Which therapies are effective?
Drug therapy
The NICE (National Institute for Health and Clinical Excellence) guidelines
on the treatment of anxiety state that benzodiazepine tranquillisers, such
as diazepam (Valium), are associated with a less good outcome in the long-term
and should not be used to treat panic disorder. If drug treatment is used,
SSRI antidepressants, such as Prozac, should be used first, and if these
are not effective, the tricyclic antidepressants imipramine or clomipramine
(Anafranil) may be tried instead. SSRI antidepressants are difficult to
come off for many people, so when you are ready to stop taking them, you
should always withdraw slowly. When starting antidepressants, the side
effects may include anxious, jittery feelings. The longer you are on them,
the more likely you are to experience withdrawal symptoms, which can cause
panic attacks. (See Minds Making sense of series.)
Psychotherapy
Emotional conflicts and past difficulties may lead to anxiety, which
is released through panic attacks. Without realising it, you may be experiencing
these bodily sensations and physical reactions as a way of avoiding painful
emotions. Psychotherapy can help you to understand your present reactions
in the light of past difficulties, and to overcome them. (For more information,
see Useful organisations.)
Cognitive behaviour therapy (CBT)
Our thoughts have a very powerful impact on our behaviour. You may
be unaware of seemingly automatic thoughts and misinterpretations that
provoke attacks. This is because thoughts happen so quickly and may take
the form of images and sensations, rather than words. The way we interpret
things can cause extreme distress. But it is possible to bring about a
state of wellbeing by changing habitual thought patterns. If we think that
our racing heart is a sign of a possible heart attack we'll be very frightened,
but if we think that it is due to excitement or too much coffee, we'll
feel very differently about it.
CBT aims to identify and change the negative thought patterns and misinterpretations
that are feeding your panic attacks. If you are interested in this kind
of therapy, ask your GP to refer you to a clinical psychologist. Its also
possible to apply self-help techniques. (See Making sense of cognitive
behaviour therapy.)
Behaviour therapy
Many people develop a pattern of avoiding situations that have previously
provoked a panic attack. They may become withdrawn and phobic. A clinical
psychologist can address the problem using behavioural therapy. The therapy
concentrates on encouraging you to imagine anxiety-provoking situations,
at the same time as practising relaxation. You will be encouraged to confront
your fears, in fantasy, and then move on to facing your fears in reality.
In learning to relax and face up to feared situations, you will unlearn
your feelings of panic.
Complementary and alternative therapies
Complementary and alternative therapies have proved to be helpful when
people are experiencing stress-related symptoms, anxiety and depression.
They can be a useful tool in promoting relaxation and inducing a state
of wellbeing. Complementary health practitioners stress the connections
between mind and body, and arent concerned with merely treating symptoms.
There is an enormous number of different therapies: acupuncture, aromatherapy,
autogenic training and homeopathy, to name but a few. (See Useful organisations
and Further reading for more information.)
Other treatments
Treatment can bring significant relief to 70 to 90 percent of people with
panic disorder, and early treatment can help keep the disease from progressing
to the later stages where agoraphobia develops.
Before undergoing any treatment for panic disorder, a person should
undergo a thorough medical examination to rule out other possible causes
of the distressing symptoms. This is necessary because a number of other
conditions, such as excessive levels of thyroid hormone, certain types
of epilepsy, or cardiac arrhythmias, which are disturbances in the rhythm
of the heartbeat, can cause symptoms resembling those of panic disorder.
Several effective treatments have been developed for panic disorder
and agoraphobia. In 1991, a conference held at the National Institutes
of Health (NIH) under the sponsorship of the National Institute of Mental
Health and the Office of Medical Applications of Research, surveyed the
available information on panic disorder and its treatment. The conferees
concluded that a form of psychotherapy called cognitive-behavioral therapy
and medications are both effective for panic disorder. A treatment should
be selected according to the individual needs and preferences of the patient,
the panel said, and any treatment that fails to produce an effect within
6 to 8 weeks should be reassessed.
Cognitive-Behavioral Therapy. This is a combination of cognitive
therapy, which can modify or eliminate thought patterns contributing to
the patient's symptoms, and behavioral therapy, which aims to help the
patient change his or her behavior.
Typically the patient undergoing cognitive-behavioral therapy meets
with a therapist for 1 to 3 hours a week. In the cognitive portion of the
therapy, the therapist usually conducts a careful search for the thoughts
and feelings that accompany the panic attacks. These mental events are
discussed in terms of the "cognitive model" of panic attacks.
The cognitive model states that individuals with panic disorder often
have distortions in their thinking, of which they may be unaware, and these
may give rise to a cycle of fear. The cycle is believed to operate this
way: First the individual feels a potentially worrisome sensation such
as an increasing heart rate, tightened chest muscles, or a queasy stomach.
This sensation may be triggered by some worry, an unpleasant mental image,
a minor illness, or even exercise. The person with panic disorder responds
to the sensation by becoming anxious. The initial anxiety triggers still
more unpleasant sensations, which in turn heighten anxiety, giving rise
to catastrophic thoughts. The person thinks "I am having a heart attack"
or "I am going insane," or some similar thought. As the vicious cycle continues,
a panic attack results. The whole cycle might take only a few seconds,
and the individual may not be aware of the initial sensations or thoughts.
Proponents of this theory point out that, with the help of a skilled
therapist, people with panic disorder often can learn to recognize the
earliest thoughts and feelings in this sequence and modify their responses
to them. Patients are taught that typical thoughts such as "That terrible
feeling is getting worse!" or "I'm going to have a panic attack" or "I'm
going to have a heart attack" can be replaced with substitutes such as
"It's only uneasiness it will pass" that help to reduce anxiety and ward
off a panic attack. Specific procedures for accomplishing this are taught.
By modifying thought patterns in this way, the patient gains more control
over the problem.
Often the therapist will provide the patient with simple guidelines
to follow when he or she can feel that a panic attack is approaching. One
therapist has offered a set of strategies that have helped some of her
patients to cope with panic attacks.
Strategies for Coping with Panic
Remember that although your feelings and symptoms are very frightening,
they are not dangerous or harmful.
Understand that what you are experiencing is just an exaggeration of
your normal bodily reactions to stress.
Do not fight your feelings or try to wish them away. The more you are
willing to face them, the less intense they will become.
