Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/S2237-60892012000200004
Trends in Psychiatry and Psychotherapy
Review Article

Anxiety and inhibition of panic attacks within translational and prospective research contexts

Ansiedade e inibição de ataques de pânico no contexto das pesquisas translacionais e prospectivas

Ruan Cabral; Antonio Egídio Nardi

http://dx.doi.org/10.1590/S2237-60892012000200004 Trends Psychiatry Psychother, vol.34, n2, p.62-72, 2012
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Abstract

Basic research involving animal models is an important tool to improve our understanding of clinical conditions related with anxiety and panic attacks. In fact, animal models have been used to study several paradigms on analogous and homologous elements of human anxiety phenomena. However, the direct transposition (translation) to clinical practice of the results obtained with animal models may be restricted by the different constructs used to describe and explain empirical evidence of anxiety phenomena among humans. We aimed to analyze whether theoretical assumptions on the potential inhibitory effects of anxiety on panic could be observed among humans in prospective studies designed to analyze the relationship between anxiety and panic. A systematic literature review including papers published in English language between 1997 and 2011 was undertaken on the MEDLINE database. The search yielded a total of 257 articles, of which 11 were included in the review. In three studies, the global dimension of the anxiety sensitivity construct worked as a facilitator of panic attacks. Six studies showed a positive correlation between the AS-Physical Concerns subfactor and the occurrence of panic attacks, whereas two studies found a greater effect of the AS-Mental Incapacitation Concerns subfactor on panic. There was no evidence that anxiety might act as an inhibitor of panic attacks in humans, and there were no conclusive findings on the possibility that any anxiety construct could contribute toward inhibiting panic attacks. In sum, there seems to be a need for refining descriptions of anxious phenomena addressed both in basic preclinical research and in prospective-longitudinal studies involving humans.

Keywords

Construct, anxiety, panic, prospective studies, animal models, basic research

Resumo

As pesquisas básicas elaboradas com modelos animais são importantes ferramentas para melhorar a compreensão de condições clínicas relacionadas a ansiedade e ataques de pânico. De fato, modelos animais tem servido de base para vários paradigmas sobre elementos análogos e homólogos aos fenômenos ansiosos humanos. No entanto, a transposição (translação) direta dos resultados dessas pesquisas para a prática clínica pode ser limitada pelos diferentes construtos usados para descrever e explicar as evidências empíricas de fenômenos ansiosos em humanos. Este artigo buscou analisar se proposições teóricas sobre o potencial efeito inibitório da ansiedade sobre ataques de pânico poderiam ser observadas em estudos prospectivos envolvendo humanos e desenhados para analisar a relação entre ansiedade e pânico. Uma revisão sistemática da literatura incluindo artigos publicados em língua inglesa entre 1997 e 2011 foi realizada na base de dados MEDLINE. Foram identificados 257 artigos, dos quais 11 foram incluídos na revisão. Em três pesquisas, a dimensão geral do construto anxiety sensitivity atuou como facilitador de ataques de pânico. Seis pesquisas apresentaram correlação positiva entre o subfator AS-Physical Concerns e a ocorrência de ataques de pânico, e duas apontaram para um maior efeito de favorecimento do pânico pelo subfator AS-Mental Incapacitation Concerns. Não foi possível observar se de fato a ansiedade pode agir como um agente inibidor de ataques de pânico em humanos, e os artigos analisados não ofereceram resultados conclusivos sobre a possibilidade de algum construto sobre ansiedade contribuir para a inibição de ataques de pânico. Em suma, parece evidente a necessidade de um refinamento das descrições sobre fenômenos ansiosos abordados tanto em pesquisas básicas pré-clínicas quanto em estudos prospectivos envolvendo humanos.

Palavras-chave

Construtos, ansiedade, pânico, estudos prospectivos, modelos animais, pesquisa básica

References

Pasquali L. Princípios de elaboração de escalas psicológicas Rev Psiquiatr. Clin. 1998;25:206-13.

Schmidt NB, Lerew DR, Jackson RJ. The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. J Abnorm Psychol. 1997;106:355-64.

Andrade LH, Gorenstein C. Aspectos gerais das escalas de avaliação de ansiedade. Rev Psiquiatr Clin. 1998;25:285-90.

