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Panic Disorder, Is It Really a Mental Disorder? From Body Functions to the Homeostatic Brain

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Panic Disorder

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Abstract

Panic disorder (PD), is characterized by repeated PAs (i.e. abrupt surges of anxiety and fear accompanied by physical – e.g. pounding heart, sweating, trembling, etc. – and cognitive – e.g. fear of dying, fear of losing control, etc. – symptoms that usually reach their peak within 10 min), and major changes in behavior or persistent anxiety over having further attacks for at least 1 month. Since PD can be treated with psychotropic drugs and/or psychotherapy it has been commonly considered a mental disorder. However, recent evidence indicates that patients with PD exhibit subclinical anomalies in the respiratory, cardiac, and balance systems. In addition, apart from reducing panic symptoms, many antipanic pharmacotherapies (e.g. SSRIs) improve the functioning of the abovementioned systems. Therefore, some authors believe PAs may be real alarms arising from transient instability of homeostatic body functions. The idea PD is a mere psychiatric disease may be challenged by acknowledging a paramount role also to aberrant homeostatic functioning. This might pave the way to a more integrated approach of treating PD.

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References

  1. Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

    Google Scholar 

  2. Amaral JM, Spadaro PT, Pereira VM, Silva AC, Nardi AE. The carbon dioxide challenge test in panic disorder: a systematic review of preclinical and clinical research. Rev Bras Psiquiatr. 2013;35(3):318–31. doi:10.1590/1516-4446-2012-1045.

    Article  PubMed  Google Scholar 

  3. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84. doi:10.1002/mpr.1359.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Goodwin RD, Faravelli C, Rosi S, Cosci F, Truglia E, de Graaf R, et al. The epidemiology of panic disorder and agoraphobia in Europe. Eur Neuropsychopharmacol. 2005;15(4):435–43. doi:10.1016/j.euroneuro.2005.04.006.

    Article  CAS  PubMed  Google Scholar 

  5. Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry. 1993;50(4):306–17.

    Article  CAS  PubMed  Google Scholar 

  6. Gorman JM, Liebowitz MR, Fyer AJ, Stein J. A neuroanatomical hypothesis for panic disorder. Am J Psychiatry. 1989;146(2):148–61.

    Article  CAS  PubMed  Google Scholar 

  7. Gorman JM, Kent JM, Sullivan GM, Coplan JD. Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry. 2000;157(4):493–505.

    Article  CAS  PubMed  Google Scholar 

  8. Bouton ME, Mineka S, Barlow DH. A modern learning theory perspective on the etiology of panic disorder. Psychol Rev. 2001;108(1):4–32.

    Article  CAS  PubMed  Google Scholar 

  9. Clark DM, Salkovskis PM, Ost LG, Breitholtz E, Koehler KA, Westling BE, et al. Misinterpretation of body sensations in panic disorder. J Consult Clin Psychol. 1997;65(2):203–13.

    Article  CAS  PubMed  Google Scholar 

  10. Bellodi L, Perna G. The panic respiration connection. Milan, Italy: Medical Media; 1998.

    Google Scholar 

  11. Davidson Jr, Nutt D. Anxiety and respiration. In: Disorders eA, editor. Anxiety disorders. Oxford: Blackwell Science Ltd.; 2003.

    Google Scholar 

  12. Schruers K, Griez E. The effects of tianeptine or paroxetine on 35 % CO2 provoked panic in panic disorder. J Psychopharmacol. 2004;18(4):553–8. doi:10.1177/0269881104047283.

    Article  CAS  PubMed  Google Scholar 

  13. Briggs AC, Stretch DD, Brandon S. Subtyping of panic disorder by symptom profile. Br J Psychiatry. 1993;163:201–9.

    Article  CAS  PubMed  Google Scholar 

  14. Grassi M, Caldirola D, Vanni G, Guerriero G, Piccinni M, Valchera A, et al. Baseline respiratory parameters in panic disorder: a meta-analysis. J Affect Disord. 2013;146(2):158–73. doi:10.1016/j.jad.2012.08.034.

    Article  PubMed  Google Scholar 

  15. Grassi M, Caldirola D, Di Chiaro NV, Riva A, Dacco S, Pompili M, et al. Are respiratory abnormalities specific for panic disorder? A meta-analysis. Neuropsychobiology. 2014;70(1):52–60. doi:10.1159/000364830.

    Article  PubMed  Google Scholar 

  16. Cowley DS, Roy-Byrne PP. Hyperventilation and panic disorder. Am J Med. 1987;83(5):929–37.

    Article  CAS  PubMed  Google Scholar 

  17. van den Hout MA, Hoekstra R, Arntz A, Christiaanse M, Ranschaert W, Schouten E. Hyperventilation is not diagnostically specific to panic patients. Psychosom Med. 1992;54(2):182–91.

    Article  PubMed  Google Scholar 

  18. Griez E, Zandbergen J, Lousberg H, van den Hout M. Effects of low pulmonary CO2 on panic anxiety. Compr Psychiatry. 1988;29(5):490–7.

