Hyperventilation in panic disorder patients and healthy first-degree relatives

Nardi, Antônio Egídio; Valença, Alexandre Martins; Nascimento, Isabella; Mezzasalma, Marco A.; Lopes, Fabiana L.; Zin, Walter A.

doi:10.1590/s0100-879x2000001100009

Cited by 16 publications

(11 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(10) Anxiety disorders, such as panic disorder, are associated with mild hyperventilation and other breathing pattern abnormalities. (11) There is a bidirectional association between hyperventilation and anxiety, as evidenced by the fact that individuals with idiopathic hyperventilation have been shown to score higher on anxiety and depression scales than do control subjects. (12) Hyperventilation can therefore be considered a cause, a correlate and a consequence of panic attacks.…”

Section: Hyperventilation Syndromementioning

confidence: 99%

“…(12) Hyperventilation can therefore be considered a cause, a correlate and a consequence of panic attacks. (1,11) Acute hyperventilation can produce anesthesia, paresthesia, ataxia, tremor, tinnitus, cold extremities, palmar hyperhidrosis, giddiness, loss of consciousness, visual disturbances, headache and chest pain. (10) There is therefore symptom overlap between panic disorder and hyperventilation syndrome, since panic attacks include most of these symptoms, together with others, such as breathlessness, feeling of choking, nausea, derealization (an alteration in the perception or experience of the external world that makes it seem strange or unreal), depersonalization (an alteration in the perception or experience that causes a feeling of detachment from the mental processes or the body), fear of dying and fear of losing control.…”

Section: Hyperventilation Syndromementioning

confidence: 99%

See 1 more Smart Citation

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

et al. 2009

View full text Add to dashboard Cite

Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO 2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO 2 , triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.Keywords: Panic disorder; Anxiety; Respiration; Hyperventilation; Carbon dioxide. ResumoMúltiplas anormalidades respiratórias podem ser encontradas em pacientes com transtornos de ansiedade, particularmente no transtorno de pânico (TP). Indivíduos com TP experimentam ataques de pânico inesperados, caracterizados por ansiedade, medo e diversos sintomas autonômicos e respiratórios. A estimulação respiratória é um fenômeno comum durante os ataques de pânico. A anormalidade respiratória mais citada em pacientes com TP é a sensibilidade aumentada para o CO 2 , que originou a hipótese de uma disfunção fundamental nos mecanismos fisiológicos de controle da respiração no TP. Há evidências de que pacientes com TP com sintomas respiratórios predominantes são mais sensíveis a testes respiratórios do que aqueles sem a manifestação de tais sintomas, representando um subtipo distinto. Pacientes com TP tendem a hiperventilar e a reagir com pânico como resposta a estimulantes respiratórios como o CO 2 , gerando uma ativação de um circuito de medo hipersensível. Apesar de a fisiologia respiratória desses pacientes permanecer normal, algumas evidências recentes apontam a presença de disfunções subclínicas na respiração e em outras funções relacionadas à homeostase corporal. O circuito do medo, composto pelo hipocampo, córtex pré-frontal medial, amígd...

show abstract

Section: Hyperventilation Syndromementioning

confidence: 99%

Section: Hyperventilation Syndromementioning

confidence: 99%

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

et al. 2009

View full text Add to dashboard Cite

show abstract

“…We have been studying the relationship between hyperventilation-(HPA) and breathholding-induced panic attacks (BHPA) (12)(13)(14)(15)(16). Although in all investigations the PD group had a higher sensitivity to the respiratory challenge tests, some patients responded selectively to either hyperventilation or breath holding.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of panic patients sensitive to hyperventilation or breath-holding methods for inducing panic attacks

