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Panic patients in the non-panic state: physiological and cognitive dysfunction

Published online by Cambridge University Press:  16 April 2020

L Dratcu  and
A Bond
L Dratcu
Affiliation:
Guy's Hospital, United Medical und Dentol Schools, York Clinic, 47 Weston Srreer, LondonSE1 3RR
A Bond
Affiliation:
Section of Clinical Psychopharmacology, Institute of Psychiatry, King's College, London, United Kingdom
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Summary

Panic attacks and the antipanic effect of antidepressants are claimed to distinguish panic disorder (PD) from generalised anxiety disorder. However, most studies showing neurochemical disturbances in PD overlook the non-panic state. We compared panic patients in the non-panic state with controls on biochemical, psychological and physiological measures. There were no differences on the neuroendocrine tests. Self-ratings of bodily and psychological symptoms of anxiety were significantly higher in patients and they scored worse on word recall. Patients had significantly more skin conductance fluctuations and slow wave activity in the electroencephalogram, a sign of hyperventilation which may have implications for brain activity. Discrepancies between patients' self-ratings and objective measures of pulse rate and psychomotor performance indicated that panic patients have distorted perceptions of both physical and mental functioning. Hyperventilation and cognitive distortions in the non-panic state may facilitate panic attacks and are part of the pathophysiology of PD.

Keywords

panic disordercognitive distortionhyperventilationelectroencephalogramanxiety disorders
Type
Original article
Information
European Psychiatry , Volume 13 , Issue 1 , 1998 , pp. 18 - 25
Copyright
Copyright © Elsevier, Paris 1998