Do not add to your panic by thinking about what "might" happen. If
you find yourself asking "What if?" tell yourself "So what!"
Stay in the present. Notice what is really happening to you as opposed
to what you think might happen.
Label your fear level from zero to ten and watch it go up and down.
Notice that it does not stay at a very high level for more than a few seconds.
When you find yourself thinking about the fear, change your "what if"
thinking. Focus on and carry out a simple and manageable task such as counting
backward from from 100 by 3's or snapping a rubber band on your wrist.
Notice that when you stop adding frightening thoughts to your fear,
it begins to fade.
When the fear comes, expect and accept it. Wait and give it time to
pass without running away from it.
Be proud of yourself for your progress thus far, and think about how
good you will feel when you succeed this time.
(Courtesy Jerilyn Ross, M.A., L.I.C.S.W., The Ross Center for Anxiety
and Related Disorders, Inc., Washington, DC. Adapted from Mathews et al.,
1981.)
In cognitive therapy, discussions between the patient and the therapist
are not usually focused on the patient's past, as is the case with some
forms of psychotherapy. Instead, conversations focus on the difficulties
and successes the patient is having at the present time, and on skills
the patient needs to learn.
The behavioral portion of cognitive-behavioral therapy may involve systematic
training in relaxation techniques. By learning to relax, the patient may
acquire the ability to reduce generalized anxiety and stress that often
sets the stage for panic attacks.
Breathing exercises are often included in the behavioral therapy. The
patient learns to control his or her breathing and avoid hyperventilation
a pattern of rapid, shallow breathing that can trigger or exacerbate
some people's panic attacks.
Another important aspect of behavioral therapy is exposure to internal
sensations called interoceptive exposure. During interoceptive exposure
the therapist will do an individual assessment of internal sensations associated
with panic. Depending on the assessment, the therapist may then encourage
the patient to bring on some of the sensations of a panic attack by, for
example, exercising to increase heart rate, breathing rapidly to trigger
lightheadedness and respiratory symptoms, or spinning around to trigger
dizziness. Exercises to produce feelings of unreality may also be used.
Then the therapist teaches the patient to cope effectively with these sensations
and to replace alarmist thoughts such as "I am going to die," with more
appropriate ones, such as "It's just a little dizziness I can handle
it."
Another important aspect of behavioral therapy is "in vivo" or real-life
exposure. The therapist and the patient determine whether the patient has
been avoiding particular places and situations, and which patterns of avoidance
are causing the patient problems. They agree to work on the avoidance behaviors
that are most seriously interfering with the patient's life. For example,
fear of driving may be of paramount importance for one patient, while inability
to go to the grocery store may be, at most, handicapping for another.
Some therapists will go to an agoraphobic patient's home to conduct
the initial sessions. Often therapists take their patients on excursions
to shopping malls and other places the patients have been avoiding. Or
they may accompany their patients who are trying to overcome fear of driving
a car.
The patient approaches a feared situation gradually, attempting to stay
in spite of rising levels of anxiety. In this way the patient sees that
as frightening as the feelings are, they are not dangerous, and they do
pass. On each attempt, the patient faces as much fear as he or she can
stand. Patients find that with this step-by-step approach, aided by encouragement
and skilled advice from the therapist, they can gradually master their
fears and enter situations that had seemed unapproachable.
Many therapists assign the patient "homework" to do between sessions.
Sometimes patients spend only a few sessions in one-on-one contact with
a therapist and continue to work on their own with the aid of a printed
manual.
Often the patient will join a therapy group with others striving to
overcome panic disorder or phobias, meeting with them weekly to discuss
progress, exchange encouragement, and receive guidance from the therapist.
Cognitive-behavioral therapy generally requires at least 8 to 12 weeks.
Some people may need a longer time in treatment to learn and implement
the skills. This kind of therapy, which is reported to have a low relapse
rate, is effective in eliminating panic attacks or reducing their frequency.
It also reduces anticipatory anxiety and the avoidance of feared situations.
Treatment with Medications. In this treatment approach,
which is also called pharmacotherapy, a prescription medication is used
both to prevent panic attacks or reduce their frequency and severity, and
to decrease the associated anticipatory anxiety. When patients find that
their panic attacks are less frequent and severe, they are increasingly
able to venture into situations that had been off-limits to them. In this
way, they benefit from exposure to previously feared situations as well
as from the medication.
The three groups of medications most commonly used are the tricyclic
antidepressants, the high-potency benzodiazepines, and the monoamine oxidase
inhibitors (MAOIs). Determination of which drug to use is based on considerations
of safety, efficacy, and the personal needs and preferences of the patient.
Some information about each of the classes of drugs follows.
The tricyclic antidepressants were the first medications shown to have
a beneficial effect against panic disorder. Imipramine is the tricyclic
most commonly used for this condition. When imipramine is prescribed, the
patient usually starts with small daily doses that are increased every
few days until an effective dosage is reached. The slow introduction of
imipramine helps minimize side effects such as dry mouth, constipation,
and blurred vision. People with panic disorder, who are inclined to be
hypervigilant about physical sensations, often find these side effects
disturbing at the outset. Side effects usually fade after the patient has
been on the medication a few weeks.
It usually takes several weeks for imipramine to have a beneficial effect
on panic disorder. Most patients treated with imipramine will be panic-free
within a few weeks or months. Treatment generally lasts from 6 to 12 months.
Treatment for a shorter period of time is possible, but there is substantial
risk that when imipramine is stopped, panic attacks will recur. Extending
the period of treatment to 6 months to a year may reduce this risk of a
relapse. When the treatment period is complete, the dosage of imipramine
is tapered over a period of several weeks.
The high-potency benzodiazepines are a class of medications that effectively
reduce anxiety. Alprazolam, clonazepam, and lorazepam are medications that
belong to this class. They take effect rapidly, have few bothersome side
effects, and are well tolerated by the majority of patients. However, some
patients, especially those who have had problems with alcohol or drug dependency,
may become dependent on benzodiazepines.
Generally, the physician prescribing one of these drugs starts the patient
on a low dose and gradually increases it until panic attacks cease. This
procedure minimizes side effects.
Treatment with high-potency benzodiazepines is usually continued for
6 months to a year. One drawback of these medications is that patients
may experience withdrawal symptoms malaise, weakness, and other unpleasant
effects when the treatment is discontinued. Reducing the dose gradually
generally minimizes these problems. There may also be a recurrence of panic
attacks after the medication is withdrawn.
