Anxiety: Panic and Agoraphobia: 5.3 a, b, c, d

Clinical Description

Panic disorder and agorophobia connection

panic disorder is when one continually faces unexpected panic attacks.

it is closely linked with agoraphobia because if they stay at home they avoid panic attacks, etc. in public

Agorophobia

a disorder in which people stay house bound to avoid situations where they feel unsafe, or out of control (if something were to go wrong)

(ex. panic attack happens, or medical issue and can’t reach hospital)

they stay home since they don’t know when symptoms might happen

Why are panic disorder and agoraphobia not just one disorder

because either disorder can occur without the other.

not all agoraphobics get panicked

not all those with panic disorder stay at home

Panic Disorder

its not just having panic attacks. its having a unexpected panic attack(s) and having anxiety about whether there’ll be a next one, or the implications of the attack and its consequences

people with the disorder fear getting it in public and plan escape routes

Panic Disorder Diagnostic criteria: (physical symptoms)
(HSTB, NDC, PDFF)
Hot shit to be is NDC PDF F

these physical symptoms can come from a calm or anxious state

Heart palpitations

Sweating

Trembling

Short of breath/smother

Nausea / abdominal distress

Dizzy / lightheaded

Chills or heated

Paresthesis (numb tingly)

Derealization or depersonalization

Fear of going crazy (losing control)

Fear of dying

culture specific doesnt count: crying, screaming, neck sore, tinnitus may be seen

Derealization

feelings of unreality (world isnt real)

Panic Disorder Diagnostic Criteria (activies, lifestyle)

one or more of these follow a panic attack for a month of longer

• persistently afraid of a panic attack happening, worried about its consequences

• Maladaptive behaviour change to avoid panic attacks (avoiding unfamilar situations)
  

• Behaviour is not due to a substance or other medical condition

• Not better explained by another disorder

Depersonlizaiton

feeling detached from oneself (outerbody)

Diagnostic criteria for Agoraphobia (situations)

Anxiety about 2 or more of the following:

• anxiety of Public Transport

• open spaces (parking lots , malls)

• standing in line being in a crowd

• being outside or home alone

B C D: Agoraphobia diagnostic criteria

B. believes escape might be difficult

or may be unable to get help for panic attack, or another embarrassing instance

C. The agoraphobic situations always envoke feelings of fear or anxiety

D. The situations are avoided or require a companion or are endured with instense fear and anxiety

E F G: Agoraphobia diagnostic criteria

E. fears or anxieties or out of proportion to the sociocultural context, and actual danger in reality

F. fear, anxiety, is persistant lasting up to six months or more

G. the fear, anxiety causes distress and significantly disrupts social life, work 

H I: Agoraphobia diagnostic criteria

H. if another condition is present the fear anxiety is excessive

I. Not better explained by another disorder

origin for Agorophobia name

named by greek physician agora means greek marketplace

Agorophobia: consequences of panic attacks become even more of an issue than the panic symptoms and can be become a problem independent of panic attacks

simply put since panic attacks are severe and unexpected, a lot of complications are involved dealing the attacks, worrying about the attacks.

they want a space space (home), and safe person in case things go wrong

What does it mean that agoraphobic behaviour can become independent of the panic attacks

Agoraphobics who haven’t panics attacks for many years will still be stuck with agoraphobic behaviours, fearing situations, etc

is agorophobic behaviour determined by the number of panic attacks you have?

no infact it is more so related to how much you expect panic attacks will happen, or when

Panic Disorder and Alcohol use

people with panic disorder or agorophobia cope using alcohol or drugs.

they like the anxiety reducing effects

interfeering with their anxiety leads to reduction in drinking

People with agoraphobia endure the intensity of anxiety and fear

People with agoraphobia endure the intensity of anxiety and fear to go on with life achieve their goals. still debilitating

Interoceptive avoidance (trait of panic disorder and agorophobia)

avoidance of internal physical sensations. removing oneslf from arousing activies like exercise

Panic disorder prevelance

3.5 % of population has panic disorder sometime within their life

the majority are women

Agorophobia prevelance

5% of population meets criteria for agorophobia (could be overestimated but experience real)

