Reduced Sensitivity to Non-Fear-Related Stimulus Changes in Panic Disorder

Panic disorder (PD) is associated with increased body vigilance and reduced cognitive resources directed at non-fear-related stimuli, particularly in the absence of stimulus-rich environments. To date, only few studies have investigated whether this deficit in PD is reflected in reduced mismatch negativity (MMN), an event-related potential indexing preattentive sensitivity to unexpected stimulus changes. We tested 35 patients affected by PD and 42 matched healthy controls in an oddball paradigm, using frequency and duration deviant stimuli to measure auditory MMN. PD patients displayed reduced duration MMN amplitudes in comparison to healthy controls. No group differences were detected for duration MMN latency, as well as frequency MMN indices. Results support the notion of reduced larly with regard to the preattentive processing of sound duration deviants. Additionally, our findings are in line with clinical studies reporting divergent deficits in preattentive processing of frequency and duration deviants

P50, N100, and P200 Sensory Gating in Panic Disorder

Panic disorder (PD) has been linked to abnormalities in information processing. However, only little evidence has been published for sensory gating in PD. Sensory gating describes the brain’s ability to exclude stimuli of low relevance from higher level information processing, thereby sustaining efficient cognitive processing. Deficits in sensory gating have been associated with various psychiatric conditions, most prominently schizophrenia. In this case-control event-related potential study, we tested 32 patients with PD and 39 healthy controls in a double click paradigm. Both groups were compared with regard to pre-attentive (P50), early-attentive (N100), and late-attentive (P200) sensory gating indices. Contrary to a hypothesized deficit, PD patients and healthy controls showed no differences in P50, N100 and P200 values. These results suggest that sensory gating seems to be functional across the pre-attentive, early-attentive, and late-attentive time span in this clinical population. Given this consistency across auditory sensory gating indices, further research aiming to clarify information processing deficits in PD should focus on other neurophysiological markers to investigate information processing deficits in PD (eg, P300, error-related negativity or mismatch negativity).Peer Reviewe

Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in patients with panic disorder with/without agoraphobia

Einleitung: Körperliche Aktivität und hierbei insbesondere aerobe Aktivität wird in der Behandlung von Angsterkrankungen als therapeutische Alternative oder zusätzliche therapeutische Option diskutiert. Bisher gibt es eine kleine Anzahl an randomisierten kontrollierten Studien, deren Ergebnisse die zusätzliche klinische Wirkung von körperlicher Aktivität bei Patienten mit Panikstörung nahelegen. Ziel dieser Studie war es, zu untersuchen, ob aerobe Aktivität im Vergleich zu körperlicher Aktivität mit niedriger Intensität den Effekt einer kognitiven Verhaltenstherapie (KVT) bei Patienten mit Panikstörung mit/ohne Agoraphobie zusätzlich verbessern kann. Methode: Die Studie folgte einem monozentrischen, randomisierten, doppelblinden, kontrollierten Design und wurde in einer Ambulanz in Berlin, Deutschland, durchgeführt. 413 Patienten wurden auf Studieneignung untersucht (Panikstörung mit/ohne Agoraphobie in geringer bis mittelgradiger Ausprägung, 18 – 70 Jahre, Möglichkeit der regelmäßigen Teilnahme), davon willigten 58 schriftlich in die Studie ein und wurden randomisiert. 47 Patienten schlossen die Studie ab und wurden in die Auswertungen aufgenommen (26 Frauen, durchschnittliches Alter: 35.8, sämtlich kaukasischer Ethnie). Die Patienten nahmen über vier Wochen zweimal wöchentlich an einer Gruppen-KVT teil, die von einem achtwöchigen Trainingsprotokoll begleitet wurde. Dieses bestand in der Experimentalgruppe aus einem aeroben Aktivitätstraining (70% VO2max; n = 24) und in der Kontrollgruppe aus Übungen sehr niedriger Intensität (n = 23). Beide Trainingsprotokolle wurden dreimal pro Woche durchgeführt wurden, je 30 Minuten lang. Primärer Zielparameter war der Gesamtscore der Hamilton Angst- Skala (Ham-A), als sekundäre Outcome-Maße wurden die Panik- und Agoraphobie- Skala (PAS), das Beck Angst Inventar (BAI), und die Hamilton Depressions-Skala (Ham-D) eingesetzt. Für die Datenanalyse wurden 2 x 3 ANCOVAs mit Baseline- Wert als Kovariate durchgeführt. Ergebnisse: Die benötigte Anzahl an Studienteilnehmern war in einer Power-Analyse bestimmt worden. Zum Baseline- Zeitpunkt gab es keine signifikanten Gruppenunterschiede hinsichtlich Alter, Geschlecht, Diagnosen, Medikation, körperliche Aktivität und Scores auf den Zielparametern. Die Interaktion Zeit x Gruppe zeigte für den Ham-A einen signifikanten Effekt (p = .047; η2p = .072), der aus einem signifikanten Gruppenunterschied zum 7-Monats-Follow-Up resultierte. Für die sekundären klinischen Outcome-Skalen ließen sich keine signifikanten Gruppenunterschiede feststellen, wenn auch die Verbesserung in der Experimentalgruppe stets deutlicher war als in der Kontrollgruppe. Die Ergebnisse der Completer- Analysen waren größtenteils identisch mit denen der Intent-to-Treat-Analysen und veränderten insgesamt das Ergebnismuster nicht. Zusammenfassung: Regelmäßige aerobe Aktivität hat für Patienten mit Panikstörung mit/ohne Agoraphobie einen zusätzlichen Effekt zur KVT. Dies unterstützt bisherige Ergebnisse und liefert zusätzliche Hinweise über die für eine zusätzliche Verbesserung benötigte Intensität des körperlichen Aktivitätstrainings.Introduction: Physical activity and especially aerobic exercise has been discussed as a therapeutic alternative or add-on for the treatment of anxiety disorders. Up to date, a small number of randomized controlled trials suggests supplementary clinical effectiveness of exercise for patients with panic disorder. The aim of this study was to determine whether aerobic exercise training compared to physical activity with low impact can improve the effect of cognitive behavioral therapy (CBT) in patients with panic disorder with/without agoraphobia. Methods: This mono-center, randomized, double-blind, controlled trial was set in an outpatient department in Berlin, Germany. 413 patients were assessed for eligibility (panic disorder with/without mild or moderate agoraphobia, 18 - 70 years, ability to attend regularly), 58 consented and were randomized. 47 patients completed the study and were included in the analyses (26 female, mean age: 35.8, all Caucasian). Patients received group CBT treatment over four weeks (two sessions per week), which was augmented with an eight-week protocol of either aerobic exercise (70% VO2max; n = 24) or a training program including exercises with very low intensity (n = 23). Both training protocols included 24 sessions, 3 times/week, 30 min each. The primary outcome measure was the total score on the Hamilton Anxiety Scale (Ham-A), while Panic and Agoraphobia Scale (PAS), Beck Anxiety Inventory (BAI), and Hamilton Depression Scale (Ham-D) served as secondary outcome measures. 2 x 3 ANCOVAs with baseline value as a covariate were conducted for data analyses. Results: Subject number was determined by power calculation. No significant baseline group differences were found regarding age, sex, diagnoses, medication, amount of physical activity, and scores on the outcome measures. Time x group interaction for the Ham-A revealed a significant effect (p = .047; η2p = .072), which resulted from a significant group difference at a 7-month follow-up. For the secondary clinical outcome measures no statistical significance emerged, although improvement was more sustained in the aerobic exercise group. Results for completer analysis were largely identical to those for intent-to-treat- analyses and did not change the overall pattern of findings. Conclusion: For patients with panic disorder with/without agoraphobia, regular aerobic exercise adds an additional benefit to CBT. This supports previous results and provides additional evidence about the intensity of exercise that needs to be performed

