Are Respiratory Abnormalities Specific for Panic Disorder? A Meta-Analysis

Grassi, Massimiliano; Caldirola, Daniela; Chiaro, Nunzia Valentina Di; Riva, Alice; Daccò, Silvia; Pompili, Maurizio; Perna, Giampaolo

doi:10.1159/000364830

Cited by 35 publications

(26 citation statements)

References 38 publications

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“…Anxiety and panic disorder are classically associated with hyperventilation (31) [Carnevali et al (9); Grassi et al (18)]. However, our results show an opposite effect.…”

Section: Perspectives and Significancecontrasting

confidence: 54%

Long-lasting bradypnea induced by repeated social defeat

Brouillard

Carrive

Camus

et al. 2016

American Journal of Physiology-Regulatory, Integrative and Comp

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peated social defeat in the rat induces long-lasting cardiovascular changes associated with anxiety. In this study, we investigated the effects of repeated social defeat on breathing. Respiratory rate was extracted from the respiratory sinus arrhythmia (RSA) peak frequency of the ECG in rats subjected to social defeat for 4 consecutive days. Respiratory rate was recorded under anesthesia 6 days (Dϩ10) or 26 days (Dϩ30) after social defeat. At Dϩ10, defeated (D) rats spent less time in the open arms of the elevated plus maze test, had heavier adrenal glands, and displayed bradypnea, unlike nondefeated animals. At Dϩ30, all signs of anxiety had disappeared. However, one-half of the rats still displayed bradypnea (D L rats, for low respiratory rate indicated by a lower RSA frequency), whereas those with higher respiratory rate (D H rats) had recovered. Acute blockade of the dorsomedial hypothalamus (DMH) or nucleus tractus solitarii (NTS) 5-HT 3 receptors reversed bradypnea in all D rats at Dϩ10 and in DL rats at Dϩ30. Respiratory rate was also recorded in conscious animals implanted with radiotelemetric ECG probes. DH rats recovered between Dϩ10 and Dϩ18, whereas DL rats remained bradypneic until Dϩ30. In conclusion, social stress induces sustained chronic bradypnea mediated by DMH neurons and NTS 5-HT3 receptors. These changes are associated with an anxiety-like state that persists until Dϩ10, followed by recovery. However, bradypnea may persist in one-half of the population up until Dϩ30, despite apparent recovery of the anxiety-like state.anxiety; breathing; serotonin; social defeat; telemetric recording BREATHING AND ANXIETY ARE intimately related (44). For example, respiratory distress and asphyxia are associated with dreadful feelings, and fear and anxiety can have profound effects on breathing. Clinical studies have shown that panic disorder, characterized by acute and unexpected anxiety attacks and substantial anxiety over the possibility of experiencing further attacks, is associated with symptoms including palpitations, shortness of breath, sweating, and hyperventilation (1). In addition, high levels of anxiety-related behavior in rats are associated with elevation of the resting respiratory rate (9). The respiratory rate also decreases during certain specific responses to stress, for instance during freezing behavior in the rat, when it is associated with ultrasonic vocalizations (19). However, much less is known about the long-term effects of emotional stress on breathing. In adult rats, intense neonatal emotional stress, such as maternal separation, can lead to a decrease in breathing rate during non-rapid-eye-movement sleep (24). A lower respiratory rate was also observed in anesthetized Flinder-Sensitive rats, a well-validated animal model of depression (33). However, respiratory rate does not appear to be altered in patients with major depression, although cardiovascular changes are observed (4). Clearly, more work needs to be done to understand the long-term effects of emotional stress on breathin...

