Giovanna Spantigati

The behavioral aspects of the attack are rare and often a panic attack goes unnoticed by people in the nearby. Far from showing his sufferings, the patient tries to hide people his sensations experienced during panic attacks. Sometimes, however, the patient interrupts what he is doing and inexplicably turns away, trying to reach a familiar place quickly. These sympthomatological events do not always occur in a complete way and there are critical incidents that come out through one or two symptoms. Usually this type of lighter attack is different from the ones described above for the smaller number of symptoms and for a reduced intensity of anxiety.

Among the typical symptoms of the lighter attacks we must remember vertigo, which are often isolated, palpitations, feelings of unreality, hot flushes and chills. Sometimes the first episode occurs in dramatic situations, or when the person is risking his life, such as serious accidents, sudden deaths of beloved people, postpartum, in conjunction with the use of drugs, particularly marijuana, cocaine, amphetamines. In many cases, however, even when these underlying situations are over, the attacks continue to recur. The occasion in which the first attack occurs is usually remembered with precision and described in great detail. The first critical episode is almost always a reference point in the history of the disease and it remains marked in the memory of the patient: the attack is of unprecedented magnitude, never felt before.

Generally the patient during the first panic attack, is afraid of having a stroke, or a heart attack. The first crisis is generally associated to the immediate perception of the inevitability of its recurrence. In the initial phase of the disease, the attacks, although isolated, are soon accompanied by a persistent state of fear and anxiety associated with neurovegetative symptoms. A growing fear that the crisis will repeat, in fact, pervades the entire life of the patient who becomes, thus, anxious, tense, fearful, and lives in a constant state of apprehension, hypervigilance and persistent alert. This particular type of anxiety, called anticipatory anxiety, is different from panic attacks: it lasts longer, even hours, it grows slowly and can reach an intensity that can cause physical symptoms similar to those of the attack. (Dr. Salvatore Di Salvo) End of Part Eight.

Giovanna Spantigati