Full-blown Panic Attacks Research Articles

The ED is not ready for survivors of sexual violence, and especially not survivors like me.

The ED is not ready for survivors of sexual violence, and especially not survivors like me.

The education of an educator.

My students were taking midterms when my phone erupted with urgent messages. “Student is having a panic attack,” texted a teaching assistant. I ran out of my office, down a flight of stairs and found the student—a pupil in my 350-person organic chemistry class—lying motionless on the ground outside the exam hall. “I can't move my fingers, head, or legs,” she cried. “I don't know what's happening to me.” My mind raced as she slipped in and out of consciousness. I asked a bystander to call 911 and held the student's hand, reassuring her that help was on the way. “Did my exam really trigger a panic attack?” I asked myself. “Why am I not prepared to deal with a situation like this?” ![][1] ILLUSTRATION: ROBERT NEUBECKER > “I think of [my students] as flowers—different flowers with different needs.” It was my first time teaching the course. But I knew that the subject was challenging for my undergraduate students. I also knew that the course had a reputation for doling out few A's. This was a source of stress for premed students in particular, who feared that a low grade in organic chemistry would keep them from getting into medical school. I had no idea that my exam could elicit a full-blown panic attack, though. The saving grace that day was another student, who had emergency medical training and rushed over to help. She led the student through a series of breathing exercises that calmed her down and helped her regain the use of her limbs. Afterward, I asked her what happened. “I panicked when I was reading the questions,” she said. My heart sank, wondering whether I could have done anything to prevent this. The following day, I was scheduled to lecture to the same class. I knew that I had to address what had happened during the midterm. I didn't want to infringe on the student's privacy by mentioning her. So, I started by saying: “I want to take some time today to talk about something important. How many of you think that this is a weed-out course?” Half of my students raised their hands gingerly. “I'm sorry to hear that,” I continued. “I want you all to know that I do not consider any of you to be weeds; you all deserve to be here.” I flashed a slide of flowers in various shapes and hues—a stark contrast from the chemical structures I'd shown in past lectures. I smiled at my students and said: “I think of you as flowers—different flowers with different needs. You may not bloom at the same time, but you will bloom! You may not do well in a midterm exam, but you will learn from your mistakes and do better on the final exam. I believe this. I believe in you.” From that point on, my office hours were packed. Previously, only a few top-performing students had come, but the new batch included students who were struggling as well as those who were first-generation college attendees. Some asked about lecture topics and study strategies; others opened up about personal issues—family health problems, impostor syndrome, depression—that they'd been struggling with. I was amazed that a simple, frank discussion in lecture could make such a difference. We educators shouldn't need a crisis to remind us of our students' emotional needs. But it took a crisis to transform my approach to teaching. I now make a point of talking about mental health at the outset of every course, giving the students my “flower” speech and mentioning places where they can go for extra support. Before exams, I ask my students to use digital clickers to rate their current mental health and I share the results onscreen, which helps students realize that they're not alone in feeling stressed. Finally, I do my best to learn my students' names. This may seem like a small thing, and it's challenging in such a large class. But I've found that they feel valued—and are more likely to ask me for help—when I put in the effort to recognize them as unique individuals. [1]: /embed/graphic-1.gif

The Hidden Health Crisis: What Family Caregivers Want You to Know

The Hidden Health Crisis: What Family Caregivers Want You to Know

Artist Describes How Art Saved Her Life

Artist Describes How Art Saved Her Life

A synopsis of original research projects published in scientific database in the Russian Federation.

The article describes the current state of scientific publications in the field of psychiatry in the Russian Federation. Issues of academic dissertations, lack of access to recent Russian language research in foreign databases, and recent reforms in the Ministry of Education and Science for overcoming these limitations are discussed in detail. Four exemplary dissertation studies published in Russian language are summarized. The first research examines the contribution of patient's verbal behavior to the reliable diagnosis of mild depression, identifying objective signs for distinguishing it from normal sadness; the mood component influenced the whole mental status and was represented in both structure and semantics of patients' speech. The second paper describes the course of panic disorder with agoraphobia, with the notable results that debut of panic disorder with full-blown panic attacks, often declines to a second accompanied with agoraphobia, which after several years gives way to limited symptom attacks and decreased agoraphobic avoidance. The third study describes the high prevalence of affective and anxiety disorders in patients with diabetes mellitus type 1 and 2, and the role of personality traits in adherence to treatment in patients with poor glucose control. The fourth project uses functional MRI for probing the features of neuronal resting-state networks in patients with temporal lobe epilepsy; the association with affective symptoms provides a model for investigating the pathophysiology of mood disorder.

