Background

Panic disorder (PD) is an anxiety disorder characterized by recurrent panic attacks whose aetiology might be associated with alterations of the prefrontal-amygdala circuitry. The prefrontal cortex is a key region involved in executive functioning (EF) whose disturbance may imply harsh consequences over personal, social, and working aspects of PD patients. Indeed, defining the real involvement of EF in PD could lead to early assessment, better treatment, and rehabilitation options. These could have a substantial impact on the quality of life of these patients and their caregivers, thus reducing long-term health care needs.

Methods

We reviewed findings from different studies that investigated executive functioning in PD patients using standardized neuropsychological measures. The review was conducted with the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA). In addition, peer-reviewed human-based research articles were selected and twelve studies were retrieved through a search on PubMed. Four uniquely focused on PD patients, two also included a sample of first-degree relatives, while six included a mixed sample of different psychiatric illnesses, including PD.

Results

The majority of the studies found no alterations in PD patients, suggesting that EF might not be a core deficit in this disorder. However, some studies (N = 4) found EF deficits in selective domains, which included attention and set-shifting processes, cognitive flexibility, decision-making abilities, and working memory in PD patients and/or in their first-degree relatives.

Limitations

Unbalanced and small samples, unmonitored therapies, and the heterogeneity of cognitive and diagnostic assessment measures might have limited the generalizability of the results.

Conclusions

Overall, the results point towards the hypothesis that PD patients had preserved EF. However, future studies with standardized methodological procedures and with a gold standard assessment of EF will be required to finally exclude its involvement in the disease.

中文翻译：

---

惊恐症中的执行功能：迷你回顾

背景

恐慌症（PD）是一种以复发性恐慌发作为特征的焦虑症，其病因可能与额叶前杏仁核回路的改变有关。前额叶皮层是参与执行功能（EF）的关键区域，其功能紊乱可能暗示对PD患者的个人，社会和工作方面会产生严重后果。确实，定义EF在PD中的真正参与可能会导致早期评估，更好的治疗和康复选择。这些可能会对这些患者及其护理人员的生活质量产生重大影响，从而减少长期医疗保健需求。

方法

我们回顾了来自不同研究的结果，这些研究使用标准化的神经心理学方法调查了PD患者的执行功能。进行了系统评价和荟萃分析的首选报告项目（PRISMA）的审查。此外，选择了经过同行评审的基于人的研究文章，并通过在PubMed上进行搜索检索了十二项研究。四位特别关注PD患者，其中两位还包括一级亲属样本，而六位包括不同精神疾病（包括PD）的混合样本。

结果

大多数研究未发现PD患者有任何改变，这表明EF可能不是该疾病的核心缺陷。但是，一些研究（N  = 4）发现选择性领域的EF缺陷，包括PD患者和/或其一级亲属的注意力和设定转移过程，认知灵活性，决策能力和工作记忆。

局限性

样本不平衡，样本量少，疗法不受监督以及认知和诊断评估措施的异质性可能会限制结果的推广性。

结论

总体而言，结果指向PD患者保留EF的假说。但是，将来需要采用标准化的方法学程序以及对EF进行金标准评估的研究，才能最终排除其与疾病的关系。