Panic as a harbinger of pancreatic cancer.

Posted on October 4, 2009 by Maurice Preter MD
Psychosomatics. 2008 Nov-Dec;49(6):538-9.Click here to read Links

Panic as a harbinger of pancreatic cancer.

Griffeth BT, Mehra A.

Salem VAMC, Mental Health, Code 116A7, 1970 Roanoke Blvd., Salem, VA 24153, USA. benjamin.griffeth@va.gov

BACKGROUND: Previous literature has discussed the diagnosis of cancer with psychiatric symptoms. There are noted associations made between pancreatic cancer and depression and anxiety symptoms both in literature and textbooks. METHOD: The authors discuss the case of a patient who presented with anxiety and panic attacks before his diagnosis of pancreatic cancer. CONCLUSION: There has been a previous association noted between depression and anxiety and pancreatic cancer; however, this work and another report have noted panic episodes preceding diagnosis, as well. These symptoms could prove to be an important marker for early detection.

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When anxiety symptoms masquerade as medical symptoms: what medical specialists know about panic disorder and available psychological treatmen

Posted on October 4, 2009 by Maurice Preter MD
J Clin Psychol Med Settings. 2008 Dec;15(4):314-21. Epub 2008 Oct 15.Click here to read Links

When anxiety symptoms masquerade as medical symptoms: what medical specialists know about panic disorder and available psychological treatments.

Teng EJ, Chaison AD, Bailey SD, Hamilton JD, Dunn NJ.

Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. ellen.teng@va.gov

Under-recognition of somatic symptoms associated with panic in primary care settings results in unnecessary and costly diagnostic procedures and inappropriate referrals to cardiologists, gastroenterologists, and neurologists. In the current study specialists’ knowledge regarding the nature and treatment of panic were examined. One-hundred and fourteen specialists completed a questionnaire assessing their knowledge about panic attacks, including their perceptions of psychologists’ role in treating panic. Respondents answered 51% of knowledge items correctly. Although most knew the definition of a panic attack, they knew less about clinical features of panic and its treatment. Specifically, whereas 97.4% believed medication effectively relieves panic symptoms, only 32.5% knew that cognitive-behavioral therapy (CBT) is a first-line treatment. Only 6% reported knowing how to implement CBT, and only 56.1% recognized that psychologists could effectively treat panic. These findings demonstrate significant gaps in specialists’ knowledge about panic and the need to enhance physician knowledge about panic attacks and their treatment.

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Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Posted on November 16, 2008 by Maurice Preter MD
Environ Health Perspect. 2002 Aug;110 Suppl 4:669-71. Related Articles, Cited Articles, Compound (MeSH Keyword), Substance (MeSH Keyword), Free in PMC, Cited in PMC, LinkOut
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Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Tarlo SM, Poonai N, Binkley K, Antony MM, Swinson RP.

Gage Occupational and Environmental Health Unit, University of Toronto, Toronto, Ontario, Canada. susan.tarlo@utoronto.ca

Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

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Panic attacks in an individual with bilateral selective lesions of the amygdala.

Posted on November 12, 2008 by Maurice Preter MD
Arch Neurol. 2006 Dec;63(12):1798-801. Related Articles, LinkOut
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Panic attacks in an individual with bilateral selective lesions of the amygdala.

Wiest G, Lehner-Baumgartner E, Baumgartner C.

Department of Neurology, Medical University of Vienna, Vienna, Austria. gerald.wiest@meduniwien.ac.at

OBJECTIVE: To describe the unique case of a patient with panic attacks and bilateral selective amygdala lesions due to Urbach-Wiethe disease. DESIGN: Case report. SETTING: Epilepsy Monitoring Unit, Medical University of Vienna. Patient A 38-year-old man with Urbach-Wiethe disease developed spontaneous panic attacks and depressive mood, which ceased after antidepressive treatment. INTERVENTIONS: Video electroencephalography monitoring, magnetic resonance imaging, and neuropsychological testing. RESULTS: Extended video electroencephalography monitoring excluded an epileptic etiology of the panic attacks. Results of cranial magnetic resonance imaging showed bilateral selective calcifications of the whole amygdaloid complex. Neuropsychological testing revealed selective memory impairment of autobiographic episodes with preserved memory for autobiographic facts. CONCLUSIONS: Our findings indicate that the occurrence of panic attacks does not critically depend on the integrity of the amygdala. Furthermore, the neuropsychological findings in our patient suggest that the amygdala represents an essential neural substrate for the processing of episodic autobiographic memories.

Publication Types:

  • Case Reports


PMID: 17172622 [PubMed – indexed for MEDLINE]

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Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson’s disease.

Posted on November 11, 2008 by Maurice Preter MD
Neurology. 2004 Oct 26;63(8 Suppl 3):S35-8. Related Articles, Substance (MeSH Keyword), LinkOut

Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson’s disease.

Barone P, Amboni M, Vitale C, Bonavita V.

Department of Neurological Sciences, University of Napoli Federico II, Via Pansini 5, 80131 Naples, Italy.

Nocturnal disturbances are common in Parkinson’s disease (PD) patients, with almost 70% of these patients reporting nocturnal disturbances. The etiology of sleep disturbances in patients with PD is still controversial. They might be dependent on dopaminergic drugs, on disease progression, or on a combination of these two factors. Nocturnal disturbances can be categorized in four groups: 1) PD-related motor symptoms, including nocturnal akinesia, early-morning dystonia, painful cramps, tremor, and difficulty turning in bed; 2) treatment-related nocturnal disturbances; 3) psychiatric symptoms, including hallucinations, vivid dreams, depression, dementia, insomnia, psychosis, and panic attacks; 4) other sleep disorders, including insomnia, REM behavioral disorder (RBD), restless legs syndrome (RLS), periodic leg movements (PLMS), and excessive daytime sleepiness (EDS). Specific treatment options are supplied for every group. A global evaluation of nocturnal disturbances would provide clinicians with a valuable tool to establish an optimal regimen that could positively influence all nocturnal disturbance categories and thus improve PD management on. However, it is important to consider that management of some nocturnal disturbances in a group may worsen nocturnal symptoms of another group or may increase EDS. PD-related symptoms can be treated with long-acting DA agonists to obtain continuous DA receptor stimulation during the night. Both treatment-related nocturnal disturbances and psychiatric symptoms may be related to drug treatment, and therefore, in both cases, drug reduction or discontinuance should be considered. Some sleep disorders, such as RLS and PLMS, may be controlled by DA agents, and others, such as insomnia and EDS, may be improved by reducing dopaminergic stimulation.

Publication Types:

  • Review


PMID: 15505142 [PubMed – indexed for MEDLINE]

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