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Am J Psychiatry 1993; 150:250-257
Copyright © 1993 by American Psychiatric Association
Diagnostic and substance specificity of carbon-dioxide-induced panic
LA Papp, DF Klein, J Martinez, F Schneier, R Cole, MR Liebowitz, E Hollander, AJ Fyer, F Jordan and JM Gorman
Biological Studies Unit, New York State Psychiatric Institute, NY 10032.
OBJECTIVE: The authors assessed the substance and diagnostic specificity of
carbon-dioxide-induced panic since, in addition to the specific biochemical
effects of inhaled carbon dioxide (CO2), simple physiologic distress is
also frequently implicated as a panicogenic factor during respiratory
challenge studies with CO2 in patients with anxiety disorders. METHOD:
Eighteen patients with panic disorder, 20 with social phobia, and 23
psychiatrically normal subjects inhaled a mixture of 35% CO2 and 65% O2 for
30 seconds through a face mask. They also breathed for 30 seconds through a
valve reducing the diameter of the airway. A double-blind, counterbalanced,
randomized design was used. RESULTS: In spite of important similarities
between the two interventions, including the induction of equal amounts of
subjective respiratory distress, carbon dioxide inhalation was
significantly more potent than increased airway resistance in provoking
panic in the anxiety disorder patients. The patients with panic disorder
were significantly more sensitive to CO2 than were the patients with social
phobia or the normal subjects. CONCLUSIONS: Carbon dioxide inhalation
appears to have a specific panicogenic effect in panic patients that goes
beyond simple breathlessness.
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