Skip to main content

Physiological, biochemical and subjective parameters in anxiety patients with panic disorder during stress exposure as compared with healthy controls

Abstract

Physiological (heart rate, blood pressure, electrodermal activity), biochemical (epinephrine, norepinephrine, cortisol) and subjective parameters (self-rating score) of 33 patients with panic disorder (diagnoses according to DSM-III-R) before, during and after stress exposure were compared with those of healthy controls. As stressors a video containing frightening scenes (FS), mental arithmetic (MA), a video documenting a patient suffering from a panic attack (PA) and an improvised speech (IS) were applied. We found significantly higher baseline levels of electrodermal activity (EDA) and norepinephrine (NE) secretion and a subsequent further increase during stress exposure in panic disorder patients as compared with normal controls. The most potent stressors during the trial proved to be mental arithmetics and improvised speech, which was evident in both groups. The situation panic attack video appeared to be a “panic disorder patient-specific” stressor; here we noticed the most pronounced reactions in the patient group. Panic disorder patients had significantly higher self-rating scores of the parameters panicky feelings, anxiety and nervousness at the beginning and throughout the investigation. We conclude that panic disorder patients have a higher degree of activation compared with normal controls, which is evident regarding levels of electrodermal activity and norepinephrine secretion. Furthermore, the panic attack video appears to be a panic disorder patient-specific stressor.

This is a preview of subscription content, access via your institution.

References

  • Ackenheil M, Fröhler M, Goldig G, Rall C, Welter D (1982) Katecholaminbestimmung in Blut und Liquor mit Hochdrucksflüssigkeitschromatographie und elektrochemischem Detektor, Arzneimittelforschung. Drug Res 32 (II) 8: 893

    Google Scholar 

  • Ackenheil M, Albus M, Engel R, Hippius H (1984) Stress und Individuum. Ein Beitrag zur Psychobiologie in Belastungssituationen. Zivilschutzforschung 16

  • Albus M, Ackenheil M, Engel R, Müller F (1982) Situational reactivity of autonomic functions in schizophrenic patients. Psychol Res 6: 361–370

    CAS  Google Scholar 

  • Albus M (1984) Medikamentöse Beeinflussung autonomer Reaktionsmuster in angstinduzierenden Streflsituationen. Dissertation zur Erlangung des akademischen Grades eines Doktors der Sozialwissenschaften, Tübingen

  • Albus M, Stahl S, Müller-Spahn F, Engel RR (1986) Psychophysiological differentiation of two types of anxiety and its pharmacological modification by minor tranquilizer and beta-receptor-Blocker. Biol Psychol 23: 39–51

    PubMed  CAS  Google Scholar 

  • Albus M (1987) Psychiatric patients and their response to experimental stress. Stress Med 3: 233–238

    Google Scholar 

  • Altschule MD (1953) Bodily physiology in mental and emotional disorder. Grune and Stratton, New York

    Google Scholar 

  • Ball SG, Buchwald AM, Waddell MT et al. (1995) Depression and generalized anxiety symptoms in panic disorder, implications for comorbidity. J Nerv Ment Dis 183 (5): 304–308

    PubMed  CAS  Google Scholar 

  • Ballenger JC, Peterson GA, Laraia M (1984) A study of plasma catecholamines in agoraphobia and the relationship of serum tricyclic levels to treatment response. In: Ballenger JC (ed) Biology of agoraphobia. American Psychaitric Press, Washington, DC

    Google Scholar 

  • Baltissen R, Boucsein W (1987) Comparative studies on state scaling and change scaling in psychophysiological experiments evaluating subjective effects of stress. Z Different Diagn Psychol 8 (1):1–23

    Google Scholar 

  • Battaglia M, Bertella S, Politi E et al. (1995) Age at onset of panic disorder: influence of familial liability to the disease and of childhood separation anxiety disorder. Am J Psychiatry 152 (9): 1362–1364

    PubMed  CAS  Google Scholar 

  • Belfer PL, Munoz LS, Schachter J et al. (1995) Cognitive-behavioral group psychotherapy for agoraphobia and panic disorder. Int J Group Psychother 45 (2): 185–206

