Zusammenfassung
Die diagnostische Symptomprovokation hat in der Medizin eine lange Tradition und wird z.B. bei der koronaren Herzerkrankung oder dem Diabetes mellitus angewandt. In der Psychiatrie wird die experimentelle Symptomprovokation z.B. eingesetzt, um neurobiologische Grundlagen psychiatrischer Erkrankungen zu untersuchen. Plötzlich und unerwartet, d.h. ohne ersichtlichen äußeren Auslöser auftretende Panikattacken können wegen ihres klar abgrenzbaren Verlaufs, sowie ihres charakteristischen Musters somatischer, emotionaler, kognitiver und behavioraler Symptome als eine prototypische Erscheinungsform von Angst angesehen werden. Seit Pitts & McClure 1967 erstmals beschrieben, dass eine Laktatinfusion bei Patienten mit Panikstörung panikogen wirkt, wurde die experimentelle Provokation von Panikattacken, auch mit anderen Stimuli, genutzt, um die Neurobiologie der Panikstörung zu charakterisieren. Serotonerg, noradrenerg, aber auch GABA-erg vermittelte Panikattacken verweisen auf unterschiedliche Mechanismen, die an der Entstehung von Panikattacken beteiligt sind. Neben primär pathophysiologisch orientierten wissenschaftlichen Untersuchungen kann die experimentelle Symptomprovokation bei der Panikstörung z.B. auch als Therapie i.S. einer Exposition verwendet werden. Zudem lassen sich damit mögliche neue Therapieansätze untersuchen. Dies wird hier am Beispiel des atrialen natriuretischen Peptids dargestellt. Obwohl die Neurobiologie der Angst in vielen Bereichen noch ungeklärt ist, stellt die experimentelle Provokation von Panikattacken eine Möglichkeit dar, standardisiert so komplexe Verhaltensweisen wie Angst und Panik besser zu verstehen und neue Behandlungsstrategien zu entwickeln.
Summary
The diagnostic symptom provocation has a long tradition in medicine. In psychiatry, symptom provocation studies are used to study the pathophysiology and treatment of disorders. Suddenly, and unexpected panic attacks have a characteristic course and a typical pattern of somatic, cognitive, emotional and behavioral symptoms. Beginning with the study of Pitts and McClure who described the panicogenic activity of sodium lactate, the experimental induction of panic attacks with different challenges has been used to characterize the neurobiology of anxiety. Furthermore, experimentally induced panic attacks can be used to study possible new treatment approaches. An anxiolytic activity of atrial natriuretic peptide suggests that modulation of natriuretic peptide receptors with nonpeptidergic ligands may be a new treatment approach. Experimentally induced panic attacks are a tool to characterize the neurobiology of anxiety and panic and may be used to develop new treatment approaches.
Key Words
panic disorder - panic - anxiety - experimental anxiety - neurobiology of anxiety
Literatur
-
1
Bonn JA, Harrison J, Rees L.
Lactate infusion in the treatment of 'free-floating' anxiety.
Canad Psychiat Ass J.
1973;
18
41-46
-
2
Bradwejn J, Koszycki D, Shriqui C.
Enhanced sensitivity to cholecystokinin tetrapetide in panic disorder.
Arch Gen Psychiatry.
1991;
48
603-610
-
3
Bradwejn J, Koszycki D.
Imipramine antagonism of the panicogenic effects of cholecystokinin tetrapeptide in panic disorder patients.
Am J Psychiatry.
1994;
151
261-263
-
4
Charney DS, Heninger GR, Breier A.
Noradrenergic function in panic anxiety. Effects of yohimbine in healthy subjects and patients with agoraphobia and panic disorder.
Arch Gen Psychiatry.
1984;
41
751-763
-
5
De Bold AJ, Borenstein HB, Veress AT, Sonnenberg H.
A rapid and potent natriuretic response to intravenous injection of atrial myocardial extracts in rats.
Life Sci.
1981;
28
89-94
-
6
Dillon DJ, Gorman JM, Liebowitz MR, Fyer AJ, Klein DF.
Measurement of lactate-induced panic and anxiety.
Psychiatry Res.
1987;
20
97-105
-
7
Gorman JM, Fyer MR, Goetz R, Askanazi J, Liebowitz MR, Fyer AJ, Kinney J, Klein DF.
Ventilatory physiology of patients with panic disorder.
Arch Gen Psychiatry.
1988;
45
31-39
-
8
Kahn RS, Asnis GM, Wetzler S, van Praag HM.
Neuroendocrine evidence for serotonin receptor hypersensitivity in panic disorder.
Psychopharmacology (Berl).
1988;
96
360-364
-
9
Kellner M, Herzog L, Yassouridis A, Holsboer F, Wiedemann K.
