Panic attacks (PAs) are acute anxiety episodes that are pervasive, with one in 10 individuals having experienced a PA in the past year. PAs impair daily functioning and are associated with an increase in emergency room visits and suicide attempts. Despite their impact, the unpredictable nature of PAs makes them challenging to manage. PAs are transdiagnostic, occurring in individuals across and without a mental health diagnosis. However, prior work has largely focused on PA indications within individuals with panic disorder. This study identifies PA risk factors from over 6 months of passive sensing data recorded by Oura Rings in 182 young adults with and without adverse childhood experiences and psychiatric diagnoses, beyond just panic disorder. Our findings reveal that changes in Oura Ring-derived measures are associated with next-day PAs, with distinct associations observed across different mental health diagnoses. For individuals with panic disorder, the likelihood of PA increases with time spent inactive. For those with depression, the likelihood of PA increases with decreased variation in nightly respiratory rate, decreased rapid eye movement sleep, and increased time spent in high-intensity activity. For those without a mental health diagnosis, the likelihood of PA increases with decreased heart rate variability. Data aggregation window sizes that capture the associations with PA risk vary by diagnosis and the type of feature, suggesting that cumulative physiological patterns from windows up to 7 days before a PA contribute to onset. These findings point to the possibility that continuous monitoring of panic attack risk could one day support preventive mental health intervention.
When South African obstetricians, majority care providers for pregnant and birthing persons in the private-sector experienced exponential increases in medical indemnity insurance premiums, predictions were made that medico-legal risk would bring about their demise by 2020. I coin the terms 'obstetric demise' and 'obstetric resilience' to highlight how the outcry confirms an obstetric malpractice litigation moral panic. In contrast, the corresponding dissolution of independent midwifery - at the exact date predicted for an obstetric demise - went relatively unnoticed. How did private-sector 'obstetric resilience' ensue despite its predicted demise, and how did midwives become 'folk devils' in an obstetric malpractice litigation moral panic? Data comes from in-depth, longitudinal interviews with seven obstetricians, a narrative interview with leading medical litigation lawyer, and participant observation across multiple sites over two-and-a-half years of fieldwork between 2017 and 2019. I highlight the relational processes symbolised in tussles over hegemony in risk societies, wherein even elite professionals are objects of moral scrutiny and surveillance. The construction of a narrative of 'obstetric demise', part of a discursive strategy by moral entrepreneurs, amplified private-sector obstetric concerns, enabling individual and collective defensive practices that are negatively correlated with a denial of human rights in childbirth. A moral panic discourse upheld and stabilised unequal birthing relations. Emerging from the mutual entanglement of structures and agents in the healthcare system, the patient, who should be at the centre of care, ended up worst-off. The medico-legal litigation 'crisis' construction process led by the Department of Health was strengthened by a private-sector, obstetric malpractice moral panic. In a vicious cycle inherent to medico-legal litigation, the cost and quality of healthcare provision has been significantly affected, ironically undermining the very propositions for universal healthcare that promoted a moral panic in the first place.
Panic disorder (PD) exhibits marked clinical heterogeneity, and individual differences in autistic traits may contribute to variability in symptom severity and treatment course. This study examined whether autistic traits are associated with panic severity and agoraphobic avoidance during pharmacological treatment. In this retrospective observational study, 41 adults with DSM-5-diagnosed PD receiving guideline-based pharmacotherapy were followed over six months. Symptom trajectories were assessed using the Panic Disorder Severity Scale (PDSS) at baseline, one month, and six months, while autistic traits were measured using the Autism Spectrum Quotient (AQ) at the six-month visit. Linear mixed-effects models and repeated-measures ANCOVA examined associations between autistic traits and symptom burden while adjusting for age and sex. PDSS total and agoraphobia scores declined significantly over time (p <.001). Higher AQ total scores were associated with greater overall PD severity (p = .043) and more pronounced agoraphobic avoidance (p = .015) across assessments. Exploratory analyses indicated that attention switching and social skills were associated with overall severity, whereas reduced imagination was specifically linked to agoraphobic severity. Age was independently associated with agoraphobic severity but not with overall panic severity. No significant Time × AQ interactions were observed, indicating comparable symptom improvement across trait levels during the six-month treatment period. These findings suggest that elevated autistic traits are associated with persistently higher symptom burden during treatment without altering pharmacological response.
