Respiratory Psychophysiology of Panic Disorder: Three Respiratory Challenges in 98 Subjects
American Journal of PsychiatryPublished 1 November 1997Open access
Laszlo A. Papp, Jose M. Martinez, D F Klein, Jeremy D. Coplan, Robert G. Norman, Randolph P. Cole
Citations250
SJR quartileQ1
SJR score5.27
SNIP3.68
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The findings confirm the greater behavioral and physiological sensitivity of patients with panic disorder to CO2 inhalation and identify a series of respiratory abnormalities that were confirmed during three respiratory challenges that used improved methodology.
Abstract
The findings confirm the greater behavioral and physiological sensitivity of patients with panic disorder to CO2 inhalation and identify a series of respiratory abnormalities. Panic attacks in panic disorder may be explained by inefficient compensatory mechanisms, primarily of respiratory rate.
Keywords
Psychology
Medicine & Science in Sports & ExercisePsychophysical bases of perceived exertion
16,410 Citations1982Gunnar Borg
A presentation is made of ratio-scaling methods, category methods, especially the Borg Scale for ratings of perceived exertion, and a new method that combines the category method with ratio properties.
Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic
3,178 Citations1988David H. Barlow
Australasian Annals of MedicineA CLINICAL METHOD FOR ASSESSING THE VENTILATORY RESPONSE TO CARBON DIOXIDE
1,145 Citations1967Derek Read
Archives of General PsychiatryFalse Suffocation Alarms, Spontaneous Panics, and Related Conditions
1,137 Citations1993Donald F. Klein
The phenomena of panic during relaxation and sleep, late luteal phase dysphoric disorder, pregnancy, childbirth, pulmonary disease, separation anxiety, and treatment are used to test and illuminate the suffocation false alarm theory.
Archives of General PsychiatryThe Influence of an Illusion of Control on Panic Attacks Induced via Inhalation of 5.5% Carbon Dioxide-Enriched Air
502 Citations1989William C. Sanderson
Patients who believed they could not control the CO2 administration were significantly more likely to report panic attacks and psychologic factors to laboratory induction of panic attacks through inhalation of 5.5% CO2-enriched air.
Journal of Psychiatric ResearchSchedule for Affective Disorders and Schizophrenia—Lifetime version modified for the study of anxiety disorders (SADS-LA): Rationale and conceptual development
397 Citations1986Salvatore Mannuzza, Abby J. Fyer +2 more
Current difficulties in assessing and conceptualizing anxiety disorders, as addressed in the SADS-LA are focused on.
Archives of General PsychiatryLactate Provocation of Panic Attacks
392 Citations1984Michael R. Liebowitz
It is suggested that lactate acts, by as yet unidentified mechanisms, to trigger the same panic attacks as occur spontaneously in vulnerable persons.
Archives of General PsychiatryLactate Provocation of Panic Attacks
378 Citations1985Michael R. Liebowitz
Lactate-induced panic attacks were regularly accompanied by biological changes consistent with hyperventilation and central noradrenergic activation and irregularly by elevation of plasma norepinephrine and cortisol levels.
American Journal of PsychiatryResponse to hyperventilation in a group of patients with panic disorder
356 Citations1984Jack M. Gorman, J. Askanazi +5 more
Patients with DSM-III diagnoses of panic disorder and normal volunteers were studied during hyperventilation of room air and increased ventilation stimulated by 5% CO2, consistent with other evidence implicating the locus ceruleus in panic anxiety.
Archives of General PsychiatryVentilatory Physiology of Patients With Panic Disorder
355 Citations1988Jack M. Gorman
Patients with panic disorder may have hypersensitive CO2 receptors that, when triggered, evoke a subjective panic associated with an exaggerated ventilatory response and consequent hypocapnic alkalosis.
American Journal of PsychiatryCarbon dioxide hypersensitivity, hyperventilation, and panic disorder
269 Citations1993Laszlo A. Papp, D F Klein +1 more
Panic disorder may be due to an inherently unstable autonomic nervous system, coupled with cognitive distress, and cognitive strategies through cognitive control of respiration may supplement and accentuate these interventions.
American Journal of PsychiatryAnxiogenic effects of CO2 and hyperventilation in patients with panic disorder
227 Citations1994Jack M. Gorman, Laszlo A. Papp +6 more
Panic patients were clearly more sensitive to the anxiogenic effects of CO2 than comparison subjects, and CO2 was a more potent anxiolysis stimulus than room-air hyperventilation.
