Vascular Reactivity and Panic Attacks

To the Editor.—  Pies1 recently reported a case in which presumptive Raynaud's phenomenon occurred in a patient with panic disorder and suggested the possibility of a common underlying mechanism. We have obtained data from several sources that argue against this hypothesis. First, although panic disorder patients had significantly lower finger temperatures than normal subjects before and during intravenous infusions in the laboratory,² this difference was not found during 24-hour ambulatory monitoring.³ We ascribed the laboratory finding to anticipatory anxiety resulting from the experimental situation: the patients had previously been informed that they were likely to experience panic attacks during sodium lactate and isoproterenol infusions.Second, the pattern of peripheral vasomotor activity found during panic attacks is different from that occurring during Raynaud's phenomenon. During panic attacks, we usually found a pattern of peripheral vasodilation followed by vasoconstriction.³ During ambulatory monitoring of Raynaud's phenomenon,⁴ peripheral vasoconstriction alone