I recently presented this case at a conference and I figured you guys might want to hear it too. Various details have been obfuscated or changed around to protect confidentiality of the people involved.
She accepts voluntary admission to the psychiatric unit with a diagnosis of panic disorder. We start her on an SSRI with as usual little immediate effect. On the ward, she continues to have panic attacks, which look like her gasping for breath and being utterly convinced that she is about to die; these last from a few minutes to a few hours.
There are no other psychiatric symptoms. These episodes can happen either after a particular stressor for example, a claustrophobic patient getting stuck in a small room or randomly for no reason at all when everything is fine. In a few cases, they even happen when patients are asleep and they wake up halfway through. The standard model of panic disorder involves somatosensory feedback loops.
Any major organ dysfunction is going to produce a variety of abnormalities β pain, blockage of normal activities like digestion and circulation, change in chemical composition of the blood, etc. In the feedback model of panic disorder, this response begins too early and recurses too heavily.
So maybe you have an itch on your back. Your body notices this unusual sensation and falsely interprets it as the sort of abnormality that might indicate major dysfunction. It increases heart rate, starts sweating, et cetera. At some point your body just maxes out on its stress response, your heart is beating as fast as it can possibly go and your brain is full of as many terror-related chemicals as you can produce on short notice, and then after a while of that it plateaus and returns to normal.
