anxiety_lec - ANXIETY DISORDERS Anxiety is the predominant...

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ANXIETY DISORDERS * Anxiety is the predominant symptom * Avoidance is almost always present DSM-IV lists: - PANIC DISORDER - PHOBIAS - GENERALIZED ANXIETY DISORDER (GAD) - OBSESSIVE-COMPULSIVE DISORDER (OCD) - ACUTE & POST-TRAUMATIC STRESS DISORDER (PTSD) * Note that there is high comorbidity among the five anxiety disorders! PANIC DISORDER: DSM-IV criteria for “panic attack”: * “A discrete period of intense fear of discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes.” * Pounding heart or palpitations * Sweating * Trembling * Shortness of breath * Feeling of choking * Chest pain * Nausea * Feeling dizzy * Depersonalization (= feeling detached from oneself) * Fear of going crazy * Fear of dying * Numbness * Chills or hot flashes Etymology “Panic:” * Pan : Greek god of fertility
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DSM-IV definition of Panic Disorder includes: * Recurrent and unexpected panic attacks. * Concern about expected future panic attacks or about losing control. * Symptoms cause significant distress or dysfunction Note: Panic disorder can occur with or without agoraphobia. Prevalence: * One year prevalence: 2.7% * Lifetime prevalence: 5% Gender Ratio: * 5:2 (female: male) Onset: * 15-35 years * Rarely before puberty Etiology of Panic Disorder : * Often biological predisposition (genetic; hypersensitive NS; oversensitive locus ceruleus) * First panic attack may be triggered by drugs, medications, medical condition, or trauma * Conditioning process Treatment of Panic Disorder Education about: * Panic attack as a normal "flight-fight" response * Conditioning process: Catastrophic thoughts to bodily sensations trigger panic attacks * Encourage moderate aerobic exercise * Regular eating (panic sufferers are often borderline hypoglycemics) * Reducing caffeine intake, etc. * Breathing exercises (to prevent hyperventilating) * Relaxation training (to reduce overall stress) NOTE: Education can be done in a group setting
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Cognitive-Behavior Therapy: * Cognitive exercises to restructure thinking about panic: - Identify negative thoughts and learn to combat them - Devise coping statements (e.g., "I won't die”; “I can ride this out, it will pass.")
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