Articles on panic attacks

Self Help Tips to Manage Panic Attacks

Udayan Bhaumik, Psychiatrist
When it comes to panic attacks, professional treatment and therapy can make a big difference. But there are many things you can do to help yourself, too:Learn about panic. Simply knowing more about panic can go a long way towards relieving your distress. So read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack. You’ll learn that the sensations and feelings you have when you panic are normal and that you aren’t going crazy.Avoid smoking and caffeine. Smoking and caffeine can provoke panic attacks in people who are susceptible. As a result, it’s wise to avoid cigarettes, coffee, and other caffeinated beverages. Also be careful with medications that contain stimulants, such as diet pills and non-drowsy cold medications.Learn how to control your breathing. Hyperventilation brings on many sensations (such as lightheadedness and tightness of the chest) that occur during a panic attack. Deep breathing, on the other hand, can relieve the symptoms of panic. By learning to control your breathing, you develop a coping skill that you can use to calm yourself down when you begin to feel anxious. If you know how to control your breathing, you are also less likely to create the very sensations that you are afraid of.Practice relaxation techniques. When practiced regularly, activities such as yoga, meditation, and progressive muscle relaxation strengthen the body’s relaxation response—the opposite of the stress response involved in anxiety and panic. And not only do these relaxation practices promote relaxation, but they also increase feelings of joy and equanimity. So make time for them in your daily routine.These are not easy to do but can be managed with a little please remember and practise!!!

Chest Pain - Panic Attacks/panic Disorder

Dr. Naresh Vadlamani, Psychiatrist
"All of a sudden, I felt afraid and feared that something bad was going to happen to me as if I was going to die for no reason at all. I was having chest pain, my heart was beating faster and I had difficulty in breathing, I felt giddy and thought I was going to die." I immediately wanted to go to the hospital-emergency. From then on, I was afraid to be alone or was afraid of travelling. I started avoiding places, food, rooms or even travel after that attack.Medical professionals generally attempt to reassure the panic attack patient that he or she is not in great danger. But these efforts at reassurance can sometimes add to the patient's difficulties: If the doctors use expressions such as "nothing serious," "all in your head," or "nothing to worry about," this may give the incorrect impression that there is no real problem. The actual problem is in the panic area in the brain. The nerves in this area are dysfunctional. Its is like going to a doctor for cough and all the doctor says is "don’t cough" which sounds ridiculous. Anxiety and worry is what the patient has. That requires diagnosis and appropriate treatment. Not by saying "relax" or "Don't Worry".WHAT ARE THE SYMPTOMS OF A PANIC ATTACK?As described above, the symptoms of a panic attack appear suddenly, without any apparent cause. They may includeRacing or pounding heartbeatChest painsStomach discomfortDizziness, light headedness, nauseaDifficulty in breathing, a sense of feeling smotheredTingling or numbness in the handsFlushes or chillsDreamlike sensations or perceptual distortionsTerror: a sense that something unimaginably horrible is about to occur and one is powerless to prevent itFear of losing control and doing something embarrassingFear of dyingA panic attack typically lasts for several minutes and is one of the most distressing conditions that a person can experience. Most who have one attack will have others. When someone has repeated attacks, or feels severe anxiety about having another attack, he or she is said to have panic disorder.Panic attacks can occur at any time, even during sleep. An attack generally peaks within 10 minutes, but some symptoms may last much longer.Once someone has had a panic attack, for example, while driving, shopping in a crowded store, or riding in an elevator, he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where the individual with panic disorder may be unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus, panic disorder can have as serious an impact on a person's daily life as other major illnesses, unless the individual receives effective treatment.No, panic attacks are never life threatening. But yes, panic attacks are real and emotionally disabling, but they can be controlled with specific treatments. Because of the disturbing symptoms that accompany panic attacks, they may be mistaken for heart disease or some other life-threatening medical illness. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions.CAN PEOPLE WITH PANIC DISORDER LEAD NORMAL LIVES?The answer to this is a resounding YES -- if they receive treatment.Panic disorder is highly treatable, with a variety of available therapies. These treatments are extremely effective. Once treated, panic disorder doesn't lead to any permanent complications.COMPLICATIONS OF UNTREATED ILLNESSA recent study showed that people who suffer from panic disorder:Are more prone to alcohol and other drug abuseHave greater risk of attempting suicideSpend more time in hospital emergency roomsSpend less time on hobbies, sports and other satisfying activitiesTend to be financially dependent on othersReport feeling emotionally and physically less healthy than non-sufferersAre afraid of going more than a few miles away from home

'Brain Attack' and 'Heart Attack': How Are They Different?

