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

描述(申请人提供)：恐慌症是一种衰弱的精神健康问题，其特征是反复发作的、意想不到的恐慌症，女性的患病率是男性的两倍。然而，对这种性别差异的潜在解释的研究有限。在焦虑敏感度(AS；即对焦虑症状做出恐惧反应的倾向)上存在显著的性别差异，女性比男性更倾向于焦虑敏感度，这是恐慌病理的一个公认的认知风险因素。具体地说，女性在强直性脊柱炎的测量上比男性得分更高；在1到3年的随访中，强直性脊柱炎患者患自发性恐慌症和恐慌症的风险增加。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有的周期性应激源，导致易受焦虑影响的女性(即高AS)出现适应不良焦虑、不明原因的恐慌症和恐慌症。因此，女性对恐慌相关反应的易感性-应激途径可能涉及恐慌病理(AS)的已知认知风险因素与自然发生的、性别特定的内部应激源(月经前阶段)之间的相互作用。作为探索这一拟议途径的第一步，这项拟议的R36精神健康论文授予增加多样性项目的主要目的是研究AS和月经周期阶段(月经前期与卵泡期)在预测对引起恐慌相关反应的实验室生物挑战(即吸入10%二氧化碳浓度的空气3分钟)时的焦虑和恐慌相关反应方面的交互影响。正常情况下，成年女性(N=60)将在经前阶段和卵泡期分别接受一次二氧化碳挑战。周期阶段将通过日数和排卵试剂盒进行估计，并通过孕酮测定进行确认。预计AS较高的女性将报告更多的挑战后恐慌和焦虑感觉，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)，与在她们的卵泡期评估时相比，与在任何一个周期阶段评估的较低女性相比，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标是检查AS和月经周期阶段(经前和卵泡)对自我报告的当前月经症状严重程度的交互影响。识别特定性别的脆弱性-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，还将有助于为处于恐慌病理高危状态的女性制定预防计划。这项研究的重点是确定可能解释女性恐慌症病理易感性的机制，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有关，也与NIMH改变精神障碍预防、为治愈铺平道路的愿景相关。 公共卫生相关性：恐慌症患病率的男女比例为2：1，这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，拟议的研究试图通过关注女性比男性更高的潜在素质(即焦虑敏感度或对恐惧的恐惧)和可能相互作用引发焦虑反应的周期性、性别特定的压力因素(即月经前周期阶段)来确定女性特有的致病风险因素和/或压力源。结果将对预防、评估、治疗和未来使用实验室范例研究妇女的恐慌症易感性的研究产生影响。

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.