Psychiatry ResearchMeasurement of lactate-induced panic and anxiety
223 Citations1987Donald J. Dillon, Jack M. Gorman +3 more
Point of panic API scores, as well as increments of panic scores over prelactate scores, were higher for patients who experienced lactate panics than for both controls and patients who did not panic.
Psychiatry ResearchCO2 vulnerability in panic disorder
201 Citations1987Eric Griez, H. Lousberg +1 more
The immediate effects of a single inhalation of a 35% CO2 mixture in oxygen were examined in patients with panic disorders and normal control subjects, and the overall CO2-induced state was rated as very similar to a real-life panic attack.
Archives of General PsychiatryCarbon Dioxide Sensitivity in Panic Anxiety
196 Citations1986Scott W. Woods
Differences in anxiogenic sensitivity to CO2 between patients and controls may be due to differences in the regulation of noradrenergic or other neuronal systems.
American Journal of PsychiatryDiagnostic and substance specificity of carbon-dioxide-induced panic
145 Citations1993Laszlo A. Papp, D F Klein +8 more
Carbon dioxide inhalation appears to have a specific panicogenic effect in panic patients that goes beyond simple breathlessness.
American Journal of PsychiatryIrregular breathing during sleep in patients with panic disorder
131 Citations1995Murray B. Stein, T. W. Millar +2 more
These findings extend the observations in the awake state that patients with panic disorder breathe more irregularly than healthy comparison subjects and may be attributable to altered brainstem sensitivity to CO2 or to other as yet unexplained factors.
Psychiatry ResearchSpecific sensitivity of patients with panic attacks to carbon dioxide inhalation
130 Citations1990Eric Griez, C. De Loof +3 more
CO2 elicited high levels of subjective anxiety in the PD group, and it is speculated that CO2 may trigger some as yet undefined mechanisms, possibly linked to ventilation control, which demarcate panic from other types of pathological anxiety.
Journal of Psychiatric ResearchThe 35% CO2 challenge in panic disorder: Optimization by receiver operating characteristic (ROC) analysis
123 Citations1995Marco Battaglia, Giampaolo Perna
It is confirmed that the CO2 challenge discriminates well between PD patients and controls, with 86% probability to classify them correctly on the basis of subjective anxiety after the test.
American Journal of PsychiatrySensitivity to 35% CO2 in healthy first-degree relatives of patients with panic disorder
118 Citations1995Giampaolo Perna, Silvia Cocchi +3 more
These findings suggest an association between family history of panic disorder and hyperreactivity to 35% CO2 in healthy subjects.
Archives of General PsychiatryStress Test Reactivity in Panic Disorder
93 Citations1992Walton T. Roth, Jürgen Margraf +5 more
Patients with panic disorder were tonically more anxious and much more likely to ask to stop carbon dioxide inhalation or to report panic attacks during this test, and patients who reported panic attacks had manifested greater anticipatory anxiety before the gas was delivered.
Biological PsychiatryFive percent carbon dioxide challenge: Valid analogue and marker of panic disorder?
87 Citations1990William C. Sanderson, Scott Wetzler
It is concluded that the 5% CO2 challenge test is a valid and useful laboratory analogue of naturally occurring panic attacks, and shows promise as a marker to identify a subset of PD patients.
Biological PsychiatryHyperventilation-induced panic attacks in panic disorder with agoraphobia
85 Citations1991Richard J. Maddock, Cameron S. Carter
Eight minutes of hyperventilation to an end-tidal PCO2 of less than 20 mmHg led to a panic attack in 7 of 12 patients with panic disorder with agoraphobia and only 1 of 12 normal controls.
NeuropsychopharmacologyReanalysis of The National Institute of Mental Health Treatment of Depression Collaborative Research Program General Effectiveness Report
78 Citations1993Donald F. Klein, Donald C. Ross
Reanalysis of the NIMH Treatment of Depression Collaborative Research Program General Effectiveness Report statistical analyses indicates a reasonable ordering for the treatments with medication superior to the psychotherapies and the psychotherapy somewhat superior to placebo.
Biological PsychiatryRebreathing tests in panic disorder
67 Citations1995Laszlo A. Papp, Jose M. Martinez +3 more
Panic patients panicked significantly more during the test, responded with more respiratory rate and less tidal volume, but showed no hypersensitivity to inhaled carbon dioxide compared to normal controls.
PubMedAmbulatory monitoring of respiration in anxiety.
