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Carbon Dioxide—Induced Anxiety: Behavioral, Physiologic, and Biochemical Effects of Carbon Dioxide in Patients With Panic Disorders and Healthy Subjects

Carbon Dioxide—Induced Anxiety: Behavioral, Physiologic, and Biochemical Effects of Carbon... Abstract • Carbon dioxide was administered for 15 minutes to patients with panic disorders (5% CO2, n =14) and healthy subjects (5% CO2, n =11; 7.5% CO2, n = 8). Following administration of CO2 and air placebo, changes in behavioral ratings, vital signs, and plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol, cortisol, growth hormone, and prolactin were measured over three hours. In the healthy subjects, CO2 produced dose-related increases in anxiety, somatic symptoms, vital signs, and plasma cortisol levels. In the patients, the frequency of panic attacks (in eight of 14 patients) and the increases in anxiety and somatic symptoms induced by 5% CO2 exceeded those in the healthy subjects and were similar to those induced by 7.5% CO2 in the healthy subjects. The physiologic and biochemical measurements obtained did not elucidate the mechanisms underlying CO2-induced anxiety or the greater anxiogenic effects of CO2 seen in patients with panic disorders. References 1. Gorman JM, Askanazi J, Liebowitz MR, Fyer AJ, Stein J, Kinney JM, Klein DF: Response to hyperventilation in a group of patients with panic disorder . Am J Psychiatry 1984;141:857-861. 2. Woods SW, Charney DS, Loke J, Goodman WK, Redmond DE, Heninger GR: Carbon dioxide sensitivity in panic anxiety . Arch Gen Psychiatry 1986;43:900-909.Crossref 3. Ehlers A, Margraf J, Roth WT, Taylor CB, Maddock RJ, Kopell BS: CO2 as a trigger for panic in panic patients. Read before the annual meeting of the American Psychiatric Association, Dallas, May 23, 1985. 4. Drury AN: The percentage of carbon dioxide in the alveolar air and the tolerance to accumulating carbon dioxide in cases of so-called 'irritable heart' of soldiers . Heart 1919;7:165-173. 5. Cohen ME, White PD: Life situations, emotions, and neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome) . Res Publ Assoc Res Nerv Ment Dis 1950;29:832-869. 6. Singh BS: Ventilatory response to CO2: II. Studies in neurotic psychiatric patients and practitioners of transcendental meditation . Psychosom Med 1984;46:347-362.Crossref 7. Sechzer PH, Egbert LD, Linde HW, Cooper DY, Dripps RD, Price HL: Effect of CO2 inhalation on arterial pressure, ECG and plasma catecholamines and 17-OH corticosteroids in normal man . J Appl Physiol 1960;15:454-458. 8. Lambertsen CJ: Therapeutic gases: Oxygen, carbon dioxide, and helium , in DiPalma JR (ed): Drill's Pharmacology in Medicine , ed 4. New York, McGraw-Hill International Book Co, 1971, pp 1167-1171. 9. Van den Hout MA, Griez E: Panic symptoms after inhalation of carbon dioxide . Br J Psychiatry 1984;144:503-507.Crossref 10. Van den Hout MA, Griez E: Peripheral panic symptoms occur during changes in alveolar carbon dioxide . Compr Psychiatry 1985;26:381-387.Crossref 11. American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 12. Redmond DE Jr: New and old evidence for the involvement of a brain norepinephrine system in anxiety , in Fann WE (ed): The Phenomenology and Treatment of Anxiety . New York, Spectrum Press, 1979, pp 153-203. 