Panic Attacks.

[jim]

I'm not sure if I have posted this before.




Extracts from- What You Can Change and What You Can't.- By Martin E. P. Seligman.

Panic attacks.

The defining feature of the disorder is simple; recurrent, awful attacks of panic that come out of the blue. They are accompanied by feelings of overwhelming dread and thoughts that you are going to die, that you are having a heart attack, that you are loosing control, or that you are going crazy.

Inducing panic. panic attacks can be created by a chemical agent. patients who have a history of panic attacks are hooked up to an intravenous line. Sodium lactate, a chemical that normally produces rapid, shallow breathing and heart palpitation, is slowly infused into their bloodstream. Within minutes, about 60 to 90 percent of these patients have a panic attack. Normal controls, subjects with no history of panic, rarely have attacks when infused with lactate.

Genetics of panic. There may be some heritability of panic. If one of two identical twins has panic attacks, 31 percent of the co-twins also have them. But if one of two fraternal twins has panic attacks, none of the co-twins are so afflicted. More than half of panic-disorder patients, moreover, have close relatives who have some anxiety disorder or alcoholism.

Panic and the brain. The brains of people with panic disorders look somewhat unusual upon close scrutiny. There neurochemistry shows abnormalities in the system that turns on and then dampens fear. In addition. PET scans show that patients who panic from the infusion of lactate have higher blood flow and oxygen use in relevant parts of their brain than patients who don't panic.

Drugs. Anti-depressant and anti-anxiety drugs both work better than placebos. Panic attacks are dampened, and sometimes even eliminated. General anxiety and depression also decrease.

Psychologist David Clark put forward the theory, that panic may simply be the catastrophic misinterpretation of bodily sensations.
For example, when you panic, your heart starts to race. You notice this, and you see it as a possible heart attack. This makes you very anxious, which means your heart pounds more. You now notice that your heart is really pounding. You are now sure it's a heart attach. This terrifies you, and you break into a sweat, you feel nauseated, short of breath - all symptoms of terror, but for you, they're confirmation of a heart attack. A full-blown panic attack is under way, and at the root of it is your misinterpretation of the symptoms of anxiety as symptoms of impending death.


This psychological theory handles the biological findings well.
* Sodium lactate induces panic because it makes you heart race. It creates the initial bodily sensations that you then misinterpret as catastrophe.
* Panic is partially heritable because having a particular noticeably bodily sensation , such as heart palpitations, is heritable, not because panic itself is directly heritable.
* Brain areas that prevent the dampening of anxiety are active because this activity is a mere symptom of panic.
* Drugs relieve panic because they quiet the bodily sensations that get interpreted as a heart attack.

David Clark's Therapy.

Patients are told that panic results when they mistake normal symptoms of mounting anxiety for symptoms of heart attack, going crazy, or dying. Anxiety itself, they are informed, produces shortness of breath, chest pain, and sweating. Once they misinterpret these normal bodily sensations as an imminent heart attack, their symptoms become even more pronounced because the misinterpretation changes their anxiety into terror. A vicious circle culminates in a full-blown panic attack.

Patients are taught to reinterpret the symptoms realistically, as mere anxiety symptoms. Then they are given practice right in the office, breathing rapidly into a paper bag. This causes a build-up of carbon dioxide and shortness of breath, mimicking the sensations that provoke a panic attack. The therapist points out that the symptoms that the patient is experiencing - shortness of breath and heart racing - are harmless, simply the result of overbreathing, not a sign of a heart attack. The patient learns to interpret the symptoms correctly.

One patient, when he felt somewhat faint, would have a panic attack. He became afraid that he would actually faint and collapse, and interpreted his anxiety as a further symptom of imminent fainting. This escalated to panic in seconds.
"Why?" Clark asked him, "have you never actually fainted?"
"I always manages to avoid collapsing just in time by holding onto something," replied the patient.
"That's one possibility. An alternative explanation is that the feeling of faintness you get in a panic attack will never lead you to collapse, even if you don't control it. In order to decide which possibility is correct, we need to know what happens to your body for you to actually faint. Do you know/"
"No."
"Your blood pressure needs to drop," said Clark. "Do you know what happens to your blood pressure during a panic attack?"
?Well, my pulse is racing. I guess my blood pressure must be up," the patient responded.
"That's right. In anxiety, heart rate and blood pressure tend to go up together. So you are actually less likely to faint when you are anxious than when you are not," said Clark.


"But why do I feel so faint?"
"Your feeling of faintness is a sign that your body is reacting in a normal way to the perception of danger. When you perceive danger, more blood is sent to your muscles and less to your brain. This means there is a small drop in oxygen to the brain. That is why you feel faint. However, this feeling is misleading because you will not actually faint since your blood pressure is up not down."
The patient concluded, "That's very clear. So next time I feel faint, I can check out whether I'm going to faint by taking my pulse. If it's normal or quicker than normal, I know I won't faint."
"this simple therapy appears to be a cure," Clark told us. "Ninety to one hundred percent of the patients are panic free at the end of therapy. One year later, only one person had had another panic attack."

Treatments.
Cognitive Therapy.
Drugs.

Drugs.
Improvement ------------- 60 to 80%
Relapse ------------- moderate to high
Side effects ------------- moderate
Time scale ------------- days/weeks
Overall ------------- useful

Cognitive Therapy.
Improvement ------------- 80 t0 100%
Relapse ------------- 10% or fewer
Side effects -------------- none
Time scale -------------- weeks
Overall -------------- excellent

[David]

So far I control my panic attacks with Ativan and Tramadol. Works for me.

[lavishgail]

Me too, just like David! But be4 that, I always would have heart racing and sweating and feel like I'm passing out! Very awful. I can't control it so my meds work good for me. Good read though. Thank you.