Os mecanismos de defesa representam uma dimensão importante da estrutura da personalidade e do funcionamento psicodinâmico, sendo uma das formas de medir como o indivíduo habitualmente responde aos estressores. O estudo dos mecanismos de defesa utilizados por pacientes com Transtorno do Pânico (TP) pode ter utilidade no entendimento e no tratamento desse transtorno. O objetivo deste trabalho é o de avaliar os mecanismos de defesa do ego, nos pacientes com TP, e sua associação com gravidade, resposta ao tratamento e alteração pós tratamento. Sessenta pacientes com TP e 31 controles participaram da primeira fase do trabalho. O Mini International Neuropsychiatric Interview foi usado para confirmar o diagnóstico de TP e estabelecer o diagnóstico de co-morbidades. A Impressão Clínica Global (CGI) foi usada para avaliar a gravidade do TP e o Defense Style Questionnaire (DSQ-40) foi usado para avaliar os mecanismos de defesa. Em uma segunda etapa, 33 pacientes com TP sintomáticos e 33 voluntários normais foram avaliados com os mesmos instrumentos, aplicados no início do estudo e após 16 semanas. Os pacientes receberam durante esse período tratamento farmacológico com sertralina. Ambos os estudos demonstraram que pacientes com TP utilizam mais defesas neuróticas e imaturas comparados ao grupo controle. Os pacientes com pânico grave (CGI>4) apresentaram maior co-morbidade com depressão atual e usaram mais defesas imaturas do que os pacientes com CGI< 4 (média=4.2 vs. 3.5; p<0.001). Após 4 meses de tratamento, houve diminuição no uso de defesas neuróticas (4.6 vs. 4.2; p=0.049) e imaturas (3.6 vs. 3.4 p=0.035) no grupo de pacientes. Pacientes que usavam mais defesas neuróticas e imaturas apresentaram pior resposta ao tratamento. Pacientes com TP usaram mais defesas mal-adaptativas quando comparados ao grupo controle, no basal e após 4 meses. O uso de defesas neuróticas e imaturas está associado à gravidade do TP e à pior resposta ao tratamento. Os mecanismos de defesa são, então, parte de uma maneira estável do indivíduo lidar com conflitos, mas também são influenciados pelo estado agudo da doença. / This study aims at evaluating the defense mechanisms most frequently used by Brazilian patients with panic disorder when compared to a control group as well as at examining the association between severity of disease and co morbidity and the use of specific defense mechanisms. Sixty panic disordered patients and thirty-one controls participated in the study. The Mini International Neuropsychiatric Interview was used to confirm the panic disorder diagnosis and to establish the co morbid diagnosis. The Clinical Global Impression (CGI) was used to assess severity and the Defensive Style Questionnaire (DSQ-40) was used to evaluate the defense mechanisms. Panic patients used more neurotic (mean=4.9 vs. 3.6; p<0,001) and immature (mean=3.9 vs. 2.8; p< 0,001) defenses as compared to controls. Panic patients with severe disease (n=37; CGI>4) had more depression co morbidity and used more immature defenses than patients with CGI<4 (n=23; mean=4.2 vs. 3.5; p<0.001). It was concluded that the Panic severity and depression co morbidity found in Brazilian panic disordered patients are associated with the use of maladaptive mechanisms, namely immature defenses.

INTRODUÇÃO: A busca por subtipos clínicos com melhor resposta terapêutica a tratamentos específicos levou à descrição do transtorno de pânico subtipo respiratório. A qualidade de vida de pacientes com transtorno de pânico (TP) é prejudicada devido a agorafobia, a mais freqüente das conseqüências do TP não tratado. Apesar de ser uma forma de esquiva, há poucos estudos sobre esquiva de atividade física e TP. OBJETIVO: Identificar se uma população com sintomas predominantemente respiratórios apresenta esquiva de atividade física e verificar as diferenças fisiológicas no exame clínico de ergoespirometria desta população, em comparação a pessoas sem transtorno de pânico e com transtorno de pânico subtipo não respiratório. MÉTODOS: Foram selecionados casos novos consecutivos registrados no Ambulatório de Ansiedade do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que apresentavam diagnóstico de transtorno de pânico. Foram submetidos a diferentes questionários e a um teste ergoespirométrico. Aqueles que preencheram os critérios de inclusão e sem os critérios de exclusão foram dispostos em três grupos: 1) grupo de participantes com transtorno de pânico respiratório (TPR), 2) grupo de participantes com transtorno de pânico não respiratório (TPNR) e 3) grupo de participantes sem diagnóstico psiquiátrico (C). RESULTADOS: 1) Observou-se uma proporção maior de mulheres (63,9%) e uma média de faixa etária de 34,14 anos. 2) Os grupos TPNR e TPR apresentam uma diferença na auto avaliação 3) Para qualidade de vida, o componente físico difere estatisticamente (p 0,001), nos dois grupos, TPNR e TPR em relação ao grupo controle (C). Entretanto entre os mesmos (TPNR e TPR) não houve diferenças, apresentando como médias +- desvio padrão (DP), de 64,94 +- 16,53 e 62,80 +- 17,89 respectivamente, (p = 0,906). 4) A maior diferença à esquiva de atividade física encontra-se entre o grupo C e os outros dois grupos: TPNR e TPR, (p 0,001) principalmente em relação ao medo de praticar exercícios. 5) Ocorreu um consumo máximo de oxigênio (VO2máx.), inferior nos grupos TPNR e TPR em relação ao grupo C, valores de VO2máx. são menores no grupo TPR em comparação ao grupo C, (p = 0,029), com médias +- DP, de 27,47 +- 4,08 e 32,13 +- 5,81 respectivamente, de acordo com o nível de aptidão funcional cardiorrespiratória e metabólica. CONCLUSÕES: Existem evidências da utilidade do conceito de TPR para caracterizar um subgrupo de pacientes com transtorno de pânico. Esquiva de atividade física parece não ser um fator determinante para os subtipos de TP, embora se apresente como característica fundamental nos pacientes com transtorno de pânico. Isto sugere a utilização do exercício como uma alternativa de tratamento ainda a ser estudada, como uma exposição terapêutica. Diferenças fisiológicas de VO2máx. no teste ergoespirométrico entre os grupos TPR e TPNR, não foram significativas, mas em relação a indivíduos sem transtorno de pânico, apresentaram resultados piores no consumo máximo de oxigênio, principalmente por uma questão comportamental de condicionamento ao medo, do que em relação a fisiopatologia do TP. Como uma hipótese: os valores mais baixos de VO2máx., apresentados pelo TPR em relação ao C, devem-se ao fato de um possível aumento do grau de sedentarismo apresentado em TPR, como decorrência do TP e pela má interpretação da escala de Borg utilizada como identificação subjetiva de esforço, determinante na conclusão do teste ergoespirométrico, porém estas conclusões devem ser melhores analisadas em um projeto futuro / INTRODUCTION: The search for subtypes with better therapeutic response to specific treatments led to the description of the respiratory panic disorder subtype. The quality of life of patients with panic disorder (PD) is impaired due to agoraphobia, the most frequent consequences of untreated PD. OBJECTIVE: Identify whether a population with mainly respiratory symptoms presents avoidance of physical activity and verify physiological differences in clinical examination of ergoespirometry in this population, in comparison with people who do not have panic disorder and people with non-respiratory panic disorder subtype. METHODS: patients selected consecutive new cases recorded in Anxiety Outpatient Department of Psychiatry Institute at Hospital das Clínicas from University of São Paulo School of Medicine, who presented a diagnosis of panic disorder. They answered to different questionnaires and underwent an ergoespirometric test. Those who met the inclusion criteria and no exclusion criteria were assigned to three groups: 1) group of participants with respiratory panic disorder (RPD), 2) group of participants with non-respiratory panic disorder (NRPD), and 3) group of participants with no psychiatry diagnosis (C). RESULTS: 1) A higher ratio of women was observed (63,9%) and mean age group of 34,14 years old. 2) NRPD and RPD presented a difference in self-evaluation. 3) As regards to quality of life, the physical component statistically differs (p 0,001) in both groups, NRPD and RPD relative to control group (C). However between these groups (NRPD and RPD) there been no differences at all, showing as averages +- standard deviation (SD) 64,94 +- 16,53 and 62,80 +- 17,89 respectively, (p = 0,906). 4) The higher difference in avoidance of physical activity was found among group C and the order two groups: NRPD and RPD, (p 0,001) mainly related to fear of practicing physical activity. 5) It was observed lower maximum oxygen uptake (VO2 máx.) in NRPD and RPD groups relative to group C, VO2 máx. Is lower in RPD group in comparison to group C, (p = 0,029), with averages +- SD 27,47 +- 4,08 and 32,13 +- 5,81 respectively, according to the level of metabolic and cardiorrespiratory performance status. CONCLUSIONS: There are evidences of the utility of RPD concept to characterize a subgroup of patients with panic disorder. Avoidance of physical activity does not seen a determining factor to PD subtypes, although it is presented as an essential characteristic in panic disorder patients. This suggests the use of physical activity as a treatment alternative to be studied, as a therapeutic exposition. Physiological differences in VO2 máx during ergoespirometric test between RPD e NRPD groups were not significant, but as regards to individuals with no panic disorder, they presented worse results in maximum oxygen uptake mainly due to a behavioral reason of being conditioned to fear, rather than PD physiopathology. As a hypothesis: lower VO2 máx values observed in RPD, arising from PD and from misinterpretation of Borg scale, which is subjectively used to identify the effort, and is a determining factor to obtain a conclusion of ergoespirometric test, however such conclusions must be further analyzed in a future project

Purpose: The relation between the causal attributions of individuals with panic disorder (PD) and their health outcomes remains relatively unexplored. Therefore we examined 1) the relationship between participants’ etiological beliefs about PD and baseline demographic and clinical characteristics and 2) whether participants’ etiological beliefs about PD predicted compliance, clinical response, and side effect profiles with the treatments they were assigned. Method: The study included 251 participants. A series of multiple linear regressions were used to evaluate the relationship between participants’ causal attributions, measured by the Etiological Model Questionnaire, and their baseline characteristics. To determine whether these beliefs predicted treatment outcome, logistic and linear regressions were conducted. Results: Our results revealed that participants with a family history of psychiatric illnesses were more likely to endorse biological etiological beliefs whereas those with a younger age, comorbid psychiatric disorders, and a history of suicide attempts were more likely to attribute their illness to psychological causes. Participants experiencing impairment in family life endorsed both psychological and environmental causal beliefs, while those reporting higher fear of body sensations and agoraphobic cognitions were more likely to attribute their illness to biological and psychological causes. With regards to treatment outcome, results indicated that participants who endorsed psychological and environmental etiological beliefs experienced more severe symptoms 12 weeks following treatment; irrespective of the type of treatment they received. Implications: The consideration of individuals’ causal attributions might help health-care professionals better assist clients by communicating a more balanced perspective of the causes of PD and deliver interventions that are in line with clients’ individual beliefs.

[pt] A matéria cinzenta periaquedutal dorsal (MCPD) é associada com comportamento defensivo e ataques de pânico em humanos. Estimulações elétricas da MCPD induzem a um repertório de defesa: o congelamento pré fuga, reação de fuga e congelamento pós fuga. Evidências já apresentadas suportam a hipótese que enquanto o congelamento pré fuga seria um modelo de ataque de pânico o congelamento pós fuga seria um modelo de transtorno de pânico. Os resultados no experimento 1 indicaram que as duas linhagens de animais selecionadas para alto (Carioca alto congelamento) e baixo (Carioca baixo congelamento) congelamento em resposta ao contexto associado com choque nas patas, demonstraram que embora a ansiedade antecipatória possa exercer um efeito inibitório na expressão do congelamento pré fuga e na reação de fuga, pode por sua vez facilitar o congelamento pós fuga. No experimento 2, o efeito de lesões eletrolíticas no Córtex Cingulado Anterior Rostral não alteraram o congelamento pré fuga e a reação de fuga, porém as mesmas exercem um efeito inibitório no congelamento pós fuga demonstrando que os tipos de congelamento no medo incondicionado são mediados por circuitarias de defesa independentes. No experimento 3, o efeito de lesões eletrolíticas no Córtex Cingulado Anterior Rostral (CCAr) aumentou a sensibilidade a dor (comportamento recuperativo) de animais submetidos ao teste de formalina no paradigma de analgesia condicionada demonstrando a importância do CCAr na modulação da circuitaria de dor. / [en] The dorsal portion of the periaqueductal Gray (DPAG) is notably associated with defensive behavior and panic attacks in humans. Electrical stimulation of the DPAG induces a repertoire of defense: dPAG-evoked freezing, escape