Fear of bodily symptoms of arousal has been implicated in the pathogenesis of both spontaneously occurring and experimentally provoked panic. Fear of bodily symptoms may be characteristic for panic disorder (PD) and is hypothesized to predict state anxiety and panic frequency during experimentally induced peripheral arousal. Twenty-eight subjects, 14 with PD and 14 with social phobia (SP) were infused with placebo and epinephrine (20, 40 and 80 ng/kg bodyweight/min) according to a fixed schedule in a single blind design. Fear of bodily symptoms was higher in subjects with PD, who also reported more bodily symptoms and higher state anxiety scores during the experiment. The panic rate (five out of 14), however, was the same in both groups. Panickers did not differ from non-panickers in trait- or baseline measures except for fear of bodily symptoms, which was marginally higher in panickers. Panickers showed greater reactivity in heart rate, diastolic blood pressure and capillary PCO2. Our data do not support the hypothesis of a major role for fear of bodily symptoms in epinephrine-induced panic. Also, our results do not demonstrate a different reaction to epinephrine in PD and SP with situational panic attacks.
Ackerman S.H., Sachar E.J. (1974) The lactate theory of anxiety: a review and a reevaluation . Psychosom Med36: 69-81
2.
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorder, 3rd edn revised. American Psychiatric Association, Washington DC
3.
Aronson T.A., Whitaker-Azmitia P., Caraseti I. (1989) Differential reactivity to lactate infusions: the relative role of biological, psychological, and conditioning variables. Biol Psychiatr25: 469-481
4.
Balon R.,Yeragani V.K., Pohl R., Muench J., Berchou R. (1990) Somatic and psychological symptoms during isoprotenerol-induced panic attacks. Psychiatr Res32: 103-112
5.
Basoglu M., Marks I.M., Sengun S. (1992) A prospective study of panic and anxiety in agoraphobia with panic disorder. Br J Psychiatr160: 57-64
6.
Breggin P.R. (1964) The psychophysiology of anxiety. J Ment Nerv Dis139: 558-568
7.
Cameron O.G., Lee M.A., Curtis G.C., McCann D.S. (1987) Endocrine and physiological changes during spontaneous panic attacks. Psychoneuroendocrinology12: 321-331
8.
Carr D.B., Sheehan D.V., Surmos O.S., Coleman J.H., Greenblatt D.J., Heninger G.R., Jones K.J., Levine P.H., Watkins W.D. (1986) Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy. Am J Psychiatr143: 483-494
9.
Chambless D.L., Caputo G.C., Bright P., Gallagher R. (1984) Assessment of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobics Cognitions Questionnaire. J Cons Clin Psychol52:1090-1097
10.
Clark D.M. (1986) A cognitive approach to panic. Behav Res Ther24: 461-470
11.
Clark D.M. (1993) Cognitive mediation of panic attacks induced by biological challenge tests. Adv Behav Res Ther1575-84
12.
den BoerJ.A.,Westenberg H G M, Klompmakers A.A., Lint L E M van (1989) Behavioral biochemical and neuroendocrine concomitants of lactate-induced panic anxiety. Biol Psychiatr26: 612-622
13.
Dimsdale J., Moss J. ( 1980) Short-term catecholamine response to psychological distress . Psychosom Med42: 493-497
14.
DiNardo P.A., Barlow D.H. (1989) Anxiety Disorders Interview Schedule Revised (ADIS-R) . State University of New York, Albany, NY
15.
DiNardo P.A., Moras K., Barlow D.H., Rapee R., Brown T.A. (1993) Reliability of DSM-III-R anxiety disorder categories . Arch Gen Psychiatr50: 251-256
16.
Donnell C.D., McNally R.J. (1989) Anxiety sensitivity and history of panic as predictors of response to hyperventilation. Behav Res Ther27:325-332
17.
Faassen I van, Popp-Snijders C., Nauta J J P, Zijderveld G A van, Doornen L J P van, Tilders F J H (1992) Platelet catecholamine contents as related to trait anxiety and aerobic fitness. Am J Physiol263: E245-E249
18.
Goldstein A.J., Chambless D.L. (1978) A reanalysis of agoraphobia. Behav Ther9: 47-59
19.
Gorman J.M., Fyer M.R., Goetz R., Askanazi J., Liebowitz M.R., Fyer A.J., Kinney J., Klein D.F. (1988) Ventilatory physiology of patients with panic disorder . Arch Gen Psychiatr45: 31-39
20.
Gorman J.M., Liebowitz M.R., Fyer A.J., Stein J. (1989) A neuroanatomical hypothesis for panic disorder . Am J Psychiatr146:148-161
21.
Griez E., Zandbergen J., Pols H., de Loof C. (1990) Response to 35% CO2 as a marker of panic in severe anxiety. Am J Psychiatr147: 796-797
22.