Of the MAOIs, a class of antidepressants which have been shown to be
effective against panic disorder, phenelzine is the most commonly used.
Treatment with phenelzine usually starts with a relatively low daily dosage
that is increased gradually until panic attacks cease or the patient reaches
a maximum dosage of about 100 milligrams a day.
Use of phenelzine or any other MAOI requires the patient to observe
exacting dietary restrictions, because there are foods and prescription
drugs and certain substances of abuse that can interact with the MAOI to
cause a sudden, dangerous rise in blood pressure. All patients who are
taking MAOIs should obtain their physician's guidance concerning dietary
restrictions and should consult with their physician before using any over-the-counter
or prescription medications.
As in the case of the high-potency benzodiazepines and imipramine, treatment
with phenelzine or another MAOI generally lasts 6 months to a year. At
the conclusion of the treatment period, the medication is gradually tapered.
Newly available antidepressants such as fluoxetine (one of a class of
new agents called serotonin reuptake inhibitors) appear to be effective
in selected cases of panic disorder. As with other anti-panic medications,
it is important to start with very small doses and gradually increase the
dosage.
Scientists supported by NIMH are seeking ways to improve drug treatment
for panic disorder. Studies are underway to determine the optimal duration
of treatment with medications, who they are most likely to help, and how
to moderate problems associated with withdrawal.
Combination Treatments. Many believe that a combination
of medication and cognitive-behavioral therapy represents the best alternative
for the treatment of panic disorder. The combined approach is said to offer
rapid relief, high effectiveness, and a low relapse rate. However, there
is a need for more research studies to determine whether this is in fact
the case.
Comparing medications and psychological treatments, and determining
how well they work in combination, is the goal of several NIMH-supported
studies. The largest of these is a 4-year clinical trial that will include
480 patients and involve four centers at the State University of New York
at Albany, Cornell University, Hillside Hospital/Columbia University, and
Yale University. This study is designed to determine how treatment with
imipramine compares with a cognitive-behavioral approach, and whether combining
the two yields benefits over either method alone.
Psychodynamic Treatment. This is a form of "talk therapy"
in which the therapist and the patient, working together, seek to uncover
emotional conflicts that may underlie the patient's problems. By talking
about these conflicts and gaining a better understanding of them, the patient
is helped to overcome the problems. Often, psychodynamic treatment focuses
on events of the past and making the patient aware of the ramifications
of long-buried problems.
Although psychodynamic approaches may help to relieve the stress that
contributes to panic attacks, they do not seem to stop the attacks directly.
In fact, there is no scientific evidence that this form of therapy by itself
is effective in helping people to overcome panic disorder or agoraphobia.
However, if a patient's panic disorder occurs along with some broader and
pre-existing emotional disturbance, psychodynamic treatment may be a helpful
addition to the overall treatment program.
BACK TO INDEX
Symptoms
Palpitations, heart pounding or a rapid pulse
Palpitations are heartbeat sensations that feel like pounding or racing. You may simply have an unpleasant awareness of your own heartbeat. You may feel skipped or stopped beats. The heart's rhythm may be normal or abnormal. Palpitations can be felt in your chest, throat, or neck.
Normally the heart beats between 60-100 times per minute. In people who exercise routinely or take medications that slow the heart, the rate may drop below 55 beats per minute.
If your heart rate is very fast (over 100 beats per minute), this is called tachycardia. An unusually slow heart rate is called bradycardia, and an occasional extra heart beat is known as extrasystole.
Palpitations are often not serious. However, it depends on whether or not the sensations represent an abnormal heart rhythm (called an arrhythmia). You are more likely to have an abnormal heart rhythm if you have:
Known heart disease at the time the palpitations begin
Significant risk factors for heart disease
An abnormal heart valve
An electrolyte abnormality -- for example, low potassium
Heart palpitations can be caused by:
Exercise
Anxiety, stress, fear
Fever
Caffeine, nicotine, cocaine, diet pills
Overactive thyroid
Anemia
Hyperventilation
Low levels of oxygen in your blood
Medications such as thyroid pills, asthma drugs, beta blockers for high blood pressure or heart disease, or anti-arrhythmics (medications to treat an irregular heart rhythm can sometimes cause a different irregular rhythm)
Mitral valve prolapse -- the valve that separates the left upper chamber (atrium) from the left lower chamber (ventricle) of the heart does not close properly
Heart disease
Reducing stress and anxiety can help lessen your heart palpitations. Try breathing exercises or deep relaxation (a step-by-step process of tensing and then relaxing every muscle group in your body) at the time of your heartbeat sensations. Also, consider practicing yoga or tai chi on a regular basis to reduce the frequency of your palpitations.
Keep a record of how often you have palpitations, when they happen, how long they last, your heart rate at the time of the palpitations, and what you are feeling at the time. This information may help your doctor figure out both their seriousness and the cause.
Once a serious cause has been ruled out by your doctor, try NOT to pay attention to heart palpitations, unless you notice a sudden increase or a change in them.
If you have never had heart palpitations before, bring them to the attention of your doctor. He or she will do a work up to determine the cause and whether they are treatable or not.
Sweating
Sweat, also called perspiration, is a salty liquid produced by the sweat glands. Sweating is an essential function that helps the body stay cool. Sweat is commonly found under the arms, on the feet, and on the palms of the hands.
How much you sweat depends on how many sweat glands you have. A person is born with about two to four million sweat glands. The glands start to become fully active during puberty. Women actually have more sweat glands then men -- the men's glands are just more active.
Because sweating is the body's natural way of regulating temperature, people sweat more in when it's hot outside. People also sweat more when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid.
If sweating is accompanied by fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat, talk to a doctor. These symptoms may indicate an underlying problem, such as hyperthyroidism. Excessive sweating may also be a symptom of menopause.
Common Causes
Warm temperatures
Fever
Menopause
Overactive thyroid gland
Low blood sugar
Infection
Cancer (sweating at night without an obvious cause)
Emotional or stressful situations
Exercise
Spicy foods (known as "gustatory sweating")
Drugs, including antipyretics, some antipsychotics, sympathomimetics, caffeine, morphine, alcohol and thyroid hormone
Withdrawal from alcohol or narcotic pain killers
After an episode of sweating, a person should:
Wash the face and body
Change clothes and bed sheets
Replace lost body fluids by drinking plenty of water
Slighly adjust room temperature to prevent additional sweating
Trembling or shaking
A tremor is an involuntary movement or shaking of any body part (even your head or voice may be involved). It is often most noticeable in your hands. There are three main types of tremors:
Resting or static tremors -- occur when your hand or affected body part is at rest.