13. Carlsson A, Holmin T, Lindqvist M, Siesjo BK: Effect of hypercapnia and hypocapnia on tryptophan and tyrosine hydroxylation in rat brain . Acta Physiol Scand 1977;99:503-509.Crossref 14. Garcia de Yebenes Prous J, Carlsson A, Mena Gomez MA: The effect of CO2 on monoamine metabolism in rat brain . Naunyn Schmiedebergs Arch Pharmacol 1977;301:11-15.Crossref 15. Stone EA: Rapid adaptation of the stimulatory effect of CO2 on brain norepinephrine metabolism . Naunyn Schmiedebergs Arch Pharmacol 1983;324:313-315.Crossref 16. Oke A, Kent T, Preskorn S, Adams RN: In vivo electrochemical detection of the effects of CO2 on biogenic amine release, abstracted . Soc Neurosci Abstr 1983;9:1002. 17. Elam M, Yao T, Thoren P, Svensson TH: Hypercapnia and hypoxia: Chemoreceptor mediated control of locus coeruleus neurons and splanchnic svmpathetic nerves . Brain Res 1981;222:373-381.Crossref 18. Maas JW, Hattox SE, Greene NM, Landis DH: 3-Methoxy-4-hydroxyphenylethyleneglycol production by human brain in vivo . Science 1979;205:1025-1027.Crossref 19. Kopin IJ, Jimerson DC, Markey SP, Ebert MH, Polinsky RJ: Disposition and metabolism of MHPG in humans: Application to studies in depression . Pharmacopsychiatry 1984;17:3-8.Crossref 20. Woods SW, Charney DS, Heninger GR, Goodman WK, Loke J, Redmond DE Jr: Mechanisms of CO2-induced anxiety, abstracted . Soc Neurosci Abstr 1985;11:132. 21. Fyer MR, Goetz R, Askanzi T, Klein DF, Gorman JM: Hyperventilation, carbon dioxide, and anxiety. Read before the 139th Annual Meeting of the American Psychiatric Association, Washington, DC, May 14, 1986. 22. Richards JB, Stein SN: Effect of CO2 exposure and respiratory acidosis on adrenal 17-OH corticosteroid secretion in anesthetized dogs . Am J Physiol 1957;188:1-10. 23. Charney DS, Heninger GR, Breier A: Noradrenergic function in panic anxiety: Effects of yohimbine in healthy subjects and patients with agoraphobia and panic disorder . Arch Gen Psychiatry 1984;41:751-763.Crossref 24. Schneider EC, Truesdell D: The effects on the circulation and respiration of an increase in the carbon dioxide content of the blood in man . Am J Physiol 1922;63:155-175. 25. Dripps RD, Comroe JH Jr: The respiratory and circulatory response of normal man to inhalation of 7.6 and 10.4% CO2 with a comparison of the maximal ventilation produced by severe muscular exercise, inhalation of CO2, and maximal voluntary hyperventilation . Am J Physiol 1947;149:43-51. 26. Goldstein JD, DuBois EL: The effect on the circulation in man of rebreathing different concentrations of carbon dioxide . Am J Physiol 1927;81:650-660. 27. Hardgrove M, Roth GM, Brown GE: The pressor reaction produced by inhalation of carbon dioxide: Studies of patients with normal blood pressure and with hypertension . Ann Intern Med 1938;12:482-492.Crossref 28. Downing SE, Siegel JH: Baroreceptor and chemoreceptor influences on sympathetic discharge to the heart . Am J Physiol 1963;204:471-479. 29. Nahas GG: Effect of hydrocortisone on acidotic failure of the isolated heart . Circ Res 1957;5:489-492.Crossref 30. Price HL: Effects of carbon dioxide on the cardiovascular system . Anesthesiology 1960;21:652-663.Crossref 31. Honig CR, Tenney SM: Determinants of the circulatory response to hypoxia and hypercapnia . Am Heart J 1957;53:687-698.Crossref 32. Lurie AA, Jones RE, Linde HW, Price ML, Dripps RD, Price HL: Cyclopropane anesthesia: Cardiac rate and rhythm during steady levels of cyclopropane anesthesia at normal and elevated end-expiratory carbon dioxide tensions . Anesthesiology 1958;19:457.Crossref 33. McDowall RJS: On variation in activity of cardio-inhibitory centre . J Physiol 1931;71:417. 