WHEN TERROR STRIKES CLINICIANS OFFER HOPE, HELP FOR PARALYZING PANIC ATTACKS.

Byline: Evan Henerson Staff Writer

``Panic'' - the word sounds like what actually happens: an accelerated heart beat, sweating, shortness of breath.

For someone with panic disorder, an attack is worse than anything we can dream up because it's precisely that person's imagination that goes haywire.

When she has an attack, Liz, a former executive secretary who lives in Diamond Bar, said she develops a feeling of hyper self-awareness. A sneeze or cough isn't just something she can brush aside and ignore. It's something she builds upon and becomes obsessed with.

``I could go from this one little pain to the funeral,'' Liz said, who asked that her last name not be used. ``The worrier part of you escalates all these feelings that cause your anxiety level.''

UCLA psychologist Michelle Craske characterizes hypersensitivity as a fear of one's own body - a prevalent theory in panic disorder research. A person can feel a twinge, Craske said, and think cancer.

True panic sufferers often become convinced that they're going crazy or that they're about to die. Attacks happen often, usually without warning, and typically peak within 10 minutes. Nevertheless, for panic sufferers it's 10 minutes of terror. It's the fact that you can't predict it that differentiates panic attacks from stage fright or other anxieties.

Researchers say the condition is probably genetic, passed directly from parent to child, and may be the result of a chemical imbalance.

``It's not some imaginary thing that people talk themselves into. It's a pathological disorder,'' said Dr. John Murphy, a Beverly Hills psychiatrist who, with his partner Dennis Munjack, conducts clinical trials in which panic sufferers experiment with new medications.

``As best we understand it, it's a chemical imbalance. But we don't know if it's in the brain, the blood stream or the respiratory tract.''

After living with and studying her condition for seven years, Liz knows all the theories and medical terminology. She recognizes a panic attack when one is in progress. Still it can feel like ants are crawling up her face.

``My son had (the condition), and that really made me sad,'' she said. ``This is something you don't want to be passing on. This affects my husband, my children. It's scary.''

According to Pasadena psychiatrist and neurologist Dr. Stuart Shipko, 1 out of 75 people worldwide suffers from panic disorder. Sufferers are 12 times more likely to go to hospital emergency rooms and visit doctors 700 percent more than the general population.

In 1999, panic even became pop-culturally trendy. We watched fictional mob bosses played by Robert De Niro (in the film ``Analyze This'') and James Gandolfini (star of the HBO series ``The Sopranos'') visit analysts for treatment of panic attacks. Celebrities like actress Kim Basinger and talk-show-host/singer Donny Osmond admitted they suffered from panic and anxiety disorders.

Shipko, who runs the Panic Disorders Institute and Web site, said the condition is hardly a new phenomenon. He doesn't believe doctors have treatment under control.

``The amount of real help for panic disorder in this country in no way meets the demand for it,'' said Shipko. ``Personally, as a clinician, I've been able to move really fast because of information forwarded to me over the Internet. I've also seen a couple of thousand people with panic disorder, and I've begun to draw my own conclusions.''

Shipko's Web site includes his theories on the link between panic, bile flow and gastroesophageal reflux. He has also written about extreme fluctuation in the heart rates of panic patients over a 24-hour period.

The site also includes a bulletin board where panic sufferers can ask questions and exchange information. Shipko, who answers many of the questions personally, said he has learned much from his ``citizen scientists.''

``I lead a group of grass-roots patients who were smarter than their doctors,'' he said.

Self-education helped Lori, who now helps operate Shipko's Panic Disorders Institute Web site from her home in Laramie, Wyo. A panic sufferer since childhood, Lori underwent years of therapy. When her youngest son started to show symptoms of the condition, Lori began conducting research. Now she's a health educator who is working on a book about anxiety disorders in children.

``Between the two of us, we give out a lot of information,'' Lori said. ``Our site isn't meant to take the place of a doctor, but it can help you understand what questions to ask your doctor. We reach a lot of people.''

To keep her panic under control, Liz - who is Murphy's patient - uses a combination of diversionary techniques and medication. But those two approaches to panic disorder treatment - biological and cognitive behavioral therapy - don't always coincide.

Patients who visit Craske at UCLA's Anxiety Disorders Behavioral Program, for example, will learn all about anxiety. During the 12 to 16 sessions in the program, patients learn to gain control of their breathing and are made to confront the symptoms they experience when suffering a panic attack. Agoraphobics are exposed to the situations they fear - elevators, driving or being alone - so they learn to be less afraid. Drugs aren't part of the program, although Craske might prescribe medication in her clinical practice.

Shipko said that by the time they contact the Panic Disorders Institute, Shipko's patients are looking for a concrete medical diagnosis - conclusive proof that they're not crazy. And they want the panic attacks stopped immediately, even if means starting on medication.

``Stopping the attacks is critical,'' Shipko said. ``If you stop the attacks, a large portion of the people will have no phobias or depression, and they're largely able to go on with their lives as normal.''

Doctors often prescribe anti-depressants, benzodiazepines (such as Klonopin and Xanax) and monoamine oxidase inhibitors (MAOIs) such as phenalzine. Selective serotonin reuptake inhibitors (SSRIs) such as Zoloft and Paxil are also now used to treat panic. All of the medications have associated risks and side effects and are potentially addictive.

Although he believes the basic panic attack cannot be stopped by any means except through medication, Shipko said drugs are not necessarily required for treatment of other related symptoms.

``It's not all black and white, that either you can control this and pull yourself up by your bootstraps or that this is a neurological disease that must be medicated,'' Shipko said. ``It's not either/or, it's both.''

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TREATMENT FOR PANIC DISORDERS

If you suffer frequent panic attacks that can can wake you up from sleep, and if these attacks are interfering with your normal social and work habits, you probably need to see a specialist. Here are some of the treatments:

--Cognitive-behavioral therapy: A combination of cognitive therapy, which can modify or eliminate thought patterns contributing to a patient's symptoms; and behavioral therapy, which aims to help a patient change his or her behavior. A patient meets with a therapist over a period of time in an attempt to locate the thoughts and feelings that typically accompany a panic attack. Often a therapist will provide the patient with simple guidelines to follow when he or she can feel that a panic attack is approaching.

--Pharmacotherapy: Treatment with medication. A prescription medication is used to prevent panic attacks, reduce their frequency and severity, and to decrease anticipatory anxiety. Medications frequently prescribed include tricyclic anti-depressants, high-potency benzodiazepines, monoamine oxidase inhibitors (MOAIs) and selective serotonin reuptake inhibitors (SSRIs).

--Psychodynamic treatments: A form of ``talk therapy'' in which a patient and therapist seek to uncover emotional conflicts that may be contributing to the patient's problem. By talking about these conflicts, the patient is helped to overcome the problem.

- Source: National Institute of Mental Health Web site.

CAPTION(S):

Illustration, photo, box

Cover illustration: Don't panic

Anxiety disorders go beyond stage fright or phobias

Photo: Dr. Stuart Shipko: ``The amount of real help for panic disorder is this country in no way meets the demand for it.''

Phil McCarten/Staff Photographer

Box: TREATMENT FOR PANIC DISORDERS (see text)