CCK-4: Psychophysiological conditioning elicits features of spontaneous panic attacks

• Published in: Journal of psychiatric research Vol. 44; no. 16; pp. 1148 - 1153
• Main Authors: Hinkelmann, Kim, Yassouridis, Alexander, Mass, Reinhard, Tenge, Henrike, Kellner, Michael, Jahn, Holger, Wiedemann, Klaus, Wolf, Karsten
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.12.2010; Elsevier
• Subjects: Activation density; Adrenocorticotropic Hormone - blood; Adult; Adult and adolescent clinical studies; Anxiety; Anxiety disorders. Neuroses; Area Under Curve; Biological and medical sciences; CCK-4; Conditioning; Dose-Response Relationship, Drug; Double-Blind Method; Electromyography - methods; Emotional facial expression; Facial EMG; Facial muscles; Facial Muscles - drug effects; Facial Muscles - physiopathology; Hormones; HPA-axis; Humans; Indexing in process; Male; Medical sciences; Pain Measurement; Panic; Panic anxiety; Panic disorder; Panic Disorder - blood; Panic Disorder - chemically induced; Panic Disorder - physiopathology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Radioimmunoassay - methods; Stress; Tetragastrin - adverse effects; Tetragastrin - blood; Time Factors; Young Adult; Emotional facial expression; Panic anxiety; Facial EMG; Conditioning; CCK-4; Activation density; HPA-axis; Affect affectivity; Panic; Emotional expression; Hypothalamohypophysoadrenal axis; Anxiety disorder; Electrophysiology; Activation; Neuropeptide; Density; Electrodiagnosis; Anxiety; Electromyography; Face; Psychophysiology; Emotion emotionality; Panic attack; Cholecystokinin; Facial expression
• ISSN: 0022-3956; 1879-1379; 1879-1379
• DOI: 10.1016/j.jpsychires.2010.04.004

Cholecystokinin-tetrapeptide (CCK-4) is an established model to generate subjective panic anxiety. CCK-4 injection also results in consistent and dose-dependent rise of stress hormones. Effects other than upon subjective panic and stress hormone activity have barely been examined. The purpose of the study was to investigate CCK-4 effects on emotional facial expression and especially on fear relevant facial muscles establishing therewith a more objective method to measure subjective panic anxiety. 20 healthy male subjects were randomly and double-blindedly assigned in two groups (dose groups), each of which was investigated three times once with placebo and twice with 25 μg or 50 μg CCK-4 respectively. Subjects of each group were randomly assigned in two different balanced orders of investigations: CCK-CCK-Placebo vs. Placebo-CCK-CCK. Facial muscle and hypothalamo-pituitary-adrenocortical (HPA)-axis activity were recorded. CCK-4 led dose-dependently to an increase of panic anxiety, an activation of fear relevant facial muscles and a rise of stress hormones. Whereas placebo administration before CCK-4 revealed no significant panic and stress response, during placebo following CCK-4 stimulations a psychophysiological conditioning effect could be observed without rise in HPA-axis activity. Our findings indicate the possibility to measure different intensities of panic anxiety and conditioning effects with a facial EMG method. Dissociation of HPA-activity and fear relevant facial muscle activity is in accordance with former results about spontaneous panic attacks.