Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

Valença, Alexandre Martins; Nardi, Antônio Egídio; Nascimento, Isabella; Zin, Walter A.; Versiani, Márcio

doi:10.1590/s0100-879x2002000700004

Cited by 37 publications

(24 citation statements)

References 15 publications

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“…Briggs et al [1993], using factor and cluster analysis, found that the group of patients with PD with prominent respiratory symptoms had more spontaneous panic attacks and better responses to imipramine, whereas patients from the NRS had more situational panic attacks and better responses to alprazolam. Studies showed that patients with prominent respiratory symptoms associated with 35% CO 2 sensitivity had a significantly longer illness duration of PD, reported more past traumatic suffocation experiences and respiratory diseases, and were more likely to be heavy smokers than were patients without respiratory symptoms [Biber and Alkin, 1999;Bouwer and Stein, 1997;Valenca et al, 2002;Verburg et al, 1995]. It seems that RS was a more severe and disabling type of PD.…”

Section: Discussionmentioning

confidence: 99%

Panic disorder subtypes: further clinical differences

Onur¹,

Alkın²,

Tural³

2007

Depress. Anxiety

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Panic disorder (PD) is a heterogeneous phenomenon with respect to symptom profile. Most studies agree that a group of patients with prominent respiratory symptoms emerged as a distinct PD subtype. In this study we compared a range of clinical features associated with PD and agoraphobia in patients with respiratory (RS) and nonrespiratory (NRS) subtypes of PD. The participants were 124 patients with PD (79 women and 45 men), with or without agoraphobia, diagnosed by DSM-IV criteria. Following the observer-rated Panic Disorder Severity Scale assessment, subjects completed self-report measures, including the Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale; the Beck Anxiety Inventory; and the Panic-Agoraphobic Spectrum Scale (PAS-SR). Multivariate analysis of variance (MANOVA) showed significant group differences [Pillai's trace = 0.95, F (5, 118)(=)2.48, P = .036]. Patients in RS group had higher mean total scores on the ASI (F = 5.00, df = 1, P = .027) and PAS-SR (F = 11.23, df = 1, P = .001) than patients in NRS group. Also, patients with RS attained higher scores than patients with NRS on four domains of PAS-SR (panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking). A descriptive discriminant analysis of the data correctly identified 69.4% of the patient group in general and 86.1% of RS group (Wilks's lambda = 0.87, df = 8, P = .048). The significant discriminating factors of the RS and NRS groups were domains of panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking. Our findings suggest that anxiety sensitivity and panic-agoraphobic spectrum symptoms might be particularly relevant to understanding subtypes of PD.

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Section: Discussionmentioning

confidence: 99%

Panic disorder subtypes: further clinical differences

Onur¹,

Alkın²,

Tural³

2007

Depress. Anxiety

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“…For example, Valenca et al [2002] found that in response to a 35% CO 2 challenge, a significantly greater percentage of patients with PD-R panicked (93.7%) than did patients with PD-NR (43.4%). This study not only bears on the robustness of these findings but also extends them by the use of a continuous measurement of subjective suffocation.…”

Section: Discussionmentioning

confidence: 99%

Evidence for respiratory and nonrespiratory subtypes in panic disorder

2006

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Recently researchers have posited a "respiratory" subtype of panic disorder (PD), which differs from "nonrespiratory" subtypes in phenomenology and perhaps treatment response. This study was designed to further examine evidence for the existence of a respiratory subtype in PD. Individuals with PD with prominent respiratory symptoms (PD-R; n=10) and without prominent respiratory symptoms (PD-NR; n=23), as well as healthy controls (n=27), underwent a standardized 5% CO(2) rebreathing challenge. Ventilatory response and subjective sensation of suffocation were continuously recorded. The PD-R group exhibited greater subjective suffocation levels, rates of respiration, and propensity to terminate the procedure voluntarily than did the other two groups, which in turn did not differ on these measures. Findings are consistent with the existence of a respiratory subtype of PD, which differs from nonrespiratory subtypes in CO(2) sensitivity.

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“…(45) In another study, comparing 117 panic disorder patients of the respiratory and non-respiratory subtypes, using the 35% CO 2 challenge test and the hyperventilation test, 80.3% and 53.0% of the patients in the respiratory subtype group had a panic attack in response to CO 2 challenge and the hyperventilation test, respectively. However, only 11.8% of the non-respiratory subtype patients had a panic attack during the CO 2 challenge, and 33.3% had a panic attack during the hyperventilation test.…”

Section: Breath-holdingmentioning

confidence: 99%

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

et al. 2009

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Multiple respiratory abnormalities can be found in anxiety disorders, especially in panic disorder (PD). Individuals with PD experience unexpected panic attacks, characterized by anxiety and fear, resulting in a number of autonomic and respiratory symptoms. Respiratory stimulation is a common event during panic attacks. The respiratory abnormality most often reported in PD patients is increased CO 2 sensitivity, which has given rise to the hypothesis of fundamental abnormalities in the physiological mechanisms that control breathing in PD. There is evidence that PD patients with dominant respiratory symptoms are more sensitive to respiratory tests than are those who do not manifest such symptoms, and that the former group constitutes a distinct subtype. Patients with PD tend to hyperventilate and to panic in response to respiratory stimulants such as CO 2 , triggering the activation of a hypersensitive fear network. Although respiratory physiology seems to remain normal in these subjects, recent evidence supports the idea that they present subclinical abnormalities in respiration and in other functions related to body homeostasis. The fear network, composed of the hippocampus, the medial prefrontal cortex, the amygdala and its brain stem projections, might be oversensitive in PD patients. This theory might explain why medication and cognitive-behavioral therapy are both clearly effective. Our aim was to review the relationship between respiration and PD, addressing the respiratory subtype of PD and the hyperventilation syndrome, with a focus on respiratory challenge tests, as well as on the current mechanistic concepts and the pharmacological implications of this relationship.Keywords: Panic disorder; Anxiety; Respiration; Hyperventilation; Carbon dioxide. ResumoMúltiplas anormalidades respiratórias podem ser encontradas em pacientes com transtornos de ansiedade, particularmente no transtorno de pânico (TP). Indivíduos com TP experimentam ataques de pânico inesperados, caracterizados por ansiedade, medo e diversos sintomas autonômicos e respiratórios. A estimulação respiratória é um fenômeno comum durante os ataques de pânico. A anormalidade respiratória mais citada em pacientes com TP é a sensibilidade aumentada para o CO 2 , que originou a hipótese de uma disfunção fundamental nos mecanismos fisiológicos de controle da respiração no TP. Há evidências de que pacientes com TP com sintomas respiratórios predominantes são mais sensíveis a testes respiratórios do que aqueles sem a manifestação de tais sintomas, representando um subtipo distinto. Pacientes com TP tendem a hiperventilar e a reagir com pânico como resposta a estimulantes respiratórios como o CO 2 , gerando uma ativação de um circuito de medo hipersensível. Apesar de a fisiologia respiratória desses pacientes permanecer normal, algumas evidências recentes apontam a presença de disfunções subclínicas na respiração e em outras funções relacionadas à homeostase corporal. O circuito do medo, composto pelo hipocampo, córtex pré-frontal medial, amígd...

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Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test

Cited by 37 publications

References 15 publications

Panic disorder subtypes: further clinical differences

Panic disorder subtypes: further clinical differences

Evidence for respiratory and nonrespiratory subtypes in panic disorder

Respiratory manifestations of panic disorder: causes, consequences and therapeutic implications

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