Guttmacher L.B., Murphy D.L., Insel T.R. (1983) Pharmacologic models of anxiety. Compr Psychiatr24: 312-325
23.
Holloway W., McNally R.J. (1987) Effects of anxiety sensitivity on the response to hyperventilation. J Abn Psychol96: 330-334
24.
Hout M A van den (1988) The explanation of experimental panic. In Rachman S, Maser J D (eds), Panic: psychological perspectives. Erlbaum, Hillsdale NJ, pp. 237-257
25.
Hout M.A.van den, Molen G.M.van der, Griez E., Lousberg H. (1987) Specificity of interoceptive fears to panic disorders . J Psychopathol Behav Ass9: 99-106
26.
Keltz H., Samortin T., Stone D.J. (1972) Hyperventilation: a manifestation of exogenous β-adrenergic stimulation. Am Rev Resp Dis105637-640
27.
Koszycki D., Cox B.J., Bradwejn J. (1993) Anxiety sensitivity and response to CCK-4 in healthy volunteers. Am J Psychiatr150: 1881-1883
28.
Liebowitz M.R., Fyer A.J., Gorman J.M., Dillon D., Davies S., Stein J.M., Cohen B.S., Klein D.F. (1985) Specificity of lactate infusions on social phobia versus panic disorders. Am J Psychiatr142: 947-950
29.
Lindemann E., Finesinger J.E. (1938) The effect of epinephrine and mecholyl in states of anxiety in psychoneurotic patients. Am J Psychiatr95: 353-370
30.
Lindemann E., Finesinger J.E. (1940) Subjective responses of psychoneurotic patients to epinephrine and mecholyl. Psychosom Med2: 231-248
31.
Manuzza S., Fyer A.J., Liebowitz M.R., Klein D.F. (1990) Delineating the boundaries of social phobia: its relationship to panic disorder and agoraphobia. J Anx Disord4: 41-59
32.
Marañon G. (1924) Contribution a l'étude de l'action émotive de l'adrénaline . Rev Fr Endocrinol2: 301-325
33.
Margraf J., Ehlers A., Roth W.T. (1987) Panic attacks: theoretical models and empirical evidence. In Wittchen H-U (ed), Panic and phobias. Springer, Heidelberg , pp. 31-43
34.
Nutt D., Lawson C. (1992) Panic attacks: A neurochemical over view of models and mechanisms. Br J Psychiatr160: 165-178
35.
Papp L.A., Gorman J.M., Liebowitz M.R., Fyer A.J., Cohen B., Klein D.F. (1988) Epinephrine infusions in patients with social phobia . Am J Psychiatr145: 733-736
36.
Papp L.A., Martinez J.M., Klein D.F., Ross D., Liebowitz M.R., Fyer A.J., Hollander E., Gorman J.M. (1989) Arterial blood gas changes in panic disorder and lactate-induced panic. Psychiatr Res28: 171-180
37.
Ploeg H M van der, Defares P.B., Spielberger C.D. (1980) Handleiding bij de Zelf-beoordelings vragenlijst, ZBV. Een Nederlandse bewerking van de Spielberger State-Trait Anxiety Inventory STAI-DY Swets and Zeitlinger, Lisse
Rapee R.M., Brown T.A., Antony M.M., Barlow D.H. (1992) Response to hyperventilation and inhalation of 5.5% carbon dioxide-enriched air across the DSM-III-R anxiety disorders. J Abn Psychol3: 538-552
40.
Ruiter C de (1989) Anxiety Disorders Interview Schedule-Revised (ADIS-R) (translated and adapted in Dutch). Rijksuniversiteit,Utrecht
41.
Schalekamp M A D H, Vincent H.H., Man in't Veld A.J. (1983) Adrenaline, stress, and hypertension. Lanceti : 362
42.
Spielberger C.D. (1983) Manual for the State-Trait Anxiety Inventory (STAI-form Y). Consulting Psychologists Press, Palo Alto, CA
43.
Taylor M., Koch W.J., Crockett D.J. (1991) Anxiety sensitivity, trait anxiety, and the anxiety disorders. J Anx Disord5: 293-311
44.
Veltman D.J., Zijderveld G A van, Dyck R van (1994) Fear of fear, trait anxiety and aerobic fitness in relation to state anxiety during adrenaline provocation. Anxiety, Stress, Coping7: 279-289
45.
Weil-Malherbe H., Axelrod J., Tomchick R. (1959) Blood-brain barrier for adrenaline. Science129:1226-1227
46.
Whelan R.F., Young I.M. (1953) The effect of adrenaline and noradrenaline infusions on respiration in man. Br J Pharmacol8: 98-102
