Hyperventilation: is it a cause of panic attacks?

Article Abstract:

To assess the role of hyperventilation in panic, 15 patients diagnosed with panic disorder were studied. Hyperventilation was assessed by measuring arterial partial pressure of carbon dioxide (PCO2). The partial pressure of a gas is a measure of the concentration of that gas in a mixture of gases. Values for gas pressures are measures of the relative magnitude of alveolar (cells containing air) ventilation, oxygen consumption, and carbon dioxide production. Low PCO2 indicates hyperventilation, in which the normal amount of CO2 entering alveoli becomes diluted by a larger alveolar ventilation. The patients were attached to an apparatus that transmitted PCO2 values to a digital computer converter. During the monitoring period, patients indicated panic symptoms by pressing a button that left a digital signal in the recorded data. Patients kept detailed diaries of symptoms and noted the severity of anxiety, and extent of physical exertion at the time of panic. The subjects also underwent two minutes of forced air ventilation and were asked to compare the sensations, such as tremor, dizziness, and chest pain, induced by this provoked hyperventilation with those of typical panic attack. Seven were diagnosed as hyperventilators. However, there were no differences on the provocation test in those who hyperventilated and those who did not, nor were there difference in the number, types, or severity of panic symptoms between the two groups. PCO2 levels did not influence symptoms. This indicates that, although hyperventilation occurs often during panic attacks in susceptible individuals, it is probably not a precipitating cause of panic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Anxiety, Hyperventilation

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Symptom specificity in patients with panic

Article Abstract:

Panic disorder is a psychiatric disorder characterized by acute episodes of panic and exaggerated fear. Seven patients with panic disorder (PD), whose principal somatic symptoms were gastrointestinal (GI; i.e abdominal pain or cramping, diarrhea or flatulence), were compared with 13 PD patients with predominantly cardiorespiratory (CR) symptoms (i.e., heart palpitations, chest tightness and difficulty breathing). The GI group tended to be phobic about losing fecal control, while the CR group tended to fear heart attacks, impending death and collapse. Patients were given a psychological stressor called 'phobia talk' in which they were helped to imagine scenes which they most feared, and were asked to engage in voluntary hyperventilation (VHV; breathing rapidly at a rate of 30 to 40 breaths per minute for three minutes) in order to assess differences in reactions between groups. During these procedures, respiratory and heart rates were monitored. Data analysis revealed that GI patients were younger than CR patients and tended to have shorter symptom duration. CR patients were more anxious than GI patients in general, but there were no differences between groups in rise of anxiety level during the experiment. CR patients responded to phobic talk with more respiratory symptoms than the GI group and also demonstrated a greater fall in carbon dioxide partial pressure. The CR group also reported more distress during VHV, which they tended to experience as a panic attack. Although further study among larger groups of patients and comparison groups is required, these findings suggest that PD is not a heterogenous illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Panic disorders

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Pituitary microadenoma presenting as panic attacks

Article Abstract:

Psychological symptoms often occur in patients with brain tumors. The case report of a 26-year-old married Caucasian woman diagnosed with panic disorder is presented. Prior to the onset of episodes of intense anxiety accompanied by rapid heart beat and palpitations, shortness of breath and a sense of dread, she had suffered a six-month period of mild depression, fatigue and weight gain. Two days after a neurological examination, which proved to be negative, the patient was seen in a hospital emergency room for acute panic, and was admitted for observation. Laboratory test findings were consistent with those found in Cushing's syndrome (hypercortisolism), a disease in which pituitary abnormalities lead to cortisol imbalances and to depression, mania, confusion or psychosis. A computerized tomography scan demonstrated a left anterior pituitary tumor (microadenoma). The woman underwent surgery (by transphenoidal resection) and received follow-up treatment with replacement hormones. Panic and anxiety ceased after surgery, and the patient remained free of panic symptoms after 18 months. Research has shown that pituitary tumors and ensuing endocrine disturbances account for approximately 13 percent of the cerebral disorders found among psychiatric patients. Since pituitary conditions often present as psychopathology, this case illustrates the importance of medical screening for all psychiatric patients. Although cost-containment measures attempt to limit routine testing in patients who do not exhibit obvious physical problems, a thorough medical evaluation for patients with psychiatric symptoms is extremely important. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Cushing syndrome, Endocrine gland diseases, Endocrine diseases

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