The newest entry in my Pittsburgh set series of thrillers is called Panic Attack. It’s the sixth book featuring Daniel Rinaldi, a psychologist and trauma expert who consults with the Pittsburgh Police.

In this latest, the city is terrorized by a series of rooftop sniper attacks, aimed at seemingly random victims. Dubbed the Steel City Sniper by the media, his haunting presence throws the citizens into a kind of collective panic.

At the same time, Dr. Rinaldi is treating a young patient who narrowly avoided the sniper’s bullet, and is now paralyzed by his own panic symptoms.

So what is a panic attack, and what are its symptoms? During the recent pandemic, many people have reported symptoms of both depression and anxiety. But while prolonged anxiety can itself be frightening and even debilitating, it’s not as severe as a panic attack.

A panic attack can begin at any time and without warning, its main symptoms being a fear of loss of control and sense of impending doom. Given the breathlessness and hypertension that often accompany panic attacks, most people experiencing these effects believe they’re having a heart attack. Particularly because one of its other symptoms is chest pain.

Additional symptoms can range from shaking and chills to abdominal cramps and headaches. In some cases, the affected person may even develop suicidal thoughts.

The causes of panic attacks span an equally varied range, from simple stress and depression to phobias and drug use. Many studies also suggest that genetic factors are involved.

Moreover, it’s likely that there are certain triggers—unique to each person—that might be to blame. Personal issues (divorce, a job loss, financial crises) can often trigger a panic attack, as well as troubling external events (harrowing stories in the news, a brush with a violent assailant, etc.).

How are panic attacks treated? There are an array of options (of which Daniel Rinaldi avails himself when treating his patient), most of which are applied concurrently. To prevent future panic attacks, antidepressant medications such as Sertraline or Fluoxetine are usually prescribed. To reduce panic symptoms in progress, the medications typically used are Clonazepam or Lorazepam.

At the same time, a course of psychotherapy is recommended to help identify the patient’s triggers. Even techniques such as gradually recreating the panic symptoms in a safe, supportive environment can be employed.

Self-care is also a crucial aspect of alleviating or heading off symptoms. Practicing yoga or simply doing deep breathing exercises can be invaluable. Many people also benefit from eliminating alcohol and caffeine from their diets. As well as getting enough sleep.

In Daniel Rinaldi’s latest adventure, the panic attacks to which his traumatized patient falls victim mirror the heightened feelings of personal vulnerability and impending doom experienced by the citizens of Pittsburgh. As the Steel City Sniper’s list of victims grows, and with the police and FBI as yet unable to discover his identity, both Rinaldi and the authorities fear the growth of a widespread, ungovernable panic.

Until, at last, the alleged shooter is caught and the series of murders seemingly comes to an end.

After which, the real mystery begins...!

Dennis Palumbo is a licensed psychotherapist and author. Panic Attack, Dennis Palumbo, Poisoned Pen Press, September 2021, $15.99