A possible role of atrial natriuretic hormone in pituitary-adrenocortical unresponsiveness in lactate-induced panic.
Am J Psychiatry.
1995;
152
1365-1367
-
10
Nutt DJ, Glue P, Lawson C, Wilson S.
Flumazenil provocation of panic attacks. Evidence for altered benzodiazepine receptor sensitivity in panic disorder.
Arch Gen Psychiatry.
1990;
47
917-925
-
11
Perna G, Bertani A, Caldirola D, Bellodi L.
Family history of panic disorder and hypersensitivity to CO2 in patients with panic disorder.
Am J Psychiatry.
1996;
153
1060-1064
-
12
Pitts FM, McClure JN.
Lactate metabolism in anxiety neurosis.
New England J Med.
1967;
177
1329-1336
-
13
Randall PK, Bremner JD, Krystal JH, Nagy LM, Heninger GR, Nicolaou AL, Charney DS.
Effects of the benzodiazepine antagonist flumazenil in PTSD.
Biol Psychiatry.
1995;
138
319-324
-
14
Roy-Byrne PP, Cowley DS, Greenblatt DJ, Shader RI, Hommer D.
Reduced benzodiazepine sensitivity in panic disorder.
Arch Gen Psychiatry.
1990;
47
534-538
-
15
Seibyl JP, Krystal JH, Price LH, Woods SW, D'Amico C, Heninger GR, Charney DS.
Effects of ritanserin on the behavioral, neuroendocrine, and cardiovascular responses to meta-chlorophenylpiperazine in healthy human subjects.
Psychiatry Res.
1991;
38
227-236
-
16
Shear MK, Fyer AJ, Ball G, Josephson S, Fitzpatrick M, Gitlin B, Frances A, Gorman J, Liebowitz M, Klein DF.
Vulnerability to sodium lactate in panic disorder patients given cognitive behavioral therapy.
Am J Psychiatry.
1991;
148
795-797
-
17
Shlik J, Aluoja A, Vasar V, Vasar E, Podar T, Bradwejn J.
Effects of citalopram treatment on behavioral cardiovascular and neuroendocrine response to cholecystokinin tetrapeptide challenge in patients with panic disorder.
J Psychiatry Neurosci.
1997;
22
332-340
-
18
Ströhle A, Jahn H, Montkowski A, Liebsch G, Boll E, Landgraf R, Holsboer F, Wiedemann K.
Central and peripheral administration of atriopeptin is anxiolytic in rats.
Neuroendocrinology.
1997;
65
210-215
-
19
Ströhle A, Kellner M, Yassouridis A, Holsboer F, Wiedemann K.
Effect of flumazenil in lactate-sensitive patients with panic disorder.
Am J Psychiatry.
1998;
155
610-612
-
20
Ströhle A, Kellner M, Holsboer F, Wiedemann K.
Atrial natriuretic hormone decreases endocrine response to a combined dexamethasone corticotropin-releasing hormone test.
Biol Psychiatry.
1998;
43
371-375
-
21
Ströhle A, Holsboer F, Rupprecht R.
Increased ACTH concentrations associated with cholecystokinin tetrapeptide-induced panic attacks in patients with panic disorder.
Neuropsychopharmacology.
2000;
22
251-256
-
22
Ströhle A, Kellner M, Holsboer F, Wiedemann K.
Anxiolytic activity of atrial natriuretic peptide in patients with panic disorder.
Am J Psychiatry.
2001;
158
1514-1516
-
23
Ströhle A, Romeo E, di F Michele, Pasini A, Holsboer F, Rupprecht R.
Induced panic attacks shift GABAA receptor modulatory neuroactive steroid composition. Preliminary results.
Arch Gen Psychiatry.
2003;
60
161-168
-
24
Wiedemann K, Jahn H, Yassouridis A, Kellner M.
Anxiolytic activity of atrial natriuretic peptide on cholecystokinin tetrapeptide-induced panic attacks.
Arch Gen Psychiatry.
2001;
58
371-377
-
25
Zwansger P, Baghai TC, Schuele C, Ströhle A, Padberg F, Kathmann N, Schwarz M, Möller H-J, Rupprecht R.
Vigabatrin decreases cholecystokinin-tetrapeptide (CCK-4) induced panic in healthy volunteers.
Neuropsychopharmacology.
2001;
25
699-703
Korrespondenzadresse:
Priv.-Doz. Dr. med. Andreas Ströhle
Klinik für Psychiatrie und Psychotherapie
Charité Campus Mitte
Charité - Universitätsmedizin Berlin
Schumannstr. 20/21
10117 Berlin
eMail: andreas.stroehle@charite.de