Watson D, Clark LA. Negative affectivity: the disposition to experience aversive emotional states. Psychol Bull. 1984;96:465-90.

Gray JA. The psychology of fear and stress. 1987.

Bernik MA. Dificuldades na utilização de escalas de avaliação de sintomas ansiosos em psicofarmacologia clínica e experimental Rev Psiquiatr. Clin. 1998;25:326-30.

Kazdin AE, Kessler RC, Kraemer HC. Contributions of risk-factor research to developmental psychopathology. Clin Psychol Rev. 1997;17:375-406.

Brandão ML, Vianna D, Masson S, Santos J. Organização neural dos diferentes tipos de medo e suas implicações na ansiedade. Rev Bras Psiquiatr. 2003;25:36-41.

Magierek V, Ramos PL, Fernandez JL. Context fear conditioning inhibits panic-like behavior elicited by electrical stimulation of dorsal periaqueductal gray. Neuroreport. 2003;16:1641-4.

Graeff FG. Serotonin, the periaqueductal gray matter and panic. Neurosci Biobehav Rev. 2004;28:239-59.

Nardi AE, Valença AM. Transtorno de pânico: diagnóstico e tratamento. 2005.

Schmidt NB, Richey A. Anxiety sensitivity as an incremental predictor of later anxiety symptoms and syndromes. Compr Psychiatry. 2008;49:407-12.

Schimdt NB, Keouhg ME, Mitchell MA, Reynolds EK, Macpherson L, Zvolensky MJ. Anxiety sensitivity: prospective prediction of anxiety among early adolescents. J Anxiety Disord. 2010;24:503-8.

Spira AP, Zvolensky MJ, Eiert GH, Feldner MT. Avoidance-oriented coping as predictor of panic-related distress: a test using biological challenge. J Anxiety Disord. 2004;18:309-23.

Schmidt NB, Zvolensky MJ, Maner JK. Anxiety sensitivity: prospective prediction of panic attacks and Axis I pathology. J Psychiatr Res. 2006;40:691-9.

Zinbarg ER, Brown TA, Barlow DH, Rapee RM. Anxiety sensitivity, panic, and depressed mood: a reanalysis teasing apart the contributions of the two levels in the hierarchical structure of the Anxiety Sensitivity Index. J Abnorm Psychol. 2001;110:372-7.

Zinbarg ER, Barlow DH, Brown TA. The hierarchical structure and general factor saturation of the Anxiety Sensitivity Index: evidence and implications. Psychol Assess. 1997;9:277-84.

Hayward C, Killen JD, Kraemer HC, Taylor CB. Predictors of panic attacks in adolescents. J Am Acad Child Adolesc Psychiatry. 2000;39:207-14.

Benitez CL, Shea MT, Raffa S, Rende R, Dyck IR, Ramsawh HJ. Anxiety sensitivity as a predictor of the clinical course of panic disorder: a 1-year follow-up study. Depress Anxiety. 2009;26:335-42.

Schmidt NB, Lerew DR, Jackson RJ. Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. J Abnorm Psychol. 1999;108:532-7.

Li W, Zinbarg RE. Anxiety sensitivity and panic attacks: a 1-year longitudinal study. Behav Modif. 2007;31:154-61.

Telch MJ, Lucas JA, Nelson P. Nonclinical panic in college students: an investigation of prevalence and symptomatology. J Abnorm Psychol. 1989;98:300-6.

Campos RN, Campos JAO, Sanches M. A evolução histórica dos conceitos de transtorno de humor e transtorno de personalidade: problemas no diagnóstico diferencial. Rev Psiquiatr Clin. 2010;37:162-6.

Bruce ES, Yonkers MD, Otto WO, Eisen JL, Weisberg RB, Pagano M. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162:1179-87.

Biederman J, Pollack MH, Rosenbaum JF. Moderating effects of major depression on patterns of comorbidity in patients with panic disorder. Psychiatry Res. 2004;126:143-9.

Schmidt NB, Lerew DR, Joiner TE. Anxiety sensitivity and pathogenesis of anxiety and depression: evidence for symptom specificity. Behav Res Ther. 1998;36:165-77.

Darwich RA, Tourinho EZ. Respostas emocionais à luz do modo causal de seleção por conseqüências. Rev Bras Ter Comp Cogn. 2005;7:107-18.

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