Dr. sudheerambekar
It is a common notion among people that 'brain attack' or 'stroke' and 'heart attack' are one and the same. There is also a profound lack of knowledge of common risk factors and symptoms of stroke. The inability of bystanders to recognise the common symptoms of stroke is a major hurdle in the appropriate management of patients with stroke as the golden hour is lost, especially in India where the pre-hospital services are not well organised. Treatment within the first 8 hours of onset of symptoms is most effective and prevents long-term morbidity and mortality. It is estimated that one person dies of a stroke every 36 seconds in India. In a study conducted among the rural population in Maharashtra in 2012, only 51% of the 373 respondents were able to correctly identify 'stroke' as a disorder of the brain, while 19% associated it with a heart attack! Also, one-third of the respondents (34%) did not know at least one risk factor for stroke. This phenomenon is seen in both developing and developed countries, although the proportions are lower in developed countries. What are the similarities and differences between 'stroke' and 'heart attack'?A heart attack refers to damage to the muscle of the heart, usually from a lack of blood flow. Most of the time, a blood clot forms in one of the arteries that supply the heart muscle with blood, blocking the flow of blood. As the heart muscle starves, it begins to die, causing chest pain and other symptoms of heart attack.A Stroke is a similar blockage in an artery in the brain or neck that supplies blood to the brain. When a clot forms in one of those arteries and stops blood flow, a section of the brain begins to die. When those cells die, the person loses whatever function those brain cells controlled. There is another category called the 'hemorrhagic stroke' in which a blood vessel bursts and bleeds in the brain.While the common symptoms of a heart attack are chest pain, tightness and shoulder pain, the symptoms of stroke are completely different and may range from nothing to a headache, paralysis of an arm or leg, unconsciousness, coma and death. Another type of stroke is a transient ischemic attack (TIA), essentially a “mini-stroke” caused by a temporary clot. TIA symptoms are identical to those of other kinds of strokes, but because they occur quickly and usually last less than five minutes, this brain attack often goes unnoticed.While a TIA doesn’t usually cause permanent injury to the brain, it serves as a warning for patients and gives them time to seek further medical treatment in preventing ischemic or hemorrhagic strokes.Because specific areas of the brain control certain functions, one can predict the effects of a stroke based on the location of the blockage. If the blockage occurs near the front of the brain, it can affect such things as organisation skills, memory, communication, and problem-solving. If it occurs lower down, near the brainstem, it can cause unconsciousness and an inability to breathe, swallow, or control elimination.if it occurs to one side near the temple, speech may be affected. In addition, which side (hemisphere) of the brain the stroke occurs on determines its side effects and which body functions are affected. The right side generally controls a person's emotions, creativity and abstract thinking. If the blockage occurs anywhere on the right side of the brain, it can cause the following symptoms: Paralysis or weakness on the left side of the bodyDisorientationExcessive talkingAn inability to perform routine tasks such as brushing the teeth, buttoning a shirt or tying shoelaceThe left side controls more of speech, logic, perception and organisation. If the stroke occurs anywhere on the left side of the brain, it can cause the following symptoms:Paralysis or weakness on the right side of the bodyDepressionAn inability to understand languageTrouble speakingMemory problemsDecreased attention span Heart attack and Stroke have many risk factors in common. They may be modifiable or non-modifiable. Some of the modifiable risk factors include High Blood PressureHeart DiseaseDiabetes MellitusCigarette smokingHistory of transient Ischemic Attacks (TIAs)High blood CholesterolLack of exercise, physical inactivityObesityExcessive alcohol useDrug abuse  Some of the non-modifiable risk factors include- Age > 55 yearsMale genderRace (Asians and African-Americans have a greater risk than Caucasians)History of prior strokeFamily history of stroke

