What are PANIC ATTACKS? Mental Health Help with Kati Morton
Hey Everybody!
Today I am going to
talk about panic attacks.
What are they?
(intro music playing)
So like I said today I want
to talk about panic attacks.
Many of you have asked me
andquot;is this what I am having?andquot;
andquot;Is this a panic attack?andquot;
andquot;People say they have
panic attacks!andquot;
andquot;What does that look like?andquot;
And there are a lot
of misconceptions out there,
like with anything
that we talk about.
Am I right?
Now, panic attacks are
a little different.
The first thing I want to
make sure you understand
is that panic attacks are not
something I can diagnose you with.
andquot;You have panic attacksandquot;
You may have panic attacks
but that is not a diagnostic criteria.
Panic attacks are something that can happen
with any anxiety disorder.
In the DSM, I have my DSM here,
They have what they call specifiers,
or different things you may feel
that will help you better understand
if you are having panic attacks,
and then let you know what
you can say to your physician,
therapist, psychiatrist, whatever to
get the help that you need.
The thing that is
interesting about panic attacks
is that the more they happen,
the more we fear
they are going to happen,
and then
they happen more frequently.
Because they start based
on the fear of having more of them.
So the better and sooner
we get ahold of it
and understand what is happening
the better the outcome for us.
Does that make sense?
the prevalence in the United States,
just so you know,
is panic attacks happen
to 11-12% of people.
That's just in the States.
So we know that these happen a lot.
The sooner we get them
taken care of and under control,
the better off
we all are.
Now some of the specifiers
that they talk about,
things you may notice,
(side note:) before I even get into that,
my clients will say things to me like:
andquot;I felt like I was drowningandquot;
or andquot;I couldn't catch my breath! andquot;
andquot;I was taking all these short little breaths
and then it progressively got worse.andquot;
Panic attacks andquot;peakandquot;,
they call it the peak,
when it reaches the most intense
amount of panic within a few minutes.
So, there aren't things
that go on for a full day.
or a full week.
These are things that peak quickly
and then slowly go down.
Now, everyone's experience is different.
This is just the overall mean
for how long panic attacks last.
Now, panic attacks
can feel like:
palpatations, pounding heart
accelerated heart rate,
some people will say
andquot;I felt like I was having a heart attack.andquot;
sweating, a lot of people's palms
will sweat suddenly,
or their back, and they will be embarassed
because they are somewhere
and they are like,
andquot;Oh no, Oh no!andquot;
Trembling or shaking,
sensations, shortness of breath,
like being smothered.
Some people will feel like I said,
taking short breaths,
like they couldn't catch their breath.
Feelings of choking,
chest pain or discomfort,
which is why a lot of people will report
that it feels like they
are having a heart attack or drowning.
Nausea, or abdominal distress.
Now I dont hear that one
as frequently as others,
but everyone experiences things differently,
so if you feel anxiety in general
in your stomach,
them maybe you feel it
there during a panic attack.
Feeling dizzy, unsteady,
lightheaded, faint
which leads to that fear of
having it,
and feeling like we need to sit down
and catch our breath.
People will feel that a lot.
Chills or heat sensations,
numbness or tingling sensations,
derealization, kind of depersonalization,
I have a video actually
about dissociation.
I have done videos with Melissa
'Idranktheseawater' (youtube name)
about maladaptive daydreaming,
all of those things where we
have an 'out of body' experience.
We can have that happen.
For many of you who struggle
with dissociation,
having panic attacks you will find
you go into that automatically.
And really what that is
is a coping skill for our mind
because it feels like things
are getting a little too intense,
and it needs to take a break.
Fear of losing control,
or going crazy,
A lot of people have
said that to me,
andquot;I feel like I am just going crazy!andquot;
andquot;I don't know whats happening!andquot;
and lastly fear of dying.
A lot of people
because they think
it's a heart attack or they
feel like they are being smothered,
they can't catch their breath.
You can understand why then they
feel like they are dying
and it can be really really scary.
I think that's the most important thing
that I want to make sure you understand
is that panic attacks
happen to a lot of people.
And they can be really scary.
And they feel
completely out of control.
And that fear,
having that fear of them happening,
and then when we have
any kind of sensation,
some of my patients struggle to
go underwater,
they had little swim tests
at this college,
on of my clients had to go underwater
and hold her breath for a certain
amount of time
and made her so anxious,
I had to write her a letter
we were afraid she would
have a panic attack,
which can be dangerous if you
are underwater.
And so it can be
a scary experience.
But the more we know
about our situation,
the more we talk about it,
the better.
I would encourage any of you
if you are worried that you are
having these,
had some,
or you are having them all
the time,
please, please please reach out
to a physician in your area.
It can be your general doctor,
they can refer you to someone
who may specialize in it,
or a lot of medications
are out there
to help with this.
