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The Difference between Panic, Manic, and Psychotic Attacks

Panic Driving

By Christine Hammond, MS, LMHC on

At first, everything seemed fine for Tess. She was driving back from visiting her parents a few hours away. Suddenly a flood of intense emotions, pounding heart rate, difficulty breathing, and erratic thoughts overwhelmed her.

She pulled the car over hoping to catch her breath but things got worse. Life became a distorted kaleidoscope, with nothing familiar from before. She couldn’t remember where she was and where she was going. Even speaking was difficult.

Having never experienced this before, Tess became frightened. The fear made her condition worse till she felt like her head was spinning out of control. It was impossible to rationally explain the event was so unlike anything she experienced before.

In the past, the term nervous breakdowns described such an event. But this is not a diagnosable disorder; rather it is a cultural euphemism. Instead there are three possibilities for the condition described above. Each has unique characteristics with very different treatments.

Panic Attack. One possibility is that Tess was having a panic or anxiety attack. For a person never experiencing this event, it can seem similar to the symptoms of a heart attack. The sudden onset of intense fear usually reaches a peak within minutes. Initially, most are unable to identify the fear that caused the event. It is only after some counseling that the trigger can be recognized and properly addressed. Other symptoms include:

Pounding heart
Trembling or shaking
Shortness of breath
Feelings of choking
Chest pain
Chills or heat sensations
Numbness or tinging sensations
De-realization or depersonalization
Fear of losing control
Fear of dying
It is important to rule out a medical condition first, so seek the help of a physician immediately. Once the physical symptoms have subsided and there is no finding other than a panic attack, a counselor can assist in discovering the cause. Untreated attacks can lead to an increase in the duration, frequency and intensity.

Manic Episode. Another possibility is that Tess was experiencing a manic episode which may or may not be part of Bi-Polar Disorder or another type of depression. Unlike a panic attack, periods of mania tend to be longer lasting and have less panicky physical symptoms. Rather, the episode creates a larger than life impression. For a person experiencing this for the first time, it can increase anxiety so some of the symptoms of a panic attack could also be present. The main characteristics of mania are:

Intense feelings of euphoria
Fast speech, talkative
Racing thoughts
Impulsive and “high-risk” behaviors: shopping, gambling, sex
Insomnia or feels rested after three hours of sleep
Ideas of grandeur: can do anything
Easily distracted
Increase in goal-directed activity
Discernable pattern of episodes
It is best to see a psychiatrist to get a proper diagnosis of manic depression. The good news is that this condition is can be successfully treated with medication. This is a brain chemistry issue and not a manifestation of intense fear or anxiety.

Brief Psychotic Episode. The last possibility is that Tess experienced a brief psychotic episode. While the name may sound a bit intimidating, the condition is more common than realized. This does not mean a person has a psychotic disorder, although it might be an indicator of one. Usually this lasts for a couple of hours to several days but not longer than a month. It has the following symptoms:

Delusions (beliefs without any basis in reality)
Hallucinations (hearing voices or seeing things that are not actually present)
Disorganized speech
Severely disorganized or catatonic behavior
No discernable pattern of episodes
To receive the best diagnosis, it is good to be treated in a mental facility for this condition. A combination of medication and rest might be just what is needed. Anyone can have a one-time episode; it is not a sign of weakness in any way.

For Tess, it was determined that she experienced a severe panic attack. Her anxiety about the attack worsened her symptoms which made it look more like a brief psychotic episode. Once she learned how to manage the attacks, the intensity diminished.

Cape Coral Office:
1404 Del Prado Blvd, Unit 135
Cape Coral, FLORIDA 33990

Sarasota Offices:
1487 2nd Street Suite C-4
Sarasota, FL 34236
(239) 565-6921

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