    PubMed  CAS  Google Scholar 

  • Birket-Smith M, Hasle N, Jensen HH (1993) Electrodermal activity in anxiety disorders. Acta Psychiatr Scand 88 (5): 350–355

    PubMed  CAS  Google Scholar 

  • Bond AJ, James DC, Lader MH (1974) Physiological and psychological measures in anxious patients, Psychol Med 4: 364–373

    PubMed  CAS  Google Scholar 

  • Bonelli J et al. (1979) Effect of calculation stress on hemodynamics and plasma catecholamines before and after β-blockade with propranolol and mepindolol sulfate. Eur J Clin Pharmacol 15: 1–8

    PubMed  CAS  Google Scholar 

  • Braune S, Albus M, Frohler M, Hohn T, Scheibe G (1994) Psychophysiological and biochemical changes in patients with panic attacks in a defined situational arousal. Eur Arch Psychiatry Clin Neurosci 244 (2): 86–92

    PubMed  CAS  Google Scholar 

  • Bystritsky A, Craske M, Maidenberg E et al. (1995) Ambulatory monitoring of panic patients during regular activity: a preliminary report. Biol Psychiatry 38: 684–689

    PubMed  CAS  Google Scholar 

  • Cameron OG, Lee MA, Curtis GC, McCann DS (1987), Endocrine and physiological changes during “spontaneous” panic attacks. Psychoneuroendocrinology 12 (5): 321–331

    PubMed  CAS  Google Scholar 

  • Charney DS, Heninger GR (1985) Noradrenergic function and the mechanism of action of antianxiety treatment. Arch Gen Psychiatry 42: 458–467

    PubMed  CAS  Google Scholar 

  • Charney DS, Heninger GR, Breier A (1984) Noradrenergic function in panic anxiety. Arch Gen Psychiatry 41: 751–763

    PubMed  CAS  Google Scholar 

  • Charney DS, Heninger GR, Jadow PI (1985a) Increased anxiogenic effects of caffeine in panic disorder. Arch Gen Psychiatry 135: 233–243

    Google Scholar 

  • Charney DS, Woods SW, Goodman WK, Heninger GR (1987) Neurobiological mechanisms of panic anxiety: biochemical and behavioral correlates of yohimbine-induced panic attacks. Am J Psychiatry 144: 1030–1036

    PubMed  CAS  Google Scholar 

  • Cowley DS, Hyde TS, Dager SR, Dunner DL (1987) Lactate infusions: the role of baseline anxiety. Psychiatr Res 21: 169–179

    CAS  Google Scholar 

  • Cowley DS, Roy-Byrne PP, Greenblatt DJ et al. (1993) Personality and benzodiazepine sensitivity in anxious patients and control subjects. Psychiatr Res 47 (2): 151–162

    CAS  Google Scholar 

  • Cox BJ, Swinson RP, Norton GR et al. (1991) Anticipatory anxiety and avoidance in panic disorder with agoraphobia. Behav Res Ther 29 (4): 363–365

    PubMed  CAS  Google Scholar 

  • Cox BJ, Endler NS, Swinson RP (1995) Anxiety sensitivity and panic attack symptomatology. Behav Res Ther 33 (7): 833–836

    PubMed  CAS  Google Scholar 

  • Dimsdale JE (1984) Generalizing from laboratory studies to field studies of human stress physiology. Psychosom Med 46 (5): 463–469

    PubMed  CAS  Google Scholar 

  • Dimsdale JE, Moss JM (1980) Short-term catecholamine response to psychological stress. Psychosom Med 42 (5): 493–497

    PubMed  CAS  Google Scholar 

  • Ehlers A, Margraf J, Roth W (1986) Interaction of expectancy and physiological stressors in a laboratory model of panic. In: Hellhammer D, Florin I (eds) Neuronal control of bodily function: basic and clinical aspects. Martinus-Nijhoff, Boston

    Google Scholar 

  • Erdmann G, Janke W, Bisping R (1984) Wirkungen und Vergleich der Wirkungen von vier experimentellen Belastungssituationen. Z Exp Angew Psychol XXXI:521–543

    Google Scholar 

  • Fagerström KO, Hugdahl K, Lundström N (1985) Effect of betareceptor blockade on anxiety with reference to the three-systems model of phobic behavior. Neuropsychobiology 13: 187–193

