Nardi Antonio E, Valença Alexandre M, Lopes Fabiana L, Nascimento Isabella, Veras Andre B, Freire Rafael C, Mezzasalma Marco A, de-Melo-Neto Valfrido L, Zin Walter A
Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22410-003, Brazil.
Compr Psychiatry. 2006 May-Jun;47(3):209-14. doi: 10.1016/j.comppsych.2005.07.007.
Our aim was to describe the clinical features of 35% CO2-induced panic attacks in patients with panic disorder (PD) (Diagnostic and Statistical Manual and Mental Disorders, Fourth Edition) and compare them with the last spontaneous panic attack in patients with PD who had not had a panic attack after the 35% CO2 challenge test. We examined 91 patients with PD submitted to the CO2 challenge test. The test consisted of exhaling as fully as possible, took a fast vital capacity breath, held their breath for 8 seconds, exhaled, and then repeated the fast vital capacity breath, again holding for 8 seconds. The patients inhaled the 35% CO2/65% O2 mixture or atmospheric compressed air, randomly selected in a double-blind design. Scales were applied before and after the test. A total of 68.1% (n = 62) patients with PD had a panic attack (responders) after the CO2 test (chi2(1) = 25.87, P = .031). The last spontaneous panic attack and the symptom profile from the patients with PD who had not had a panic attack after the test (n = 29, 31.9%) were described to compare. The responders had more respiratory symptoms (chi2(1) = 19.21, P < .001), fulfilling the criteria for respiratory PD subtype (80.6%); the disorder started earlier (Mann-Whitney, P < .001), had a higher familial prevalence of PD (chi2(1) = 20.45, P = .028), and had more previous depressive episodes (chi2(1) = 27.98, P < .001). Our data suggest that there is an association between respiratory PD subtype and hyperreactivity to a CO2 respiratory challenge test. The responders may be a subgroup of respiratory PD subtype with future diagnostic and therapeutic implications.
我们的目的是描述惊恐障碍（PD）（《精神疾病诊断与统计手册》第四版）患者中35%二氧化碳诱发的惊恐发作的临床特征，并将其与在35%二氧化碳激发试验后未出现惊恐发作的PD患者的最后一次自发性惊恐发作进行比较。我们检查了91例接受二氧化碳激发试验的PD患者。该试验包括尽可能完全地呼气，进行一次快速肺活量呼吸，屏气8秒，呼气，然后重复快速肺活量呼吸，再次屏气8秒。患者随机吸入35%二氧化碳/65%氧气混合物或大气压缩空气，采用双盲设计。在试验前后应用量表。共有68.1%（n = 62）的PD患者在二氧化碳试验后出现惊恐发作（反应者）（χ2(1)=25.87，P = 0.031）。描述了试验后未出现惊恐发作的PD患者（n = 29，31.9%）的最后一次自发性惊恐发作和症状特征以进行比较。反应者有更多的呼吸系统症状（χ2(1)=19.21，P < 0.001），符合呼吸性PD亚型的标准（80.6%）；该障碍起病更早（曼-惠特尼检验，P < 0.001），PD的家族患病率更高（χ2(1)=20.45，P = 0.028），且既往有更多抑郁发作（χ2(1)=27.98，P < 0.001）。我们的数据表明，呼吸性PD亚型与对二氧化碳呼吸激发试验的高反应性之间存在关联。反应者可能是呼吸性PD亚型的一个亚组，具有未来诊断和治疗意义。
