Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

Posted on September 11, 2007 by Maurice Preter MD
J Affect Disord. 2007 Aug 27; [Epub ahead of print] Related Articles, Links
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Acute exercise reduces the effects of a 35% CO(2) challenge in patients with panic disorder.

Esquivel G, Díaz-Galvis J, Schruers K, Berlanga C, Lara-Muñoz C, Griez E.

Academic Anxiety Center, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.

BACKGROUND: Chronic exercise has been shown to have therapeutic effects in panic disorder (PD). The mechanism of these effects is unknown. Acute exercise reduces the effect of a panic challenge in healthy volunteers. Such an effect has not yet been demonstrated in PD patients. The present study aimed at exploring the antipanic effects of acute exercise on a 35% CO(2) panic provocation in treatment-naïve PD patients to further elucidate the mechanisms of the beneficial effects of exercise on panic. METHODS: Eighteen PD patients performed either moderate/hard exercise or very-light exercise before a 35% CO(2) challenge in a randomized, between-group design. The reactivity to CO(2) was assessed with the Visual Analogue Anxiety Scale and the DSM-IV Panic Symptom List. RESULTS: Panic reactions to CO(2) were smaller in patients that performed moderate/hard exercise in contrast to those that performed very-light exercise. Increments in both measurements and panic rates were consistently reduced by intense exercise. LIMITATIONS: Since this study focuses on the acute effects of exercise on CO(2) sensitivity in patients with PD, the results of repetitive exercise sessions on the rate of spontaneous panic attacks and overall symptoms are warranted. The small sample size and other limitations are addressed. CONCLUSIONS: Exercise reduced the panicogenic effects of a CO(2) challenge. In addition to its therapeutic potential, exercise may also be useful as a laboratory maneuver with heuristic value in experimental research into the mechanisms of antipanic treatment.

PMID: 17727960 [PubMed – as supplied by publisher]

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Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Posted on August 19, 2007 by Maurice Preter MD

Progress in Neuro-Psychopharmacology and Biological Psychiatry
Article in Press, Accepted Manuscript – Note to users

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doi:10.1016/j.pnpbp.2007.07.029 How to Cite or Link Using DOI (Opens New Window)
Copyright © 2007 Elsevier Inc. All rights reserved.

Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids

Maurice Pretera, Corresponding Author Contact Information, E-mail The Corresponding Author and Donald F. Kleinb, 1, E-mail The Corresponding Author
aNew York State Psychiatric Institute Columbia University College of Physicians and Surgeons, 1160 Fifth Avenue, Suite 112 New York, NY 10029, USA
bNew York State Psychiatric Institute Columbia University College of Physicians and Surgeons 1051 Riverside Drive, New York, NY 10032, USA
Received 23 February 2007; revised 24 July 2007; accepted 24 July 2007. Available online 9 August 2007.


Corresponding Author Contact InformationCorresponding author. Tel.: +1 212 713 5336; fax: +1 212 713 5336.
1 Tel.: +1 212 543 6249.

Review article

Panic, suffocation false alarms, separation anxiety and endogenous opioids

Maurice Preter a,⁎, Donald F. Klein b,1

a New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1160 Fifth Avenue, Suite 112, New York, NY 10029, USA

b New York State Psychiatric Institute, Columbia University College of Physicians&Surgeons, 1051 Riverside Drive, New York, NY 10032, USA

Received 23 February 2007; received in revised form 24 July 2007; accepted 24 July 2007

Abstract

This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively
occur when the alarm is erroneously triggered. That panic is distinct from Cannon’s emergency fear response and Selye’s General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic–pituitary–adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO2 and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of “spontaneous” panic requires an integrative explanation. Because of the opioid system’s central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.

© 2007 Elsevier Inc. All rights reserved.

Keywords: Affective neuroscience; Endogenous opioids; Panic disorder; Respiratory physiology; Separation anxiety

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Headache as a sole manifestation in nonconvulsive status epilepticus.