What to Do When Someone Has a Heart Attack

Dr. Rudradev pandey, Cardiologist
Definition A heart attack occurs when oxygen fails to reach the heart. The vital organ needs oxygen, contained in your blood, which travels through the arteries to the heart. But if an artery has a blockage in it, blood doesn’t reach the heart and the heart’s cells die, resulting in a heart attack.A heart attack is a serious, life-threatening situation — but many people who witness someone experiencing the symptoms of a heart attack don’t treat it that way. IF YOU HAVE SUSPICION OF ANY HEART PROBLEM GO AND CONSULT TO YOUR DOCTOR RATHER THAN SELF-MEDICATION. Symptoms Of Heart Attack: The symptoms of a heart attack aren’t always obvious and often differ between men and women. Those symptoms can be subtle — perhaps one reason why some people don’t make it to an emergency room — or they can be very painful. Knowing what to look for can help you know when to take action for a friend, colleague, or loved one in distress:For men: The typical male symptom is a crushing pressure behind the breastbone, also called the sternum. That pressure, can radiate to your arms (often the left arm) and can go into the back, shoulder blades, and jaw above to umblicus below. Men suffering a heart attack can break out in a sweat, may vomit or feel nauseating.The onset of pain may be gradual and last several minutes or more. Sometimes the pain fades and comes back.For women: Women can have any of the same symptoms that men experience, but women often have more “atypical” symptoms, such as shortness of breath, and they may feel some indigestion. A woman having a heart attack may also experience pain in her jaw, and could feel a little faint.These symptoms are not what most people think are indications of a heart attack, Dr Pandey says. “Doctors and patients have to be very wary when it comes to heart symptoms with women,” he says. And for good reason: Heart disease kills more women than any other health condition.What to doIt’s good to have a plan in place before a heart attack occurs, especially if the person has close relatives who have had heart attacks. According to Dr Pandey, smoking & tobacco chewing play a big part in who has a heart attack and who doesn’t. Genetics of patient also plays important role. especially in young patients with heart attack.Chances of recovery are much better if the affected artery can be opened up within an hour-and-a-half of the heart attack, making it essential to get the person having the attack to the emergency room immediately(Primary PTCA) “By the time 90 minutes go by, you want to get that artery open,” Dr Pandey says. “If you’re in a rural emergency room, and [the medical team can’t open the artery], you need clot-busting drugs.” followed by transfer to hospital with cath lab facilityYou Think It’s A Heart Attack? Dr Pandey says it’s extremely important for caregivers and friends to know the symptoms of a heart attack. Call 108 if you even suspect it's a heart attack and here’s what you can do before help arrives:Stay close. Do not leave the person to find medications to give them . It's better to call for help first; emergency personnel can administer aspirin or any other appropriate treatmentsGive a dose of sublingual nitriglycerine. If the person has been prescribed nitroglycerin in the past for heart disease, and the medication is close at hand, you can give them a dose. BUT NOT MORE THAN TWO TABLETSGo for comfort. Make the heart attack victim more comfortable by placing them in a comfortable position, loosening clothing, and staying close to provide reassuranceIf needed, give CPR. Studies have shown that CPR given by a bystander can double or triple a victim's chance of surviving cardiac arrest. If you are with someone who suddenly collapses, stops breathing, or is unresponsive, start performing hands-only CPR at 100 chest presses a minute with minimal interruptions. It’s just as effective as standard CPR

Anxiety and Addiction - Is There a Link?