Intention tremors -- occur when you are moving your hand or affected body part and disappear at rest.
Postural tremors -- occur when you are holding your hand or affected body part in a particular position for a period of time.
Tremors can happen at any age but tend to be more common in older people.
You can develop a tremor from fatigue, stress, anxiety, or even rage. However, an ongoing tremor that is not associated with a change in your emotional state may be a sign of an underlying medical condition and should be evaluated. You may learn, as many do, that your tremors are perfectly normal, but eliminating medical reasons for the shaking is important.
It is especially important to have tremors evaluated if body parts other than the hands are involved, like your tongue or head, or if you have other types of involuntary movements other than shaking.
Essential tremor is common in older people. Essential tremor is rarely present when the hands are not being used. It becomes most apparent when the affected person is trying to do something, like reaching for an object or writing. It is not caused by an underlying disease.
Another common type of tremor is called familial tremor which, as the name implies, tend to run in families.
Both essential and familial tremors may be suppressed by drinking alcohol. This is a useful fact for making the diagnosis, but alcohol is not a desirable treatment.
Tremors may be caused by:
Too much coffee or other caffeinated drink
Excessive alcohol consumption, alcoholism, or alcohol withdrawal
Stress, anxiety, or fatigue -- these can cause a postural tremor
Normal aging
A variety of drugs and prescription medicines
Low blood sugar
Parkinson's disease -- this is the classic cause of a resting tremor and is often accompanied by slowness of movement, muscle rigidity, and an abnormal gait
Multiple sclerosis -- can cause an intention tremor
Over active thyroid -- can cause a postural tremor
For tremors caused by stress, try relaxation techniques like meditation, deep relaxation, or breathing exercises. For tremors of any cause, avoid caffeine and get enough sleep.
For tremors caused by a medication, consult with your doctor about stopping the drug, reducing the dosage, or switching medications. DO NOT change or stop medications on your own.
For certain types of tremors, like essential tremor and familial tremor, medications such as beta-blockers, gabapentin, primidone, and others may be an option. If medication doesn't work, your doctor may even consider surgery. Also, botulinum toxin injections have been used for essential hand tremors.
For tremors caused by alcohol abuse, seek treatment and support to help you avoid alcohol.
Severe tremors may interfere with your ability to perform daily activities. Assistance with these activities may be necessary. Precautions should be taken to avoid injury during activities such as walking or eating.
Shortness of breath
Definition
Breathing difficulties involve a sensation of difficult or uncomfortable
breathing or a feeling of not getting enough air. See also difficulty breathing
- first aid.
Considerations
No standard definition exists for difficulty breathing. For some individuals,
a sense of breathlessness may occur with only mild exercise (for example,
climbing stairs) without an indication of the presence of a specific disorder.
Others may have advanced lung disease and difficulty exchanging air but
may never feel a sensation of shortness of breath.
In some circumstances, a small degree of breathing difficulty may be
normal. Severe nasal congestion is one example. Strenuous exercise, especially
when a person does not exercise regularly, is another. In many situations,
however, difficulty breathing represents the presence of significant disease
and should be evaluated by a health care provider immediately.
Wheezing is one form of breathing difficulty. See also rapid breathing,
apnea, and other lung diseases.
Common Causes
Shortness of breath has many different causes. Obstruction of the air
passages of the nose, mouth, or throat may lead to difficulty breathing.
Heart disease can cause breathlessness if the heart is unable to pump enough
blood to supply oxygen to the body. If the brain, muscles, or other body
organs do not receive enough oxygen, a sense of breathlessness may occur.
Sometimes emotional distress, such as anxiety, can lead to difficulty breathing.
Specific causes include the following:
Lung disease
Cigarette smoking
Asthma
Emphysema
Coronary artery disease
Heart attack (myocardial infarction)
Interstitial lung disease
Pneumonia
Pulmonary hypertension
Rapid ascent to high altitudes, with less oxygen in the air
Airway obstruction
Inhalation of a foreign object
Dust-laden environment
Allergies (such as to mold, dander, or pollen)
Congestive heart failure (CHF)
Heart arrhythmias
Deconditioning (lack of exercise)
Obesity
Compression of the chest wall
Panic attacks
Home Care
Breathing difficulty, whether sudden or long term, should always be
taken seriously. Though many causes are harmless and are easily corrected,
any difficulty breathing requires a thorough medical evaluation.
Follow prescribed therapy to treat the underlying cause.
Dizziness
Definition
Dizziness is lightheadedness, feeling like you might faint, being unsteady,
loss of balance, or vertigo (a feeling that you or the room is spinning
or moving).
Most causes of dizziness are not serious and either quickly resolved on their own or are easily treated.
Common Causes
Lightheadedness happens when there is not enough blood getting to the
brain. This can happen if there is a sudden drop in your blood pressure
or you are dehydrated from vomiting, diarrhea, fever, or other causes.
Many people, especially as they get older, experience lightheadedness if
they get up too quickly from a lying or seated position. Lightheadedness
often accompanies the flu, common cold, or allergies.
More serious conditions that can lead to lightheadedness include heart
problems (such as abnormal heart rhythm or heart attack), stroke, and severe
drop in blood pressure ( shock). If any of these serious disorders is present,
you will usually have additional symptoms like chest pain, a feeling of
a racing heart, loss of speech, change in vision, or other symptoms.
The most common causes of vertigo are benign positional vertigo and
labyrinthitis. Benign positional vertigo is vertigo that happens when you
change the position of your head. Labyrinthitis usually follows a cold
or flu and is caused by a viral infection of the inner ear. Meniere's disease
is another common inner ear problem. It causes vertigo, loss of balance,
and ringing in the ears.
Much less commonly, vertigo or feeling unsteady is a sign of stroke,
multiple sclerosis, seizures, a brain tumor, or a bleed in your brain.
In such conditions, other symptoms usually accompany the vertigo or imbalance.
Home Care
If you tend to get lightheaded when you stand up, avoid sudden changes
in posture.
