Panic Disorder and GAD Flashcards
Panic disorder
Recurrent, unexpected panic attacks, leading to anxiety about having more panic attacks Maladaptive behaviours:
•Avoiding overstimulation, physiological arousal (exercise), crowded spaces
Impairment:
•Avoiding public/important situations, can’t sleep or relax, can’t focus on school/work/relationships
Symptoms:
•F/F, dizzy, parethesia (numbness/tingling), derealitization (mind separate from what body is doing), depersonalization (something in me has shifted), thinking you’re dying
Timing:
•Intensity reached fast, rarely lasts longer than 20-30 minutes (ave. 10)
Panic attacks in panic disorder
Person often cannot identify the trigger
•Ex: asleep (nocturnal panic), positive activating emotions (excitement)
Panic often triggered by specific situation/stress
•Ex: scared of having panic attack in crowd/ in public, or while driving
May show up to ER thinking their having a heart attack
•People with cardiac conditions can be more prone to developing panic disorder
First panic attack usually happens during a stressful time
•Because it’s distressing, can be worried about having more
Panic disorder prevalence
Lifetime: 5%//One year: 2-3%
Gender: 2x more prevalent in women
Onset: adolescence/early adulthood
Chronic course: symptoms fluctuate overtime
Outcomes: agoraphobia can be complication and increased suicide rate
Biological factors to panic disorder
Moderately heritable
•Developmental experiences important
•Ex: stressful life experiences
•Hypersensitive limbic system (amygdala)
•Ex: increased startle response, slower habituation startle
•Hipocampus: learned associations with bodily cues
•Cortex: giving meaning to panic attacks (fear of dying)
•Dysrecuilation in norepinephrine, serotonin, and GABA
Psychological factors
Feedback loop
•Associate initial panic attack with internal (body sensations) and external (env.) cues
•Strengthen over time through safety behaviours and hyper-vigilance
*Safety behaviour: behaviour intended to reduce anxiety
•Lack of catastrophe is given credit to safety behaviours rather than realistic view that panic is not dangerous
•Ex: medication, paper bag
Agoraphobia
Fear/avoidance of public spaces where they can’t escape because of fear of panic, wont be able to get help,or embarrassment
•Ex: crowds, busy streets, lines
Misinterpretation of what could happen
•Ex: if I get lost nobody will help me
Outcomes:
•Cognitive avoidance in public (thinking about something else), or going out with a trusted companion
•Avoiding scary things: coffee, sex
•Generates overtime to other situations (can become fear of everything)
Often a complication of panic disorders •Starts with avoidance of where panic occurred and spreads
Has its own diagnosis in DSM
Prevalence: 1.7% (2x more likely in women)
Onset: adolescence/early adulthood
Treatment for panic disorder
1) Education about panic (not dangerous)
2) Exposure to internal cues
•Interceptive exposure (get person to do physical things step by step)
3) Exposure to external cues associated with panic (if panic occurs, sit through it)
4) Challenging beliefs about panic
5) Relaxation strategies
•Ex: deep breathing, progressive muscle relaxation, hypnosis, meditation
6) Medication
•Anxiolytic: GABA activating, short acting, can become safety behaviour
•Antidepressant
Generalized anxiety disorder
Excessive worry/concern about a number of different issues causing impairment
•Ex: school/work performance, health and safety of self/others, finances, relationships
Symptoms:
•Worries are hard to control and consuming
•Tension (muscles) and anxiety (can’t sleep)
•Often doesn’t seek treatment for anxiety, but for other relevant medical concerns
•Future oriented uneasiness
•Struggle for control (wants to manage everything) but world feels uncontrollable
•Subtle avoidance and safety behaviours
•Ex: checking on family really often, procrastinating (feels like won’t do well, so avoids)
•Difficulty making choices/concerned about making wrong choices
Can lead to panic attacks
Prevalence
Lifetime:5-9%//One year: 3%
Gender: 2x more common in women
Onset: adulthood, but often anxious since childhood (lots of childhood fears)
Persistant
Psychological factors
Attends to threatening cues
•Interpret many things as threatening
•Chain of worry: minor concerns become major (engine light spirals into life threat)
•Overestimates risk: likelihood plane crash
Developmental role •Uncertainty/uncontrollable stressors
•Ex: parents getting mad at you and you don’t know why, over controlling parents lead you to thinking the world is dangerous
Worries are often perceived as helpful
•Superstitions avoid disaster
•Worrying helps with coping and preparing
•Distance from emotional components
Biological components
Moderately heritable
•Other anxieties, GAD, then phobias
•Shared heritability with other depressive disorders
•Manifestations of neuroticism
•Environment dependent
•Gaba: hyperactive
•Seretonin and norepinephrine dysregulation
•CRH and HPA axis elevation
•Limbic system: bed nucleus of the strila terminals (amygdala)
Treatment
1) Challenge catastrophic thinking (beliefs about worrying)
2) Insight around underlying fears
3) Relaxation, tension reduction techniques
4) Medication: anxiolytic or antidepressants
