Search

Hyperventilation is assumed to produce a set of somatic and psychological symptoms, the so-called Hyperventilation Syndrome (HVS). Recognition of symptoms during the hyperventilation provocation test (HVPT) is the most widely used criterion for diagnosing HVS, but additional physiological and symptom criteria have been proposed. The concordance of various diagnostic criteria for HVS is investigated in the present study. Forty-eight psychiatric patients with panic disorder and 90 somatic patients with symptoms suspective of HVS performed a HVPT. There was a strong interrelationship between the various symptom criteria as well as the physiological criteria. However, almost no association between symptom and physiological HVS criteria were found. Symptom recognition was significantly related to trait anxiety, agoraphobia and depression. These data do not only question the validity of the HVPT, but also of the concept of HVS. The results are more consistent with a cognitive approach to anxiety in which the HVPT is seen as an aspecific stressor during which more anxious patients anticipate an anxiety attack.

Sixty agoraphobics were treated by behavioural therapy (self-exposure in vivo) either with their partner involved in all aspects of treatment or without their partner. The two treatment formats were about equally effective. Behavioural treatment directed at the agoraphobia resulted in improvement irrespective of marital quality and partner involvement in the therapy. The effects of treatment led neither to a deterioration of the marriage nor to adjustment problems in the partner. Avoidance behaviour, intropunitivity and overprotection were found to predict treatment response. The partners of agoraphobics were not found to have psychological problems themselves.

The present study addresses the hypothesis consistent with the dyspnea-fear theory of panic, that in a subgroup of panic patients a non-pathological pulmonary obstructive component may induce dyspnea, dyspneic fear and, ultimately, panic. In 38 patients who met DSM-III-R criteria for panic disorder, pulmonary function was assessed and various measurements for panic symptoms and concomitant psychopathology were collected. In comparison to patients with a high Forced Expiratory Flow at 50% (FEF 50%), low FEF 50% patients demonstrated significantly lower levels of Forced Expiratory Volume (first second) and Peak Expiratory Flow and significantly lower FEV1/FVC ratios. None of the differences on psychological measurements for symptom severity between low and high FEF 50% patients proved to be significant. Moreover, FEF 50% scores and FEV1/FVC ratios were not correlated to any of the measures for panic or associated psychopathology. It is concluded that the existence of a distinct subgroup of panic patients with signs of actual airway obstruction leading to uncontrollable dyspnea and fear of suffocation remains questionable.

The 2-week prevalence of panic attacks according to DSM-III-R criteria was assessed in 102 general hospital patients with unexplained somatic symptoms suggestive of the hyperventilation syndrome (HVS). Thirty-six patients were classified as panickers. In comparison to nonpanickers, panickers reported more severe panic and hyperventilation symptoms and state anxiety during anxiety episodes in daily life and also obtained higher scores on measures for depression, generalized anxiety, agoraphobic anxiety, and agoraphobic avoidance. During the Hyperventilation Provocation Test, panickers reported more panic and hyperventilation symptoms and state anxiety and also rated their symptoms to be more similar to those occurring in daily life than nonpanickers. However, no differences were observed between panickers and nonpanickers in base excess values or in minute respiratory volume, respiratory rate, or fraction of end-tidal carbon dioxide during the resting, hyperventilation, and recovery phase. It is concluded that the prevalence of panic attacks in this group of patients is relatively high and that medical specialists must be more attentive to the occurrence of panic attacks or panic disorder in general hospital patients with unexplained somatic symptoms suggestive of HVS.

Forty-eight patients with DSM-III-R Panic Disorder underwent a hyperventilation provocation Test (HVPT). Twenty-four patients rated the symptoms induced during the HVPT as similar to those occurring during panic attacks in daily life. Contrary to the classical hyperventilation model of panic, no differences were found in respiratory physiology between recognizers and non-recognizers before and during voluntary hyperventilation. Moreover, recognizers and non-recognizers reported comparable levels of panic and hyperventilation symptoms and state anxiety during panic attacks in daily life. Ten of the recognizers also had a panic attack during the HVPT, independent of any differential CO2 alterations. Compared to non-panickers, panickers obtained higher scores for agoraphobia and depression. On the basis of these results, it is concluded that recognizers or panickers do not show a tendency towards hyperventilation, but that reports of severe panic and hyperventilation symptoms are more closely related to the level of anxiety. These results are more consistent with the cognitive model of panic, which emphasizes the patient's tendency to interpret somatic symptoms catastrophically.