Panic disorder: the role of the balance system
Introduction
Significant relationships between balance function disorders and panic disorder (PD) has been repeatedly reported (27, 28, 29, 48, 12, 14, 25, 50, 52, 53, 16, 19, 2). The studies into these relationships have focused on two main areas: vestibular abnormalities in patients with PD, and anxiety symptoms or disorders among patients with abnormalities in the vestibular system. Jacob and co-workers (26, 28) reported vestibular abnormalities in patients with PD who complained of dizziness. This finding has been replicated in patients with PD non-specifically selected for the presence of dizziness (48, 25, 32), where the abnormalities were not the expression of a full-blown vestibular disorder. Similarly, patients with vestibular disorders have psychiatric syndromes with a particular reference to PD and agoraphobia (Hallam and Stephens, 1985).
Yardley and co-workers (1995) reported an association between vestibular abnormalities and phobic avoidance. Jacob and co-workers (1996) showed that patients with PD and agoraphobia had more vestibular abnormalities than patients with PD but without agoraphobia, patients with depressive disorders or with anxiety disorders other than panic or healthy controls. We (Allevi et al., 1997) found a significant relationship between the presence of dizziness during panic attacks and agoraphobia. It seems that in some patients phobic avoidance might not be a mere consequence of panic attacks but rather the result of a more complex interaction.
Abnormalities in the respiratory function may play a central role in the pathogenetic mechanisms underlying PD and has been mainly associated with panic attacks (34, 8). Some observations have indicated that the vestibular and the respiratory systems may work in complex interrelationships with one another. Dizziness is one of the main symptoms induced by CO2 inhalations (Perna et al., 1994a) and by hyperventilation (Fried and Grimaldi, 1993).
Balance and respiratory systems seem to influence two different aspects of panic disorder, respectively agoraphobia and panic attacks. Control centers of both, however, are located nearby in the brainstem with significant reciprocal influences and there is evidence of vestibular-respiratory functional interconnections (Furman et al., 1998). We hypothesize that balance function might play a role in the development of agoraphobia and that respiratory reactivity might influence this process. To test this hypothesis we evaluated the balance system function by posturography and respiratory reactivity by CO2 inhalation test in a sample of patients with PD.
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Subjects
Nineteen patients with PD with/without agoraphobia were included in the study [13 women and six men, mean age 27.1±9.1 years (17–46 years), age at onset: 20.1±4.8]. The patients were consecutively recruited over 8 months at the outpatient facilities of the Anxiety Disorders Clinical and Research Unit at San Raffaele Hospital in Milan. Eighteen patients (95%) admitted to the study had a lifetime history of agoraphobia. Since no normative data for the Italian general population on static
Results
The clinical characteristics of the sample and CO2 reactivity are listed in Table 1. The scores on the psychometric scales and CO2 reactivity tests equaled those of other patient populations with PD but were higher than those of healthy controls (42, 43, 44). The DHI scale score was higher than those of the general population (Guidetti, 1989) and similar to those of patients with peripheral vestibular system disorders (Mann et al., 1996).
MANOVA showed significant differences in static
Discussion
We have studied the balance system function in relation to respiratory abnormal reactivity in patients with PD. The results should be considered preliminary for two reasons. The sample size could create type II errors and the absence of comparison groups with other psychiatric disorders precludes discussion on the specificity of our findings. Moreover, static posturography measures postural sway, a valid indicator of the balance system function. However, this technique is relatively unspecific
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2015, Human Movement ScienceCitation Excerpt :It is well established that specific emotions (i.e., fear and anxiety) influence postural control. For instance, differences in postural control have been observed between individuals with and without pathological anxiety disorders (Jacob, Furman, Durrant, & Turner, 1997; Perna et al., 2001; Redfern, Furman, & Jacob, 2007) as well as between older adults with and without a fear of falling (Maki, 1997; Maki, Holliday, & Topper, 1991; Rochat et al., 2010), with anxious and fearful individuals typically demonstrating greater instability. To explore how these emotions influence postural control, researchers have experimentally manipulated fear and anxiety in healthy individuals using methods such as increasing the height of the surface on which they stand (height-induced postural threat; Adkin, Frank, Carpenter, & Peysar, 2000, 2002; Brown, Polych, & Doan, 2006; Carpenter, Adkin, Brawley, & Frank, 2006; Carpenter, Frank, Adkin, Paton, & Allum, 2004; Carpenter, Frank, Silcher, & Peysar, 2001; Cleworth, Horslen, & Carpenter, 2012; Davis, Campbell, Adkin, & Carpenter, 2009; Hauck, Carpenter, & Frank, 2008; Huffman, Horslen, Carpenter, & Adkin, 2009; Yiou, Deroche, Do, & Woodman, 2011) or presenting them with pictures known to elicit negative emotional responses (Azevedo et al., 2005; Horslen & Carpenter, 2011).
Visuo-vestibular contributions to anxiety and fear
2015, Neuroscience and Biobehavioral ReviewsCitation Excerpt :It is worth noting that agoraphobia was named by Westphal (1871) to describe symptoms of dizziness, palpitations and trembling, experienced by patients walking in open spaces, this being close to what is now described as panic (see Boyd and Crump, 1991). It is also critical, particularly in order to help explaining panic attacks which occur during the night, to consider how the vestibular and respiratory systems are linked (Perna et al., 2001). The locus coeruleus, the raphe nuclei and the ventrolateral medulla have been proposed as contributors to panic etiology (Bellodi and Perna, 1998); these regions are interconnected with the vestibular nuclei and related pathways (Balaban, 1996; Balaban and Thayer, 2001).
Performance in anxiety and spatial memory tests following bilateral vestibular loss in the rat and effects of anxiolytic and anxiogenic drugs
2012, Behavioural Brain ResearchCitation Excerpt :Vestibular dysfunction in humans is often associated with anxiety disorders, including panic attacks and phobias [1–15]. While it is possible that anxiety is a direct consequence of vestibular dysfunction, it has also been reported that anxiety disorders can cause dizziness of vestibular origin [16–20] and antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been reported to relieve dizziness associated with psychiatric symptoms [21–24]. Vestibular dysfunction in humans is also associated with cognitive deficits [25–37; see 36 and 37 for reviews].