Dissertation > Medicine, health > Neurology and psychiatry > Psychiatry > Neurosis > Anxiety disorders

Abnormal Error Processing in Patients with Panic Disorder: an Event-related Potential Study

Author YaoHong
Tutor XuJing
School Dalian Medical University
Course Neurology
Keywords Panic disorder error processing event-related potentials error-related negativity error positivity
CLC R749.72
Type Master's thesis
Year 2013
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Objective: Panic disorder (PD) is an anxiety disorder characterized by frequentpanic attacks that are unforeseen and sudden. The mechanism of PD has not yet beenfully clarified, and there was a lack of objective physiological measures. Patients withpanic disorder have a high use of medical services due to the recurrence of panic, whichaccompany with many bodily symptoms (e.g. breathlessness, palpitations, dizzinessetc.). Clark’s model, the dominant cognitive theory of PD, has been valuable inexplaining the occurrence and maintenance of panic. With this model panic attacks aresaid to result from the catastrophic misinterpretation of certain bodily sensations. It wasspeculated that the dysfunction in recognizing and controlling the misinterpretationshould be an important part in the mechanism of PD according to the recurrent anduncontrollable panic attack.Event-related potentials (ERPs) technique has been generally used in research oferror processing with the high temporal resolution. The error-related negativity (ERN)and error positivity (Pe) are two ERP components related to error processing, but havenot yet been fully applied to the study of PD.Using the ERPs technology and flankertask, the present study investigates the characteristic of error processing in patients withpanic disorder.Method: Nineteen newly diagnosed patients with PD and20age, sex andeducational level matched healthy volunteers were recruited for the study. All subjectswere interviewed by Structured Clinical Interview for DSM-IV-TR Axis IDisorders-Patient Edition (SCID) and were required to complete the HAMA andHAMD-17.The patients also completed the PDSS and LES. A visual arrow flankerparadigm was used in the study. All subjects were instructed to press the left or rightmouse button, corresponding to the direction of the center arrow, and to respond in sucha way as to maximize speed and accuracy. Electroencephalogram (EEG) was recordedcontinuously by a set of64Ag/AgCI electrodes placed. After off-line analysis, the mean amplitudes of ERN were measured at3electrodes (Fz, FCz, Cz), and the meanamplitudes of Pe were measured at another3electrodes (Cz, CPz, Pz).6participantswere excluded because of an insufficient number of errors or correct artifact-free trialswere available. Thus, final study enrollment included16patients and17healthyvolunteers. Behavioral data were analyzed via t-test. For ERPs data, Within-groupcomparisons and between-group comparisons were performed using repeatedmeasurement analysis of variance (RMANOVA).Results:1. Between-group comparison did not show any observable difference inbehavioral performance of the flanker task.2. Within-group comparison showed a significant difference in response types (Ps<0.01). The ERN and Pe were successfully induced by error trils.3. Between-group comparison of the mean amplitudes of ERN showed asignificant main effect of site(F2,62=21.697,P<0.001), and an interaction of site×group(F2,62=3.733,P=0.038).There was no significant main effect of group (F1,31=0.018,P=0.895).4. Between-group comparison of the mean amplitudes of Pe showed a significantmain effect of group(F1,31=7.617,P=0.010),and site (F2,62=4.257,P=0.039). There wasno a interaction of site×group (F2,62=0.391,P=0.573).5. There were no any significantly correlations between the amplitudes of ERN orPe and the clinical indexes (HAMA、HAMD、PDSS、LEU)(Ps>0.05).Conclusion:1. In the early error processing, there was an abnormal brain activity distribution inpatients with PD.2. Patients with PD are dysfunction in error-awareness and posterror adaptation,which are the main content in the late error processing.3. The characteristics of error processing and the severity of PD patients had nocorrelation, and the ERN and Pe may be trait markers.

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