Regulation of the hypothalamic-pituitary-adrenocortical system in patients with panic disorder.
Anxiety and depressive disorders are among the most common psychiatric disorders with a high number of hospital admissions and a lifetime prevalence of up to 25%. So far, the pathophysiological mechanisms for anxiety disorders remain to be found. Preclinical studies suggest that changes in hypothalamic-pituitary-adrenocortical (HPA) system function are causally related to the expression of anxiety-related behavior. The findings on HPA system function in patients with anxiety disorders are, however, heterogeneous. Both hypo- and hyperresponsiveness of HPA response in various anxiety disorders under different experimental conditions were found. In order to characterize putative case/control differences in HPA system function, we performed a Dex-CRH test, a widely used test to pick up changes in HPA system regulation with high sensitivity, in 30 patients with panic disorder, 35 patients with major depressive episode and in 30 controls individually matched for ethnicity, age and gender. The results indicate a similar dysregulation of the HPA system response in the Dex-CRH test in both patient groups. This finding further underlines the hypothesis that both, depression and panic disorder, share impaired HPA system regulation, supporting the notion that the impairment is involved in the pathophysiology of these clinical conditions. However, differences in the suppression effects and psychopathological correlation patterns between depressed and panic patients suggest different biological mechanisms of HPA system dysregulation in both disorders.
Erhardt
Angelika
A
Max Planck Institute of Psychiatry, Munich, Germany.
Ising
Marcus
M
Unschuld
Paul Gerson
PG
Kern
Nikola
N
Lucae
Susanne
S
Pütz
Benno
B
Uhr
Manfred
M
Binder
Elisabeth B
EB
Holsboer
Florian
F
Keck
Martin E
ME
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology; D003865:Major Depressive Disorder / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D007297:Inpatients; D008297:Male; D015999:Multivariate Analysis; D010045:Outpatients; D016584:Panic Disorder / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D013997:Time Factors
D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone