Psychophysiological aspects of disproportionate breathlessness
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290 R. Rtchter and B. Tmmons, eds. / Resprrutory Psychophysiolqy ohstrcrcts CLINICAL SYNDROMES OF CHRONIC HYPERVENTILATION L.C. LUM London Medmzl Centre, London WIN IAH, UK Over the period 1965 to 1981 the author studied more than 2000 cases of chronic hyperventilation. Comprehensive clinical and respiratory physiological studies were done in all cases reported. Symptoms were complained of in virtually any organ or system - usually several. Occasionally organic disease is closely mimicked (e.g. angina, hiatus hernia). Psychological disturbances of varying severity are usual: phobic states. depersonalization and occasionally hallucinations occur. Phobias are manifest in about one quarter. Spirometric studies have shown a characteristic, usually diagnostic pattern. Arterial and alveolar PCO, studies have shown: (1) A generally low resting PCO,; 66% are below 35 mm. Hg. while the remainder are between 35 and 40 mm. Hg. (i.e. the lower end of the normal range). (2) Abnormally wide fluctuations of alveolar and arterial PCO,. (3) An abnormal degree of reactivity of the breathing to physical and emo- tional stimuli. The effect of this fluctuating hypocarbia on the central and autonomic nervous systems, and on higher cerebral function will be discussed. The physiological dysfunction is correlated with somatic and psychological mani- festations. A complete cure (i.e. total loss of all symptoms: of morbid anxiety, and of all need for medication) has been obtained in 75-80% of all patients by appropriate breathing retraining. In this series, the distribution between the sexes was equal. PSYCHOPHYSIOLOGICAL ASPECTS OF DISPROPORTIONATE BREATHLESSNESS Teresa M. McEVOY and Don MARCER Department of Psychologv, Univernty of Southampton, Southumpton SO9 5NH. UK J.B.L. HOWELL Faculty of Medxine, Southumpton Generul Hmprtal, Southampton, UK
Transcript of Psychophysiological aspects of disproportionate breathlessness
290 R. Rtchter and B. Tmmons, eds. / Resprrutory Psychophysiolqy ohstrcrcts
CLINICAL SYNDROMES OF CHRONIC HYPERVENTILATION
L.C. LUM
London Medmzl Centre, London WIN IAH, UK
Over the period 1965 to 1981 the author studied more than 2000 cases of chronic hyperventilation. Comprehensive clinical and respiratory physiological studies were done in all cases reported. Symptoms were complained of in virtually any organ or system - usually several. Occasionally organic disease is closely mimicked (e.g. angina, hiatus hernia).
Psychological disturbances of varying severity are usual: phobic states. depersonalization and occasionally hallucinations occur. Phobias are manifest in about one quarter.
Spirometric studies have shown a characteristic, usually diagnostic pattern. Arterial and alveolar PCO, studies have shown:
(1) A generally low resting PCO,; 66% are below 35 mm. Hg. while the remainder are between 35 and 40 mm. Hg. (i.e. the lower end of the normal
range). (2) Abnormally wide fluctuations of alveolar and arterial PCO,. (3) An abnormal degree of reactivity of the breathing to physical and emo-
tional stimuli.
The effect of this fluctuating hypocarbia on the central and autonomic nervous systems, and on higher cerebral function will be discussed. The physiological dysfunction is correlated with somatic and psychological mani- festations.
A complete cure (i.e. total loss of all symptoms: of morbid anxiety, and of all need for medication) has been obtained in 75-80% of all patients by appropriate breathing retraining.
In this series, the distribution between the sexes was equal.
PSYCHOPHYSIOLOGICAL ASPECTS OF DISPROPORTIONATE BREATHLESSNESS
Teresa M. McEVOY and Don MARCER
Department of Psychologv, Univernty of Southampton, Southumpton SO9 5NH. UK
J.B.L. HOWELL
Faculty of Medxine, Southumpton Generul Hmprtal, Southampton, UK
R. Richter und B. Timmons, eds. / Respircrtory Psychoph_~siolo~ abstracts 291
Patients suffering from asthma, chronic bronchitis and disproportionate breathlessness talked freely about their illnesses. Using conventional content analysis techniques, these informal reports were used to construct and validate a questionnaire, designed to measure two aspects of breathlessness: (a) the frequency with which certain symptoms are experienced; and (b) the level of distress associated with these symptoms.
Following a cluster analysis of the questionnaire data, it was shown that:
(1) Breathlessness is not solely a sensory phenomenon. Rather, it must be viewed as an experience involving at least six components, which include cognitive and affective, as well as sensory factors.
(2) There are differences in the extent to which any one of these factors
contributes to the symptoms experienced by the three groups of patients. (3) The frequency with which a particular component of breathlessness is
experienced does not necessarily predict the distress that it produces.
The findings in (2) and (3) above suggest that the patterns of breathing normally exhibited by the three classes of patients will be affected differently when the patient is asked to breathe under certain experimental conditions. The results of two such experiments will be discussed which measured changes in breathing patterns brought about by: (a) requiring the subject to perform a physical and a mental task. and (b) re-breathing CO,.
THE EFFECT OF CHEST STRAPPING ON RESPONSE BIAS IN RESISTIVE LOAD DETECTION
P.G. NARBED, J.B.L. HOWELL and E. SPENCER
Faculty of Medrcine. Southampton General Hospital. Southampton, UK
D. MARCER
Department of Psychology, University of Southampton, Southumpton, SO9 5NH, UK
Zechman and Wiley (1977) found that clamping the thoracic cage did not affect the mean AR/R, detection threshold for flow resistive loads to breath- ing, leading them to suggest that sensory information from the chest wall is not necessary for the perception of resistance.
However, alterations in rates of detection may be due to changes in subjective factors as well as changes in the sensory mechanisms of sensation, hence if these two variables are not controlled for, the interpretation of threshold results will be equivocal (Swets, 1973).