34. CoTui, Burnstein CL, Ruggiero WF: Total spinal block: A preliminary report . Anesthesiology 1940;1:280-291.Crossref 35. Smith HW, Rovenstine EA, Goldring W, Chasis H, Ranges HA: The effects of spinal anesthesia on the circulation in normal, unoperated man with reference to the autonomy of the arterioles, and especially those of the renal circulation . J Clin Invest 1939;18:319-341.Crossref 36. Cullen DJ, Eger EI II: Cardiovascular effects of carbon dioxide in man . Anesthesiology 1979;41:345-349.Crossref 37. Rose RM: Overview of endocrinology of stress , in Brown GM, Koslow SH, Reichlin S (eds): Neuroendocrinology and Psychiatric Disorder . New York, Raven Press, 1984, pp 95-131. 38. Pinter EJ, Tolis G, Guyda H, Katsarkas A: Hormonal and free fatty acid changes during strenuous flight in novices and trained personnel . Psychoneuroendocrinology 1979;4:79-82.Crossref 39. Noel GL, Suh HK, Stone JG, Frantz AG: Human prolactin and growth hormone release during surgery and other conditions of stress . J Clin Endocrinol Metab 1972;35:840-851.Crossref 40. Miyabo S, Asato T, Mizushima N: Prolactin and growth hormone responses to psychological stress in normal and neurotic subjects . J Clin Endocrinol Metab 1977;44:947-951.Crossref 41. Hamilton M: Diagnosis and ratings of anxiety . Br J Psychiatry 1969;3:76-79. 42. Zitrin GM, Klein DF, Woerner MG, Ross DC: Treatment of phobias: Comparison of imipramine and placebo . Arch Gen Psychiatry 1983;40:125-138.Crossref 43. Dekirmenjian H, Maas JW: MHPG in plasma . Clin Chim Acta 1974;52:203-208.Crossref 44. Maas JW, Hattox SE, Roth RH: The determination of a brain arteriovenous difference for 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) . Brain Res 1976;118:167-174.Crossref 45. Schalch DS, Packer ML: A sensitive double antibody immunoassay for human growth hormone in plasma . Nature 1964;263:1141-1142.Crossref 46. SAS Institute Inc: SAS User's Guide: Statistics. Cary, NC, SAS Institute Inc, 1982. 47. Dixon WJ, Brown MB, Engelman L, Frane JW, Hill MA, Jennvick RI, Toporek JD: BMDP Statistical Software: 1983 Printing With Additions . Berkeley, Calif, University of California Press, 1983. 48. Checkley SA, Glass IB, Thompson C, Corn T, Robinson P: The GH response to clonidine in endogenous as compared with reactive depression . Psychol Med 1984;14:773-777.Crossref 49. Berger AJ, Mitchell RA, Severinghaus JW: Regulation of respiration . N Engl J Med 1977;297:92-97, 138-143, 194-201.Crossref 50. Rebuck AS, Slutsky AS: Measurement of ventilatory responses to hypercapnia and hypoxia , in Hornbein TF (ed): Regulation of Breathing . New York, Marcel Dekker Inc, 1981, pp 745-772. 51. Dempsey JA: CO2 response: Stimulus definition and limitations . Chest 1976;70( (suppl) ):114-118.Crossref 52. Slater SL, Leavy A: The effects of inhaling a 35% CO2—65% O2 mixture upon anxiety level in neurotic patients . Behav Res Ther 1966;4:309-316.Crossref 53. Ley R, Walker H: Effects of carbon dioxide-oxygen inhalation on heart rate, blood pressure, and subjective anxiety . J Behav Ther Exp Psychiatry 1973;4:223-228.Crossref 54. Latimer P: Carbon dioxide as a reciprocal inhibitor in the treatment of neurosis . J Behav Ther Exp Psychiatry 1977;8:83-85.Crossref 55. Haslam MT: The relationship between the effect of lactate infusion on anxiety states, and their amelioration by carbon dioxide inhalation . Br J Psychiatry 1974;125:88-90.Crossref 56. Wolpe J: Psychotherapy by Reciprocal Inhibition . Stanford, Calif, Stanford University Press, 1985, pp 74, 166, 168. 57. Rose EC Jr, Althaus JA, Kaiser DL, Miller ED, Carey RM: Acute hypoxemia and hypercapnia: Increase in plasma catecholamines in conscious dogs . Am J Physiol 1983;245:H924-H929. 