Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Biol Psychol. 2010 Apr;84(1):142-6. doi: 10.1016/j.biopsycho.2010.02.007. Epub 2010 Feb 20.
The prevalence of panic disorder (PD) in patients with chronic obstructive pulmonary disease (COPD) is significantly higher than that in the general population. Comorbid anxiety disorders in COPD are associated with a number of worse outcomes, however little is known about the mechanisms by which PD affects patients with COPD. We hypothesized that patients with COPD and PD would have greater dyspnea severity, but not greater somatosensory sensitivity, to dyspneic stimuli. We studied 10 patients with COPD and PD, 9 patients with COPD without PD, and 9 healthy, matched controls. Participants were administered the Anxiety Sensitivity Index-3. We tested interoceptive sensitivity using a respiratory load detection protocol and dyspnea ratings in response to inspiratory resistive loads. Participants with COPD and PD had higher anxiety sensitivity scores and reported greater dyspnea in response to resistive loads. However no group differences were found in resistive load detection threshold. Anxiety sensitivity scores accounted for a significant amount of the variance in the group difference in dyspnea ratings. Patients with COPD and PD do not show heightened interoceptive sensitivity, but report greater dyspnea to inspiratory resistive loads. Emotional responses to dyspneic sensations may account for higher dyspnea ratings in patients with PD and COPD.
慢性阻塞性肺疾病（COPD）患者中惊恐障碍（PD）的患病率明显高于普通人群。COPD 合并焦虑障碍与许多预后较差有关，但 PD 影响 COPD 患者的机制知之甚少。我们假设 COPD 和 PD 患者的呼吸困难严重程度更大，但对呼吸困难刺激的躯体感觉敏感性没有更大。我们研究了 10 名 COPD 合并 PD 患者、9 名 COPD 无 PD 患者和 9 名健康匹配的对照者。参与者接受了焦虑敏感指数-3 测试。我们使用呼吸负荷检测方案和对吸气阻力负荷的呼吸困难评分来测试内脏敏感性。COPD 和 PD 患者的焦虑敏感评分更高，对阻力负荷的呼吸困难反应更大。然而，在阻力负荷检测阈值方面没有发现组间差异。焦虑敏感评分解释了呼吸困难评分组间差异的很大一部分方差。COPD 和 PD 患者没有表现出更高的内脏敏感性，但对吸气阻力负荷的呼吸困难反应更大。对呼吸困难感觉的情绪反应可能解释了 PD 和 COPD 患者更高的呼吸困难评分。
