What do we do during a panic attack?

3 answers | Last updated: Oct 31, 2016
A fellow caregiver asked...

My mother-in-law is 87 and has Parkinson's. Sometimes she experiences up to three-hour long episodes of anxiety and panic with heavy, fast breathing, abdominal pain, nausea and some hallucinations. What do you recommend doing during these episodes?

Expert Answers

Kenneth Robbins, M.D., is a senior medical editor of Caring.com. He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

These sound like panic attacks, which are very common and very treatable. Before assuming that is the cause of her symptoms, however, she should see her physician and be sure there is not some other medical explanation. One of the medical explanations to consider if she experiences the hallucinations before the anxiety hits, is that the hallucinations may be the primary problem. It is common with Parkinson's Disease to have hallucinations either because of the disease itself, or because of the medications used to treat the disease. The medications used to treat Parkinson's Disease are meant primarily to increase dopamine, and while that helps with the rigidity, tremor and slow movements, it can cause hallucinations. This can be treated by either reducing the medications that increase dopamine, or by adding an antipsychotic medication.

If there is not another medical explanation for her symptoms, she probably is dealing with panic attacks. Panic attacks are characterized by the sudden onset of severe anxiety, which is associated with a number of physiologic symptoms. The anxiety goes from 0 to 100 in what feels like no time, and generally the person experiences palpitations and sweating along with the intense anxiety. Other common symptoms include trembling, shortness of breath, chest pain, dizziness, fear of going crazy or dying, and a tingling sensation. It is common to feel as though everything is foggy and unreal or feel detached, as though mind and body are disconnected. Actual hallucinations are less common.

The treatment for someone who is having multiple panic attacks is a combination of talk therapy and antidepressant medication. The talk therapy is primarily education about the illness, which we know is a physiological problem, and help with relaxation exercises to use at the start of a panic attack. Antidepressants are very helpful in preventing these attacks. It is very common that someone who has panic attacks will try to self-medicate with alcohol. This will decrease the anxiety that people often experience as they worry about having more of these frightening attacks, but it will not prevent the attacks themselves, and may even increase the risk of such attacks. Panic attacks are extremely uncomfortable, and it is very important therefore that your mother-in-law get proper care.

Community Answers

Nellie327 answered...

I don't agree with the talk therapy...I experienced a panic attack when I was in Florence Italy in August of 1999 or 2000...it was one of the hottest summers on record...when I walked out of my house (i was staying in with friends) I was suddenly over taken by a feeling of intense dread and fear. I knew I was going to pass out unless I went back inside immediately...my friends understood and we went back to the house...I was freaked out...I had never experienced this before...all I wanted to do was lie down on my bed in the dark with a cold cloth on my forehead...I did not want anyone talking to me about what had happened...thank god my friends didn't bother me...after an hour or so I was much better and we got a cab and went to a pool...It was 110 degrees outside...I got through it but I was really glad I had a quiet place to rest by myself and I'm glad my friends didn't bug me about it and left me on my own.

Ladydawn answered...

To Nellie 327 - it is possible that you had a reverse SAD reaction. Seasonal Affective Disorder is usually considered a winter issue but it can also occur as a result of changing light in spring and heat and light in the summer.

Reactions can include anxiety and social withdrawl which you appear to have exhibited. Since heat is also involved, your reaction might have been an automatic one to protect your body from the 110 degrees F outside.

It is also possible that the dread and fear were triggered by the knowledge that your body was not reacting well to the extreme heat. None of these are necessarily conscious efforts but rather a sequence of events which occur very rapidly, kind of taking you with the flow.

I can certainly understand that in this state talking to anyone would have been too much of an effort and indeed one which felt as if it would push you over the brink.

Talk therapy need not occur during the actual attack but rather later when it might be possible to learn coping mechanisms: learning to control breathing at the first sign, learning to understand and recognize the trigger(s), learning to face the fears.

PD hallucinations can be quite scary and/or confusing. Since the often seem real, no matter how illogical, the issue for the caregiver becomes very difficult. What do you say to help the patient? What is appropriate to say? How do you bring the person back to "reality" when they feel they are in a reality no matter how altered.

I see a crossover in the above question where possibly because the hallucinations of the 87 year old mother-in-law panicking because she has lost connection to a safe reality.

I think there is a question about which came first? The panic attack and the need to understand the trigger(s) or the hallucinations.