Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome
Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome
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DOI：
10.1007/s10286-006-0365-0
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发表时间：
2006-12-01
影响因子：
5.8
通讯作者：
Khurana, Ramesh K.
中科院分区：
文献类型：
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作者：
Khurana, Ramesh K.
体位性心动过速综合征（POTS）患者可能会被误诊为惊恐障碍，由于共同的临床特征。本研究的第一个目的是探讨POTS症状与惊恐障碍之间的关系。第二个目的是描述区分POTS症状和惊恐障碍的临床特征。共有11名POTS患者和11名对照受试者参加了IRB批准的前瞻性安慰剂对照研究。采用急性惊恐量表（API）对实验性诱发的POTS惊恐样症状进行了系统研究。参与者在每次安慰剂输注后和三种激发刺激后回答问卷：直立倾斜试验（HUT），异丙肾上腺素输注（ISI）和乳酸钠输注（SLI）。在每个给药时间点对每例受试者的API反应进行汇总。分析单个API症状和总应答的统计学显著性。所有POTS患者在HUT期间均出现立位不耐受症状。在ISI期间，11例患者中有5例患者的药物诱导症状主观上模仿自发症状，而在SLI期间，11例患者中无一人模仿自发症状。相比之下，这些患者的API评分在HUT后11例中0例达到惊恐阈值，在ISI后11例中4例达到惊恐阈值，在SLI后11例中4例达到惊恐阈值。个别症状分析显示，得分的显著增加仅限于心悸、呼吸困难和抽搐或颤抖的躯体症状。总之，POTS的症状在现象学上是不同的，并且在临床上与惊恐障碍症状不同。
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.