Panic Disorder
- Panic Attack
- Panic Disorder
- Recurrent Panic Attacks
- Anticipatory Anxiety
- Agoraphobia
- Hypochondriasis
- Demoralisation
- Epidemiology
- Age of Onset
- Situation of Onset
- Stressful Life Events
- Early Life Events
- Maternal Over-Protection
- Separation Anxiety
- Short and Long-term Outcomes
- Comorbidity
- Panic Disorder: Pathogenesis
- Biological Findings
- Provocative Agents
- Neurotransmitter Systems
- Neuroanatomical Models
- Brain Imaging
- Psychological Models
- Psychodynamic Models
- Behavioural Models
- Cognitive Models
- Areas of Controversy and Debate
- The Evolutionary Perspective
- Panic Disorder: Treatment
- Pharmacotherapy
- Benzodiazepines
- Tricyclic Antidepressants
- Monoamine Oxidase Inhibitors
- Selective Serotonin Re-uptake Inhibitors
- Other Drugs
- Psychotherapy
Provocative Agents
Intravenous infusion of sodium lactate 0.5–1M has been reported to reliably induce panic attacks in PD patients . Twenty minutes inhalation of air containing 5% CO2 or a single inhalation of 35% CO2 induces panic attacks in PD patients. Many hypotheses have been offered to explain the panicogenic effect of lactate and CO2. One is that CO2 and lactate, after being metabolised to CO2, induce panic attacks by stimulating the respiratory centres, which are hypersensitive in PD patients. This hypothesis is consistent with the ‘‘false suffocation alarm’’ theory of Klein . This theory supposes that PD patients have a low Anxiety Disorders.
Patients with PD are more sensitive to the panicogenic effects of caffeine than normal controls. Also, m-chlorophenylpiperazine, a mixed 5-HT agonist-antagonist, and fenfluramine, a 5-HT releasing drug, have both been reported to provoke panic attacks in challenge paradigms suggesting a role for 5-HT in PD pathogenesis. Cholecystokinin-tetrapeptide (CCK- 4), a CCK agonist, is panicogenic in man