The current research was made to investigate the effect of an intervention program based on CBT on coping with stress and psychological well-being in persons with panic disorder. This research was conducted between May 2021 and July 2022 in a training and research hospital and a university hospital as quasi-experimental design with two-site comparison research with a pretest-posttest and control group. The research's participants were 105 persons with panic disorder (54 in the control group and 51 in the experimental group). The Descriptive Features Form, the Psychological Well-being Scale (PWS), and the coping with stress scale (CSS) were utilized to gather data. The persons in the experimental group performed eight sessions (one session per week) of CBT-based intervention program in the form of group training, and no training was performed on the persons in the control group. The variation between the PWS and the CSS pretest total mean score and the posttest total mean score of the persons in the experimental group was statistically significant (p < 0.05). CBT-based intervention program can be utilized as an effective psychosocial intervention to enhance coping with stress and promote psychological well-being in persons with panic disorder.
Acute Suicidal Affective Disturbance (ASAD) is a proposed clinical diagnosis characterized by sudden, intense escalations in suicidal intent, profound social and self-alienation, hopelessness, and heightened physiological arousal. Unlike traditional linear frameworks implying an "ideation-to-action" trajectory, ASAD captures temporally discrete, high-risk states occurring within hours or days. Although accumulating evidence supports the construct validity of ASAD, direct research remains constrained by ethical and practical challenges. This paper proposes Panic Disorder (PD) as a useful analogue for advancing the study of ASAD. The two share phenomenological features, including abrupt affective surges, intense physiological activation, and compromised cognitive control. Importantly, PD offers an experimentally tractable and ethically feasible model: panic-like states can be reliably induced and studied through well-established paradigms (e.g., CO₂ inhalation, interoceptive exposure). Leveraging PD as a proxy provides a unique opportunity to examine underlying mechanisms of ASAD while bypassing the risks inherent to provoking suicidal crises. We propose a Discontinuity Continuum Model, positioning PD and ASAD along a shared spectrum of death-related affective experiences, separated by a psychological threshold of suicidal desire. By integrating insights from panic science into ASAD research, new pathways for mechanistic discovery, diagnostic refinement, and development of targeted interventions will likely emerge.
Shame and loneliness are two important emotions that have been suggested to play a maintaining role in social anxiety disorder (SAD). However, it is not clear whether emotional processes involving these emotions are predominantly experienced in SAD or shared with other anxiety disorders. In the present study we examined the temporal relationship between shame and loneliness on one hand and anxiety on the other among individuals with SAD and among individuals with panic disorder (PD). We used a daily diary design in which participants reported their emotional experiences every evening for 21 consecutive days. We found that individuals with SAD had higher levels of shame but not higher levels of loneliness compared to individuals with PD. We also found evidence for a bidirectional relationship among individuals with SAD, in which anxiety on a given day predicted shame and loneliness on the following day, and shame and loneliness on given day predicted anxiety on the following day. This relationship was not found for individuals with panic disorder. Our findings are consistent with a negative cycle of emotions that may play a role in SAD. Implications for emotional models of psychopathology and for treatment of SAD are discussed.