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“…Anxiety and panic disorder are classically associated with hyperventilation (31) [Carnevali et al (9); Grassi et al (18)]. However, our results show an opposite effect.…”

Section: Perspectives and Significancecontrasting

confidence: 54%

Long-lasting bradypnea induced by repeated social defeat

Brouillard

Carrive

Camus

et al. 2016

American Journal of Physiology-Regulatory, Integrative and Comp

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“…Furthermore, smoking exacerbates the irregularity in their breathing pattern, whereas smoking does not seem to affect subjects without the disorder similarly 20 . Patients with PD have behavioral and respiratory hypersensitivity to hypercapnic challenges, with peculiar respiratory patterns during the challenge and recovery phases 14 – 18 . Similarly, they seemingly have a higher sensitivity to other respiratory stimuli, such as hypoxic challenge 21 , 22 and hyperventilation 23 .…”

Section: Are Panic Attacks Really the Results Of False Alarms?mentioning

confidence: 99%

Is panic disorder a disorder of physical fitness? A heuristic proposal

Perna

Caldirola²

2018

F1000Res

Self Cite

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Currently, panic disorder (PD) is considered a mental disorder based on the assumptions that panic attacks (PAs) are “false alarms” that arise from abnormally sensitive defense systems in the central nervous system and that PD is treated with therapies specifically acting on anxiety or fear mechanisms. This article aims to propose an alternative perspective based on the results of some experimental studies. Our heuristic proposal suggests not only that PD may be a mental disorder but also that patients with PD have real abnormal body functioning, mainly involving cardiorespiratory and balance systems, leading to a decline in global physical fitness. PAs, as well as physical symptoms or discomfort in some environmental situations, may be “real alarms” signaling that the adaptability resources of an organism are insufficient to respond appropriately to some internal or external changes, thus representing the transient conscious awareness of an imbalance in body functioning. The antipanic properties of several modern treatments for PD may include their beneficial effects on body functions. Although anxiety or fear mechanisms are evidently involved in PD, we hypothesize that a reduction of physical fitness is the “primum movens” of PD, while anxiety or fear is induced and sustained by repeated signals of impaired body functioning. We propose considering panic in a broader perspective that offers a central role to the body and to contemplate the possible role of somatic treatments in PD.

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“…While stress may lead to hyperventilation-depending on the intensity of the stressor and the learned reactivity to stress-respiratory rate can also be controlled volitionally and is therefore a potential therapeutic target (Moraveji, 2012). Irregularities in baseline respiratory rate have been observed in some diagnoses of anxiety (Grassi et al, 2014). Furthermore, a decreased baseline respiratory rate has been observed following clinical interventions like meditation (Pascoe, Thompson, Jenkins, & Ski, 2017).…”

Section: Respiration Biofeedbackmentioning

confidence: 99%

Wearable devices as adjuncts in the treatment of anxiety‐related symptoms: A narrative review of five device modalities and implications for clinical practice.

Hunkin

King

Zajac

2019

Clinical Psychology: Science and Practice

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Anxiety disorders are a major public health problem, and a range of wearable technological devices for addressing the somatic symptoms of anxiety are increasingly available. This narrative review summarizes five distinct modalities underlying wearable devices and investigates clinical implications for managing clients using such devices. The literature suggests potential benefits of heart rate variability (HRV) biofeedback devices, while other modalities (aided meditation, false physiological feedback, electrodermal biofeedback, and respiration biofeedback) are less supported. High‐quality research on the efficacy of such devices is also lacking, particularly in clinical populations. Wearables could offer potential benefits, but may be contraindicated in some cases. Collaborative use of clinical evaluation tools, such as the American Psychiatric Association's application evaluation model, can aid in shared decision‐making about device use.

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Are Respiratory Abnormalities Specific for Panic Disorder? A Meta-Analysis

Cited by 35 publications

References 38 publications

Long-lasting bradypnea induced by repeated social defeat

Long-lasting bradypnea induced by repeated social defeat

Is panic disorder a disorder of physical fitness? A heuristic proposal

Wearable devices as adjuncts in the treatment of anxiety‐related symptoms: A narrative review of five device modalities and implications for clinical practice.

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