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Robinaugh DJ, Ward MJ, Toner ER, et al. Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. Gen Psychiatr. 2019;32(6):e100140doi: 10.1136/gpsych-2019-100140.
Robinaugh, D. J., Ward, M. J., Toner, E. R., Brown, M. L., Losiewicz, O. M., Bui, E., & Orr, S. P. (2019). Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. General psychiatry, 32(6), e100140. https://doi.org/10.1136/gpsych-2019-100140
Robinaugh, Donald J, et al. "Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder." General psychiatry vol. 32,6 (2019): e100140. doi: https://doi.org/10.1136/gpsych-2019-100140
Robinaugh DJ, Ward MJ, Toner ER, Brown ML, Losiewicz OM, Bui E, Orr SP. Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. Gen Psychiatr. 2019 Dec 23;32(6):e100140. doi: 10.1136/gpsych-2019-100140. eCollection 2019. PMID: 31922089; PMCID: PMC6936969.
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Gen Psychiatr. 2019 Dec 23;32(6):e100140. doi: 10.1136/gpsych-2019-100140. eCollection 2019.

Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder.

General psychiatry

Donald J Robinaugh, Meredith J Ward, Emma R Toner, Mackenzie L Brown, Olivia M Losiewicz, Eric Bui, Scott P Orr

Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
  2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 31922089 PMCID: PMC6936969 DOI: 10.1136/gpsych-2019-100140

Abstract

BACKGROUND: Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO

METHOD: We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder.

RESULTS: We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder.

CONCLUSIONS: These findings provide support for the prediction derived from cognitive-behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development.

TRIAL REGISTRATION NUMBER: 135908.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: biological challenge; panic attacks; panic disorder; prediction; spontaneous panic attacks; systematic review; vulnerability

Conflict of interest statement

Competing interests: None declared.

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