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Fenster schliessen

Biological theories of panic; Noradrenergic theory

• Redmond (1981): stimulation locus coeruleus produced fear response in


• Efferent axons of locus coeruleus that project to the hypothalamus are of

special significance for panic disorder (Charney & Heiniger, 1986)-

>influence on HPA-axis

• Administration of the noradrenergic antagonist yohimbine produced panic

attacks in panic disorder ( Abelson et al. 1992)

• Dysregulation (hyperactive) of noradrenergic system in panic disorder

(Coplan et al., 1997)

• Desynchronization of noradrenergic system and HPA axis possible but not

completely successful (Coplan et al. 1995)

Fenster schliessen

Biological theories of panic; Serotonergic theory

• Dysfunctional neurotransmission at the serotonin receptors (5HT1A) may result in

anxiety or avoidant behavior (Deakin 1996)

• Activation of HPA Axis in panic disorder, may contribute to disruption of

hippocampal 5HT1A

neurotransmission (Lesch and Lerer 1991)

• Aberrant noradrenergic- serotonergic function (Boyer 1995)

• Serotonin depletion resulted in increased minute ventilation in panic disorder


unaltered ventilatory function in controls (Kent et al., 1996)

Fenster schliessen

Biological theories of Panic; GABAergic Theory

• GABA = inhibitory neurotransmitter

• Benzodiazepines increase function of GABA

• global decrease in benzodiazepine binding

• with a peak decrease in orbitofrontal cortex, and insula, hippocampus in panic

disorder patients compared to healthy controls (Malzia et al., 1998)

• Injection of sodium lactate (panicogen) led to panic-like response in

GABA-blocked rats only (Shekhar 2006)

• Interaction GABA-glutamate interrupted in panic disorder

Fenster schliessen

Role of Panicogens in Panic Disorders

= substances that can induce panic attacks

substances that influence HPA Axis

Yohimbine (noradrenaline increase)

coffein: adenosinergic (inhibitory) receptor antagonist

Substances that influence lactate metabolism

sodium lactate, sodium bicarbonate, carbon dioxide

Fenster schliessen

Role of Genetics in the Pathogenesis of Panic Disorder

• Twin studies have attributed 30-40% of the variance for the liability to develop

panic disorder to genetic factors (Kendler et al., 2001; Scherrer et al. 2000)

• highly significant association between panic disorder in probands

and first degree relatives (Hettema et al. 2001)

• cholecystokinin, adenosine 2A, MAO A, and COMT genes.

Fenster schliessen

Psychological Theories of Panic Disorder

Dynamic Model:

panic attack = expression of an intense unconscious conflict (Bush et al. 1999)

core conflict of depencency and inadequacy (Shear et al. 1993)

Contemporary dynamic models: integration of biological and developmental stressors

(Milrod et al. 2004)

Cognitive Behavioral Models

Anxiety Sensitivity

Fenster schliessen

Theoretical perspective: cognitive factors

Anxiety sensitivity (Reiss and Mc Nally (1985)

• Core fear toward anxiety and its associated somatic symptoms

• Measured by anxiety sensitivity index

(Reiss et al. 1986)

• Significant predictor of the onset of panic in different patient populations

(e.g Ehlers 1995, Hayward et al. 2000; Maller and Reiss 1992)

Fenster schliessen

Hyperventilation & Respiratory Theories

• Ley (1985): hyperventilation theory : hyperventilation causes panic attacks

• Klein (1993): false suffocation alarm model: hyperventilation avoid panic