The symptom structure of panic disorder: a trial using factor and cluster analysis

Shioiri, Toshiki; Someya, Toshiyuki; Murashita, Jun; Takahashi, Saburo

doi:10.1111/j.1600-0447.1996.tb09806.x

Cited by 61 publications

(44 citation statements)

References 23 publications

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“…Previous reports on PD patients (Briggs et al (1993); Argyle and Roth (1989); De Beurs et al (1994); Cox et al (1994); Meuret et al (2006); Shioiri et al (1996)) generally agreed on several clusters, one representing a respiratory component. The similarity between our clusters, extracted in a normal sample, and clusters found in studies on PD patients supports the idea that the CO 2 challenge in healthy volunteers may be a valid model to study the phenomenology of clinical panic.…”

Section: Discussionmentioning

confidence: 68%

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Carbon Dioxide-Induced Emotion and Respiratory Symptoms in Healthy Volunteers

Colasanti

Salamon

Schruers

et al. 2008

Neuropsychopharmacol

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A number of evidences have established that panic and respiration are closely related. Clinical studies indicated that respiratory sensations constitute a discrete cluster of panic symptoms and play a major role in the pathophysiology of panic. The aim of the present study was to explore the phenomenology of an experimental model of panic in healthy volunteers based on the hypothesis that: (1) we can isolate discrete clusters of panic symptoms, (2) respiratory symptoms represent a distinct cluster of panic symptoms, and (3) respiratory symptoms are the best predictor of the subjective feeling of panic, as defined in the DSM IV criteria.Sixty-four healthy volunteers received a double inhalation of four mixtures containing 0, 9, 17.5 and 35% CO 2, respectively, in a double-blind, cross-over, random design. An electronic visual analog scale and the Panic Symptom List (PSL) were used to assess subjective 'fear/discomfort' and panic symptoms, respectively. Statistical analyses consisted of Spearman's correlations, a principal component factor analysis of the 13 PSL symptoms, and linear regressions analyses.The factor analysis extracted three clusters of panic symptoms: respiratory, cognitive, and neurovegetative (r 2 ¼ 0.65). Respiratory symptoms were highly related to subjective feeling of fear/discomfort specifically in the CO 2 -enriched condition. Moreover, the respiratory component was the most important predictor of the subjective feeling of 'fear/discomfort' (b ¼ 0.54).The discrete clusters of symptoms observed in this study were similar to those elicited in panic attacks naturally occurring in patients affected by panic disorder. Consistent with the idea that respiration plays a crucial role in the pathophysiology of panic, we found that respiratory symptoms were the best predictors the subjective state defined in the DSM IV criteria for panic.

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Section: Discussionmentioning

confidence: 68%

“…The cardiorespiratory cluster included shortness of breath, chest pain, fear of dying, palpitations, tingling, and choking. Shioiri et al (1996), in a Japanese study of 207 PD patients, found slightly different results. Their cluster analysis revealed three panic symptom clusters.…”

Section: Introductionmentioning

confidence: 94%

Carbon Dioxide-Induced Emotion and Respiratory Symptoms in Healthy Volunteers

Colasanti

Salamon

Schruers

et al. 2008

Neuropsychopharmacol

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“…Poucos estudos fenomenológicos sobre TP têm sido realizados, a maioria em ambiente natural, não controlado. Shioiri et al 28 …”

Section: Discussionunclassified

Ataques de pânico provocados pelo dióxido de carbono: estudo clínico-fenomenológico

Valença

Nardi

Nascimento

et al. 2001

Rev. Bras. Psiquiatr.

