THE ANXIETY DISORDERS

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PANIC DISORDERS
A Panic Attack is a discrete episode of intense
fear usually lasting less than 20 minutes,
characterized by at least four of the following
SX
Pounding, racing heart
Sweating
Trembling or shaking
Shortness of breath
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Chest pain or discomfort
Nausea or stomach distress
Dizziness, lightheadedness
Derealization
Fear of dying
Numbness, tingling
Chills or hot flushes
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PANIC DISORDER
A Panic Attack by itself is not a disorder and
can happen to psychologically normal individuals
however, when these episodes start to reoccur,
then we have a panic disorder. The person must
have recurrent, unexpected attacks with at least
one of the attacks followed by one month of worry
about having another attack. Panic is not due to
a medical condition or better explained by
another disorder (e.g. phobia). Agoraphobia may
or may not be present. Agoraphobia is a fear of
being in a place where escape may not be possible
(it literally means fear of the marketplace).
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CHARACTERISTICS OF PANICDISORDERS

• Fairly common disorder (4.7 of adult population)
• Usual age of onset 15-24 more common in women
• Men often try to tough it our dont get help
• Can ne disabling without treatment
• Often have comorbidity (esp. depression)
• Often SX are judged to be heart attack
• GABA serotonin are key neurotransmitters
• Learning explanations are most adequate
• Genetics play some role (moderate)

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TREATMENT OF PANIC DISORDERS

• MEDICATIONS (XANAX, SSRI, TRICYCLICS)
• CBT
• MEDICATION CBT

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AGORAPHOBIA

• DISCUSSED PREVIOUSLY
• MAY OCCUR ALONE BUT THIS IS NOT COMMON
• USUALLY DEVELOPS AS A COMPLICATION OF PANIC
  DISORDER

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OBSESSIVE-COMPULSIVE DISORDER
Obsession- involves persistent, recurrent
unwanted thought/images. Person cant ignore
these thoughts.
Compulsion- involves repetitive, overt or covert
behaviors which are performed by the person to
neutralize the thoughts or prevent certain
dreaded events or situations. These behaviors
often have a ritualized quality and can be quite
diverse in nature. These can be quite time
consuming disruptive.
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COMMON OBSESSIONS

• INFECTIONS
• CONTAMINATION
• DOUBTS
• SEXUAL PREOCCUPATION
• FEARS OF SELF HARM
• FEARS OF HARMING OTHERS
• SYMMETRY
• RELIGIOUS CONCERNS

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COMMON COMPULSIONS

• CLEANING
• CHECKING
• COUNTING
• REPEATING
• ORDERING/ARRANGING

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CHARACTERISTICS OF OCD

• Often described as a What if illness
• Role of avoidance learning in explanation
• Biological/genetic factors in causation stronger
  than in other
• anxiety disorders
• Serotonin key neurotransmitter
• More common than once thought

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TREATMENTS FOR OCD

• Medications useful (esp. SSRI clomipramine
  which is similar to tricyclic)
• CBT which includes exposure, cogniitve Rx, and
  response prevention is helpful
• Meds CBT may not be better than CBT alone ???

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GENERALIZED ANXIETY DISORDER
Generalized Anxiety Disorder (GAD) is a condition
characterized by nearly constant worry (free
floating anxiety) that is difficult to control
and persists for gt than 6 months. The worry is
not just about having a panic attack.
Persons with GAD also experience restlessness,
fatigue, poor concentration, muscle tension
sleep disturbance (induction insomnia).
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CHARACTERISTICS OF GAD

• RELATIVELY COMMON DISORDER (5.7 LIFETIME
  PREVALENCE)
• MUCH MORE COMMON AMONG WOMEN
• PATIENTS MORE OFTEN SEEK HELP FROM LMD RATHER
  THAN PSYCH.
• HIGH CO-OCCURENCE WITH OTHER ANXIETY DISORDERS
  MAJOR DEPRESSION
• GAD PATIENTS EXPERIENCE LIFE AS UNPREDICTABLE
• CENTRAL ROLE OF WORRY (PROTECTIVE FUNCTIONOF
  WORRY)
• MODEST GENETIC ROLE IN CAUSE
• GABA IS KEY NEUROTRANSMITTER

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RX FOR GAD

• CBT IS EFFECTIVE
• MEDICATION (BUSPAR, BENZODIAZEPAM) CAN BE HELPFUL
• GROUP RX CAN BE OF SOME VALUE
• RELAXATION AND OTHER STRESS LOWERING
• SKILLS CAN HELP
• CAN BE DIFFICULT TO TREAT

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THE END