Panic Symptomatology Research Articles

Discovering your presumed father is not your biological father: Psychiatric ramifications of independently uncovered non-paternity events resulting from direct-to-consumer DNA testing

Direct-to-consumer DNA tests provide information on ancestry and family relations. Their increased use in recent years has led many to discover that their presumed father is not their biological father, a non-paternity event (NPE). We aimed to explore and quantify the psychiatric effects of discovering one's father's identity was misattributed. We distributed questionnaires in a private online community of individuals who learned they were NPEs. Questionnaires included clinical scales assessing depressive, anxiety, and panic symptomatology as well as background and personal details regarding participants' NPE discovery and demography. A total of 731 people participated. Results demonstrated increased levels of depression, anxiety, and panic symptoms relative to controls. Multiple factors influenced such effects, including demographics, background information, family members' reactions, and personal reactions. We identified a worsening relationship or attitude toward the mother as a risk factor for worse mental health. The ability to openly discuss the discovery and acceptance of it were identified as protective factors. This is the first paper to explore the psychiatric sequelae of discovering misattributed paternity in a large cohort. This unique psychosocial stressor is likely to become more common as direct-to-consumer DNA tests gain popularity, requiring the attention of mental health professionals.

Defensive Mobilization During Anticipation of Symptom Provocation: Association With Panic Pathology

BackgroundAnxious apprehension about feared body symptoms is thought to play a crucial role in the development, chronicity, and treatment of panic disorder (PD). In this study, we therefore aimed to elucidate the role of defensive reactivity to anticipated unpleasant symptoms in PD that can contribute to a better understanding of pathomechanisms of PD as well as identification of potential targets in PD-focused interventions. By measuring amygdala-dependent potentiation of the startle reflex, we aimed to investigate whether 1) patients with PD exhibit a specifically increased defensive reactivity to anticipated unpleasant body symptoms and 2) whether clinical severity of panic symptomatology varies with magnitude of defensive activation. MethodsDefensive mobilization to anticipated threat was investigated in 73 patients with a primary diagnosis of PD with agoraphobia (PDA) and 52 healthy control subjects. Threat of symptom provocation was established by a standardized hyperventilation task and contrasted to threat of shock to the forearm of the participant. ResultsPatients with PDA and healthy control subjects did not differ in their defensive responses during anticipation of shock. In contrast, patients with severe PDA as compared with healthy control subjects exhibited increased defensive response mobilization and reported more anxiety and panic symptoms during anticipation of feared body symptoms. Moreover, startle potentiation during anticipation of hyperventilation covaried with the severity of panic symptomatology. ConclusionsThe present findings suggest that increased defensive mobilization during anticipation of body symptoms is a neurobiological correlate of severe PDA that should be specifically targeted in PD interventions and might be used to monitor treatment success.

Decreased defensive reactivity to interoceptive threat after successful exposure-based psychotherapy in patients with panic disorder

Panic disorder (PD) is characterized by a dysfunctional defensive responding to panic-related body symptoms that is assumed to contribute to the persistence of panic symptomatology. The present study aimed at examining whether this dysfunctional defensive reactivity to panic-related body symptoms would no longer be present following successful cognitive behavior therapy (CBT) but would persist when patients show insufficient symptom improvement. Therefore, in the present study, effects of CBT on reported symptoms and defensive response mobilization during interoceptive challenge were investigated using hyperventilation as a respiratory symptom provocation procedure. Changes in defensive mobilization to body symptoms in the course of CBT were investigated in patients with a primary diagnosis of PD with or without agoraphobia by applying a highly standardized hyperventilation task prior to and after a manual-based CBT (n = 38) or a waiting period (wait-list controls: n = 20). Defensive activation was indexed by the potentiation of the amygdala-dependent startle eyeblink response. All patients showed a pronounced defensive response mobilization to body symptoms at baseline. After treatment, no startle reflex potentiation was found in those patients who showed a clinically significant improvement. However, wait-list controls and treatment non-responders continued to show increased defensive responses to actually innocuous body symptoms after the treatment/waiting period. The present results indicate that the elimination of defensive reactivity to actually innocuous body symptoms might be a neurobiological correlate and indicator of successful CBT in patients with PD, which may help to monitor and optimize CBT outcomes.