reaction and dPAG post-stimulation freezing. Past evidence support the hypothesis that whereas dPAG-evoked freezing would serve as model of panic attack, the dPAG post-stimulation freezing appears to be a model of panic disorder. The experiment 1 used two lines of animals selectively bred for high (Carioca High-Freezing) and low (Carioca Low-Freezing) freezing in response to contextual cues associated with footshock. The results suggest that although anticipatory anxiety might exert an inhibitory effect on the dPAG-evoked freezing and escape reaction, it might also facilitate the dPAG post-stimulation freezing. The experiment 2 studied the effect of electrolytic lesions on rostral anterior cingulated cortex (rACC). The results of electrolytic lesions on rACC suggest that although rACC lesions did not change the dPAG-evoked freezing and escape threshold, it might exert an inhibitory effect on the dPAG post-stimulation freezing, reinforcing the hypothesis that dPAG-evoked freezing and dPAG post- stimulation freezing are modulated by two independent circuitry of defense. The experiment 3 studied pain sensibility of rACC lesioned animals submitted to formalin test on conditioned analgesia paradigm. The results suggest that rACC lesions might exert an inhibitory effect on conditioned analgesia and consequently exacerbates recuperative behavior. The results also support the hypothesis of the rule of rACC on pain modulation.

Panikstörung und Agoraphobie sind häufig auftretende Angststörungen, die mit einer hohen individuellen aber auch gesellschaftlichen Belastung einhergehen. Es existieren sehr erfolgreiche, aber auch aufwändige Behandlungsmethoden. Trotz einer hohen Erfolgsquote dieser Behandlungen kommt es immer wieder zu einer nicht ausreichenden Verbesserung der Beschwerden oder auch Therapieabbrüchen. Zu möglichen Einflussfaktoren auf den Therapieerfolg, -misserfolg oder Abbrüche wurde bereits mit widersprüchlichen Ergebnissen geforscht. Es erscheint sinnvoll, diese Faktoren zu kennen, um Fehlindikationen in ein aufwändiges Therapieverfahren zu vermeiden und den Leidensdruck der Patient:innen gegebenenfalls mit einem anderen Verfahren schneller zu lindern. Die vorliegende Arbeit untersucht, ob solche Prädiktoren für den Nicht-Erfolg im Kontext eines naturalistischen Behandlungssettings in der Angst-Tagesklinik an der Klinik und Poliklinik für Psychotherapie und Psychosomatik des Universitätsklinikums Carl Gustav Carus identifiziert werden können. Dazu wurde der Therapieeffekt anhand 214 Patient:innen geprüft. Weiterhin wurden sie hinsichtlich demografischer, sozialmedizinischer und störungsspezifischer Kennwerte am Anfang und am Ende der Behandlung untersucht und am Grad der Veränderung angstspezifischer Kennwerte in Responder und Non-Responder unterteilt. Anschließend wurden über logistische Regressionen Faktoren für die Non-Response identifiziert. Es stellte sich heraus, dass die Behandlung einen mittleren bis großen Effekt auf verschiedene Störungsmaße aufwies, jedoch ca. 57,5% der Patient:innen keine oder eine im klinischen Sinne unzureichende Verbesserung erlebt hatten. Dabei zeigte sich, dass sich die Betrachtung des Familienstands, des Ausmaßes der Angst vor körperlichen Krisen und die Mobilitätsvermeidung ohne Begleitperson gemeinsam am besten eignen, um eine mögliche Non-Response vorherzusagen. Das errechnete Modell fällte dabei auf Basis der Aufnahmedaten in 62,8% der Fälle die korrekte Entscheidung zur Zuordnung in die Gruppen der Responder und Non-Responder. Somit ist das Modell leider nicht ausreichend, um zweifelsfrei im Vorfeld einer Behandlung individuell zu entscheiden, ob die angebotene Expositionsbehandlung zielführend ist oder nicht. Das Modell gibt allerdings wichtige Hinweise auf mögliche Einflussfaktoren auf die Eignung zur Behandlung, auch wenn weitere, nicht untersuchte oder nicht messbare Faktoren bedeutsam sein könnten. / Panic disorder and agoraphobia are common anxiety disorders that are associated with a high individual burden, but also social burden. There are very successful, but also costly treatment methods. Despite a high success rate of these treatments, there sometimes is an insufficient reduction of symptoms or even therapy discontinuation in individual patients. Research has already been done on possible factors influencing the success, failure or discontinuation of therapy, with contradictory results. It makes sense to know these factors in order to avoid wrong indications for a complex therapy procedure and to alleviate the patients' suffering more quickly with another procedure. This study investigates whether such predictors of non-response can be identified in the context of a naturalistic treatment setting in the Angst-Tagesklinik at the Klinik und Poliklinik für Psychotherapie und Psychosomatik of the University Hospital Carl Gustav Carus Dresden. For this purpose, the therapy’s effect was tested on 214 patients. Furthermore, they were examined with regard to demographic, socio-medical and disorder-specific parameters at the beginning and end of treatment and divided into responders and non-responders according to the degree of change in anxiety-specific parameters. Subsequently, logistic regressions were used to identify factors for non-response. It was found that the treatment had a medium to large effect on various disorder specific measures, but that about 57.5% of the patients had experienced no improvement or insufficient improvement in the clinical sense. It was found that looking at marital status, level of fear of physical crises and mobility avoidance without a companion were best suited to predict a possible non-response to the treatment. Based on the patients’ admission data, the calculated predictor model made the correct decision to assign the patient to the responder and non-responder groups in 62,8% of the cases. In conclusion, the model is not sufficient to predict, whether the exposure treatment will be successful or not. However, the model provides important indications of possible factors influencing the suitability for treatment, even though other factors that have not been investigated or that are not measurable could be significant.

Panic disorder (PD) is a debilitating anxiety disorder that often reduces the quality of life and some of its symptoms are physical distress and fear. PD is often comorbid with other anxiety disorders and depressive disorders and also cardiovascular and respiratory illnesses. Pharmacotherapy and psychotherapy are the two most common treatment options for people with PD. A standard type of pharmacotherapy is selective serotonin reuptake inhibitors (SSRI) which in short work by increasing the level of serotonin in the brain and has been shown to be efficacious and safe. A vital brain structure that is closely linked to PD is the amygdala, and some of its functions are learning, emotional processing, and memory. There seems to be a functional and structural abnormality in the amygdala for people with PD compared to healthy individuals, for example, a smaller volume of gray matter and increased activity. The aim of the thesis is to conduct a systematic review on the effect of SSRIs on the functional alterations of the amygdala in patients suffering from PD. The present systematic review will try to answer the question: If SSRIs affect amygdala activation for PD patients compared to healthy individuals who are currently not undergoing any kind of pharmacotherapy. The results showed opposite findings; one study did not detect activation changes in the amygdala for PD patients using SSRIs, one detected higher activity in the right amygdala, whereas the other two showed a decrease in the left amygdala (one study did not specify left, bilateral, or right). More research regarding amygdala activation in PD patients using SSRIs is needed due to the small scale of studies currently available.

Panic disorder (PD) and claustrophobia are commonly co-occurring anxiety disorders associated with high distress and impairment. Interoceptive exposure (IE; exposure focused on anxiety about somatic sensations) is a well-established component of treatments for PD, but little is known about the specificity of its effects or individual response patterns resulting from this intervention. This study investigated the utility of IE in the treatment of PD with claustrophobia, examining its mechanisms in isolation and in combination with more traditional exposure to phobic situations (situational exposure). Ten adults with PD and claustrophobia (aged 23-74, 30% female) were treated with a flexible single-case experimental approach. Participants received up to 6 sessions of IE exercises (e.g., running in place to build tolerance to racing heart). Nonresponders received up to 6 additional sessions of IE combined with situational exposure entailing entering a closet to induce claustrophobia. Hypotheses included: 1) Reductions in somatic anxiety coinciding with the introduction of IE; 2) Reductions in agoraphobic symptoms coinciding with the introduction of situational exposure for initial nonresponders; 3) Habituation to both interventions whereby distress and participants’ expectancy of the most feared outcome (e.g., fainting) would decrease, and fear tolerance would increase, with improvements maintained at retest. Four participants experienced a clinically significant reduction in somatic anxiety coinciding with IE as predicted; three other participants improved following the addition of situational exposure. One aspect of agoraphobic anxiety – willingness to enter enclosed spaces – generally improved only after combined exposure, as predicted. Both IE and combined exposure elicited habituation whereby distress and expectancies of feared outcomes decreased and fear tolerance increased, supporting hypotheses. All improvements were maintained at retest. Ideographic analysis suggested that IE can rapidly change beliefs about somatic sensations and lead to distress habituation, but has variable immediate effects on overall somatic anxiety and does not reliably reduce related symptom sets (e.g., agoraphobia). IE appeared more helpful to participants who were fearful of the physical consequences of somatic sensations (e.g., heart attack) vs. other consequences (e.g., embarrassment). The observed variability in response to IE and combined exposure suggests a need for individualized implementation of treatments in PD with claustrophobia.

