title: Can panic be induced in deep sleep? Examining the necessity of cognitive processing for panic.
abstract: This study examines the relative contribution of biological and psychological processes to the induction of panic attacks by a biochemical challenge agent. Panicogenic doses of caffeine were administered to 8 panic disorder (PD) patients and 11 healthy volunteers during stage 3-4 sleep, when cognitive processing is minimal and the threshold to external stimuli is high. Panic attacks were induced directly from sleep in 3 subjects and subclinical panics in an additional 3. Subjects who experienced full panic attacks spent periods of time ranging from 4 to 52 minutes in stage 2 sleep before awakening in a panic, while those who awakened in subclinical panic awakened almost directly from stage 4 sleep. PD patients experienced significantly more panic symptoms than healthy volunteers. Although limited by a small sample size, this study suggests a combined biological-psychological model of panic induction in which panic disorder patients are more biologically predisposed than healthy controls to panic symptoms but may require cognitive processing for the elaboration of a full panic attack.
authors.affiliation: Bronx Veteran's Affairs Medical Center, New York 10468, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Koenigsberg
authors.forename: C P
authors.initials: CP
authors.lastname: Pollak
authors.forename: D
authors.initials: D
authors.lastname: Ferro
mesh_terms: D000293:Adolescent; D000328:Adult; D002110:Caffeine / Q000494:pharmacology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010200:Panic / Q000502:physiology*; D016584:Panic Disorder / Q000503:physiopathology*; D012044:Regression Analysis; D012894:Sleep Stages / Q000187:drug effects / Q000502:physiology*
chemical_list: D002110:Caffeine