Anticonvulsant and antipsychotic medications in the pharmacotherapy of panic disorder: a structured review

Background:As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are needed. We aimed to firstly review data regarding use of antipsychotic and non-benzodiazepine anticonvulsant medication in PD patients with or without comorbidities; secondly, to review data concerning reduction of panic symptoms during treatment of another psychiatric disorder with the same medications; and thirdly, to examine reports of anticonvulsant- or antipsychotic-induced new-onset panic symptomatology.Methods:We performed a PubMed search (last day: 28 April 2020) of English-language studies only, combining psychopathological terms (e.g. ‘panic disorder’) and terms referring either to categories of psychotropic medications (e.g. ‘anticonvulsants’) or to specific drugs (e.g. ‘carbamazepine’). All duplications were eliminated. All studies included in the review met certain inclusion/exclusion criteria. The level of evidence for the efficacy of each drug was defined according to widely accepted criteria.Results:In treatment-resistant PD, beneficial effects have been reported after treatment (mostly augmentation therapy) with a range of anticonvulsant (carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbamazepine, valproate, vigabatrin, tiagabine) and antipsychotic (aripiprazole, olanzapine, risperidone, sulpiride) medications: overall, most medications appear generally well tolerated. Additionally, bipolar patients receiving valproate or quetiapine-XR (but not risperidone or ziprasidone) demonstrated reductions of comorbid panic-related symptoms. There are case reports of new-onset panic symptoms associated with clozapine, haloperidol, olanzapine and topiramate, in patients with conditions other than PD. The small-to-modest sample size, the lack of control groups and the open-label and short-term nature of most of the reviewed studies hinder definitive conclusions regarding either the short-term and long-term efficacy of antipsychotic and anticonvulsant medications or their potential long-term side effects.Conclusion:Some atypical antipsychotic and anticonvulsant medications may have a role in the treatment of some PD patients, mostly when more conventional approaches have not been successful, but the quality of supporting evidence is limited.

Pituitary-adrenal axis hormones in early-onset versus late-onset panic disorder

Objective It has been hypothesised that early-onset panic disorder (PD) may constitute a biologically distinct subtype of PD, but the few relevant data are inconclusive. We systematically explored for potential psychopathological and hormonal differences between early-onset (age at onset ≤ 27 years) versus late-onset PD, in consecutively-referred, medication-free, acutely-ill PD outpatients, moreover without comorbid mental disorders except agoraphobia (N = 54; age = 32.3 ± 7.5 years; early-onset = 27; females = 38). Methods Hormones assessed (plasma levels) included adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEAS). Psychopathological measures included panic attacks’ number during last three weeks, the Agoraphobic Cognitions and the Body Sensations Questionnaires and the Hamilton Anxiety Rating Scale. Results Early-onset PD patients – compared to their late-onset counterparts – had longer duration of the disease. The two onset-groups demonstrated similar panic and anxiety symptoms and similar ratios of smokers/never-smokers. However, early-onset patients demonstrated significantly greater ACTH and DHEAS levels and higher (marginally significant) cortisol levels than the late-onset patients. Moreover, in the early-onset patients only, significant positive correlations emerged between ACTH levels and the severity of both panic and anxiety symptomatology. Conclusions These findings suggest that the two onset-groups demonstrate significant differences in the hypothalamic-pituitary-adrenal axis functioning, at least when acutely-ill. Key points Early-onset panic disorder (EOPD) may differ biologically from late-onset PD (LOPD). EOPD was correlated with greater adrenocorticotropic hormone (ACTH) plasma levels. EOPD was correlated with greater dehydroepiandrosterone sulphate plasma levels. In EOPD only, ACTH levels were positively correlated with panic and anxiety symptoms.

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder

Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. The present event-related functional MRI (fMRI) study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.

Changes of valued behaviors and functioning during an Acceptance and Commitment Therapy Intervention

BackgroundLiving in line with one's values is believed to be beneficial for a person's well-being. Working with values in the therapeutic context often reveals that individuals do no live congruent with their chosen values. This study aimed to investigate how patients’ valued behaviors change during an Acceptance and Commitment Therapy (ACT) and how these changes are associated with functioning. Further, this study aimed to examine whether valued behaviors changed depending on pre-treatment levels of symptomatology. MethodsThis was a standardized randomized controlled trial with an ACT intervention. Participants were 41 adult patients with treatment-resistant panic disorder. Measurements were completed at pre-treatment, 4-weeks-post-treatment, as well as 6-months after treatment. ResultsThe discrepancy between how important something is and how much someone does in accordance to their values decreased across treatment. Higher pre-treatment panic symptomatology led to higher improvements in valued action, compared to lower pre-treatment symptomatology. Yet, all patients reached comparable end-points. Functioning increased over the entire study period and increases in functioning were associated with increases in importance and valued action. DiscussionOur study extends prior findings about valued behaviors in ACT by showing that treatment-resistant patients with panic disorder decreased the discrepancy between what is considered important and valued action. Further studies investigating changes in valued behaviors across various diagnoses and treatments are clearly necessary.

