Talk:Panic attack/Archive 1

Section header added just to push TOC to top
I'm trying to change this article around a bit to improve clarity. For one thing, the introduction is a jumble of information about panic disorder and panic attacks, which are two separate things.

Trypanophobia 00:39, 18 June 2006 (UTC)

What's an "adrenal overload"? Is this an orthodox medical term? Please provide cites for this usage. Any doctors in the house?

reply: I am not a doctor (though hopefully in a few years, I will be). I started suffering from panic and anxiety attacks about 7 years ago. After about a year, I learned to control the panic attacks but had anxiety attacks and pretty much a constant level of anxiety during and after that time. The only drugs that provided relief were benzodiazepines. I also had high blood pressure and arrhythmias. After years of trying to get the arrhythmias on an EKG (don't know why they wouldn't give me a holter monitor), they finally got them on a trip to the E.R. My doctor began treating me with beta blockers and an hour after the first pill, my anxiety was gone and has never returned since (I still have anxiety, but like normal people). After discussion with 2 doctors, it was finally decided that my problem was an overproduction of catecholamines, primarily epinephrine (adrenaline) and norepinephrine (noradrenaline). The beta blockers block the action of the epinephrine and norepinephrine.

The "medical terms", I believe, are simply catecholamine overproduction or catecholamine imbalance. And since you mention it, someone might want to consider adding this to the page. This is, however, a very uncommon cause of panic and anxiety attacks. It's sometimes associated with pheochromocytoma, but that's a very rare finding. It's also sometimes the result of other tumors and/or cancers of the adrenal system.


 * Added some text from the public domain NIMH web page at http://www.pueblo.gsa.gov/cic_text/health/panic/panfly.htm
 * Removed most of the "adrenal overload" stuff.
 * Added more public domain stuff from http://www.nimh.nih.gov/anxiety/panicfacts.cfm and the public domain Report of the Surgeon-General on Mental Health at http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html

This article now consists of three public-domain articles aimed at audiences with different levels of understanding, and a paragraph of lead-in from an earlier article. It now needs copyediting and merging. Any volunteers?


 * I've taken some of the heavy technical stuff from lower down & lightened up (like egg white! fluffy!) to give an introduction which states what a PA actually is. I'm not sure we can include people's testimonials (GFDL...), so I suggest we remove them. We have a list of what people report as the sensations anyway. -- Tarquin 17:25 Dec 24, 2002 (UTC)


 * The triple redundancy in the article confused me until I read this talk page. If noone plans to merge the three source articles soon, I'd like to put a notice at the top along the lines of "this page contains three articles, please help us merge them."  I don't have the patience to merge the articles myself.  The subject matter is too sensitive for me. -- Crag 02:19, 2004 May 1 (UTC)

It isn't necessary to have so much repeated information. Would you find such an article in a normal encyclopedia? The section I've moved here has little information beyond that contained in the other sections, and isn't written for an audience of laypeople. --Eequor 19:49, 22 Jun 2004 (UTC)

I've listed this on Pages needing attention. --Eequor 20:02, 22 Jun 2004 (UTC)

In my opinion, this article ought to be rewritten from scratch. The language the government uses to make its documents accessible tends to sound uneducated. --Eequor 20:07, 22 Jun 2004 (UTC)

EADD
So what does EADD stand for? It's not explained on this page, and this page is the only google result for define:EADD

Panic attacks and panic disorder
A panic attack is a discrete period of intense fear or discomfort that is associated with numerous somatic and cognitive symptoms (DSM-IV). These symptoms include palpitations, sweating, trembling, shortness of breath, sensations of choking or smothering, chest pain, nausea or gastrointestinal distress, dizziness or lightheadedness, tingling sensations, and chills or blushing and "hot flashes." The attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes. Most people report a fear of dying, "going crazy," or losing control of emotions or behavior. The experiences generally provoke a strong urge to escape or flee the place where the attack begins and, when associated with chest pain or shortness of breath, frequently results in seeking aid from a hospital emergency room or other type of urgent assistance. Yet an attack rarely lasts longer than 30 minutes. Current diagnostic practice specifies that a panic attack must be characterized by at least four of the associated somatic and cognitive symptoms described above. The panic attack is distinguished from other forms of anxiety by its intensity and its sudden, episodic nature. Panic attacks may be further characterized by the relationship between the onset of the attack and the presence or absence of situational factors. For example, a panic attack may be described as unexpected, situationally bound, or situationally predisposed (usually, but not invariably occurring in a particular situation). There are also attenuated or "limited symptom" forms of panic attacks.

