Panic disorder

Question 1

Panic disorder

Answer 1

-Panic attacks occur frequently enough to cause the person difficulty in adjusting to daily life e.g. panic attack

Question 2

Panic attack

Answer 2

-Sudden onset of intense panic in which multiple physical symptoms of stress occur, often with feelings that one is dying

Question 3

Agoraphobia

Answer 3

-Fear of leaving one’s familiar surroundings because one might have a panic attack in public.

Question 4

DSM-5 for panic disorder

Answer 4

• Fear or anxiety of public transport, open spaces, public spaces, standing in line or a crowd or being outside of the home alone
• The individual fears these situations are due to thoughts that escape might be difficult or help might not be available in the event of panic-like symptoms or other incapacitating symptoms
• The agoraphobic situations almost always provoke fear or anxiety leading to active avoidance, dependency on a companion or endurance behaviours
• Out of proportion to the actual danger posed
• Persisted for 6 months or more and causes clinically significant distress or impairment
• The disturbance is not attributable to the direct physiological effects of a substance or another medical condition

Question 5

Aetiology of panic disorders

Answer 5

• Biological theories
• Classical conditioning
• Anxiety sensitivity
• Catastrophic

Question 6

Biological theories

Answer 6

• Hyperventilation: rapid breathing that results in ventilation exceeding metabolic demand and raises blood pH level. Panic attacks induced by encouraging hyperventilation only showed in ppts with a history of panic attacks
• Noradrenergic over activity: Noradrenaline network may mediate the effects of biological challenges and Individuals with panic disorder may be deficient in GABA neurons

Question 7

Classical conditioning

Answer 7

• Anxiety is anticipatory and prepares the system for trauma
• Panic deals with trauma
• Anxiety becomes the conditioned response to a CS which may predict a panic attack

Question 8

Anxiety sensitivity

Answer 8

• Fear of anxiety symptoms based on beliefs that symptoms such as rapid heart beat is actually a heart attack
• sufferers have high bodily sensitivity

Question 9

Catastrophic misinterpretation of bodily sensations

Answer 9

• Individuals with panic disorder attend to their bodily sensations more than others and will interpret ambiguous signs as threatening
• Panic attack may be triggered by the expectancy of an attack as anxiety and arousal increases (vicious cycle)

Question 10

Treatment of panic disorders

Answer 10

• Try-cyclic antidepressants and benzodiazepines
• CBT
• Exposure therapy
• Cognitive reconstruction of dysfunctional beliefs about bodily sensations

Question 11

Treatment programme

Answer 11

• Education about the nature and physiology of panic attacks
• Breathing training to control hyperventilation
• Cognitive restructuring therapy to identify and challenge faulty threat perceptions
• Interoceptive exposure to reduce fear of harmless bodily sensations
• Prevention of ‘safety’ behaviors that may maintain attacks and avoid disconfirmation of faulty beliefs