ABC of Anxiety Disorder: Panic Disorder

ABC of Anxiety Disorder: Panic Disorder

By Dr Leow Chee Seng

Consultant,

Fellow of British Institute of Homeopathy (UK),

Certified Stress Management Consultant (IACT, USA),

We become anxious from time to time. For example, meeting with important person, changing a new job, concern over a new relationship creates anxiety. A person’s anxieties are about the future, whether long-term concerns about a new career.

The terms fears and anxiety is commonly used interchangeable. However, fear refers to an innate, almost biological based alarm response to a dangerous or life-threatening situation. Anxiety, in contrast, is more future oriented and global. The term anxiety is inordinately apprehensive, tense, and uneasy about the prospect of something terrible happening. Anxiety becomes clinically concern when it interferes with the ability to function in daily life, when a person enters a maladaptive state characterized by extreme physical and psychological reactions.

Referring to Diagnostic and Statistic Manual of Mental Disorder (DSM-IV-TR), panic disorder occurs in context of several disorders in this section, criteria sets for a panic attack is listed separately at the beginning.

Diagnostic features of panic attack

A panic attack is a period of intense fear or discomfort, during which a person experiences four or more of the following symptoms, which develop abruptly and reach a peak within 10 minutes:

· palpitations. pounding heart. or accelerated heart rate

• · sweating
• · trembling or shaking
• · sensations of shortness of breath or smothering
• · feeling of choking
• · chest pain or discomfort
• · nausea or abdominal distress
• · feeling dizzy, unsteady, lightheaded. or faint
• · derealization (feelings of unreality) or depersonalization (being detached from
• · oneself)
• · fear of losing control or going crazy
• · fear of dying
• · paresthesias (numbness or tingling sensations)
• · chills or hot flushes (Reference: DSM-IV-TR)

Type of panic attack

There are three categories of panic attack mainly, unexpected panic attack, situational bound panic attack and situational predisposed panic attack. For unexpected panic attack, there is no situational cue or trigger. The second type of panic attack, situational bound panic attack occurs where a person has a tendency to have a panic attack in the situation but does not have one every time. For example, when one of my friends hears an ambulance siren, he begins to experience the symptoms of a panic attack. She could not work in a hospital especially in accident and emergency department. So, she finally settled herself in the area of public health. The last category of panic attack is situational predisposed panic attack where a person will have situational panic attack but not every time.

Biological Perspective

In trying to understand the cause and strategy to fight panic disorder, we should discuss both biological prospective and psychological prospective. However, in this article, I will focus more on psychological perspective.

In biological prospective, panic attack is associated with excess of noreponephrine in the amygdala, a structure in limbic system involved in fear. Besides, the disorder derives from defect in gamma-aminobutyric acid (GABA), a neurotransmitter with inhibitory effects on neurons.

According to anxiety sensitivity theory, people with panic disorder tend to interpret cognitive and somatic manifestation of stress and anxiety in a catastrophic manner. For example, they feel that they cannot breathe even others feel the situation is normal. This false alarm mechanism causes the person to hyperventilate and the person is thrown to a panic state.

Psychological perspective

Turning to psychological perspective, we focus on conditioned fear reactions as contributing to the development of panic attacks. This person relates bodily sensation with memories with the last attack, causing a full-brown panic attack to develop even before measurable biological changes have occurred. Over time, the individual begins to have panic attack before it happens.

David Barlow and his colleagues proposed in a cognitive-behavioural model that anxiety becomes an unmanageable problem for an individual through the development of vicious cycle. The diagram shows the cycle of panic attack.

Stress management techniques help in treatment of panic disorder. In this approach, the client learns systematically to alternative tensing and relaxation muscle all over the body, starting from forehead down to the feet. After stress management techniques, the client should be able to relax the whole body when confronting feared situation.

However, I like to use panic control therapy (PCT) developed by Barlow and his colleagues. This technique consists of cognitive restructuring, the development of an awareness of bodily cues associated with panic attacks, and breathing retraining. I found that clients treated with PCT show marked improvement, at levels comparable to improvement shown by clients treated with antianxiety medication. I would propose combination of both antianxiety medication and PCT should give a marked improve among clients.

During my training in counselling and psychotherapy, Prof Malik Badri, Professor of Psychology, Fellow of International Islamic University Malaysia explained that more comprehensive interventions involving cognitive techniques. He recommended in vivo exposure when treating individual with panic disorder, especially with those with agoraphobia. He taught me the use of graduated exposure, a procedure in which clients expose themselves to increasing greater anxiety-provoking situation. For example, Mr X finds visiting to large shopping malls to be emotionally overshelming. I would recommend that his exposure to stressful environments begin with a small shop in which he feels safe and relatively anxiety free. Step-by-step, Mr X would progress to environments that are higher list of anxiety provoking settings.

I have just completed attending training in conterconditioning. This technique is used to treat hyperventilation, a common symptom in panic attacks. In this approach, the client hyperventilates intentionally and begins slow breathing, a response that is incompatible with hyperventilation. In this training, the client can begin the slow breathing at the first signs of hyperventilation. Hence, the clients learn that it is possible to exert voluntary control over hyperventilation.

If the recommended psychological approach does not able to control anxiety of a person, the use of medication can help alleviate symptoms, with the most commonly prescribed being antianxiety and antidepresant medication.

