Carl F. Jensen

Sodium lactate and hypertonic sodium chloride induce equivalent panic incidence, panic symptoms, and hypernatremia in panic disorder

BACKGROUND Although experimental induction of panic by infusion of 0.5 mol/L sodium lactate in persons with panic disorder was described three decades ago, the mechanism underlying this observation remains unclear. Here we asked if the rapid administration of the large sodium load contained in the 0.5-mol/L sodium lactate infusion might be involved in panic induction. METHODS We compared in panic disorder and healthy subjects behavioral, electrolyte, endocrine, and acid-base responses to three double-blind randomly ordered equal volume 20-min infusions: 0.5 mol/L sodium lactate, hypertonic saline (3% sodium chloride), and normal saline placebo. RESULTS Sodium lactate (0.5 mol/L) and hypertonic saline produced the same high incidence of panic and equivalent increases in panic symptoms, serum sodium, and plasma vasopressin in the panic disorder subjects. Neither hypertonic infusion increased cortisol or adrenocorticotropin. No normal subject experienced panic in any condition. The 0.5-mol/L sodium lactate infusion induced alkalosis, whereas hypertonic saline and normal saline induced a mild acidosis. CONCLUSIONS Hypertonic sodium solution containing either chloride or lactate anion induces panic in panic disorder. The large sodium loads delivered by hypertonic saline and 0.5 mol/L sodium lactate may be involved in the mechanism of panic induction.

Cerebrospinal Fluid Epinephrine in Alzheimer’s Disease and Normal Aging

Central nervous system (CNS) adrenergic systems are involved in regulation of behavior and blood pressure. The effects of Alzheimers disease (AD) and normal aging on resting CNS adrenergic activity were estimated by measuring cerebrospinal fluid (CSF) epinephrine (EPI) concentrations in 74 persons with AD, 42 cognitively normal healthy older persons, and 54 healthy young persons. The responsiveness of CSF EPI to the alpha-2 adrenergic antagonist yohimbine and the alpha-2 adrenergic agonist clonidine was measured in smaller subject groups. Resting CSF EPI was higher in AD than in older or young subjects, and increased with dementia severity in AD subjects. There was no relationship between resting CSF EPI and blood pressure. CSF EPI increased following yohimbine in AD and older subjects but not in young subjects. CSF EPI was unaffected by clonidine in all subject groups. The agitation increase following yohimbine was substantially greater in AD subjects than in older or young subjects. CNS adrenergic activity seems increased in AD, may further increase as AD progresses, and may be involved in the pathophysiology of agitation.

Hypertonic saline infusion induces panic in patients with panic disorder

The mechanism by which sodium lactate (NaLAC) infusion induces panic remains obscure. That the standard 0.5 M NaLAC solution is a hypertonic sodium (Na) solution that produces a marked and rapid increase in plasma Na and osmolality (Osm) (George et al 1989) suggests that these rapid increases in plasma Na and Osm are involved in t?:e induction of panic. In this pilot study, we administered to par~ic disorder (PD) patients a hypertonic saline (HS) infusion (3% NaCI) designed to produce an increa~ in serum Na, Osm, and volume equal to the standard NaLAC infusion. We tested the hypothesis that increasing serum Osm and Na an equivalent amount with HS or NaLAC infusions would p ~ u c e panic ,~ymptoms of similar frequency and quality and that an equal volume infusion of normal saline (NS) would not produce panic symptoms.

An analysis of criteria used by VA clinicians to diagnose combat-related PTSD

The diagnostic criteria for post-traumatic stress disorder (PTSD) were consensually derived from the expert opinions of a small group of DSM-III-R Task Force and advisory committee members. In this study, 448 psychiatrists and psychologists were surveyed to assess their opinions of the criteria they utilize to assign a diagnosis of PTSD to veterans of war. The various DSM-III-R criteria for PTSD were perceived by clinicians as being differentially useful in making diagnostic judgments. Evidence of exposure to traumatic stress and symptoms of reexperiencing the trauma were consistently rated as more influential than criteria of avoidance/numbing and increased arousal. Moreover, symptoms that are directly ascribed to the traumatic event were rated more influential than those not directly referenced to the traumatic experience. Clinicians report they utilize supplemental information that extends beyond the DSM-III-R criteria to diagnose PTSD, and that this information is as important as many official DSM-III-R symptom criteria.

Control Issues and Body Image in Panic Disorder

Mean perceived emotional control and body image were compared for 7 subjects with and 6 without panic disorder, all physically healthy. The former had a lower mean on sense of emotional control and showed greater emphasis on the back of the body. These preliminary data encourage replication with a larger group.