    Article  CAS  PubMed  Google Scholar 

  19. Gorman JM, Papp LA, Martinez J, Goetz RR, Hollander E, Liebowitz MR, et al. High-dose carbon dioxide challenge test in anxiety disorder patients. Biol Psychiatry. 1990;28(9):743–57.

    Article  CAS  PubMed  Google Scholar 

  20. Meuret AE, Rosenfield D, Wilhelm FH, Zhou E, Conrad A, Ritz T, et al. Do unexpected panic attacks occur spontaneously? Biol Psychiatry. 2011;70(10):985–91. doi:10.1016/j.biopsych.2011.05.027.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Goodwin RD, Pine DS. Respiratory disease and panic attacks among adults in the United States. Chest. 2002;122(2):645–50.

    Article  PubMed  Google Scholar 

  22. Perna G, Battaglia M, Garberi A, Arancio C, Bertani A, Bellodi L. Carbon dioxide/oxygen challenge test in panic disorder. Psychiatry Res. 1994;52(2):159–71.

    Article  CAS  PubMed  Google Scholar 

  23. Spinhoven P, Ros M, Westgeest A, Van der Does AJ. The prevalence of respiratory disorders in panic disorder, major depressive disorder and V-code patients. Behav Res Ther. 1994;32(6):647–9.

    Article  CAS  PubMed  Google Scholar 

  24. Niccolai V, van Duinen MA, Griez EJ. Respiratory patterns in panic disorder reviewed: a focus on biological challenge tests. Acta Psychiatr Scand. 2009;120(3):167–77. doi:10.1111/j.1600-0447.2009.01408.x.

    Article  CAS  PubMed  Google Scholar 

  25. Perna G, Caldirola D, Bellodi L. Panic disorder: from respiration to the homeostatic brain. Acta Neuropsychiatr. 2004;16:57–67.

    Article  PubMed  Google Scholar 

  26. Preter M, Klein DF. Panic, suffocation false alarms, separation anxiety and endogenous opioids. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32(3):603–12. doi:10.1016/j.pnpbp.2007.07.029.

    Article  CAS  PubMed  Google Scholar 

  27. Feinstein JS, Buzza C, Hurlemann R, Follmer RL, Dahdaleh NS, Coryell WH, et al. Fear and panic in humans with bilateral amygdala damage. Nat Neurosci. 2013;16(3):270–2. doi:10.1038/nn.3323.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Preter M, Klein DF. Lifelong opioidergic vulnerability through early life separation: A recent extension of the false suffocation alarm theory of panic disorder. Neurosci Biobehav Rev. 2014;46:345–51. doi:10.1016/j.neubiorev.2014.03.025.

    Article  PubMed  Google Scholar 

  29. Faravelli C, Lo Sauro C, Godini L, Lelli L, Benni L, Pietrini F, et al. Childhood stressful events, HPA axis and anxiety disorders. World J Psychiatry. 2012;2(1):13–25. doi:10.5498/wjp.v2.i1.13.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pine DS, Klein RG, Coplan JD, Papp LA, Hoven CW, Martinez J, et al. Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group. Arch Gen Psychiatry. 2000;57(10):960–7.

    Article  CAS  PubMed  Google Scholar 

  31. Perna G, Cocchi S, Bertani A, Arancio C, Bellodi L. Sensitivity to 35 % CO2 in healthy first-degree relatives of patients with panic disorder. Am J Psychiatry. 1995;152(4):623–5.

    Article  CAS  PubMed  Google Scholar 

  32. Coryell W, Pine D, Fyer A, Klein D. Anxiety responses to CO2 inhalation in subjects at high-risk for panic disorder. J Affect Disord. 2006;92(1):63–70. doi:10.1016/j.jad.2005.12.045.

    Article  PubMed  Google Scholar 

  33. Caldirola D, Bellodi L, Caumo A, Migliarese G, Perna G. Approximate entropy of respiratory patterns in panic disorder. Am J Psychiatry. 2004;161(1):79–87.

    Article  PubMed  Google Scholar 

  34. Perna G, Bertani A, Caldirola D, Gabriele A, Cocchi S, Bellodi L. Antipanic drug modulation of 35 % CO2 hyperreactivity and short-term treatment outcome. J Clin Psychopharmacol. 2002;22(3):300–8.

    Article  CAS  PubMed  Google Scholar 

  35. Nardi AE. Panic disorder is closely associated with respiratory obstructive illnesses. Am J Respir Crit Care Med. 2009;179(3):256–7. doi:10.1164/ajrccm.179.3.256.

    Article  PubMed  Google Scholar 

  36. Homma I, Masaoka Y. Breathing rhythms and emotions. Exp Physiol. 2008;93(9):1011–21. doi:10.1113/expphysiol.2008.042424.

