This document summarizes research on anxiety and panic attacks. It discusses neurological and genetic causes of panic attacks and factors that influence predisposition. Physiological symptoms are described for both spontaneous and induced panic attacks. The role of neuropeptides and neurotransmitters in regulating anxiety levels is also summarized. Finally, the document outlines areas for future research on directly studying symptomology and variables related to different levels of anxiety expression.

1. Aida Vargas De Jesús
BIOL-3095- Seminar in Scientific Literature
Department of Biology at UPR Cayey (RISE program)
Prof. Eneida Díaz Pérez
*

2. *
Anxiety in panic attacks (PAs)
*I. Causes
1. Neurological
2. Genetic by-products
*II. Predisposition
1. Genetics
2. Environmental/Social factors
*III. Physiological Symptoms
1. Spontaneous PAs
2. Induced PAs

3. *Emotionally driven
*Builds up over time
(persists)
*Pavlov’s orienting response
(freeze)
*Instinctual response
*Immediate response
*Acute stress response (flight
or fight)
*
From: http://www.healthybodyme.net/about-
stress-and-anxietyFrom:
http://brainlesionandme.com/2012/11/12/nhbpm
-day-twelve-invisible-disabilities-vs-visible-
disabilities/

4. From: http://www.jewishjournal.com/images/articles/nihstress.jpg

5. *
*Generalized Anxiety Disorder
*Post Traumatic Stress Disorder
*Obsessive-Compulsive Disorder
* Social Anxiety Disorder
* Panic Disorder
*Specific phobias (such as agoraphobia)
*Panic attacks From:http://www.123rf.com/photo_1
1947983_stress-meter-showing-panic-
attack-from-stress-and-worry.html

6. *Corticotropin-releasing factor (CRF)and its
receptors (CRF1R,CRF2R)
(Miguel and Nuñez-de-Souza 2013)
*Neuropeptide Y and its receptors
(Y1R,Y2R,Y4R,Y5R,Y6R) (Wu et al. 2011)
*Classical neurotransmitters such as GABA
(gamma-aminobutyric acid)
(Kash and Winder 2006)
Neurological causes
From: http://www.mpipsykl.mpg.de/en/institute/services/emolab/index.html

7. *
• The dorsal portion
of the midbrain
pariqueductual grey
matter (dPAG)
• The bed nucleus of
the stria terminalis
(BNST)
• The basolateral
amygdala (BLA)
• The central
amygdalae (CeA) From: http://neuropolitics.org/defaultsep11.asp

8. *
*DSM-IV for panic attacks (Diagnosis and Statistical
Manual IV)
*Induced panic attacks
-lack emotional response
-shows no changes in neurosteroid levels (Brambilla
et al. 2013)
*Spontaneous panic attacks
- large range in severity (fear driven)
-show linear relationship between distress and
physiological symptoms (Lewis and Drewett 2006)

9. *
*Genetic
-SNPrs4684677 in the preprogrelein gene, obestatin
protein is compromised
(Hansson et al. 2013)
-Children can inherit panic disorder
*Environmental or social factors
-Shyness and behavioral inhibitions
-Parental behavior (overprotective mothers)
-Children of a parent with major depression or
bipolar disorder have been connected to panic disorder
(Hirshfeld-Becker 2008)

10. *
* Neuropeptide Y and CRFs regulate anxiety levels within the
brain
* Panic attacks involve a large range of symptoms
(palpitations, trembling, choking sensation, nausea, sense of
unreality among others described in PSL-III-R).
* Severity of a panic attack is shaped by individual
circumstances
* Genetics, temperament and filial relationships contribute to
anxiety susceptibility.

11. *
From: http://www.basipilates.com/rendezvous/blog/2013/09/how-pilates-can-help-with-anxiety/
Future panic attack studies:
 Direct approach to symptomology studies
 Focus on variables at different levels of
anxiety expression (interdisciplinary studies)
 Correlate the variables to physiological symptoms

12. *
*Brambilla F, Perini G, Serra M,Pisu MG, Zanone S,
Toffanin T, Milleri S, Garcia CS, Biggio G. 2013. Changes
in neuroactive steroid secretion associated with CO2-
induced panic attacks in normal individuals.
Psychoneuroendocrinology.38(1): 2234-2242.
*Hansson C, Annerbrink K, Nilsson S, Bah J, Olsson M,
Allgulander C, 2013.A possible association between panic
disorder and a polymorphism in the
preproghrelingene.Psychiatry Res. 206(1): 22-25.
*Kash TL,Winder DG. 2006. Neuropeptide Y and
corticotropin-releasing factor bi-directionally modulate
inhibitory synaptic transmission in the bed nucleus of the
stria terminalis. Neurophamocology. 51(5):1013-1022.

13. *Lewis LE, Drewett RF. 2006. Psychophysiological correlates
of anxiety: A single-case study. J Anxiety Disord. 20 (6): 829–
835.
*Miguel TT, Nuñes-de-Souza RL. 2011. Anxiogenic and
antinociceptive effects induced by corticotropin-releasing
factor (CRF) injections into the periaqueductal gray are
modulated by CRF1 receptor in mice. Horm Behav. 60(1):
292-300.
*Hirshfeld-Becker DR, Micco JA, Simoes NA, Henin A. 2008.
High risk studies and developmental antecedents of anxiety
disorders. Am J Med Genet C Semin Med Genet. 148C:99–117
*Wu G, Feder A, Wegener G, Bailey C, Saxena S, Charney D,
Mathe AA. 2011. Central functions of neuropeptideY in mood
and anxiety disorders. Expert Opin. Ther. Targets. 15(11):
1317-1331.