状做出恐惧反应的倾向），这是恐慌病理学的一个已确定的认知风险因素。具体来说，女性在AS指标上的得分高于男性;在1至3年的随访中，AS高的个体发生自发性恐慌发作和恐慌症的风险增加。考虑到高AS个体将身体感觉误解为危险的倾向，月经周期的经前期可能构成性别特异性的周期性应激源，其导致易受焦虑影响的女性的适应不良焦虑、无线索惊恐发作和惊恐障碍的发作（即，高AS）。因此，女性恐慌相关反应的性别特异性易患性压力途径可能涉及恐慌病理学（AS）的已知认知风险因素与自然发生的性别特异性内部压力源（经前期）之间的相互作用。作为探索这一拟议途径的第一步，这一拟议的R36心理健康论文资助增加多样性项目的主要目的是检查AS和月经周期阶段（经前期与卵泡期）在预测焦虑和恐慌相关反应时的相互作用，以应对实验室生物挑战，从而消除恐慌相关反应（即，吸入10%CO2富集空气3分钟）。正常排卵的成年女性（N = 60）将在经前期和卵泡期分别接受一次CO2挑战。将通过日计数和排卵试剂盒估计周期阶段，并通过孕酮测定确认。预计AS较高的女性将报告更大的挑战后恐慌和焦虑的感觉，并表现出更高的心理生理反应（皮肤电导水平）在生物挑战时，在其经前期评估相比，当评估在其卵泡期，并在与女性相比，AS较低的评估在任何一个周期阶段。该项目的第二个目的是研究AS和月经周期阶段（经前与卵泡）对自我报告的当前月经症状严重程度的相互作用。确定性别特异性的易患性压力途径将提供有关的潜在病因和维护妇女的恐慌病理学的信息，也将有助于制定预防计划，为妇女在恐慌病理学的高风险。这项研究的重点是确定机制，可能会解释妇女的恐慌病理脆弱性是相关的国家心理健康研究所的使命，以减少精神疾病的负担，通过行为研究和NIMH的愿景，以改变精神疾病的预防，铺平了道路治愈。 公共卫生相关性：惊恐障碍患病率的2：1女性与男性的性别差异是一个重要的公共卫生挑战。为了进一步了解这种性别差异，拟议的研究旨在通过关注女性相对于男性升高的潜在素质（即，焦虑敏感性或害怕恐惧）和周期性的、性别特异性的应激源（即，经前周期阶段），可能相互作用，以引起焦虑反应。研究结果将对预防、评估、治疗和未来的研究产生影响，这些研究将使用实验室范式来研究女性的恐慌脆弱性。

DESCRIPTION (provided by applicant): The prevalence of panic disorder, a debilitating mental health problem characterized by recurrent, unexpected panic attacks, is 2 times higher among females relative to males. However, research on potential explanations for this gender difference is limited. There is a prominent gender difference, favoring females over males, on anxiety sensitivity (AS; i.e., the tendency to respond fearfully to anxiety symptoms), an identified cognitive risk factor for panic pathology. Specifically, women score higher than men on measures of AS; and individuals with high AS have an increased risk of developing spontaneous panic attacks and panic disorder over 1- to 3-year follow ups. Given the tendency for high AS individuals to misinterpret bodily sensations as dangerous, the premenstrual phase of the menstrual cycle may constitute a gender-specific, cyclical stressor that contributes to the onset of maladaptive anxiety, uncued panic attacks, and panic disorder in women with a vulnerability to anxiety (i.e., high AS). Therefore, a gender-specific vulnerability-stress pathway to panic-relevant responding in women may involve an interaction between a known cognitive risk factor for panic pathology (AS) and a naturally occurring, gender-specific, internal stressor (premenstrual phase). As a first step in exploring this proposed pathway, the primary aim of this proposed R36 Mental Health Dissertation Grant to Increase Diversity project is to examine the interactive effects of AS and menstrual cycle phase (premenstrual phase vs. follicular phase) in predicting anxious- and panic-relevant responding to a laboratory biological challenge that elicits panic-relevant responses (i.e., 3 minutes of inhaling 10% CO2-enriched air). Normally menstruating adult women (N = 60) will undergo the CO2 challenge once in their premenstrual phase and once in their follicular phase. Cycle phase will be estimated by day count and ovulation kits and confirmed via progesterone assay. It is expected that women higher on AS will report greater post-challenge panic and anxiety sensations and exhibit heightened psychophysiological responses (skin conductance level) during the biological challenge when assessed in their premenstrual phase in comparison to when assessed in their follicular phase and in comparison to women lower on AS assessed in either cycle phase. A secondary aim of the proposed project is to examine the interactive effects of AS and menstrual cycle phase (premenstrual vs. follicular) on self-reported current menstrual symptom severity. Identifying gender-specific vulnerability-stress pathways will provide information pertinent to the potential etiology and maintenance of panic pathology in women and will also aid in developing prevention programs for women at high risk for panic pathology. This study's focus on identifying mechanisms that may explain vulnerability to panic pathology in women is relevant to the National Institute of Mental Health's mission to reduce the burden of mental disorders through behavioral research and to the NIMH's vision to transform the prevention of mental disorders, paving the way for a cure. PUBLIC HEALTH RELEVANCE: The 2:1 female-to-male gender difference in the prevalence of panic disorder is an important public health challenge. To further understand this gender difference, the proposed study seeks to identify etiological risk factors and/or stressors specific to women by focusing on an underlying diathesis that is elevated in women relative to men (i.e., anxiety sensitivity or fear of fear) and a cyclical, gender-specific stressor (i.e., premenstrual cycle phase) that may interact to elicit anxious responding. Results will have implications for prevention, assessment, treatment, and future research using laboratory paradigms to study panic vulnerability in women.