Impact of Panic on Psychophysiological and Neural Reactivity to Unpredictable Threat in Depression and Anxiety.

Exaggerated anxious responding to unpredictable threat (U-threat) is a core feature of panic disorder (PD). However, it is unknown whether this abnormality is specific to the diagnosis of PD or would manifest along a continuum of panic symptomatology (PS). Additionally, little is known about the neural processes underlying this abnormality among those high in PS. Finally, no studies have tested whether startle potentiation and limbic neural reactivity - commonly used indices of U-threat responsivity - are associated and therefore reflect common abnormalities. These questions were investigated in 42 adults with a range of PS. U-threat responding was measured twice during threat-of-shock - once with startle and once with functional magnetic resonance imaging (fMRI). As hypothesized, PS positively predicted startle potentiation and dACC reactivity to U-threat. Startle potentiation and dACC activation to U-threat were positively associated. These results suggest a biobehavioral profile of aberrant responding to U-threat associated with PS.

Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder

The inhalation of 35% carbon dioxide (CO2) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO2 in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO2-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO2-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO2) and dichotomous variables (positive versus negative responses to CO2). Analyses of each outcome measure demonstrated that CO2-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO2-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO2-hyperreactivity, such as anxiety sensitivity, which may account for this study׳s results.

Reducing the symptomatology of panic disorder: the effects of a yoga program alone and in combination with cognitive-behavioral therapy.

Introduction: Yoga is a holistic system of different mind–body practices that can be used to improve mental and physical health. It has been shown to reduce perceived stress and anxiety as well as improve mood and quality of life. Research documenting the therapeutic benefits of yoga has grown progressively for the past decades and now includes controlled trials on a variety of mental health conditions such as depression, anxiety, and panic disorder.Objectives: The primary goal of this study was to investigate the effects of yoga in patients suffering from panic disorder. We aimed at observing the efficacy of yoga techniques on reducing the symptomatology of panic disorder (anxiety and agoraphobia), compared to a combined intervention of yoga and psychotherapy.Method: Twenty subjects previously diagnosed with panic disorder were selected. Subjects were randomly assigned to both experimental groups: Group 1 (G1-Yoga: 10 subjects) attended yoga classes and Group 2 (G2-CBT + Yoga: 10 subjects) participated in a combined intervention of yoga practice followed by a cognitive-behavioral therapy (CBT) session. Both interventions occurred weekly for 100 min and lasted 2 months. Subjects were evaluated two times during the study: pre-test and post-test. Psychometric tools included the Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HAM-A), The Panic Beliefs Inventory (PBI), and Body Sensations Questionnaire (BSQ).Results: Statistical analysis showed significant reductions in anxiety levels associated with panic disorder (G1: BAI – p = 0.035, HAM-A – p = 0.000; G2: BAI – p = 0.002, HAM-A – p = 0.000), panic-related beliefs (G1: PBI – p = 0.000; G2: PBI – p = 0.000) and panic-related body sensations (G1: BSQ – p = 0.000; G2: BSQ – p = 0.000) both in G1 and G2. However, the combination of yoga and CBT (G2) showed even further reductions in all observed parameters (mean values).Conclusion: This study observed significant improvement in panic symptomatology following both the practice of yoga and the combination of yoga and psychotherapy. While contemplative techniques such as yoga promote a general change in dealing with private events, CBT teaches how to modify irrational beliefs and specific cognitive distortions. The results observed in G2 might indicate that the techniques complemented each other, increasing the intervention efficacy. These findings are in agreement with many investigations found in the literature which observed improvements in different mental health parameters after the practice of contemplative techniques alone or combined to psychotherapy. Future research joining psychological and physiological variables could help better elucidate the mechanisms through which mind-body practices work to improve mental health.

Is Interpersonal Psychotherapy Infinitely Adaptable? A Compendium of the Multiple Modifications of IPT.

