Panic Disorders Flashcards
Long-standing debate about whether anxiety should be included in …..
mood disorders
Why should anxiety be grouped in with mood disorders (4 reasons)
- high rates of comorbidity
- serve as a predisposition to mood disorders
3.can shape severity of symptoms
- those with cormorbid disorders = greater illness severity ( with anxiety)
Why should anxiety NOT be included in mood disorders ( 3 reasons)
1.earlier age of onset
2.more of a feeling that we all experience
3.may be more independently transmitted
Why do depression and anxiety cooccur at high rate? (4 reasons)
- high prevalance rate
- overlapping symptoms
- poor placement of diagnostic boundaries
- shared etiology
4 causes of shared etiology between depression and anxiety …
- Shared genetic liability
- Shared environmental risks / responsible brain regions
- Shared temperament/personality traits
- Shared maintaining processes
Neuroticism is defined as sensitive to ______, tendency to experience ______.
negative stimuli, subjective distress
Neuroticism __________ vulnerability to almost all ___________, especially _______ and ______ disorders.
increases, psychopathology, mood, anxiety,
The shared maintaining process between depression and anxiety include
Attentional biases to ________
Also ________ and _______, which involve the same ________
negative stimuli, worry, rumination, processes
Tripartate model is a framework for parsing out _______ and ______ symptomology based on their _______ and _______
depressive, anxiety-like, similarities, differences
Triparte model has three dimensions
- depression
- anxiety
- both/overlapping
Triparte model: Depression is characterized by ….
low positive affect
Triparte model: Anxiety is characterized by….
physiological hyperarousal
Triparte model: Both/Overlapping is characterized by …
negative affect
Triparte model was intended to …
help diagnostic accuracy
other self questionnaire scales meant to help diagnostic accuracy ….
(PANAS)
(MASQ)
(DASS)
HiTOP (Hierarchical Taxonomy of Psychopathology) Pros: (4) …..
- Developed from real clinical data
- Multi-dimensional
- Higher reliability
- Comorbidity is built into the system
HiTOP (Hierarchical Taxonomy of Psychopathology) Cons (3) : ……
- Does not consider developmental course
- Does not consider etiology
- Harder to use to make categorical decisions
Anxiety Disorders are between ________ and _________ disorders
Depressive, Obsessive compulsive
Anxiety Disorders include excessive _______, _________, and ______ to these emmotions.
fear, anxiety, abnormal responses
Anxiety is defined as an …
emotional response to anticipation of
future threat
Fear is defined as an ….
emotional response to real/perceived
imminent threat
Anxiety includes increased ________ and ________ in preperation
muscle tension, vigilance
Fear includes surges of __________, and _________.
autonomic arousal, fight -or-flight response
Panic disorder 12 month prevalence……
2-3%
Panic disorder has a ______ ratio of biological females to males
2:1
Panic disorder lifetime prevalence….
4.7%
Panic disorder median age onset is ..
20-24 years old
Development of Panic Disorder is _____ in children, while _______ in older adult population
Low, declining
Panic Attack Symptoms (list (approximately 13 symptoms presented )…
- Palpitations/accelerated heart rate.
- Sweating.
- Trembling or shaking.
- shortness of breath
- Feelings of choking.
- Chest pain or discomfort
- Nausea or abdominal distress.
- Feeling dizzy, light-headed
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations)
- Derealization or depersonalization
- Fear of losing control or “going crazy.”
- Fear of dying
panic attacks is what defines ________, and can also act as a ________ for a majority of all disorders.
panic disorder, specifier
Specifier: with panic attack follows the same symptoms as described in ……
panic attack symptomology
Panic attack is not a _______ disorder. Panic attacks can occur in the context of any ______ disorder as well as other _______ disorders, and some _________.
mental, anxiety, mental, medical
conditions
Type of panic attacks …
Unexpected, Expected, Limited symptom attacks
Unexpected panic attack =
no obvious cue / trigger of an attack
Expected panic attack =
obvious cue / trigger of an attack
Limited symptom panic attacks =
attacks that meet all other criteria, but have fewer than four symptoms
panic attacks can arise from a ______ or ______ state and can _______ to either state
calm, anxious, return
Panic Disorder, Diagnostic Criteria: Experiences ________, _________ panic attacks and is worried about having ______ and therefore changes their _______.
recurrent, unexpected, more, behavior
With panic attacks (specifier) are associated with _______ symptom severity, _________ of comorbidity and suicidality, and _______ treatment response
increased, higher rates, poorer
Panic Disorder Diagnostic Criteria: Panic attack usually peaks within ______ during which time ______or more of these symptoms might occur.
minutes, 4
Panic Disorder Diagnostic criteria: At least ______ of the attacks has been followed by ______ or more of one or both of the following:
- _________.