58. O'Brodovich HM, Stalcup SA, Pang LM, Mellins RB: Hemodynamic and vasoactive mediator response to experimental respiratory failure . J Appl Physiol 1982;52:1230-1236. 59. Miller RA, Morris ME: Norepinephrine release during respiratory acidosis in adrenalectomized dogs . Anesthesiology 1961;22:62-66.Crossref 60. Price HL, Lurie AA, Jones RE, Price ML, Linde HW: Cyclopropane anesthesia: II. Epinephrine and norepinephrine in initiation of ventricular arrhythmias by carbon dioxide inhalation . Anesthesiology 1958;19:619-630.Crossref 61. Charney DS, Heninger GR, Jatlow PI: Increased anxiogenic effects of caffeine in panic disorders . Arch Gen Psychiatry 1985;42:233-243.Crossref 62. Carr DB, Sheehan DV, Surman OS, Coleman JH, Greenblatt DJ, Heninger GR, Jones KJ, Levine PH, Watkins WD: Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy . Am J Psychiatry 1986;143:483-494. 63. Woods SW, Charney DS, McPherson CA, Gradman AH, Heninger GR: Situational panic attacks: Behavioral, physiological, and biochemical characterization . Arch Gen Psychiatry 1987;44:365-375.Crossref 64. Woods SW, Goodman WK, Charney DS: NE Hyperactivity Associated With Yohimbine Panic , New Research Abstract 7. Washington, DC, American Psychiatric Association, 1986. 65. Nesse RM, Cameron OG, Curtis GC, McCann DS, Huber-Smith MJ: Adrenergic function in patients with panic anxiety . Arch Gen Psychiatry 1984;41:771-776.Crossref 66. Carr DB, Sheehan DV: Panic anxiety: A new biological model . J Clin Psychiatry 1984;45:323-330. 67. Bledsoe SW, Hornbein TF: Central chemosensors and the regulation of their chemical environment , in Hornbein TF (ed): Regulation of Breathing . New York, Marcel Dekker, Inc, 1981, pp 347-428. 68. Loeschcke HH: Central chemosensitivity and the reaction theory . J Physiol 1982;332:1-24. 69. Liebowitz MR, Gorman JM, Fyer AF, Levitt M, Dillon D, Levy G, Appleby IL, Anderson S, Palij M, Davies SO, Klein DF: Lactate provocation of panic attacks: II. Biochemical and physiological findings . Arch Gen Psychiatry 1985;42:709-719.Crossref 70. Evans IM: A conditioning model of a common neurotic pattern: Fear of fear . Psychother Theory Res Pract 1972;9:238-241.Crossref 71. Clark DM: A cognitive approach to panic . Behav Res Ther 1986;24:461-470.Crossref 72. Barlow DH: A psychological model of panic , in Shaw BF, Cashman F, Segal ZV, Vallis TM (eds): Anxiety Disorder: Theory, Diagnosis and Treatment . New York, Plenum Publishing Corp, in press. 73. Cameron IR, Davson H, Segal MB: The effect of hypercapnia on the blood-brain barrier to sucrose in the rabbit . Yale J Biol Med 1969-70;42:241-247. 74. Kety SS, Schmidt CF: The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men . J Clin Invest 1948;27:484-492.Crossref 75. Lassen NA, Christensen MS: Physiology of cerebral blood flow . Br J Anaesth 1976;48:719-734.Crossref 76. Reiman EM, Raichle ME, Robins E, Butler FK, Herscovitch P, Fox P, Perlmutter J: The application of positron emission tomography to the study of panic disorder . Am J Psychiatry 1986;143:469-477. 77. Reiman EM, Raichle ME, Butler FK, Herscovitch P, Robins E: A focal brain abnormality in panic disorder, a severe form of anxiety . Nature 1984;310:683-685.Crossref 78. Ramana Reddy SV, Yaksh TL, Anderson RE, Sundt TM Jr: Effect in cat of locus coeruleus lesions on the response of cerebral blood flow and cardiac output to altered paCO2 . Brain Res 1986;365:278-288.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Carbon Dioxide—Induced Anxiety: Behavioral, Physiologic, and Biochemical Effects of Carbon Dioxide in Patients With Panic Disorders and Healthy Subjects

