I disturbi d

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I disturbi dansia

• Disturbo Ossessivo-Compulsivo
• Disturbo dAnsia generalizzato
• Disturbo da Attacchi di Panico
• Disturbo Fobico
• Disturbo Post-Traumatico da Stress

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I disturbi dansia

• Disturbo Ossessivo-Compulsivo
• Disturbo dAnsia generalizzato
• Disturbo da Attacchi di Panico
• Disturbo Fobico
• Disturbo Post-Traumatico da Stress

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Epidemiology

• General Profile of Sufferers of Panic Disorder
• Biological
• -female
• -Panic Attack onset at 15-24 years
• -Panic Disorder onset at 25-34 years
• Psychological
• -locus of control
• -anxiety
• Social
• -Separated/Disorder

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• DSM-IV Criteria for Panic Disorder
• Recurrent Unexpected Panic Attacks
• At least 1 month (or more) of at least one (or
  more) of the following
• Persistent concern about having additional
  attacks
• Worry about the implications of attack or its
  consequence
• Significant change in behavior related to attacks
• Panic attacks are not due to the direct
  physiological effects of a substance or a general
  medical condition
• Panic Attacks are not better accounted for by
  another mental disorder

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ETIOLOGY Combination of Biological,
Psychological and Social Factors Biological
Approach -Can be induced in a lab -Genetic
Evidence -Effective Medications -Hyperactivity
of Stress System Psychological
Approach -Catastrophic misinterpretations of
bodily sensations Social Contributions -Genetic
s explained -Life Events
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I disturbi dansia

• Disturbo Ossessivo-Compulsivo
• Disturbo dAnsia generalizzato
• Disturbo da Attacchi di Panico
• Disturbo Fobico
• Disturbo Post-Traumatico da Stress

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I disturbi dansia

• Disturbo Ossessivo-Compulsivo
• Disturbo dAnsia generalizzato
• Disturbo da Attacchi di Panico
• Disturbo Fobico
• Disturbo Post-Traumatico da Stress

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I disturbi dansia

• Disturbo Ossessivo-Compulsivo
• Disturbo dAnsia generalizzato
• Disturbo da Attacchi di Panico
• Disturbo Fobico
• Disturbo Post-Traumatico da Stress

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I disturbi dansia

• Disturbo Ossessivo-Compulsivo
• Disturbo dAnsia generalizzato
• Disturbo da Attacchi di Panico
• Disturbo Fobico
• Disturbo Post-Traumatico da Stress

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What is PTSD ?

• Confrontation with threat of death or injury
  responded to with horror or helplessness, fear
  and sense of ruination.
• Includes rape, mugging, seeing a bad accident,
  killing someone, fighting in a war, being in a
  concentration camp, even losing a loved one or
  being sued in court.
• Acute PTSD symptoms last for less than three
  months.
• Chronic PTSD symptoms persist for more than
  three months, or first appear more than six
  months after the traumatic event.

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What is PTSD? Symptoms

• Wide range of emotional, behavioral and somatic
  symptoms
• Reliving of trauma, pervasive numbness, and
  anxiety are some of the most common symptoms.
• Often, the patient cannot remember important
  parts of what happened to them
• Many PTSD sufferers feel pessimistic about their
  future, and worry what will happen to them and
  their loved ones
• Symptoms may persist and interfere with many
  areas of functioning for a long time, even
  decades.

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Long-Term Traumatic Effects

• Krystal (1968) found that 97 of Nazi
  concentration camp survives out of a sample of
  149 still had anxiety twenty years later
• 71 had persecution nightmares
• 80 suffered survivor guilt, self-reproach,
  depression, and crying spells
• Kuch and Cox (1992) found that even 40 years
  later, Auschwitz survivors were 3 times more
  likely to have PTSD than holocaust survivors who
  were not in concentration camps.

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Long-Term Traumatic Effects

• Engdahl et al (1997) out of 262 WWII and Korean
  War veterans who were POWs, 53 had experienced
  PTSD, and 29 still had it 50 years later.
• Yehuda, Halligan and Bierer (2002) (in reading
  packet) found that children of Holocaust
  survivors are at greater risk for PTSD because of
  their lower than normal cortisol levels.
• Foa et al (1992,1997) 95 of rape victims have
  PTSD two weeks after the event 70 recover in a
  few months.
• However, 25 do not recover after even 4-6 years
  17 years later, 16 of victims still have PTSD.

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Epidemiology

• Lifetime prevalence rates are 10 in women, 5 in
  men.
• 7.8 percent of Americans will experience PTSD at
  some point in their lives.
• About 3.6 percent of U.S. adults aged 18 to 54
  (5.2 million people) have PTSD during the course
  of a given year.

• Although most people show signs of trauma after a
  terrible experience, studies show that about 8
  of men and 20 of women go on to develop
  full-blown PTSD, and roughly 30 of these develop
  a chronic form that persists throughout their
  lifetimes.

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Epidemiology

• The traumatic events most often associated with
  PTSD for men are rape, combat exposure, childhood
  neglect, and childhood physical abuse.
• The most traumatic events for women are rape,
  sexual molestation, physical attack, being
  threatened with a weapon, and childhood physical
  abuse.

• The disorder is particularly common in veterans
  an estimated 30 of people who spend time in war
  zones get PTSD.
• The National Vietnam Veterans Readjustment Study
  estimated in 1988 that the prevalence of PTSD in
  that group was 15.2 at that time, and that 30
  of veterans had experienced the disorder at some
  point since returning from Vietnam.

