Assessing Panic: Bridging the Gap Between Fundamental Mechanisms and Daily Life Experience

Abstract

Panic disorder (PD) is one of the most common psychiatric disorders. Recurrent, unexpected panic attacks (PAs) are the primary symptom and strongly impact patients’ quality of life. Clinical manifestations are very heterogeneous between patients, emphasizing the need for a dimensional classification integrating various aspects of neurobiological and psychological circuits in line with the Research Domain Criteria (RDoC) proposed by the US National Institute of Mental Health. To go beyond data that can be collected in the daily clinical situation, experimental panic provocation is widely used, which has led to important insights into involved brain regions and systems. Genetic variants can determine the sensitivity to experimental models such as carbon dioxide (CO2) exposure and can increase the risk to develop PD. Recent developments now allow to better assess the dynamic course of PAs outside the laboratory in patients’ natural environment. This can provide novel insights into the underlying mechanisms and the influence of environmental factors that can alter gene regulation by changing DNA methylation. In this mini review, we discuss assessment of PAs in the clinic, in the laboratory using CO2 exposure, genetic associations, and the benefits of real-life assessment and epigenetic research.

Framework for Selecting and Benchmarking Mobile Devices in Psychophysiological Research

“…In contrast, telemetric devices can capture intensive longitudinal data across time and realworld contexts both within and across individuals (Myrtek, 2004). Such capabilities are advantageous because they are more likely to capture events that are rare and unpredictable (e.g., panic attacks or cardiac arrhythmias; Leibold & Schruers, 2018;Mittal, Movsowitz, & Steinberg, 2011;Mittal et al, 2011), events that unfold over longer periods of time (e.g., sleep across days or metabolic changes with physical activity; Gao, Brooks, & Klonoff, 2018;Sano, Picard, & Stickgold, 2014), or salient events that may be unethical to elicit experimentally (e.g., receiving news about the death of a loved one; Wilhelm & Grossman, 2010). Ambulatory physiological recordings have also demonstrated utility performing dynamic assessments of symptoms over time in patients with cancer (Savard et al, 2013), Parkinson's disease (Moore et al, 2008), Autism Spectrum Disorder (Goodwin et al, 2019), borderline personality disorder (Ebner-Priemer et al, 2008), and seizures (Michel et al, 2015).…”

Expecting the Unexpected: Predicting Panic Attacks from Mood and Twitter

“…Many studies examining panic attacks in a laboratory induce panic attacks medically [5]) or experientially via interoceptive therapy [6]. We have only recently started to identify triggers of naturally occurring panic attacks [7]. The DSM-5 mentions some cognitive risk factors associated with panic attacks such as negative affect and anxiety sensitivity, but new evidence suggests anxiety sensitivity could have a causal role in panic [8].…”

“…Many studies examining panic attacks in a laboratory induce panic attacks medically [5]) or experientially via interoceptive therapy [6]. We have only recently started to identify triggers of naturally occurring panic attacks [7].…”

Cardiorespiratory Assessments in Panic Disorder Facilitated by Wearable Devices: A Systematic Review and Brief Comparison of the Wearable Zephyr BioPatch with the Quark-b2 Stationary Testing System

“…The involvement of respiratory and cardiac functions in panic attacks (PAs) and panic disorder (PD) has been extensively documented. Prominent respiratory symptoms during PAs and respiratory complaints not occurring during PAs during daily life are common in patients with PD [ 1 , 2 , 3 , 4 ]. Furthermore, palpitations and accelerated heart rate (HR) are frequent symptoms both during and beyond PA events [ 1 , 2 , 3 , 4 ].…”