Panic Disorder and Agoraphobia

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Marked fear/anxiety for two or more

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1

Marked fear/anxiety for two or more

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

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2

Combined psychological and drug treatments are no better than

CBT or drugs alone

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3

Psychological intervention

  • Exposure-based

  • Reality testing

  • Relaxation and breathing skills

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4

Panic Control Treatment

Exposure to interoceptive cues

Cognitive therapy

Relaxation/breathing

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5

CBT is better

long-term

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6

Multiple systems affected by medication

serotonergic

noradrenergic

GABA

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7

High relapse rates after

discontinuation of medication

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8

Causes of nocturnal panic

Generalized biological vulnerability

Cues get associated with situations

Generalized psychological vulnerability

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9

Generalized biological vulnerability

Alarm reaction to stress

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10

Cues get associated with situations

Conditioning occurs

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11

Generalized psychological vulnerability

Anxiety about future attacks

Hypervigilance

Increase interoceptive awareness

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12

60% with panic disorder experience

nocturnal attacks

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13

When do nocturnal panic attacks occur?

Occur in non-REM sleep

Occur during delta/slow wave sleep

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14

Nocturnal attacks are caused by

deep relaxation

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15

Sensations of “letting go” are

anxiety provoking to people with panic attacks

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16

~75% of those with agoraphobia are

female

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17

In developing countries, somatic symptoms more emphasized than

emotional symptoms

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18

Diagnostic Criteria for Agoraphobia: Situations always provoke

fear

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19

Diagnostic Criteria for Agoraphobia: Anxiety not proportional to

real danger

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20

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

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21

Diagnostic Criteria for Agoraphobia: Anxiety is

excessive

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22

Diagnostic Criteria for Agoraphobia: Not better explained by

another mental disorder

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23

Diagnostic Criteria for Agoraphobia: Significant

distress

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24

Diagnostic Criteria for Panic Disorder: Recurrent

unexpected panic attaches

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25

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

significant worry or maladaptive change in behavior

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26

Diagnostic Criteria for Panic Disorder: Not attributable to

substance use

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27

Diagnostic Criteria for Panic Disorder: Not better explained by

another mental disorder

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28

What is a common symptom in children with panic disorder?

hyperventilation

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29

Agoraphobia: fear or avoidance of

situations/events

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30

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)

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