ABSTRACT
As noted above, lactate, carbon dioxide and CCK-4 all have the ability to provoke panic attacks and have been implicated in alterations in respiratory control. Klein (1993) hypothesized that panic disorder was the result of an abnormally sensitive suffocation alarm in the brain stem. Thus, in vulnerable individuals, activation of this alarm system provokes hyperventilation with associated fear and attempts to flee. Support for this theory comes from studies on children with a congenital hypoventilatory syndrome. These children lack the normal automatic drive to breathe, presumably because they lack the suffocation monitor. In a study of 13 such children, Pine et al (1994) showed that they had the lowest incidence of anxiety disorders. Interestingly they also compared them with children with asthma and found that the children with asthma had the highest rates of anxiety disorder. As already noted earlier (page 14) there is an increased incidence of panic disorder in those who have respiratory disease. Taken together, these clinical abnormalities suggest a significant role for respiratory factors in panic disorder.