Onset of panic disorder

happens between midteens to late 40s

mean is 25 yrs old

majoritiy of people developed it before 33

Can children have panic attacks

they hyperventaliate, dont have feelings of “going crazy”, or fear dying, but don’t really know how to idenity such things

most panic attacks happen after puberty

panic disorder gender prevelance in older adults

primarily older women to men

the more intense the agoraphobia the higher proportion of women reasons are potentially cultural":

the more intense the agoraphobia the higher proportion of women could be because it is more socitetally acceptable for women to show fear and avoid, whereas men are supposed to be strong, braver

Fear of anxiety men vs women

women are more afraid of their anxiety symptoms compared to men

How do men with panic disorder commonly cope

in a societally acceptable way like consuming alcohol. a study showed that the less anxiety avoidance to higher the alcohol consumption

depedence on alchohol → addiction (arguably worse)

but it can mask the underlying panic issue

Panic disorder cultural influences

panic disorders occur everywhere in the world, but may manifest differently depending on the culture

lowest for Africans and Asisns and this continues into immgigrants from those regions howeverpanic disordr is associated with racial discrimination
Immigrants need to be model

Nocturnal Panic

panic attacks tat happen when you’re asleep

and awake during the attack.

causes best we got rn is that when were asleep we have slow delta waves and it simulates the feeling of letting go which can trigger the panic attack

different from sleep paralysis

Agorophobia causes

evidence that it develops after unexpected panic attack, but whether it develops or not or its deverity is determined by social, cultural factors

Panic / panic disorder causes

caused by genetic vulnerabilities activated by stress. also psychological as you could get panic attacks (trigerred) based upon the external, internal cues from your frist panic attacks

learned alarms

internal and external cues that trigger panic attacks

What ahppens to individuals who don’t develop panic disorder after having panic attacks

they attribute their panic attack to an event that was happening at the time

What is the model of panic disorder (with or without agorophobia)

General Bio vulnerablity , General Psycho vulnerability + stress from events
→ false alarm, learned alarms

→ Specific psychological vulnerability (unexplained physical sensations dangerous)

→ Anxious apprehension (determined by social, cultural factors)

→ Panic disorder

how many people in thw orld have experience a panic attack

8-12 % of thep population

Treatments for Panic Disorder and Agorophobia

Medication

Psychologiclal Intervention

Combination

Medications to treat Panic disorder

benzodiazipine

SSRI (prozac, paxil)]

SNRI (venlafaxine)

benzodiazipine panic disorder drawbacks

calms person, makes the person dependent, weakens cognitive and motor skills

(ex. alazopram/xanax)
still most widely used class of drugs

SSRI panic disroder

currently the reccomended drug for panic disorder, works with consistent use, downside is sexual dysfunction

medication overall effective?

yes majority 60% don’t experience panic attacks if used consistently. some don’t take it long enough for there to be any effect and panic relapses are prob is high

Is Psychological intervention effective?

Cognitive Yes it is effective. focus is on reducing agoraphobic avoidance. convincing them on a rational and an emotional level

relaxation breathing exercises

PCT

cognitive therapy
booster sessions are good to prevent relapse

PCT panic control treatment

involves exposing patient to a number of triggering sensations (mini panic attacks)

spin them around to make em dizzy

or breathe fast to elevate heart rate

remain better for at least 2 yrs

cognitive therapy panic disorders

figuring out the unconscious attituides perceptions behind feared situations and addressing them

the concern of misuse of breathing exercises

the breathing excersies can be used to avoid / escape the feared bodily sensations

the long term effective of medication, therapy, and both

medication, therapy, and combination work equally well at first

after 9 months, combination worked slightly better

15th month patients with CBT kept most of their gains, those on meds, or combinations were deterioating

used benzodiazepine so interference

the long term effective of medication, therapy with SSRI

SSRI worked rapidly but less likely to improve over time compared to therapy

though pretty close

General conclusion about treatment

combined doesnt due that much. psychological treatment doesnt do that much at first but helps overtime. SSRI works quickly but dicipates

start with both SSRI and psychological treatment