Diagnostic Criteria Flashcards
A. re-current unexpected panic attacks. A panic attack is an abrupt search of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur:
- palpitations, pounding heart, or accelerated heart rate
- sweating
- trembling or shaking
- sensations or shortness of breath or smothering
- feelings of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded, or faint
- chills or heat sensations
- numbness or tingling sensations
- feelings of unreality. Being detached from oneself
- fear of losing control or going crazy
- Fear of dying
B. At least one of the attacks has been followed by one month or more of one or both of the following:
- persistent concern or worry about additional panic attacks or the consequences. For example losing control, having a heart attack, going crazy.
- A significant maladaptive change in behavior related to the attacks. For example behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations.
C.this disturbance is not attributable to the physiological effects of a substance as:
- A drug of abuse
- Medication
- or another medical condition for example: hyperthyroidism, cardiopulmonary disorders
The disturbance cannot be better explained by another medical disorder such as:
- Panic attacks in response to feared Social Situations, like social anxiety disorder
2.in response to circumscribed phobic objects or situations
In response to obsessions as in obsession compulsive disorder - In response to traumatic events as in PTSD
4.in response to separation from attachment figures as in separation anxiety disorder
Panic disorder refers to:
- Recurrent unexpected panic attacks as in criterion A.
- an abrupt surge of intense fear or discomfort that reaches peak within minutes and during which time four of the list of 13 physical and cognitive symptoms occur.
- re-current literally means more than one unexpected panic attack
- unexpected refers to a panic attack for which there is no obvious queue or trigger at the time of occurrence. In other words they happen out of the blue, like when one is relaxing or is coming or emerging from sleep
Frequency of panic attacks:
- moderately frequent attacks: one per week for months at a time
- more frequent attacks: daily, separated by weeks or months without any attacks.
- less frequent attacks: two per month, over many years
- -weather less frequent or more frequent people with panic attacks display the same symptoms, demographic characteristics, comorbidity with other disorders, family history, and biological data.
Severity of panic attacks include:
Individuals with panic disorder may have both full symptom, four or more symptoms, or limited symptom, fewer than four symptoms, attacks. The number and type of panic attack symptoms frequently differ from one panic attack to the next.however more than one unexpected. The panic attack is required for the diagnosis of panic disorder.
Worries about panic attacks or their consequences usually pertain to
1.physical concerns, 2.social concerns, and 3.concerns about mental functioning. What are these?
- Physical concerns: worry that panic attacks reflect the presence of life-threatening illnesses, e.g. cardiac disease, seizure disorder.
- social concerns: embarrassment or fear of being judged negatively by others because of visible panic symptoms.
- Concerns about mental functioning: such as going crazy or losing control.
What are some examples of maladaptive changes in behavior that represent attempts to minimize or avoid panic attacks or their consequences?
- avoiding physical exertion
- Reorganizing daily life to ensure that help is available in the event of a panic attack,
- restricting usual daily activities,
- avoiding Agoraphobia type situations such as leaving home, using public transportation, or shopping.
Nocturnal panic attack:
Waking from sleep in a state of panic which differs from panicking after fully waking from sleep. Happens to a 1/4 to one-third of individuals with panic disorder. The majority also have daytime panic attacks
Many individuals with panic disorder report constant or intermittent feelings of anxiety there are more broadly related to health and mental concerns. For example:
- They often anticipate a catastrophic outcome from a mild physical symptom or medication side effect, e.g. thinking that they may have heart disease or that a headache means presence of a brain tumor.
- They are relatively intolerant of medication side effects
- They may have pervasive concerns about abilities to complete daily tasks or withstand daily stressors,
- excessive use of drugs and alcohol may be used to help control panic attacks
- Extreme behaviors aimed at controlling panic attacks, e.g., so if you’re restrictions on food intake or avoidance of specific foods or medications because of concerns about physical symptoms that provoke panic attacks
Prevalence of panic disorder in Latinos:
The rates are lower and Latinos then non-latino whites. But they do not really happen before the age of 14 and they are more likely to happen to females at that young age. Panic disorder shows a gradual increase during adolescence and possibly the onset of puberty and peak during adulthood.
Development and course:
- The median age of onset is 20 to 24 years old
- Individuals may have episodic outbreaks with years of remission in between
- Very few have full remission without subsequent relapse within a few years
- can be chronic and is frequently comorbid with other anxiety, just press of disorders
Risk and prognostic factors
- smoking is a risk factor
- identifiable stressors in the months before their first panic attack, e.g., interpersonal stressors and stressors related to physical well-being such as negative experiences with elicit or prescription drugs, disease, or death in the family
- Offspring of parents with anxiety, depressive, and bipolar disorders
- Respiratory disturbance, such as asthma, is associated with panic disorder
Other risk and prognostic factors, functional consequences of panic disorder
- associated with high levels of social, occupational, and physical disability
- considerable economic costs
- Highest number of medical visits among the anxiety disorders although the effects are strongest with the presence of Agoraphobia
- frequently absent from work or school for Dr. any Mergen see visits which can lead to unemployment or dropping out of school
- maybe seen in caregiving duties or volunteer activities
- Full symptom panic attacks are associated with greater morbidity, e.g., greater health care utilization, more disability, poor quality of life, than Limited symptom attacks
