— B — PANIC ATTACKS CONTROL

Every weekday, a CNN Health expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind–body connection for health.

 

QUESTION ASKED BY STEPHANIE VIA E-MAIL

I’ve been having a lot of panic attacks, almost every day; sometimes when I'm working, dealing with the kids or just nothing at all. I'll get shortness of breath, chest hurts on both sides or just one side, and a lot of my heart skipping a beat. And it scares me. I’m 29 years old and in good health. How can I control this?

 

EXPERT ANSWER:

Dear Stephanie,

I don't need to tell you that panic attacks are among the most hideous experiences a human being can have. They are such strange occurrences. While being in no physical danger at all, you feel as if you are in mortal peril. In the midst of perfectly good health, you feel as if you are on the edge of sudden death. And telling yourself that there is no real danger is of almost no help whatsoever.

 

My strongest piece of advice is that you make an appointment to see your doctor immediately. Many primary care doctors feel comfortable treating panic disorder or will know a clinician who does.

Like everything else in psychiatry, treatment options come in two general flavors: medications and psychotherapy.

 

The best proven psychotherapy for panic attacks is similar in many ways to the type of therapy that I've described several times before for obsessive-compulsive disorder. It has two main components, neither of which is pleasant, but which are in the aggregate often highly effective. First, the therapist would work with you to gradually expose yourself to situations that cause panic. Then, once you are in these situations, he or she would teach you to tolerate the terrible panic feelings when they arose.

 

I suspect that just thinking about doing this might have you breaking out in a cold sweat, which is why it is so important to get professional help.

 

Among psychotropic medications, two classes are particularly effective for panic, and they are very different from each other. Benzodiazepines, like Valium, Ativan or Klonopin, have powerful anti-anxiety effects that happen very rapidly after they are ingested. If you have long panic attacks, or attacks that come in prolonged volleys, these medications work quickly enough that they can interrupt things in mid-attack.

 

Most antidepressants also treat panic attacks, but unlike benzodiazepines, they require several weeks of being taken daily before their effects are usually seen. For this reason, many clinicians will start patients on an antidepressant and a benzodiazepine. Once the antidepressant has been on board for several weeks, the benzodiazepine can often be discontinued.

 

Let me alert you to a few challenges in these treatments. Psychotherapy is great, but depending where you live and the state of your finances, it can be hard to find and expensive. Benzodiazepines work extremely well but have addictive potential when taken long term. If you elect treatment with an antidepressant, make sure that your clinician starts you on the lowest dose possible, because –paradoxically– antidepressants can cause panic attacks when they are first taken and can certainly worsen them in people already afflicted.

 

The good news is that all these treatment options are effective, so it is very likely you will be able to gain control of your symptoms, find relief and continue with your life.

 

http://thechart.blogs.cnn.com/2011/08/30/how-can-i-control-my-panic-attacks/

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— A — HOW TO WRITE A SUMMARY

Read the passage carefully. Determine its structure. Identify the author’s purpose in writing. (This will help you to distinguish between more important and less important information.) 

 

Reread, label, and underline. This time divide the passage into sections or stages of thought. The author’s use of paragraphing will often be a useful guide. Label, on the passage itself, each section or stage of thought. Underline key ideas and terms.

 

Write one-sentence summaries, on a separate sheet of paper, of each stage of thought.

 

Write a thesis –a one-sentence summary of the entire passage—. The thesis should express the central idea of the passage, as you have determined it from the preceding steps. You may find it useful to keep in mind the information contained in the lead sentence or paragraph of most newspaper stories –the what, who, why, where, when, and how of the matter—.

For persuasive passages, summarize in a sentence the author’s conclusion.

For descriptive passages, indicate the subject of the description and its key features.

 

Note: In some cases, a suitable thesis may already be in the original passage. If so, you may want to quote it directly in your summary.

 

Write the first draft of your summary by (1) combining the thesis with your list of one-sentence summaries or (2) combining the thesis with one-sentence summaries plus significant details from the passage.

 

In either case, eliminate repetition. Eliminate less important information. Disregard minor details, or generalize them. Use as few words as possible to convey the main ideas.

 

Check your summary against the original passage, and make whatever adjustments are necessary for accuracy and completeness.

 

Revise your summary, inserting transitional words and phrases where necessary to ensure coherence. Check for style. Avoid series of short, choppy sentences. Combine sentences for a smooth, logical flow of ideas. Check for grammatical correctness, punctuation, and spelling.

Writing and Reading Across the Curriculum, by L. Behrens and L. Rosen.