Disturbances in or lack of serotonin 5 ht1a receptors

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Disturbances in or lack of serotonin 5-HT1A receptors Genetic studies: Higher concordance rates for MZ than for DZ twins for panic disorder; less support for genetics in GAD
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Treatment of panic disorder and generalized anxiety disorder Biochemical treatment Antidepressants (tricyclic antidepressants and Selective Serotonin Reuptake Inhibitors (SSRIs)) and antianxiety medications (e.g., benzodiazepines); relapse after stopping drug therapy quite common; unclear if due to placebo effects which can approach 75% success rate in clinical trials. Benzodiazepines (Valium and Librium) useful in GAD but can cause tolerance and dependence
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Cognitive-behavioral treatment of panic disorder: Educate about panic symptoms, restructure catastrophic thinking, self-induce physiological symptoms, self- controlled exposure, substitute coping statements, identify high-risk situations. Higher success rates in behavioral treatment than medication; 80 percent treated with cognitive behavioral treatments were panic free Cognitive-behavioral treatment of GAD: focus on worrisome thoughts, discriminate between realistic and irrational worries, challenge irrational and catastrophic beliefs underlying worry, substitute coping and problem-solving thoughts, and use relaxation to counter somatic symptoms.
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Phobias Types of Phobias Agoraphobia: Fear of being in public places without help; fear of panic symptoms; anxiety over symptoms can result in people being house-bound. DSM-5: Endorsement of fears from 2+ situations now required; 6-month duration of symptoms Lifetime prevalence: 3.5 percent for males, 7.0 percent for females Panic attacks precede agoraphobia, but relationship unclear; clear precipitating event in 75 percent of those surveyed in one nationwide survey
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Catastrophic thoughts of losing control, becoming ill, and other extreme outcomes often associated with agoraphobia. Social anxiety disorder: Fear of being scrutinized; fear of negative evaluation from others. One subcategory: Performance (i.e., public speaking).
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Lifetime prevalence: 11.1 percent for males, 15.5 percent for females; 8.7 percent annually Women twice as likely to have social phobia, but men are more likely to seek treatment. Specific phobias: Irrational fear to object or situation In DSM-5, five “specifiers”: Animals, natural environmental (such as thunder), blood/injection or injury (e.g., needle phobics) – usually associated with fainting, situational (such as elevators, flying), and others (such as choking)
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Table: Phobias and Their Objects Table: Phobias and Their Objects
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Most common are small animals, heights, the dark, and being teased Two times more prevalent in women than in men; men may not admit to their fears more than women Etiology of phobias Psychodynamic perspective : Displaced sexual or aggressive conflict; phobic stimulus or situation has symbolic significance of real conflict that is threatening the person. Little Hans's fear that a horse would bite him represents his castration anxiety over Oedipal conflict with his father.
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Behavioral perspective Classical conditioning : Conditioned emotional responses; some research and clinical support for conditioned learning in that most phobic patients report conditioning experiences as perceived cause.
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