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January 1988, Vol 45, No. 1 >
Article | January 1988

Blood Gas Changes and Hypophosphatemia in Lactate-Induced Panic

Christopher Bass, MD, MRCPsych; W. N. Gardner, DPhil, MRCP
Arch Gen Psychiatry. 1988;45(1):95-96. doi:10.1001/archpsyc.1988.01800250111014
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To the Editor.—  Gorman et al1 urge that further work be aimed at defining the nature of ventilatory abnormalities in patients with panic disorder (PD) but do not elaborate on the substantial body of work that has already been published in this field. The important association between agoraphobia and hyperventilation (HV)-related complaints has already been established in different populations,2,3 and we have shown that some patients with agoraphobia and PD spend large portions of the waking day in the hypocapnic range (carbon dioxide partial pressure [Pco2], <30 mm Hg).4,5 For those patients at or close to the threshold for hypocapnia, relatively minor stressors, such as exercise, talking, or even exposure to phobic talk,6 may provoke sudden reductions in Pco2 that are accompanied by somatic symptoms and panic anxiety. Rapee7 also demonstrated that patients with PD had not only lower resting end-tidal Pco2 and

REFERENCES

1 +
Gorman JM, Cohen BS, Liebowitz MR, Fyer AJ, Ross D, Davies SO, Klein DF:  Blood gas changes and hypophosphatemia in lactate-induced panic . Arch Gen Psychiatry 1986;;43:1067-1071.
2 +
Garssen B, Van Veenendaal W, Bloemink R:  Agoraphobia and the hyperventilation syndrome . Behav Res Ther 1983;;21:643-649.
3 +
Bass C, Cawley RH, Wade C, Ryan KC, Gardner WN, Hutchison DCS, Jackson G:  Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries . Lancet 1983;;1:605-609.
4 +
Bass C, Gardner WN:  Respiratory and psychiatric abnormalities in chronic symptomatic hyperventilation . Br Med J 1985;;290:1387-1390.
5 +
Gardner WN, Meah MS, Bass C:  Controlled study of respiratory responses during prolonged measurement in patients with chronic hyperventilation . Lancet 1986;;2:826-830.
6 +
Freeman LJ, Conway AV, Nixon PGF:  Physiological responses to psychological challenge under hypnosis in patients considered to have the hyperventilation syndrome: Implications for diagnosis and therapy . J R Soc Med 1986;;79:76-83.
7 +
Rapee R:  Differential response to hyperventilation in panic disorder and generalized anxiety disorder . J Abnorm Psychol 1986;;95:24-28.
8 +
Ackerman S, Sachar E:  The lactate theory of anxiety: A review of re-evaluation . Psychosom Med 1974;;36:69-81.
9 +
Margraf J, Ehlers A, Roth WT:  Biological models of panic disorder and agoraphobia: A review . Behav Res Ther 1986;;24:553-567.
10 +
Hibbert GA: The diagnosis of hyperventilation using ambulatory carbon dioxide monitoring. Read before the Fourth International Symposium on Respiratory Psychophysiology, Southampton, England, 1984.
11 +
Salkovskis PM, Jones DR, Clark DM:  Respiratory control in the treatment of panic attacks: Replication and extension with concurrent measurement of behaviour and CO2 . Br J Psychiatry 1986;;148:526-532.
12 +
King R, Margraf J, Ehlers A, Maddock RJ:  Panic disorder: Overlap with symptoms of somatization disorder , in Hand I, Wittchen HU (eds): Panic and Phobias . New York, Springer Publishing Co Inc, 1986;.
13 +
Smith GR, Monson RA, Ray DC:  Patients with multiple unexplained symptoms . Arch Intern Med 1986;;146:69-72.

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1 +
Gorman JM, Cohen BS, Liebowitz MR, Fyer AJ, Ross D, Davies SO, Klein DF:  Blood gas changes and hypophosphatemia in lactate-induced panic . Arch Gen Psychiatry 1986;;43:1067-1071.
2 +
Garssen B, Van Veenendaal W, Bloemink R:  Agoraphobia and the hyperventilation syndrome . Behav Res Ther 1983;;21:643-649.
3 +
Bass C, Cawley RH, Wade C, Ryan KC, Gardner WN, Hutchison DCS, Jackson G:  Unexplained breathlessness and psychiatric morbidity in patients with normal and abnormal coronary arteries . Lancet 1983;;1:605-609.
4 +
Bass C, Gardner WN:  Respiratory and psychiatric abnormalities in chronic symptomatic hyperventilation . Br Med J 1985;;290:1387-1390.
5 +
Gardner WN, Meah MS, Bass C:  Controlled study of respiratory responses during prolonged measurement in patients with chronic hyperventilation . Lancet 1986;;2:826-830.
6 +
Freeman LJ, Conway AV, Nixon PGF:  Physiological responses to psychological challenge under hypnosis in patients considered to have the hyperventilation syndrome: Implications for diagnosis and therapy . J R Soc Med 1986;;79:76-83.
7 +
Rapee R:  Differential response to hyperventilation in panic disorder and generalized anxiety disorder . J Abnorm Psychol 1986;;95:24-28.
8 +
Ackerman S, Sachar E:  The lactate theory of anxiety: A review of re-evaluation . Psychosom Med 1974;;36:69-81.
9 +
Margraf J, Ehlers A, Roth WT:  Biological models of panic disorder and agoraphobia: A review . Behav Res Ther 1986;;24:553-567.
10 +
Hibbert GA: The diagnosis of hyperventilation using ambulatory carbon dioxide monitoring. Read before the Fourth International Symposium on Respiratory Psychophysiology, Southampton, England, 1984.
11 +
Salkovskis PM, Jones DR, Clark DM:  Respiratory control in the treatment of panic attacks: Replication and extension with concurrent measurement of behaviour and CO2 . Br J Psychiatry 1986;;148:526-532.
12 +
King R, Margraf J, Ehlers A, Maddock RJ:  Panic disorder: Overlap with symptoms of somatization disorder , in Hand I, Wittchen HU (eds): Panic and Phobias . New York, Springer Publishing Co Inc, 1986;.
13 +
Smith GR, Monson RA, Ray DC:  Patients with multiple unexplained symptoms . Arch Intern Med 1986;;146:69-72.

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