Ms. Rajeshwari Luther
Substance abuse and mood disorders are closely linked for a variety of reasons. Many people believe that using substances is an effective way of feeling happier and calmer. People with severe anxiety may discover that alcohol or drugs give them short term relief and may resort to using them regularly. Often, people with anxiety are prescribed drugs like Xanax. They may like the calmness they feel when on this medication and may begin to take dosages higher than those recommended by their psychiatrist.What is Anxiety?There are many different kinds of anxiety disorders - obsessive compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, social anxiety and panic disorder. Many of these are caused by severe chemical imbalances in the brain, something that alcohol and drugs alter further. Alcohol and drugs make anxiety disorders worse, rather than better, in the long run. In addition to feeling anxiety, a substance abuser with a dual diagnosis of addiction and anxiety, is likely to feel symptoms such as:- Irritability- Restlessness- Paranoia- Psychosis- Physical complications like highly elevated heart rate and shortness of breathWhat does it have to do with addiction?While people with anxiety may use alcohol or drugs to calm themselves, and not ‘get high’, they may find excitement in a calm euphoria. Their addiction begins to develop as they find that they are unable to feel calm and happy without drugs, not realizing that the continued abuse of drugs and alcohol would render them unable to feel happy or calm at all. These positive emotions can only return once addicts enter recovery, where not only their addiction is addressed, but also its underlying issues.  Another common form of anxiety is phobia - a disorder which is characterized by an extreme, irrational fear of an object or situation. Common examples of these are claustrophobia and agoraphobia. As alcohol is known to release inhibitions, people with phobias may find that they are more relaxed and less on-edge when they drink. Somebody with agoraphobia may actually have the courage to leave their house, when they know that they can consume drugs that consume their fear.What hope does?One of the risks in addiction treatment is the process of detox. Detoxification comes with many withdrawal symptoms, a very common one being panic attacks. When a person with anxiety goes through withdrawal, they are likely to have severe panic attacks with acute physical symptoms. This is why rehabilitation centres like Hope Trust monitor clients throughout the process of detoxification.With anxiety, as with all dual disorders, patients are trapped in a vicious cycle. Their anxiety will lead them to consume drugs or alcohol; and their consumption of drugs and alcohol will cause them more anxiety. This is why patients must be treated in a highly specialized way with individual attention placed on them.Hope Trust places emphasis on keeping our in-patient group small so we can ensure that patients with dual disorders, such as addiction and anxiety, receive specific treatments targeting their personal issues, with reference to their bio-psycho-social background. At Hope Trust, we aim to enable addicts to break free from their problems - whatever they may be - so they can live a happier, fuller and more content lives.

How Is Life After a Heart Attack

Dr. Nishith Chandra, Cardiologist
People think, after a heart attack, they cannot have a normal life. But if you take certain precautions and adopt lifestyle changes, you can live and enjoy almost normal life. Once you survive a heart attack, you tend to realize how close your brush with death has been and how important your lifestyle choices can be. Most people go on to live a productive life after a heart attack provided they can adhere to making healthy choices. Here's what you can do if you have experienced your first attack and want to change for the better:1. Start at the hospital: A person usually stays in the hospital for 3 days after an attack to monitor their condition. This duration increases if you have complications that involve procedures like a bypass surgery. Your first significant change will come in the form of your medication routine. Your existing dosage may be adjusted and you'll possibly be prescribed newer medicines that will treat and control your symptoms. You'll not only need to know the names of all your medicines, but when you have to take them. It's best you know exactly why you are taking each one of them, if there are other more economic alternatives since this may last a lifetime and what side effects they may have.2. Maintaining your mental health: Once bitten, twice shy applies for heart attack victims too. Not only do they live in a constant worry about another attack, every small symptom like a harmless muscle pull can trigger the fear factor. You also get into the "heart patient" dependent mode based on how much help you need to recover. Check for support groups and other heart attack survivors in your locality to see how they are coping. Read more about your recovery and try to keep a positive frame of mind.3. Go to a cardiac rehab: Many hospitals have a rehabilitation program that you can participate in as an outpatient or you can go to a clinic that specializes in it. Such programs help speed up your recovery. It is run by people who will hand hold you in bringing positive changes in your life to protect and strengthen your heart. You'll learn activities that positively improve heart functions and reduce your chances of developing complications or dying from heart disease. You'll also get benefit from exercises that'll be taught by a certified exercise specialist.4. Make a change in your lifestyle: Quit smoking that is an obvious one. You'll now have to lead a more active lifestyle with daily exercise. You'll also need to actively manage your diabetes and obesity. None of these changes can happen in a day. In fact, behavioral scientists suggest that you need to practice a new activity continuously for twenty one days for it to become a habit.

