<h3>By Judith Treadway</h3>
A middle-aged person presents at the mental health center. They have been referred by the emergency room where they have been seen several times over the last month.

They have had numerous tests for complaints varying from dizziness to chest pain.

The person complains that the problem began a year or so ago when things were going well in their life. Their adult child had just had a baby and the whole family was excited. On a visit to the store, they were rushing and suddenly felt hot and like the lights were too bright and felt dizzy and faint and had to sit down and then leave.

Attributing it to the weather and rushing, they thought little of it until a week later at the same store the same thing happened. This time they became short of breath and felt they were smothering and going to black out and the store called an ambulance.

There are no findings and the situation is similar a few weeks later.

The patient now has a dread of the store and has started to wonder if it is all the perfume at the store bothering them.

The emergency doctor believes the person has panic disorder.

The mental health center evaluates them and diagnoses panic disorder with agoraphobia.

Panic attacks often start out of the blue and seldom linger more than about 30 minutes and typically have a start, a peak and an end. The sufferer has physical symptoms and may not know that they are anxious and they do not have to be under stress at the time of the attack.

Symptoms can include rapid heart dizziness, smothering sensations and other unpleasant feelings.

After several attacks the patient may start to avoid places where they have them, which sets up a negative cycle of attack and avoiding.

Evaluation includes ruling out medical causes such as thyroid problems and/or substance use such as stimulants and overuse of caffeine, which can trigger the attacks.

Treatment may include therapy, which may be supportive or cognitive (looking at and helping correct irrational thoughts), relaxation therapy and or medication treatments such as certain antidepressant medications which also can help panic attacks.

Please note that this case is a composite for illustration and not bases on a particular individual patient.

<i>Dr. Judith Treadway is chief of Psychiatric Services at the Coastal Empire Mental Health Center at 1050 Ribaut Road in Beaufort. She can be reached at 843-473-6350.</i>