We employed standard literature search techniques and surveyed participants on the International Society for Interpersonal Psychotherapy listserve (isiptlist@googlegroups.com) to catalogue the multiple and highly creative ways in which Klerman's and Weissman's original concept of interpersonal psychotherapy (IPT) has been modified to meet the needs of a vast range of patient populations. Focusing first on adaptations of the individual treatment model for subgroups of adult patients, we next describe further adaptations of four major off-shoots of IPT: interpersonal counseling (IPC), IPT for adolescents (IPT-A), group IPT (IPT-G) and most recently, brief IPT (IPT-B). We then discuss IPT "in-laws," those treatments that have married IPT with of other forms of psychotherapy for patients with bipolar disorder, panic symptomatology, and substance abuse. We conclude with that although there have been myriad successful adaptations of IPT, there remain some conditions for which IPT adaptations have not been found to be efficacious.

Associations between mindfulness and panic symptoms among young adults with asthma

Despite the well-documented associations between panic psychopathology and asthma, there has been a dearth of empirical work examining factors that may reduce the negative effects of panic for individuals with asthma. Thus, the goal of the present study was to examine the role of mindfulness skills (i.e. observe, describe, acting with awareness, nonjudgment, and nonreactivity) in symptoms of panic psychopathology (i.e. panic symptoms, anxiety sensitivity, and body vigilance). Participants were young adults with asthma (n = 56; 30.4% male, Mage = 19.5 years, SD = 2.7) who completed online self-report measures for course credit. After controlling for the effects of asthma control and negative affectivity, greater use of the mindfulness skill of acting with awareness, relative to the other mindfulness skills, significantly predicted fewer panic symptoms and decreased anxiety sensitivity. The skill of observing approached statistical significance in terms of predicting increased body vigilance and anxiety sensitivity. These finding suggest that targeting the skill of acting with awareness may be a novel way to decrease panic symptomatology among individuals with asthma.

A preliminary study of subclinical panic symptom elevations among adolescent offspring of parents with PTSD who smoke

Objectives: Research has linked parental post-traumatic stress disorder (PTSD) and parental smoking to a wide array of psychological and physical health concerns among offspring. Furthermore, the combination of parental anxiety psychopathology generally, along with smoking, has been linked to elevated adolescent panic symptomatology. However, no research has examined the unique and interactive associations between parental PTSD and smoking in terms of offspring panic. Method: The current study sought to begin to address this gap in the literature by examining adolescent-reported panic symptom levels as a function of parent-reported PTSD and current smoking. Results: Among 25 dyads (Mparent age = 42.92 years [SD = 6.71]; Moffspring age = 15.80 years [SD = 1.04]), adolescent offspring of smokers with PTSD reported significantly higher panic symptoms compared with all other combinations of these factors after controlling for multiple theoretically relevant and empirically associated covariates. Supporting model specificity, parental PTSD and smoking were not related to adolescent depression or other types of anxiety. Conclusions: These results are consistent with research linking the combination of parental anxiety psychopathology and smoking to offspring panic generally, and parental PTSD and smoking to panic symptoms specifically. Research on possible mechanisms of intergenerational transmission as well as replication and extension of these findings is now needed.

Timing matters: Change depends on the stage of treatment in cognitive behavioral therapy for panic disorder with agoraphobia.

The mechanisms of action underlying treatment are inadequately understood. This study examined 5 variables implicated in the treatment of panic disorder with agoraphobia (PD/AG): catastrophic agoraphobic cognitions, anxiety about bodily sensations, agoraphobic avoidance, anxiety sensitivity, and psychological flexibility. The relative importance of these process variables was examined across treatment phases: (a) psychoeducation/interoceptive exposure, (b) in situ exposure, and (c) generalization/follow-up. Data came from a randomized controlled trial of cognitive behavioral therapy for PD/AG (n = 301). Outcomes were the Panic and Agoraphobia Scale (Bandelow, 1995) and functioning as measured in the Clinical Global Impression scale (Guy, 1976). The effect of process variables on subsequent change in outcome variables was calculated using bivariate latent difference score modeling. Change in panic symptomatology was preceded by catastrophic appraisal and agoraphobic avoidance across all phases of treatment, by anxiety sensitivity during generalization/follow-up, and by psychological flexibility during exposure in situ. Change in functioning was preceded by agoraphobic avoidance and psychological flexibility across all phases of treatment, by fear of bodily symptoms during generalization/follow-up, and by anxiety sensitivity during exposure. The effects of process variables on outcomes differ across treatment phases and outcomes (i.e., symptomatology vs. functioning). Agoraphobic avoidance and psychological flexibility should be investigated and therapeutically targeted in addition to cognitive variables.