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References (81)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-990X
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1598-3636
DOI
10.1001/archpsyc.1988.01800250051007
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Abstract

Abstract • Carbon dioxide was administered for 15 minutes to patients with panic disorders (5% CO2, n =14) and healthy subjects (5% CO2, n =11; 7.5% CO2, n = 8). Following administration of CO2 and air placebo, changes in behavioral ratings, vital signs, and plasma levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol, cortisol, growth hormone, and prolactin were measured over three hours. In the healthy subjects, CO2 produced dose-related increases in anxiety, somatic symptoms, vital signs, and plasma cortisol levels. In the patients, the frequency of panic attacks (in eight of 14 patients) and the increases in anxiety and somatic symptoms induced by 5% CO2 exceeded those in the healthy subjects and were similar to those induced by 7.5% CO2 in the healthy subjects. The physiologic and biochemical measurements obtained did not elucidate the mechanisms underlying CO2-induced anxiety or the greater anxiogenic effects of CO2 seen in patients with panic disorders. References 1. Gorman JM, Askanazi J, Liebowitz MR, Fyer AJ, Stein J, Kinney JM, Klein DF: Response to hyperventilation in a group of patients with panic disorder . Am J Psychiatry 1984;141:857-861. 2. Woods SW, Charney DS, Loke J, Goodman WK, Redmond DE, Heninger GR: Carbon dioxide sensitivity in panic anxiety . Arch Gen Psychiatry 1986;43:900-909.Crossref 3. Ehlers A, Margraf J, Roth WT, Taylor CB, Maddock RJ, Kopell BS: CO2 as a trigger for panic in panic patients. Read before the annual meeting of the American Psychiatric Association, Dallas, May 23, 1985. 4. Drury AN: The percentage of carbon dioxide in the alveolar air and the tolerance to accumulating carbon dioxide in cases of so-called 'irritable heart' of soldiers . Heart 1919;7:165-173. 5. Cohen ME, White PD: Life situations, emotions, and neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome) . Res Publ Assoc Res Nerv Ment Dis 1950;29:832-869. 6. Singh BS: Ventilatory response to CO2: II. Studies in neurotic psychiatric patients and practitioners of transcendental meditation . Psychosom Med 1984;46:347-362.Crossref 7. Sechzer PH, Egbert LD, Linde HW, Cooper DY, Dripps RD, Price HL: Effect of CO2 inhalation on arterial pressure, ECG and plasma catecholamines and 17-OH corticosteroids in normal man . J Appl Physiol 1960;15:454-458. 8. Lambertsen CJ: Therapeutic gases: Oxygen, carbon dioxide, and helium , in DiPalma JR (ed): Drill's Pharmacology in Medicine , ed 4. New York, McGraw-Hill International Book Co, 1971, pp 1167-1171. 9. Van den Hout MA, Griez E: Panic symptoms after inhalation of carbon dioxide . Br J Psychiatry 1984;144:503-507.Crossref 10. Van den Hout MA, Griez E: Peripheral panic symptoms occur during changes in alveolar carbon dioxide . Compr Psychiatry 1985;26:381-387.Crossref 11. American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980. 12. Redmond DE Jr: New and old evidence for the involvement of a brain norepinephrine system in anxiety , in Fann WE (ed): The Phenomenology and Treatment of Anxiety . New York, Spectrum Press, 1979, pp 153-203. 