Brain Circulation during Panic Attack: A Transcranial Doppler Study with Clomipramine Challenge.

Introduction. Cerebral blood flow has been well studied in patients with panic disorder, but only few studies analyzed the mechanisms underlying the onset of a panic attack. The aim of the present study was to monitor the cerebral hemodynamics modifications during a panic attack. Materials and Methods. 10 panic disorder patients with recent onset, fully drug naïve, were compared to 13 patients with panic disorder with a previous history of treatment and to 14 controls. A continuous bilateral monitoring of mean flow velocities in right and left middle cerebral arteries was performed by transcranial Doppler. Clomipramine was chosen as challenge. Results. Eight out of 10 patients drug naïve and 6 control subjects out of 13 had a full blown panic attack during the test, whereas none of the patients with a history of treatment panicked. The occurrence of a panic attack was accompanied by a rapid decrease of flow velocities in both right and left middle cerebral arteries. Discussion. The bilateral acute decrease of mean flow velocity during a panic attack suggests the vasoconstriction of the microcirculation of deep brain structures perfused by middle cerebral arteries and involved in the so-called “fear circuitry,” thus suggesting that cerebral homeostatic dysfunctions seem to have a key role in the onset of a panic attack.

Sub-threshold panic attacks and agoraphobic avoidance increase comorbidity of mental disorders: Results from an adult general population sample

Full-blown panic attacks are frequently associated with other mental disorders. Most comorbidity analyses did not discriminate between isolated panic attacks vs. panic attacks that occurred in the context of a panic disorder and rarely evaluated the impact of comorbid agoraphobia. Moreover, there are no larger scale epidemiological studies regarding the influence of sub-threshold panic attacks. 4075 German-speaking respondents aged 18–64 were interviewed using the fully structured Munich Composite International Diagnostic Interview. Limited symptom attacks, isolated panic attacks, and panic disorder were associated with other lifetime DSM-IV disorders with monotonically increasing odds and increasing tendency for multiple comorbidities across the three groups. The presence of agoraphobia was associated with more frequent comorbidity in all panic subgroups and also in persons who never experienced panic attacks. The present study suggests that populations with isolated or limited symptom should be carefully attended to in clinical practice, especially if agoraphobia is present.

Panic Attacks and Subsequent Cardiovascular Events

The aim of this study was to examine whether panic attacks are associated with cardiovascular disease in postmenopausal women. Subjects were 3369 community-dwelling, generally healthy postmenopausal women (age range, 51–83 years), enrolled in the Myocardial Ischemia and Migraine Study (MIMS), who completed a questionnaire about panic attack occurrence in the previous 6 months. Full-blown panic attack was defined as an attack of sudden fear, anxiety, or extreme discomfort accompanied by 4 or more panic-attack symptoms from a 12-symptom checklist. Cardiovascular and cerebrovascular endpoints were …

The lactate provocation test to investigate the relationships between panic attacks and psychosis: A report of two cases

It was suspected that the delusional convictions of bewitchment and devil persecution of two female patients (41 and 40 years old) could be the consequence of an erroneous interpretation of the sensations induced by panic attacks, as several authors have previously suggested. The interest of this case report stems from the manner in which we tested our clinical hypothesis. The patients agreed to the use of a lactate provocation test in double-blind, placebo-controlled conditions during four randomized sessions on consecutive days (two with lactate and two with placebo). The results for patient A strongly supported our hypothesis: patient A developed two full-blown panic attacks during the active lactate sessions, whereas patient B developed one subthreshold and one moderate panic attack during the active lactate sessions. The results of these investigations led to a more specific psychotherapeutic approach for patient A.