Anxiety Sensitivity and Childhood Learning Experiences: Impacts on Panic Symptoms Among Adolescents

Specific parenting behaviors, in the context of offspring bodily arousal, relate to elevated risk for panic symptomatology. Research with adults also suggests anxiety sensitivity (AS) plays an important role in this relationship. However, very limited research has been conducted with adolescents. To address this gap in the literature, the current study evaluated the interplay between AS and arousal-reactive as well as arousal non-reactive childhood learning experiences in predicting panic symptomatology among a community sample of 10–17 year old adolescents (n = 153). Findings indicated arousal-reactive learning experiences were associated with increased panic symptomatology, but only among youth high in AS. Further, this model evidenced relative specificity in that arousal non-reactive learning experiences did not interact with AS to predict panic symptomatology. The current findings add to the literature seeking to elucidate the interplay between specific parenting behaviors and offspring characteristics as they relate to elevated risk for panic-related outcomes.

Changes in neuroactive steroid secretion associated with CO2-induced panic attacks in normal individuals

Neuroactive steroids modulate anxiety in experimental animals and possibly in humans. The secretion of these compounds has been found to be altered in panic disorder (PD), with such alterations having been suggested to be a possible cause or effect of panic symptomatology. Panic-like attacks can be induced in healthy individuals by administration of panicogenic agents or by physical procedures, and we have now measured the plasma concentrations of neuroactive steroids in such individuals before, during, and after panicogenic inhalation of CO2 in order to investigate whether abnormalities of neuroactive steroid secretion might contribute to the pathogenesis of PD. Fifty-nine psychologically and physically healthy subjects, including 42 women (11 in the follicular phase of the menstrual cycle, 14 in the luteal phase, and 17 taking contraceptive pills) and 17 men, who experienced a panic-like attack on previous exposure to 7% CO2 were again administered 7% CO2 for 20min. Thirty-three of these individuals (responders) again experienced a panic-like attack, whereas the remaining 26 subjects did not (nonresponders). All subjects were examined with the VAS-A and PSL-III-R scales for anxiety and panic symptomatology before and after CO2 inhalation. The plasma concentrations of progesterone, 3α,5α-tetrahydroprogesterone (3α,5α-THPROG=allopregnanolone), 3α,5α-tetrahydrodesoxycorticosterone (3α,5α-THDOC), dehydroepiandrosterone (DHEA), and cortisol were measured 15min and immediately before the onset of CO2 administration as well as immediately, 10, 30, and 50min after the end of CO2 inhalation. Neuroactive steroids were measured in the laboratory of Prof. Biggio in Cagliari, Sardinia, Italy. Neurosteroid levels did not change significantly in both responders and nonresponders before, during, or after CO2 inhalation. These data suggest that neuroactive steroid concentrations before, during, or after CO2 inhalation do not seem to correlate with panic symptomatology during panic-like attacks in subjects not affected by PD, and they therefore do not support the notion that abnormalities in neuroactive steroid secretion are either a cause or an effect of such attacks.

The role of parental anxiety sensitivity in parent reports of child anxiety in treatment seeking families

Recent research has examined the contribution of parental anxiety sensitivity to child anxiety, suggesting only a modest relationship between these two variables. No study to date, however, has examined the role of parental anxiety sensitivity in parent reports of the child's anxiety. It was hypothesized that anxiety sensitivity, a cognitive risk factor for the development of anxiety, would be significantly correlated with parents' reports of their child's anxiety, specifically with respect to panic and separation anxiety. The present study employed a sample of 56 treatment-seeking children and their parents. Parent and child reports of the child's anxiety were obtained, and self-reports of anxiety sensitivity were obtained from parent and child. Parent reports of their child's panic and separation anxiety symptoms were significantly related to not only parental anxiety sensitivity (r = .39 and r = .29, respectively) but also the child's self-reported level of anxiety sensitivity (r = .35 and r = .37, respectively). These findings suggest that anxiety sensitivity, a significant predictor of panic symptomatology amongst both adults and children, might be related to parents' perceptions of their child's symptoms of panic and separation anxiety. These findings further suggest taking into consideration parental levels of anxiety sensitivity when interpreting parent reports of child anxiety in clinical settings.

Alcohol use history and panic-relevant responding among adolescents: a test using a voluntary hyperventilation challenge.