Prevention is better than cure: Breast Cancer

Prevention is better than cure: Breast Cancer

By Dr Leow Chee Seng

Consultant,

Fellow of British Institute of Homeopathy (UK),

Certified Stress Management Consultant (IACT, USA),

Epidemiology of Breast Cancer

Breast cancer is the third most common cancer worldwide and is the most common cancer among women. Various health promotion programs have been conducted to create awareness among citizen because breast cancer has been the second leading cause of cancer admission in Ministry of Health hospitals. Now, breast cancer falls on the fourth place in terms of cancer deaths accounting for 6-8% of all cancer death. (Ministry of Health Malaysia, 2005). Another research conducted by Penang Cancer Registry reported that the incidence of Breast cancer in Malaysia was estimated 34.0 per 100, 000 population and at least 3,500 cases annually.

Factors of Breast Cancer

Dr K McPherson has published an article, “ABC of breast diseases” in British Medical Journal. In his article, a few factors that affect the risk of having breast cancer include:

· The later the age of the first menstrual cycle, the lower the risk.

· Full-term pregnancy at an early age lowers the risk

· Being overweight increases the risk of post-menopausal breast cancer.

· Use of hormone replacement therapy increases the risk, but this increase in risk has been reported to disappear shortly after hormone use is discontinued.

· Being older at the time of the last menstrual cycle confers a higher risk compared with women who have had their last menstrual cycle at a younger age.

· Use of oral contraceptive increases risk of postmenopausal breast cancer.

Dietary Therapy

Several clinical researches have proven that women who drink alcohol have a higher risk of breast cancer compared with teetotalers. Alcohol increases level of estrogen that stimulates the increase of the risk. For drinkers with low intake of folic acid had a 32% increase risk of breast cancer as compared with nondrinkers. Folic acids supplement is useful among women who drink alcohol because folic acids are able to reverse the damaging effect alcohol on DNA. A research concluded that supplement of at least 600mcg per day was associated with a 43% reduction of risk factor of breast cancer. However, the supplementary of folic acids must not be taken by cancer patients who are taking chemotherapy drug methotrexate.

Insoluble fiber from grains helps reducing breast cancer among young women. Fiber lowers estrogen levels in premenopausal women but not in postmenopausal women. Phytate, an active component in fiber and isoflavones provide protection in the absence of a decrease in estrogen levels. In practice, switching from white rice to brown rice from bakery goods made with white flour or mixed flours to 100% whole wheat bread, whole rye crackers and whole grain pancake mixes.

I encountered a patient that was diagnosed with last stage of breast cancer. The oncologist told the patient to enjoy her last 6 months in her life. She was depressed. I advised her to shift from normal diet to vegetarian diet. Besides, I advise her to steam all organic vegetable without salt and oil during food preparation. Surprisingly, after seven years, I was able to meet her and have a wonderful dinner with her. Female vegetarians have been reported to have lower estrogen levels compared with meat-eating women.

In addition, tomatoes help reduction of risk factor of breast cancer. Tomatoes contain lycopene, an antioxidant that is similar to beta-carotene. Lycopene is able to inhibit proliferation of cancer cells. Higher intake of tomatoes intake of tomatoes reduces risk of variety of cancers in 57 of 72 studies. Besides, tomatoes also improve condition of prostate and lung cancer.

Onion and garlic are rich sources of the potent anti-cancer bioflavonoid quercetin. One onion daily inhibits malignant cell growth, and cooking does not destroy the effectiveness of quercetin. Garlic also contains large quantities of antiviral, antibiotics, and antifungal/anti-yeast compounds such as allicin. Thus it is useful in the treatment of breast cancer with concurrent candida proliferation. Garlic compounds also appear to be effective against leukemia.

On the other hand, omega-3 fatty acids rich in fish are responsible for protection against cancer. Fish eaters have low risk of breast cancer. Hence, fish oil supplement is always associated with reduction of risk factor of breast cancer. Besides, olive oil consumption is able to reduce risk factor of breast cancer. As a strategy of cancer prevention, I would recommend you to take a dressing of salads with olive oil, a little wine vinegar three times a week. Vinegar stimulates qi flow, which is helpful in stagnant condition.

Brassica-genus vegetables such as cabbage, turnip, kale, cauliflower, broccoli, Brussels sprouts have been recommended in general by the National Cancer Institute for cancer prevention. These contain dithiolthiones, a group of compounds which have anti-cancer, antioxidant properties; indoles, substances which protect against breast cancer; and sulphur, which has antibiotics and antiviral characteristics. The family of vegetables also mildly stimulates the liver and other tissues out of stagnancy. Cabbage and its juice are particularly useful because they help clear mental depression.

Method of meat preparation is directly associated with risk factor of breast cancer. Well-done meat contains more carcinogenic materials than does lightly cooked meet. However, genetic factors may determine which women increase their risk of breast cancer by eating well-done meat.

Several researches have been conducted to determine the relationship between CoQ₁₀ enzyme and the risk factors of breast cancer. Denmark and the United States have been conducted studies to study the effects of CoQ₁₀ among 32 breast cancer patients. From the research, they found that only one patient suffered a recurrence, all were still alive. Patients continued to do well after two years of supplementation, and after three to five years, surprising improvements were reported in two patients who had had advanced disease at the beginning of the trial. Unfortunately, CoQ₁₀ remains unproven as a cancer treatment.