Panic Disorder and Agoraphobia

Marked fear/anxiety for two or more

public transportation, open spaces, enclosed spaces, standing in line, being outside the home alone

Combined psychological and drug treatments are no better than

CBT or drugs alone

Psychological intervention

• Exposure-based

• Reality testing

• Relaxation and breathing skills

Panic Control Treatment

Exposure to interoceptive cues

Cognitive therapy

Relaxation/breathing

CBT is better

long-term

Multiple systems affected by medication

serotonergic

noradrenergic

GABA

High relapse rates after

discontinuation of medication

Causes of nocturnal panic

Generalized biological vulnerability

Cues get associated with situations

Generalized psychological vulnerability

Generalized biological vulnerability

Alarm reaction to stress

Cues get associated with situations

Conditioning occurs

Generalized psychological vulnerability

Anxiety about future attacks

Hypervigilance

Increase interoceptive awareness

60% with panic disorder experience

nocturnal attacks

When do nocturnal panic attacks occur?

Occur in non-REM sleep

Occur during delta/slow wave sleep

Nocturnal attacks are caused by

deep relaxation

Sensations of “letting go” are

anxiety provoking to people with panic attacks

\~75% of those with agoraphobia are

female

In developing countries, somatic symptoms more emphasized than

emotional symptoms

Diagnostic Criteria for Agoraphobia: Situations always provoke

fear

Diagnostic Criteria for Agoraphobia: Anxiety not proportional to

real danger

Diagnostic Criteria for Agoraphobia: Marked fear/anxiety for two or more:

public transportation, open spaces, enclosed spaces, standing in line, being outside the home alone

Diagnostic Criteria for Agoraphobia: Anxiety is

excessive

Diagnostic Criteria for Agoraphobia: Not better explained by

another mental disorder

Diagnostic Criteria for Agoraphobia: Significant

distress

Diagnostic Criteria for Panic Disorder: Recurrent

unexpected panic attaches

Diagnostic Criteria for Panic Disorder: At least one attack has been followed by

significant worry or maladaptive change in behavior

Diagnostic Criteria for Panic Disorder: Not attributable to

substance use

Diagnostic Criteria for Panic Disorder: Not better explained by

another mental disorder

What is a common symptom in children with panic disorder?

hyperventilation

Agoraphobia: fear or avoidance of

situations/events

Agoraphobia: Concern about being unable to

escape or get help in the event of panic symptoms or other unpleasant physical symptoms (e.g., incontinence, vomiting, falling)