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Anxiety Disorders. Panic Attack. Brief episode where pt. feel intense dread accompanied by a variety of physical and other symptoms that begin suddenly and peak rapidly (usually 10 minutes) Physical/mental sensations

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panic attack
Panic Attack
  • Brief episode where pt. feel intense dread accompanied by a variety of physical and other symptoms that begin suddenly and peak rapidly (usually 10 minutes)
  • Physical/mental sensations
    • Chest pain, chills or hot flashes, choking sensation, derealization/depersonalization, dizziness, fear of losing control, tachycardia, numbness, sweating, shortness of breath, trembling.
panic disorder
Panic Disorder
  • Repeated Panic Attacks
  • Worry/dread at having additional attacks
  • With/without Agoraphobia
Posttraumatic StressDisorder
  • Symptoms following exposure to extreme trauma present for at least one month.
  • Experiencing or witnessing an event that involves actual or threatened death or serious injury to self or another
  • Elicits a reaction of intense fear, helplessness, or horror
  • After trauma there is persistent reexperiencing of the trauma, persistent avoidance of stimuli associated with trauma, and persistent symptoms of increased arousal
Acute Distress Disorder
  • Similar to PTSD, except Sx must have onset within 4 weeks of the trauma and must last for at least 2 days but no longer than 4 weeks
  • 3 or more dissociative Sxs (e.g.. sense of numbing or emotional detachment, derealization, dissociative amnesia)
  • Must exhibit persistent reexperiencing of the trauma.
  • Marked avoidance of stimuli that cause recollection the trauma
  • Sxs of marked anxiety or increased arousal.
  • Specific Phobia-patients fear specific objects or situation, such as animals, storms, heights, blood, airplanes, being closed in or any situation that may lead to vomiting, choking or developing an illness.
  • Social Phobia-These patient imagine themselves embarrassed when they speak, write, or eat in public, use a public urinal; during exposure-immediate panic attacks.
Generalized Anxiety Disorder
  • Excessive anxiety and worry about multiple events or activities.
  • The anxiety and worry are relatively constant for at least 6 months, and the person finds them difficult to control.
  • Must entail 3 of following: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance
  • Disproportionate to feared events or their potential impact
  • Worrier or GAD? Measures-State Trait Inventory; How else?
Substance-InducedAnxiety Disorder
  • The development of anxiety, OC Sxs, or panic attacks are present within one month of Substance Intoxication or Withdrawal or are due to medication use.
  • Associated with caffeine, cannabis, cocaine, hallucinogen, inhalant, and PCP intoxication and withdrawal from alcohol, cocaine, or a sedative, hypnotic or anxiolytic
  • Medications and toxins (e.g. gasoline, paint, insecticides, and CO can produce anxiety symptoms.)
Obsessive-Compulsive Disorder
  • Characterized by recurrent obsessions or compulsions that are severe enough to cause significant distress, to be time-consuming (take more than one hour per day), or to markedly interfere with the person’s usual routine, occupational or academic functioning, social activities and relationships.
  • Person must be aware, at some time during the course of the disorder, that his/her obsessions and compulsions are excessive or unreasonable
biology anxiety
Biology & Anxiety
  • Peripheral Nervous System
    • Somatic
      • Sensory Systems
      • Skeletal Motor System
    • Autonomic
      • Sympathetic-arousal & energy expenditure
      • Parasympathetic-conservation of energy
ans anxiety disorders
ANS & Anxiety Disorders
  • Although primarily involuntary, it has been found to be brought under voluntary control
  • Pts. With Anxiety D/O’s demonstrate delayed response to repeated stimuli and excessive response to moderate stimuli
  • Predisposition or Learning?????
anxiety d o epidemiology lifetime 12 month
Panic (M/F%) 2/5

Agoroph. W/O 3.5/7

Social Phobia 11/15

Simple Phobia 7/16

Gen. ADO 4/7

OCD 2/3

Any Phobia 10/18

Any ADO 19/31

1.3 vs. 3.2

1.7 vs. 3.8

6.6 vs. 9.1

4.4 vs. 13.2

2.0 vs. 4.3

1.4 vs. 1.9

6.2 vs. 12.8

11.8 vs. 22.6

Anxiety D/O EpidemiologyLifetime % 12-Month %
  • Norepinephrine, Serotonin & GABA
  • Act in brainstem (noradrenergic neurons); limbic system(anticipatory anxiety) and prefrontal cortex
  • PFC associated with the possible generation of phobic avoidance
  • Pts. have poorly regulated noradrenergic systems leading to occasional energy bursts
  • Stimulation leads to fear response
  • Beta-adrenergic agonists (Isuprel) or Alpha2-adrenergic antagonist (Yohimbine) lead to severe panic attacks
  • Alpha2-adrenergic agonist (Clonidine/Catapres) & B-ATN (Propanolol/Inderal) reduce anxiety
  • Many SE type receptors-more selective
  • Clomipramine (Anafranil)-OCD
  • Buspirone (Buspar) 5HT agonist with projections from brainstem, cortex, limbic system and hypothalamus
gaba aminobutyric acid
GABA (Aminobutyric Acid)
  • Most common inhibitory NT in CNS
  • Benzodiazepines increase the activity of GABA at the receptor
  • Low potency most treatment for GAD
  • High potency GABA’s (e.g. Xanex) have been effective in treatment of PDO
anxiolytic medications what to rx
Anxiolytic MedicationsWhat to Rx?
  • SSRIs: Paroxetine (Paxil)
    • other alternatives?
  • Benzodiazepines
    • Alprazolam (Xanex) Lorazepam (Ativan) & Clonzaepam (Klonopin)
    • Advantages and disadvantages?
  • Tricyclics: Clomipramine & Imipramine (Tofranil)
    • Alternatives, advantages & disadvantages
psychotherapy and ados
Psychotherapy and ADOs
  • Controversies?
  • In vivo exposure with response prevention (flooding) –Agoraphobia
  • SDT or Participant modeling-Specific Phobias (observation/graded participation)
  • CBT, PMR, Social skills training & Assertiveness Training
  • Medication vs. Psychotherapy?