Abstract
Panic disorder is a frequent and disabling mental disorder characterized by recurrent periods or abrupt surges of intense fear or discomfort, the panic attacks. The clinical phenomenology of panic attacks suggests a prominent role of a disturbed stress response regulation in the aetiopathology of this disorder. We summarize the results of challenge tests of the hypothalamus-pituitary-adrenocortical (HPA) axis in panic disorder and give an overview of studies using psychosocial challenge paradigms. The results of HPA axis challenge tests suggest an increased expression of the hypothalamic neuropeptides, but an intact negative feedback inhibition at the level of the pituitary. Psychosocial challenge tests give evidence for dissociation between the subjective stress response and the HPA axis response in panic disorder, which might be the result of an over-focussed self-monitoring leading to an enhanced stress perception despite normal HPA axis activation. We integrated these findings in a cognitive stress control model suggesting that panic disorder patients develop efficient strategies to control the somatic stress response despite a hypothalamic hyperdrive of the HPA axis. To employ these strategies at the right time, patients acquired an enhanced perception of stress symptoms, leading to the reported dissociation of the subjective and HPA axis response. It can be inferred from these findings that cognitive behavioral therapy addressing over-focussed self-monitoring and maladaptive control strategies in combination with pharmacological treatment against over-expression of the hypothalamic neuropeptides should be an effective treatment in severe forms of panic disorder, which corresponds with recent treatment guidelines.
Keywords: Panic disorder, HPA axis, dexamethasone suppression test, CRH stimulation test, dex/CRH test, psychosocial challenge, Trier Social Stress Test
Current Pharmaceutical Design
Title:Stress Response Regulation in Panic Disorder
Volume: 18 Issue: 35
Author(s): Marcus Ising, Nina Hohne, Anna Siebertz, Anna-Mareike Parchmann, Angelika Erhardt and Martin Keck
Affiliation:
Keywords: Panic disorder, HPA axis, dexamethasone suppression test, CRH stimulation test, dex/CRH test, psychosocial challenge, Trier Social Stress Test
Abstract: Panic disorder is a frequent and disabling mental disorder characterized by recurrent periods or abrupt surges of intense fear or discomfort, the panic attacks. The clinical phenomenology of panic attacks suggests a prominent role of a disturbed stress response regulation in the aetiopathology of this disorder. We summarize the results of challenge tests of the hypothalamus-pituitary-adrenocortical (HPA) axis in panic disorder and give an overview of studies using psychosocial challenge paradigms. The results of HPA axis challenge tests suggest an increased expression of the hypothalamic neuropeptides, but an intact negative feedback inhibition at the level of the pituitary. Psychosocial challenge tests give evidence for dissociation between the subjective stress response and the HPA axis response in panic disorder, which might be the result of an over-focussed self-monitoring leading to an enhanced stress perception despite normal HPA axis activation. We integrated these findings in a cognitive stress control model suggesting that panic disorder patients develop efficient strategies to control the somatic stress response despite a hypothalamic hyperdrive of the HPA axis. To employ these strategies at the right time, patients acquired an enhanced perception of stress symptoms, leading to the reported dissociation of the subjective and HPA axis response. It can be inferred from these findings that cognitive behavioral therapy addressing over-focussed self-monitoring and maladaptive control strategies in combination with pharmacological treatment against over-expression of the hypothalamic neuropeptides should be an effective treatment in severe forms of panic disorder, which corresponds with recent treatment guidelines.
Export Options
About this article
Cite this article as:
Ising Marcus, Hohne Nina, Siebertz Anna, Parchmann Anna-Mareike, Erhardt Angelika and Keck Martin, Stress Response Regulation in Panic Disorder, Current Pharmaceutical Design 2012; 18 (35) . https://dx.doi.org/10.2174/138161212803530880
DOI https://dx.doi.org/10.2174/138161212803530880 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
The Role of β-Amyloid Protein in Synaptic Function: Implications for Alzheimers Disease Therapy
Current Neuropharmacology Monoamine Receptors in the Regulation of Feeding Behaviour and Energy Balance
CNS & Neurological Disorders - Drug Targets Age-Related Sleep Changes and its Implication in Neurodegenerative Diseases
Current Aging Science subject Index To Volume 1
Current Medicinal Chemistry - Immunology, Endocrine & Metabolic Agents Neuro-Transmitters in the Central Nervous System & their Implication in Learning and Memory Processes
Current Medicinal Chemistry PDZ Domain Protein-Protein Interactions: A Case Study with PICK1
Current Topics in Medicinal Chemistry New Frontiers in Alcoholism and Addiction Treatment
Recent Patents on CNS Drug Discovery (Discontinued) The Vitamin D Neuroendocrine System as a Target for Novel Neurotropic Drugs
CNS & Neurological Disorders - Drug Targets Medicinal Chemistry of the Epigenetic Diet and Caloric Restriction
Current Medicinal Chemistry Current Evaluation of the Millennium Phytomedicine- Ginseng (II): Collected Chemical Entities, Modern Pharmacology, and Clinical Applications Emanated from Traditional Chinese Medicine
Current Medicinal Chemistry The Pursuit of Differentiated Ligands for the Glucocorticoid Receptor
Current Topics in Medicinal Chemistry Molecular Actions of Polyhalogenated Arylhydrocarbons (PAHs) in Female Reproduction
Current Medicinal Chemistry Dendrimers As Vectors for Genetic Material Delivery to the Nervous System
Current Medicinal Chemistry Gender Differences in Autonomic Control of the Cardiovascular System
Current Pharmaceutical Design Obesity in China: What are the Causes?
Current Pharmaceutical Design Endocannabinoids in Neuroimmunology and Stress
Current Drug Targets - CNS & Neurological Disorders Adipose-Derived Factors During Nutritional Transitions
Current Nutrition & Food Science The Multifunctional Mesencephalic Locomotor Region
Current Pharmaceutical Design Melatonin and Hypothalamic-Pituitary-Gonadal Axis
Current Medicinal Chemistry Prenatal Exposure of a Novel Antipsychotic Aripiprazole: Impact on Maternal, Fetal and Postnatal Body Weight Modulation in Rats
Current Drug Safety