How study of respiratory physiology aided our understanding of abnormal brain function in panic disorder

被引:48
作者
Sinha, S
Papp, LA
Gorman, JM
机构
[1] Columbia Univ, Dept Psychiat, New York, NY 10032 USA
[2] New York State Psychiat Inst, Dept Clin Psychobiol, New York, NY USA
关键词
fear and neuroimaging; hyperventilation; panic attacks;
D O I
10.1016/S0165-0327(00)00337-2
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
There is a substantial body of literature demonstrating that stimulation of respiration (hyperventilation) is a common event in panic disorder patients during panic attack episodes. Further, a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in panic patients. This led some to posit that there is a fundamental abnormality in the physiological mechanisms that control breathing in panic disorder and that this abnormality is central to illness etiology. More recently, however, evidence has accumulated suggesting that respiratory physiology is normal in panic patients and that their tendency to hyperventilate and to react with panic to respiratory stimulants like CO2 represents the triggering of a hypersensitive fear network. The fear network anatomy is taken from preclinical studies that have identified the brain pathways that subserve the acquisition and maintenance of conditioned fear. Included are the amygdala and its brain stem projections, the hippocampus, and the medial prefrontal cortex. Although attempts to image this system in patients during panic attacks have been difficult, the theory that the fear network is operative and hyperactive in panic patients explains why both medication and psychosocial therapies are clearly effective. Studies of respiration in panic disorder are an excellent example of the way in which peripheral markers have guided researchers in developing a more complete picture of the neural events that occur in psychopathological states. (C) 2000 Elsevier Science B.V. All rights reserved.
引用
收藏
页码:191 / 200
页数:10
相关论文
共 48 条
[1]  
[Anonymous], 1996, The Emotional Brain
[2]   Basilar artery response to hyperventilation in panic disorder [J].
Ball, S ;
Shekhar, A .
AMERICAN JOURNAL OF PSYCHIATRY, 1997, 154 (11) :1603-1604
[3]  
Barlow DH, 1997, J CLIN PSYCHIAT, V58, P32
[4]  
BENKELFAT C, 1995, AM J PSYCHIAT, V152, P1180
[5]   SEROTONIN UPTAKE INHIBITORS ARE SUPERIOR TO IMIPRAMINE AND ALPRAZOLAM IN ALLEVIATING PANIC ATTACKS - A METAANALYSIS [J].
BOYER, W .
INTERNATIONAL CLINICAL PSYCHOPHARMACOLOGY, 1995, 10 (01) :45-49
[6]   SUBTYPING OF PANIC DISORDER BY SYMPTOM PROFILE [J].
BRIGGS, AC ;
STRETCH, DD ;
BRANDON, S .
BRITISH JOURNAL OF PSYCHIATRY, 1993, 163 :201-209
[7]  
Coplan JD, 1997, ARCH GEN PSYCHIAT, V54, P643
[8]   Plasma cortisol concentrations preceding lactate-induced panic -: Psychological, biochemical, and physiological correlates [J].
Coplan, JD ;
Goetz, R ;
Klein, DF ;
Papp, LA ;
Fyer, AJ ;
Liebowitz, MR ;
Davies, SO ;
Gorman, JM .
ARCHIVES OF GENERAL PSYCHIATRY, 1998, 55 (02) :130-136
[9]  
DAGER SR, 1994, AM J PSYCHIAT, V151, P57
[10]  
DAGER SR, 1995, AM J PSYCHIAT, V152, P666