    Article  PubMed  Google Scholar 

  37. Munjack DJ, Brown RA, Cabe DD, McDowell DE, Baltazar PL. A naturalistic follow-up of panic patients after short-term pharmacologic treatment. J Clin Psychopharmacol. 1993;13(2):156–8.

    Article  CAS  PubMed  Google Scholar 

  38. Wilhelm FH, Gerlach AL, Roth WT. Slow recovery from voluntary hyperventilation in panic disorder. Psychosom Med. 2001;63(4):638–49.

    Article  CAS  PubMed  Google Scholar 

  39. Wilhelm FH, Gevirtz R, Roth WT. Respiratory dysregulation in anxiety, functional cardiac, and pain disorders. Assessment, phenomenology, and treatment. Behav Modif. 2001;25(4):513–45.

    Article  CAS  PubMed  Google Scholar 

  40. Putnam RW, Filosa JA, Ritucci NA. Cellular mechanisms involved in CO(2) and acid signaling in chemosensitive neurons. Am J Physiol Cell Physiol. 2004;287(6):C1493–526. doi:10.1152/ajpcell.00282.2004.

    Article  CAS  PubMed  Google Scholar 

  41. Bailey JE, Argyropoulos SV, Lightman SL, Nutt DJ. Does the brain noradrenaline network mediate the effects of the CO2 challenge? J Psychopharmacol. 2003;17(3):252–9.

    Article  CAS  PubMed  Google Scholar 

  42. Protopopescu X, Pan H, Tuescher O, Cloitre M, Goldstein M, Engelien A, et al. Increased brainstem volume in panic disorder: a voxel-based morphometric study. Neuroreport. 2006;17(4):361–3. doi:10.1097/01.wnr.0000203354.80438.1.

    Article  PubMed  Google Scholar 

  43. Perna G, Guerriero G, Brambilla P, Caldirola D. Panic and the brainstem: clues from neuroimaging studies. CNS Neurol Disord Drug Targets. 2014;13(6):1049–56.

    Article  CAS  PubMed  Google Scholar 

  44. Remmers JE. Central neuron control of breathing. In: Altose MD, Kawakami Y, editors. Control of breathing in health and disease (lung biology in health and disease). New York: Marcel Dekker; 1999.

    Google Scholar 

  45. Esquivel G, Schruers KR, Maddock RJ, Colasanti A, Griez EJ. Acids in the brain: a factor in panic? J Psychopharmacol. 2010;24(5):639–47. doi:10.1177/0269881109104847.

    Article  CAS  PubMed  Google Scholar 

  46. Horn EM, Waldrop TG. Suprapontine control of respiration. Respir Physiol. 1998;114(3):201–11.

    Article  CAS  PubMed  Google Scholar 

  47. Roncon CM, Biesdorf C, Santana RG, Zangrossi Jr H, Graeff FG, Audi EA. The panicolytic-like effect of fluoxetine in the elevated T-maze is mediated by serotonin-induced activation of endogenous opioids in the dorsal periaqueductal grey. J Psychopharmacol. 2012;26(4):525–31. doi:10.1177/0269881111434619.

    Article  CAS  PubMed  Google Scholar 

  48. Balaban CD, Thayer JF. Neurological bases for balance-anxiety links. J Anxiety Disord. 2001;15(1–2):53–79.

    Article  CAS  PubMed  Google Scholar 

  49. Maddock RJ. The lactic acid response to alkalosis in panic disorder: an integrative review. J Neuropsychiatry Clin Neurosci. 2001;13(1):22–34.

    Article  CAS  PubMed  Google Scholar 

  50. Knuts IJ, Cosci F, Esquivel G, Goossens L, van Duinen M, Bareman M, et al. Cigarette smoking and 35 % CO(2) induced panic in panic disorder patients. J Affect Disord. 2010;124(1-2):215–8. doi:10.1016/j.jad.2009.10.012.

    Article  PubMed  Google Scholar 

  51. Breslau N, Klein DF. Smoking and panic attacks: an epidemiologic investigation. Arch Gen Psychiatry. 1999;56(12):1141–7.

    Article  CAS  PubMed  Google Scholar 

  52. Caldirola D, Bellodi L, Cammino S, Perna G. Smoking and respiratory irregularity in panic disorder. Biol Psychiatry. 2004;56(6):393–8. doi:10.1016/j.biopsych.2004.06.013.

    Article  CAS  PubMed  Google Scholar 

  53. Abelson JL, Weg JG, Nesse RM, Curtis GC. Persistent respiratory irregularity in patients with panic disorder. Biol Psychiatry. 2001;49(7):588–95.

    Article  CAS  PubMed  Google Scholar 

  54. Ley R. The many faces of Pan: psychological and physiological differences among three types of panic attacks. Behav Res Ther. 1992;30(4):347–57.