13. Carlsson A, Holmin T, Lindqvist M, Siesjo BK: Effect of hypercapnia and hypocapnia on tryptophan and tyrosine hydroxylation in rat brain . Acta Physiol Scand 1977;99:503-509.Crossref 14. Garcia de Yebenes Prous J, Carlsson A, Mena Gomez MA: The effect of CO2 on monoamine metabolism in rat brain . Naunyn Schmiedebergs Arch Pharmacol 1977;301:11-15.Crossref 15. Stone EA: Rapid adaptation of the stimulatory effect of CO2 on brain norepinephrine metabolism . Naunyn Schmiedebergs Arch Pharmacol 1983;324:313-315.Crossref 16. Oke A, Kent T, Preskorn S, Adams RN: In vivo electrochemical detection of the effects of CO2 on biogenic amine release, abstracted . Soc Neurosci Abstr 1983;9:1002. 17. Elam M, Yao T, Thoren P, Svensson TH: Hypercapnia and hypoxia: Chemoreceptor mediated control of locus coeruleus neurons and splanchnic svmpathetic nerves . Brain Res 1981;222:373-381.Crossref 18. Maas JW, Hattox SE, Greene NM, Landis DH: 3-Methoxy-4-hydroxyphenylethyleneglycol production by human brain in vivo . Science 1979;205:1025-1027.Crossref 19. Kopin IJ, Jimerson DC, Markey SP, Ebert MH, Polinsky RJ: Disposition and metabolism of MHPG in humans: Application to studies in depression . Pharmacopsychiatry 1984;17:3-8.Crossref 20. Woods SW, Charney DS, Heninger GR, Goodman WK, Loke J, Redmond DE Jr: Mechanisms of CO2-induced anxiety, abstracted . Soc Neurosci Abstr 1985;11:132. 21. Fyer MR, Goetz R, Askanzi T, Klein DF, Gorman JM: Hyperventilation, carbon dioxide, and anxiety. Read before the 139th Annual Meeting of the American Psychiatric Association, Washington, DC, May 14, 1986. 22. Richards JB, Stein SN: Effect of CO2 exposure and respiratory acidosis on adrenal 17-OH corticosteroid secretion in anesthetized dogs . Am J Physiol 1957;188:1-10. 23. Charney DS, Heninger GR, Breier A: Noradrenergic function in panic anxiety: Effects of yohimbine in healthy subjects and patients with agoraphobia and panic disorder . Arch Gen Psychiatry 1984;41:751-763.Crossref 24. Schneider EC, Truesdell D: The effects on the circulation and respiration of an increase in the carbon dioxide content of the blood in man . Am J Physiol 1922;63:155-175. 25. Dripps RD, Comroe JH Jr: The respiratory and circulatory response of normal man to inhalation of 7.6 and 10.4% CO2 with a comparison of the maximal ventilation produced by severe muscular exercise, inhalation of CO2, and maximal voluntary hyperventilation . Am J Physiol 1947;149:43-51. 26. Goldstein JD, DuBois EL: The effect on the circulation in man of rebreathing different concentrations of carbon dioxide . Am J Physiol 1927;81:650-660. 27. Hardgrove M, Roth GM, Brown GE: The pressor reaction produced by inhalation of carbon dioxide: Studies of patients with normal blood pressure and with hypertension . Ann Intern Med 1938;12:482-492.Crossref 28. Downing SE, Siegel JH: Baroreceptor and chemoreceptor influences on sympathetic discharge to the heart . Am J Physiol 1963;204:471-479. 29. Nahas GG: Effect of hydrocortisone on acidotic failure of the isolated heart . Circ Res 1957;5:489-492.Crossref 30. Price HL: Effects of carbon dioxide on the cardiovascular system . Anesthesiology 1960;21:652-663.Crossref 31. Honig CR, Tenney SM: Determinants of the circulatory response to hypoxia and hypercapnia . Am Heart J 1957;53:687-698.Crossref 32. Lurie AA, Jones RE, Linde HW, Price ML, Dripps RD, Price HL: Cyclopropane anesthesia: Cardiac rate and rhythm during steady levels of cyclopropane anesthesia at normal and elevated end-expiratory carbon dioxide tensions . Anesthesiology 1958;19:457.Crossref 33. McDowall RJS: On variation in activity of cardio-inhibitory centre . J Physiol 1931;71:417. 