Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder - An ambulatory monitor study
Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder - An ambulatory monitor study
复制标题
DOI：
10.1001/archpsyc.61.9.913
复制
发表时间：
2004-09-01
影响因子：
--
通讯作者：
Kowalski, P
中科院分区：
文献类型：
--
作者：
Hoehn-Saric, R;McLeod, DR;Kowalski, P
背景资料：焦虑症患者对日常事件的生理反应知之甚少。Objective：To comparison self-reports and physiological recordings in patients with panic disorder（PD），patients with generalized anxiety disorder（GAD），and nonanxious controls during daily activities.Design：参与者在日常活动中进行了4次6小时的记录，同时佩戴动态监测器。每30分钟记录一次生理和主观数据，并在受试者发出焦虑或紧张或惊恐发作增加的信号期间记录一次。设置：参与者的日常环境。研究对象：26名PD患者和40名GAD患者，均无实质性合并症，以及24名对照。干预：在日常活动期间获得的记录。主要结果测量：记录的心脏interbeat间隔，皮肤电导水平，呼吸，运动，主观躯体症状和紧张或anxiety.Results的评级：焦虑症患者的精神和躯体焦虑症状评分高于对照组。这两种焦虑症的共同点是自主神经灵活性降低，这一点在一整天中都表现出来，伴随着对身体状态的不精确感知。PD和GAD患者之间的主要差异是对身体感觉的敏感性提高和更频繁的按钮按压。也有一个趋势，提高基础唤醒PD患者，表现在更快的心率在整个day.Conclusions：PD或GAD患者比nonanxious个人更敏感的身体变化，PD患者比GAD更敏感。PD患者比GAD和对照组患者更频繁地经历痛苦，但他们的生理反应强度相当。研究结果表明，惊恐发作的感觉反映了中枢反应，而不是外周反应。在这两种焦虑状态下观察到的自主神经灵活性减弱可能是由于焦虑加剧时信息处理功能障碍，无法区分焦虑相关输入和中性输入。
Background: Physiologic responses of patients with anxiety disorders to everyday events are poorly understood.Objective: To compare self-reports and physiologic recordings in patients with panic disorder (PD), patients with generalized anxiety disorder (GAD), and nonanxious controls during daily activities.Design: Participants underwent four 6-hour recording sessions during daily activities while wearing an ambulatory monitor. Physiologic and subjective data were recorded every 30 minutes and during subject-signaled periods of increased anxiety or tension or panic attack.Setting: Participants' everyday environment.Participantst Twenty-six patients with PD and 40 with GAD, both without substantial comorbidity, and 24 controls.Interventions: Recordings obtained during everyday activities.Main Outcome Measures: Recordings of heart interbeat intervals, skin conductance levels, respirations, motion, and ratings of subjective somatic symptoms and tension or anxiety.Results: Patients with anxiety disorders rated higher on psychic and somatic anxiety symptoms than did controls. Common to both anxiety disorders was diminished autonomic flexibility that manifested itself throughout the day, accompanied by less precise perception of bodily states. The main differences between patients with PD and GAD were a heightened sensitivity to body sensations and more frequent button presses. There also was a trend toward heightened basal arousal in patients with PD, manifesting itself in a faster heart rate throughout the day.Conclusions: Patients with PD or GAD are more sensitive to bodily changes than nonanxious individuals, and patients with PD are more sensitive than those with GAD. Patients with PD experience more frequent distress than those with GAD and controls, but their physiologic responses are comparable in intensity. The findings suggest that the perception of panic attacks reflects central rather than peripheral responses. The diminished autonomic flexibility observed in both anxiety conditions may result from dysfunctional information processing during heightened anxiety that fails to discriminate between anxiety-related and neutral inputs.