Whether you believe in
medication is completely up to you,
but know that their are options.
And the sooner we reach out,
the sooner we can realize if what
we are having
is panic attacks, and is it
part of our anxiety disorder
that maybe we are not
even aware we have.
Maybe we have PTSD
but we never actually
realized we did
and now we are
having panic attacks.
The sooner we get
a hold of this,
the sooner we talk to someone,
the better!
So I encourage all of you
to reach out for support.
Even hop on my website:
www.katimorton.com
There are chat rooms, forums
and places to talk to
one another about this.
So you can get more information
about what things look like.
I mean I have videos about
what the first appointment looks like,
and all sort of stuff like that,
if that worries you as well.
But know that we are working together.
We are in this together.
Towards a healthy mind
and a healthy body.
As always, don't forget
to subscribe to my channel.
I put out videos all the time
and you don't want to miss them!
and like I said, hop on:
www.katimorton.com
because good stuff is happening there.
(end video)
(bottom right video plays
a sample of past video)
andquot;everybody talks about that too,
and that falls under this as well.
Now, Agoraphobia differs from
social anxiety or social phobia...andquot;
(end clip)
Subtitles by the Amara.org community
https://www.youtube.com/watch?v=e_aeUx4qhZQ
Anxiety Disorders: OCD, PTSD, Panic Attack, Agoraphobia, Phobias, GAD Generalized
Distinguished future physicians welcome to
Stomp on Step 1 the only free videos series
that helps you study more efficiently by focusing
on the highest yield material. I’m Brian
McDaniel and I will be your guide on this
journey through Anxiety Disorders. This is
the 3rd video in my playlist covering Psychiatry
and we are going to review things like Generalized
Anxiety Disorder, PTSD, Phobias andamp; Panic attacks.
Anxiety is uncontrolled fear, nervousness
and/or worry about trivial or non-existent
things. It is an unpleasant fear of future
events that are unlikely to occur. Some patients
have insight and realize that their uneasiness
is illogical, but that does not alleviate
symptoms. A certain level of anxiety is considered
normal in many situations, but frequent anxiety
or anxiety that inhibits function is pathologic.
During anxiety sympathetic nervous system
activation can result in physical symptoms
such as Palpitations, Tachycardia, Shortness
of breath, Muscle tension, Restlessness, Lack
of focus, Sweating or chills and Changes in
sleeping pattern.
In order to make a diagnosis of anxiety, one
must rule out other potential causes of these
symptoms. The differential diagnosis for anxiety
includes other psychiatric disorders, cardiac
abnormalities (such as myocardial infarction
or valvular disease), endocrine disorders
(like hyperthyroidism) and respiratory disease
(such as asthma or Pulmonary Embolism). Substances
such as street drugs and prescribed medications
must also be ruled out as a potential cause
of the symptoms.
We are going to hold off on discussing most
of the different treatment options for anxiety
until a later video that will cover all of
pharmacology for the psychiatry section. That
video will cover things like SSRIs, anxiolytics
and cognitive behavioral therapy which can
be used to treat anxiety disorders. However,
during this video I will mention a couple
treatment options that are used for specific
anxiety disorders.
We will start our discussion with Generalized
Anxiety Disorder or GAD. You can see here
in the top right corner I give GAD a high
yield rating of 2. For those of you who aren’t
familiar with the High Yield Rating it is
a scale from 0 to 10 that gives you an estimate
for how important each topic is for the USMLE
Step 1 Medical Board Exam. GAD is a prolonged
period of near constant anxiety. Their anxiety
is not linked to a specific item, person,
or situation (AKA it isn’t a phobia).
They usually worry about a wide variety of
things including school/work performance,
finances, health, friends and/or family members.
Their anxiety is “generalized†across
many situations. Their anxiety frequently
presents with “physical†symptoms and
may be severe enough to impair function.
A Panic Attack is sudden onset period of extremely
intense anxiety accompanied by numerous signs
and symptoms of anxiety. The attack is often
associated with a sense of impending doom.
These “episodes†usually last 10 to 30
minutes and are disabling. The patient returns
to their normal level of function soon after
the panic attack. They may be brought on by
an inciting event or be completely unprovoked.
I’d like to stop here for a moment to clarify
the difference between generalized anxiety
disorder and a panic attack. GAD can be thought
of as a constant moderate level of anxiety
while panic attacks are short periods of severe
anxiety.
Panic Disorder is recurrent panic attacks
that are unprovoked and have no identifiable
trigger. The onset of these anxiety episodes
is unpredictable. Patients may be relatively
asymptomatic between attacks, but often have
anxiety about having more attacks. Their fear
is related to the panic attacks themselves
rather than a particular external stimuli.