Posted on August 14, 2007 by Maurice Preter MD
J Child Neurol. 2007 May;22(5):660-2. Related Articles, Links
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Headache as a sole manifestation in nonconvulsive status epilepticus.

Ghofrani M, Mahvelati F, Tonekaboni H.

Child Neurology Department, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. fmshamsa@yahoo.com.

Nonconvulsive status epilepticus may present with several manifestations, and many of them may not be obvious. The most important for the diagnosis of nonconvulsive status epilepticus is the electroencephalogram pattern. This is a case report of a 9-year-old boy with severe and continuous headache. He received chemotherapy for histiocytosis that was diagnosed when he was 3 years, 6 months years old. He had no evidence of central nervous system histiocytosis involvement or drug toxicity. He was diagnosed with nonconvulsive status epilepticus. The headache and electroencephalogram anomaly disappeared completely when anticonvulsant therapy began. Headache and seizure disorder may coexist, but this may be the first report of nonconvulsive status epilepticus with headache as a sole manifestation.

PMID: 17690080 [PubMed – in process]

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Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

Posted on August 8, 2007 by Maurice Preter MD

Arch Phys Med Rehabil. 2004 Jul;85(7):1183-7. Related Articles, Links
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Intensity and duration threshold for aerobic exercise-induced analgesia to pressure pain.

Hoffman MD, Shepanski MA, Ruble SB, Valic Z, Buckwalter JB, Clifford PS.

Department of Physical Medicine and Rehabilitation, Veterans Affairs Medical Center and Medical College of Wisconsin, WI, USA. martin.hoffman@med.va.gov

OBJECTIVE: To examine how exercise-induced analgesia is affected by the duration and intensity of aerobic exercise. DESIGN: Repeated-measures design. SETTING: Exercise science laboratory. PARTICIPANTS: Convenience sample of 12 healthy male and female volunteers (mean age +/- standard deviation, 32+/-9 y). INTERVENTIONS: Pain ratings were assessed before and at 5 and 30 minutes after treadmill exercise of 10 minutes at 75% maximal oxygen uptake (Vo(2)max), 30 minutes at 50% Vo(2)max, and 30 minutes at 75% Vo(2)max (randomized order and no less than 48 h between each bout). MAIN OUTCOME MEASURES: Pain ratings were measured on a visual analog scale at 10-second intervals during a 2-minute pressure-pain stimulus to the nondominant index finger. RESULTS: Pain ratings were significantly decreased (P<.05) from pre-exercise values 5 minutes after 30 minutes of exercise at 75% Vo(2)max but returned toward baseline by 30 minutes after exercise. There were no significant changes in pain ratings after 10 minutes of exercise or after exercise at 50% Vo(2)max. CONCLUSIONS: There are thresholds for both the intensity (>50% Vo(2)max) and duration (>10 min) of exercise required to elicit exercise analgesia.

Publication Types:

PMID: 15241771 [PubMed – indexed for MEDLINE]

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A pilot study of a yoga and meditation intervention for dementia caregiver stress.

Posted on August 6, 2007 by Maurice Preter MD
J Clin Psychol. 2004 Jun;60(6):677-87. Related Articles, Links
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A pilot study of a yoga and meditation intervention for dementia caregiver stress.

Waelde LC, Thompson L, Gallagher-Thompson D.

Pacific Graduate School of Psychology, Palo Alto, CA 94303, USA. lwaelde@pgsp.edu

Twelve older female dementia patient family caregivers (eight Latinas and four Caucasians) participated in a six-session manualized yoga-meditation program (called Inner Resources) designed to help caregivers cope with stress. Pre/post comparisons revealed statistically significant reductions in depression and anxiety and improvements in perceived self-efficacy. Average minutes of weekly yoga-meditation practice were significantly associated with improvements in depression. The majority of caregivers found the intervention useful and reported subjective improvements in physical and emotional functioning. These findings suggest that Inner Resources may be a feasible and effective intervention for family caregivers and may improve affect, coping, physical well-being, and stress management. Copyright 2004 Wiley Periodicals, Inc.

Publication Types:

PMID: 15141399 [PubMed – indexed for MEDLINE]

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