    PubMed  Google Scholar 

  • Fahrenberg J, Walschburger P, Foerster F, Myrtek M, Müller W (1979) Psycbophysiologische Aktivierungsforschung, ein Beitrag zu den Grundlagen der multivariaten Emotions- und Stress-Theorie. Minerva, München

    Google Scholar 

  • Forsman L, Lindblad LE (1983) Effect of mental stress on baroreceptor-mediated changes in blood pressure and heart rate and on plasma catecholamines and subjective responses in healthy men and women. Psychosom Med 45:435–445

    PubMed  CAS  Google Scholar 

  • Foster K, Humphries S (1951) Translation of Aristotle’s De Anima. Yale University Press, New Haven

    Google Scholar 

  • Frankenhaeuser M (1975) Experimental approach to the study of catecholamines and emotion. In: Levi L (ed) Emotions: their parameters and measurement. Raven, New York

    Google Scholar 

  • Freedman DX, Glass AM (1984) Psychiatry. J Am Med Assoc 252: 2223–2228

    Google Scholar 

  • Freedman RB, Ianni P, Ettedgui E (1985) Ambulatory monitoring of panic disorder. Arch Gen Psychiatry 42: 244–248

    PubMed  CAS  Google Scholar 

  • Freud S (1926) Hemmung, Symptom and Angst. Internationaler Psychoanalytischer Verlag, Leipzig

    Google Scholar 

  • Froberg J, Karlsson C, Levi L, Lindberg L (1971) Physiological and biochemical stress reactions induced through psychosocial stimuli. In: Levi L (ed) Society, stress and disease, vol 1. Oxford University Press, New York, pp 280–299

    Google Scholar 

  • Gaffney FA, Fenton BJ et al. (1988) Hemodynamic, ventilatory and biochemical responses of panic patients and normal controls with sodium lactate infusions and spontaneous panic attacks. Arch Gen Psychiatry 45: 53–60

    PubMed  CAS  Google Scholar 

  • Gasic S, Grünberger J, Kom A, Oberhummer I, Zapotoczky HG (1985) Biochemical, physical and psychological findings in patients suffering from cardiac neurosis. Neuropsychobiology 13: 12–16

    PubMed  CAS  Google Scholar 

  • Goisman RM, Warshaw MG, Peterson LG et al. (1994) Panic, agoraphobia, and panic disorder with agoraphobia. Data from a multicenter anxiety disorders study. J Nerv Ment Dis 182 (2): 72–79

    PubMed  CAS  Google Scholar 

  • Gorman JM, Fyer MR, Goetz R, Askanazi J, Liebowitz MR, Fyer AJ, Kinney J, Klein DF (1988) Ventilatory physiology of patients with panic disorder. Arch Gen Psychiatry 45: 31–39

    PubMed  CAS  Google Scholar 

  • Griez EJL, Lousberg H, van den Hout MA, van der Molen GM (1987) CO2-vulnerability in panic disorder. Psychiatr Res 20: 87–95

    CAS  Google Scholar 

  • Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32: 50–55

    PubMed  CAS  Google Scholar 

  • Hamilton M (1969) Diagnosis and rating of anxiety. In: MH Lader (ed) Studies of anxiety. Br J Psychiatry Spec Publ 3: 76–79

  • Hamilton M (1976a) Hamilton anxiety scale. In: Guy W (ed) ECDEU assessment manual for psychopharmacology, revised. Rockville, Maryland, pp 193–198

  • Hamilton M (1976b) Hamilton depression scale. In: Guy W (ed) ECDEU assessment manual for psychopharmacology, revised. Rockville, Maryland, pp 179–192

  • Hart JD (1974) Physiological responses of anxious and normal subjects to simple signal and non-signal auditory stimuli. Psychophysiology 11: 443–451

    PubMed  CAS  Google Scholar 

  • Herbert J, Moore GF, de la Riva C, Watts FN (1986) Endocrine responses and examination anxiety. Biol Psychol 22: 215–226

    PubMed  CAS  Google Scholar 

  • Hjemdahl P, Daleskog M, Kahan T (1979) Determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection: comparison with a radioenzymatic method. Life Sci 25: 131–138

