Abstract

In the described patient, the author diagnosed fear attacks. Some authors believe that sertraline is an effective and safe drug in reducing the number of panic fear attacks and in short term treatment of patients with attacks of fear.

Introduction

It is commonly known worldwide how harmful for the health is cigarette smoking. This is evidently one of the most widespread addictions. Cigarette smoke alone contains about 4 000 carcinogenic substances. Nicotine causes blood vessel contraction which enhances coronary artery disease, myocardial infarction, Burger’s disease. Nicotine increases also hydrochloric acid secretion in the stomach which enhances gastroduodenal ulcer development. Cigarette smoke, that is carcinogenic substances contained in it, are the pathognomonic factor of pulmonary and laryngeal malignancies. Despite this, many people have problems with abandoning the smoking habit. Persons are frequently observed who stopped smoking but in situations of minor or greater stress return immediately to the addiction. Special antinicotine outpatient clinics have been even organized worldwide. Many methods are tried to break free from the addiction. Apart from individual psychotherapy, e.g. hypnosis is used and various drugs, such as Tabex, Nicotinel, Nicorette chewing gum and many other are administered.

Case Report

Male patient H.R., aged 41 years, previously never received any psychiatric treatment. The patient was born after normal pregnancy and labour. His childhood was moderately good. His mother was quarrelsome, peremptory, overprotective, emotionally slightly cold. She never demonstrated any warm emotions towards the patient nor his two younger brothers. She was rather irascible, dominant and was making family rows. The father was quiet but passively subordinated to the dominant mother of the patient. In primary school and technical secondary school the patient achieved very good results. In spite of this he had no ambitions to continue education. After graduation from the secondary school and obtaining of secondary school certificate he started to work in a design office where he has been working until now. In his work he is not quarrelsome and liked by co-workers. He failed to settle a family. He had a number of quite significant complexes. The patient thought he was not resourceful and active enough to keep a family. He is a recluse type and feels good as a bachelor.

No mental diseases occurred in the patient’s family. He denied any head trauma and loss of consciousness. He never abused alcohol. In private life he never had any girl and he feels comfortable with it. But he is a typical heterosexualist. Until now he was satisfying his libido by masturbation. He reads many books, frequently goes alone to a cinema or theatre. Detailed psychiatric examination demonstrated only vegetative-anxiety neurosis of insignificant degree.

The only problem of the patient is his very advanced tobacco-smoking habit. Since eight years he has been smoking about 40 cigarettes a day. The patient many times tried to abandon the addiction. He knows well the harmful effects of the addiction and has a very critical attitude to it. He is strongly motivated to abandon smoking. He tried various methods, such as acupuncture, hypnosis. He visited many specialists and used such drugs as: Tabex, Nicotinel, Nicorette chewing gum and many others. Unfortunately, each attempt at abandoning the addiction caused strong fear attacks which were unbearable for the patient. He immediately backslided.

Laboratory tests:

• Detailed laboratory blood and urine analyses gave normal results
• ECG record was normal,
• EEG record was normal,
• Chest radiogram was normal,

The author instituted intensive individual psychotherapy for the patient. In order to control fear attacks, sertraline was administered in 50 mg oral daily doses. After abandoning the addiction, fear attacks were not occurring and the patient reported no backsliding.

Discussion

Other authors1,2 used sertraline in the treatment of fear attacks with great success. In the described patient, the author diagnosed fear attacks by direct psychiatric examination. The diagnosis was confirmed by the author, similarly as in the case of other authors1,2 with the following tests:

• Hamilton Anxiety Scale
• Anxiety Attack Intensity Scale
• Patient Global Evaluation (PGE) self-assessment scale

Other authors1,2 demonstrated that sertraline proved effective in reduction of the number of panic fear attacks, situational fear attacks, unexpected fear attacks, morning panic fear manifestations and reduction of time spent for bothering about possible development of another attack. No higher effectiveness of the drug was observed with doses exceeding 50 mg daily. These authors1,2 believe that sertraline is an effective and safe drug in reducing the number of panic fear attacks and in short term treatment of patients with attacks of fear.

References

• Londborg PD, Wokow R, Smith WT. Summit Research Network, Seattle, Washington 98104, USA. Sertraline in the treatment of panic disorder. A multi-site,double-blind, placebo-controlled, fixed-dose investigation. Leczenie zespoBu l’ku napadowego przy u|yciu sertraliny. Badanie wieloo[rodkowe z wykorzystaniem podwójnie [lepej próby, kontroli placebo i staBej dawki leku. British Journal of Psychiatry 1998; 173 : 54-60.
• Pollack MH, Otto MW, Wortington JJ. Anxiety Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Boston 02114-3117, USA. Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Sertralina w leczeniu zespoBu l’ku napadowego: badanie wieloo[rodkowe z u|yciem zmiennych dawek. Archives of General Psychiatry 1993; 55 (11) : 1010-6.

Professor Jan Krzysztof Podgorski, Department of Neurosurgery with Outpatient Clinic, Private Practice, Central University Teaching Hospital with Polyclinic, Armed Forces School of Medicine, Independent Public Health Care Institution.