Panic Disorder

To the Editor: Missing from Katon's review of panic disorder (June 1 issue)¹ is the frequent correlation of symptoms with acute respiratory alkalosis resulting from hyperventilation. Table 1 of the article, showing criteria for the diagnosis of panic disorder, lists 13 symptoms, all of them common in the hyperventilation syndrome.² Many patients with this syndrome are referred for a cardiac or neurologic workup before the correct diagnosis is made. Good symptomatic relief may be obtained with the use of a simple three-step approach. First, provide an elementary explanation of the carbon dioxide depletion consequent to overbreathing and the symptoms that . . .