    Article  CAS  PubMed  Google Scholar 

  55. Song HM, Kim JH, Heo JY, Yu BH. Clinical characteristics of the respiratory subtype in panic disorder patients. Psychiatry Investig. 2014;11(4):412–8. doi:10.4306/pi.2014.11.4.412.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Nardi AE, Valenca AM, Mezzasalma MA, Lopes FL, Nascimento I, Veras AB, et al. 35 % carbon dioxide and breath-holding challenge tests in panic disorder: a comparison with spontaneous panic attacks. Depress Anxiety. 2006;23(4):236–44. doi:10.1002/da.20165.

    Article  PubMed  Google Scholar 

  57. Meuret AE, White KS, Ritz T, Roth WT, Hofmann SG, Brown TA. Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder. J Psychiatr Res. 2006;40(6):520–7. doi:10.1016/j.jpsychires.2005.09.006.

    Article  PubMed  Google Scholar 

  58. Roberson-Nay R, Latendresse SJ, Kendler KS. A latent class approach to the external validation of respiratory and non-respiratory panic subtypes. Psychol Med. 2012;42(3):461–74. doi:10.1017/S0033291711001425.

    Article  CAS  PubMed  Google Scholar 

  59. Soares-Filho GL, Machado S, Arias-Carrion O, Santulli G, Mesquita CT, Cosci F, et al. Myocardial perfusion imaging study of CO(2)-induced panic attack. Am J Cardiol. 2014;113(2):384–8. doi:10.1016/j.amjcard.2013.09.035.

    Article  PubMed  Google Scholar 

  60. Starcevic V, Berle D. Cognitive specificity of anxiety disorders: a review of selected key constructs. Depress Anxiety. 2006;23(2):51–61. doi:10.1002/da.20145.

    Article  PubMed  Google Scholar 

  61. Batelaan N, De Graaf R, Van Balkom A, Vollebergh W, Beekman A. Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder. Psychol Med. 2007;37(2):247–56. doi:10.1017/S0033291706009007.

    Article  PubMed  Google Scholar 

  62. Katon WJ. Chest pain, cardiac disease, and panic disorder. J Clin Psychiatry. 1990;51(Suppl):27–30. discussion 50–3.

    PubMed  Google Scholar 

  63. Coryell W, Noyes Jr R, House JD. Mortality among outpatients with anxiety disorders. Am J Psychiatry. 1986;143(4):508–10.

    Article  CAS  PubMed  Google Scholar 

  64. Chignon JM, Lepine JP, Ades J. Panic disorder in cardiac outpatients. Am J Psychiatry. 1993;150(5):780–5.

    Article  CAS  PubMed  Google Scholar 

  65. Fleet R, Lavoie K, Beitman BD. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res. 2000;48(4–5):347–56.

    Article  CAS  PubMed  Google Scholar 

  66. Jeejeebhoy FM, Dorian P, Newman DM. Panic disorder and the heart: a cardiology perspective. J Psychosom Res. 2000;48(4–5):393–403.

    Article  CAS  PubMed  Google Scholar 

  67. Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics. 2003;44(3):222–36. doi:10.1176/appi.psy.44.3.222.

    Article  PubMed  Google Scholar 

  68. Lynch P, Galbraith KM. Panic in the emergency room. Can J Psychiatry. 2003;48(6):361–6.

    PubMed  Google Scholar 

  69. Katerndahl D. Panic plaques: panic disorder & coronary artery disease in patients with chest pain. J Am Board Fam Pract. 2004;17(2):114–26.

    Article  PubMed  Google Scholar 

  70. Katerndahl DA. The association between panic disorder and coronary artery disease among primary care patients presenting with chest pain: an updated literature review. Prim Care Companion J Clin Psychiatry. 2008;10(4):276–85.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Katerndahl DA. Chest pain and its importance in patients with panic disorder: an updated literature review. Prim Care Companion J Clin Psychiatry. 2008;10(5):376–83.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Bunevicius A, Staniute M, Brozaitiene J, Pop VJ, Neverauskas J, Bunevicius R. Screening for anxiety disorders in patients with coronary artery disease. Health Qual Life Outcomes. 2013;11:37. doi:10.1186/1477-7525-11-37.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry. 2008;65(1):62–71. doi:10.1001/archgenpsychiatry.2007.4.

    Article  CAS  PubMed  Google Scholar 

  74. Parker GB, Owen CA, Brotchie HL, Hyett MP. The impact of differing anxiety disorders on outcome following an acute coronary syndrome: time to start worrying? Depress Anxiety. 2010;27(3):302–9. doi:10.1002/da.20602.

    Article  PubMed  Google Scholar 

  75. Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev. 2007;27(2):86–91. doi:10.1097/01.HCR.0000265036.24157.e7.

    Article  PubMed  Google Scholar 

  76. Dammen T, Arnesen H, Ekeberg O, Friis S. Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease. Gen Hosp Psychiatry. 2004;26(6):463–9. doi:10.1016/j.genhosppsych.2004.08.004.

    Article  PubMed  Google Scholar 

  77. Grenier S, Potvin O, Hudon C, Boyer R, Preville M, Desjardins L, et al. Twelve-month prevalence and correlates of subthreshold and threshold anxiety in community-dwelling older adults with cardiovascular diseases. J Affect Disord. 2012;136(3):724–32. doi:10.1016/j.jad.2011.09.052.