Background and Objectives: Cyberchondria (CYB) has been associated with health anxiety and anxiety sensitivity (AS); however, its role in panic disorder (PD) remains unclear. This study aimed to compare CYB and AS levels between patients with PD and healthy controls and to examine their associations with PD severity. Materials and Methods: This cross-sectional case-control study included 71 patients with PD and 69 age- and sex-matched healthy controls. Participants completed the Cyberchondria Severity Scale (CSS), Anxiety Sensitivity Index-3 (ASI-3), and Beck Anxiety Inventory (BAI). PD severity was assessed using the Panic Disorder Severity Scale (PDSS). Group comparisons were additionally conducted using analysis of covariance (ANCOVA), controlling for relevant sociodemographic and clinical variables. Pearson correlation and hierarchical multiple regression analyses were performed. Results: Patients with PD had significantly higher CSS (80.70 ± 22.71 vs. 60.62 ± 17.22) and ASI-3 total scores (35.66 ± 17.87 vs. 12.25 ± 10.18) than healthy controls. In the PD group, CYB was positively correlated with AS (r = 0.38, p < 0.01), whereas no significant association was found between CYB and PD severity (r = 0.09, p > 0.05). AS showed a moderate positive correlation with PD severity (r = 0.46, p < 0.01). In hierarchical regression analyses, CYB did not predict PD severity. Adding AS significantly increased the explained variance; however, in the final model, only general anxiety severity (BAI) remained a significant predictor of PD severity. Conclusions: Patients with PD exhibit elevated levels of CYB and AS, which are positively associated with each other. Nevertheless, PD severity appears to be primarily driven by general anxiety symptoms rather than CYB. These findings suggest that CYB may represent a parallel maladaptive coping behavior rather than a direct determinant of symptom severity, with potential implications for assessment and intervention. Longitudinal studies are warranted to clarify causal relationships.
Panic disorder (PD) is associated with altered interoceptive experience, but it remains unclear how self-reported interoception relates to neurophysiological indices of bodily-signal processing. This study examined whether associations between self-reported interoception and resting-state electroencephalography (EEG) markers differ between participants with PD and healthy controls (HC). This analysis included 19 PD participants and 21 HCs from a previously published resting-state EEG dataset. Self-reported interoception was assessed using the Body Perception Questionnaire-Very Short Form (BPQ-VSF) and the Multidimensional Assessment of Interoceptive Awareness (MAIA). Resting-state EEG signals were recorded during eyes-closed and eyes-open conditions. Heartbeat-evoked potentials (HEP) and relative band power (RBP) were extracted to index cardiac-related cortical processing and frequency-specific resting-state activity. Associations between self-report measures and EEG indices were examined using Pearson correlations with 95% confidence intervals, Bayes factors, and false-discovery-rate (FDR) correction across scalp regions within predefined analysis families. Age-adjusted sensitivity analyses and group × self-report interaction models were used to assess robustness and formally test group differences in association patterns. Compared with HCs, PD participants reported higher body-focused attention and lower scores on several adaptive interoceptive dimensions, including Not-Distracting, Not-Worrying, and Trusting. In the 235-301 ms HEP window, age-adjusted interaction models showed that BPQ-VSF HEP coupling differed between groups, especially under eyes-open conditions. Within-group analyses showed an exploratory opposite-direction BPQ-VSF HEP pattern, with positive associations in HC and negative associations in PD. The clearest FDR-corrected HEP association within panic disorder involved Not-Worrying under eyes closed. RBP analyses showed PD-concentrated θ (theta)- and β (beta)-band association profiles. Trusting was positively associated with θ power in PD, and BPQ-VSF showed positive β-band associations under eyes closed that remained robust after age adjustment. Not-Distracting showed negative θ-band associations in the primary correlation analyses, but these were attenuated after controlling for age. These findings provide preliminary FDR-controlled and age-informed evidence that PD involves altered, condition- and frequency-dependent mappings between subjective bodily experience and resting-state EEG markers. The clearest formal group-difference evidence was observed for BPQ-VSF HEP coupling, whereas PD-specific associations were most robust for Not-Worrying-HEP, Trusting-θ power, and BPQ-VSF β power. Given the modest sample size and exploratory correlational design, replication in larger samples is needed.