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References

Abelson, JL, Nesse, RM, Vinik, AI. Pentagastrin infusions in patients with panic disorder. II Neuroendocrinology Biol Psychiatry 1994; 36: 84–9610.1016/0006-3223(94)91188-6CrossRefGoogle ScholarPubMed
American Psychiatric Association, Third Edition, Revised Diagnostic and Statistical Manual of Mental Disorders Washington, DC: American Psychiatric Association, 1987Google Scholar
American Psychiatric Association Fourth Edition Diagnostic and Statistical Manual of Mental Disorders Washington, DC: American Psychiatric Association, 1994Google Scholar
Angst, J, Vollrath, M. The natural history of anxiety disorders Acta Psychiatr Stand 1991; 84: 446–452CrossRefGoogle ScholarPubMed
Barlow, DH, Vermilyea, J, Blanchard, EB, Vermilyea, BB et al. The phenomenon of panic J Abnorm Psychol 1985; 94: 320–328CrossRefGoogle Scholar
Bass, C. Panic attacks and hyperventilation Br J Psychiatry 1987; 150: 563–56410.1192/bjp.150.4.563CrossRefGoogle ScholarPubMed
Bond, AJ, Lader, M. The use of analogue scales in rating subjective feelings Br J Clin Pharmacol 1974; 47: 211–218Google Scholar
Breier, A, Charney, DS, Heninger, GR. Agoraphobia with panic attacks: development, diagnostic stability, and course of illness Arch Gen Psychiatry 1986; 43: 1029–1036CrossRefGoogle ScholarPubMed
Cassano, GB, Perugi, G, Musetti, L. Co-morbidity in panic disorder Psychiatr Ann 1990; 20: 517–521CrossRefGoogle Scholar
Clark, DM. A cognitive approach to panic Behav Res Ther 1986; 24: 461–470CrossRefGoogle ScholarPubMed
Clark, DM, Salkovskis, PM, Hackmann, A, Middleton, H et al. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder Br J Psychiatry 1994; 164: 759–769CrossRefGoogle ScholarPubMed
De Beurs, E, Van Balkom, AJLM, Lange, A, Koele, P, Van Dick, R. Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo and psychological panic management combined with exposure, and of exposure in vivo alone Am J Psychiatry 1995; 152: 683–691Google ScholarPubMed
Dratcu, L, Bond, A. Referrals for panic disorder to a clinical psychopharmacology research unit Psychiatr Bull 1993; 17: 416–41710.1192/pb.17.7.416CrossRefGoogle Scholar
Dratcu, L, Keating, JW, Sherwood, R, Lader, M. A comparison of augmenting central serotonin and noradrenaline function in healthy subjects: implications for studies on the neurochemistry of anxiety J Psychopharmacol 1995; 9: 127–135CrossRefGoogle ScholarPubMed
Edelman, RJAnxiety. Theory, Research and Intervention in Clinical and Health Psychology Chichester: John Wiley and Sons, 1992Google Scholar
Jolkkonen, J, Lepola, U, Bissette, G, Nemeroff, C, Riekkinen, P. CSF corticotropin-releasing factor is not affected in panic disorder Biol Psychiatry 1993; 33: 136–138CrossRefGoogle Scholar
Kiloh, LG, McComas, AJ, Osselton, JW, Upton, ARMFourth Edition Clinical Electroencephalography London: Butterworth, 1981 64–87Google Scholar
Klein, DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis Arch Gen Psychiatry 1993; 50: 306–317CrossRefGoogle ScholarPubMed
Lader, MH, Wing, LPhysiological Measures, Sedative Drugs, and Morbid AnxietyMaudsley Monograph 14 Oxford: Oxford University Press, 1966Google Scholar
Lader, MH, Bruce, MS. States of anxiety and their induction by drugs Br J Clin Pharmacol 1986; 22: 251–26110.1111/j.1365-2125.1986.tb02884.xCrossRefGoogle ScholarPubMed
Lishman, WAOrganic psychiatrySecond Edition The psychological consequences of cerebral disorder London: Blackwell, 1987 428–485Google Scholar
Lum, LC. Hyperventilation syndromes in medicine and psychiatry: a review J Roy Soc Med 1987; 80: 229–231CrossRefGoogle ScholarPubMed
McPherson, FMPsychology in relation to psychiatryKendell, RE, Zealley, AKCompanion to Psychiatric Studies Fifth Edition Edinburgh: Churchill Livingstone, 1993 23–42Google Scholar
Nesse, RM, Cameron, OG, Curtis, GC, McCann, DS, Huber-Smith, MJ. Adrenergic function in patients with panic anxiety Arch Gen Psychiatry 1984; 41: 771–776CrossRefGoogle ScholarPubMed
Nutt, DJ, Lawson, C. Panic attacks: a neurochemical overview of models and mechanisms Br J Psychiatry 1992; 160: 165–178CrossRefGoogle ScholarPubMed
O'Sullivan, G, Harvey, I, Bass, C, Sheehy, M et al. Psychophysiological investigations of patients with unilateral symptoms in the hyperventilation syndrome Br J Psychiatry 1992; 160: 664–667CrossRefGoogle ScholarPubMed
Rainey, JM, Ettedgui, E, Pohl, R, Balon, R et al. The β-receptor: isoproterenol anxiety states Psychopathology 17suppl 31984 40–5110.1159/000284130CrossRefGoogle ScholarPubMed
Rosenbaum, AH, Schatzberg, AF, Jost, FA, Cross, PD et al. Urinary free cortisol levels in anxiety Psychosomatics 1983; 24: 835–837CrossRefGoogle ScholarPubMed
Roth, WT, Ehlers, A, Taylor, CB, Margraf, J, Agras, WS. Skin conductance habituation in panic disorder patients Biol Psychiatry 1990; 27: 1231–1243CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Uhde, TW, Sack, D, Linnoila, M, Post, RM. Plasma HVA and anxiety in patients with panic disorder Biol Psychiatry 1986; 21: 849–85310.1016/0006-3223(86)90253-2CrossRefGoogle ScholarPubMed
Roy-Byrne, PP, Cowley, DS. Course and outcome in panic disorder: a review of recent follow-up studies Anxiety 1 1994/1995 151–160CrossRefGoogle Scholar
Schachter, S, Singer, JE. Cognitive, social and physiological determinants of emotional state Psychol Review 1962; 69: 379–399CrossRefGoogle ScholarPubMed
Spielberger, CD, Gorsuch, RL, Lushene, REThe State-Trait Anxiety Inventory Palo Alto: Consulting Psychologists Press, 1970Google Scholar
Stokes, PE. The neuroendocrinology of anxiety. In: Tuma, AH, Tuma, AHMaser, J, eds. Anxiety and the Anxiety Disorders. Hillsdale: Lawrence Erlbaum; 198. p. 53–76Google Scholar
Uhde, TW, Joffe, RT, Jimerson, DC, Post, RM. Normal urinary free cortisol and plasma MHPG in panic disorder: clinical and theoretical implications Biol Psychiatry 1988; 23: 565–585CrossRefGoogle ScholarPubMed
Vachon, LRespiratory disordersKaplan, HI, Sadock, BJFifth Edition Comprehensive Textbook of Psychiatry Baltimore: Williams & Wilkins, 1989 1198–1209Google Scholar
Wittchen, HU, Essau, CA, Krieg, JC. Anxiety disorders: similarities and differences of comorbidity in treated and untreated groups Br J Psychiatry 159suppl 121991 23–33CrossRefGoogle Scholar
Zahn, TPPsychophysiological approaches to psychopathologyColes, GH, Donchin, E, Porges, SWPsychophysiology. Systems, Processes, and Applications Oxford: Elsevier, 1986 508–610Google Scholar
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