    Article  PubMed  Google Scholar 

  78. Chen YH, Tsai SY, Lee HC, Lin HC. Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study. Psychosom Med. 2009;71(7):798–804. doi:10.1097/PSY.0b013e3181ad55e3.

    Article  PubMed  Google Scholar 

  79. Gomez-Caminero A, Blumentals WA, Russo LJ, Brown RR, Castilla-Puentes R. Does panic disorder increase the risk of coronary heart disease? A cohort study of a national managed care database. Psychosom Med. 2005;67(5):688–91.

    Article  PubMed  Google Scholar 

  80. Alvarenga ME, Richards JC, Lambert G, Esler MD. Psychophysiological mechanisms in panic disorder: a correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables. Psychosom Med. 2006;68(1):8–16. doi:10.1097/01.psy.0000195872.00987.db.

    Article  PubMed  Google Scholar 

  81. Yapislar H, Aydogan S, Ozum U. Biological understanding of the cardiovascular risk associated with major depression and panic disorder is important. Int J Psychiatry Clin Pract. 2012;16(1):27–32. doi:10.3109/13651501.2011.620127.

    Article  CAS  PubMed  Google Scholar 

  82. Jakovljevic M, Reiner Z, Milicic D. Mental disorders, treatment response, mortality and serum cholesterol: a new holistic look at old data. Psychiatr Danub. 2007;19(4):270–81.

    CAS  PubMed  Google Scholar 

  83. Hoge EA, Brandstetter K, Moshier S, Pollack MH, Wong KK, Simon NM. Broad spectrum of cytokine abnormalities in panic disorder and posttraumatic stress disorder. Depress Anxiety. 2009;26(5):447–55. doi:10.1002/da.20564.

    Article  CAS  PubMed  Google Scholar 

  84. Fleet R, Lesperance F, Arsenault A, Gregoire J, Lavoie K, Laurin C, et al. Myocardial perfusion study of panic attacks in patients with coronary artery disease. Am J Cardiol. 2005;96(8):1064–8. doi:10.1016/j.amjcard.2005.06.035.

    Article  PubMed  Google Scholar 

  85. Niccolai V, van Duinen MA, Griez EJ. Objective and subjective measures in recovery from a 35 % carbon dioxide challenge. Can J Psychiatry. 2008;53(11):737–44.

    PubMed  Google Scholar 

  86. Guyenet PG, Stornetta RL, Abbott SB, Depuy SD, Fortuna MG, Kanbar R. Central CO2 chemoreception and integrated neural mechanisms of cardiovascular and respiratory control. J Appl Physiol. 2010;108(4):995–1002. doi:10.1152/japplphysiol.00712.2009.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Girotti LA, Crosatto JR, Messuti H, Kaski JC, Dyszel E, Rivas CA, et al. The hyperventilation test as a method for developing successful therapy in Prinzmetal’s angina. Am J Cardiol. 1982;49(4):834–41.

    Article  CAS  PubMed  Google Scholar 

  88. Fujii H, Yasue H, Okumura K, Matsuyama K, Morikami Y, Miyagi H, et al. Hyperventilation-induced simultaneous multivessel coronary spasm in patients with variant angina: an echocardiographic and arteriographic study. J Am Coll Cardiol. 1988;12(5):1184–92.

    Article  CAS  PubMed  Google Scholar 

  89. Yeragani VK, Pohl R, Jampala VC, Balon R, Ramesh C, Srinivasan K. Increased QT variability in patients with panic disorder and depression. Psychiatry Res. 2000;93(3):225–35.

    Article  CAS  PubMed  Google Scholar 

  90. Yeragani VK, Sobolewski E, Igel G, Johnson C, Jampala VC, Kay J, et al. Decreased heart-period variability in patients with panic disorder: a study of Holter ECG records. Psychiatry Res. 1998;78(1–2):89–99.

    Article  CAS  PubMed  Google Scholar 

  91. Yeragani VK, Pohl R, Berger R, Balon R, Ramesh C, Glitz D, et al. Decreased heart rate variability in panic disorder patients: a study of power-spectral analysis of heart rate. Psychiatry Res. 1993;46(1):89–103.

    Article  CAS  PubMed  Google Scholar 

  92. Molgaard H, Sorensen KE, Bjerregaard P. Attenuated 24-h heart rate variability in apparently healthy subjects, subsequently suffering sudden cardiac death. Clin Auton Res. 1991;1(3):233–7.

    Article  CAS  PubMed  Google Scholar 

  93. Bigger Jr JT, Fleiss JL, Rolnitzky LM, Steinman RC. Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol. 1993;21(3):729–36.

    Article  PubMed  Google Scholar 

  94. Yeragani VK, Pohl R, Jampala VC, Balon R, Kay J, Igel G. Effect of posture and isoproterenol on beat-to-beat heart rate and QT variability. Neuropsychobiology. 2000;41(3):113–23. doi:26642.