Panic attacks are not always indicative of a mental disorder, and up to 10 percent of otherwise healthy people experience an isolated panic attack per year (Barlow, 1988; Klerman et al., 1991). Panic attacks also are not limited to panic disorder. They commonly occur in the course of social phobia, generalized anxiety disorder, and major depressive disorder (DSM-IV).

Panic disorder is diagnosed when a person has experienced at least two unexpected panic attacks and develops persistent concern or worry about having further attacks or changes his or her behavior to avoid or minimize such attacks. Whereas the number and severity of the attacks varies widely, the concern and avoidance behavior are essential features. The diagnosis is inapplicable when the attacks are presumed to be caused by a drug or medication or a general medical disorder, such as hyperthyroidism.

Lifetime rates of panic disorder of 2 to 4 percent and 1-year rates of about 2 percent are documented consistently in epidemiological studies (Kessler et al., 1994; Weissman et al., 1997) (Table 4-1). Panic disorder is frequently complicated by major depressive disorder (50 to 65 percent lifetime comorbidity rates) and alcoholism and substance abuse disorders (20 to 30 percent comorbidity) (Keller & Hanks, 1994; Magee et al., 1996; Liebowitz, 1997). Panic disorder is also concomitantly diagnosed, or co-occurs, with other specific anxiety disorders, including social phobia (up to 30 percent), generalized anxiety disorder (up to 25 percent), specific phobia (up to 20 percent), and obsessive-compulsive disorder (up to 10 percent) (DSM-IV). As discussed subsequently, approximately one-half of people with panic disorder at some point develop such severe avoidance as to warrant a separate description, panic disorder with agoraphobia.

Panic disorder is about twice as common among women as men (American Psychiatric Association, 1998). Age of onset is most common between late adolescence and midadult life, with onset relatively uncommon past age 50. There is developmental continuity between the anxiety syndromes of youth, such as separation anxiety disorder. Typically, an early age of onset of panic disorder carries greater risks of comorbidity, chronicity, and impairment. Panic disorder is a familial condition and can be distinguished from depressive disorders by family studies (Rush et al., 1998).

Question from person who has not had a panic attack
Is someone who has experienced an attack willing to describe any visual disturbances they have encountered during an attack?

I am hoping to produce a scene for a TV series where we see a character's point of view as they go through one. I'd like to get it right. Any help much appreciated. --bodnotbod 03:52, July 28, 2005 (UTC)


 * Consider talking to a psychiatrist; they can ask suitable patients if they would be willing to help. And, I'd suggest having the sound people take care of this bit. Failing that, my two simple suggestions would be to (a) inhale carbon dioxide from dry ice under controlled circumstances to cause a panic attack, making sure to have someone standing by in case you forget to get enough oxygen, and/or (b) consume a single dose of a drug that provokes interpretation-related hallucination-like effects and try to get a feedback loop of fear going. An authentic experience is the only thing that'll really let you take it to the screen. Zuiram 04:04, 3 January 2007 (UTC)

reply: pretty much just dizzyness, things blending into another. Sometimes the surroundings go quiet and dull and other times everything like sounds and colours are magnified.