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Who is most at risk for PTSD?

• Those with prior vulnerability factors such as
  genetics, early age of onset and longer-lasting
  childhood trauma, lack of functional social
  support, and concurrent stressful life events
•  Those who report greater perceived threat or
  danger, suffering, upset, terror, and horror or
  fear
•  Those with a social environment that produces
  shame, guilt, stigmatization, or self-hatred
  people with less education and lower SES are at
  greater risk.
• Those who experience greater stressor magnitude
  and intensity, unpredictability,
  uncontrollability, sexual (as opposed to
  nonsexual) victimization, real or perceived
  responsibility, and betrayal.
• Psychologically healthy people and those who are
  better prepared for the traumatic event (like
  knowing a hurricane is going to hit) are less
  likely to get PTSD afterwards.

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Other risk factors for PTSD

• Genetic component identical twins who served in
  Vietnam show more similar PTSD symptoms than
  fraternal twins (True et al 1993)
• This could be a result of underlying neural
  circuitry, but no exact reason is known.

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Psychological Aspects

• People who suffer from PTSD often relive the
  experience through nightmares and flashbacks and
  have difficulty sleeping
• Avoid things that remind them of the trauma
• feel detached or estranged, even from loved ones,
  and want to be left alone
• Decreased interest in normal activities
• Become over-alert (hypervigilant) to stimuli that
  remind them of the trauma
• Trouble concentrating on work and study
• Outbursts of hostility and anger
• Obviously, these symptoms can impair daily
  functioning.

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Psychological Aspects

• The disorder is often comorbid with depression,
  substance abuse, and problems of memory and
  cognition, like dissociative amnesia.
• In a large-scale study, 88 percent of men and 79
  percent of women with PTSD met criteria for
  another psychiatric disorder.
• For men alcohol abuse or dependence (51.9
  percent), major depressive episodes (47.9
  percent), conduct disorders (43.3 percent), and
  drug abuse and dependence (34.5 percent).
• For women major depressive disorders (48.5
  percent), simple phobias (29 percent), social
  phobias (28.4 percent), and alcohol
  abuse/dependence (27.9 percent).
• (Courtesy of the National Center for PTSD)

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Biological Aspects

• May affect both the central and autonomic nervous
  systems
• altered brainwave activity
• decreased volume of and damage to the hippocampus
  (abnormalities with long-term memory) because of
  excessive hormone exposure
• abnormal activation (increased blood flow) the
  amygdala
• involved in coordinating the fear response and
  memory
• More blood flow in the cingulate gyrus, reduced
  blood flow in Brocas area, which is responsible
  for spoken language.

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Biological Aspects

• Psychophysiological problems
• hyper-arousal of the sympathetic nervous system
• increased sensitivity of the startle reflex
• sleep abnormalities
• Enhanced thyroid function
• Abused children have smaller corpus callosums,
  which allow communication between brain
  hemispheres.
• They also have chronic overarousal of the
  autonomic nervous system, faster resting heart
  rate, stress-related changes (Bremner et al 1997)

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Biological Aspects How PTSD is Related to Stress
Pathways

• Lifelong increase in HPA axis activity
• Cortisol levels lower than normal
• Yehuda et. al Holocaust survivor study of
  urinary cortisol excretion.
• Epinephrine and norepinephrine levels higher than
  normal
• High levels of natural opiates in the brain
• These neurohormonal changes are particularly
  interesting because they are the opposite of what
  happens when people get depression this occurs
  even when PTSD is comorbid with depression!

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Biological Aspects Somatic Symptoms

• Many people with PTSD experience a variety of
  physical complaints, which may be psychogenic in
  origin often, they seek treatment from a
  physician without knowing they have PTSD.

• Headaches
• gastrointestinal disturbances
• immune system problems
• dizziness
• chest pain
• general physical discomfort in other parts of the
  body

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Social Aspects

• PTSD is associated with decreased ability to
  function in social or family life, including
  occupational instability, marital problems and
  divorce, family discord, and difficulty
  parenting.
• For example, in one study,Vietnam veterans with
  PTSD exhibited problems in family and other
  interpersonal relationships, problems with
  employment, and involvement with the criminal
  justice system.

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Treating PTSD

• PTSD is diagnosed using a combination of
  questionnaires, structured interviews, and
  diagnostic tests.
• Early intervention with both stress inoculation
  and exposure therapy may work well.
• Drugs have been proven mostly ineffective
  however, some moderate effects have been found
  with selective serotonin reuptake inhibitors
  (SSRI) like Prozac and Zoloft. These help reduce
  anxiety, depression, and sleep disturbances.

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Treatment Clinical Methods

• Prolonged Exposure Therapy (PET)
• Patients relive trauma by describing it to a
  therapist repeatedly over many sessions and tries
  not to dissociate from memories
• Group Therapy
• Patients with PTSD meet with one another to
  provide social support and a safe place to
  disclose what happened to them
• Stress Inoculation Training (SIT)
• Anxiety management techniques, deep muscle
  relaxation, positive cognitions and prevention of
  dwelling on traumatic thoughts
• Eye Movement Desensitization and Reprocessing
• EMDR teaches patients to think of a disturbing
  memory, then focus on the therapist moving
  his/her finger rapidly in front of patients
  face- saccadic eye movements. Results in strong,
  almost immediate improvement, but is very
  controversial

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