Introduction: Obesity is one of the most important medical problems in the U.S. and is considered to be an epidemic with over 30% of the population being obese. Obesity is associated with increased risk of hypertension, diabetes, cardiovascular diseases, certain cancers and a shorter life expectancy. Recent studies have shown that higher BMI levels are also significantly associated with several lifetime mental disorders such as major depressive disorder, anxiety disorders as well as panic attacks and panic disorders. Purpose: The purpose of this study was to quantify the extent to which higher BMI increased the likelihood of Depression, Anxiety Disorder and Panic Disorder and to observe if co-morbid illnesses such as Hypertension and Diabetes affect this association. Methods: A cross-sectional secondary data analysis was conducted using the 2008 National Health Interview Survey. There were 20,593 adult respondents (over 18 years of age) who were included in the study. Logistic regression models were weighted to account for the complex weighting scheme. Main Determinant measures: Based on their BMI, the participants were classified into 5 groups: Underweight (BMI <18.50), Normal Weight (BMI 18.50 – 24.99), Overweight (BMI 25.00 – 29.99), Obese (BMI 30.00-39.99) and Morbidly Obese (BMI > 40.00). Main Outcome Measures: Presence or absence of Depression, Anxiety Disorder or Panic Disorder based on self-report. Results: People who were obese or morbidly obese had higher odds of suffering from depression, anxiety disorder and panic disorder compared to people who were normal weight. Obese individuals were 35% as likely to suffer from depression, 22% as likely to suffer from anxiety disorder and 36% as likely to suffer from panic disorder relative to normal weight persons. Morbidly obese people were 85% as likely to suffer from depression, 27% as likely to suffer from anxiety disorder and 34% as likely to suffer from panic disorder. No interactions were observed based on the presence of hypertension or diabetes. Conclusion: Obesity is associated with an increased prevalence of depression, anxiety disorder and panic disorder. With obesity rates steadily increasing, understanding the impact of obesity on the occurrence of mental disorders is important.

L'objectif du travail était l'étude des effets ventilatoires et cardiovasculaires de l'hyperventilation volontaire (HV) ainsi que psychophysiologiques chez les sujets sains et les patients souffrant de trouble panique. Nous avons mené deux études : la première sur des sujets sains sur lesquels le débit ventilatoire, les mouvements du thorax et de l'abdomen, le pourcentage de CO2 dans l'air expiré (FETCO2), l'électrocardiogramme (ECG) ont été enregistre au cours de deux tests d'hyperventilation : l'un à la fréquence de repos (THV) et l'autre à la fréquence de 20 cycles par minute (THV20). La deuxième étude a porté sur un groupe de sujets sains (groupe contrôle) et un groupe de patients souffrant du trouble panique (TP) sur lesquels le débit ventilatoire et l'ECG ont été enregistrés et les niveaux d'anxiété (Spielbergher), de dépression (Beck), du stress (Holmes), des symptômes de troubles fonctionnels (Profil Végétatif) et des symptômes produits par l'hyperventilation ont été évalués. Les variables ventilatoires classiques ont été calculées cycle par cycle. La forme des cycles ventilatoires a été étudiée en calculant les asters (représentation vectorielle des quatre premières harmoniques d'une décomposition en série de Fourier de chaque cycle respiratoire) ainsi que les triads (complexe trivarié: volume courant Vt, temps d'inspiration Ti et d'expiration Te). Les asters et triads ont été comparés dans les différentes conditions en utilisant un test statistique multi-varié (test de similarité). Les composantes du spectre de la période cardiaque, les périodes cardiaques moyennes et les coefficients de variation de la période cardiaque ont été calculés à partir des intervalles RR de l'ECG. Les résultats du test de similarité montrent que la forme du cycle ventilatoire de repos est modifiée au cours de l'hyperventilation volontaire, mais que la forme cycle à l'HV est conservée à un an d'intervalle et aussi pour les périodes d'HV des deux tests THV et TVH20. L'hyperventilation volontaire modifie significativement les caractéristiques de la ventilation (variables et forme du cycle). Cependant, au cours de l'hyperventilation volontaire ces caractéristiques sont conservées à un an