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Panic disorder. Is it a matter of a defective gene?

Q: How does panic disorder differ from other anxiety states?

A: The phobic personality has many fears, but they are specific. An individual who is afraid of heights can avoid getting into such situations. The sufferer with an elevator phobia can manage to stay out of them. There are people who become seriously anxious when near insects; it is a common anxiety and can be avoided. Panic disorder, however, does not react to a particular object. It overcomes its victim without apparent provocation.

Q: What are some physical symptoms of panic disorder?

A: The somatic symptoms are numerous and appear in varying combinations. Cardiac manifestations are common, including very rapid heartbeat rising to more than 140 beats a minute. Palpitations, along with sharp and sticking pains in the anterior chest wall to the left of the sternum, may cause intensified fright because of their similarity to symptoms of heart attacks.

Q: Sufferers of panic disorder sometimes complain of "air hunger." Are the lungs involved?

A: The feeling of breathlessness is not caused by insufficient lung functioning. Intense anxiety changes breathing patterns and becomes severe enough to cause sweating, chills, flushing of the face and queasiness in the stomach. Dizziness and lightheadedness are common.

Q: Can panic disorder cause digestive problems?

A: Heartburn, belching, diarrhea and constipation sometimes occur during a panic attack.

Q: Can aches and pains that seem chronic be caused by frequent panic attacks?

A: Chronic muscular tension may lead to musculoskeletal aches and pains, especially backache, shoulder pains, headaches and neck pains.

Q: How does the onset of a panic attack differ from the other anxiety neuroses?

A: The onset can be sudden with no warning; in others, the appearance of a generalized anxiety heralds the outbreak. Panic attacks may last for a few moments or can continue for several minutes, with waves of rising anxiety overwhelming the patient. As the episode fades, the individual is left exhausted and limp.

Every case is not the same. Intensity varies, as does frequency of attacks.

Q: If panic attacks cannot be treated successfully by nondrug therapy and the condition is considered the result of a defective gene, what are the biological processes?

A: Panic disorders have a biological and a psychodynamic component. The hypothalamic (the part of the brain that affects emotions) and autonomic nervous system functions (which controls the unconscious operation of the body's activities: blinking, breathing, swallowing, processing of food, some thinking processes) are widely related to anxiety. Overactivity in the limbic system of the brain can set off a series of reactions that trigger panic fears.

The fact that some medications lessen or often eliminate panic attacks is considered proof that the problem is genetically based. Various antidepressants are effective. A skilled physician, with experience in this particular specialty, would be qualified to prescribe and monitor a particular drug according to the patient's particular metabolism.

Q: Do sufferers of panic disorder also experience anxieties related to phobia neuroses?

A: Because panic disorders are generated internally, outside influences usually have no effect. Patients suffering from panic disorders seldom fear heights, open spaces, public places, animals, insects or other such forbidding objects.

Q: When is the usual age of onset?

A: The average age of onset is in the late 20s. The individual may have been prone to other types of anxiety attacks in childhood (such as those caused by separation, sudden loss of support or other traumatic experiences).

Q: Can the use of alcohol be therapeutic?

A: One reason that alcoholism is prevalent among sufferers of obsessive-compulsive disorder, Tourette Syndrome and panic disorder is that alcohol has a calming and ameliorating effect. It works well, but the dangers are predictable. For the few hours that alcohol can provide relief, the toll on the body physically and mentally are cumulative.

Q: Because panic disorders are supposed to be hereditary, to what extent do they appear in families?

A: Unlike obsessive-compulsive disorder (OCD) and Tourette Syndrome, panic disorder has not been identified by a clear biological marker. It is known that OCD is the result of a serotonin malfunction and Tourette is caused by dopamine deficiency. But with panic disorder the evidence for a genetic link is circumstantial. Particular medications have been effective and, in the case of panic disorder, a vulnerability is inherited. What is the vulnerability? Perhaps an overly responsive nervous system.

Q: Are panic attacks during the night more dangerous than those that occur during waking hours?

A: Some panic attacks have reportedly been triggered by dreams. But research has not provided reliable statistics to implicate the dreaming process. The majority of nocturnal panic attacks occur within one to four hours of sleep onset, the time when slow-wave sleep is most prevalent. Slow-wave sleep tends to be associated with reduced eye movements, lowered blood pressure, reduced heart rate and respiration -- bodily functions that would not incite anxiety.

Shortness of breath has been reported as the most frequent symptom of nocturnal panic distress. Several authorities conjecture that people who suffer from apnea (a pause or complete cessation of breathing) may coincidentally suffer from panic disorder.

Q: What are the common problems in misdiagnosing panic disorder?

A: The consulting physician should be aware that many anxiety disorders may be caused by fears and behavior idiosyncrasies that can be treated with medications and behavior therapy. Panic disorders, although strongly resembling cases of "nerves" and problems "in the head," are complexes that cannot be dealt with by conditioning and ordinary antidepressives. Psychiatrists and psychologists have traditionally dealt with anxiety as a reflection of conflicts within personality.

Panic disorder, like genetic malfunctioning, requires the expertise of a practitioner fully cognizant of the great differences between psychological anxieties and genetically based panic disorder.

Q: Are panic attacks ever related to mitral valve prolapse?

A: The symptoms may be similar at times. Mitral valve prolapse is usually a harmless condition in which the leaflets of the heart do not close properly. Patients experience heart palpitations, a rapid and irregular heartbeat, shortness of breath and dizziness. These symptoms produce anxiety, and some doctors have erred in concluding that they were dealing with panic disorders.

Q: What is the most common manifestation of panic disorder?

A: Among the most specific fears is agora-phobia, the fear of being in places or situations from which escape might be imagined difficult. The place is seldom a particular location; the fear extends to "just being out."
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:questions and answers
Publication:Nutrition Health Review
Date:Jan 1, 1991
Previous Article:Prozac, depression, serotonin and Tourette Syndrome.
Next Article:Adverse effects of vaccine suspected.

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