Objective : Benzodiazepine medications (BZDs) are commonly prescribed for insomnia and are known to impact slow-wave sleep (SWS). This study aimed to investigate how reductions in SWS caused by BZDs influence autonomic nervous system activity in individuals with panic disorder. Methods : We selected patients with panic disorder whose sleep efficiency was normalized by BZDs (≥85%). Participants were categorized into two groups: those with extremely reduced SWS (<3%, Low SWS, n=39) and those with normal SWS levels (>15%, Norm SWS, n=42). Additionally, we included patients with obstructive sleep apnea (OSA) who also had normal sleep efficiency (≥85%) and extremely reduced SWS (<3%, OSA, n=35). We compared sleep architecture and heart rate variability (HRV) between the Low SWS and Norm SWS groups, as well as between the Low SWS and OSA groups. Results : The Low SWS group exhibited significantly increased NREM stage 2 sleep (63.3% vs. 48.6%, p<0.001) compared to the Norm SWS group, alongside lower high-frequency power (HF) (5313.6 vs. 8057.0, p<0.001), a higher LF/HF ratio (1.80 vs. 0.96, p=0.001), and reduced normalized HF (HFnu) (40.6 vs. 54.0, p<0.001). When compared to the Norm OSA group, the Low SWS group showed decreased NREM stage 1 sleep, increased NREM stage 2 sleep, and a lower arousal index. There were no significant differences in HRV values (LF, HF, LF/HF ratio, and HFnu), indicating sympathetic nervous system hyperactivity. Conclusion : Our findings suggest that the reductions in SWS caused by BZDs may lead to sympathetic nervous system hyperactivity, comparable to that observed in sleep apnea, which is known for its increased cardiovascular risk and sympathetic activity.

Objective : This pilot study assessed the effectiveness and feasibility of a transdiagnostic emotion regulation program for patients with posttraumatic stress disorder (PTSD), panic disorder (PD), and generalized anxiety disorder (GAD), while also examining differences among the diagnostic groups. Methods : Fifty-six outpatients (PTSD n=23, PD n=21, GAD n=12) completed a 10-session treatment program. Outcomes were evaluated before and after treatment. The assessment included clinician-rated anxiety using the Hamilton Anxiety Rating Scale (HAM-A; primary outcome) and self-reported measures of anxiety, anxiety sensitivity, depression, resilience, and clinician-rated functioning. Treatment effects were analyzed using repeated-measures ANOVA. Results : Significant time effects were found across all measures (ps <0.05), indicating a reduction in symptoms and improvement in functioning after treatment. The group-by-time interaction for the HAM-A was not statistically significant (p=0.101), although a tendency toward differential change across groups was observed. The PTSD group exhibited higher symptom levels despite improvements, the PD group reported lower baseline severity and higher functioning, while the GAD group showed overall improvement with minimal change in anxiety sensitivity. Conclusion : The transdiagnostic emotion regulation program was feasible and resulted in clinically significant improvements in anxiety and trauma-related disorders. The variability observed among diagnostic groups suggests the necessity for tailored interventions within a transdiagnostic framework.

Objective : Economic conditions influence population mental health, but the relationship between economic growth and the incidence of mental disorders across different stages of development is not well understood. This study investigates whether the link between economic growth and the incidence of depressive and anxiety disorders varies by national development level. Methods : We performed a cross-sectional analysis of data from 153 countries, averaged over the years 2010-2019. We examined log-transformed GDP per capita and GDP per capita growth as predictors of the incidence of depressive and anxiety disorders. Countries were categorized as developed (HDI≥0.8) or developing (HDI<0.8). Separate multiple linear regression models were created for each group, adjusting for income inequality (Gini index), unemployment, mean years of schooling, and health expenditure per capita (logtransformed). Results : The associations varied by development level. In developing countries, GDP per capita growth was inversely related to the incidence of depressive disorders (β=-0.22, p=0.019) and anxiety disorders (β=-0.32, p<0.001). In contrast, no significant associations were found in developed countries (p>0.05). Additionally, unemployment was positively correlated with the incidence of depressive disorders, while education was negatively correlated with the incidence of anxiety disorders in both groups. Conclusion : Economic growth is associated with a lower incidence of depressive and anxiety disorders in developing countries, but this relationship weakens in more developed contexts. Enhancing population mental health likely necessitates structural improvements beyond mere income growth.

Objective : This study investigated the effects of group art therapy combined to pharmacological treatment, compared with pharmacological treatment alone, on psychological and physiological indicators in adults with panic disorder. Methods : Using a quasi-experimental unequal control pretest-posttest design, 34 adults with panic disorder were assigned to either an experimental group, which received six weekly 90-minute sessions of group art therapy alongside ongoing pharmacological treatment, or a control group that received pharmacological treatment alone. Psychological indicators were measured using the Hamilton Rating Scale for Anxiety (HAM-A), the Anxiety Sensitivity Inventory-Revised (ASI-R), the Panic Disorder Severity Scale-Self Report (PDSS-SR), and the Albany Panic and Phobia Questionnaire (APPQ). The physiological indicator assessed was salivary cortisol. Within-group changes were analyzed using paired t-tests, while between-group differences were examined using ANCOVA, controlling for baseline scores. Results : The experimental group demonstrated significant pre-post improvements across all variables: HAM-A (t=20.49, p<0.001), ASI-R (t=22.90, p<0.001), PDSS-SR (t=-2.52, p<0.05), APPQ (t=-3.21, p<0.01), and salivary cortisol (t=-3.00, p<0.01). In contrast, the control group did not exhibit significant pre-post changes in any variable. Between-group comparisons indicated significantly greater improvements in the experimental group for HAM-A (F=4.38, p<0.05), ASI-R (F=4.31, p<0.05), APPQ (F=5.71, p<0.05), and salivary cortisol (F=5.73, p<0.05). Conclusion : Standardized group art therapy as an adjunct to pharmacological treatment may more effectively improve psychological and physiological indicators in adults with panic disorder compared to pharmacological treatment alone.

Objective : This study investigated fear learning and recall in patients with anxiety disorders, specifically examining their differential responses to extinguished and unextinguished cues using a two-day fear conditioning-extinction-recall paradigm. Methods : We analyzed data from 50 patients with anxiety disorders and 62 healthy controls. On the first day, participants underwent fear conditioning followed by extinction learning, with extinction recall assessed 24 hours later. Three conditioned stimuli (CS) were employed: a neutral CS (CSN), an extinguished CS (CSE), and an unextinguished CS (CSU). Threat expectancy ratings (1-9) were obtained after each phase. Results : Both groups demonstrated strong fear acquisition and successful extinction learning, but patients reported higher threat expectancy ratings for all stimuli compared to controls. During the recall phase, significant main effects for both group and stimulus were observed, along with a notable group-by-stimulus interaction. Further analysis of the extinction-to-recall change for CSU revealed that threat expectancy ratings decreased from extinction to recall in controls, while no such decrease was observed in patients. Conclusion : Patients with anxiety disorders exhibited heightened threat appraisal throughout fear learning and extinction. The recall pattern, particularly the lack of attenuation of threat for the unextinguished cue, indicates impaired updating of threat expectancy for ambiguous stimuli, which may contribute to persistent threat appraisal in the face of residual uncertainty.