Case 1: anxiety & hyperventilation Flashcards
What is the DSM-5 criteria?
- Diagnostic and Statistical Manual of Mental Disorders (DSM) = handbook used by health care professionals as guide to diagnosis of mental disorders.
- contains descriptions, symptoms & other criteria for diagnosis
What are Axis I disorders?
- most common
- include anxiety disorders such as PD, SAD, PTSD, eating disorders, mood disorders, psychotic disorders, substance use disorders.
What are axis II disoders?
- ## include developmental & personality disorders.
What is anxiety?
an innate, adaptive mechanism that readies human beings for action and protects them from anticipated threat (alarm system).
What is a panic disorder?
- Anxiety disorder where you regularly have sudden attacks of panic or fear.
- everyone experiences anxiety/panic at times (natural response to stressful/dangerous situations)
- people with PD has feelings of anxiety, stress, and panic regularly, and at any time often for no apparent reason
When can your “alarm system” have detrimental consequences with regards to anxiety?
- triggered for excessive lengths of time
- triggered in situations known to be harmless
- triggered for no apparent cause.
What are anxiety disorders?
disorders that share features of excessive fear and anxiety and related behavioural disturbances
e.g. SAD, PD, GAD, Agoraphobia, specific phobia
What is common with anxious people?
- highly aroused and alert & most often in a state of “over preparedness”.
- anxious patients are less relaxed.
- Harmonic driving is higher in anxious patients than in non-anxious/depressed patients (more beta activity and less alpha activity).
What is panic?
Panic can be result of a malfunctioning “alarm system,” & will sometimes = panic attack.
What is the DSM-V for panic disorder?
- Recurrent unexpected panic attacks
- Atleast 1 attack followed by atleast 1 month of either: persistent worry about additonal panic attacks & consequences and maladaptive change in behaviour related to attack (e.g. behaviours to avoid panic attacks)
- disturbance NOT due to physiological effects of substance (e.g. drug abuse, medication) or other medical condition
- Cannot be caused by another mental disorder
- significant disability & impairment in physical, occupational, social and daily functioning
What is the aetiology of panic disorder?
- The age of onset of PD tends to occur in the mid-twenties
- Biological, social, psychological effects, environmental, physical
What is the treatment of panic disorder?
- CBT
What is a panic attack?
Discrete period of intense fear or discomfort that reaches a peak within minutes and is accompanied by 4 or more symptoms
What are the symptoms of a panic attack according to the DSM?
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling/shaking
- Shortness of breath
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed or faint
- Chills or heat sensations
- Paresthesias (numbness of tingling sensations)
- Derealization (feelings of unreality) or depersonalisation (being detached from one-self)
- Fear of losing control or “going crazy”
- Fear of dying
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
Does panic atttack = panic disorder diagnosis?
No, panic attacks alone are not sufficient to warrant a PD-diagnosis (many people have panic attacks but never develop PD)
What are the 3 types of panic attacks according to the DSM?
- Unexpected panic attacks
- Cued or situationally bound attacks
- Situationally predisposed
What are unexpected panic attacks?
to occur out of the blue and are not associated with particular situation or internal cue (central to PD)
What are cued or situationally bound panic attacks?
Almost always occur upon exposure to or in anticipation of a particular situation
What are situationally predisposed panic attacks?
panic attacks linked to a particular situation but don’t always occur
What is the cognitive model of panic?
CMP suggests panic attacks result from the catastrophic misinterpretation of certain bodily sensations.
Why is hyperventilation often associated with panic attacks?
sensations produced by hyperventilation are interpreted in a negative and catastrophic way (major determinant of panic)
What determines the vulnerability of patients to experience panic attacks?
result of person’s tendency to interpret bodily sensations in a catastrophic way
What are 2 types of interpretations of sensations?
- Positive interpretation → experiencing hyperventilation as pleasant → positive affect
- Negative interpretation → experiencing hyperventilation as unpleasant → negative affect
- Without the negative interpretation, panic would not occur
Define agoraphobia
fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless or embarrassed.