This differentiates Panic Disorder from Panic
Attacks that are caused by things like phobias.
Agoraphobia is anxiety related to open spaces
and/or crowded places. These people are afraid
of being helpless or embarrassed in a situation
that is difficult to “escape†from. This
often leads to avoidance of such experiences
and in severe cases these people never leave
their homes. Agoraphobia is most closely related
to Panic Disorder. In this situation patients
fear having an unexpected panic attack in
a place where they may be embarrassed in front
of other or help may not be available. However,
agoraphobia can be the result of other psychiatric
disorders such as specific phobia.
Specific Phobia is an excessive amount of
anxiety related to a specific situation or
item that interferes. Common examples include
fear of heights, spiders or medical injections.
These individuals can be relatively asymptomatic
in the absence of exposure to what they fear.
Some individuals will adapt quite well and
you won’t even know they have a phobia because
they are good at avoiding the exposure. For
example, somebody afraid of heights may move
to an area with no mountains or high rise
buildings.
Specific phobia can lead to a panic attack.
However, these attacks only occur as a result
of exposure to what they fear. They will not
have panic attack in the absence of external
stimuli. This differentiates it from panic
disorder where the individual will have unprovoked
panic attacks. In extreme cases specific phobia
can lead to Agoraphobia. For example, if somebody
is deathly afraid of spiders they may never
want to leave their house.
Treatment can include Exposure Therapy. Here
the patient creates a hierarchy of fears and
is exposed to them in order of increasing
level of fear. So a person who is afraid of
heights will start with standing on a step
stool and then slowly work their way up to
using an elevator and going to the top of
a sky scraper. By taking “baby stepsâ€
patients are often able to do things they
would have never been able to without the
process. In certain situations benzos may
be used if the feared stimuli is infrequent
and unavoidable. For example, somebody who
is afraid of flying but only takes a few flights
a year may be well controlled with benzos
on an as needed basis.
Social Anxiety Disorder (AKA Social Phobia)
is anxiety in social situations such as public
speaking, eating in public or using public
restrooms. This usually includes an intense
fear of scrutiny and judgment from others.
These patients may be relatively asymptomatic
if they can avoid being the center of attention.
Social Phobia can be thought of as a Specific
Phobia where the fear is related to social
situations. However, despite the similarities
the two disorders are separate diagnoses in
the DSM.
In extreme cases it can lead to panic attacks.
Beta blockers are sometimes used on an as
needed basis for “performance anxietyâ€
of “stage freightâ€. For example, if a
person has to give a big presentation you
can give a beta blocker about 30 minutes before
the meeting in order to block some of the
sympathetic signals. They will still have
the anxiety, but because the physical symptoms
of anxiety are blunted they won’t realize
they are anxious.
Obsessive-Compulsive Disorder is anxiety and
intrusive thoughts that drive the patient
to unusual repetitive actions called Compulsions.
The compulsions temporarily relieve the anxiety
in some patients while others feel like they
“just have to†do their rituals. Common
compulsions include counting their steps,
repetitively washing hands, preoccupation
with certain numbers and rituals such as opening
and closing doors repetitively. The patient
often realizes that their fears and compulsions
are irrational, but there remains a lack of
control.
OCD should not be confused with the similar
sounding Obsessive Compulsive Personality
Disorder (OCPD). There are some similarities
between the two as both can include a preoccupation
with things like order, cleanliness and organization.
However, OCDP patients usually lack the “classicâ€
compulsions found in OCD. OCD patients also
have insight, while OCPD patients do not.
In OCD they view their thoughts and behaviors
as abnormal, unwanted and distressing. In
OCPD they view their way of thinking as normal
and beneficial. They don’t realize they
have a disorder. We will discuss OCPD in much
more detail in a later video covering personality
disorders. If you would like to skip ahead
to that video you can click on this orange
box here
Post-traumatic Stress Disorder is anxiety
related to a traumatic experience that may
include flashbacks, nightmares and avoidance
of certain triggers that remind them of the
experience. These patients may also have hyperarousal
where they have an amplified response to external
stimuli such as loud noises. Classically the
trauma is experiencing or witnessing a life
threatening event or sexual assault. Symptoms
must be present for more than a month in order
to make a diagnosis of PTSD. If these same
symptoms last for less than a month the patient
would more correctly be diagnosed with Acute
Stress Disorder.
That brings us to the end of this video. If
you found it helpful please leave a comment
below. Feedback from our viewers helps us
improve Stomp On Step 1 and rank higher in
search results. The next video in the psychiatry
section is going to cover Malingering, Somatoform
Disorder andamp; Factitious Disorder. If you would
like to be taken directly to that video you
can click on this black box here. Thank you
so much for watching and good luck with the
rest of your studying
https://www.youtube.com/watch?v=Ha23BbieZO8
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