Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
Topics are updated frequently; if you have a topic or question, let us know!
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MISSIONARY MEDICAL MOMENT
Panic Disorder
"...then the king's face grew pale, and his thoughts alarmed
him; and his hip joints when slack, and his knees began knocking
together..."
Dan 5:6, NASB
Everyone has had the experience of a feeling of fear, sometimes in response
to a real threat, other times in response to an artificial one such as a
frightening movie, or a roller coaster ride. The basic physical reaction is
a God-given normal response, meant to provide protection for our system in
the event of true danger; the body can react quickly to a true danger by
what is commonly known as the "fight or flight" response.
Some people, however, suffer severe attacks of debilitating fear (panic
attacks) from either minimal provocation or no obvious provocation: such
episodes are the bases for the diagnosis of Panic Disorder. At other times,
a person might experience a panic attack which is obviously cued by a
particular trigger (like seeing a snake, or having to speak in front of a
large group of people); that type of panic attack is considered part of a
different diagnostic group, Specific Phobia or Social Phobia.
The Diagnostic and Statistical Manual (Fourth Edition) lists a number of
criteria for Panic Disorder: "…a discrete period of intense fear or
discomfort, in which four or more of the following symptoms develop abruptly
and reach a peak within 10 minutes: 1) palpitations (feeling as if one's
heart beats irregularly), pounding heart, or accelerated heart rate, 2)
sweating, 3) trembling or shaking, 4) sensations of shortness of breath or
smothering, 5) feeling of choking, 6) chest pain or discomfort, 7) nausea or
abdominal distress, 8) feeling dizzy, unsteady, lightheaded, or faint, 9)
feelings of unreality or being detached from oneself, 10) fear of losing
control or going crazy, 11) fear of dying, 12) numbness or tingling
sensations, and 13) chills or hot flushes."
Panic disorder may or may not be accompanied by agoraphobia; the original
Latin word means "fear of the marketplace", but in common use describes
"...anxiety about being in places or situations from which escape might be
difficult, or help may not be available..." Agoraphobic fears typically
involve situations such as being outside the home alone, being in a crowd or
standing in a line, or being on a bridge.
It has been estimated that between 1.5 - 3.5% of people will suffer Panic
Disorder at some time in their lifetime. Up to 65% of people with Panic
Disorder either have already experienced or will experience a Major
Depressive Disorder (see prior Missionary Medical Moments: Depression).
Panic disorder typically is first seen between late adolescence and the
mid-30s.
Panic attacks may occur frequently or infrequently, but the usual course is
that after an initial attack, the person begins to avoid any situation which
might lead to another attack, so even if there are few attacks, there may be
great limitation of life activity. Sufferers often avoid going outdoors, are
limited in how far or where they travel, and experience demoralization and
discouragement in their inability to "conquer" their fears. Associated
anxiety and apprehension about medical illness, medication effects, and the
outcome of even routine activities and experiences are common. While a
single panic attack may last only minutes, episodes of repeated panic
attacks and the associated anticipatory anxiety of further attacks can last
for months or even years.
Even with treatment, there is a 50% risk of some ongoing symptoms or
recurrence. Recent research has shown that there are particular areas of the
brain which appear to exhibit abnormal biochemical responses in panic
attacks, suggesting that panic attacks are more of a physical disorder than
a strictly psychological one.
Since the symptoms of Panic Disorder can be similar to some general medical
illnesses (such as thyroid disease, heart abnormalities, lung diseases, and
certain types of seizures), a medical evaluation is necessary to rule out
those causes. Treatment for Panic Disorder can be accomplished with either
medications or specific types of behavioral and cognitive counseling
therapy; often, both may be used.
Medications which have been found effective in the treatment and prevention
of panic attacks include some types of tranquilizers; alprazolam (U.S. trade
name Xanax, available generically worldwide) has been particularly effective
in treating acute attacks, while many of the class of medications known as
antidepressants are successful in decreasing the likelihood of further
attacks. The newer antidepressants known as SSRIs [selective serotonin
reuptake inhibitors; fluoxetine (Prozac), paroxetine (Paxil), sertraline
(Zoloft), others] as well as an older group of antidepressants known as MAO
Inhibitors [tranylcypramine (Parnate) and phenelzine (Nardil), others] are
particularly effective in the long term management of Panic Disorder.
The author of Proverbs accurately notes, "…anxiety in the heart of a man
weighs it down, but a good word makes it glad." (Pr 12:25). Often,
missionaries and pastors with panic attacks suffer needlessly by trying to
conceal their symptoms rather than seeking counsel and assurance from
others. And as with all other types of problems, God directs us to go to Him
and trust Him to provide peace even in the midst of discomfort: "…when my
anxious thoughts multiply within me, Thy consolations delight my soul." (Ps
94:19).
View Other Missionary Medical Moments
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