If you are thirsty or lightheaded, drink fluids. If you are unable to
keep fluids down from nausea or vomiting, you may need intravenous fluids.
These are delivered to you at the hospital.
Most times, benign positional vertigo and labyrinthitis go away on their
own within a few weeks. During attacks of vertigo from any cause, try to
rest and lie still. Avoid sudden changes in your position as well as bright
lights. Be cautious about driving or using machinery.
Some vertigo can be reduced by working with a physical therapist. Medications
from your doctor may help you feel better.
Such medications include antihistamines, sedatives, or pills for nausea.
For Meniere's disease, surgery may be necessary.
Faintness
Definition
Fainting is a temporary loss of consciousness due to a drop in blood
flow to the brain. The episode is brief (lasting less than a couple of
minutes) and is followed by rapid and complete recovery. You may feel lightheaded
or dizzy before fainting.
A longer, deeper state of unconsciousness is often called a coma.
Considerations
When you faint, you not only experience loss of consciousness, but also
loss of muscle tone and paling of color in your face. You may also feel
weak or nauseated just prior to fainting, and you may have the sense that
surrounding noises are fading into the background.
Common Causes
Fainting may occur while you are urinating, having a bowel movement
(especially if straining), coughing strenuously, or when you have been
standing in one place too long. Fainting can also be related to fear, severe
pain, or emotional distress.
A sudden drop in blood pressure can cause you to faint. This may happen
if you are bleeding or severely dehydrated. It can also happen if you stand
up very suddenly from a lying position.
Certain medications may lead to fainting by causing a drop in your blood
pressure or for another reason. Common drugs that contribute to fainting
include those used for anxiety, high blood pressure, nasal congestion,
and allergies.
Other reasons you may faint include hyperventilation, use of alcohol
or drugs, or low blood sugar.
Less common but more serious reasons include heart disease (like abnormal
heart rhythm or heart attack) and stroke.
Home Care
If you have a history of fainting and have been evaluated medically,
follow your doctor's instructions for how to prevent fainting episodes.
For example, if you know the situations that cause you to faint, avoid
or change them. Avoid sudden changes in posture. Get up from a lying or
seated position slowly and gradually. When having blood drawn (if this
makes you faint), tell the technician and make sure that you are lying
down.
Immediate treatment for someone who has fainted includes:
Checking the person's airway and breathing. If necessary, call 911 and
begin rescue breathing and CPR.
Loosening tight clothing around the neck.
Keeping the affected person lying down for at least 10 - 15 minutes,
preferably in a cool and quiet space. If the person cannot lie down, have
him sit forward and lower his head below the levels of the shoulders, between
the knees.
If vomiting has occurred, turning the person onto one side to prevent
choking
Elevating the feet above the level of the heart (about 12 inches).
Feeling of choking
Often one of the first symptoms of anxiety. People complain of feeling as though they will choke or being strangled. In reality its not nearly so dramatic - the muscles in the throat contract and salivary glands produce thick mucus leading to a feeling of restriction around the throat, it can produce a feeling that you are having difficulty swallowing or breathing. In fact you are not having difficulty, it just feels as though you are. You also get a dry mouth and it can feel like you cannot drink but you can.
You feel as though there is something stuck in your throat or sometimes feel there is a lump in your throat. Other times you may feel that you can barely swallow or that there is a tightness in the throat, or that you have to really force yourself to swallow. Sometimes this feeling can lead you to think that you may suffocate or get something stuck in your throat.
When in danger, stress biology produces a tightening in the throat muscles which produces the choking or 'something stuck in the throat' feeling. When in a nervous or stressful situation, many people will experience this feeling. It is often referred to as 'a lump on your throat'.
There is minimal danger of choking or suffocating under normal conditions, however, some people are very sensitive to things in their throat and therefore caution should always be observed when eating. Chewing food thoroughly and slowly will prevent inadvertently swallowing something that may provoke someone to gag.
This symptom can come and go, and may seem to intensify if one becomes focused on it.
Nausea
Definition
Nausea is the sensation of having an urge to vomit. Vomiting is forcing
the contents of the stomach up through the esophagus and out of the mouth.
Considerations
Your body has a few main ways to respond to an ever-changing, wide variety
of invaders and irritants. Sneezing ejects the intruders from the nose,
coughing from the lungs and throat, diarrhea from the intestines, and vomiting
from the stomach.
Vomiting is a forceful action accomplished by a fierce, downward contraction
of the diaphragm. At the same time, the abdominal muscles tighten against
a relaxed stomach with an open sphincter. The contents of the stomach are
propelled up and out.
You may have more saliva just before vomiting.
Vomiting is a complex, coordinated reflex orchestrated by the vomiting
center of the brain. It responds to signals coming from:
The mouth, stomach, and intestines
The bloodstream, which may contain medicines or infections
The balancing systems in the ear (motion sickness)
The brain itself, including unsettling sights, smells, or thoughts
An amazing variety of stimuli can trigger vomiting, from migraines
to kidney stones. Sometimes, just seeing someone else vomit will start
you vomiting, in your body's effort to protect you from possible exposure
to the same danger.
Vomiting is common. Almost all children will vomit several times during
their childhood. In most cases, it is due to a viral gastrointestinal infection.
Spitting up, the gentle sloshing of stomach contents up and out of
the mouth, sometimes with a burp, is an entirely different process. Some
spitting up is normal for babies, and usually gets gradually better over
time. If spitting up worsens or is more frequent, it might be reflux disease.
Discuss this with your child's doctor.
Most of the time, nausea and vomiting do not require urgent medical
attention. However, if the symptoms continue for days, they are severe,
or you cannot keep down any food or fluids, you may have a more serious
condition.
Dehydration is the main concern with most vomiting. How fast you become
dehydrated depends on your size, frequency of vomiting, and whether you
also have diarrhea.
Common Causes
The following are possible causes of vomiting:
Viral infections
Medications
Seasickness or motion sickness
Migraine headaches
Morning sickness during pregnancy
Food poisoning
Food allergies
Brain tumors
Chemotherapy in cancer patients
Bulimia
Alcoholism
These are possible causes of vomiting in infants (0 - 6 months):
Congenital pyloric stenosis, a constriction in the outlet from the
stomach (the infant vomits forcefully after each feeding but otherwise
appears to be healthy)
Food allergies or milk intolerance
Gastroenteritis (infection of the digestive tract that usually causes
vomiting with diarrhea)
Gastroesophageal reflux
An inborn error of metabolism
Hole in the bottle nipple may be wrong size, leading to overfeeding
Infection, often accompanied by fever or runny nose
Intestinal obstruction, evidenced by recurring attacks of vomiting
and crying or screaming as if in great pain
Accidentally ingesting a drug or poison
Call the doctor immediately or take the child to an emergency care
facility if you suspect poisoning or drug ingestion!