How to Diagnose Heart Attack ?

Dr. Nishith Chandra, Cardiologist
Heart Attack is  caused by blockage of the blood flow to the heart muscles.  Reduced blood flow leads to death of some portion of the heart muscle wall. While the word heart attack sounds almost fatal, it need not be the case. Knowing how to identify an attack and being aware of some simple measures can help save lives. SymptomsThe tell tale signs of a heart attack are as follows:- chest pain and discomfort usually described as a tightness or burning in the chest region- pain along the left side of the shoulder and neck, going up into the jaw, down to the arm- nausea and vomiting - profuse sweating - difficulty breathing - dizzy or fuzzy feeling - tired, extreme fatigue- anxious, apprehensive feeling However, be also aware that there are a lot of people who experience a silent heart attack. Women, obese, elderly, and diabetic patients can have silent attacks and depending on severity, either they go on with life as usual or can have a fatal attack.DiagnosisOnce you are doubtful of a heart attack, the next step is to reach the closest medical facility for a diagnosis. In addition to a detailed examination and history, the following two tests will be performed.1. Electrocardiogram (ecg): a 12-lead ecg will measure electrical activity of the heart and identify irregular electrical activity, which is indicative of a myocardial infarction.2. Blood tests: presence of certain enzymes in the blood, ck-mb and troponin are indicative of a heart attack. A complete electrolyte profile also will be done, and increase or decrease of some electrolytes is helpful in diagnosing a heart attack.3. In addition to these two, chest radiography, cardiac angiography, echocardiogram, stress test, and computed coronary tomography may also be required to confirm the diagnosis.ManagementOnce diagnosed, the first step would be to relieve the symptoms, negate the effects of reduced blood flow, and restore cardiac function. 1. Dissolve the clot - using blood thinners like aspirin & clopidogrel 2. Nitroglycerin - to dilate the blood vessels and improve blood flow, especially to the heart muscles3. Anticoagulant therapy - blood thinners are usually used to avoid blood clot formation; aspirin and heparin are the most commonly used agents.4. Drug therapy - blood pressure maintaining drugs like beta blockers and/or angiotensin-converting enzyme (ace) inhibitors are also used5. Use of statins - statins are used to reduce the amount of cholesterol in the blood and stabilize plaque deposits.In very severe cases, angioplasty and stenting or coronary bypass surgery may be required. Educating people on how to identify a heart attack and manage it is very useful and can help save lives.

