Abstract
Panic disorder is characterized by symptoms with abrupt surges of fear with palpitations, sweating, trembling, heat sensations. Considering its disease burden on each individual and on society, understanding its etiology is important. Though no one specific etiology has been known, like other psychiatric disorders, multiple factors such as genetic, environmental, neurobiological, psychopathological factors have been suggested. In this article, we reviewed currently known etiologies and related study results, regarding especially genetic and epigenetic aspects of the panic disorder. Early studies, including twin studies, family studies, adoption studies suggested highly familial trait of panic disorder. Linkage studies, either, found panic disorder is not a single gene disorder but confirmed existence of multiple related genes. Chromosome and candidate gene studies found few related genes, NPY, ADORA2A, COMT, IKBKE. Newer method, genome-wide association studies (GWAS) have been searching for newer genes. No genome-wide significant genes, however, were detected, confirming previously known candidate genes, NPY5R on 4q31.3-32, BDKRB2 on 14q32, instead. Epigenetic modification has also been studied on many different psychiatric disorders. Monoamine oxidase A (MAOA) hypomethylation, taken together with negative life events, showed relation with panic disorder. Glutamate decarbodylases 1 (GAD1) hypomethylation was also specific on panic disorder patients. Relation with noradrenaline transporter (NET) gene SLC6a2 promoter methylation has also been studied. In conclusion, no specific gene or epigenetic pattern can fully explain etiology of panic disorder. Few genes and epigenetic patterns, however, showed strong association with panic disorder compared to healthy controls. Considering its multivariable background, further studies with larger populations can confirm current results and clarify etiologies of panic disorder.
Highlights
Panic disorder (PD) is defined with recurrent unexpected panic attacks, indicating abrupt surges of fear with palpitations, sweating, trembling, feeling dizzy, heat sensations and other somatic symptoms
We reviewed currently known etiologies and related study results, regarding especially genetic and epigenetic aspects of the panic disorder
Few genes and epigenetic patterns, showed strong association with panic disorder compared to healthy controls
Summary
Panic disorder (PD) is defined with recurrent unexpected panic attacks, indicating abrupt surges of fear with palpitations, sweating, trembling, feeling dizzy, heat sensations and other somatic symptoms. On this aspect, disability-adjusted life years lost (DALY) were once estimated for panic disorder. Ferris Pitt found hyperosmolar sodium lactate could provoke anxiety neurosis [8], so-called panic attacks in patients with panic disorder but not in healthy controls. After such findings, many substances that can provoke panic disorder have been suggested [9]. In continuum to the findings, gamma-aminobutyric acid (GABA) concentration difference was found on some studies [13] These findings partially explained neurobiological background of panic disorder.
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