- _________.
one, 1 month
Persistent concern or worry about additional panic attacks or their
consequences
Significant maladaptive change in behavior related to the attacks
With Panic Disorder: The _______ attack is recurrent and unexpected, and frequently occurs after a ________.
first, stressful event
With Panic Disorder, the frequency and severity of the panic attacks ….
vary tremendously
One ________ panic attack is required for the ________ of panic disorder
unexpected-full-symptom, diagnosis
Panic disorder causes _________ to ensue :
maladaptive behavioral responses
1. Avoidance behaviors
2. Probability overestimation
3.Catastrophic thinking
Probability overestimation is to …
overestimate probability that a negative event will occur
Catastrophic thinking is the …
tendency to exaggerate the consequences of negative events
Cognitive theory of panic is when people are…
hypersensitive to their bodily sensations and are prone to giving them the most dire interpretation
Why do people keep having panic attacks if nothing bad happens afterward ?
Engagement of safety behaviors
Only people that _________ can go on to develop a panic disorder
catastrophize
Many attribute the “nothing happened” to their ……
safety behaviors
Comprehensive Learning Theory includes __________, anxiety becomes ________ to ________ associated with ________.
Interoceptive / exteroceptive conditioning, conditioned, neutral cues, panic attacks
Interoceptive Conditioning Example
Heart palpitations have been paired with panic many times → then basic heart palpitations can trigger a panic attack without anything else
Exteroceptive Conditioning Example
Have panic attacks while making mood disorder slides → then just being on a computer can trigger a panic attack
Anxiety sensitivity is a …
fear/trait-like belief that certain bodily symptoms may have harmful consequences.
scoring high on anxiety sensitivity early on is a _______ factor for developing _______.
risk, anxiety disorders
Anxiety sensitivity ->
Tendency to ________ sensations as ________.
Lack of perceived ________.
Mistake bodily sensations for _________.
misinterpret, catastrophic, control, negative experiences
Panic Disorder has a ________ heritable component: ________ of variance in liability to panic symptoms due to _______
moderate, 30-34%, genetics
Amygdala: emotion of ______ within the ________ (activates _________)
fear, limbic system, locus coeruleus
Locus coeruleus:
________ response
activates _________ nervous system
easily ________.
fight-or-flight, sympathetic, triggered
The Cortex is in charge of
higher order thinking
Hippocampus – learned _________ response
emotional/fear
Neurotransmitter systems involved in Panic Disorder include: _______, ________ (which activates the _________ nervous system), and __________ (which _________ norepinephrine activity)
GABA, norepinephrine, sympathetic, serotonin, decreases
CBT Basic Tenet for treating Panic Disorders: is to change the ______ of how the individual ______ and ______ their moods, experiences, and behavior into ______
conceptualization, structures, interprets, evidence-based
CBT for Panic Disorders, Post-treatment response rates :
53%
Panic Control Treatment (PCT) includes ______ so the patient can _____ and ______, ______ thoughts
cognitive restructuring, identify, correct, maladaptive
Interoceptive exposure is….
deliberate exposure to feared internal sensations
Panic Control Treatment (PCT) involves _________ treatment for _________.
Also has _________, _______, and ________ components
integrative, logical reanalysis, physical, cognitive, behavioral
With Interoceptive Exposure hopefully _______ of _________ will ensue
habituation, conditioned panic attacks
Relaxation techniques includes ……
breathing, muscle relaxation, guided imagery
Mindfulness training is the _______ process of bringing one’s _______ to experiences at the _______
psychological, attention, present moment
Relaxation techniques do not work in a _________.This is about controlling the _______.
full blown-out panic attack, escalation
Exposure (situational) based therapy is exposing individuals to ______ situations to _____ up a ______ for the ______ that _______ existed for those situations
feared, build, tolerance, discomfort, previously
Exposure (situational) Based Therapy, introduces the individuals to the “feared” situation in a ________. This is similar to ________. Used for _______ cues
step-wise manner, phobias, external
Anxiolytics include …..
benzodiazepines
examples of anxiolytics …
Xanax, Klonopin, Valium, Ativan
Anxiolytics have very _____ effects, within ________, which are ______ and _______.
rapid, minutes, sedative, muscle relaxing
Anxiolytics can induce _________ side effects -> _______, ________, and increased _________.
undesirable, cognitive, aggression, suicide risk
With anxiolytics, can develop _________, therefore can lead to _________, and relapse of _________.
physiological dependence, withdrawal, panic disorders
Mechanism of Anxiolytics: _________ by binding to _________ receptors and altering the _________ of the ______ when ______ binds
allosteric modulator, GABA-A, responsiveness, ion channel, GABA
Anxiolytics increase ……
chloride ion conductance
Anxiolytics move the ________ more ________ and prevent further
__________.
resting membrane potential, negative, depolarization / activation
Anxiolytics potentiate……
GABAergic inhibitory synaptic transmission
SSRIs don’t create ________ to the degree that ________ do.
physiological dependence, benzodiazepines
SSRIs can alleviate ……
comorbid depressive symptoms
SSRIs takes about _______ to have any noticeable effects
4 weeks
SSRIs have mild ________ side effects
undesirable
Short term mechanism for SSRIs, blocks the ________, therefore more ________ is present in the ________.
serotonin reuptake transporter, serotonin, synaptic clef