8 Ways to Manage Your Anxiety Better, Now!

Ms. Pallavi Tomar, Psychologist
Anxiety can be a helpful, healthy emotion, but when it spurs out of control it can be especially difficult to deal with. Following are a few techniques to help you manage your anxiety better:1. Understand false alarmsIntense anxiety or a panic attack may feel like you are dying. It’s important to understand how such an instance may mimic a panic attack but that’s only because the brain has made you believe it’s a heart attack or an uncontrollable symptom. When you experience such symptoms, understand that a panic attack is only a momentary experience of intense anxiety but it does fade away and is definitely not life threatening. 2. Learn to challenge your thoughtsIn a state of anxiety, one’s thoughts are generally highly unrealistic and unlikely to occur in reality. There is a tendency to think of the worst possible outcome when anxious. In fact, one’s experience of anxiety comes from these flawed perceptions and thoughts about a situation. In such a situation, make it a habit to question the possibility of your thought actually occurring in reality and even if it does what would be so bad about it. Make a list of all possible outcomes, positive and negative for a situation. Challenge your present negative thought and question the probability of its occurrence. For example: one may think that asking a question in a group meeting may bring them ridicule. Ask yourself what are the other possibilities in such a situation? That people may appreciate their question, be indifferent to the question, or many other questions may be brought forth because of his point or if nothing else you at least participated in the meeting. Now even if people feel it’s a ridiculous question, how many times in the past has someone been ridiculed for asking a question? Does that really happen? Or is it just perceived by you because you are overly sensitive to rejection due to anxiety?3. Avoid AvoidanceThe biggest mistakes people with anxiety make is avoiding the triggers in their environment which makes them anxious. The way out of anxiety is only through it. Do not avoid such situations. In fact, try to gradually expose yourself to that which makes you anxious starting from a lower intensity trigger moving up to a more anxiety producing trigger. For example: If you get anxious talking on the phone to a friend in front of others, try having a conversation on WhatsApp first in front of other people. Then initiate a call for 2 minutes in front of one another person, then a 2 minutes call in front of 3-4 people gradually increasing the time and number of people till you can habituate yourself to such a situation. 4. Equip yourself with relaxation techniquesThis differs from person to person. Indulge in activities on a daily basis (with or without the experience of anxiety) that lower your stress and help you relax such as exercising, listening to music, reading, practising a hobby, spend time with loved ones. Learn relaxation techniques, visualization techniques and take a regular time out to de-stress.5. Learn to identify unsolvable problemsVery often, anxious individuals are unable to distinguish between a real / solvable problem versus an imagined /unsolvable problem. Learn to ask yourself; “Is this a problem I am currently facing or something I fear may happen (what if)?”“Even if it’s a problem I am currently facing, can I do something about it or is it unsolvable?”A concern that is solvable and you can take action on right away are the ones to work with.If the concern is presently there and solvable, make a list all possible ways to deal with it (even if some seem ridiculous). Focus on those things you can try and change rather than trying for perfection or fretting over what cannot be solved for. 6. Accept uncertaintyThe inability to tolerate uncertainty is one of the main underlying causes of anxiety problems. People suffering from anxiety always want to be 100% assured about a certain outcome or decision. Worrying then is seen as a way to predict what may happen in the future or how things may go wrong and to control the problem. Thinking of all the ways in which things can go wrong does not make life decisions any more predictable. Focusing on worst case scenarios does not prevent them from occurring. 7. Stay in the presentThe biggest issue with people suffering from anxiety is their inability to stay in the moment, they are constantly worrying about things that may go wrong in the future. Make it a habit to remind yourself to be in the present moment and really be involved. If your attention again drifts to thoughts of the future, gently bring it back to whatever you are doing at the moment and make the most of it.8. Don't hesitate to ask for professional helpIf despite your best efforts you are unable to manage your anxiety, do seek professional advice from a Clinical Psychologist or a Psychiatrist.

5 Signs That Can Help You Identify Anxiety Disorder

Dr. Vasavi Samyukta Sunki, Psychologist
Anxiety is a very normal emotion, which gives rise to feelings of nervousness every now and then. An anxiety disorder is a serious medical condition in which people experience a high degree of distress and mental trauma, which causes difficulties in leading a normal life. People suffering from this medical condition experience high levels of anxiety and nervousness almost all the time. Here are the symptoms that indicate you're suffering from anxiety disorder.1. Excessive worry - This condition persists if you worry about the day to day activities a bit too much on a regular basis. It is identified when you start taking too much stress about very petty things, which tends to affect you in an adverse manner. A noticeable sign of excessive worry can be too much fatigue.2. Sleep problems - Problems falling asleep at the right time and problems in maintaining sound sleep are two signs that indicate you have an anxiety disorder.3. Irrational fears - This symptom is not generalized; instead, it is specific and subjective in relation to a particular thing or situation. The fears that are experienced under this category are sudden and unexpected in nature and there is no fixed rationale behind these fears.4. Muscle tension - Muscle discomfort and pain is one of the leading physiological causes of an anxiety disorder. The pain felt is chronic and pervasive, and is very common among people facing situations of anxiety. If you are exposed to constant periods of anxiety, you will experience fatigue, muscle pains and unwillingness to work.5. Chronic indigestion - Problems related to the digestive system are also a sign of anxiety disorder. In this case, you may face constant digestive problems accompanied by a common disorder called IBS (Irritable Bowel Syndrome). IBS refers to an anxiety situation in the digestive tract, which is characterized by stomach aches, cramping, bloating, gas, constipation, and/or diarrhea.Apart from the above-mentioned symptoms, other symptoms of an anxiety disorder include stage fright, self- consciousness, panic attacks, memory flashbacks, perfectionism, compulsive behaviors, self- doubt, and such others.