Nardi

Valença

Lopes

et al. 2004

Braz J Med Biol Res

Self Cite

View full text Add to dashboard Cite

Our aim was to compare the clinical features of panic disorder (PD) patients sensitive to hyperventilation or breath-holding methods of inducing panic attacks. Eighty-five PD patients were submitted to both a hyperventilation challenge test and a breath-holding test. They were asked to hyperventilate (30 breaths/min) for 4 min and a week later to hold their breath for as long as possible, four times with a 2-min interval. Anxiety scales were applied before and after the tests. We selected the patients who responded with a panic attack to just one of the tests, i.e., those who had a panic attack after hyperventilating (HPA, N = 24, 16 females, 8 males, mean age ± SD = 38.5 ± 12.7 years) and those who had a panic attack after breath holding (BHPA, N = 20, 11 females, 9 males, mean age ± SD = 42.1 ± 10.6 years). Both groups had similar (χ 2 = 1.28, d.f. = 1, P = 0.672) respiratory symptoms (fear of dying, chest/pain disconfort, shortness of breath, paresthesias, and feelings of choking) during a panic attack. The criteria of Briggs et al. [British Journal of Psychiatry, 1993; 163: 201-209] for respiratory PD subtype were fulfilled by 18 (75.0%) HPA patients and by 14 (70.0%) BHPA patients. The HPA group had a later onset of the disease compared to BHPA patients (37.9 ± 11.0 vs 21.3 ± 12.9 years old, Mann-Whitney, P < 0.001), and had a higher family prevalence of PD (70.8 vs 25.0%, χ 2 = 19.65, d.f. = 1, P = 0.041). Our data suggest that these two groups -HPA and BHPA patients -may be specific subtypes of PD. Correspondence

show abstract

“…However, for a small group of PD patients hyperventilation may be a safe and easy test for a more precise diagnosis. However, hyperventilation has been considered as a cause, a correlate and a consequence of panic attacks [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…We have previously studied the relationship between hyperventilation and panic attacks, contrasting PD patients with a normal control group [12], with healthy firstdegree relatives [11] and other anxiety disorders [13][14][15]. In all the investigations, the PD group had a higher sensitivity to the hyperventilation challenge test.…”

Section: Introductionmentioning

confidence: 99%

Psychopathological Description of Hyperventilation-Induced Panic Attacks: A Comparison with Spontaneous Panic Attacks

et al. 2004

View full text Add to dashboard Cite

Our aim was to describe the clinical features of hyperventilation-induced panic attacks (HPA) in panic disorder patients – DSM-IV – and to compare them with their spontaneous panic attacks and with spontaneous panic attacks in panic disorder (PD) patients not sensible to the hyperventilation challenge test. We reexamined 88 previously studied PD patients when they were submitted to a hyperventilation challenge test. They were induced to hyperventilate (30 breaths/min) for 4 min and anxiety scales were applied before and after the test. A total of 51.1% (n = 45) PD patients had a panic attack after hyperventilating – HPA (χ² = 13.11, d.f. = 1, p = 0.017). The clinical symptoms of the most severe panic attack were recorded by the HPA patient and by the PD patients not sensible to this test (non-HPA; n = 43, 48.9%) in a diary during a 1-week period and then compared. The HPA group had more respiratory symptoms (χ² = 15.26, d.f. = 1, p < 0.001), fulfilling the criteria for the respiratory PD subtype (75.6%), the disorder started later (Mann-Whitney, p < 0.001), had a higher familial prevalence of PD (χ² = 19.45, d.f. = 1, p = 0.036), and had more previous depressive episodes (χ² = 18.74, d.f. = 1, p < 0.001). The HPA group had similar symptomatology in spontaneous attacks and HPA. The HPA group may be regarded as a subgroup of the respiratory panic disorder subtype with diagnostic and therapeutic implications.

show abstract

Hyperventilation in panic disorder patients and healthy first-degree relatives

Cited by 16 publications

References 21 publications

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

Clinical features of panic patients sensitive to hyperventilation or breath-holding methods for inducing panic attacks

Psychopathological Description of Hyperventilation-Induced Panic Attacks: A Comparison with Spontaneous Panic Attacks

Contact Info

Product

Resources

About