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Objective: Autism spectrum disorder (ASD) is characterized by high rates of comorbidity with other mental disorders, including anxiety disorders and obsessive–compulsive disorder. Beyond a mere concept of comorbidity, recent literature is speculating the existence of a neurodevelopmental nature of such mental disorders. The aim of the study is to investigate the distribution of social-phobic, obsessive–compulsive and panic-agoraphobic traits within a sample of individuals with ASD, social anxiety disorder (SAD), obsessive–compulsive disorder (OCD) and panic disorder (PD). Methods: 40 participants with ASD, 40 with SAD, 40 with OCD, 40 with PD and 50 HC were assessed with the Social Anxiety Spectrum—Short Version (SHY-SV) questionnaire, the Obsessive—Compulsive Spectrum—Short Version (OBS-SV) questionnaire and the Panic Agoraphobic Spectrum—Short Version (PAS-SV) questionnaire. Statistical analyses included Kruskal–Wallis test and Chi-square test. Results: When analyzing SHY-SV scores, the SAD group obtained the highest scores, with individuals with ASD following closely, significantly surpassing the scores of the remaining diagnostic groups. In the examination of OBS-SV questionnaire scores, individuals with ASD once again secured the second-highest scores, trailing only the OCD group. These scores were notably higher than those of both the PD group and healthy controls. In the analysis of PAS-SV scores, the ASD group once again achieved the highest scores after the PD individuals, although this time the difference was not statistically significant compared to the other diagnostic groups. Discussion: These findings highlight the central role of the autism spectrum in SAD and OCD diagnoses. They provide support for the hypotheses of a neurodevelopmental basis for social anxiety and OCD, contributing to the growing body of evidence supporting a dimensional and interconnected view of mental health conditions. [ABSTRACT FROM AUTHOR]

Background: The Bergen 4-Day Treatment (B4DT) is a concentrated cognitive behaviour therapy (CBT) approach that has shown promise in treating panic disorder (PD). However, the effectiveness of the B4DT, particularly regarding long-term outcomes in rural clinical settings, remains underexplored. Methods: A total of 58 patients were included using a naturalistic open-label trial design. Patients were assessed at 12-month follow-up. Measures included the Panic Disorder Severity Scale (PDSS), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 scale (GAD-7). Results: The study revealed significant and lasting reductions in PD symptoms, with a high rate of remission maintained at 12-month follow-up (82.8%). Regarding the secondary outcomes, significant improvements in symptoms of depression and generalized anxiety were also shown. Conclusions: The B4DT represents a promising treatment approach for PD, demonstrating stable long-term outcomes in rural settings. This finding supports the potential of concentrated CBT formats in achieving sustained symptom improvement in patients with PD, warranting further investigation and broader implementation. Trial registration: The study was reviewed by the Regional Committee for Medical Research Ethics Northern Norway, REK North (REK Nord2021/273145). [ABSTRACT FROM AUTHOR]

The measurement of amino acid and monoamine neurotransmitters (NTs) in serum plays a central role in the identification and monitoring of clinical panic disorder (PD). However, the strong polarity and chemical heterogeneity of NTs make direct extraction and rapid detection extremely challenging. Herein, we developed a strategy that integrated solid phase extraction based on magnetic Fe3O4 coated with polydopamine (Fe3O4@PDA) and direct analysis of mass spectrometry in real time (DART-MS) for quantification of 10 NTs. We systematically investigated the optimal conditions of this strategy to achieve good accuracy and precision. Compared with existing magnetic solid phase extraction methods for NTs detection in biological samples, this strategy could adsorb more targets while having similar adsorption efficiencies, and the total process time was reduced by an average of 69.42%. We rapidly determined the metabolic abnormality of 6 types of NTs in the serum of PD patients and demonstrated their diagnostic accuracy. In addition, an outstanding feature of PD in which tryptophan was more metabolized by the KYN pathway and the 5-hydroxytryptamine pathway was inhibited could be elucidated by this strategy. Our results highlighted the potential ability of Fe3O4@PDA coupled with DART-MS to assist in the clinical diagnosis of PD. [ABSTRACT FROM AUTHOR]