    PubMed  CAS  Google Scholar 

  • Hjemdahl P, Freyschuss U, Juhlin-Dannfelt A, Linde B (1984) Differentiated sympathetic activation during mental stress evoked by the Stroop test. Acta Physiol Scand Suppl 527: 25–29

    PubMed  CAS  Google Scholar 

  • Hoffart A, Thomes K, Hedley LM et al. (1994) DSM-III-R axis I and II disorders in agoraphobic patients with and without panic disorder. Acta Psychiatr Scand 89 (3): 186–191

    PubMed  CAS  Google Scholar 

  • Horvath T, Meares R (1979) The sensory filter in schizophrenia: a study of habituation, arousal and the dopamine hypothesis. Br J Psychiatry 134:39–45

    PubMed  CAS  Google Scholar 

  • Houtman ILD, Bakker FC (1987) Stress in student teachers during real and simulated standardized lectures. J Hum Stress 13: 180–187

    CAS  Google Scholar 

  • Kimmel HD, Gardner KA (1986) Giving context emotional significance by administration of aversive pictures. Int J Psychophysiol 3: 227–234

    PubMed  CAS  Google Scholar 

  • King DJ, Denaney NM, Gilbert JK (1987) A double-blind placebo controlled trial of a selective β2-adrenoceptor antagonist (ICI 118551) in chronic anxiety. Int Clin Psychopharmacol 2: 191–200

    PubMed  CAS  Google Scholar 

  • Klein E, Cnaani E, Harel T et al. (1995) Altered heart rate variability in panic disorder patients. Biol Psychiatry 37 (1): 18–24

    PubMed  CAS  Google Scholar 

  • Kralik PM, Ho BT, Mathew RJ, Taylor DL, Weinman ML (1982) Effects of adrenalin administration on platelet MAO of anxious and normal subjects. Neuropsychobiology 8: 205–209

    PubMed  CAS  Google Scholar 

  • Lacey J (1967) Somatic patterning and stress. In: M Appley, R Trumbull, (eds) Psychological stress issue in research. Appleton-Century-Crofts, New York

    Google Scholar 

  • Lader M (1982) Biological differentiation of anxiety, arousal and stress. In: Mathew RJ (ed) The biology of anxiety. Brunner/ Mazel, New York, pp 11–22

    Google Scholar 

  • Lader MH, Wing L (1966) Physiological measures, sedative drugs and morbid anxiety. Maudsley Monogr 14. Oxford University Press, London

    Google Scholar 

  • Lake C, Ziegler M, Kopin I (1976) Use of norepinephrine for evaluation of sympathetic neuronal function in man. Life Sci 18: 1315–1326

    PubMed  CAS  Google Scholar 

  • Lawler KA (1980) Cardiovascular and electrodermal response patterns in heart rate reactive individuals during psychological stress. Psychophysiology 17 (5): 464–469

    PubMed  CAS  Google Scholar 

  • Levitt EE (1967) The psychology of anxiety. Indianapolis, Bobbs-Merrill Company

    Google Scholar 

  • Liebowitz MR, Coplan JD, Martinez J, Fyer AJ, Dillon DJ, Campeas RB, Davies SO, Gorman JM, Klein DF (1995) Effects of intravenous diazepam pretreatment on lactate-induced panic. Psychiatry Res 58 (2): 127–138

    PubMed  CAS  Google Scholar 

  • Margraf J, Ehlers A, Roth W (1986) Biological models of panic disorders and agoraphobia. Behav Res Ther 24:553–568

    PubMed  CAS  Google Scholar 

  • Mathew RJ, Ho BT, Kralik P et al. (1981) Anxiety and platelet MAO levels after relaxation training. Am J Psychiatry 138: 371–373

    PubMed  CAS  Google Scholar 

  • Mathews AM (1982) Anxiety and its management. In: Gaind R, Hudson B (eds) Current themes in psychiatry, vol 3. Spectrum, New York

    Google Scholar 

  • Middleton HC, Ashby M (1995) Clinical recovery from panic disorder is associated with evidence of changes in cardiovascular regulation. Acta Psychiatr Scand 91 (2): 108–113

