Anxiety Disorders Panic Disorder with and without

1
Anxiety Disorders

• Panic Disorder with and without agoraphobia

2
Panic Disorder

• Unexpected or recurrent panic attacks
• Somatic anxiety symptoms
• Some develop agoraphobia
• Interoceptive avoidance

3
Panic Disorder Diagnostic Criteria

• Recurrent unexpected panic attacks( A discrete
  period of intense fear of discomfort in which
  four or more somatic/anxiety symptoms developed
  abruptly and reached a peak within 10 minutes)
• At least one of the attacks has been followed by
  conern for additional attacks and significant
  change in behavior
• Not due to physiological effects of medications,
  drugs, or medical conditions
• Not accounted for by another disorder

4
Three Types of Panic Attacks

• Unexpected out of the blue
• Situationally bound almost always occur in
  certain contexts
• Situationally predisposed occur in certain
  contexts but not all the time

5
Prevalence Panic Disorder

• 3.5 lifetime prevalence
• 2/3 are female (men often drink to cover up
  anxiety symptoms and become alcoholics instead
  with co-morbid anxiety)
• Average age of onset is between 25 and 29
• 60 experience nocturnal panic attacks
• African Americans more frequently experience
  sleep paralysis

6
Etiology Panic Disorder Biological Explanations

• Neurotransmitters
• Biological vulnerability neurotransmitters
  norepinephrine
• Not clear whether the problem is excessive or
  deficient activity or some other form of
  dysfunction related to norepinephrine

• Genetics
• One study found 24 concordance among identical
  twins and 11 concordance in fraternal twins.
  (baserate is 3.5)

7
Etiology Panic Disorder Cognitive Explanations

• Misinterpreting bodily sensations
• Anxiety sensitivity focus on their bodily
  sensations and inability to assess these
  sensations logically

8
(No Transcript)
9
Panic Disorder Treatment

• Medication
• Antidepressant medications associated with some
  improvement in 80 of patients with 40 to 60
  recovering markedly or fully
• Improvements contingent on medications
• Benzodiazepines (such as Xanax) have also been
  empirically effective

• Cognitive
• Emphasis on correcting misinterpretations of body
  sensations
• Educating about panic attacks
• Teach more accurate interpretations
• Exposure
• 70 of patients improve but few are cured

10
Panic Attacks Combined Treatment

• Short Term
• Combined treatment no more effective than
  individuals treatments in the short term

• Long Term
• Those receiving CBT alone maintained most of
  their treatment gains
• Those taking medication (alone or in combination)
  deteriorated somewhat

Recommendation Psychological treatment offered
first, followed by medication