An analysis of panic symptoms during hypercarbia compared to hypocarbia in patients with panic attacks

Zandbergen, J.; Pols, Henk; Fernandez, Isabella; Griez, Eric

doi:10.1016/0165-0327(91)90025-n

Cited by 17 publications

(11 citation statements)

References 21 publications

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“…In a subgroup of 20 PD patients (18), using a vital capacity inhalation of 35% CO 2 , it was found that the symptoms of shortness of breath and choking were significantly correlated with subjective anxiety, suggesting a specific role of respiratory symptoms in PD.…”

Section: Discussionmentioning

confidence: 99%

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

Valença

Nardi

Nascimento

et al. 2002

Braz J Med Biol Res

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The aim of the present study was to verify the sensitivity to the carbon dioxide (CO 2 ) challenge test of panic disorder (PD) patients with respiratory and nonrespiratory subtypes of the disorder. Our hypothesis is that the respiratory subtype is more sensitive to 35% CO 2 . Twenty-seven PD subjects with or without agoraphobia were classified into respiratory and nonrespiratory subtypes on the basis of the presence of respiratory symptoms during their panic attacks. The tests were carried out in a double-blind manner using two mixtures: 1) 35% CO 2 and 65% O 2 , and 2) 100% atmospheric compressed air, 20 min apart. The tests were repeated after 2 weeks during which the participants in the study did not receive any psychotropic drugs. At least 15 of 16 (93.7%) respiratory PD subtype patients and 5 of 11 (43.4%) nonrespiratory PD patients had a panic attack during one of two CO 2 challenges (P = 0.009, Fisher exact test). Respiratory PD subtype patients were more sensitive to the CO 2 challenge test. There was agreement between the severity of PD measured by the Clinical Global Impression (CGI) Scale and the subtype of PD. Higher CGI scores in the respiratory PD subtype could reflect a greater sensitivity to the CO 2 challenge due to a greater severity of PD. Carbon dioxide challenges in PD may define PD subtypes and their underlying mechanisms.

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Section: Discussionmentioning

confidence: 99%

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

Valença

Nardi

Nascimento

et al. 2002

Braz J Med Biol Res

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show abstract

“…39 In respiratory challenges with CO 2 , the main difference between PD patients and control subjects is that the first group present intense respiratory symptoms and fear of dying, whereas the second group do not show these symptoms. 63,64 Perna and colleagues 64 found that 35% CO 2 inhalation induced a strong dyspnea sensation in PD patients, and more than a half reported that "I cannot take a deep breath" or "my breath does not go in all the way." The sensations "I feel out of breath," "my breathing requires more concentration," and "my breathing requires effort" were also prevalent.…”

Section: Diagnostic Challenge Testsmentioning

confidence: 97%

Panic Disorder Respiratory Subtype: Psychopathology, Laboratory Challenge Tests, and Response to Treatment

Freire

Perna

Nardi

2010

Harvard Review of Psychiatry

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“…Gorman et al [1990] reported that all subjects experienced a high degree of dyspnea during a single breath challenge of 35% CO 2 . Zandbergen [1991] reported among anxiety patients that dyspnea, dizziness, flushes or chills, nausea, choking, and palpitation were more prominent during 35% CO 2 double breath challenge than during hyperventilation. Perna et al [1994] reported, in response to a single breath of 35% CO 2 , that dyspnea, choking, fear of dying, sweating, and dizziness distinguished patients with panic disorder (PDs) from normal controls (NCs), with 34 of 71 patients panicking compared to 2 of 44 controls.…”

Section: Introductionmentioning

confidence: 97%

Acute panic inventory symptoms during CO2 inhalation and room-air hyperventilation among panic disorder patients and normal controls

et al. 2001

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There is scant literature on anxiety symptoms induced during respiratory challenges developed to induce panic symptoms and attacks. Here we report on the prevalence of Acute Panic Inventory (API) symptoms during three consecutive respiratory challenges to patients with panic disorder (PD) and normal controls (NC). The challenges performed using a closed canopy system included voluntary room air hyperventilation (RAH), inhalation of 5% CO(2), and 7% CO(2)-enriched air. The PD patients were 41 men and 53 women whose mean age was 33.4 (SD = 8.55). The normal comparison group consisted of 35 men and 27 women with a mean age of 31.3 (SD = 9.21). The diagnosis of panic disorder was made using the Structured Clinical Interview for DSM-III-R. All potential normal controls underwent structured clinical interview using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version Modified for the Study of Anxiety Disorders (SADS-LA), and must have been free of a lifetime history of anxiety disorders, affective disorders, substance use disorders, and schizophrenia. All participants also had a complete medical evaluation and were in good health. The experiment consisted of seven experimental epochs: three baseline/recovery periods each followed by a respiratory challenge, and then a final recovery epoch. The API was administered at the end of each epoch. Clinical staff trained and experienced in rating panic attacks rated participants' response during each challenge as panic or no panic. Three groups were defined for analysis: PD patients who panicked, PD patients who did not panic, and NC who did not panic. Staff ratings indicated that the 7% CO(2) challenge was the most panicogenic, followed by the 5% CO(2), and the RAH challenges. Conventional statistics (analysis of variance and partial correlations) indicated that many baseline symptoms as well as symptom increments differed across groups, and were associated with the outcome of panic/no panic during each challenge. However, logistic regression analysis indicated that only a few symptoms independently predicted the panic/no panic outcome because many symptoms were redundant. The symptom cluster of fear in general, dizziness, difficulties with concentrating, and doing one's job predicted panic to RAH. The cluster of fear in general, confusion, dyspnea, and twitching/trembling predicted the response to 5% CO(2). Finally, fear in general, confusion, twitching/ trembling and dizziness predicted the response to 7% CO(2). While univariate analyses indicated that many symptoms distinguished between panic and no panic outcome, logistic regression revealed that group differences were subsumed under a few prominent symptoms, namely, fear in general, confusion, dizziness, twitching/trembling, and dyspnea. The results are discussed in the context of patient (having a diagnosis of PD) and panic effects (rated as panicking to a challenge).

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An analysis of panic symptoms during hypercarbia compared to hypocarbia in patients with panic attacks

Cited by 17 publications

References 21 publications

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

Panic Disorder Respiratory Subtype: Psychopathology, Laboratory Challenge Tests, and Response to Treatment

Acute panic inventory symptoms during CO2 inhalation and room-air hyperventilation among panic disorder patients and normal controls

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