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Is Semi-incontinent And Non-ambulatory. Have Panic Attack When Urine Flow Starts. Was On Prednisone. Suggest?

Posted on Thu, 4 Jul 2013

Question: My 92-year-old mother goes directly into full panic attack when her urine flow starts without warning. She is semi-incontinent and non-ambulatory. We have stopped all diruetics and that has helped. Also havw stopped the 0.5mg per day of prednisone and that also helped, but we are not there yet. Any suggestions as to why this causes such a debilitating panic ---can happen at any time of the day now---used to happen only in the late afternoon. Thanks! I am her daughter and live-in caregiver.

Answered by Dr. Dr. Rakhi Tayal (3 hours later)

Hello,
Thanks for posting your query.
Recurrent panic attacks are often triggered by a specific situation, especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel unable to escape. In your mother's case, it happens after urinary incontinence.
It can be aggravated by the cardiac problem that she is having. She can learn relaxation exercises like controlled breathing. Catheterizing the bladder can also avoid such frequent attacks. In case the symptoms are persistent then you can get some ant depressants and benzodiazepines prescribed for her.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (2 hours later)

Thank you kindly for your answer. Do you think there is a neurological trigger for the panic as it always appears to be a very physical response? I am looking for a way to trace or track the origin of the response in order to suggest a more specific type of medical test to submit to her doctor. She is still at home right now and catherization would not be practical as she does bear weight and is able to transfer from her bed to a nearby toilet chair and also transfer during bathing. During her 4-months on a food bag in the hospital after many tries for meds to keep her calm, they gave her the most minimal dose of klonopin which cause confusion, extreme drowsiness and hallucinations. They also used remeron which caused similar symptoms along with restlessness. It took us several months and many tries with her doctor to find that she responded to the hydroxyzine. We are in the process of increasing the dosage from 25 mg, 4X daily, to 50mg, 4X daily. Finally, thank you for the insight on the explanation of recurrence.

Answered by Dr. Dr. Rakhi Tayal (53 minutes later)

Hello.
Thanks for writing again.
A neurological trigger is likely but it is very difficult to pin point the exact cause and then treat it. Right now gradually increasing the dose of hydroxyzine seems to be the best option.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar