P0073 - Panic attacks and the homeostatic alarm system

Abstract

Several experimental evidences support the existence of a panic respiration connection, however only recent studies, investigating the complexity of respiratory physiology, revealed consistent irregularities in respiratory pattern and suggest that these abnormalities might be a trait marker of the panic disease. The high irregularity observed, together with the unpleasant respiratory sensations in patients with PD, could be the result of the activation of a suffocation false alarm. Basic physiological functions in the organism are strictly interrelated in a global network with reciprocal modulations and, since also abnormalities in cardiac and balance system function have been described in patients with panic disorder, perturbations of these other basic systems or a more general dysfunction of our homeostatic brain might explain respiratory findings (Perna et al 2004). A recent brain imaging study reported an increase in brainstem volume in patients with panic disorder (Protopescu et al 2006). Regulatory physiologic processes take place continuously beyond the consciousness and only occasionally they pervade the conscious awareness as “primal emotions”. Panic attacks could be the expression of primal emotion arising from phylogenetically ancient brain circuits processing physiological perceptions/sensations linked to homeostatic functions.

Protopopescu X, Pan H, Tuescher O, Cloitre M, Goldstein M, Engelien A, Yang Y, Gorman J, LeDoux J, Stern E, Silbersweig D. Increased braistem volume in panic disorder: a voxel-based morphometric study. Neuroreport, 20;17:361-3, 2006

Perna G, Caldirola D, Bellodi L: Panic Disorder: from respiration to the homeostatic brain. Acta Neuropsychiatrica, 16: 57-67, 2004