Oxytocin receptor (OXTR) gene variations are associated with empathy, trust, emotional stability, stress reactivity, social bonding and attachment behaviors. We aimed to explore the impact of three OXTR gene variations (rs53576, rs237902, rs2254298) in susceptibility to panic disorder (PD). We also investigated the possible effects of these variants on separation anxiety scale scores in patients, with a comprehensive approach covering environmental adversity effects. The hypothesis was studied in PD patients and healthy controls with the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. By applying the Separation Anxiety Symptom Inventory (SASI) and the Adult Separation Anxiety Questionnaire (ASA), the relationships between the OXTR gene variants and these scales were also evaluated comprehensively. A statistically significant association was found for OXTR rs237902; presence of the A allele was associated with a 1.585-fold increase in probability of PD. Moreover, all of the analyzed OXTR variants were found to be associated with childhood and adult separation anxiety in the patients in the combined analyses of various demographic and clinical data; striking associations of AA genotype with SASI and ASA scores were observed in these models. The study supports the involvement of oxytocinergic gene variants in PD. It also represents one of the most comprehensive models examining gene-environment (G × E) interactions in this context.
Research in the mental health field has focused on exploration and implementation of digital interventions both in research and society. However, demographic and mental health factors that may influence engagement with research on such interventions have not been explored. This study aims to investigate the relationship between demographics, signs of mental disorders, and interest in participating in an intervention study. Using data collected in the Swedish arm of the World Health Organization’s World Mental Health International College Student (WHO-WMH-ICS) initiative (n = 9140), we conducted a multinomial logistic regression to assess relationships between these factors. Older age, as well as female and non-binary gender identities, were factors significantly associated with increased interest in the intervention study. Treatment flags, indicating fulfilment of criteria for possible mental disorder diagnosis, were significantly associated with clear interest (“yes” response) in intervention research for five of the 15 treatment flags: depression, general anxiety, social anxiety, panic disorder and self-harm. Possible interest (“maybe” response) was also indicated for four of these, excluding general anxiety. These findings may facilitate a better-informed approach to recruiting student participants for treatment research, enhancing unbiased recruitment practices, reducing treatment gaps, and increasing engagement in digital intervention studies for improved mental health.
Individuals with social anxiety disorder (SAD) have been found to have distinct patterns of nonverbal synchrony with others. In the present study, we examined whether patterns of nonverbal synchrony differ between individuals with SAD and individuals with panic disorder (PD). We examined diagnostic interviews of 29 individuals with SAD and 22 individuals with PD, and assessed nonverbal synchrony using motion energy analysis (MEA). We divided interviews into 10 segments and derived nonverbal synchrony indices for each segment to capture changes in nonverbal synchrony over the course of the interview. According to our first hypothesis, we found that nonverbal synchrony was best modelled by a sinusoidal model (r2 = .59) which explained significantly more variance than linear, quadratic and logarithmic models. This suggests that nonverbal synchrony is best characterized by a repeating pattern of increases and decreases. According to our second hypothesis, we found that sine wave amplitudes were greater among individuals with SAD compared to those with PD. Thus, individuals with SAD experienced greater fluctuations in nonverbal synchrony during the interview, compared to individuals with PD. We discuss these findings in the context of models of SAD and models of synchrony, as well as suggest implications for research and clinical practice.
Avoidance behavior is a hallmark of panic disorder (PD), yet experimental evidence remains limited due to challenges in assessing unconditioned avoidance without specific threats. The human Elevated Plus Maze (EPM), implemented in mixed reality, provides an ecologically valid paradigm to measure approach-avoidance behavior under controlled conditions. Twenty PD patients and 20 healthy controls (HC) were tested on the human EPM. Approach-avoidance behavior was assessed alongside subjective anxiety, tension, and cardiovascular responses across multiple time points. Hormonal markers (copeptin, ACTH, cortisol) were analyzed in a subgroup. PD patients showed significantly higher anticipatory anxiety, tension, and heart rate responses than HC, indicating heightened emotional and physiological reactivity. Contrary to our hypothesis, no significant group differences emerged in approach-avoidance behavior. Sensation seeking emerged as the strongest inverse predictor of both avoidance and subjective anxiety. Across groups, higher anxiety in the EPM center robustly predicted avoidance. Subgroup analyses suggested antidepressant use may attenuate avoidance behavior in PD. The EPM elicited ecologically valid subjective and physiological anxiety responses, supporting its translational utility. However, avoidance behavior was more strongly shaped by trait factors than by diagnostic status. In particular, sensation seeking may represent a protective trait promoting approach tendencies and extinction learning, offering a potential target for personalized interventions. The human EPM thus provides a promising tool to investigate transdiagnostic mechanisms of avoidance and to inform tailored treatment strategies in PD.