reply: vertigo was common, i.e., things feeling like they're moving when you're not. Sharp sounds and visual cues were disturbing (e.g., listening to a door shut suddenly was jarring. light flashing in from a newly-opened window strikes the brain) --filipem 09:18, November 15, 2005

reply: nothing visual really, just emotions going wild, although dizziness or disorientation is common. Unlike the article states, I have never experienced tunnel vision, althouygh maybe some others have. Vertigo in some cases I also suffered like filipem states. Arundhati Bakshi 19:12, 29 January 2006 (UTC)

reply : no visual effects, just a fear of an "inevitable" vicious circle where physical symptoms increase mental worry which in turn increases the physical symptoms --PopUpPirate 00:03, 7 February 2006 (UTC)

reply : lightheadedness and the sense that the walls were closing in (I suppose this could be tunnel vision of a sort). Also, disturbing sensitivity to touch, light and sound. I hate to be touched when I'm having an attack. Walkerb4 19:21, 21 February 2006 (UTC)

reply: Nothing definitely visual during an attack. Nothing so dramatic as tunnel vision (At least as I understand it, from the article on tunnel vision), just a crippling fear (Which at the time seems perfectly rational). No dizziness but extreme vertigo and lightheadedness, feeling of being about to fall despite being firmly on the ground. I wouldn't envy you trying to portray a panic attack on-screen, I'm very glad you're going for accuracy and not stereotypical stuff though. Eeblefish 05:04, 31 March 2006 (UTC)

reply: Many of my panic incidents occurred just after migraine attacks, so sometimes the symptoms are "intertwined" (Migraine has caused typical classical migraine hallucinations for me some times, "scintillating scotoma"). But quite often when I get severe or milder panic attacks I get a feeling of unsteadiness, a feeling that everything is tilted some way (a slope to the right, or left). matsols 22:07, 11 April 2006 (UTC)

reply: For the record, I have experienced tunnel vision during panic attacks. Nothing else visual, except for a vague 'distancing from reality' sensation, which is difficult to describe, and a 'television static' sensation, which is also difficult to describe, but both manifest visually as well as intellectually. O. Harris 09:30, 14 April 2006 (UTC)

reply: From my reading and experience, a panic attack is essentially invisible. And if there are any visible signs, they certainly don't begin to evidence the severity of the patient's suffering. This is, I theorize, the reason why, on The Sopranos (where panic attacks have been an ongoing theme since the beginning of the series) they always show the sufferer losing concsiousness and hitting the floor, even though this would NOT be symptomatic of a panic attack in real life. The loss of consciousness serves as visual evidence for purposes of the TV show, but it's not realistic. (I think it works well for their purposes, however.)

reply:i have never used wikipedia and have no idea what I'm writing on right now but.. I smoked too much marijuana (it was one of my first times) and I had a panick attack. I was lying on the floor of the woods and my friends were telling me I needed to try and cheer myself up to avoid feeling like death was inevitable, so I looked into the trees and I began to see small animals appearing in the trees (cannabis does not make you hallucinate) I saw a butterfly made of leaves and a little to it's left my eyes lost the image and fixed on an area where the twigs and leaves bent and formed a cute puppy dog, and another formed a puppy dog's face with big eyelashes and a round tongue.. I cannot remember the others I saw (there were about three others) but I then tried to sleep. I couldnt sleep but because I wasn't thinking (concentrating helped me fight the overwhelming feeling and keep the tingling at my fingertips and feet) I began to feel fear taking me over again so I tried thinking of a sunny farm with happy animals frolicking and when I opened my eyes I saw a fierce creature formed in the same leaves that had earlier been a butterfly.. I looked over to my left and saw another mean animal (I forget what they looked like, sorry) but then I saw a dog made of straight lines and zig-zags with sharp teeth and a sharp tongue coming out of it's open mouth so i stopped and fell asleep. I might have just rambled a bit, sorry.. but a panic attack wouldnt make for a good movie because most of the emotions are irrational and the sensation of succombing to death are somewhat indescribable and not something seen

reply: I have had three panic attacks in the course of about 6 months a couple of years ago. I belive they came about because of my inability to cope/deal with the death of a close family member. The panic attacks I had lasted several hours until I got so exhausted I fell asleep. I had most of the symptoms described in the article. I can also say that I had experiences wich I believe where some kind of hallucinations. Possibly objects I focused my eyes on blended together and created new "things" like people/animals not being in the room. PK

reply: I had, for the first time in my life, what I believe was a panic attack today. Several, hours before the 'tense' period, my right hand was numbish/tingly. Before I knew it I felt like I couldn't breath (I almost drown once and was in the hospital on a oxygen machine - that's how I felt today). The intense part lasted for about an hour, and during that time I honestly felt like I was having a stroke. The tingly feeling spread to both of my hands and my lips. My heart was racing, all the muscles in my body tensed up causing much pain. My vision was blurry in splotches. I really thought I was going to die of a stroke. I was very dizzy. I was about to go to the hospital. But I came here to wiki first. It helped put things in perspective. I decided to have a glass of wine and lay on my back on the floor. That really helped! I feel fine now, and I'm glad I had access to this information. It was really scary.

