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Panic disorder: from respiration to the homeostatic brain

Published online by Cambridge University Press:  24 June 2014

Giampaolo Perna ,
Daniela Caldirola  and
Laura Bellodi
Giampaolo Perna*
Affiliation:
Anxiety Disorders Clinical and Research Unit, Istituto Scientifico H. San Raffaele, Vita-Salute University, Milan, Italy
Daniela Caldirola
Affiliation:
Anxiety Disorders Clinical and Research Unit, Istituto Scientifico H. San Raffaele, Vita-Salute University, Milan, Italy
Laura Bellodi
Affiliation:
Anxiety Disorders Clinical and Research Unit, Istituto Scientifico H. San Raffaele, Vita-Salute University, Milan, Italy
*
Giampaolo Perna MD PhD, Anxiety Disorders Clinical and Research Unit, Istituto Scientifico H. San Raffaele, Vita-Salute University, 20 Via Stamira d'Ancona, 20127, Milan, Italy. Tel.(39)-02-26433211; Fax: (39)-02 26433265. E-mail: perna.giampaolo@hsr.it
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Abstract

There is some experimental evidence to support the existence of a connection between panic and respiration. However, only recent studies investigating the complexity of respiratory physiology have revealed consistent irregularities in respiratory pattern, suggesting that these abnormalities might be a vulnerability factor to panic attacks. The source of the high irregularity observed, together with unpleasant respiratory sensations in patients with panic disorder (PD), is still unclear and different underlying mechanisms might be hypothesized. It could be the result of compensatory responses to abnormal respiratory inputs or an intrinsic deranged activity in the brainstem network shaping the respiratory rhythm. Moreover, since basic physiological functions in the organism are strictly interrelated, with reciprocal modulations and abnormalities in cardiac and balance system function having been described in PD, the respiratory findings might arise from perturbations of these other basic systems or a more general dysfunction of the homeostatic brain. Phylogenetically ancient brain circuits process physiological perceptions/sensations linked to homeostatic functions, such as respiration, and the parabrachial nucleus might filter and integrate interoceptive information from the basic homeostatic functions. These physiological processes take place continuously and subconsciously and only occasionally do they pervade the conscious awareness as ‘primal emotions’. Panic attacks could be the expression of primal emotion arising from an abnormal modulation of the respiratory/homeostatic functions.

Keywords

brainstememotionhomeostasispanic attacksrespiration
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 2 , April 2004 , pp. 57 - 67
Copyright
Copyright © 2004 Blackwell Munksgaard

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