anxiety disorders: panic disorders, agoraphobia

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anxiety defined

negatve mood/affect, somatic symptoms and apprehensively anticipates future danger.

somatic symptoms (ex)

goosebumps, tense muscles, increased heart rate

emotional symptoms (ex)

sense of dread, terror, restlessness, irritability

cognitive symptoms (ex)

anticipation of harm, problems concentrating, fear of losing control, fear of dying, hypervigilance

behavioural symptoms (ex)

escape, avoidance, aggression, freezing, decreasing appetitive responding, increased aversive responding

maladaptive fear/anxiety

unrealistic, disproportionate and persistent/anticipatory

anxiety disorders: prevalence, comorbid

year prev 20%, lifetime prev 30%, comorbid (depression, schizophrenia, substance abuse) 80%

anxiety disorders: types (5)

panic disorder, phobias, GAD, OCD, PTSD

panic attacks

discrete period of intense fear/discomfort which develops abrupty and peaks within 10 mintues.

panic attack criteria: 4+ (of 12)

palpitations/pounding heart/accelerated heart rate, sweating/trembling/shaking, feeling smothered, feeling of choking, chest pain, nausea/abnominal distress, feeling dizzy/unsteady/lightheaded/faint, derealization/depersonalization, fear of losing control/going crazy, fear of dying, paresthesias, chills/hot flushes

panic attack: themes (3)

dizziness-related symptoms, cardo-respitatory distress, cognitive factors

panic attacks: descriptions (3)

triggered by specific situations/events, completely unanticipated, characterized by increased likelihood in certain situations

panic disorder

recurrent, unexpected panic attacks where at least one attack was followed by 1 month+ of 1+: persistent concern about having additional attacks, worry about the implications of an attack, signicant change in behaviour related to attacks

not a panic disorder if... (2)

caused by direct physiological effects of a substance/medical condition, accounted for by another disorder

panic disorder: agoraphobia

fear/anxiety about and avoidance of unsafe situations where a panic attack may occur (usually outside house), diagnosed if there is a significant change in behaviour related to attacks

agoraphobia: criteria (5)

escape might be difficult/embarassing, help might not be avaliable in event of attack, situations are avoided, situations endured with distress, situations require presence of a companion

(panic disorder) interoceptive avoidance

avoidance of activites which may trigger symptoms similar to those experienced with a panic attack (ex, exercising)

panic disorder: prev, gender, onset, treatment, comorbid

year prev (3%), lifetime prev (4%), f:m (5:2), onset (15-35)/chronic, 1/4 get treatment (20% suicide risk), comorbid (depression, GAD, substance abuse)

panic disorder: misconceptions (3)

belief there is a life threatening illness, don't like idea of psychological origin, embarassed/hide problem

panic disorder: genetics

10% of 1st degree relatives, 30-40% heritability

panic disorder: biological theories

neurotransmitters, kindling model, fight/flight response, suffocation false alarm theory

(PD: bio theories) neurotransmitters (2)

disregulation of NE in LC, 5-HT and GABA may be involved. over stimulation of LC enduces panic response

(PD: bio theories) kindling model

LC/limbic system have pathways connecting each other which is responsible for production and then diffusion of anticipatory anxiety.

(PD: bio theories) fight-flight response

oversensitive CO2 receptors (NE, 5-HT, GABA) and is set off by "normal things" (caffeine, over breathing, physical exercise)

(PD: bio theories) suffocation false alarm theory

brain is hypersensitve to CO2 and fight/flight response is induced - spontaneous panic [not fear].

panic disorders: cognitive model

pay close attention to bodily sensations (interoceptive awareness), misinterpret bodily sensations in negative way (anxiety sensitivity), engage in snowballing catastrophic thinking

panic disorders: integrated model

biological vulnerability (hypersensitivity to ff response) + psychological factors (anxiety sensitivity, interoceptive awareness)

panic disorders: pharmacotherapies (2)

antidepressants (tricyclic, SSRIs), benzodiazepines (GABA agonists)

panic disorders: psycho cogntive behavioural therapy (5 steps)

relaxation training, identify maladaptive cognitions (catastrophizing thoughts/interoceptive exposure), practice relaxation techniques in present of symptoms, challenge clients' catastrophizing thoughts about bodily sensations (help interpret accurately), systematic desensitization

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