reply: I have had many panic attacks, and I have yet to really get my panic disorder under control. One of the visual effects I've had are a sloping floor; the floor was perfectly flat, but it was sloping greatly in my perception, and I was holding on to the desk for dear life. A couple of times, I've had a variant of tunnel vision where my vision popcorn fades to white very briefly. Usually that is followed by intense lightheadedness and dizziness and all the other classic panic attack symptoms. A way I describe most of my panic attacks are like being on a very turbulant airplane ride. I realize that the question was asked a long time ago, but I wanted to let anyone know that there are some visual effects in some people. BahKnee 12:02, 2 January 2007 (UTC)

reply: I've had many panic and anxiety attacks over the years. They pretty much go hand in hand for me and can trigger each other. (Sweet huh?) I usually have just "mild" attacks, the most interfering -- unsurprisingly -- are the severe attacks. With a severe attack I just want to run and get the h*ll out of the situation. I get irritable, my mind goes blank, there's a sense that nothing is real, almost like in a nightmare. Sounds are amplified tremendously. Loud and sudden noises make me jump and send a "chill" -- for lack of a better term -- up my spine. I'm tense all my hands tremble, as does my voice. To summarize, I'm twitchy, jumpy, crabby, just want "out", my hearts racing, I can't reason correctly, my breathing is constricted, my memory sucks, and I... JUST... WANT.. OUT! The *most beautiful* part of all is the follow up anxiety attack. These can go on for a couple of days. (Well until I got some Ativan, that's been a great help.) For mild panic attacks it's everything as described for the intense ones, only scaled back to about half or less intensity and duration. So there isn't as pressing of a desire to run and get out of the situation, but there is extreme emotional discomfort that I can't quite put into words. CBT has helped a little. However, the biggest benefit I've seen is from medications. Best of luck in your portrayal. —Preceding unsigned comment added by 75.73.245.254 (talk) 02:10, 6 September 2007 (UTC)

Commonality and recovery
I just made some changes to the article (though I don't think I was logged in when I made them) that highlights the commonality and the likelihood of recovery from this disorder with proper treatment. I thought the earlier rendition focused too much on how serious a threat it is to a person and too much on pharmaceutical treatments.

I added notes about additional treatment options, how common the full blown disorder is in the U.S. (1.6%, which I clarified as 1 in 60 or 1.66666666666%), and about how medication is usually not necessary in most cases. Most of my information was gathered from practicing psychologists, psychiatrists, and the American Psychological Assocation. -- filipem November 15, 2005

Panic Attack vs Anxiety Attack
I searched for anxiety attack, and it redirected to this article. I'd been sure there was a considerable difference between the two. Does anyone have more information about this? Nuggit 01:28, 18 January 2006 (UTC)

They're one and the same - there's so much crossover imo --PopUpPirate 00:38, 22 March 2006 (UTC)

Technically speaking, I think they're terms for different flavors of the same thing. An anxiety attack can present itself with the same symptoms as a panic attack, but is unlikely to progress to a fullblown attack, and will generally be "milder" but often of longer duration. A panic attack may start off with mild symptoms, but rapidly progresses to a fullblown attack, generally with "stronger" symptoms of a shorter duration. Not easy to make a clear distinction, though. Zuiram 04:07, 3 January 2007 (UTC)

I recently spoke to a psychiatrist who said they were two different things: an anxiety attack being an episode of severe anxiety in response to a anxiety-producing trigger (I have GAD and have had a few episodes like this when something terrible I wasn't expecting happened), and a panic attack being pretty much what this article explains, and generally happening with no apparant cause or warning, often resembling a heart attack, etc. 69.85.181.195 23:56, 24 January 2007 (UTC)

