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Panic Attacks: Klein's False Suffocation Alarm, Taylor and Rachman's Data, and Ley's Dyspneic-Fear Theory-Reply

Edwin H. Cook Jr, MD
Arch Gen Psychiatry. 1996;53(1):83-85. doi:10.1001/archpsyc.1996.01830010085013.
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In Reply  Ley claims that the findings of Taylor and Rachman1 support his theory as well as mine. However, I do not believe this is substantiated by Ley's article2 in which he states that a classic "panic attack" is marked by "uncontrollable high intensity dyspnea (sense of impending suffocation)." However, this has nothing to do with chronic suffocation fear, which Taylor and Rachman address. Nowhere in Ley's (clinical rather than data-based) presentation of a variety of panics does he make any specific prediction that chronic suffocation fear predicts any sort of panic. If anything, Ley's "anticipatory panic attack" or "cognitive panic attack," both marked by anticipatory anxiety, might better be predicted by chronic fear of suffocation than the "classic panic attack" heralded by acute dyspnea. However, since Ley did not address this issue, his claim forsubstantive support from Taylor and Rachman is unwarranted.As we have pointed out,3 carbon monoxide asphyxiation does challenge the false suffocation alarm theory of panic since such unfortunates asphyxiate but do not panic. One possibility is that carbon monoxide and similar agents disable the suffocation monitor or alarm system. This apparently ad hoc hypothesis finds support in the discovery by Prabhakar et al4 and Snyder (personal communication, April 18, 1994) that carbon monoxide is an inhibitory neurotransmitter within the carotid body, since we had hypothesized5 that the carotid body is a suffocation


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