66 Citations1996Jose M. Martinez, Laszlo A. Papp +5 more
An ambulatory monitor, body suit, and calibration procedure were developed to compare the respiration of seven patients with panic disorder and twelve normal volunteers, finding that respiratory rate increases characterized the periods of anxiety and limited symptom attacks.
Psychiatry ResearchHypersensitivity to inhalation of carbon dioxide and panic attacks
65 Citations1995Giampaolo Perna, Angela Gabriele +2 more
It is suggested that subjects with sporadic unexpected panic attacks and patients with panic disorder belong to the same spectrum of vulnerability and CO2 hypersensitivity might be a trait marker of panic attacks rather than of a clinical diagnosis of panic disorder.
Archives of General PsychiatryPanic Attacks During Placebo Procedures in the Laboratory
63 Citations1993Raymond R. Goetz
The belief that significant cardiorespiratory stimulation occurring during panic attacks in the laboratory is not simply secondary to the intrinsic physiologic effects of panic-inducing substances such as lactate, yohimbine, and carbon dioxide is validated.
Biological PsychologyVoluntary hyperventilation: the influence of duration and depth on the development of symptoms
51 Citations1995Hellen Hornsveld, Bert Garssen +1 more
To be sure that the HVPT is long enough and deep enough to elicit symptoms in most people, a minimum duration of 3 min is advised, with end-tidal PCO2 decreasing to at least 1.9 kPa or dropping well over 50% of baseline.
Psychosomatic MedicinePanic disorder, the ventilatory response to carbon dioxide and respiratory variables.
46 Citations1988M. C. F. Pain, N. Biddle +1 more
The interpretation of the effects of carbon dioxide inhalation as a neurobiologic and behavioral probe may be enhanced if the components of the ventilatory response are examined separately.
American Journal of PsychiatryHypersensitivity to carbon dioxide in panic disorder
45 Citations1989Laszlo A. Papp, Ray Goetz +7 more
Seven male panic patients did not panic but were significantly more sensitive to steady-state carbon dioxide inhalation than five male normal control subjects, and their hypersensitivity to carbon dioxide was unrelated to current state of anxiety or acute panic.
Psychiatry ResearchArterial blood gas changes in panic disorder and lactate- induced panic
42 Citations1989Laszlo A. Papp, Jose M. Martinez +6 more
Arterial blood seems more sensitive than venous blood in detecting baseline differences between panicking and nonpanicking patients and a baseline arterial carbon dioxide pressure of 40 mmHg or higher and an arterial pH below 7.40 may predict no subsequent panic to lactate infusion.
Biological PsychiatryContinuous physiological changes and subjective reports in panic patients: A preliminary methodological report
41 Citations1992Alexander Bystritsky, David Shapiro
Some patients who panicked on CO2 showed a definite association between changes in physiological responses that preceded their subjective ratings of anxiety; however, others did not show this pattern and the possibility of different physiological mechanisms of panic in different patients is discussed.
Biological PsychiatryInstructional set does not alter outcome of respiratory challenges in panic disorder
25 Citations1995Laszlo A. Papp, Lawrence A. Welkowitz +4 more
In an attempt to reproduce the findings of Rapee et al (1986), 45 patients with panic disorder received two sets of instructions and then underwent a series of respiratory challenges, which failed to alter the anxiogenic response to any of the interventions.
Journal of Psychiatric ResearchHypercapneic ventilatory response in patients with panic disorder before and after alprazolam treatment and in pre- and postmenstrual women
23 Citations1994Scott M. Fishman, Daniel B. Carr +2 more
A significant decrease in the ventilatory response of panic disorder patients comparing pre- and post-therapy is found, confirming previous reports indicating increased sensitivity to CO2 in patients with panic disorder and that this sensitivity can be attenuated by treatment.
Acta Anaesthesiologica ScandinavicaReliability of CO<sub>2</sub> measurements from the airway by a pharyngeal catheter in unintubated, spontaneously breathing subjects
13 Citations1995Tina Waldau, B Oberg +1 more
It is demonstrated that reliable recordings of CO2 concentrations during spontaneous respiration can be obtained by a thin catheter positioned in the hypopharynx, as well as the significant influence of the measurement site.
Neurobiology of Anxiety
11 Citations2007Miklós Tóth, Bojana Zupan
It is apparent that anxiety-related pathways and processes involve communication between various neurons that, via signaling pathways, eventually converge onto regulation of transcription and/or translation and the proper function of these pathways is especially crucial during early postnatal development.