Panic disorder (PD) may accompany elevated social avoidance and distress (SAD). Higher SAD in patients with PD predicts a poorer prognosis and response to treatment. As heart rate variability (HRV) reflects the self‐regulatory capacity underlying SAD, applying HRV to distinguish PD heterogeneity would be clinically beneficial in formulating personalized treatment strategies. We hypothesized that HRV would be lower in patients with PD and severe SAD (PD‐SAD group) than in those without SAD (PD group). A total of 288 patients met the eligibility criteria, with complete collection of variables of interest and HRV. The inverse probability of treatment weighting (IPTW) method was used to balance the groups for the baseline characteristics of patients. Following IPTW adjustment, the average treatment effects were computed using inverse propensity weighting with regression adjustment (IPW‐RA). All characteristics were similar in both groups after IPTW adjustment. The PD‐SAD group showed a decreased tendency in time domain parameters, including mean heart rate, SDNN, RMSSD, and pNN50 with a nonlinear domain of SD1. However, no significant intergroup differences were observed in the frequency domain. Higher SAD in PD was associated with reduced HRV, mainly in the time domain, which may be attributed to the shared neural networks between dysfunctional self‐regulation statuses, as indexed by reduced HRV. As respiratory sinus arrhythmia is mainly reflected in the frequency domain, the time domain may be more reliable for identifying heterogeneity within patients with PD, who are frequently associated with respiratory pattern abnormalities. [ABSTRACT FROM AUTHOR]

Background: Theta-gamma coupling (TGC) describes the modulation of gamma oscillations by the theta phasic activity, which is crucial for processes such as the ordering of information during working memory (WM) performance. The mental arithmetic (MA), which involves performing calculations with numbers, is a crucial tool for evaluating and understanding the sensory processing and management abilities of WM. Evaluating TGC may provide greater insight into the neural mechanisms mediating WM deficits in panic disorder (PD). Methods: Medical and electroencephalography (EEG) records of psychiatric outpatient clinic between 1 March 2020 and 30 September 2023 were retrospectively reviewed. A total of 34 PD patients and 34 age- and sex-matched healthy controls (HCs) underwent EEG to assess the overall functional interaction of the brain using multi-channel EEG analysis, focusing on specific brain regions including the frontal, temporal, parietal, and occipital lobes. EEG recordings were conducted during two sessions: a 5-min eyes-closed resting-state (RS) and a subsequent 5-min eyes-closed MA. The TGC and the spectral power of the theta and gamma frequency bands, which are well known to be associated with WM, were analysed. Results: Compared to those in HCs, TGC and theta power were significantly attenuated in PD patients. When analysing both HCs and PD patients together, RS TGC and relative theta power were negatively correlated with state anxiety and perceived stress scores, respectively. In contrast, TGC and relative theta power during the MA condition were positively correlated with the MA performance. Specifically, in PD patients, RS theta power across all electrodes was significantly negatively correlated with the Hamilton Anxiety Scale (HAMA) score. Linear regression analysis revealed that theta power in the T5 channel remained negatively correlated with pathological anxiety as measured by the HAMA score, even after controlling for other confounding factors. Conclusions: This study highlights significant alterations in TGC and theta power in PD patients. PD patients exhibit reduced TGC and theta power compared to HCs, indicating deficits in the neural mechanisms underlying anxiety and/or WM in PD. These insights contribute to a better understanding of the neural basis of WM deficits in PD and suggest potential avenues for targeted therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: The effects of panic disorder (PD) and pharmacotherapy on brain functional hubs in drug-free patients, and the utility of their degree centrality (DC) in diagnosing and predicting treatment response (TR) for PD, remained unclear. Aims: This study aimed to assess the effects of PD and paroxetine on brain functional hubs in drug-free patients and to identify neuroimaging biomarkers for diagnosing and predicting TR in patients with PD. Methods: Imaging data from 54 medication-free PD patients and 54 matched healthy controls (HCs) underwent DC and functional connectivity (FC) analyses before and after a 4-week paroxetine treatment. Diagnosis and prediction of TR models for PD were constructed using support vector machine (SVM) and support vector regression (SVR), with DC as features. Results: Patients with PD showed aberrant DC and FC in the anterior cingulum, temporal, and occipital areas compared with HCs at baseline. After treatment, DC of the patients increased in the calcarine cortex, lingual gyrus, and cerebellum IV/V, along with improved clinical symptoms. Utilizing voxel-wise DC values at baseline, the SVM effectively distinguished patients with PD from HCs with an accuracy of 83.33%. In SVR, the predicted TR significantly correlated with the observed TR (correlation coefficient (r) = 0.893, Mean Squared Error = 0.009). Conclusion: Patients with PD exhibited abnormal DC and FC, notably in the limbic network, temporal, and occipital regions. Paroxetine ameliorated patients' symptoms while altering their brain FC. SVM and SVR models, utilizing baseline DC, effectively distinguished the patients from HCs and accurately predicted TR. [ABSTRACT FROM AUTHOR]