    Article  CAS  PubMed  Google Scholar 

  95. Sullivan GM, Kent JM, Kleber M, Martinez JM, Yeragani VK, Gorman JM. Effects of hyperventilation on heart rate and QT variability in panic disorder pre- and post-treatment. Psychiatry Res. 2004;125(1):29–39. doi:10.1016/j.psychres.2003.10.002.

    Article  PubMed  Google Scholar 

  96. Atmaca M, Yavuzkir M, Izci F, Gurok MG, Adiyaman S. QT wave dispersion in patients with panic disorder. Neurosci Bull. 2012;28(3):247–52.

    Article  PubMed  Google Scholar 

  97. Yavuzkir M, Atmaca M, Dagli N, Balin M, Karaca I, Mermi O, et al. P-wave dispersion in panic disorder. Psychosom Med. 2007;69(4):344–7. doi:10.1097/PSY.0b013e3180616900.

    Article  PubMed  Google Scholar 

  98. Tomaselli GF, Beuckelmann DJ, Calkins HG, Berger RD, Kessler PD, Lawrence JH, et al. Sudden cardiac death in heart failure. The role of abnormal repolarization. Circulation. 1994;90(5):2534–9.

    Article  CAS  PubMed  Google Scholar 

  99. Manttari M, Oikarinen L, Manninen V, Viitasalo M. QT dispersion as a risk factor for sudden cardiac death and fatal myocardial infarction in a coronary risk population. Heart. 1997;78(3):268–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(3):352–8.

    Article  CAS  PubMed  Google Scholar 

  101. Fisher AJ, Woodward SH. Cardiac stability at differing levels of temporal analysis in panic disorder, post-traumatic stress disorder, and healthy controls. Psychophysiology. 2014;51(1):80–7. doi:10.1111/psyp.12148.

    Article  PubMed  Google Scholar 

  102. Cosci F, Knuts IJ, Abrams K, Griez EJ, Schruers KR. Cigarette smoking and panic: a critical review of the literature. J Clin Psychiatry. 2010;71(5):606–15. doi:10.4088/JCP.08r04523blu.

    Article  PubMed  Google Scholar 

  103. Muotri RW, Bernik MA. Panic disorder and exercise avoidance. Rev Bras Psiquiatr. 2014;36(1):68–75. doi:10.1590/1516-4446-2012-1012.

    Article  PubMed  Google Scholar 

  104. Caldirola D, Namia C, Micieli W, Carminati C, Bellodi L, Perna G. Cardiorespiratory response to physical exercise and psychological variables in panic disorder. Rev Bras Psiquiatr. 2011;33(4):385–9.

    Article  PubMed  Google Scholar 

  105. Sardinha A, Araujo CG, Soares-Filho GL, Nardi AE. Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy. Expert Rev Cardiovasc Ther. 2011;9(2):165–75. doi:10.1586/erc.10.170.

    Article  CAS  PubMed  Google Scholar 

  106. Furman JM, Redfern MS, Jacob RG. Vestibulo-ocular function in anxiety disorders. J Vestib Res. 2006;16(4–5):209–15.

    PubMed  Google Scholar 

  107. Jacob RG. Panic disorder and the vestibular system. Psychiatr Clin North Am. 1988;11(2):361–74.

    CAS  PubMed  Google Scholar 

  108. Mezzasalma MA, Mathias Kde V, Nascimento I, Valenca AM, Nardi AE. Imipramine for vestibular dysfunction in panic disorder: a prospective case series. Arq Neuropsiquiatr. 2011;69(2A):196–201.

    Article  PubMed  Google Scholar 

  109. Stambolieva K, Angov G. Balance control in quiet upright standing in patients with panic disorder. Eur Arch Otorhinolaryngol. 2010;267(11):1695–9. doi:10.1007/s00405-010-1303-2.

    Article  PubMed  Google Scholar 

  110. Teggi R, Caldirola D, Fabiano B, Recanati P, Bussi M. Rehabilitation after acute vestibular disorders. J Laryngol Otol. 2009;123(4):397–402. doi:10.1017/S0022215108002983.

    Article  CAS  PubMed  Google Scholar 

  111. Perna G, Dario A, Caldirola D, Stefania B, Cesarani A, Bellodi L. Panic disorder: the role of the balance system. J Psychiatr Res. 2001;35(5):279–86.

    Article  CAS  PubMed  Google Scholar 

  112. Staab JP, Ruckenstein MJ. Which comes first? Psychogenic dizziness versus otogenic anxiety. Laryngoscope. 2003;113(10):1714–8.

    Article  PubMed  Google Scholar 

  113. Furman JM, Jacob RG. A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J Anxiety Disord. 2001;15(1–2):9–26.

    Article  CAS  PubMed  Google Scholar 

  114. Schuerger RJ, Balaban CD. Immunohistochemical demonstration of regionally selective projections from locus coeruleus to the vestibular nuclei in rats. Exp Brain Res. 1993;92(3):351–9.

