Panic disorders and phobias Flashcards
What is a panic disorder?
This is a short and intense burst of anxiety commonly accompanied by somatic symptoms.
They usually last about 10 minutes and are sudden in onset
Someone must have had more than 4 ‘attacks’ over 4 weeks or longer
What are the ICD-10 criteria for a panic disorder ?
RECURRENT ATTACKS OF SEVERE ANXIETY (Panic attacks)
Not restricted to any particular setting or circumstances
Unpredictable
Physical symptoms
Impending sense of death (usually due to misinterpretations of physical symptoms)
What are some of the characteristic physical symptoms that are seen in panic disorders?
Chest pain Breathlessness Sweating Palpitations Feeling of being unable to breath (tight throat/chest) Choking sensations Dizziness DeREALISATION or DePERSONALISATION
When should you NOT make a diagnosis of panic disorder?
When someone has another ongoing mental health diagnosis e.g. depression
OR if their panic attacks relate to a specific set of circumstances (consider phobia disorder)
How should a panic disorder be managed?
Can be managed in primary care
SSRIs are first line as well as low/high intensity psychological interventions
How long should you wait to see if there is any response to the SSRIs and what should you try if there is not?
12 weeks
If no response then you should offer imipramine or clomipramine
What are imipramine and clomipramine?
TCA anti-depressant
***if this doesn’t work then they need to be referred to specialist mental health services.
What are some key features of a phobia disorder?
AVOIDANCE - people will go out of their way or make their lives seemingly more complicated just to avoid the phobia
PANIC ATTACKS - short, discrete periods of severe anxiety and somatic symptoms
ANTICIPATORY ANXIETY - becoming anxious just at the thought of being exposed to the thing
***the anxiety or fear cannot be reasoned or explained away
What is agoraphobia?
One of the most common specific phobias - fear of going outside / into public places
What are some features of agoraphobia?
People become very anxious about going into public spaces and this often leaves them housebound
What other mental health disorder does agoraphobia have a close relationship with?
Panic disorder - hard to know which comes first.
Sometimes people develop agoraphobia because they are having panic attacks and are scared to go into public spaces just in case they have one there and are unable to easily leave.
How is agoraphobia commonly managed?
Usually CBT and exposure therapy
- therapist accompany people out of their houses little by little until they’re able to get to the bottom of the bath, down the road, to the shop etc.
MEDICATION NOT HELPFUL
What is social phobia?
The fear or anxiety of being scrutinised by others - usually leads to avoidance of interaction
Can be generalised (fear of all social interaction) or quite specific e.g. fear of being seen eating by others, fear of talking to the opposite sex
Who is social phobia more common in and when does it usually start?
It is more common in women and seems to start most often in the adolescent period.
How is social phobia managed?
Again with CBT, problem formulation and discussion and some exposure therapy
