PANIC DISORDER

anxiety disorder

symptoms

• need four in order for a diagnosis to occur:

  • Palpitations

  • Sweating

  • Trembling

  • Shortness of breath

  • Choking

  • Fear of losing control

  • Fear of dying

  • Numbness

  • Chills or hot flashes, etc.

uncued panic attacks

• sudden and occur unexpectedly

  • Need in order to get diagnosis

cued panic attacks

• triggered by situations

  • Ex: driving across a bridge or getting into an elevator

  • Diagnosed with specific phobias

biological factors

mitral valve prolapse, locus coeruleus, amygdala, genetics

mitral valve prolapse

• blood leaks backward into the atrium

  • This backflow of blood may result in some symptoms of a panic attack (heart palpitations or chest pain)

  • Thought to be linked to heredity; may affect up to 3% of the population

  • Not everyone who has MVP has panic disorder, and vice versa; sometimes associated

locus coeruleus

• Changes in norepinephrine activity

• Norepinephrine important in fight or flight response

• Monkey research:

  • When this area is electrically stimulated, the monkeys have a panic like reaction

  • When area is surgical damaged, they show no reaction

• Specific problem unclear; is it too much/little norepinephrine?

amygdala

• Stimulation of the ____ is known to stimulate the locus coeruleus as well as other automatic responses to panic attacks

• When anyone confronts a frightening object or situation, the ____ is stimulated

  • This then stimulates other parts of the brain

genetics

• Family studies: 25% risk of panic in 1st degree relatives

• Twin studies concordance rates: MZ = 31%  DZ = 11%

• As far as we know, no adoption studies have been done

cognitive-behavioral

• Research has found that more than 25% of adults have experienced one panic attack in their lifetime

  • Often during a period of intense stress

  • Most of these individuals don't develop panic disorder 

• three important factors: attributions, anxiety sensitivity, importance of control

attributions

• People who don't develop panic disorder tend to attribute the attack to the stressor

• People who develop panic disorder tend to attribute the attack to organic causes such as heart attacks

anxiety sensitivity

• “_______ Index” – measures patients fear response to bodily sensations

• High scores on this index are hypersensitive to physical sensations

• Ex: woman who runs of 4 flights of stairs will think she is having a panic attack when she is really just tired

importance of control

• High scores on this index are likely to make “catastrophic” misinterpretations of bodily symptoms

• Stressor → Perception of unpleasant bodily sensations → Catastrophizing thoughts → Increased bodily sensations → More thoughts (all in a loop)

medications

• Benzodiazepines: when discontinued attacks recur, and they are addictive; Good in short run

• Some try to self-medicate through alcohol and other sedatives

• Antidepressants:

  • SSRIs (Pacil and Prozac) have been helpful

Tricyclic (imipramine) ok, but more difficult side effects

panic control therapy

• Newest cognitive behavioral treatment

• High success rates: 70-80% of those treated are free of panic by the end of treatments  

• Creation of “mini” panic attacks 

• Cognitive restructuring for response to physical sensations

• Patients can be taught relaxation exercises, distraction techniques, and breathing techniques