    PubMed  CAS  Google Scholar 

  • Moss A, Wynar B (1970) Tachycardia in house officers presenting at great rounds. Ann Intern Med 72: 255–256

    PubMed  CAS  Google Scholar 

  • Müller T, Hofschuster E, Kuss JJ, Welter D (1979) A highly sensitive and precise radioenzymatic assay for plasma epinephrine and norepinephrine. J Neural Transm 45: 219–225

    PubMed  Google Scholar 

  • Nesse RM, Cameron OG, Curtis GC et al. (1984) Adrenergic function in patients with panic anxiety. Arch Gen Psychiatry 41: 771–776

    PubMed  CAS  Google Scholar 

  • Norusis MJ (1988) Manual SPSS/PC+. SPSS Inc., Chicago

    Google Scholar 

  • Papp LA, Klein DF et al. (1993) Diagnostic and substance specificity of carbon-dioxide-induced panic. Am J Psychiatry 150 (2): 250–257

    PubMed  CAS  Google Scholar 

  • Pichot P (1971) Quantification of psychological stress responses. In: Levi L (ed) Society, stress and disease, vol 1. Oxford University Press, New York, pp 49–53

    Google Scholar 

  • Rainey JM, Frohman CE, Freedman RR (1984) Specificity of lactate infusion as a model of anxiety. Psychopharmacol Bull 20 (1): 45–49

    PubMed  Google Scholar 

  • Raskin M (1975) Decreased skin conductance response habituation in chronically anxious patients. Biol Psychol 2: 309–319

    PubMed  CAS  Google Scholar 

  • Rechlin T, Weis M, Spitzer A et al. (1994) Are affective disorders associated with alterations of heart rate variability? J Affect Disord 32 (4): 271–275

    PubMed  CAS  Google Scholar 

  • Roth WT, Telch MJ, Taylor CB, Sachitano JA, Gallen CC, Kopell ML, McClenahan KL, Agras WS, Pfefferbaum A (1986) Autonomic characteristics of agoraphobics with panic attacks. Biol Psychiatry 21:1133–1154

    PubMed  CAS  Google Scholar 

  • Roth WT, Ehlers A, Taylor CB, Margraf J, Agras WS (1990) Skin conductance habituation in panic disorder patients. Biol Psychiatry 27 (11): 1231–1243

    PubMed  CAS  Google Scholar 

  • Roth WT, Margraf J, Ehlers A, Taylor CB, Maddock RJ, Davies S, Agras WS (1992) Stress test reactivity in panic disorder. Arch Gen Psychiatry 49 (4): 301–310

    PubMed  CAS  Google Scholar 

  • Sarason IG (1960) Empirical findings and theoretical problems in the use of anxiety scales. Psychol Rep 57 (5): 403–415

    CAS  Google Scholar 

  • Scheibe G, Albus M, Walther AU et al. (1993) Group psychotherapy in patients with panic disorder and agoraphobia. Psychother Psychosom Med Psychol 43 (7): 238–244

    PubMed  CAS  Google Scholar 

  • Schmidt NB, Jacquin K, Telch MJ (1994) The overprediction of fear and panic in panic disorder. Behav Res Ther 32 (7): 701–707

    PubMed  CAS  Google Scholar 

  • Spielberger CD, Gorsuch RL, Lushene RE (1970) The State-Trait Anxiety Inventory (test manual). Consulting Psychologists Press, Palo Alto, Calif.

    Google Scholar 

  • Spinks JA, Siddle DAT (1985) The effect of anticipated information on skin conductance and cardiac activity. Biol Psychol 20: 39–50

    PubMed  CAS  Google Scholar 

  • Starcevic V, Fallon S, Uhlenhuth EH et al. (1994) Comorbidity rates do not support distinction between panic disorder and generalized anxiety disorder. Psychopathology 27 (6): 269–272

    PubMed  CAS  Google Scholar 

  • Stein MB, Asmundson GJ (1994) Autonomic function in panic disorder: cardiorespiratory and plasma catecholamine responsivity to multiple challenges of the autonomic nervous system. Biol Psychiatry 36 (8): 548–558