    Article  CAS  PubMed  Google Scholar 

  115. Yates BJ, Goto T, Kerman I, Bolton PS. Responses of caudal medullary raphe neurons to natural vestibular stimulation. J Neurophysiol. 1993;70(3):938–46.

    CAS  PubMed  Google Scholar 

  116. Licata F, Li Volsi G, Maugeri G, Santangelo F. Excitatory and inhibitory effects of 5-hydroxytryptamine on the firing rate of medial vestibular nucleus neurons in the rat. Neurosci Lett. 1993;154(1–2):195–8.

    Article  CAS  PubMed  Google Scholar 

  117. Balaban CD. Projections from the parabrachial nucleus to the vestibular nuclei: potential substrates for autonomic and limbic influences on vestibular responses. Brain Res. 2004;996(1):126–37.

    Article  CAS  PubMed  Google Scholar 

  118. Balaban CD. Vestibular nucleus projections to the parabrachial nucleus in rabbits: implications for vestibular influences on the autonomic nervous system. Exp Brain Res. 1996;108(3):367–81.

    Article  CAS  PubMed  Google Scholar 

  119. Balaban CD, Beryozkin G. Vestibular nucleus projections to nucleus tractus solitarius and the dorsal motor nucleus of the vagus nerve: potential substrates for vestibulo-autonomic interactions. Exp Brain Res. 1994;98(2):200–12.

    Article  CAS  PubMed  Google Scholar 

  120. Reilly S, Trifunovic R. Lateral parabrachial nucleus lesions in the rat: neophobia and conditioned taste aversion. Brain Res Bull. 2001;55(3):359–66.

    Article  CAS  PubMed  Google Scholar 

  121. Hayward LF, Felder RB. Lateral parabrachial nucleus modulates baroreflex regulation of sympathetic nerve activity. Am J Physiol. 1998;274(5 Pt 2):R1274–82.

    CAS  PubMed  Google Scholar 

  122. Chamberlin NL, Saper CB. Topographic organization of respiratory responses to glutamate microstimulation of the parabrachial nucleus in the rat. J Neurosci. 1994;14(11 Pt 1):6500–10.

    CAS  PubMed  Google Scholar 

  123. Huh YE, Kim JS. Bedside evaluation of dizzy patients. J Clin Neurol. 2013;9(4):203–13. doi:10.3988/jcn.2013.9.4.203.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3(8):655–66. doi:10.1038/nrn894.

    Article  CAS  PubMed  Google Scholar 

  125. Craig AD. How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci. 2009;10(1):59–70. doi:10.1038/nrn2555.

    Article  CAS  PubMed  Google Scholar 

  126. Gauriau C, Bernard JF. Pain pathways and parabrachial circuits in the rat. Exp Physiol. 2002;87(2):251–8.

    Article  PubMed  Google Scholar 

  127. Zylka MJ. Nonpeptidergic circuits feel your pain. Neuron. 2005;47(6):771–2. doi:10.1016/j.neuron.2005.09.003.

    Article  CAS  PubMed  Google Scholar 

  128. Fanselow MS. Neural organization of the defensive behavior system responsible for fear. Psychon Bull Rev. 1994;1(4):429–38. doi:10.3758/BF03210947.

    Article  CAS  PubMed  Google Scholar 

  129. Balaban CD. Vestibular autonomic regulation (including motion sickness and the mechanism of vomiting). Curr Opin Neurol. 1999;12(1):29–33.

    Article  CAS  PubMed  Google Scholar 

  130. Berencsi A, Ishihara M, Imanaka K. The functional role of central and peripheral vision in the control of posture. Hum Mov Sci. 2005;24(5–6):689–709. doi:10.1016/j.humov.2005.10.014.

    Article  PubMed  Google Scholar 

  131. Balaban CD. Neural substrates linking balance control and anxiety. Physiol Behav. 2002;77(4–5):469–75.

    Article  CAS  PubMed  Google Scholar 

  132. Redfern MS, Yardley L, Bronstein AM. Visual influences on balance. J Anxiety Disord. 2001;15(1–2):81–94.

    Article  CAS  PubMed  Google Scholar 

  133. Szirmai A, Kisely M, Nagy G, Nedeczky Z, Szabados EM, Toth A. Panic disorder in otoneurological experience. Int Tinnitus J. 2005;11(1):77–80.

    PubMed  Google Scholar 

  134. Jacob RG, Whitney SL, Detweiler-Shostak G, Furman JM. Vestibular rehabilitation for patients with agoraphobia and vestibular dysfunction: a pilot study. J Anxiety Disord. 2001;15(1–2):131–46.

    Article  CAS  PubMed  Google Scholar 

  135. Simon NM, Parker SW, Wernick-Robinson M, Oppenheimer JE, Hoge EA, Worthington JJ, et al. Fluoxetine for vestibular dysfunction and anxiety: a prospective pilot study. Psychosomatics. 2005;46(4):334–9. doi:10.1176/appi.psy.46.4.334.