Home Care
It is important to stay hydrated. Try steady, small amounts of clear
liquids, such as electrolyte solutions. Other clear liquids -- such as
water, ginger ale, or fruit juices -- also work unless the vomiting is
severe or it is a baby who is vomiting.
For breastfed babies, breastmilk is usually best. Formula-fed babies
usually need clear liquids.
Dont drink too much at one time. Stretching the stomach can make nausea
and vomiting worse. Avoid solid foods until there has been no vomiting
for six hours, and then work slowly back to a normal diet.
An over-the-counter bismuth stomach remedy like Pepto-Bismol is effective
for upset stomach, nausea, indigestion, and diarrhea. Because it contains
aspirin-like salicylates, it should NOT be used in children or teenagers
who might have (or recently had) chickenpox or the flu.
Most vomiting comes from mild viral illnesses. Nevertheless, if you
suspect the vomiting is from something serious, the person may need to
be seen immediately.
There is currently no treatment that has been approved by the FDA for
morning sickness in pregnant women.
The following may help treat motion sickness:
Lying down
Over-the-counter antihistamines (such as Dramamine)
Scopolamine prescription skin patches (such as Transderm Scop) are
useful for extended trips, such as an ocean voyage. Place the patch 4 -
12 hours before setting sail. Scopolamine is effective but may produce
dry mouth, blurred vision, and some drowsiness. Scopolamine is for adults
only. It should NOT be given to children.
Chest pain or discomfort
Definition
Chest pain is discomfort or pain that you feel anywhere along the front
of your body between your neck and upper abdomen.
Considerations
Many people with chest pain fear a heart attack. However, there are
many possible causes of chest pain. Some causes are mildly inconvenient,
while other causes are serious, even life-threatening. Any organ or tissue
in your chest can be the source of pain, including your heart, lungs, esophagus,
muscles, ribs, tendons, or nerves.
Angina is a type of heart-related chest pain. This pain occurs because
your heart is not getting enough blood and oxygen. Angina pain can be similar
to the pain of a heart attack.
Angina is called stable angina when your chest pain begins at a predictable
level of activity. (For example, when you walk up a steep hill.) However,
if your chest pain happens unexpectedly after light activity or occurs
at rest, this is called unstable angina. This is a more dangerous form
of angina and you need to be seen in an emergency room right away.
Common Causes
Other causes of chest pain include:
Asthma, which is generally accompanied by shortness of breath, wheezing,
or cough.
Pneumonia, a blood clot to the lung (pulmonary embolism), the collapse
of a small area of a lung (pneumothorax), or inflammation of the lining
around the lung ( pleurisy). In these cases, the chest pain often worsens
when you take a deep breath or cough and usually feels sharp.
Strain or inflammation of the muscles and tendons between the ribs.
Anxiety and rapid breathing.
Chest pain can also be related to problems with your digestive system.
These include stomach ulcer, gallbladder disease, gallstones, indigestion,
heartburn, or gastroesophageal reflux (when acid from your stomach backs
up into your esophagus).
Ulcer pain burns if your stomach is empty and feels better with food.
Gallbladder pain often gets worse after a meal, especially a fatty meal.
In children, most chest pain is not caused by the heart.
Home Care
If injury, over-exertion, or coughing have caused muscle strain, your
chest wall is often tender or painful when you press a finger at the location
of the pain. This can often be treated at home. Try acetaminophen or ibuprofen,
ice, heat, and rest.
If you know you have asthma or angina, follow the instructions of your
doctor and take your medications regularly to avoid flare-ups.
Hyperventilation
Definition
Hyperventilation is rapid or deep breathing, usually caused by anxiety
or panic. This overbreathing, as it is sometimes called, may actually leave
you feeling breathless.
When you breathe, you inhale oxygen and exhale carbon dioxide. Excessive
breathing may lead to low levels of carbon dioxide in your blood, which
causes many of the symptoms that you may feel if you hyperventilate.
Considerations
Feeling very anxious or having a panic attack are the usual reasons
that you may hyperventilate. However, rapid breathing may be a symptom
of an underlying disease, such as a heart or lung disorder, bleeding, or
an infection. (See rapid shallow breathing.)
Your doctor will determine the cause of your hyperventilation. Rapid
breathing may be considered a medical emergency -- unless you have experienced
this before and have been reassured by your doctor that your hyperventilation
can be self treated. (See below.).
Often, panic and hyperventilation become a vicious cycle -- panic leads
to rapid breathing while breathing rapidly can make you feel panicked.
If you frequently overbreathe (sometimes referred to as hyperventilation
syndrome), this may be triggered by ongoing emotions of stress, anxiety,
depression, or anger. However, hyperventilation from panic is generally
related to a specific fear or phobia, such as a fear of heights, dying,
or closed-in spaces (claustrophobia).
If you have hyperventilation syndrome -- that is, if you regularly hyperventilate
-- you might not be aware of it. But you will be aware of having many of
the associated symptoms, including dizziness or lightheadedness, shortness
of breath, belching, bloating, dry mouth, weakness, confusion, sleep disturbances,
numbness and tingling in your arms or around your mouth, muscle spasms
in hands and feet, chest pain, and palpitations.
Common Causes
anxiety and nervousness
stress
panic attack
situations where there is a psychological advantage in having a sudden,
dramatic illness (for example, somatization disorder)
stimulant use
lung disease such as asthma, chronic obstructive pulmonary disease
(COPD), or pulmonary embolism (blood clot in the lung)
infection such as pneumonia or sepsis
cardiac disease such as congestive heart failure or heart attack
severe pain
bleeding
drugs (such as an aspirin overdose)
pregnancy
ketoacidosis and similar medical conditions
Home Care
Assuming that a more serious, underlying cause of hyperventilation has
been eliminated and your doctor has explained that you hyperventilate from
anxiety, stress, or panic, there are steps you can take at home. You, your
friends, and family can learn techniques to stop you from hyperventilating
when it happens and to prevent future attacks.