Given the onset of alcohol use, neurological sensitivity, and enhanced panic-relevant vulnerability, adolescence is a key period in which to study the documented linkage between alcohol and panic-related problems. The current study was designed to build upon and uniquely extend extant work via (a) utilization of well-established experimental psychopathology techniques and (b) evaluation of unique associations between alcohol use and panic symptoms after controlling for theoretically relevant behavioral, environmental, and individual difference variables (i.e., age, gender, negative affectivity, anxiety sensitivity, child and parent tobacco use, and parental panic disorder). Participants were 111 community-recruited adolescents ages 12-17 years (M = 15.76 years; n = 50 girls). Youth completed a battery of well-established questionnaires and a voluntary hyperventilation challenge, and parents present at the laboratory completed a structured clinical interview. Adolescent alcohol use was categorized as Non-Users, Experimenters, or Users. Panic symptoms were indexed via retrospective self-report and adolescents' response to a biological challenge procedure (i.e., voluntary hyperventilation). After controlling for theoretically relevant covariates, Users evidenced elevated panic-relevant symptoms and responding compared with Non-Users; Experimenters did not differ from Non-Users. Findings suggest alcohol use history is uniquely associated with panic symptomatology among youth, including "real-time" reactivity elicited by a laboratory challenge. Although there is significant work yet to be done, these data advance extant work and lay the groundwork for the types of sophisticated designs that will be needed to answer the most pressing and complex questions regarding the link between alcohol use and panic symptoms among adolescents.

Physiological and affective reactivity to a 35% CO2 inhalation challenge in individuals differing in the 5-HTTLPR genotype and trait neuroticism

The inhalation of 35% carbon dioxide (CO2) results in an acute stress response in healthy individuals and may accordingly provide a good paradigm to examine potential vulnerability factors for stress reactivity and stress-related psychopathology. It has been proposed that CO2 reactivity is moderated by genetic (5-HTTLPR) and personality (neuroticism) factors, yet no experimental study has investigated their effects on CO2 reactivity simultaneously. The current study examined the singular and interactive effects of the 5-HTTLPR genotype and neuroticism in predicting the affective and physiological response to a 35% CO2 challenge in a healthy sample of male and female students. From a large group of 771 students, 48 carriers of the low/low expressing allele (S/S, S/Lg, Lg/Lg) and 48 carriers of the high/high expressing allele (La/La) with the lowest and the highest neuroticism scores (77 females, 19 males; mean age±SD: 20.6±2years) were selected and underwent a 35% CO2 inhalation. Visual analogue scales for anxiety and discomfort and the Panic Symptom List were used to assess affective symptomatology, while salivary samples and heart rate were assessed to establish the physiological response. A typical pattern of responses to CO2 was observed, characterised by increases in anxiogenic symptoms and physical panic symptomatology and a reduction in heart rate; however, no effect on salivary cortisol concentration was observed. Additionally, the CO2 reactivity did not differ between groups divided by the 5-HTTLPR genotype or neuroticism. Findings of the current study do not support a role for singular or interactive effects of the 5-HTTLPR genotype and trait neuroticism on affective and physiological reactivity to a 35% CO2 inhalation procedure.

The differential impact of prognostic and process expectations versus panic severity on depressive symptoms in panic disorder with agoraphobia

Background: Panic disorder with agoraphobia (PDA) co-occurs highly with depression. Greater panic symptoms, agoraphobic avoidance, comorbidity and anxiety sensitivity have all been linked to depressive symptoms in PDA. Psychotherapy research has historically linked prognostic and process expectationsto symptom severity. However, no study has explored the relationship of expectancies and depressive symptoms in PDA. The purpose of the present study was to determine the extent to which expectations and panic symptomatology have a differential impact on depressive symptoms in PDA above and beyond the influence of anxiety sensitivity and secondary Axis I comorbid disorders (e.g., generalized anxiety disorder, social anxiety disorder) just prior to entering therapy. Method: The relationship between depressive symptoms, panic symptomatology and expectancies (i.e., prognostic and process expectations) was investigated in 74 patients with a primary diagnosis of panic disorder with agoraphobia. It was hypothesized that expectancy measures rather that panic symptomatology would add to the prediction of depressive symptoms beyond the effects of secondary comorbid disorders and anxiety sensitivity. Results: The findings showed that prognostic and process expectations accounted for significant variance in depressive symptoms beyond that predicted by anxiety sensitivity and secondary Axis I comorbid disorders. In addition, PDA symptomatology failed to significantly enter into our prediction model. Conclusions: These results suggest that expectancies have a greater impact on depressive symptoms in PDA regardless of the secondary comorbid disorders and severity of symptoms in PDA. Implications of these findings on the treatment of PDA are discussed.