Despite the high prevalence, and high functional impairment associated with panic disorder, programs targeting the prevention of panic psychopathology are still very limited. This article aims to guide panic disorder prevention programs, by analyzing different psychological risk factors, and their interactions in the pathogenesis of the psychopathology of panic disorder. The results show, on the one hand, that neuroticism, perceived control, emotional clarity, and anxiety sensitivity are causal risk factors for the development of panic disorder. On the other hand, several causal pathways involving complex chains of these factors lead to the development of panic disorder. These results may help guide panic disorder prevention interventions by guiding, on the one hand, decisions concerning the populations to be targeted for prevention efforts as well as, on the other hand, by identifying the risk and protective factors to be targeted to reduce the probability of occurrence of panic disorder. [ABSTRACT FROM AUTHOR]

Panic disorder is costly, and while evidence-based interventions for panic disorder are effective, obtaining a diagnosis often precludes access to such treatments. This is problematic because the categorical diagnosis of panic disorder (i.e. “you have it, or you don’t”) supported by modern diagnostic manuals contradicts empirically supported dimensional models of panic disorder. Taxometric analyses, which test the dimensional or categorical latent structure of constructs, have consistently revealed dimensional latent structures when applied to other anxiety disorders and panic-related processes, but taxometric analyses have never been applied to panic disorder. To address this gap in the literature, three nonredundant taxometric procedures were applied to seven theoretically-relevant indicators of panic disorder derived from Panic Disorder Severity Scale data collected from 663 participants recruited via Amazon Mechanical Turk. Simulated comparison plots and objective fit indices were also evaluated. The collective results provided consistent empirical support for a dimensional model of panic disorder, with an overall mean CCFI score of .39. The implications of the present findings for the measurement, assessment, diagnosis, and treatment of panic disorder are discussed. [ABSTRACT FROM AUTHOR]

The network theory of psychopathology posits that mental disorders are systems of mutually reinforcing symptoms. This framework has proven highly generative but does not specify precisely how any specific mental disorder operates as such a system. Cognitive behavioral theories of mental disorders provide considerable insight into how these systems may operate. However, the development of cognitive behavioral theories has itself been stagnant in recent years. In this article, we advance both theoretical frameworks by developing a network theory of panic disorder rooted in cognitive behavioral theory and formalized as a computational model. We use this computational model to evaluate the theory's ability to explain five fundamental panic disorder-related phenomena. Our results demonstrate that the network theory of panic disorder can explain core panic disorder phenomena. In addition, by formalizing this theory as a computational model and using the model to evaluate the theory's implications, we reveal gaps in the empirical literature and shortcomings in theories of panic disorder. We use these limitations to develop a novel, theory-driven agenda for panic disorder research. This agenda departs from current research practices and places its focus on (a) addressing areas in need of more rigorous descriptive research, (b) investigating novel phenomena predicted by the computational model, and (c) ongoing collaborative development of formal theories of panic disorder, with explanation as a central criterion for theory evaluation. We conclude with a discussion of the implications of this work for research investigating mental disorders as complex systems. [ABSTRACT FROM AUTHOR]

