Panic Disorder Flashcards
why is there a long standing debate about whether anxiety should be included in mood disorders?
are depressive and anxiety disorders distinct, a variation of a single disorder, or should there be a third category
why do depression and anxiety cooccur at high rates? (arising stuff)
arises from chance, arises from overlapping symptoms, arises from poor placement of diagnostic boundaries
why do depression and anxiety cooccur at high rates? (shared stuff)
shared genetic liability, shared environmental risks/responsible brain regions, shared temperament/personality traits, shared maintaining processes
neuroticism=
sensitive to negative stimuli, tendency to experience subjective distress
tripartite model and affect:
framework for parsing out depressive and anxiety-like symptomology based on their similarities and differences. affect=expression of emotion/feeling
tripartite model divided based on 3 dimensions:
depression
anxiety
both/overlapping
depression characteristic in tripartite model:
characterized by low positive effect; anhedonia, no pleasure from anything, fatigue, low energy
anxiety characteristic in tripartate model:
characterized by physiological hyperarousal, increased heart rate, dizzy, sweating, shortness of breath
both/overlapping characteristic in tripartite model:
characterized by negative affect, general distress, insomnia, difficulty concentrating, worrying, restlessness, irritability
general components of anxiety disorders:
excessive fear, anxiety, and related behavioral disturbances
anxiety:
emotional response to anticipation of future threat
fear:
emotional response to real/perceived imminent threat
panic attack symptoms:
physical symptoms like palpitations, sweating, trembling, chest fain, feelings of choking, cognitive symptoms like fear of losing control or “going crazy”, fear of dying
the only specifier for panic attacks:
with panic attack
panic attacks are associated with:
increased symptom severity, higher rates of comorbidity and suicidality, and poorer treatment response
panic disorder diagnostic criteria:
experiences recurrent, unexpected panic attacks and is worried about having more panic attacks and changes their behavior. usually peaks within minutes and during time 4 or more of the symptoms may occur
at least one of the attacks has been followed by:
1 month or more of one of the following: persistent worry or concern about having additional panic attacks, significant maladaptive change in behavior related to attacks
the 3 maladaptive behaviors in panic disorder:
- avoidance behaviors
- probability overestimation
- catastrophic thinking
probability overestimation:
overestimate probability that a negative event will occur eg. had a panic attack while driving so therefore will have one every time I drive
catastrophic thinking:
tendency to exaggerate the consequences of negative events ie. worst case scenario. increased heart rate= “im having a heart attack”
cognitive theory of panic
people are hypersensitive to their bodily sensations and are prone to giving them misinterpretation, only people that catastrophize can go on to develop panic disorder
engagement of safety behaviors:
why do people keep having panic attacks if nothing bad happens afterward? used as coping mechanisms and can lead to overanalyzes of situations and can worsen situations.
comprehensive learning theory
interoceptive/exteroceptive conditioning- anxiety becomes conditioned to neutral cues associated with panic attacks
interoceptive conditioning:
heart palpitations have been paired with panic many times, then basic heart palpitations can trigger a panic attack without anything else
exteroceptive conditioning:
have panic attacks while making mood disorder slides, then just being on a computer can trigger a panic attack
anxiety sensitivity:
fear/trait like belief that certain bodily symptoms may have harmful consequences/outcomes (scoring high on this early on is a risk factor for developing anxiety disorders)
biological causal factors of panic disorder:
genetics, dysfunction in fear network, (heightened/overly sensitive system)
amygdala in panic disorder:
emotion of fear within the limbic system (activates locus coeruleus)
locus coeruleus:
fight or flight response, activates sympathetic nervous system
cortex:
higher order thinking- “im dying, im losing control”
hippocampus:
learned emotional/fear response (conditioned response)
neurotransmitter systems involved:
GABA, noreoinprine (activates sympathetic nervous system), serotonin (decreases norepinephrine activity)
CBT basic tenet:
change conceptualization of how the person structures their moods, experiences, and behaviors
panic control treatment (PCT)
cognitive restructuring so the patient can identify and correct maladaptive thoughts
interoceptive exposure:
deliberate exposure to feared internal sensations (i.e. exercise to increase heart rate, spinning in a chair, hyperventilating to induce respiratory change
relaxation techniques:
breathing, muscle relaxation, guided imagery
mindfulness training
psychological process of bringing one’s attention to experiences at the present moment
panic disorder medications:
anxiolytics: benzos (i.e. xanax, klonopin, valium, ativan)
anxiolytics:
very rapid effects. within minutes, can develop physiological dependence
anxiolytics mechanism:
modulator by binding GABA-A receptors and alter the responsiveness of the ion channel when GABA binds. potentiate GABAergic inhibitory synaptic transmission
SSRIS comparison to benzos:
can’t create physiological dependence to the degree that benzos do, takes about 4 weeks to have any noticeable effects
