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March 1990

The Diagnostic Utility of Lactate Sensitivity in Panic Disorder

Author Affiliations

From the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dr Cowley); and the Department of Psychiatry and Behavioral Science and the Institute of Psychiatry, Medical University of South Carolina, Columbia, and the Inpatient Service, Psychiatry Service, Charleston (SC) Veterans Administration Medical Center (Dr Arana).

Arch Gen Psychiatry. 1990;47(3):277-284. doi:10.1001/archpsyc.1990.01810150077012

• Lactate infusion is the most extensively studied of the pharmacological challenge tests in panic disorder. We assessed the value of this test in the diagnosis and subtyping of panic in clinical and research settings. Analysis of lactate infusion studies to date suggests that patients with panic attacks are significantly more sensitive to lactate than are healthy controls or patients with other psychiatric disorders without panic attacks. However, the usefulness of lactate infusion is limited by the lack of standardized, objective criteria for lactate-induced panic and uncertainty as to the sensitivity and specificity of the test for current, clinically significant panic attacks. Except in rare cases, the clinical history is likely to be of more value than lactate response in diagnosing panic disorder. Determination of the role of the test in subtyping patients with panic disorder awaits further study of the diagnostic, prognostic, genetic, and pathophysiologic significance of lactate sensitivity.