34. CoTui, Burnstein CL, Ruggiero WF: Total spinal block: A preliminary report . Anesthesiology 1940;1:280-291.Crossref 35. Smith HW, Rovenstine EA, Goldring W, Chasis H, Ranges HA: The effects of spinal anesthesia on the circulation in normal, unoperated man with reference to the autonomy of the arterioles, and especially those of the renal circulation . J Clin Invest 1939;18:319-341.Crossref 36. Cullen DJ, Eger EI II: Cardiovascular effects of carbon dioxide in man . Anesthesiology 1979;41:345-349.Crossref 37. Rose RM: Overview of endocrinology of stress , in Brown GM, Koslow SH, Reichlin S (eds): Neuroendocrinology and Psychiatric Disorder . New York, Raven Press, 1984, pp 95-131. 38. Pinter EJ, Tolis G, Guyda H, Katsarkas A: Hormonal and free fatty acid changes during strenuous flight in novices and trained personnel . Psychoneuroendocrinology 1979;4:79-82.Crossref 39. Noel GL, Suh HK, Stone JG, Frantz AG: Human prolactin and growth hormone release during surgery and other conditions of stress . J Clin Endocrinol Metab 1972;35:840-851.Crossref 40. Miyabo S, Asato T, Mizushima N: Prolactin and growth hormone responses to psychological stress in normal and neurotic subjects . J Clin Endocrinol Metab 1977;44:947-951.Crossref 41. Hamilton M: Diagnosis and ratings of anxiety . Br J Psychiatry 1969;3:76-79. 42. Zitrin GM, Klein DF, Woerner MG, Ross DC: Treatment of phobias: Comparison of imipramine and placebo . Arch Gen Psychiatry 1983;40:125-138.Crossref 43. Dekirmenjian H, Maas JW: MHPG in plasma . Clin Chim Acta 1974;52:203-208.Crossref 44. Maas JW, Hattox SE, Roth RH: The determination of a brain arteriovenous difference for 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) . Brain Res 1976;118:167-174.Crossref 45. Schalch DS, Packer ML: A sensitive double antibody immunoassay for human growth hormone in plasma . Nature 1964;263:1141-1142.Crossref 46. SAS Institute Inc: SAS User's Guide: Statistics. Cary, NC, SAS Institute Inc, 1982. 47. Dixon WJ, Brown MB, Engelman L, Frane JW, Hill MA, Jennvick RI, Toporek JD: BMDP Statistical Software: 1983 Printing With Additions . Berkeley, Calif, University of California Press, 1983. 48. Checkley SA, Glass IB, Thompson C, Corn T, Robinson P: The GH response to clonidine in endogenous as compared with reactive depression . Psychol Med 1984;14:773-777.Crossref 49. Berger AJ, Mitchell RA, Severinghaus JW: Regulation of respiration . N Engl J Med 1977;297:92-97, 138-143, 194-201.Crossref 50. Rebuck AS, Slutsky AS: Measurement of ventilatory responses to hypercapnia and hypoxia , in Hornbein TF (ed): Regulation of Breathing . New York, Marcel Dekker Inc, 1981, pp 745-772. 51. Dempsey JA: CO2 response: Stimulus definition and limitations . Chest 1976;70( (suppl) ):114-118.Crossref 52. Slater SL, Leavy A: The effects of inhaling a 35% CO2—65% O2 mixture upon anxiety level in neurotic patients . Behav Res Ther 1966;4:309-316.Crossref 53. Ley R, Walker H: Effects of carbon dioxide-oxygen inhalation on heart rate, blood pressure, and subjective anxiety . J Behav Ther Exp Psychiatry 1973;4:223-228.Crossref 54. Latimer P: Carbon dioxide as a reciprocal inhibitor in the treatment of neurosis . J Behav Ther Exp Psychiatry 1977;8:83-85.Crossref 55. Haslam MT: The relationship between the effect of lactate infusion on anxiety states, and their amelioration by carbon dioxide inhalation . Br J Psychiatry 1974;125:88-90.Crossref 56. Wolpe J: Psychotherapy by Reciprocal Inhibition . Stanford, Calif, Stanford University Press, 1985, pp 74, 166, 168. 57. Rose EC Jr, Althaus JA, Kaiser DL, Miller ED, Carey RM: Acute hypoxemia and hypercapnia: Increase in plasma catecholamines in conscious dogs . Am J Physiol 1983;245:H924-H929. 