Hiperventilação: A terapia cognitivo-comportamental e a técnica dos exercícios de indução dos sintomas no transtorno de pânico

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Abstract

O transtorno de pânico (TP) caracteriza -se por ataques agudos de ansiedade frequentes e recorrentes. A actual concepção para o TP realça o medo das sensações corporais a partir do momento em que o indivíduo associa de forma equivocada as sensações físicas que se apresentam como sendo prenúncio de uma doença grave e/ou morte iminente, não conseguindo interpretá -las como mecanismos fisiológicos naturais. Relatamos três casos graves de TP do subtipo respiratório, com agorafobia, cujos sintomas de hiperventilação predominavam sobre os demais. O tratamento consistiu na prescrição de antidepressivos tricíclicos e no encaminhamento para sessões de terapia cognitivo -comportamental (TCC). O objectivo do relato dos casos é demonstrar a evolução satisfatória do tratamento com a técnica dos exercícios de indução de sintomas (EIS) em ambiente de laboratório para a redução e/ou extinção dos sintomas hiperventilatórios, entre outros. Esse procedimento foi considerado fundamental na evolução do tratamento e permitiu preparar os doentes para enfrentarem situações agorafóbicas subsequentes.

Translated abstract

Panic disorder (PD) is characterized by frequent and recurrent acute panic attacks. The current cognitive conception for PD enhances the fear of corporal sensations, when the individual define his physical sensations as being related to a serious disease or imminent death, not interpreting them as natural physiologic mechanisms. We reported three severe cases of PD of the respiratory subtype, with agoraphobia, whose symptoms of hyperventilation predominated on clinical picture. The treatment consisted on tricycles antidepressant and cognitive-behavior therapy (CBT) sessions. The objective of reporting the cases is to demonstrate the satisfactory evolution of the treatment with the technique of panic symptoms induction exercises (SIE) in controlled laboratory environment. On that way, reducing or extinguishing hyperventilation symptoms. This procedure was considered very important in the evolution of the treatment and allowed us to prepare the patients to face subsequent agoraphobic situations.

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Most cited references 2

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Respiratory psychophysiology of panic disorder: three respiratory challenges in 98 subjects.

R. Norman, L Papp, R J Coplan … (1997)

Respiratory abnormalities may play a central role in the pathophysiology of panic disorder. The current study was undertaken to examine the respiratory response in the largest series of subjects to date during three respiratory challenges that used improved methodology. Fifty-nine patients with DSM-III-R panic disorder and 39 normal volunteers were challenged with 5% and 7% CO2 inhalation and room air hyperventilation separated by room air breathing with continuous spirometry. Patients with panic disorder were more sensitive to the anxiogenic effects of CO2 than were normal subjects, and CO2 was a more potent stimulus to panic than hyperventilation. Patients increased their respiratory rate more quickly during CO2 inhalation than did comparison subjects, and this increase preceded the panic attacks. Patients who panicked in response to 5% CO2 demonstrated continued rise in end-tidal CO2, while the end-tidal CO2 of the comparison groups stabilized. Low end-tidal CO2 and high variance in minute ventilation at baseline predicted panic attacks during CO2 inhalation. Following CO2 or hyperventilation challenges, respiratory rate dropped sharply, while tidal volume remained elevated longer in patients than in comparison subjects. The findings confirm the greater behavioral and physiological sensitivity of patients with panic disorder to CO2 inhalation and identify a series of respiratory abnormalities. Panic attacks in panic disorder may be explained by inefficient compensatory mechanisms, primarily of respiratory rate.