Objective: Variants within genes encoding microRNAs (miRNAs) may alter the expression of both miRNAs and their target genes, thus contributing to the etiology of psychiatric disorders. The involvement of miRNAs in neuronal differentiation and synaptic plasticity supported this hypothesis. We aimed to investigate the links between miR-155 rs767649/miR-22 rs8076112 and the risk of panic disorder (PD) in a sample of Turkish population. Methods: In this experimental study, 134 PD patients and 140 healthy controls were recruited. Genotyping was carried out using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. To evaluate PD phenotypes, Panic Disorder Severity Scale (PDSS) was also administered to patients to clarify possible associations between the scale and risk variants analyzed. Results: The genotype analysis of miR-155 rs767649 did not show an association with PD risk and it was not related to the disease severity. For miR-22 rs8076112 variant, a statistically significant association was determined; CC genotypes were lower in patients compared to controls. Logistic regression analysis proved the highly protective effect (80.4%) of CC genotype against PD ( p = 0.041; OR = 0.196, 95% CI = 0.041-0.934). Though its significance in disease liability, miR-22 rs8076112 was not associated with the disease severity. Conclusion: Our findings firstly report the combined analysis of miR-155 rs767649 and miR-22 rs8076112 in PD in terms of both disease susceptibility and severity. These findings await replication in independent cohorts with enrichment of other miRNA gene variants. Thus, certain miRNAs and their target genes involved in the etiology and phenotypes of PD could be enlightened. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a chronic sleep-related breathing disorder that is highly prevalent in individuals with posttraumatic stress disorder (PTSD). The reason for this high prevalence remains unclear. We hypothesized that breathing instability, one of the key contributors to OSA, may be altered in PTSD and predispose OSA. Healthy participants (214 females, 98 males) aged 17 to 42 (M = 19.92; SD = 2.85) completed online questionnaires measuring PTSD symptomatology, sleep disturbances, and self-reported breathlessness. A subset of these participants (16 females, 14 males) aged 18 to 42 (M = 23.50; SD = 7.18) completed an in-lab breathing instability assessment, whereby they performed a series of 20-second and maximal duration breath-holds. PTSD severity positively predicted subjective perceptions of breathlessness (P < 0.001) but not objective measures of breathing instability, namely ventilation following 20-s breath-holds (P = 0.93) and maximal breath-hold duration (P = 0.41). These results suggest that breathing instability may not be the driving factor behind the high prevalence of OSA in PTSD. Instead, other factors such as a low arousal threshold, elevated ventilatory responses to arousal, or coexisting insomnia may explain the high rates of OSA in PTSD. One explanation for the discrepancy between subjective breathlessness and breathing stability measures relating to PTSD severity may be that hypervigilance and increased anxiety impacted self-perceptions of breathlessness while not altering breathing instability per se. NEW & NOTEWORTHY: Obstructive sleep apnea (OSA) is more common in individuals with posttraumatic stress disorder (PTSD) than the general population for unknown reasons. This study assessed one of the key contributors to OSA, respiratory control instability, in young students with a range of posttraumatic stress symptoms. Although individuals with high PTSD symptoms reported increased subjective breathlessness, objectively measured breathing instability was not altered, suggesting respiratory instability is unlikely to increase the risk of OSA in PTSD. [ABSTRACT FROM AUTHOR]

Abstract Background The Bergen 4-Day Treatment (B4DT) is a concentrated cognitive behaviour therapy (CBT) approach that has shown promise in treating panic disorder (PD). However, the effectiveness of the B4DT, particularly regarding long-term outcomes in rural clinical settings, remains underexplored. Methods A total of 58 patients were included using a naturalistic open-label trial design. Patients were assessed at 12-month follow-up. Measures included the Panic Disorder Severity Scale (PDSS), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 scale (GAD-7). Results The study revealed significant and lasting reductions in PD symptoms, with a high rate of remission maintained at 12-month follow-up (82.8%). Regarding the secondary outcomes, significant improvements in symptoms of depression and generalized anxiety were also shown. Conclusions The B4DT represents a promising treatment approach for PD, demonstrating stable long-term outcomes in rural settings. This finding supports the potential of concentrated CBT formats in achieving sustained symptom improvement in patients with PD, warranting further investigation and broader implementation. Trial registration The study was reviewed by the Regional Committee for Medical Research Ethics Northern Norway, REK North (REK Nord2021/273145).

