Panic Disorder, Is It Really a Mental Disorder? From Body Functions to the Homeostatic Brain

Perna, Giampaolo; Iannone, Giuseppe; Torti, Tatiana; Caldirola, Daniela

doi:10.1007/978-3-319-12538-1_4

Cited by 2 publications

(3 citation statements)

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“…A very useful review by Boulding and colleagues ( 6 ) examines relevant literature and proposes a useful classification of respiratory styles (termed “dysfunctional breathing”) implicated in a spectrum of health conditions including panic. More specifically, a substantial body of work posits situational as well as chronic dysfunctional breathing as risk factors in panic attacks and the subsequent development of panic disorder ( 7 ). Evidence supporting the respiratory dysregulation hypothesis comes from a substantial body of work linking CO 2 hypersensitivity to panic attacks and panic disorder, initiated in large part by Klein’s conceptualization of a faulty suffocation alarm ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study

Cuyler¹,

Katdare²,

Simon³

et al. 2022

Front. Digit. Health

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ObjectivePrior clinical trials have shown consistent clinical benefit for Capnometry Guided Respiratory Intervention (CGRI), a prescription digital therapeutic for the treatment of panic disorder (PD) and post-traumatic stress disorder (PTSD). The purpose of this study is to report real-world outcomes in a series of patients treated with the intervention in clinical practice.DesignThis paper reports pre- and post-treatment self-reported symptom reduction, measures of respiratory rate and end-tidal carbon dioxide levels, drop-out and adherence rates drawn from an automatic data repository in a large real-world series of patients receiving CGRI for panic disorder and PTSD.SettingPatients used the intervention in their homes, supported by telehealth coaching.ParticipantsPatients meeting symptom criteria for panic disorder (n = 1,395) or posttraumatic stress disorder (n = 174) were treated following assessment by a healthcare professional.InterventionCapnometry Guided Respiratory Intervention is a 28-day home-based treatment that provides breath-to-breath feedback of respiratory rate and exhaled carbon dioxide levels, aimed at normalizing respiratory style and increasing patients’ mastery for coping with symptoms of stress, anxiety, and panic. Health coaches provide initial training with weekly follow up during the treatment episode. Remote data upload and monitoring facilitates individualized coaching and aggregate outcomes analysis.Main outcome measuresSelf-reported Panic Disorder Severity Scale (PDSS) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores were obtained at pre-treatment and post-treatment.ResultsPanic disorder (PD) patients showed a mean pre-to-post-treatment reduction in total PDSS scores of 50.2% (P < 0.001, d = 1.31). Treatment response rates for PD (defined as a 40% or greater reduction in PDSS total scores) were observed in 65.3% of the PD patients. PTSD patients showed a pre-to-post-treatment reduction in total PCL-5 scores of 41.1% (P < 0.001, d = 1.16). The treatment response rate for PTSD (defined as a ≥10-point reduction in PCL-5 scores) was 72.4%. In an additional analysis of response at the individual level, 55.7% of panic disorder patients and 53.5% of PTSD patients were classified as treatment responders using the Reliable Change Index. Patients with both normal and below-normal baseline exhaled CO2 levels experienced comparable benefit. Across the 28-day treatment period, mean adherence rates of 74.8% (PD) and 74.9% (PTSD) were recorded during the 28-day treatment. Dropout rates were 10% (PD) and 11% (PTSD) respectively.ConclusionsThe results from this cohort of 1,569 patients treated with the CGRI intervention demonstrate significant rates of symptom reduction and adherence consistent with prior published clinical trials. The brief duration of treatment, high adherence rates, and clinical benefit suggests that CGRI provides an important addition to treatment options for panic disorder and PTSD.

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Section: Introductionmentioning

confidence: 99%

Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study

Cuyler¹,

Katdare²,

Simon³

et al. 2022

Front. Digit. Health

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“…Klein and colleagues' 'suffocation false alarm' hypotheses regarding carbon dioxide hypersensitivity set the stage for the examination of the respiratory irregularities associated with panic disorder and related conditions 9,10 . In the case of panic disorder, chronic hyperventilation, lower end tidal CO 2 levels, respiratory rate and tidal volume irregularities, sighing, and breath-holding are characteristic features 11 . The literature on respiratory dysregulation in PTSD is less extensive.…”

mentioning

confidence: 99%

“…Specifically, breathing exercises are associated with decreased heart rate, respiratory rate (RR), and blood pressure 20 . Recognition is growing that treatments that effectively treat panic-related conditions (psychopharmacological as well as psychotherapeutic) also reduce CO 2 sensitivity 11 . Berenz and colleagues suggest treatment implications as follows: "Given the association between PTSD and subsequent PD, particularly among men, clinicians may consider supplementing PTSD treatment with panic specific interventions" 13 .…”

mentioning

confidence: 99%

Real-world Evaluation of a Novel Technology-enabled Capnometry-assisted Breathing Therapy for Panic Disorder

Madhusudhan¹,

Glied²,

Nguyen³

et al. 2020

J Ment Health Clin Psychol

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Introduction: Anxiety disorders which include generalized anxiety disorder, panic disorder (PD), post-traumatic stress disorder, and obsessive-compulsive disorder are common psychiatric condition associated with significant social, occupational, physical, and economic costs. Interventions that target the respiratory dysregulation associated with anxiety disorders have demonstrated considerable therapeutic benefit. However, no such intervention has been evaluated in among PD patients receiving care in an employer-sponsored health center.Objective: To evaluate the use of a novel, capnometry-assisted breathing therapy on clinical outcomes, engagement, and satisfaction for patients with PD receiving care in an employer-sponsored health center.Methods: Prospective analysis of participants using the program between 1/1/2018 and 06/30/2020.Results: Twenty-two participants enrolled. Their average weekly usage remained high throughout the 4-week treatment protocol of 17 minutes twice a day for 28 days (11.6 sessions (SD 3.1) in week one and 10.4 sessions (SD 4.0) in week four). Their average Panic Disorder Severity Scale score decreased from 13.3 (SD ± 3.6) to 5.6 (SD ± 1.8), indicating that panic severity decreased from "moderately ill" to "slightly ill." Use of the program was associated with clinically and statistically significant improvements in respiratory markers: average respiratory rate decreased from 14.9 (SD 3.6) to 11.9 (SD 4.7) breaths per minute (p<0.001) and end-tidal pCO 2 increased from 37.2 mmHg (SD 4.2) to 39.1 mmHg (SD 3.6) (p<0.001). Engagement was associated with decline in utilizations of behavioral health services at employer-sponsored primary care center clinic after the intervention. Conclusion:The clinical improvements observed in this pilot suggest that capnometry-assisted breathing therapy is a valuable tool for patients suffering from panic-associated symptoms. Background / IntroductionAnxiety disorders which include generalized anxiety disorder, PD, PTSD, and obsessive-compulsive disorder are common psychiatric conditions associated with significant social, occupational, physical, and economic costs 1,2 . Approximately 27 million US adults experience panic attacks annually with over 6.7 million suffering from PD and 8 million from PTSD 3,4 . Anxiety disorders are associated with poor workplace productivity and short and long term disabilities 5,6 accounting for approximately $45 billion in annual health care spending 7 . While these conditions are commonly treated with pharmacotherapy and/or psychotherapy, not all patients respond or achieve full recovery with these modalities 8 .

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Panic Disorder, Is It Really a Mental Disorder? From Body Functions to the Homeostatic Brain

Cited by 2 publications

References 140 publications

Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study

Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study

Real-world Evaluation of a Novel Technology-enabled Capnometry-assisted Breathing Therapy for Panic Disorder

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