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

Abstract

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

Subtypes of panic attacks: a critical review of the empirical literature

“…Similar group differences were found in three studies using hyperventilation and breath-holding tasks. [21][22][23] Notably, all six of these studies were conducted in the same laboratory and did not measure physiological responding. Additionally, several studies used small sample sizes or failed to report on sample composition (e.g., presence vs. absence of agoraphobia), potentially limiting their generalizability.…”

“…Several studies have found that the respiratory subtype is associated with greater familial history of panic disorder, although findings are limited to proband self report. Numerous studies indicate that patients meeting criteria for the respiratory subtype [7,8,13] or exhibiting strong respiratory symptoms during physiological challenge [9,[21][22][23][24][25][26] report a greater familial history of panic disorder, suggestive of greater familial loading for the respiratory than nonrespiratory subtype. In two studies, respiratory subtype patients reported greater familial history of any mental disorder.…”

“…In two studies, respiratory subtype patients reported greater familial history of any mental disorder. [12,22] However, proband self report may be biased by possibly greater visibility of respiratory symptoms in the panic attacks of family members, relative to other panic symptoms. The few studies that have directly assessed first-degree relatives have produced inconsistent results.…”

ECEM (Eye Closure, Eye Movements): Application to Depersonalization Disorder

“…Klein (1993Klein ( , 2000 proposed that while fear is central to panic in post-traumatic stress disorder, persons who have panic disorder have a genetically-based carbon dioxide hypersensitivity that sets off a "deranged suffocation alarm" in the brain. People with panic can induce panic attacks through hyperventilation and/or breath-holding (Gorman, Kent, Sullivan & Coplan, 2000;Nardi et al, 2004). They have significant respiratory variability , breathing dysregulation, and "suffocation sensitivity" (Sinha et al,1999;Goetz & Klein, 2001).…”

“…Higher neural centers subserving emotion, influence changes in respiration outside of awareness (Brannan et al, 2001). Anxiety can set in motion psychological defense patterns involving maladaptive respiratory habits that in turn trigger carbon dioxide sensitivity reactions, eventuating in panic (Klein, 1993, Nardi et al, 2004.…”