Objective and Subjective Measures in Recovery from a 35% Carbon Dioxide Challenge

Niccolai, Valentina; Duinen, Marlies A. van; Griez, Eric

doi:10.1177/070674370805301105

Cited by 19 publications

(4 citation statements)

References 20 publications

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“…In addition, panic disorder patients appear to lose a certain degree of effective homeostatic control after their physiological equilibrium has been disrupted by a respiratory stressor. (18) …”

Section: Increased Co 2 Sensitivitymentioning

confidence: 99%

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

et al. 2009

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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...

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Section: Increased Co 2 Sensitivitymentioning

confidence: 99%

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

et al. 2009

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“…To this end, different criteria for panic attacks were used across the studies included in the present set of analyses. Niccolai et al [38] defined panic attacks as an increase in 25 units or more on a visual analogue scale for anxiety and the presence of 4 symptoms from the panic symptom list. These criteria for a panic attack are in contrast with those of Perna et al [39], who relied on guidelines from earlier research [40], defining panic attacks as the presence of fear or panic, along with 4 symptoms from the DSM-III-R, including at least 1 cognitive symptom (e.g., fear of dying or going crazy).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Utility of Sodium Lactate Infusion and CO<sub>2</sub>-35% Inhalation for Panic Disorder

Wiese

Boutros

2019

Neuropsychobiology

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Laboratory measures have played an integral role in diagnosing pathology; however, compared to traditional medicine, psychiatric medicine has lagged behind in using such measures. A growing body of literature has begun to examine the viability and development of different laboratory measures in order to diagnose psychopathologies. The present review examines the current state of development of both sodium lactate infusion and CO₂-35% inhalation as potential ancillary measures to diagnose panic disorder (PD). A previously established 3-step approach to identifying laboratory-based diagnostic tests was applied to available literature assessing the ability of both sodium lactate infusion or CO₂-35% inhalation to induce panic attacks in PD patients, healthy controls, and individuals with other psychiatric conditions. Results suggest that across the literature reviewed, individuals with PD were more likely to exhibit panic attacks following administration of sodium lactate or CO₂-35% compared to control participants. The majority of the studies examined only compared individuals with PD to healthy controls, suggesting that these ancillary measures are underdeveloped. In order to further determine the utility of these ancillary measures, research is needed to determine if panic attacks following administration of these chemical agents are unique to PD, or if individuals with related pathologies also respond, which may be indicative of transdiagnostic characteristics found across disorders.

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“…Non-medicated patients also had a higher variability in respiration rate and partial CO 2 pressure compared to medicated patients and healthy individuals in the 10 min after the inhalation. Sample sizes were small, but these results might be indicative of a less effective homeostatic control in response to a stimulus such as CO 2 that acutely disturbs the pH balance in PD patients ( Niccolai et al, 2008 ).…”

Section: Panic Attacks In the Laboratorymentioning

confidence: 99%

Assessing Panic: Bridging the Gap Between Fundamental Mechanisms and Daily Life Experience

Leibold

Schruers

2018

Front. Neurosci.

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Panic disorder (PD) is one of the most common psychiatric disorders. Recurrent, unexpected panic attacks (PAs) are the primary symptom and strongly impact patients’ quality of life. Clinical manifestations are very heterogeneous between patients, emphasizing the need for a dimensional classification integrating various aspects of neurobiological and psychological circuits in line with the Research Domain Criteria (RDoC) proposed by the US National Institute of Mental Health. To go beyond data that can be collected in the daily clinical situation, experimental panic provocation is widely used, which has led to important insights into involved brain regions and systems. Genetic variants can determine the sensitivity to experimental models such as carbon dioxide (CO2) exposure and can increase the risk to develop PD. Recent developments now allow to better assess the dynamic course of PAs outside the laboratory in patients’ natural environment. This can provide novel insights into the underlying mechanisms and the influence of environmental factors that can alter gene regulation by changing DNA methylation. In this mini review, we discuss assessment of PAs in the clinic, in the laboratory using CO2 exposure, genetic associations, and the benefits of real-life assessment and epigenetic research.

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Objective and Subjective Measures in Recovery from a 35% Carbon Dioxide Challenge

Cited by 19 publications

References 20 publications

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

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

Diagnostic Utility of Sodium Lactate Infusion and CO<sub>2</sub>-35% Inhalation for Panic Disorder

Assessing Panic: Bridging the Gap Between Fundamental Mechanisms and Daily Life Experience

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