Speaking purely from personal experience, I don't believe they're the same. I have GAD and have had a few anxiety attacks over the years; and while they're extremely unpleasant, they're hardly what I'd call "the most frightening experience of my life". I never felt like I was dying, going crazy, or having a heart attack. I never really feel "afraid" or fearful of anything in particular (ie. an object or person, "impending doom"); rather, it is more like an extremely intense, paralyzing and debilitating sensation of anxiety, helplessness, and unhappiness. The attacks are always brought on by mounting stress/pressure/anxiety. All of that comes to a head, and I freak out, and my attacks are all so similar that I can quickly become aware of the fact that I'm having one (although it doesn't help, at least not right away). But these attacks never feel like "fear" to me. And while there is some element of panic, I feel more anxious than panicky. If I were panicking I'd probably try to run away from the situation (literally). When I have anxiety attacks, I generally freeze, curl up in a ball, and wait until I calm down. So, no, in my (non-professional) opinion, they really aren't the same thing. Schrödinger 00:29, 30 January 2007 (UTC)

Anxiety attacks and panic attacks are NOT the same thing. Searching for "anxiety attack" should not redirect you to panic attack.

Reply: As a sufferer of both I can tell you that they are indeed different, but with substantial overlap. For me, the two key difference with an anxiety attack over a panic attack are as follows. First, I have the presence of a specific worry or thought that perpetuates the symptoms -- both psychological and physical. Second, the duration can be upwards of two to three days for an extremely bad anxiety attack. Basically it turns me into a non-functional basket case, possibly capable of eating and maybe... showering... once each... for the duration of the attack. A panic attack is very short in duration, non-specific fear or worry, and generally I feel the need to run and get away. The areas of overlap are as follows: 1) Shortness of breath 2) elevated heart rate 3) "fight-or-flight" response 4) irritability 5) easily startled ... there are more but I'm too sleepy to recall 'em all. —Preceding unsigned comment added by 75.73.245.254 (talk) 02:19, 6 September 2007 (UTC)

CBT vs medication
Each patient can have different responses to these treatment options, but without sited studies I am suggesting treating both options on equal footings. --MegaHasher 07:10, 12 February 2006 (UTC) hello


 * The general consensus appears to be that pharmacological treatment is marginally more effective than CBT, but that the synergy from applying both is significant. If going for only one of them, pharmaca are generally preferrable unless the patient prefers to avoid them. This may be relevant in an HMO situation or somesuch. There are several studies about this stuff, but my research was done a couple of reinstalls ago, so I suggest you Google them or browse PubMed.
 * Zuiram 04:12, 3 January 2007 (UTC)

hello,

(i was wondering ::: ) how can benzodiazepines be a treatment for panic attacks when it takes some time for the drug to take effect, and typical panic attacks only last up to 10 minutes? thanks

Reply: I take a benzodiazapine not because the drug helps me during the panic phase (i.e. the initial 10 minutes or so). It doesn't. But I usually have severe follow up anxiety attacks, matching the intensity of the panic attack. These can last for a week if untreated. Basically I'm completely non-functional for two to three days, marginally functional for another two, and it gradually gets better so long as I'm not re-exposed to the trigger while I "wait it out".

As for 'CBT vs Meds, my psychiatrist -- name withheld -- repeatedly drove home the point at the start of my treatment that doing both CBT and Meds is the best road to recovery. I started CBT... It helped some... My therapist then promptly got a job elsewhere... And well I've been lazy since... I'll be meeting with him tomorrow and ask about other CBT therapists in his office. —Preceding unsigned comment added by 75.73.245.254 (talk) 02:27, 6 September 2007 (UTC)

Cholinesterase
I removed the following:


 * Through recent study of the biological process, Panic Disorders have been linked to high levels of acetylcholinesterase (AChE); a blood protein released under stress. This provides a new method of diagnosis as it quicker then the standard process and offers new insight to the link between panic disorders and geneology. It may also signify the correlation between panic disorders primarily being a biological malfunction, rather then a psychological.