Previous studies suggest that internalized HIV stigma (IHS) results in HIV viral non-suppression via directly increasing depression, which then reduces adherence leading to non-suppression; however, the dynamics between IHS and mental health are likely more complex. We sought to better understand IHS-mental health dynamics using data from a longitudinal clinical cohort of people with HIV (PWH) receiving healthcare across 10 US primary care clinics. Among 8,506 PWH who had ≥2 timepoints in which IHS, depression, and anxiety were measured, we examined changes over time in both two-state (i.e. impact of IHS on depression or anxiety and vice versa) and four-state combinations of depression-IHS (i.e., no depression or IHS, depression/no IHS, no depression/IHS, both depression/IHS) and anxiety-IHS. Transition probabilities between states and factors influencing transitions were identified using multi-state Markov models. The impact of IHS on the transition rates of mental health measures (i.e., depression, anxiety) and vice versa were almost the same, suggesting that each influences the other. Over 50% of PWH remained in the same IHS-depression or IHS-anxiety state. PWH with IHS had almost twice the rate of transitioning from no depression/anxiety to having depression/anxiety compared to PWH without IHS; with similar results for the depression or anxiety with no IHS to reporting IHS transition. We demonstrate that IHS and mental health dynamics are more complex than previously suspected and that the associations are bidirectional, which has implications for both future analyses and optimal management of these conditions among PWH.
Transdiagnostic psychotherapies have been gaining in popularity due in part to their hypothesized ability to address multiple emotional disorders via a single protocol. However, to date, most randomized clinical trials of these treatments have focused on patients with anxiety disorders, or in mixed samples, limiting their use in other diagnoses. The present study compared Transdiagnostic Behavior Therapy (TBT) to disorder-specific therapies (DSTs) in 304 veterans with principal diagnoses of major depressive disorder (MDD), posttraumatic stress disorder (PTSD), or panic disorder. Disorder-specific symptom outcomes and overall impairment were assessed at baseline, mid-treatment, and posttreatment. Structural equation modeling was used to evaluate changes in outcomes over time via latent growth curve models. Support for noninferiority between TBT and the matching DSTs was found in participants with PTSD and panic disorder for the disorder-specific symptom scales and for overall impairment scores across diagnoses. Similar effect sizes were obtained for MDD, although noninferiority could not be concluded because confidence intervals were wide. Similar scores for patient satisfaction and treatment completion also were observed across TBT and the comparison DSTs. Together, these findings suggest that TBT demonstrates comparable efficacy to the established DSTs in addressing symptoms of depressive disorders (MDD), trauma and stressor-related disorders (PTSD), and the anxiety disorders (panic disorder). Thus, ongoing dissemination and implementation efforts for TBT should be considered for a wider range of diagnoses, easing provider training burden and expanding treatment coverage in clinical settings.
