Tuesday, April 23, 2013

Don't Panic!

"I Think I'm Dying"

Many people, who end up in the ER or their primary care physician's office complaining that they feel like they're having a heart attack or dying, are actually having a panic attack. They report having sudden racing heart, shortness of breath, tingling hands, and intense fear.  Understandably so, patients go to their doctor to find out what is wrong.  After medical tests come back with normal results, the doctor comes in and explains, "You're experiencing a form of anxiety called a panic attack."  While this provides some relief to know that they aren't dying, it might leave patients wondering, "What do I do about it?" In some cases, a panic attack may be an isolated incident.  In other situations, people find themselves in a pattern of frequent panic attacks and begin worrying about when the next one will unexpectedly occur.

Signs and Symptoms of Panic Attack

  • Palpitations or increased heart rate
  • Sweating
  • Trembling
  • Shortness of breath; sensation that one cannot get a deep enough breath
  • Chest pain
  • Nausea; stomach upset
  • Dizziness; feeling lightheaded or faint
  • Feeling out of one's body
  • Fear of losing control
  • Fear of dying
  • Numbness or tingling (in hands, feet, face)
  • Hot flushes; chills
The symptoms listed above are generally considered to be typical experiences during a panic attack. Individuals may have only some or all of the symptoms.  

What Next?

The first step is to have a full medical evaluation to eliminate possible causes related to cardiac, pulmonary, endocrine, or other medical concerns.  Panic attacks do not have to interfere with day to day functioning.  Here are some things you might want to try on your own:
  • Exercise 
  • Eliminate nicotine, caffeine, alcohol
  • Relaxation techniques: deep, slow breathing; yoga; meditation
  • Eliminate / manage stressors
  • Adequate sleep
If you try the above techniques but still experience significant anxiety and panic attacks, it is advisable to seek help from a professional, such as a psychiatrist or therapist. Psychotherapy and/or medications are often very beneficial.  According to the National Institute of Mental Health (NIMH), 4.7% of adults meet criteria for panic disorder in their lifetime. 

Dr. Shannon Sniff, M.D., is a Board Certified General and Child & Adolescent Psychiatrist at Fort Bend Psychiatry in Missouri City, Texas.  www.FortBendPsychiatry.com

Saturday, March 2, 2013

The "Zombie" Phenomenon and ADHD

"I just don't want my child to be a zombie." This is what parents almost always tell me when discussing the possibility of using medication to treat Attention Deficit Hyperactivity Disorder (ADHD).  My response is always, "I don't want your child to be a zombie either."  Unfortunately, it is a widely accepted stereotype that children who are treated for ADHD will turn into zombies. However, in the current pop culture, I guess it is at least popular to be a zombie, if you look at shows like The Walking Dead.  Perhaps it's better to be a zombie than a vampire?

In all seriousness, though, no child should seem like a "zombie" when they are taking medication. For children who are very hyperactive, it is certainly beneficial in the academic and social setting for them to be less hyperactive. And for children who tend to be very inattentive, but perhaps not hyperactive, it is beneficial for them to be more focused.  The challenge is trying to find the right balance.  A good child psychiatrist will not want any child to be "zombie-like," and will be willing to work slowly to find the correct balance.

Common symptoms of ADHD include: fidgeting, blurting out things without permission (i.e., forgetting to raise hand to answer questions in class), difficulty remaining in seat (i.e., getting up frequently to sharpen pencil or throw things away), excessive talking (despite frequent reminders), interrupting others often, difficulty waiting for one's turn, always "on the go," climbing on things, difficulty playing quietly, losing things frequently, easily distracted, inability to complete tasks, inability to follow instructions, seeming not to listen when spoken to directly, avoiding tasks that require effort to concentrate/focus, and forgetfulness.  Each person may have a different combination and degree of symptoms, but psychiatrists look at the overall scenario, number of symptoms, and severity of symptoms.  Child psychiatrists will usually ask for information from the child, parent, and teachers to correctly diagnose ADHD.  As treatment progresses, we use this information as a baseline, or comparison, to track improvement.

I always reassure parents and patients that I will not continue treatment with a medication if everyone does not agree that there is improvement. Unfortunately, many of the symptoms of ADHD can cause academic difficulty as well as social difficulty.  Some children may be labeled as "lazy," when that is not the case.  Children with ADHD are often quite intelligent and wish they could demonstrate that academically, but their hyperactive and inattentive traits make it difficult to do so.  They also may have difficulty relating to other children and end up labeled as "the class clown" or "the bad kid."  Studies have shown that children with ADHD do much better in the long run if their symptoms are managed. They can excel academically and have lower drop-out rates.  They also have lower rates of drug, criminal, and gang involvement if treated.

So, yes, there are some cases in which children may be on too high of a dose of medication, but a good child psychiatrist will ensure that the dose is high enough to show results, but not so high that there are negative effects.  If your child seems like a "zombie," then something needs to be changed.  Ideally, children who are treated for ADHD will not seem to be "medicated," but will behave and concentrate better than if they were not treated.  

Dr. Shannon Sniff, M.D., is a Board Certified General and Child & Adolescent Psychiatrist at Fort Bend Psychiatry in Missouri City, Texas.