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Objetivos: Verificar a sensibilidade de pacientes com transtorno de pânico (TP) ao teste de indução de ataques de pânico com dióxido de carbono (CO 2 ) a 35% e analisar a intensidade, a duração e a sintomatologia dos ataques de pânico produzidos por esse agente em laboratório, comparando-os com os ataques de pânico espontâneos nesses pacientes. Métodos: Foram selecionados 31 pacientes com TP com ou sem agorafobia (DSM-IV). Após uma semana sem medicação, os pacientes realizavam duas inalações de capacidade vital: uma de mistura carbogênica (CO 2 35% e O 2 65%) e outra de ar atmosférico comprimido ("placebo"), ordenadas ao acaso e separadas por um intervalo de 20 minutos. Essas inalações eram repetidas após duas semanas. Nesse período, os pacientes não recebiam nenhuma medicação psicotrópica. Resultados: Dos pacientes, 22 (71,0%) apresentaram ataque de pânico em pelo menos um dos testes com CO 2 . Os sintomas relatados por eles com maior freqüência foram: dificuldade de respirar (n=20, 91,0%), sensação de sufocação/asfixia (n=18, 81,8%), tontura (n=18, 81,8%), estremecimento (n=14, 63,6%), palpitações (n=13, 59,0%) e medo de enlouquecer (n=12, 54,5%). Desse grupo, 11 pacientes (50,0%) consideraram os ataques de pânico experimentados no laboratório mais intensos, comparados aos ataques de pânico espontâneos, quatro (18,2%) consideraram haver a mesma intensidade entre os dois, e sete (31,8%) consideraram o ataque de pânico no laboratório mais leve. Conclusão: Pacientes com TP têm elevada sensibilidade ao CO 2 . A inalação de mistura gasosa com 35% de CO 2 produz sintomas semelhantes aos ataques de pânico espontâneos, em pacientes com TP. Esse teste pode ser considerado um bom modelo laboratorial para o TP.Ansiedade. Transtorno de pânico. Ataque de pânico. Dióxido de carbono. Objectives:To verify the sensibility of panic disorder patients to carbon dioxide challenge test and the intensity, duration and symptoms of panic attacks produced by the gas in these patients, comparing these data with those from spontaneous panic attacks. Methods: Thirty-one patients with panic disorder with or without agoraphobia (DSM-IV) were selected. After one week without receiving any medication, these patients were asked to perform two full inhalations (vital capacity): one with a carbonic mixture (35% CO 2 , 65% O 2 ) and the other with compressed atmospheric air (placebo), assigned randomly and separated by a 20-minute interval. These inhalations were repeated after 2 weeks. During this period no participants in the study received any kind of psychotropic drug. Results: Twenty-two patients (71.0%) had a panic attack in at least one of the tests where the CO 2 mixture was used. Among them (n=22), the most frequently reported symptoms were: shortness of breath (n=20, 91.0%), a feeling of suffocation or asphyxia (n=18, 81.8%), dizziness (n=18, 81.8%), trembling (n=14, 63.6%), palpitations (n=13, 59.0%), and fear of losing one's mind (n=12, 54.5%). Eleven patients (50.0%) thought the laboratoryinduced panic attacks were more intense than ...

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“…During a panic attack, fear, shortness of breath, dizziness, heart palpitations, chest pain, sweating, faintness, paresthesia, nausea and cognitive symptoms including depersonalization and fear of losing control are typically reported [1]. Panic disorder is invariably associated with anticipatory anxiety [2,3] and is characterized by phobic avoidance [1]. Indeed, agoraphobic behavior routinely accompanies panic disorder and is more prevalent among females [4,5].…”

Section: Introductionmentioning

confidence: 99%

The Myth of Panic Spontaneity: Consideration of Behavioral and Neurochemical Sensitization

Hebb¹,

Anger²,

Mendella³

et al. 2007

TOPJ

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Panic disorder is characterized by a progression of panic symptom severity with repeated attacks. Repeated panic episodes evoke heightened anticipatory anxiety, phobic avoidance and are typically associated with comorbid symptoms of depression. Due to the heterogeneity of the disorder, reliable neurochemical correlates attending panic have not been identified. However, variable neuropeptide interfacing with major and minor transmitter systems may modulate individual vulnerability to panic and account for variable panic profiles. The extensive colocalization of cholecystokinin (CCK) with other neurotransmitters, including dopamine (DA), enkephalin (ENK) and GABA, in specific central sites may influence various aspects of anxiety and panic. The behavioral correlates attending panic likely follow from variable neurochemical release and conditioning/sensitization. Clinicians maintain that recurrent panic attacks are spontaneous (unexpected, uncued) and fail to acknowledge the wealth of information implicating a prominent role for stressful life events in panic. Conditioning and sensitization of both behavior (e.g., fear-motivated) and neurochemical events (e.g., DA and CCK) in response to uncontrollable stressors parallel the diverse heterogeneity of panic amongst clinical samples. Cholecystokinin-4, pentagastrin, lactate acid, and CO 2 induce panic attacks that are dependent on subjective history, expectancy measures and panic profiles. Panic disorder is associated with chronic illness and familial sick-role modeling exacerbates the course of the illness. The current review outlines the evidence in support of a conditioning/sensitization model for panic, a model that may explain the variable efficacies of pharmacological interventions.

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The symptom structure of panic disorder: a trial using factor and cluster analysis

Cited by 61 publications

References 23 publications

Carbon Dioxide-Induced Emotion and Respiratory Symptoms in Healthy Volunteers

Carbon Dioxide-Induced Emotion and Respiratory Symptoms in Healthy Volunteers

Ataques de pânico provocados pelo dióxido de carbono: estudo clínico-fenomenológico

The Myth of Panic Spontaneity: Consideration of Behavioral and Neurochemical Sensitization

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