    Article  CAS  PubMed  Google Scholar 

  136. Palazzo L, Clemente R, Bersani G. Disturbo di panico e stagionalità: ipotesi di una sottotipizzazione del disturbo sulla base del suo andamento stagionale. Giorn Ital Psicopat. 2005;11:235–6.

    Google Scholar 

  137. Lelliott P, Marks I, McNamee G, Tobena A. Onset of panic disorder with agoraphobia. Toward an integrated model. Arch Gen Psychiatry. 1989;46(11):1000–4.

    Article  CAS  PubMed  Google Scholar 

  138. Bossini L, Frank E, Campinoti G, Valdagno M, Caterini C, Castrogiovanni P, et al. Photosensitivity and panic-agoraphobic spectrum: a pilot study. Riv Psichiatr. 2013;48(2):108–12. doi:10.1708/1272.14034.

    PubMed  Google Scholar 

  139. Kellner M, Wiedemann K, Zihl J. Illumination perception in photophobic patients suffering from panic disorder with agoraphobia. Acta Psychiatr Scand. 1997;96(1):72–4.

    Article  CAS  PubMed  Google Scholar 

  140. Bitsios P, Szabadi E, Bradshaw CM. The inhibition of the pupillary light reflex by the threat of an electric shock: a potential laboratory model of human anxiety. J Psychopharmacol. 1996;10(4):279–87. doi:10.1177/026988119601000404.

    Article  CAS  PubMed  Google Scholar 

  141. Bossini L, Fagiolini A, Valdagno M, Padula L, Hofkens T, Castrogiovanni P. Photosensitivity in panic disorder. Depress Anxiety. 2009;26(1):E34–6. doi:10.1002/da.20477.

    Article  PubMed  Google Scholar 

  142. Alici H, Ercan S, Bulbul F, Alici D, Alpak G, Davutoglu V. Circadian blood pressure variation in normotensive patients with panic disorder. Angiology. 2014;65(8):747–9. doi:10.1177/0003319713512172.

    Article  PubMed  Google Scholar 

  143. Nascimento I, de Melo-Neto VL, Valenca AM, Lops FL, Freire RC, Cassabian LA, et al. Antipanic drugs and pulmonary function in panic disorder patients. Rev Psiq Clín. 2009;36:123–9.

    Google Scholar 

  144. Olsson M, Annerbrink K, Bengtsson F, Hedner J, Eriksson E. Paroxetine influences respiration in rats: implications for the treatment of panic disorder. Eur Neuropsychopharmacol. 2004;14(1):29–37.

    Article  CAS  PubMed  Google Scholar 

  145. Tucker P, Adamson P, Miranda Jr R, Scarborough A, Williams D, Groff J, et al. Paroxetine increases heart rate variability in panic disorder. J Clin Psychopharmacol. 1997;17(5):370–6.

    Article  CAS  PubMed  Google Scholar 

  146. Perna G, Alpini D, Caldirola D, Raponi G, Cesarani A, Bellodi L. Serotonergic modulation of the balance system in panic disorder: an open study. Depress Anxiety. 2003;17(2):101–6. doi:10.1002/da.10092.

    Article  PubMed  Google Scholar 

  147. Meuret AE, Wilhelm FH, Ritz T, Roth WT. Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. J Psychiatr Res. 2008;42(7):560–8. doi:10.1016/j.jpsychires.2007.06.005.

    Article  PubMed  Google Scholar 

  148. Broocks A, Bandelow B, Pekrun G, George A, Meyer T, Bartmann U, et al. Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. Am J Psychiatry. 1998;155(5):603–9.

    Article  CAS  PubMed  Google Scholar 

  149. Sanchez-Meca J, Rosa-Alcazar AI, Marin-Martinez F, Gomez-Conesa A. Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clin Psychol Rev. 2010;30(1):37–50. doi:10.1016/j.cpr.2009.08.011.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Italy

    Giampaolo Perna, Giuseppe Iannone, Tatiana Torti & Daniela Caldirola

  2. Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands

    Giampaolo Perna

  3. Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA

    Giampaolo Perna

  4. AIAMC (Italian Association for Behavioural Analysis, Modification and Behavioural and Cognitive Therapies), Milan, Italy

    Giampaolo Perna & Tatiana Torti

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  1. Giampaolo Perna
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  2. Giuseppe Iannone
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  3. Tatiana Torti
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  4. Daniela Caldirola
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Correspondence to Giampaolo Perna .

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Editors and Affiliations

  1. Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Antonio Egidio Nardi

  2. Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Rafael Christophe R. Freire

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Perna, G., Iannone, G., Torti, T., Caldirola, D. (2016). Panic Disorder, Is It Really a Mental Disorder? From Body Functions to the Homeostatic Brain. In: Nardi, A., Freire, R. (eds) Panic Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-12538-1_4

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