Advertisement

The reply:

      We thank Bulbena et al for their interest in our paper on dysautonomia in the hypermobility syndrome (
      • Gazit Y
      • Nahir A.M
      • Grahame R
      • Jacob G
      Dysautonomia in the hypermobility syndrome.
      ). As they have pointed out, nine of the 13 somatic criteria for diagnosing a panic episode, as laid down in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM–IV) (

      American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (DSM-IV). 4th ed. Arlington, Virginia: American Psychiatric Press; 2000

      ), do, indeed, feature in the autonomic questionnaire we used. What they have omitted to mention is that our questionnaire contains 20 further questions over and above the nine they refer to, which do not form part of the DSM–IV criteria for panic attacks or other forms of psychiatric disease. None of our patients experienced “a discrete period of intense fear or discomfort in the absence of real danger” that forms “an essential feature” of the criteria for panic attack as defined in DSM–IV(

      American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (DSM-IV). 4th ed. Arlington, Virginia: American Psychiatric Press; 2000

      ), and none expressed phobic symptoms. The assertion by Bulbena et al that our patients' symptoms are psychogenic rather than dysautonomic in origin is highly contentious. Furthermore, it totally ignores the objective laboratory evidence of autonomic dysfunction demonstrated in 78% of the patients in our series presented in our paper.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gazit Y
        • Nahir A.M
        • Grahame R
        • Jacob G
        Dysautonomia in the hypermobility syndrome.
        Am J Med. 2003; 115: 33-40
      1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (DSM-IV). 4th ed. Arlington, Virginia: American Psychiatric Press; 2000

        • Stein M.B
        • Asmundson G
        Autonomic function in panic disorder.
        Biol Psychiatry. 1994; 36: 548-558
        • Schondorf R
        • Low P
        Idiopathic postural orthostatic tachycardia syndrome.
        Neurology. 1993; 43: 132-137