Hyperarousal is a common symptom key to the severity of insomnia-, depression-, anxiety-, posttraumatic stress- and attention deficit/hyperactivity disorders. Hyperarousal however remained a loosely defined construct assessed with different questionnaires in different disorders. Here we addressed the unresolved question whether hyperarousal may be one common transdiagnostic construct or rather has multiple, possibly disorder-specific, dimensions. In this cohort study, participants were recruited through media and from the Netherlands Sleep Registry between Dec 2023 and June 2024. We included 467 adults (mean age 58.3 years [range 21-89]; 77.6% female) with a wide range of psychiatric diagnoses and severities who completed all hyperarousal questionnaires and disorder symptom severity scales (Insomnia Severity Index, Rapid Measurement Toolkit-20, and ADHD Self-Report Scale). Factor analyses evaluated potential dimensions in hyperarousal assessed with 221 items from 18 questionnaires. Multiple regression models were used to reveal profiles of the most relevant hyperarousal dimensions associated with the symptom severity of insomnia disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder and attention deficit/hyperactivity disorders. We used 27 selected items representing the seven dimensions of hyperarousal to create the Transdiagnostic Hyperarousal Dimensions Questionnaire (THDQ). A second sample was recruited between March 2025 and April 2025 for confirmation and validation (n = 592; mean age 61.0 years [range 19-89]; 65.2% female), who completed the THDQ. To examine the possibility to estimate hyperarousal dimension factor scores using available UK Biobank items, we calculated the polychoric correlation between the 27 selected items and 22 UK Biobank items in 467 adults. Exploratory factor analysis identified 7 dimensions, explaining 50.2% of the variance and representing anxious-, somatic-, sensitive-, sleep-related-, irritable-, vigilant- and sudomotor hyperarousal. Multiple regression models showed that hyperarousal dimensions differentially correlated with the severity of insomnia, major depression, anxiety, panic, posttraumatic stress and attention deficit/hyperactivity disorder symptoms (standardized beta-coefficients = -0.10 to 0.70). We next developed and validated a 27-item THDQ, reliably assessing each dimension (CFI = 0.92, RMSEA = 0.05, Cronbach's alpha = 0.90). Finally, we showed that UK Biobank items can estimate anxious, irritable and sleep-related hyperarousal (r = 0.75-0.85). Distinguishing different hyperarousal dimensions, enabled by the THDQ, can propel our understanding of hyperarousal to provide clues for better treatment of multiple mental disorders. European Research Council (ERC) and ZonMw (partnership between Care Research Netherlands and Dutch Research Council).
Objectives: This study aims to examine Internet addiction profiles, their associations with comorbid anxiety and depression, and characterize network architectures of anxiety and depression across profiles. Methods: From November 2022 to November 2023, we conducted a short-term cohort study including 2503 students. Latent profile analysis (LPA) and multinomial logistic regression analysis were employed to investigate the association between Internet addiction and comorbidity of anxiety and depression, and network analysis was used to characterize anxiety-depression network structure within each profile. Results: LPA identified three profiles of Internet addiction, which were labeled: "regular" (66.60%) profile, "risk" profile (23.09%), and "addiction" profile (10.31%). The incidence of comorbid anxiety and depression was 10.67%. Both the "risk" (adjusted OR = 1.76, 95% CI: 1.27-2.44) and "addiction" (adjusted OR = 2.12, 95% CI: 1.39-3.24) profiles were significantly associated with increased comorbidity risk. The "dass13" ("Downhearted and blue") emerged as a core symptom, and "dass15" ("Close to panic") was identified as a key bridge symptom across three network models. The edge weight for the dass05-dass21 (Lack of motivation-Meaninglessness of life) was higher in the "risk" profile than in the "addiction" profile. Conclusions: Children and adolescents in the "risk" and "addiction" profiles were significantly more likely to experience comorbid anxiety and depression. "dass13" ("Downhearted and blue") and "dass15" ("Close to panic") can be used as the key target during intervention. Targeted interventions can be implemented for children and adolescents in the "risk" and "addiction" profiles.