The fear of being laughed at as additional diagnostic criterion in social anxiety disorder and avoidant personality disorder?

Social anxiety disorder (SAD) is the most common anxiety disorder and has considerable negative impact on social functioning, quality of life, and career progression of those affected. Gelotophobia (the fear of being laughed at) shares many similarities and has therefore been proposed as a subtype of SAD. This hypothesis has, however, never been tested in a clinical sample. Thus, the relationship between gelotophobia, SAD and avoidant personality disorder (APD) was investigated by examining a sample of 133 participants (64 psychiatric patients and 69 healthy controls matched for age and sex) using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition) and an established rating instrument for gelotophobia (GELOPH). As expected, gelotophobia scores and the number of gelotophobic individuals were significantly higher among patients with SAD (n = 22) and APD (n = 12) compared to healthy controls and other psychiatric patients. Furthermore, gelotophobia scores were highest in patients suffering from both SAD and APD. In fact, all patients suffering from both disorders were also suffering from gelotophobia. As explained in the discussion, the observed data did not suggest that gelotophobia is a subtype of SAD. The findings rather imply that the fear of being laughed at is a symptom characteristic for both SAD and APD. Based on that, gelotophobia may prove to be a valuable additional diagnostic criterion for SAD and APD and the present results also contribute to the ongoing debate on the relationship between SAD and APD

The fear of being laughed at as additional diagnostic criterion in social anxiety disorder and avoidant personality disorder?

Social anxiety disorder (SAD) is the most common anxiety disorder and has considerable negative impact on social functioning, quality of life, and career progression of those affected. Gelotophobia (the fear of being laughed at) shares many similarities and has therefore been proposed as a subtype of SAD. This hypothesis has, however, never been tested in a clinical sample. Thus, the relationship between gelotophobia, SAD and avoidant personality disorder (APD) was investigated by examining a sample of 133 participants (64 psychiatric patients and 69 healthy controls matched for age and sex) using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition) and an established rating instrument for gelotophobia (GELOPH). As expected, gelotophobia scores and the number of gelotophobic individuals were significantly higher among patients with SAD (n = 22) and APD (n = 12) compared to healthy controls and other psychiatric patients. Furthermore, gelotophobia scores were highest in patients suffering from both SAD and APD. In fact, all patients suffering from both disorders were also suffering from gelotophobia. As explained in the discussion, the observed data did not suggest that gelotophobia is a subtype of SAD. The findings rather imply that the fear of being laughed at is a symptom characteristic for both SAD and APD. Based on that, gelotophobia may prove to be a valuable additional diagnostic criterion for SAD and APD and the present results also contribute to the ongoing debate on the relationship between SAD and APD

Scatter plot depicting the relationship between the number of SCID diagnoses of SAD and APD and the GELOPH<15> score.

<p>The dashed horizontal line illustrates the cut-off for gelotophobia (GELOPH<15> score > 2.5).</p

Multiple linear regression predicting GELOPH<15> scores in patients and controls (<i>n</i> = 123).

<p>Multiple linear regression predicting GELOPH<15> scores in patients and controls (<i>n</i> = 123).</p

Demographic and gelotophobia data of healthy controls and psychiatric patients (with exception of sex, education and gelotophobia present, <i>means</i> and <i>SD</i> are shown).

<p>Demographic and gelotophobia data of healthy controls and psychiatric patients (with exception of sex, education and gelotophobia present, <i>means</i> and <i>SD</i> are shown).</p

Scatter plot depicting the relationship between the number of SCID diagnoses of SAD and APD and the GELOPH<15> score.

<p>The dashed horizontal line illustrates the cut-off for gelotophobia (GELOPH<15> score > 2.5).</p