**What is the DSM-V for agoraphobia?
Need to know this? otherwise look in doc, incomplete FC
Patients must have marked, persistent (≥ 6 months) fear of or anxiety about ≥ 2 of the following situations:
* Using public transportation
* Being in open spaces (eg, parking lot, marketplace)
* Being in an enclosed place (eg, shop, theatre)
* Standing in line or being in a crowd
* Being alone outside home
What is the DSM-V for SAD?
- Fear/anxiety about social situations where individual exposed to possible scrutiny by others. E.g. social interactions, being observed (eating/drinking), performing
- Social situations almost always provoke fear/anxiety.
- Social situations avoided or suffered with intense fear/anxiety.
- Fear/anxiety is out of proportion to actual threat created by social situation & to sociocultural context.
- Fear, anxiety, or avoidance = persistent (6 months or more)
- Fear, anxiety, or avoidance causes impairment in social, physical, daily, occupational functioning.
- Fear, anxiety, or avoidance = NOT due to physiological effects of a substance (e.g., a drug of abuse, meds) or another medical condition.
- Fear, anxiety, or avoidance NOT better explained by symptoms of another mental disorder, e.g PD, body dysmorphic disorder, autism.
- IF another medical condition (e.g., Parkinson’s, obesity) present, fear, anxiety, or avoidance = clearly unrelated or is excessive.
What is SAD?
- Anxiety/fear provoked by exposure to certain types of social situations
- avoiding social performance and interactions
- excessively concerned about how they are perceived and evaluated by others
What are the types of SAD?
- Performance fears
- Interactional fears
- Generalised SAD
- Non-generalised SAD
How can interpreatation of bodily sensatoins be affected?
to do with PD
- Interpretation can be result of previous experience (direct or vicarious) of particular bodily sensations as dangerous or a result of unclear information about disease or other catastrophes.
- Mood changes can temporarily increase likelihood that negative interpretations will be used, whilst also decreasing accessibility of non-catastrophic interpretations
What are performance fears?
Type of SAD
Fear of being in front of other people and putting on a performance (public speaking, eating, drinking, acting, playing an instrument)
What are interactional fears?
Type of SAD
fear of face-to-face conversations (meetings, social gatherings, parties, new situations)
What is generalised SAD?
- experience anxiety & excessive self-consciousness in wide range of social situations.
- May feel anxious & fearful in both performance-based situations & non-performance situations (e.g. conversations, social gatherings, or being in groups).
- Anxiety not limited to specific contexts but present across multiple social scenarios.
What is the aetiology of SAD?
- How parents tell you to deal with social scrutiny e.g. don’t care what people say or be careful what you say, some might think this of you.
- Negative social encounters
What do individuals with SAD often experience?
- Psychosocial problems (difficulties finding job, going to school or getting married)
- Great interference in academic or occupational life
- Significant reductions in work productivity
- Lower levels of income & educational success
- Significant decrease in QoL (problems in family, social & romantic relationships)
What is GAD?
anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities
What is worry?
- Key symptom of GAD
- “apprehensive expectation”
- repetitive thinking about potential future threats
- imagined catastrophes
- uncertainties and risks or a chain of thoughts and images
- uncontrollable
thinking about future events in a way that leaves you feeling anxious or apprehensive.
Explain different attitudes about worrying
- People without GAD - Positive thoughts about worrying coz worrying can prepare you for a threat - e.g. what do I want to do after my study?
- People with GAD - Negative metacognitive beliefs about the worry. e.g. If i am distracted by my worrying I affect others, I am a bad person if worrying, I can’t take care of others if I am worrying, fear of future, am I going to accomplish my studies, etc.
What is the DSM-V of GAD?
- Excessive anxiety & worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events (e.g. work or school performance).
- The individual finds it difficult to control worry.
- The anxiety & worry associated with 3 (+) symptoms
- Anxiety, worry, or physical symptoms = distress/impairment in social, occupational etc functioning.
- Disturbance not caused by to physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- Disturbance is not better explained by another mental disorder.
Why are anxious people less relaxed?
Anxious people are highly aroused and alert & most often in a state of “over preparedness”.
What is the difference between depression rumination & GAD worrying?
- Worrying about what may happen in future, rumination depression about past.
- GAD worry can also be about others, depression rumination always about yourself.
