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

描述（由申请人提供）：惊恐障碍的患病率是女性的2倍，女性是男性的2倍，惊恐障碍是一种使人衰弱的精神健康问题，其特征是反复出现意想不到的惊恐发作。然而，对这种性别差异的潜在解释的研究是有限的。在焦虑敏感性（AS，即对焦虑症状做出恐惧反应的倾向）这一已确定的恐慌病理的认知风险因素上，存在显著的性别差异，女性比男性更受青睐。具体来说，女性在AS方面的得分高于男性；在1到3年的随访中，高AS患者发生自发性惊恐发作和惊恐障碍的风险增加。鉴于高AS个体将身体感觉误解为危险的倾向，月经周期的经前阶段可能构成性别特异性的周期性压力源，导致易受焦虑（即高AS）影响的女性出现适应不良焦虑、不明原因的恐慌发作和恐慌障碍。因此，女性恐慌相关反应的性别特异性脆弱性-应激途径可能涉及已知的恐慌病理（AS）认知风险因素与自然发生的、性别特异性的内部应激源（经前期）之间的相互作用。作为探索这一途径的第一步，该R36心理健康论文资助增加多样性项目的主要目的是研究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的实验室生物挑战反应（即吸入10%二氧化碳浓度的空气3分钟）中的相互作用。正常月经期的成年女性（N = 60）将在经前期和卵泡期分别接受一次CO2挑战。周期阶段将通过天数计数和排卵试剂盒来估计，并通过孕酮测定来确认。与在卵泡期和在任何一个周期评估的低AS女性相比，在经前期评估时，AS水平较高的女性会报告更大的挑战后恐慌和焦虑感，并在生物挑战期间表现出更高的心理生理反应（皮肤电导水平）。拟议项目的第二个目的是检查AS和月经周期阶段（经前期和卵泡期）对自我报告的当前月经症状严重程度的相互作用。识别性别特异性的脆弱-压力途径将提供与女性恐慌病理的潜在病因和维持相关的信息，也将有助于制定针对高危女性恐慌病理的预防方案。这项研究的重点是确定可能解释女性恐慌病理易感性的机制，这与国家精神卫生研究所通过行为研究减轻精神障碍负担的使命和NIMH改变精神障碍预防、为治疗铺平道路的愿景有关。

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.