Yiannis Sotiralis presents his experience with panic attacks and shares his understanding of the neurobiology of panic disorder. He was diagnosed with panic attacks 40 days ago when he experienced chest pain, arm burning, and a racing heart at work. Tests showed he did not have a heart condition. His doctor said it was a panic attack. He discusses how panic disorder involves sudden feelings of terror from psychosomatic reactions in the brain's fear circuitry. The amygdala and other brain regions like the hypothalamus and hippocampus are involved in the fear network associated with panic attacks. Understanding the neurobiology helped him gain control over his situation and he has not had an attack in 15 days.

1. Yiannis Sotiralis

2. INTRODUCTION
I have decided to present you my thoughts about panic attack which is a type of
anxiety disorder. I was diagnosed having this kind of disorder about 40 days ago.
I was in my private practice (Physical Therapy Clinic) doing some reading and taking
literature notes. Suddenly I felt chest and left arm burning sensations and my heart
started to race. I feared having a heart attack so my colleague took me to the nearest
hospital. There I was tested with a cardiogram, ultrasound and blood work out which
all came negative. Tow days later I had a heart treadmill test also negative for a heart
condition.
Then my doctor told me that I had a panic attack.

3. PANIC DISORDER
Panic disorder is a type of anxiety disorder. It causes panic attacks, which are sudden
feelings of terror when there is no real danger. You may feel as if you are losing control.
You may also have physical symptoms, such as
• Fast heartbeat Chest or stomach pain Breathing difficulty Weakness or dizziness
• Sweating Feeling hot or a cold chill Tingly or numb hands
Panic attacks can happen anytime, anywhere, and without warning. You may live in fear of
another attack and may avoid places where you have had an attack. For some people,
fear takes over their lives and they cannot leave their homes.
Panic disorder is more common in women than men. It usually starts when people are
young adults. Sometimes it starts when a person is under a lot of stress. Most people
get better with treatment. Therapy can show you how to recognize and change your
thinking patterns before they lead to panic. Medicines can also help.
NIH: National Institute of Mental Health
Feelings and
sensations that I
had in bold writing

4. PANIC DISORDER
Recent neuroscientific findings indicate that psychosomatic reactions, set off by a danger
situation, depend on the primitive circuit of fear (including the amygdala) characterised by
its speed, but lack accurate responses and may also be activated by harmless stimuli
perceived erroneously as dangerous. The traumatic terror is stored in implicit memory and
may be set off by a conditioned stimulus linked to a previous danger situation. In the panic
attack, the traumatic event is created by the imagination and this construction (a micro-
delusion), built in loneliness and anxiety, has the same power as the real trauma. A mutual
psychosomatic short-circuit between body and psyche, in which terror reinforces the
somatic reactions and the psychic construction, is established.

5. FEAR NETWORK
The existence of a “fear network”, which has as its main point the central
nucleus of the amygdale and includes the hypothalamus, the thalamus, the
hippocampus, the periaqueductal gray region, the locus coeruleus and other
brainstem structures seems to play a key role in this pathology.

6. FEAR NETWORK
A number of experiments have tried to study the responses with the use of panicogenic
agents and the conclusions are very interesting.
PD patients frequently complain about uncomfortable somatic sensations. The
administration of a panicogenic agent would correspond to a non-specific activation; as all
those agents acutely produce unpleasant physical sensations, the hypothesis is that they
act stimulating a sensitive brain network which was conditioned to respond to harmful
stimuli.
Along time, the projections of the central amygdaloid nucleus towards brainstem
centers such as the locus coeruleus, the periaqueductal gray and the hypothalamus
can become more or less sensitive. There may also be an inter-individual difference
in the strength of these afferent projections. Therefore, the pattern of
neuroendocrine and autonomic responses presented during panic attacks may vary
from one patient to the other, and in the same patient along time.

7. NEUROBIOLOGY OF EVERY DAY LIFE HELPED ME
BETTER UNDERSTAND PANIC DISORDER
For me as I can now understand some kind of excessive stress was responsible for the first
dysregulation of my autonomic nervous system and made the brain and body connection
problematic. Then the formation o a fearful memory played a key role for the situation o
fearing and having thoughts of waiting the next panic attack to appear.
The solution to this pathology is cognitive behavioral therapy alone or a combination with
drug therapy. I had a short scheme of CBT therapy and knowing the neurobiology of panic
attack helped to take control of my situation. For 15 days now I didn’t have another attack
besides some strange sensations and rarely a little heartbeat elevation but it last’s just
minutes.
I hope that everything will resolve good for me and thanks for sharing the knowledge of
neurobiology of everyday life.

8. REFERENCES
Neurobiology of panic and pH chemosensation in the brain John A. Wemmie, MD, PhD
www.dialogues-cns.org
The psychodynamic of panic attacks: a useful integration of psychoanalysis and
neuroscience. De Masi F. Int J Psychoanal. 2004 Apr;85(Pt 2):311-36.
Neuropsychological impairments in panic disorder: A systematic review.
O‫׳‬Sullivan K1, Newman EF2. J Affect Disord. 2014 Jun 18;167C:268-284. doi:
10.1016/j.jad.2014.06.024. [Epub ahead of print]