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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
anxiety disorders: prevalence, comorbid
year prev 20%, lifetime prev 30%, comorbid (depression, schizophrenia, substance abuse) 80%
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 attacks: descriptions (3)
triggered by specific situations/events, completely unanticipated, characterized by increased likelihood in certain situations
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: 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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