Heart rate and respiratory response to doxapram in patients with panic disorder

Abstract

Panic disorder (PD) is characterized by anticipatory anxiety and panic, both causing physiological arousal. We investigated the differential responses between anticipatory anxiety and panic in PD and healthy controls (HC). Subjects (15 PD and 30 HC) received an injection of a respiratory stimulant, doxapram, with a high rate of producing panic attacks in PD patients, or an injection of saline. PD subjects had significantly higher scores in anxiety and panic symptoms during both conditions. Analysis of heart rate variability (HRV) indices showed higher sympathetic activity (LF) during anticipatory anxiety and panic states, an increase in the ratio of LF/HF during the anticipatory and panic states and a decrease in parasympathetic (HF) component in PD patients. During doxapram PD subjects increased their LF/HF ratio while HC had a reduction in LF/HF. Parasympathetic component of HRV was lower during anticipatory anxiety in PD. In general, PD showed greater sympathetic and psychological responses related to anxiety and sensations of dyspnea, reduced parasympathetic responses during anticipatory and panic states, but no differences in respiratory response. This confirms previous studies showing that PD patients do not have an intrinsic respiratory abnormality (either heightened or dysregulated) at the level of the brain stem but rather an exaggerated fear response.

Human emotion recognition using heart rate variability analysis with spectral bands based on respiration

“…Comparing these results with the literature, HRV analysis is a suitable technique for the assessment of the balance of ANS and therefore for human emotion recognition states as stress [6], [7], [8], panic [13], [14], anxiety and depression [3] among others, even for healthy or illness people, with significant results in the spectral domain for LF, HF and LF/HF.…”

Respiratory rate derived from smartphone-camera-acquired pulse photoplethysmographic signals

“…Obtaining respiratory rates from smartphone devices would represent a simple and automated way for assisting hospital clinical staff who are currently trained to measure it by counting the number of breaths in a 15 or 30-seconds window (Pimentel et al 2014), making the process cumbersome and user-dependent. Other potential applications may include anxiety, fatigue or stress monitoring at home as respiratory rate is known to change in different anxiety/fatigue/stress situations (Niccolai et al 2009, Martinez et al 2015, Marcora et al 2008, Lackner et al 2011, especially if respiratory rate information is combined with other physiological information accessible in the PPG signal, such as pulse rate and its variability (Gil et al 2010) or blood pressure (Shaltis et al 2006).…”

Neurobiology of Positive Emotion Disruption in Neurodegenerative Disease

“…A moderate (p. 469) level of parasym pathetic activity may actually be most advantageous given that very high and very low levels of parasympathetic activity are related to low empathy and may actually hinder emotional interest and understanding (Kogan et al, 2014). High parasympathetic activity is also associated with positive emotion dysregulation, including symptoms of euphoria and mania (Gruber, Johnson, Oveis, & Keltner, 2008;Martinez, Garakani, Aaronson, & Gorman, 2015;Thayer, Friedman, & Borkovec, 1996), whereas low parasympathetic activ ity is associated with negative emotion dysregulation, including symptoms of anxiety and panic (Martinez et al, 2015;Thayer et al, 1996). Taken together, these findings suggest that although the vagus downregulates arousal and facilitates a quiet internal milieu, there may be an optimal level of parasympathetic engagement for social attunement and positive emotional responsivity.…”