Panic disorder in a breath-holding challenge test: a simple tool for a better diagnosis

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

doi:10.1590/s0004-282x2003000500003

Cited by 16 publications

(6 citation statements)

References 20 publications

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“…Several studies have investigated respiratory symptoms in PD patients [2], [31], [32], [33] and found that, during PA, respiratory complaints are common, such as dyspnea and tachypnea. Some specific respiratory tests aimed at inducing PA have been used, demonstrating that respiratory maneuvers, such as hyperventilation [34], carbon dioxide inhalation [35] and voluntary apnea [36], may increase anxiety in PD patients and thereby trigger a PA. In this regard, several studies have contributed to better understand the relationship between respiration and PA.…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory Optimal Point: A Submaximal Exercise Variable to Assess Panic Disorder Patients

Ramos¹,

Sardinha

Nardi

et al. 2014

PLoS ONE

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Panic disorder (PD) patients often report respiratory symptoms and tend to perform poorly during maximal cardiopulmonary exercise testing (CPX), at least partially, due to phobic anxiety. Thus, we hypothesized that a submaximal exercise variable, minimum VE/VO2 - hereafter named cardiorespiratory optimal point (COP) -, may be useful in their clinical assessment. Data from 2,338 subjects were retrospectively analyzed and 52 (2.2%) patients diagnosed with PD (PDG) (70% women; aged 48±13 years). PD patients were compared with a healthy control group (CG) precisely matched to number of cases, age and gender profiles. PDG was further divided into two subgroups, based on having achieved a maximal or a submaximal CPX (unwilling to continue until exhaustion). We compared COP, VO2 max, maximum heart rate (HR max) between PDG and CG, and also COP between maximal and submaximal PD subgroups. COP was similar between PDG and CG (21.9±0.5 vs. 23.4±0.6; p = 0.07), as well as, for PD subgroups of maximal and submaximal CPX (22.0±0.5 vs. 21.6±1.3; p = 0.746). Additionally, PD patients completing a maximal CPX obtained VO2 max (mL.kg−1.min−1) (32.9±1.57 vs 29.6±1.48; p = 0.145) and HR max (bpm) similar to controls (173±2.0 vs 168±2.7; p = 0.178). No adverse complications occurred during CPX. Although clinically safe, it is sometimes difficult to obtain a true maximal CPX in PD patients. Normalcy of cardiorespiratory interaction at submaximal effort as assessed by COP may contribute to reassure both patients and physicians that there is no physiological substrate for exercise-related respiratory symptoms often reported by PD patients.

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Section: Discussionmentioning

confidence: 99%

Cardiorespiratory Optimal Point: A Submaximal Exercise Variable to Assess Panic Disorder Patients

Ramos¹,

Sardinha

Nardi

et al. 2014

PLoS ONE

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“…The BH test is a standardized procedure used to induce panic‐like symptoms under controlled laboratory conditions via an endogenous CO 2 increase . The duration of maximal BH is thought to reflect tolerance to CO 2 or physical sensations, with shorter times reflecting lower tolerance .…”

Section: Methodsmentioning

confidence: 99%

Effects of Nicotine Withdrawal on Panic-Like Response to Breath Holding: A Placebo-Controlled, Double-Blind, Crossover Patch Study

2013

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The findings for heart rate and BP are consistent with the stimulant properties of nicotine. The reduced capacity to maintain apnea under placebo might be due to carbon dioxide (CO2 ) hypersensitivity during periods of nicotine abstinence. The negative findings regarding fear reactivity might be due to BH being a relatively weak anxiogen. Future researchers are encouraged to employ CO2 -inhalation procedures to study the relationship between nicotine withdrawal and panic.

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“…Klein (5) proposed the existence of an evolved "false suffocation alarm" system that triggers spontaneous panic attacks when the brain erroneously signals a lack of useful air and activates maladaptive autonomic responses to suffocation. Sensitivity to CO 2 might play a role in this hypersensitive suffocation detector, (5) and various respiratory tests, such as carbon dioxide inhalation, (6) hyperventilation (7) and breathholding, (8) have been fruitful in generating hypotheses about panic disorder. (3,5) Panic disorder patients exhibit behavioral and physiological abnormal responses to respiratory challenge tests that are very similar to those experienced during spontaneous panic attacks.…”

Section: Introductionmentioning

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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Panic disorder in a breath-holding challenge test: a simple tool for a better diagnosis

Cited by 16 publications

References 20 publications

Cardiorespiratory Optimal Point: A Submaximal Exercise Variable to Assess Panic Disorder Patients

Cardiorespiratory Optimal Point: A Submaximal Exercise Variable to Assess Panic Disorder Patients

Effects of Nicotine Withdrawal on Panic-Like Response to Breath Holding: A Placebo-Controlled, Double-Blind, Crossover Patch Study

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

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