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Anxiety Disorders. Panic Disorder with and without agoraphobia. Panic Disorder. Unexpected or recurrent panic attacks Somatic anxiety symptoms Some develop agoraphobia Interoceptive avoidance. Panic Disorder: Diagnostic Criteria.

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Anxiety Disorders

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    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. 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%) Etiology Panic Disorder: Biological Explanations

    7. Etiology Panic Disorder: Cognitive Explanations • Misinterpreting bodily sensations • Anxiety sensitivity: focus on their bodily sensations and inability to assess these sensations logically

    8. 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 Panic Disorder: Treatment

    9. 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 Panic Attacks: Combined Treatment Recommendation: Psychological treatment offered first, followed by medication