Panic, suffocation false alarms, separation anxiety and endogenous opioids

• Published in: Progress in neuro-psychopharmacology & biological psychiatry Vol. 32; no. 3; pp. 603 - 612
• Main Authors: Preter, Maurice, Klein, Donald F.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.04.2008; Elsevier
• Subjects: Adult and adolescent clinical studies; Affective neuroscience; Analgesics, Opioid - metabolism; Animals; Anxiety disorders. Neuroses; Anxiety, Separation - metabolism; Anxiety, Separation - physiopathology; Asphyxia - metabolism; Asphyxia - physiopathology; Biological and medical sciences; Carbon Dioxide - physiology; Endogenous opioids; Humans; Lactates - metabolism; Medical sciences; Models, Biological; Neuropharmacology; Panic disorder; Panic Disorder - metabolism; Panic Disorder - physiopathology; Panic Disorder - psychology; Pharmacology. Drug treatments; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Respiratory physiology; Separation anxiety; DVs; CPAP; Affective neuroscience; pCO 2; ACTH; GAD; N-L; EtCO 2; Respiratory physiology; SFA; Separation anxiety; POMC; BNST; PD; ESB; SAD; Panic disorder; HPA; Endogenous opioids; PET; COPD; Affect affectivity; Panic; Anxiety disorder; Opiates; Opioid peptide; Anxiety; Respiration; Signal detection
• ISSN: 0278-5846; 1878-4216
• DOI: 10.1016/j.pnpbp.2007.07.029

This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. That panic is distinct from Cannon's emergency fear response and Selye's General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic–pituitary–adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO 2 and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of “spontaneous” panic requires an integrative explanation. Because of the opioid system's central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.