CO2 reactivity as a biomarker of exposure-based therapy non-response: study protocol

被引：4

作者：

Smits, Jasper A. J. ^{[1
,2
]}

Monfils, Marie-H ^{[1
,2
]}

Otto, Michael W. ^{[3
]}

Telch, Michael J. ^{[1
,2
]}

Shumake, Jason ^{[1
,2
]}

Feinstein, Justin S. ^{[4
]}

Khalsa, Sahib S. ^{[4
]}

Cobb, Adam R. ^{[1
,2
,5
,6
]}

Parsons, E. Marie ^{[3
]}

Long, Laura J. ^{[3
]}

McSpadden, Bryan ^{[1
,2
]}

Johnson, David ^{[1
,2
]}

Greenberg, Alma ^{[3
]}

机构：

[1] Univ Texas Austin, Dept Psychol, 1 Univ Stn, Austin, TX 78712 USA

[2] Univ Texas Austin, Inst Mental Hlth Res, 1 Univ Stn, Austin, TX 78712 USA

[3] Boston Univ, Dept Psychol & Brain Sci, 900 Commonwealth Ave,Floor 2, Boston, MA 02215 USA

[4] 3 Laureate Inst Brain Res, 6655 South Yale Ave, Tulsa, OK 74136 USA

[5] Med Univ South Carolina, Dept Psychiat & Behav Sci, 67 President St MSC 862, Charleston, SC 29425 USA

[6] Ralph H Johnson VAHCS, 67 President St MSC 862, Charleston, SC 29425 USA

来源：

BMC PSYCHIATRY | 2022年 / 22卷 / 01期

关键词：

Panic disorder; Social anxiety disorder; Obsessive-compulsive disorder; Generalized anxiety disorder; Posttraumatic stress disorder; Exposure therapy; Biomarker; Orexin; CO2; challenge; Clinical trial; POSTTRAUMATIC-STRESS-DISORDER; COGNITIVE-BEHAVIORAL THERAPY; 35-PERCENT CARBON-DIOXIDE; DSM-IV DISORDERS; PANIC DISORDER; PSYCHOMETRIC PROPERTIES; VOLUNTARY HYPERVENTILATION; HYPOCRETIN/OREXIN SYSTEM; CLINICAL PREDICTORS; ANXIETY SENSITIVITY;

D O I：

10.1186/s12888-022-04478-x

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

Background: Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. Methods: We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. Discussion: Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy.

引用

页数：15