Anxiety Disorders

Question 1

What are the diagnostic criteria for a panic attack?

Answer 1

Feeling of imminent doom and urge to escape. Plus >/= 4 of the following:

• Heart palpitations
• Sweating–sudden and perfuse
• Trembling
• SOB
• Chest pain/ tightness
• Tingling sensations
• Nausea/ Stomach distress
• Choking sensation
• Dizzy/ lightheaded
• Derealization
• Hot flashes/ chills
• Fear of dying*
• Fear of losing control or going crazy*

may include:

• -> cognitive anxiety sensitivity
• -> social anxiety sensitivity
• = specific cognitive phenomenon
• -> full and limited system attacks are possible in those with established panic disorder

panic attack does not mean a person has panic disorder

Question 2

What are the diagnostic criteria for a panic disorder?

Answer 2

Essential feature:
–> recurrent unexpected panic attacks

–> At least 1 month of concern about having more panic attacks, OR worry about consequences of having panic attacks OR behavioral changes because of panic attacks

—> i.e. uncued paid attack occurred on bus going to work. The person avoids taking buses in future because of fear of panic attack—KAREV ON GREY’S: shot in elevator

Question 3

Describe situations that provoke agoraphobia

Answer 3

Situations can include
–>being outside the home alone

–>crowds, malls, supermarkets

–>arenas, theatres

–>buses/ public transportation

–>Driving or being a passenger in a car

–>Anxiety about having panic attack or panic-like symptoms in situations from which escape is difficult or embarrassing

Ex: anxiety about having panic attacks during class

Question 4

What is the treatment for panic disorder

Answer 4

Medication
–> Serotonergic, noradrenergic, and GABA systems

–> SSRIs( i.e. Proxac and Paxil) are preferred drugs– longer acting than benzodiazapenes

–> Relapse rates are generally high following medication discontinuation

Psychological and combined treatments

–> CBT (cognitive-behavioral therapies) are highly effective

–> Limited evidence that combined treatment produces better outcome

–>Medication can be quicker, but CBT tends to lead to longer period of remission of symptoms

Question 5

Case

ID: Jerry, 34 yo Caucasian male
CC: Initial panic attack occurred while smoking marijuana

Recalls rapid heart rate, “fuzzy tingling,” fear of dying and not being able to get help

–> current avoidance of sex, leading to strain on relationship

–> Recent avoidance of food, due to sensations of bp change while eating

Diagnosis?

Answer 5

Panic disorder

• -> seen in EtOH withdrawal
• -> self-starvation is atypical

Subjective feeling:
–>heart pounding, “tunnel vision,” terror, sweating, “can’t get a full breath”

Cognitive:

• ->my daughter will end up growing up without a father
• -> Misinterpretation of heart pounding as sign of heart attack

Behavior

• -> Avoidance of food to point of starvation state
• -> Use of benzodiazepines to reduce physical sensations
• -> Purchase home BP monitor