Psychiatry in the News

<p>Psychiatry in the News summarizes consumer-oriented media reports on psychiatry and topics related to psychiatry. We recognize that for our readers, keeping abreast of new clinical information is a challenge, leaving little time to review the information, good and bad, that media outlets supply to consumers. Our purpose is to help keep you informed about subjects that your patients might read or hear and question you about. </p><p>Please note that publication of the reports in this department does not imply endorsement of the methods or systems described. </p><p>We hope you find this department both informative and entertaining. As always, we welcome your comments and contributions; please e-mail <A href="mailto:marcher@slackinc.com">marcher@slackinc.com</a>.</p> <h4>Panic Attacks Increase Risk of Stroke, Heart Trouble for Women</h4><p>At least one full-blown panic attack — which can include rapid heartbeat and shortness of breath — during a 6-month period is reported to make women three times more likely to have a heart attack or stroke over the next 5 years, according to a recent study published in <cite>Archives of General Psychiatry</cite>. [see more news...]</p>

Panic Attacks and Risk of Incident Cardiovascular Events Among Postmenopausal Women in the Women's Health Initiative Observational Study

Previous studies have documented an association of depression and phobic anxiety with cardiovascular morbidity and mortality, but little is known about the cardiovascular sequelae of panic anxiety. To determine whether panic attacks are associated with risk of cardiovascular morbidity and mortality in postmenopausal women. Prospective cohort survey. Ten clinical centers of the 40-center Women's Health Initiative. A total of 3369 community-dwelling, generally healthy postmenopausal women (aged 51-83 years) enrolled between 1997 and 2000 in the Myocardial Ischemia and Migraine Study who completed a questionnaire about occurrence of panic attacks in the previous 6 months. Cardiovascular/cerebrovascular outcomes (fatal and nonfatal myocardial infarction and stroke) and all-cause mortality were ascertained after a mean of 5.3 years of follow-up. A 6-month history of full-blown panic attacks, endorsed by 10% of postmenopausal women in this cohort, was associated with both coronary heart disease (hazard ratio, 4.20; 95% confidence interval, 1.76-9.99) and the combined end point of coronary heart disease or stroke (hazard ratio, 3.08; 95% confidence interval, 1.60-5.94) after controlling for multiple potential confounders. The hazard ratio for all-cause mortality, excluding those with a history of cardiovascular/cerebrovascular events, was 1.75 (95% confidence interval, 1.04-2.94). Panic attacks are relatively common among postmenopausal women and appear to be an independent risk factor for cardiovascular morbidity and mortality in older women.

The lactate provocation test to investigate the relationships between panic attacks and delusional disorder: A two case report

Background and aimsIt was suspected that the delusional disorders of bewitchement and devil persecution of two female patients (41 and 40 years old) could be the consequence of an erroneous interpretation of the sensations induced by panic attacks, as several authors have previously suggested. Both patients had schizophrenia spectrum antecedents (Patient A was suffering from a schizo-affective disorder, Patient B had a schizotypic disorder and an antecedent of brief hallucinatory episode). Thus these individuals had some tendency toward psychotic thinking. The interest of this case report stems from the manner in which we tested our clinical hypothesis.MethodsThe patients agreed to the use of a lactate provocation test in double-blind, placebo-controlled conditions during four randomized sessions on consecutive days (two with lactate and two with placebo). The active lactate test used a 0.5 molar racemic lactate sodium 10 ml/kg solution, infused in 20 minutes.ResultsNeither patient displayed panic symptoms during the placebo sessions whereas patient A developed two full-blown panic attacks during the active lactate sessions and patient B developed one subthreshold and one moderate panic attack during the active lactate sessions. The results of these investigations led to a specific cognitive therapeutic treatment of the delusional convictions in patient A.ConclusionThe results of this investigation, at least in patient A, strongly support our clinical hypothesis about a possible relationship between panic disorder and delusional disorder in some cases.

Physiological markers for anxiety: Panic disorder and phobias

Physiological activation is a cardinal symptom of anxiety, although physiological measurement is still not used for psychiatric diagnosis. An ambulatory study of phobics who were afraid of highway driving showed a concordance between self-reported anxiety during driving, autonomic activation, hypocapnia, and sighing respiration. Patients with panic attacks do not exhibit autonomic activation when they are quietly sitting and not having panic attacks, but do have the same respiratory abnormalities as driving phobics, suggesting that these abnormalities could be a marker for panic disorder. Such abnormalities are compatible with both the false suffocation alarm (D. Klein) and hyperventilation (R. Ley) theories of panic. Hypocapnia, however, is often absent during full-blown panic attacks. Since activation functions as preparation for physical activity, it may not occur when a patient has learned that avoidance of fear by flight or fight is futile. We developed a capnometry feedback assisted breathing training therapy for panic disorder designed to reduce hyperventilation and making breathing regular. Without feedback, conventional therapeutic breathing instructions may actually increase hyperventilation by increasing dyspnea. Five weekly therapy sessions accompanied by daily home practice with a capnometer produced marked clinical improvement compared to changes in an untreated group. Improvement was sustained over a 12-month follow-up period. The therapist avoided any statements or procedures designed to alter cognitions. Improvement occurred regardless of whether patients initially reported mostly respiratory or non-respiratory symptoms during their attacks. There is evidence that modifying any of the three systems comprising a fear network can be therapeutic, as exemplified by cognitive therapy modifying thoughts, exposure therapy modifying avoidance, and breathing training procedures modifying pCO 2.