If you start hyperventilating, the goal is to raise the carbon dioxide
level in your blood, which will put an end to most of your symptoms. There
are several ways to do this:
Reassurance from a friend or family member can help relax your breathing.
Words like "you are doing fine," "you are not having a heart attack," and
"you are not going to die" are very helpful. It is extremely important
that the person helping you remain calm and deliver these messages with
a soft, relaxed tone.
To increase your carbon dioxide, you need to take in less oxygen. To
accomplish this, you can breathe through pursed lips (as if you are blowing
out a candle) or you can cover your mouth and one nostril, breathing through
the other nostril.
Over the long term, there are several important steps to follow to
try to eliminate your tendency to overbreathe:
If anxiety or panic has been diagnosed, see a psychologist or psychiatrist
to help you understand and treat your condition.
Learn breathing exercises that help you relax and breathe from your
diaphragm and abdomen, rather than your chest wall.
Practice relaxation techniques regularly, such as progressive muscle
relaxation or meditation.
Exercise regularly.
If these methods alone are not preventing your overbreathing, your
doctor may recommend a beta blocker medication.
Eyes, Blurred vision, Eyes sensitive to light, Dry, watery or itchy eyes
You may see stars or movements out of the corner of your eyes that don't
exist. You may also see flashing lights in your eyes or your vision may
seem almost kaleidoscope-like. Sometimes you may feel that there is a dark
object or something just on the outside edge of your vision, or that your
vision is narrowing.
It seems your vision is blurry or out of focus, and it's more apparent
now than before.
There are times when your eyes seem more sensitive to light than at
others, even to a point of regular light being too bright so that you have
to wear sunglasses or squint.
You feel as though your eyes are either always dry, constantly watering
or itchy. And often, your eyes are red or 'glossy' looking. Even a good
night's rest doesn't help.
Ciliary muscles relax - pupils dilate focusing on distant items sometimes
disturbing your vision or allowing odd colours or floaters to be noticed.
Eyes are nerves. The nerves in the eyes send their information to the
brain through the nervous system. When the nervous system is over active,
the nerves in the eyes can play tricks on you which means we sometimes
receive false information. These symptoms are some of the ways we receive
this false information.
None of these symptoms are serious when they are attributed to anxiety
disorder. However, it is important that you get a professional medical
evaluation completed to ensure your condition is related to anxiety disorder.
Ear ringing
Definition
Tinnitus is the medical term for "hearing" noises in your ears when
there is no outside source of the sounds. The noises you hear can be soft
or loud. They may sound like ringing, blowing, roaring, buzzing, hissing,
humming, whistling, or sizzling. You may even think you are hearing air
escaping, water running, the inside of a seashell, or musical notes.
Considerations
Tinnitus is common. Almost everyone experiences a mild form of tinnitus
once in awhile that only lasts a few minutes. However, constant or recurring
tinnitus is stressful and can interfere with your ability to concentrate
or sleep.
Common Causes
It is not known exactly what causes a person to "hear" sounds with no
outside source of the noise. However, tinnitus can be a symptom of almost
any ear problem, including ear infections, foreign objects or wax in the
ear, and injury from loud noises. Alcohol, caffeine, antibiotics, aspirin,
or other drugs can also cause ear noises.
Tinnitus may occur with hearing loss. Occasionally, it is a sign of
high blood pressure, an allergy, or anemia. Rarely, tinnitus is a sign
of a serious problem like a tumor or aneurysm.
Home Care
Tinnitus can be masked by competing sounds, such as low-level music,
ticking clocks, or other noises. Tinnitus is often more noticeable when
you go to bed at night because your surroundings are quieter. Any noise
in the room, like a humidifier, white noise machine, or dishwasher, can
help mask tinnitus and make it less irritating.
Learn ways to relax. Feeling stressed or anxious can worsen tinnitus.
Avoid caffeine, alcohol, and smoking.
Get enough rest. Try sleeping with your head propped up in an elevated
position. This lessens head congestion and noises may become less noticeable.
Lack of appetite
Definition
This symptom describes a decreased or lack of appetite despite basic
caloric needs.
Considerations
Any illness can adversely affect a previously hearty appetite. If the
disease is treatable, the appetite should return when the disease is cured.
Loss of appetite can cause unintentional weight loss.
Common Causes
Emotional upset, nervousness, loneliness, boredom, tension, anxiety,
bereavement, and depression
Anorexia nervosa
Acute and chronic infections
HIV
Pregnancy (first trimester)
Cancer
Hypothyroidism
Medications and street drugs
Chemotherapeutic agents
Amphetamines
Sympathomimetics including ephedrine
Antibiotics
Cough and cold preparations
Codeine
Morphine
Demerol
Digitalis
Home Care
Protein and calorie intake can be increased by intake of high-calorie,
nutritious snacks or several small meals during the day. Liquid protein
drinks may be helpful. Family members should try to supply favorite foods
to help stimulate the person's appetite.
A 24-hour diet history should be recorded each day. If an anorexic person
consistently exaggerates food intake (a common occurrence in anorexia nervosa),
strict calorie and nutrient counts should be maintained by someone else.
For loss of appetite caused by taking medications, talk to your health
care provider about adjusting the dosage or changing drugs. NEVER CHANGE
MEDICATIONS WITHOUT FIRST CONSULTING YOUR HEALTH CARE PROVIDER.
Urgency to urinate
You have an urgent need to go to the toilet, even though you may have just gone. Starts decreasing urine output but initially wants to get rid of everything already waiting to be excreted. May need to visit the loo urgently.
High stress biology produces the need to eliminate. It does so because when the body prepares for action, it wants to eliminate all waste matter in order to make the body as well prepared for action as possible. Having all excess baggage removed, the individual will be at their peak readiness in order to fight or run - the fight or flight response, produced by the Emergency alarm.
This symptom is very common and often experienced by stage performers just before they are to perform. Unfortunately, for those who experience anxiety disorder, a high level of stress biology will produce this symptom, and as long as the stress biology is high, the symptom will be produced. Thats just how the body was engineered.
Some remedies include ant-acids, diarrhoea medication, relaxation and deep breathing.
