The Implications of the Diving Response in Reducing Panic Symptoms

Increased CO2 sensitivity is common in panic disorder (PD) patients. Free divers who are known for their exceptional breathing control have lower CO2 sensitivity due to training effects. This study aimed to investigate the immediate effects of cold facial immersion (CFI), breath holding and CO2 challenges on panic symptoms. Healthy participants and patients with PD were subjected to four experimental conditions in a randomly assigned order. The four conditions were (a) breath-holding (BH), (b) CFI for 30 s, (c) CO2 challenge, and (d) CO2 challenge followed by CFI. Participants completed a battery of psychological measures, and physiological data (heart rate and respiration rate) were collected following each experimental condition. Participants with PD were unable to hold their breath for as long as normal controls; however, this finding was not significant, potentially due to a small sample size. Significant reductions in both physiological and cognitive symptoms of panic were noted in the clinical group following the CFI task. As hypothesized, the CFI task exerted demonstrable anxiolytic effects in the clinical group in this study by reducing heart rate significantly and lessening self-reported symptoms of anxiety and panic. This outcome demonstrates the promise of the CFI task for clinical applications.

Child Maltreatment and Risk of Developing Panic Symptoms among Adolescent Aged 11-17-Year-old in Karachi, Pakistan: A Prospective Cohort Study

Background The effect of childhood maltreatment in the developmental pathway of panic symptoms was not well documented specifically in Pakistan. Therefore, this study aimed to examine the association between child maltreatment and the risk of developing Panic symptoms among adolescents aged 11–17 years in Karachi, Pakistan. Methods The sample of this study comprised of 800 adolescents aged 11–17 years from 32 systematically selected urban and peri-urban clusters of Karachi. The symptoms of panic (significant somatic symptoms) were assessed using a validated tool “SCARED” and the association between childhood maltreatment and panic symptoms was measured using a cox-proportional algorithm. Results Sixty-three percent of severely maltreated children developed Panic symptoms compared to nineteen percent of non-maltreated children. Severely maltreated Female children had approximately four times (95% CI: 2.11–6.35) the risk of panic symptoms and severely maltreated male children were three times (95% CI: 2.27–5.99) more likely to develop panic symptoms. Conclusion The current study provided evidence that maltreated children are at increased risk of developing panic symptoms later in adolescence. Interventions and policies to reduce childhood maltreatment and professional support and counseling to the victims may be an effective strategy to reduce the burden of panic symptoms to some extent.

Effectiveness of Self-Guided Virtual Reality-based Cognitive Behavioral Therapy for Panic Disorder (Preprint)

BACKGROUND Virtual reality (VR) is an effective technique as a traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder (PD) symptoms because VR exposure can be safer, with higher acceptability, than in vivo exposure; it is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR. Thus far, VR has required high quality devices; however, the development of mobile VR technology has improved users' availability. Meanwhile, a well-structured form of VR can be reproduced and used anywhere, which means that VR is appropriate for self–guided treatment to address the high-treatment costs of evidence–based therapy and the lack of professional therapists. This study investigates the potential of self-guided VR as an alternative to high-cost treatment. OBJECTIVE The study’s main goal is to offer data about the efficacy of the mobile app–based self-led VR CBT in the treatment of PD. METHODS 54 subjects with PD were enrolled and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed for a total of 12 sessions in 4 weeks. The VR comprises 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms. The effectiveness of the treatment was assessed through the PD Severity Scale (PDSS), the Hamilton Rating Scale for Depression (HRSD), the body sensation questionnaire (BSQ), the Albany Panic and Phobia Questionnaire (APPQ), the Anxiety Sensitivity Index (ASI), the state-trait anxiety inventory (STAI), the hospital anxiety and depression scale (HADS), the social avoidance and distress scale (K-SAD), the inventory for depressive symptomatology self-report (KIDS-SR), and the perceived stress scale, (PSS). Additionally, physiological changes using heart rate variability (HRV) were evaluated. RESULTS In total, 40 subjects (20 VR treatment and 20 waitlist patients) were included in the final analysis. For the PDSS scores, the main time (F_1,39 = 20.76, P < 0.01, η_p^2 = 0.09) and group-by-time interaction (F_1,39 = 10.59, P < 0.01, η_p^2 = 0.04) effects were significant. The post-hoc tests showed that the PDSS scores decreased significantly in the VR group (t_37 = 2.68; P = 0.01), but not in the waitlist group. The group-by-time interaction effect on the HADS total scores (F_1,39 = 5.51, P = 0.02, η_p^2 = 0.01) was significant, as was the main time effect on the STAI_total (F_1,39 = 4.32; P = 0.04) and STAI_S (F_1,39 = 6.00; P = 0.01) scores; however, there were no statistically significant between-group differences on the other scales. CONCLUSIONS The self-guided, mobile app–based VR was effective in treating panic symptoms and helped restore the autonomic nervous system, demonstrating the validity of VR for self-guided treatment and its cost-effective therapeutic approach.

Anticonvulsant and antipsychotic medications in the pharmacotherapy of panic disorder: a structured review

Background: As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are needed. We aimed to firstly review data regarding use of antipsychotic and non-benzodiazepine anticonvulsant medication in PD patients with or without comorbidities; secondly, to review data concerning reduction of panic symptoms during treatment of another psychiatric disorder with the same medications; and thirdly, to examine reports of anticonvulsant- or antipsychotic-induced new-onset panic symptomatology. Methods: We performed a PubMed search (last day: 28 April 2020) of English-language studies only, combining psychopathological terms (e.g. ‘panic disorder’) and terms referring either to categories of psychotropic medications (e.g. ‘anticonvulsants’) or to specific drugs (e.g. ‘carbamazepine’). All duplications were eliminated. All studies included in the review met certain inclusion/exclusion criteria. The level of evidence for the efficacy of each drug was defined according to widely accepted criteria. Results: In treatment-resistant PD, beneficial effects have been reported after treatment (mostly augmentation therapy) with a range of anticonvulsant (carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbamazepine, valproate, vigabatrin, tiagabine) and antipsychotic (aripiprazole, olanzapine, risperidone, sulpiride) medications: overall, most medications appear generally well tolerated. Additionally, bipolar patients receiving valproate or quetiapine-XR (but not risperidone or ziprasidone) demonstrated reductions of comorbid panic-related symptoms. There are case reports of new-onset panic symptoms associated with clozapine, haloperidol, olanzapine and topiramate, in patients with conditions other than PD. The small-to-modest sample size, the lack of control groups and the open-label and short-term nature of most of the reviewed studies hinder definitive conclusions regarding either the short-term and long-term efficacy of antipsychotic and anticonvulsant medications or their potential long-term side effects. Conclusion: Some atypical antipsychotic and anticonvulsant medications may have a role in the treatment of some PD patients, mostly when more conventional approaches have not been successful, but the quality of supporting evidence is limited.