d'intervalle et il semble que la personnalité ventilatoire de repos ne se conserve pas au cours de l'HV, mais l'on retrouve une personnalité « différente » au cours de l'HV. Les variables ventilatoires et leurs coefficients de variation sont modifiés pendant toutes les périodes des deux tests d'hyperventilation. Les variables ventilatoires du groupe contrôle ne sont significativement différentes du groupe TP qu'au cours des trois premières minutes de récupération. La variabilité cardiaque est significativement modifiée au cours des périodes des tests d'hyperventilation volontaire. La variabilité cardiaque est significativement plus faible chez les patients TP que chez les sujets sains et l'analyse des composantes spectrales de la période cardiaque permet de déduire que les patients semblent présenter au repos et pendant l'HV, une activité cardio-vagale plus faible et une activité sympathique plus élevée que les sujets sains. Les patients TP ont des niveaux plus élevés d'anxiété et de dépression que les sujets du groupe contrôle. Au cours des trois première minutes de récupération après l'hyperventilation volontaire à la fréquence de repos, la ventilation est plus élevée chez les sujets présentant une anxiété élevée que chez ceux présentant une anxiété normale à moyenne. Le nombre de symptômes fonctionnels et produits par l'hyperventilation volontaire est aussi plus élevé chez les sujets présentant une anxiété élevée. / The aim of this research was the evaluation of the ventilatory and cardiovascular effects the voluntary hyperventilation (HV) and psychophysiological peculiarities in healthy subjects and patients with panic disorder. We performed two studies: we recorded the airflow, thoracic and abdominal movements, percent of the CO2 in expired air (FETCO2), electrocardiogram (ECG) in a group of healthy subjects during the two voluntary hyperventilation tests: at rest frequency (THV) and at 20 breaths per minute (THV20). The second study was performed on the healthy subjects (control group) and panic disorder patients (TP): airflow and ECG were recorded and the levels of anxiety (Spielbergher), depression (Beck), stress (Holmes), functional symptoms (Vegetative Profile) and symptoms generated by voluntary hyperventilation were evaluated. The classical respiratory variables were calculated cycle by cycle. The shape of ventylatory cycles were studied by calculation of asters (vectorial representation of the first four harmonics obtained by Fourier transformation of each respiratory cycle) and triads (trivariate complex tidal volume - Vt, inspiratory - Ti and expiratory - Te times). The asters and triads were compared in different conditions using statistical multivariate test (similarity test). The components of heart periods spectre, mean cardiac periods and their variation coefficients were determined from the RR intervals of ECG. The results of the similarity test show the change of respiratory cycle shape during voluntary hyperventilation compared with rest, but the shape of the cycle during HV is conserved during one year interval and between periods of HV of two tests THV and THV20. Voluntary hyperventilation changes significantly ventilatory characteristics (variables and shape of cycle). However, these characteristics are conserved during voluntary hyperventilation after one year interval and the rest ventilatory personality is not conserved during HV, but the different personality appears during HV. Ventilator variables and their variation coefficients are modified during all periods of the two hyperventilation tests. The ventilatory variables of the control group compared with TP group differ only during first three minutes of recovery. Heart rate variability is significantly modified during all periods of hyperventilation test. Heart rate variability is significantly diminished in TP patients compared with healthy subjects and the analysis of spectral components of cardiac period allows affirming a weaker cardio-vagal activity and higher sympathetic activity compared with the healthy subjects. The TP patients compared with control group have higher levels of anxiety and depression. The ventilation during three minutes of recovery after voluntary hyperventilation at rest frequency is higher in subjects with high anxiety level compared with subjects with normal and mean level of anxiety. The number of functional symptoms and symptoms caused by voluntary hyperventilation is also higher in subjects with high anxiety.

