Lecture 4- panic disorders - dont revise Flashcards
Describe a panic disorder
NOT a psychological condition by itself
- Present with many other anxiety disorders:
- DSM-5 specifier (for any DSM-5 disorder)
- “An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time, four or more of the following symptoms occur. The abrupt surge can occur from a calm state or an anxious state:
Name some symptoms of a panic attack
- Palpitations, pounding heart, or accelerated heart rate
* 2. Sweating
* 3. Trembling or shaking
* 4. Sensations of shortness of breath or smothering
* 5. Feeling of choking
* 6. Chest pain or discomfort
* 7. Nausea or abdominal distress
* 8. Feeling dizzy, unsteady, lightheaded, or faint
* 9. Chills or heat sensations
* 10. Paresthesias (numbness or tingling sensations)
* 11. Derealisation or depersonalisation
* 12. Fear of losing control or going crazy
* 13. Fear of dying
Prevelance of Panic attacks
Kessler et al. (2006)
o US life-time prevalence: 22.7% of population (without necessarily meeting criteria for any anxiety disorder)
o F/M ratio: 1.4
o Mean age of onset: 22.7
origins of panic attacks and links to other illnesses
General biological & psychological vulnerabilities +
- > 70% of people with panic disorder with or without agoraphobia report significant stressors around the time of their first panic attack (Craske, Miller, Rotunda, & Barlow, 1990)
- These include illness, death of loved ones, break-up of relationships etc.
- Often people will say that the panic attack ‘came out of the blue’ but when you explore their recent history with them, there are significant stressors
name some elements of the DSM for panic disorders
A. Recurrent unexpected panic attacks
- B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
o 1. Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, going crazy).
o 2. Significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
- C. The disturbance is not due to the direct physiological effects of substance abuse or a general medical condition
- D. The disturbance is not better explained by another mental disorder
prevelance for panic disorders
Wittchen et al. (2011)
o EU 12-month prevalence: 1.8% of population (14 years old +)
o 7.9 million
F/M ratio: 2.5
- Kessler et al. (2006)
o Lifetime prevalence in USA: 3.7%
features of a panic attack
Anyone can get panic attacks
o Around 25% of us will have one at some stage
- But panic disorder is much less common
- Features of panic disorder
o Frequent, recurrent, unexpected panic attacks
o Associated with:
- Persistent concern about having additional attacks
- Worry about implications of attack or its consequences
- e.g. losing control, having a heart attack, going crazy
- Significant change in behaviour related to the attacks
why do panic disorders and agoraphobias link
ntil DSM-V agoraphobia and panic were linked diagnoses:
Panic disorder with agoraphobia
Panic disorder without agoraphobia
Agoraphobia without history of panic disorder
- Panic attacks are inherently frightening
- In response to repeated panic attacks, some people start to avoid specific places or situations for fear of panic occurring = agoraphobia
- Why change the diagnostic categories?
o To emphasise that some people do meet the diagnostic criteria for agoraphobia, without panic
name some features of the DSM for agoraphobia
A. Marked fear and anxiety about two (or more) of the following 5 situations
o Using public transportation
o Being in open spaces
o Being in enclosed spaces
o Standing in line or being in a crowd
o Being outside of the home alone
- B. The individual fear or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
- C. The agoraphobic situations almost always provoke fear or anxiety
- D. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
- E. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context
- F. The fear, anxiety, or avoidance is persistent, typical lasting for 6 months or more
- G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- H. If another medical condition is present, the fear, anxiety, or avoidance is clearly excessive
- I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorde
facts about agoraphobia and prevelance
Wittchen et al. (2011)
o EU 12-month prevalence: 2.0% of population (14 years old +)
o 8.8 million
o F/M ratio: 3.1
- Agoraphobia tends to increase as history of panic lengthens (Kikuchi et al., 2005)
- Agoraphobia is not related to age of onset or frequency of panic attacks (Arch & Craske, 2008)
- Occupational status predicts agoraphobic avoidance: have to leave the house for work - less likely to develop agoraphobia
- Strongest predictor is gender. And as agoraphobia increases in severity, the proportion of females increases: Socialized sex role
Panic and Agoraphobia Models: Behavioural
Barlow (1988) characterises panic attacks as “false alarms”
o Fight-or-flight responses triggered when there is no threat
- Panic disorder “develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues” (Bouton, Mineka, & Barlow, 2001)
- Model emphasizes interoceptive conditioning: e.g. raised heart rate becomes a conditioned stimulus due to association with intense fear: somatic sensations become stimulus & response
- Leads to “learned alarms”
- Learned alarms are triggered by natural increases in feared bodily sensation (e.g., through physical exercise, caffeine)
- This can happen without the individual being aware of the shift in the bodily sensation, although people with panic disorder often monitor their bodily sensations
Biological theories of panic disorders and agoraphobia
Genetic factors (see Hettema, et al 2001)
o Twin and family studies indicate moderate heritability
- Heritabilty = .43
o Children of Panic Disorder parents at increased risk
o PD ‘runs in families’
- Neurotransmitters
o Panic attacks may be due to biochemical dysfunction?
- But no single substance has been implicated
o Probably multiple biological causes
- See also GAD for serotonin and GABA implications
o These also apply to panic and agoraphobia
Biological treatments for P and A include…
Benzodyazapines:
- signif improve for PD
- long term effects
- reduces anxiety
- BUt causes sedation, slurred speech, memory and sexual problems- also highly dependent in 1/3 of people
TCAS
- imipramine effective in treating PD patients
- effect slower than benzos
- side effects- but reduce over time
SSRIS
- paroxetine more effective than placebo aat reducing PD
- BETTER THAN cbt for pd
SNRIS
- SIMILAR RESULTS TO SSRIS
- more effective than a placebo
psyhcological treatments of pd and ag
Panic control treatment
- clients taught about nature of anx and panic
- how panic is normal
- taught to control breathinf
- told to hyperventilate and recognise sensations
- taught how to identify faulty automatic thoughts in panic
- learn logical errors
- decatastrophosise
- exposure to feared situs
- induce sensations and evaluate them
evaluate treatments of panic/ agor
several studies show benefits of PCT
- Procedure lower levels of panic and avoidance
- more likely to achieve and maintain clinically significant change
evidnce CBT better than meds
- also say combo of bot best
- no diff with CBT alone VS srris alone