The primary symptom of stress incontinence is leakage due to activities
that apply pressure to a full bladder. High-impact exercise poses the greatest
risk for leaking. But stress incontinence can occur with even minor activities,
such as:
Coughing
Sneezing
Laughing
Running (sometimes even standing can produce leakage)
Lifting
Leakage stops when the activity stops. If the condition persists, it
is more likely to be urge incontinence.
Causes of Stress Incontinence in Women
Stress incontinence occurs because the internal sphincter does not
close completely. In both men and women, the aging process causes a general
weakening of the sphincter muscles and a decrease in bladder capacity.
Causes of stress incontinence, however, may differ between men and women.
In women, stress incontinence is nearly always due to one or both of
the following:
The urethra fails to close and becomes overly movable ( urethral hypermobility).
The muscles around the bladder neck weaken ( intrinsic sphincteric
deficiency or ISD). Some experts believe that this problem is present to
some degree in nearly all women with stress incontinence. (ISD can also
occur in anyone from an inborn disorder or injury from surgery or radiation.)
Many women are prone to one or both of these problems, which can occur
under the following circumstances:
Having had many children through vaginal deliveries. In such cases,
pregnancy and childbirth strain the muscles of the pelvic floor. Prolapsed
uterus, in which the uterus protrudes into the vagina, occurs in about
half of all women who have given birth. This condition can often cause
incontinence.
Menopause. Estrogen deficiencies after menopause can cause the urethra
to thin out so that it may not close properly.
Urethral Hypermobility. In urethral hypermobility the urethra does
not close properly and it moves too much (hypermobile). This condition
typically occurs when the pelvic floor muscles in women become weak and
the following events occur:
The weakened pelvic floor muscles stretch.
This allows the bladder to sag downward within the abdomen.
The sagging bladder pulls on the muscles surrounding the bladder neck
(internal sphincter), which are connected to the urethra.
Stress incontinence associated with urethral hypermobility is sometimes
categorized as type 1 or type 2.
Type 1 is the less severe form and the bladder neck and urethra remain
incompletely closed.
In type 2, the angle of the bladder neck shifts. In such cases cystocele
may occur, in which the bladder muscles bulge (herniate) into the vaginal
wall.
Intrinsic sphincteric deficiency (ISD). Intrinsic sphincter deficiency
(sometimes called type 3) is the other major cause of stress incontinence
in women. It occurs when the bladder neck muscles are damaged or weakened.
The result is twofold:
The bladder neck is open during filling
The closing pressure around the urethra is low
This is the most severe stress incontinence in women and usually occurs
after previous surgeries for incontinence.
Causes of Stress Incontinence in Men
Prostate treatments can impair the sphincter muscles. Such treatments
are the major causes of stress incontinence in men. They include the following:
Surgery or radiation for prostate cancer. Incontinence occurs in nearly
all male patients for the first 3 to 6 months after radical prostatectomy.
After a year of the procedure, most men retain continence, although leakage
can occur.
Surgery for benign prostatic hyperplasia. Stress incontinence occurs
in 1 - 5% of men after transurethral resection of the prostate (TURP),
the standard treatment for severe benign prostatic hyperplasia.
Weak legs
Your legs feel so weak that you think they won't be able to support you. In some cases you might feel you won't be able to walk. Sometimes your legs may feel like jelly or rubber, or that you have to force yourself to walk. You may even feel as though your legs or knees are too stiff to move.
When people feel nervous, often they will feel weak in the knees, which means jelly legs or weak legs. This is a very common symptom of stress biology and most people who are placed in stressful situations will experience this. However, the degree of which is dependent upon the amount of stress biology. The higher your stress biology, the more your legs will feel weak.
Physically, your legs are fine. You may just feel weak. Sometimes people become played out by this condition because it taxes all of their strength, leaving them feeling weak. Through rest, this symptom will subside. Also, regular exercise helps to keep muscles and body tone in shape which helps to eliminate this symptom.
As with all symptoms, when the nervous system gets sufficient rest, this symptom will diminish and eventually subside.
Constant craving for sugar or sweets
For some reason you have an increased and ongoing craving for sugar, sweets or chocolate. Although you may have a 'sweet tooth', these cravings usually go unsatisfied, while ingesting even more sweets leaves you with the same result.
High stress biology and an over stimulated nervous system continually use up the bodys energy supply, even when the body is not physically active. Because of this continual energy consumption, the body requires more fuel in order to meet the demand. This fuel comes in the form of blood sugar. When you are feeling a craving for sugar, thats the bodys way of letting you know it requires more fuel.
This in itself is a good thing because your body is letting you know it needs fuel (symptoms let the body know something needs attention). However, if you respond to this request with raw sugar (sweets, chocolate, soft drink, milkshake, flavored coffee, etc.), two negative affects happen:
The ingested raw sugar rapidly increases the bodys blood sugar. As a result, you may feel a slight surge of energy and well being immediately after the ingestion of a raw sugar. However, this rapid increase in blood sugar causes the pancreas to stimulate an appropriate dose of insulin in order to keep the bodys blood sugar within a normal range. This may make you may feel fatigued, dizzy, weak and emotionally poor because the insulin has reduced the blood sugar level too much.
In addition, if the insulin reduces the bodys blood sugar too much, the brain may automatically trigger an emergency response alarm which then adds more stress biology which may also make you feel sick, anxious and can even trigger a panic attack. Its these types of blood sugar swings that can really upset you.
Usually these raw sugars also include caffeine (such as chocolate, cola, soft drinks, coffee, etc.). When they do, the blood sugar swing is magnified because in addition to the rapid increase and decrease of blood sugar, caffeine is a stimulant that activates the stress biology. So now you have two boosts of energy which the pancreas has to work extra hard to keep in the normal range.
In affect, you are giving your body and nervous system a double whammy. As well, because caffeine is longer lasting than raw sugar, the body has to work longer to stabilize the blood chemistry. This longer action can often play havoc with a persons symptoms and mental functions.
When you feel a craving for sugar, you should acknowledge it by ingesting natural foods such as vegetables and fruit. Since these foods contain natural sugars, they are broken down and slowly released into the blood stream. This prevents the sudden and rapid fluctuations in blood sugar. As well, these natural foods contain no artificial stimulants so you wont be subjected to an increase in stress biology.
Other Symptoms
Having difficulty concentrating
Insomnia, or waking up ill in the middle of the night
Excess of energy, you feel you cant relax
Dry mouth
Fear of losing control
Headaches
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