This report presents a series of 16 patients who were admitted to the emergency department following confirmed intake of the potent synthetic cannabinoid ADB-CHMINACA. The cases are drawn from a prospective observational study following the recreational use of synthetic cannabinoids. The clinical and analytical data were combined and submitted to a Poison Centre. The severity of poisoning was evaluated on the basis of clinical data, including follow-up information. The present analysis was conducted exclusively on patients with analytically confirmed intake of ADB-CHMINACA and treatment in emergency departments for acute adverse effects. Cases with additional relevant serum concentrations of other drugs of abuse that suggested relevant interactions were excluded. Common clinical manifestations included panic attacks, tachycardia, agitation, vomiting and seizures. Most of the patients experienced these symptoms within minutes after inhaling this new psychoactive substance. Serum concentrations of ADB-CHMINACA varied widely and ranged from 0.2-31 ng/mL, without a clear correlation between severity of the poisoning and drug concentration. Severity of poisoning was moderate to severe, but all patients recovered. Notably, 1 of the patients developed a posterior reversible encephalopathy syndrome, a rare but serious neurological complication characterised by usually transient symptoms like headaches, seizures and altered mental state, often accompanied by brain oedema. In this case, the patient recovered after 4 days. Clinical presentations exhibited by patients with analytically confirmed intake of ADB-CHMINACA showed similarities to previous reports; neuropsychiatric and cardiovascular symptoms were most prominent. Notable distinctions include the prevalence of panic attacks and trembling.
To identify whether patients with arrhythmia, heart failure or ischaemic heart disease presenting with anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS) have identifiable anxiety according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) and, if so, which type of anxiety disorder based on the SCID. Initial screening data from the Heart and Mind randomised clinical trial. Patients with arrhythmia, heart failure or ischaemic heart disease were screened using HADS, and patients with a HADS-anxiety (HADS-A) score≥8 were invited to participate. Participants were interviewed by trained cardiac nurses using the SCID to determine whether they met the criteria for anxiety and, if so, the type of anxiety disorder. Of the 7816 patients who completed the HADS questionnaire, 1803 (23%) had a HADS-A score≥8. Among these, 398 (22%) agreed to the SCID interview, and 336 (84%) met the diagnostic criteria for an anxiety disorder. The mean age was 61 years, with 40% being female. The mean HADS-A score was 11.3 (SD=2.7). The most common types of anxiety were generalised anxiety disorder (61%), panic disorder (23%) and specific phobia (8%). The majority of individuals identified by the instrument also met the diagnostic criteria for an anxiety disorder. Generalised anxiety disorder and panic disorder were the most prevalent subtypes. Anxiety was common across the cardiac population, underscoring the need for routine assessment and targeted intervention in clinical practice. NCT04582734.
Anxiety disorders are the most prevalent psychiatric conditions globally, affecting up to one in four individuals over a lifetime. A strong and bidirectional relationship exists between anxiety and sleep disturbances: anxiety profoundly disrupts sleep, while poor sleep exacerbates psychological vulnerability, thereby exacerbating anxiety. This review provides a detailed exploration of how different anxiety disorders impact sleep and emphasizes the clinical importance of addressing both dimensions concurrently. This review demonstrates that sleep disturbances in anxiety disorders manifest heterogeneously, impacting sleep onset, maintenance, and depth. In generalized anxiety disorder (GAD), over 80% of patients suffer from insomnia, characterized by prolonged sleep latency, frequent awakenings, and non-restorative sleep. Panic disorder often involves nocturnal panic attacks that create anticipatory anxiety around sleep itself. PTSD is strongly linked to recurrent nightmares and hyperarousal, with significant polysomnographic evidence of disrupted sleep architecture. Obsessive-compulsive disorder (OCD) is also associated with delayed sleep onset due to compulsive rituals. The review highlights the importance of differential diagnosis, as sleep complaints in anxious patients may mask other conditions such as nocturnal epilepsy or obstructive sleep apnea. A thorough clinical approach, including detailed sleep history, psychometric evaluations, and targeted investigations such as polysomnography or EEG when indicated, is essential to distinguish these conditions. Ultimately, the review reinforces that anxiety must be systematically evaluated and treated in patients presenting with sleep disorders, as addressing anxiety can significantly improve sleep and overall functioning. It calls for integrative, patient-centered care to navigate the complex interplay of psychiatric symptoms and sleep physiology.