I did indeed find a reference (PMID 15652264, PMID 11920151), but this theory is still extremely tentative and I would discourage its insertion until there is an indication that this is an important theory in the research community. The additions were also unsourced and did not provide the usual level of caution that should be exhibited with novel theories. JFW | T@lk  15:39, 6 April 2006 (UTC)

There are more than two studies published with regards to this. Also, I'm fairly certain I recall a piece about the diagnostic accuracy of this approach somewhere, and the numbers I remember were pretty impressive. That said, a footnote is as far as it bears mentioning until anyone has done treatment based on it or made the test available on a larger scale (currently, only the original lab is offering tests for other than research purposes). If a few people get better from a cholinesteraseinhibitor, then it bears proper mentioning. Zuiram 04:16, 3 January 2007 (UTC)

Adding External Link
Hi. I am asking if editors here feel my web site on Panic Attacks (www.panicend.com)is an appropriate link to add here. The site is a completely free and non profit site on panic attacks with a community of over 250 sufferers. There is information and support for panic attacks and personal experiences. I added the link to Panic Attack and Anxiety. It was initially reverted until I asked for it to be examined closer. That editor felt it may be appropriate to add the link but suggested that I consult on the talk page for this subject. Thanks to anyone who may wish to comment.[User:Guymadison] 6 December 2006


 * I like the link. I think it's a useful resource, and provides an unusual point of view. Xzqx 16:52, 4 January 2007 (UTC)

"Provoked" Panic Attacks
Hello.

My mother has had severe panic attacks since she was young (as a result of a traumatic childhood) and I believe I may have inherited them, but the thing is, I never have unprovoked panic attacks. I get all the physical symptons described in this article, but especially the mental ones, the ones in bold particularly:
 * Fear of losing control and doing something embarrassing or of going crazy
 * Fear of dying (very slight, if at all)
 * Feeling of impending doom
 * Occasionally disassociation (ie., seeing no familiarity in family/friends, looking in a mirror and seeing just another person)

as well as:


 * An intense fear of being forgotten and/or not being recognized/respected for my merit.
 * An intense fear that time is running out or that I am not acting quickly enough to fix the situation.
 * Hopelessness.

But, as I said, these are never really unprovoked, and almost always arise from interpersonal relationship problems, but not always severe ones (ie. getting dumped by a girlfriend).

I would like to know if these symptons are severe enough to consider that I may have a panic disorder, even though my episodes are never completely unprovoked.

Also, does anyone have any experience with this type of panic disorder?

Thank you.

-Jeff  [Wednesday, May 3, 2006, 9:00 P.M.]


 * Hi Jeff,
 * I am not a doctor and I suggest you see you one to discuss the above, especially because several things that look somewhat like panic disorder are quite serious. That said, if you do indeed have panic disorder (PD), which is what it sounds like, I think you could benefit from treatment.  Several effective treatments for PD exist -- cognitive behavioral therapy, SSRIs.  Also, there are several techniques you can learn to help deal with stressful situations --box breathing, visualization, relaxation response.  Benzodiazepines (e.g. diazepam (Valium)) may be helpful in the initial stages of treatment or for occasional problems. There are numerous self-help books out there (--ones that were recommended I get if I become a family doc are: The feeling good handbook, Mind Over Mood: Change how you feel by changing the way you think).  If you're interested in the science --I've heard the The Emotional Brain is a good book. Nephron  T|C 04:39, 4 May 2006 (UTC)


 * SSRIs and CBT are not the only treatment options. In some cases, anxiolytics are indispensable, and SSRIs are not nearly as effective as TCAs, multiple reuptake inhibitors or Nardil. I wrote a short explanation about this stuff on the anxiolytic talk page.
 * Zuiram 04:19, 3 January 2007 (UTC)
 * The wikipedia link you provide mentions both SSRIs and Benzodiazapines as anxiolytics yet it has no mention of TCAs, multiple reuptake inhibitors, or Nardil. If you have verifiable sources you can cite, please add this information to the anxiolytics page as it's useful for anyone looking for alternatives. (e.g. yours truly)  —Preceding unsigned comment added by 75.73.245.254 (talk) 02:34, 6 September 2007 (UTC)