Prevalence and correlates of panic attacks in postmenopausal women: results from an ancillary study to the Women's Health Initiative.

Panic attacks are known to be more common in women than in men, but the prevalence and correlates of panic in the postmenopausal period have not been well defined. Cross-sectional survey of 3369 community-dwelling postmenopausal women enrolled between December 1, 1997, and November 30, 2000, in the Myocardial Ischemia and Migraine Study, a 10-center ancillary study of the 40-center Women's Health Initiative. Participants, aged 50 to 79 years and predominantly white (73%), completed questionnaires about the occurrence of panic attacks in the previous 6 months and about migraine headaches and underwent 24-hour ambulatory electrocardiographic monitoring. The 6-month prevalences of full-blown and limited-symptom panic attacks were calculated, and their associations with other sociodemographic and clinical variables were examined in multivariate analyses. One of the panic attack types was reported by 17.9% (95% confidence interval, 16.6%-19.2%) of women (full-blown attacks, 9.8%; limited-symptom attacks, 8.1%). Adjusting for age and race or ethnicity, full-blown panic attacks were more common in women with a history of migraine, emphysema, cardiovascular disease, chest pain during ambulatory electrocardiography, and symptoms of depression. Full-blown panic attacks were associated in a dose-response manner with negative life events during the past year. Panic attacks were associated with functional impairment even after adjusting for comorbid medical conditions and depression. There was no significant association with self-reported use of hormone replacement therapy. Panic attacks may be relatively common among postmenopausal women and seem to be associated with stressful life events, medical comorbidity, and functional impairment.

The limits of bibliotherapy: A study of the differential effectiveness of self-administered interventions in individuals with panic attacks

The present study compared the differential effectiveness of bibliotherapy with no therapist contact (bibliotherapy alone), and bibliotherapy plus daily self-monitoring and self-administered feedback (bibliotherapy plus monitoring), to daily self-monitoring and self-administered feedback (monitoring alone) and wait-list controls, in individuals with panic attacks. A repeated-measures MANOVA revealed no Condition × Time interaction or condition effect. However, a main effect for time across conditions emerged. Univariate tests revealed significant reductions from pre- to post-treatment for all groups for full-blown panic attacks, avoidance, panic cognitions, and panic symptoms. The results of this study cast doubt on the efficacy of bibliotherapy and self-monitoring interventions when utilized absent from contact with a professional who conducts the assessment and monitors treatment compliance.

Specificity of lactate response in panic disorder, panic with concurrent depression and major depression

Lactate infusions with 0.5 molar sodium lactate in a dose of 10 ml/kg within 20 min were given to patients with panic disorder ( n = 6), panic attacks with concurrent major depression ( n = 7) and major depression without panic ( n = 5). Lactate-induced anxiety and symptom attacks without panic were seen more often in the groups with panic attacks, but a full-blown panic attack was provoked in only four subjects, all belonging to the groups with a history of panic attacks. The low incidence of lactate-induced panic attacks can be explained by differences in the procedure that aimed at reducing expectancy biases and baseline anxiety.

Guided imaginal coping: An integrative treatment for panic disorder

Contemporary models suggest that persons with panic disorder inaccurately attribute somatic anxiety symptoms to catastrophic causes. This consequently exacerbates their physiological symptoms, triggering full-blown panic attacks. Researchers have modified catastrophic thinking using cognitive therapy, but typically have not employed these techniques during actual episodes of heightened arousal. Thus, reported cognitive changes may not generalize to naturalistic situations involving hyperreactivity. This study describes use of an intervention which simultaneously combines symptom exposure and cognitive therapy techniques. The client treated here experienced reductions in panic attack frequency as well as duration and became less depressed as therapy progressed. Discussion addresses potential causal mechanisms and directions for future research.