58. O'Brodovich HM, Stalcup SA, Pang LM, Mellins RB: Hemodynamic and vasoactive mediator response to experimental respiratory failure . J Appl Physiol 1982;52:1230-1236. 59. Miller RA, Morris ME: Norepinephrine release during respiratory acidosis in adrenalectomized dogs . Anesthesiology 1961;22:62-66.Crossref 60. Price HL, Lurie AA, Jones RE, Price ML, Linde HW: Cyclopropane anesthesia: II. Epinephrine and norepinephrine in initiation of ventricular arrhythmias by carbon dioxide inhalation . Anesthesiology 1958;19:619-630.Crossref 61. Charney DS, Heninger GR, Jatlow PI: Increased anxiogenic effects of caffeine in panic disorders . Arch Gen Psychiatry 1985;42:233-243.Crossref 62. Carr DB, Sheehan DV, Surman OS, Coleman JH, Greenblatt DJ, Heninger GR, Jones KJ, Levine PH, Watkins WD: Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy . Am J Psychiatry 1986;143:483-494. 63. Woods SW, Charney DS, McPherson CA, Gradman AH, Heninger GR: Situational panic attacks: Behavioral, physiological, and biochemical characterization . Arch Gen Psychiatry 1987;44:365-375.Crossref 64. Woods SW, Goodman WK, Charney DS: NE Hyperactivity Associated With Yohimbine Panic , New Research Abstract 7. Washington, DC, American Psychiatric Association, 1986. 65. Nesse RM, Cameron OG, Curtis GC, McCann DS, Huber-Smith MJ: Adrenergic function in patients with panic anxiety . Arch Gen Psychiatry 1984;41:771-776.Crossref 66. Carr DB, Sheehan DV: Panic anxiety: A new biological model . J Clin Psychiatry 1984;45:323-330. 67. Bledsoe SW, Hornbein TF: Central chemosensors and the regulation of their chemical environment , in Hornbein TF (ed): Regulation of Breathing . New York, Marcel Dekker, Inc, 1981, pp 347-428. 68. Loeschcke HH: Central chemosensitivity and the reaction theory . J Physiol 1982;332:1-24. 69. Liebowitz MR, Gorman JM, Fyer AF, Levitt M, Dillon D, Levy G, Appleby IL, Anderson S, Palij M, Davies SO, Klein DF: Lactate provocation of panic attacks: II. Biochemical and physiological findings . Arch Gen Psychiatry 1985;42:709-719.Crossref 70. Evans IM: A conditioning model of a common neurotic pattern: Fear of fear . Psychother Theory Res Pract 1972;9:238-241.Crossref 71. Clark DM: A cognitive approach to panic . Behav Res Ther 1986;24:461-470.Crossref 72. Barlow DH: A psychological model of panic , in Shaw BF, Cashman F, Segal ZV, Vallis TM (eds): Anxiety Disorder: Theory, Diagnosis and Treatment . New York, Plenum Publishing Corp, in press. 73. Cameron IR, Davson H, Segal MB: The effect of hypercapnia on the blood-brain barrier to sucrose in the rabbit . Yale J Biol Med 1969-70;42:241-247. 74. Kety SS, Schmidt CF: The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men . J Clin Invest 1948;27:484-492.Crossref 75. Lassen NA, Christensen MS: Physiology of cerebral blood flow . Br J Anaesth 1976;48:719-734.Crossref 76. Reiman EM, Raichle ME, Robins E, Butler FK, Herscovitch P, Fox P, Perlmutter J: The application of positron emission tomography to the study of panic disorder . Am J Psychiatry 1986;143:469-477. 77. Reiman EM, Raichle ME, Butler FK, Herscovitch P, Robins E: A focal brain abnormality in panic disorder, a severe form of anxiety . Nature 1984;310:683-685.Crossref 78. Ramana Reddy SV, Yaksh TL, Anderson RE, Sundt TM Jr: Effect in cat of locus coeruleus lesions on the response of cerebral blood flow and cardiac output to altered paCO2 . Brain Res 1986;365:278-288.Crossref

Journal

Archives of General Psychiatry – American Medical Association

Published: Jan 1, 1988

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