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Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome

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An Erratum to this article was published on 15 February 2007

Abstract

Patients with postural tachycardia syndrome (POTS) might be misdiagnosed with panic disorder due to shared clinical features. The first aim of our study was to investigate the relationship between symptoms of POTS and panic disorder. The second aim was to delineate clinical features distinguishing symptoms of POTS from panic disorder. A total of 11 patients with POTS and 11 control subjects participated in an IRB-approved, prospective, placebo-controlled study. The experimentally induced panic-like symptoms of POTS were systematically studied using the Acute Panic Inventory (API) questionnaire. The participants answered the questionnaire after each placebo infusion and after each of the three provoking stimuli: head-up tilt test (HUT), isoproterenol infusion (ISI), and sodium lactate infusion (SLI). API responses were summed for each subject at each time point of administration. Individual API symptoms and summed responses were analyzed for statistical significance. All patients with POTS developed symptoms of orthostatic intolerance during HUT. Pharmacologically induced symptoms subjectively mimicked spontaneous symptoms in 5 of 11 patients during ISI and in none of 11 patients during SLI. In contrast, API scores in these patients reached panic threshold in 0 of 11 following HUT, in 4 of 11 following ISI and in 4 of 11 following SLI. Individual symptoms analysis revealed that significant increase in scores was limited to the somatic symptoms of palpitations, dyspnea, and twitching or trembling. In conclusion, the symptoms of POTS are phenomenologically different and clinically distinguishable from panic disorder symptoms.

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Acknowledgments

This study was supported by Medstar Research Institute intramural grant 1999–376. The author thanks Norman Dubin, Ph.D., for detailed statistical analysis.

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Authors and Affiliations

  1. Division of Neurology, The Union Memorial Hospital, 201 East University Parkway, Baltimore, MD, 21218, USA

    Ramesh K. Khurana MD

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  1. Ramesh K. Khurana MD
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Correspondence to Ramesh K. Khurana MD.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10286-007-0404-5.

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Khurana, R.K. Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome. Clin Auton Res 16, 371–377 (2006). https://doi.org/10.1007/s10286-006-0365-0

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