Abstract Background Theta-gamma coupling (TGC) describes the modulation of gamma oscillations by the theta phasic activity, which is crucial for processes such as the ordering of information during working memory (WM) performance. The mental arithmetic (MA), which involves performing calculations with numbers, is a crucial tool for evaluating and understanding the sensory processing and management abilities of WM. Evaluating TGC may provide greater insight into the neural mechanisms mediating WM deficits in panic disorder (PD). Methods Medical and electroencephalography (EEG) records of psychiatric outpatient clinic between 1 March 2020 and 30 September 2023 were retrospectively reviewed. A total of 34 PD patients and 34 age- and sex-matched healthy controls (HCs) underwent EEG to assess the overall functional interaction of the brain using multi-channel EEG analysis, focusing on specific brain regions including the frontal, temporal, parietal, and occipital lobes. EEG recordings were conducted during two sessions: a 5-min eyes-closed resting-state (RS) and a subsequent 5-min eyes-closed MA. The TGC and the spectral power of the theta and gamma frequency bands, which are well known to be associated with WM, were analysed. Results Compared to those in HCs, TGC and theta power were significantly attenuated in PD patients. When analysing both HCs and PD patients together, RS TGC and relative theta power were negatively correlated with state anxiety and perceived stress scores, respectively. In contrast, TGC and relative theta power during the MA condition were positively correlated with the MA performance. Specifically, in PD patients, RS theta power across all electrodes was significantly negatively correlated with the Hamilton Anxiety Scale (HAMA) score. Linear regression analysis revealed that theta power in the T5 channel remained negatively correlated with pathological anxiety as measured by the HAMA score, even after controlling for other confounding factors. Conclusions This study highlights significant alterations in TGC and theta power in PD patients. PD patients exhibit reduced TGC and theta power compared to HCs, indicating deficits in the neural mechanisms underlying anxiety and/or WM in PD. These insights contribute to a better understanding of the neural basis of WM deficits in PD and suggest potential avenues for targeted therapeutic interventions.

Background: A review of previous studies shows that, among the variables that affect the underlying mechanisms of panic and depression disorders, are body awareness, difficulty in emotional regulation, and patient's self-management. Considering the lack of research background on the comparison of the above three components in patients with panic and depression disorders, the present study seeks to answer the question whether these three components are different in patients with panic, depression and nonaffected persons? Aims: The purpose of this research was to compare body awareness, difficulty in emotion regulation and self-management among people with panic disorders, depression and nonaffected persons. Methods: The current research design was descriptive and causal-comparative. The statistical population of the research included all people suffering from panic disorders, depression and non-suffering people in the city of Babol in the autumn of 2022. The sampling method was available and the sample size was 30 people for each group. The data collection tools in this study included three body awareness questionnaires of Shields (1989), the difficulty in emotion regulation questionnaire of Gratz & Roemer (2004) and the self-management questionnaire of Houthun and Neck (2000). The collected data were analyzed by multivariate analysis of variance and Benferoni post hoc test using SPSS22 software. Results: The obtained results showed that there is no significant difference in body awareness between people suffering from panic disorders, depression and non-suffering people. There was no significant difference in other variables, including difficulty in emotion regulation and self-management, between the two panic and depressed groups, but both groups had a significant difference compared to the group of non-diseased people. It was also found that three groups of people suffering from panic, depression and non-suffering people have a significant difference in the three strategies of self-management, including behavioral strategies, natural reward and constructive thought pattern and difficulty in emotional regulation (P< 0.05). Conclusion: According to the obtained results, it can be concluded that people with panic disorders and depression have problems in emotion regulation and self-management compared to non-afflicted people. Therefore, it is suggested that psychiatrists and psychotherapists pay attention to the three variables of the present study in the therapeutic interventions of patients suffering from panic and depression in order to prevent the progression and exacerbation of disease symptoms.