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Jack M. Gorman, MD; Minna R. Fyer, MD; Raymond Goetz, PhD; Jeffrey Askanazi, MD; Michael R. Liebowitz, MD; Abby J. Fyer, MD; John Kinney, MD; Donald F. Klein, MD

Arch Gen Psychiatry. 1988;45(1):31-39.

Abstract
• Thirty-one patients with DSM-III panic disorder or agoraphobia with panic attacks, 13 normal controls, and 12 patients with other anxiety disorders were studied during ventilatory challenge with room air hyperventilation and 5% carbon dioxide inhalation. Patients also underwent sodium lactate infusion. Among the patients with panic disorder, 58% panicked with sodium lactate, 39% with 5% CO₂, and 23% with room air hyperventilation. Of the other patients, four panicked with sodium lactate, none with 5% CO₂, and one with room air hyperventilation. One normal control panicked with both sodium lactate and 5% CO₂. Panic with CO₂ was associated with an exaggerated ventilatory response and increases in plasma norepinephrine level and diastolic blood pressure. Patients with panic disorder may have hypersensitive CO₂ receptors that, when triggered, evoke a subjective panic associated with an exaggerated ventilatory response and consequent hypocapnic alkalosis.

Author Affiliations
From the New York State Psychiatric Institute (Drs Gorman, M. Fyer, Liebowitz, A. Fyer, and Klein) and the College of Physicians and Surgeons, Columbia University (Drs Gorman, M. Fyer, Goetz, Askanazi, Liebowitz, Kinney, and Klein), New York.

Footnotes
Accepted for publication Nov 3, 1986.

Reprint requests to 722 W 168th St, New York, NY 10032 (Dr Gorman).

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