A caffeine challenge test in panic disorder patients, their healthy first-degree relatives, and healthy controls

Abstract

Our aim was to observe the induction of anxiety symptoms and panic attacks by a caffeine challenge test in panic disorder (PD) patients (DSM-IV) and their healthy first-degree relatives. We randomly selected 25 PD patients, 27 healthy first-degree relatives of probands with PD, and 22 healthy volunteers with no family history of PD. In a randomized double-blind experiment performed over two occasions 7 days apart, 480 mg caffeine and a caffeine-free solution were administered in a coffee form. Using specific panic attack criteria, 52.0% (n=13) PD patients, 40.7% (n=11) first-degree relatives (chi2=1.81, df=1, P=0.179), and none of the control subjects had a panic attack after the test (chi2=51.7, df=2, P<0.001). In this caffeine challenge test, PD patients and their first-degree relatives were more sensitive than healthy volunteers to the panic attack symptoms but less sensitive to headache, increase in blood pressure, and insomnia. Our data suggest that there is an association between panic attacks after the intake of 480 mg of caffeine in PD patients and their first-degree relatives. There is a clear differentiation of PD patients and their first-degree relatives by a caffeine test from the healthy group.

ADORA2A Gene Variation, Caffeine, and Emotional Processing: A Multi-level Interaction on Startle Reflex

“…Consistently, caffeine has been shown to act as a potent anxiogenic challenge substance in the rodent model (eg, Bhattacharya et al, 1997) as well as in patients with anxiety disorders, first-degree relatives of patients with panic disorders, and healthy subjects (Boulenger et al, 1984;Bruce et al, 1992;Charney et al, 1985;Lee et al, 1998;Nardi et al, 2007Nardi et al, , 2008Nardi et al, , 2009Nickell and Uhde, 1994). Also, an increase in acoustic startle reflex amplitude and a delayed habituation of acoustic startle blink amplitude as physiological correlates of anxiety have been observed after caffeine administration (Andrews et al, 1998;Blumenthal et al, 2005;Schicatano and Blumenthal, 1995).…”

Caffeine, Mental Health, and Psychiatric Disorders

“…Earlier studies have found higher sensitivity to anxiogenic effects of high dose caffeine (typically higher than 400 mg) in patients with panic disorder [35,36], generalized anxiety disorder [37], and to a lesser extent in depressed patients [38]. More recent studies extended these findings to patients with performance social anxiety disorder, but not generalized social anxiety disorder [39], and to first degree relatives of patients with panic disorder [40]. Also, patients with panic disorder who develop caffeine-induced panic attacks have significantly higher non-specific general psychopathology [41].…”

Caffeine challenge test and panic disorder: a systematic literature review

“…As for the percentage of patient loss during follow-up, only two studies reported a loss ≥30% [54,55]. According to Araujo et al, this percentage can cause a reduction in the validity of the results [56].…”

“…Among the selected studies, 62.5% had administered doses of 480 mg of caffeine [44,[54][55][56][57][58]. The justification for more than half of studies administering 480 mg of caffeine was that it was a safe dose that had been tested in the laboratory to demonstrate the significant increase of anxiety in PD patients compared with normal controls [59,60].…”