    PubMed  CAS  Google Scholar 

  • Stein MB, Tancer ME, Uhde TW (1992) Heart rate and plasma norepinephrine responsivity to orthostatic challenge in anxiety disorders. Comparison of patients with panic disorder and social phobia and normal control subjects. Arch Gen Psychiatry 49 (4): 311–317

    PubMed  CAS  Google Scholar 

  • Sternbach RA (1960) Some relationships among various ‘dimensions’ of autonomic activity. Psychosom Med 22:430–434

    Google Scholar 

  • Taggart P, Carruthers M, Somerville W (1973) Electrocardiograms, plasma catecholamines and lipids, and their modification by oxprenolol when speaking before an audience. Lancet 18:341–346

    Google Scholar 

  • Targum SD (1992) Cortisol response during different anxiogenic challenges in panic disorder patients. Psychoneuroendocrinology 17 (5): 453–458

    PubMed  CAS  Google Scholar 

  • Tyrer PJ (1976) Role of bodily feeling in anxiety. Maudsley Monogr 23. Oxfords University Press, London

    Google Scholar 

  • Tyrer PJ, Lader MH (1976) Central and peripheral correlates of anxiety: a comparative study. J Nerv Ment Dis 162: 99–104

    PubMed  CAS  Google Scholar 

  • Verburg K, Griez E, Meijer J et al. (1995) Respiratory disorders as a possible predisposing factor for panic disorder. J Affect Disord 33 (2): 129–134

    PubMed  CAS  Google Scholar 

  • Villacres EC, Hollifield M, Katon WJ, Wilkinson CW, Veith RC (1987) Sympathetic nervous system activity in panic disorder. Psychiatr Res 24:313–321

    Google Scholar 

  • Ward MM, Mefford IN, Parker SD et al. (1983) Epinephrine and norepinephrine responses in continuously collected human plasma to a series of stressors. Psychosom Med 45: 471–485

    PubMed  CAS  Google Scholar 

  • Weise V, Kopin I (1976) Assay of catecholamines in human plasma: studies of a single isotope radioenzymatic procedure. Life Sci 19: 1673–1686

    PubMed  CAS  Google Scholar 

  • Wilder J (1931) Das “Ausgangswert-Gesetz”, ein unbeachtetes biologisches Gesetz und seine Bedeutung für Forschung und Praxis. Z Neurol 137: 317–338

    Google Scholar 

  • Wing L (1964) Physiological effects of performing a difficult task in patients with anxiety states. J Psychosom Res 7: 283–294

    Google Scholar 

  • Wittchen HU, Essau CA (1993) Epidemiology of panic disorder: progress and unresolved issues. J Psychiatr Res 27 (Suppl) 1: 47–68

    PubMed  Google Scholar 

  • Woods SW, Charney DS, McPherson CA (1987) Situational panic attacks. Arch Gen Psychiatry 44: 365–375

    PubMed  CAS  Google Scholar 

  • Woods SW, Charney DS, Goodman WK et al. (1988) Carbon dioxide-induced anxiety, behavioral, physiologic and biochemical effects of carbon dioxide in patients with panic disorder and healthy subjects. Arch Gen Psychiatry 45: 43–51

    PubMed  CAS  Google Scholar 

  • Yehuda R, Boisoneau D, Mason JW et al. (1993) Glucocorticoid receptor number and cortisol excretion in mood, anxiety, and psychotic disorders. Biol Psychiatry 34 (1–2): 18–25

    PubMed  CAS  Google Scholar 

  • Yeragani VK, Pohl R, Rainey JM, Balon R, Ortiz A, Lycaki H, Gershon S (1987) Pre-infusion heart rates and laboratory-induced panic anxiety. Acta Psychiatr Scand 75: 51–54

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hoehn, T., Braune, S., Scheibe, G. et al. Physiological, biochemical and subjective parameters in anxiety patients with panic disorder during stress exposure as compared with healthy controls. Eur Arch Psychiatry Clin Nuerosci 247, 264–274 (1997). https://doi.org/10.1007/BF02900305

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02900305

Key words

  • Panic disorder
  • Agoraphobia
  • Anxiety
  • Stress exposure
  • Electrodermal activity
  • Epinephrine
  • Norepinephrine
  • Cortisol
  • Heart rate
  • Blood pressure