Panic disorders

Question 1

Define panic attacks

Answer 1

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

Question 2

Define panic disorder

Answer 2

Panic attacks occur frequently enough to cause the person difficulty in adjusting to daily life

Question 3

Signs of a panic attack

Answer 3

1) sweating
2) racing heart
3) chest pain
4) shortness of breath
5) dizziness
6) nausea
7) hot flashes/ chills
8) trembling
9) terror
10) desire to escape

Question 4

DSM-5 criteria for a diagnosis of panic disorder

Answer 4

A) recurrent unexpected panic attacks
B) At least one of the attacks have been followed by 1 month or more of one or both of the following
1) persistent concern or worry about additional panic attacks or their consequences
2) significant maladaptive change in behaviour related to the attacks
C) the disturbance is not attributable to the direct physiological effects of a substance
D) the disturbance is not better accounted for by another mental disorder

Question 5

Define Agoraphobia

Answer 5

• fear of leaving one’s familiar surroundings because one might have a panic attack in public
• agoraphobia occurs in 1/3 of sufferers of panic disorder

Question 6

DSM-5 criteria for diagnosis of agoraphobia

Answer 6

A) marked fear or anxiety about at least one situation from two or more of the following five groups of situations:
- public transportation
- open spaces
- being in shops, theatres, or cinemas
- standing in line or being in a crowd
B) the individual fears these situations 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
C) the agoraphobic situation also at always provoke fear or anxiety

Question 7

Aetiology- brain structures

Answer 7

• amygdala(emotional processing of threats)
• hippocampus (learning of emotional responses, memories of panic attacks, anticipatory anxiety)
• locus cereulus (major source of NE)

Question 8

Aetiology- Noradrenergic system

Answer 8

• increased activity in the Noradrenegic system
- increased arousal, fear or anxiety
- support from PET scan studies
- deviancy in gamma- amino butyric acid (GABA) neurons
- role of GABA neurons- inhibits noradrenergic activity

Question 9

Aetiology- hyperventilation

Answer 9

• a rapid form of breathing resulting in ventilation exceeding metabolic demand and has a result of lowering carbon dioxide levels
- upsets the balance and gases in the lungs
- low carbon dioxide levels in the lungs and lead to feelings that mimic a panic attack

Question 10

Aetiology- anxiety and sensitivity

Answer 10

• anxiety sensitivity
- fear of anxiety symptom/ related sensations
• anxiety sensitivity index
- physical
- psychological
- social concerns
• ASI - risk factor for panic attacks and panic disorder
- physical concerns dimension is a significant predictor of panic disorder symptoms

Question 11

Aetiology- Introceptive conditioning

Answer 11

Classical conditioning of panic response in response to internal bodily sensations(intorceptive cues)
- can lead to agoraphobic avoidance
- safety behaviours can maintai introceptive conditioning
- activities deployed to avoid perceived catastrophic outcome.

Question 12

Aetiology- catastrophic misinterpretations

Answer 12

• catastrophic misinterpretations of bodily sensations. (clark 1986)
  -individuals attend to bodily sensations more than others
• catastrophic beliefs increase anxiety and arousal
• catastrophizing bodily sensations can create a visious cycle of anxiety and lead to panic attacks
  -typical to panic disorder

Question 13

Ohst-Tuschen-caffier

Answer 13

Results: Catastrophic misinterpretation ore common in panic disorder than other anxiety disorders.
Study: Ppts with panic disorders, other anxiety disorders, and healthy control. Experimental group watched a suspenseful film to induce physiologocal arousal, then completed the BSIQ-FR measure. Panic disorder ppts exhibited more catastrophic misinterpretations, but only after physiological arousal was triggered.

Question 14

Treatment- relaxation

Answer 14

Psychoeducation
-nature of panic disorders and hyperventilation.
Relaxing and breathing retraining.
- education about the physiological effects of hyperventilation and practice in slow breathing
- the client learns to control breathing through repeated practice using muscles of the diaphragm, rather than the chest.

Question 15

Treatment - CBT

Answer 15

• Introceptive exposure to reduce fear of harmless bodily sensations(carrying out behaviour that induce physical sensations of panic attack)
• cognitive reconstructing therapy(identify and challenge faulty threat perceptions)
• prevention of ‘safety’ perceptions that may maintain attacks and acoid disconfirmation of faulty beliefs.

Question 16

Treatment- pharmacological therapy

Answer 16

1) Tricyclic antidepressants:
- increases levels of serotonin norepinephrine in the brain
- side effects, such as drowsiness, dry mouth and blurred vision
2) Benzodiazepines:
- slows down the nervous system
- effective for short term relief of anxiety symptoms
- side effects include mild psychomotor and cognitive impairments(attention and memory especially amongst elderly)
- potential for addiction

Question 17

Define GAD

Answer 17

Feelings of dread and impending doom along with physical symptoms of stress, which lasts 6 months or more.

Pathological worrying is a cardinal diagnostic feature
Worrying is perceived as uncontrollable

Question 18

Physical symptoms of stress include:

Answer 18

Irritability, muscles tension, restlessness, fatigue

Question 19

pathological worrying is

Answer 19

a carndinal diagnostic feature

Question 20

worrying is…

Answer 20

perceived as uncontrollable
closely associated with catastrophising

Question 21

what is catastrophising?

Answer 21

expects the worst case scenario to happen

Question 22

DSM criteria for diagnosing GAD

Answer 22

1) excessive anxiety or worry about two domains of activities or events
2) Excessive anxiety or worry on more days than not, for 6 months or more
3)The anxiety or worry are associated with 3 or more symptoms of stress
4)Clinically significant distress or impairment in social, occupational or other important areas of functioning
5) not attributable to other substance or another medical condition
6)The disturbance is not better accounted for by another mental disorder