Cardiopulmonary Exercise Testing on Patients with Panic Disorder

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  • パニック障害患者への心肺運動負荷試験
  • パニック障害患者の心肺運動負荷試験
  • パニック ショウガイ カンジャ ノ シンハイ ウンドウ フカ シケン

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Objective and Method : Despite absence of some heart disease based on examination and normal coronary angiogram, these patients, we believe, have a panic disorder (PD) , claim symptoms, social and occupational disabilities. To clarify physiological characteristics of PD, we compared findings of 24 hour Holter Electrocardiograms, personality traits and 24 hour urinary catecholamine levels in PD (n=2D with those in non-PD depressive patients (n=20) . Incremental exercise test for anaerobic threshold (AT) and six minute constant work rate tests for time constant of VO2 kinetics were performed in 10 PD patients and 10 controls. We investigated whether endogeous lactate elevation would induce panic attack. In addition, we studied the effects on the exercise capacity and catecholamine metabolism in PD patients during exercise. Results : Twenty-four hour spectral analysis of heart rate in PD showed no significant suppression of chorinergic function. However, urinary excretions of both noradrenaline and dopamine were markdly elevated in PD indicating increased noradrenergic tone in PD. All the patients completed exercise testing up to AT with-out any panic attacks. Percent of maximum oxgen uptake and % AT were reduced and time constant of V02 kinetics was prolonged in PD, demonstrating excercise characteristics of poor effort and deconditioning. Marked elevation of plasma catecholamine was observed after exercise in PD, suggesting that excess catecholamine secretion may play a role in the pathogenesis of panic disorder and possibly may be relieved by β-adrenergic blockade. Conclusion : Exercise tesing on PD patients could serve to remove patients' fears for attacks by reassuring them of excellent prognosis and promoting activity of daily life. Exercise challenge for PD could concern as one of cognitive and behavioral therapeutic strategies.

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