Made available in DSpace on 2016-04-04T18:27:27Z (GMT). No. of bitstreams: 1 Graziela Siebert.pdf: 1011844 bytes, checksum: 8cc453da65d734b48b6fc0795fde9f8d (MD5) Previous issue date: 2006-02-01 / Universidade Estadual Paulista J?lio de Mesquita Filho / Panic Disorder is one of the most frequent and incapability problems among anxiety disturbing, representing one of major reasons people look for health support in Brazil and in world. The Behavior Analyses Therapy constitutes a treatment propose with very satisfactory results, focusing on the relation between clients felt and described symptoms and the operation contingencies, of which his/her behavior means the functions. The fully removal of symptoms (private events described by client) may occur since contingencies changing. The goal of this present work is to verify the changing occurrence from a verbal report of a client (25 years old) diagnosed with Panic Disorder by a psychiatrist. The changes occurred were verbalizations on auto-analyses and symptom descriptions for observation report and description of the relation among behavior/symptoms/environment, creating an initial strategy for psychotherapy treatment of such disorder. First eleven psychotherapy sessions were recorded and transcribed, and verbalizations were divided into categories by three independent judges - categories of client verbalization: Symptom, Environment, Behavior, Symptom/ Environment, Others; and functional categories of therapist verbalizations: Information, Investigation, Feedback, Advice/Rule, Interpretations, Others. Results have demonstrated as an answer for therapy intervention an important decrease on client verbalization frequency concerning category of symptom and an increase on category concerning symptom/environment. Those results contribute with clinical practice based on Radical Behaviorism philosophy, by demonstrating, in a natural clinical situation, that client behavior statement is selected (by therapist), as any other behavior, following the behavior concept as a result of environmental concern. / O Transtorno do P?nico ? um dos mais freq?entes e incapacitantes problemas dentre os transtornos ansiosos, representando um dos motivos de maior procura dos servi?os de sa?de no Brasil e no mundo. A Terapia Anal?tico-Comportamental constitui uma proposta com resultados bastante satisfat?rios para seu tratamento, e seu enfoque ? o esclarecimento da rela??o entre os sintomas sentidos e descritos pelo cliente e as conting?ncias em opera??o, das quais seus comportamentos s?o fun??o. A completa remo??o dos sintomas (eventos privados descritos pelo cliente) poder? ocorrer em conjunto com a altera??o das conting?ncias. O objetivo do presente trabalho foi verificar a ocorr?ncia da mudan?a do relato verbal de uma cliente (25 anos) diagnosticada com Transtorno do P?nico por um psiquiatra. A mudan?a ocorrida foi de verbaliza??es sobre auto-observa??o e descri??o de sintomas para o relato de observa??o e descri??o da rela??o comportamento / sintoma / ambiente, compondo uma estrat?gia inicial para o tratamento psicoterap?utico deste transtorno. Foram gravadas e transcritas as onze primeiras sess?es de psicoterapia, e as verbaliza??es categorizadas por tr?s juizes independentes - categorias para verbaliza??es da cliente: Sintoma, Ambiente, Comportamento, Sintoma / Ambiente, Outras; e categorias funcionais para verbaliza??es do terapeuta: Informa??o, Investiga??o, Feedback, Conselhos / Regras, Interpreta??es, Outras. Os resultados demonstraram uma diminui??o acentuada na freq??ncia de verbaliza??es da cliente referentes ? categoria sintoma e um aumento na freq??ncia da categoria rela??o sintoma / ambiente, como produto da interven??o terap?utica desenvolvida. Estes resultados contribuem com a pr?tica cl?nica baseada na filosofia do Behaviorismo Radical, por demonstrar, em uma situa??o cl?nica natural , que o comportamento da cliente de relatar ? selecionado (no caso, pelo terapeuta), como qualquer outro comportamento, seguindo uma concep??o de comportamento como produto de rela??es ambientais.