1- Panic and Agoraphobia

Source: https://app.lecturio.com/#/lecture/c/7526/59633/33054

Correct answer: C. Panic disorder is characterized by recurrent panic attacks with persistent concern or behavioral change

Explanation:

• A panic attack is not a mental disorder; it is a specifier that can occur in many conditions (or even in healthy individuals).

• Panic disorder requires recurrent panic attacks plus ongoing fear of future attacks or maladaptive behavior changes.

Panic attack vs panic disorder

Which of the following statements is CORRECT?

A. A panic attack is a DSM-5 mental disorder
B. Panic disorder refers to a single unexpected panic attack
C. Panic disorder is characterized by recurrent panic attacks with persistent concern or behavioral change
D. Panic attacks only occur in panic disorder

Correct answer: B. Panic disorder

Explanation:

• Panic attacks are acute episodes.

• Panic disorder is chronic, defined by persistent worry or behavioral changes lasting ≥1 month.

Chronicity

Which condition is considered chronic rather than episodic?

A. Panic attack
B. Panic disorder
C. Acute stress reaction
D. Specific phobia

Correct answer: C. Lifetime prevalence is approximately 2–5%

Explanation:

• Lifetime prevalence ≈ 2–5%

• Women are affected about twice as often as men

• Typical onset is late adolescence to early adulthood, often early 30s

Epidemiology of panic disorder

Which of the following best describes the epidemiology of panic disorder?

A. Affects about 20% of the population
B. Occurs equally in men and women
C. Lifetime prevalence is approximately 2–5%
D. Most cases begin after age 60

Correct answer: B. Post-traumatic stress disorder (PTSD)

Explanation:

• Panic disorder commonly coexists with PTSD, GAD, and major depressive disorder.

Comorbidity

Which disorder is commonly comorbid with panic disorder?

A. Schizophrenia
B. Post-traumatic stress disorder (PTSD)
C. Autism spectrum disorder
D. Bipolar I disorder

Correct answer: C. Anxiety is persistent and may interfere with daily functioning

Explanation (correction):

• GAD involves persistent, excessive anxiety lasting ≥6 months.

• It often interferes with daily functioning, unlike what was implied earlier.

Clarifying GAD (correction)

Which statement about generalized anxiety disorder (GAD) is MOST accurate?

A. Anxiety is episodic and sudden
B. Symptoms usually resolve within one week
C. Anxiety is persistent and may interfere with daily functioning
D. GAD does not cause functional impairment

Correct answer: B. Diathesis–stress model

Explanation (correction):

• The correct term is diathesis–stress model, not “double diaphysis.”

• It refers to genetic vulnerability + environmental stressors.

Etiology model (terminology correction)

The development of panic disorder is best explained by which model?

A. Psychodynamic fixation model
B. Diathesis–stress model
C. Behavioral extinction model
D. Neurodegenerative model

Correct answer: C. Increased 4–8 times

Explanation:

• First-degree relatives have a 4–8× increased risk, supporting genetic vulnerability.

Genetic risk

If a first-degree relative has panic disorder, the individual’s risk is:

A. Unchanged
B. Doubled
C. Increased 4–8 times
D. Increased only if trauma is present

Correct answer: B. Increased fear generalization and catastrophic misinterpretation

Explanation:

• Neurotic individuals tend to misinterpret benign bodily sensations (e.g., exercise-induced tachycardia) as dangerous, triggering panic.

Neuroticism and panic

Why does neuroticism increase the risk of panic disorder?

A. Reduced emotional awareness
B. Increased fear generalization and catastrophic misinterpretation
C. Impaired memory consolidation
D. Increased serotonin production

Correct answer: B. Amygdala

Explanation:

• The amygdala, along with the hypothalamus and cortical regions, is critical in panic circuitry.

Neurobiology

Which brain structure plays a central role in fear processing and panic?

A. Cerebellum
B. Amygdala
C. Occipital cortex
D. Basal ganglia

Correct answer: B. Panic attacks peak within about 10 minutes

Explanation (clarification):

• Panic attacks peak rapidly, usually within 10 minutes, and resolve within ~20–30 minutes.

Panic attack duration (clarification)

Which statement about panic attack duration is MOST accurate?

A. Panic attacks usually last several hours
B. Panic attacks peak within about 10 minutes
C. Panic attacks are continuous throughout the day
D. Panic attacks require sedation to stop

Correct answer: C. Fear and avoidance of situations where escape or help may be difficult

Explanation:

• Core fear: being trapped, unable to escape, or unable to receive help during panic-like symptoms.

Agoraphobia definition

Agoraphobia is best defined as:

A. Fear of open spaces only
B. Fear of social embarrassment exclusively
C. Fear and avoidance of situations where escape or help may be difficult
D. Fear of enclosed spaces

Correct answer: C. Agoraphobia can occur with or without panic disorder

Explanation (clarification):

• DSM-5 recognizes agoraphobia as a separate diagnosis.

• It may occur with or without panic disorder.

Relationship between panic disorder and agoraphobia (clarification)

Which statement is CORRECT?

A. Agoraphobia only occurs with panic disorder
B. Panic disorder always leads to agoraphobia
C. Agoraphobia can occur with or without panic disorder
D. Agoraphobia is not a DSM-5 diagnosis

Correct answer: C. Panic disorder with agoraphobia

Explanation:

• Recurrent panic symptoms

• Avoidance behavior

• Fear of future attacks in public spaces
  → Panic disorder with agoraphobia

Case application (Jennifer)

Jennifer avoids grocery stores due to fear of panic symptoms and inability to escape. What is the MOST appropriate diagnosis?

A. Social anxiety disorder
B. Specific phobia
C. Panic disorder with agoraphobia
D. Generalized anxiety disorder

Correct answer: B. Recurrent unexpected panic attacks followed by ≥1 month of persistent concern or behavioral change

Explanation:

• Panic disorder requires unexpected panic attacks plus at least 1 month of:

  • Persistent worry about additional attacks and/or

  • Maladaptive behavioral changes

• Agoraphobia is not required.

DSM-5 diagnostic requirement (uncovered)

Which of the following is REQUIRED for a DSM-5 diagnosis of panic disorder?

A. Panic attacks triggered only by specific feared situations
B. Recurrent unexpected panic attacks followed by ≥1 month of persistent concern or behavioral change
C. Presence of agoraphobia
D. Daily panic attacks for at least 6 months

Correct answer: C. Unexpected nature of panic attacks

Explanation:

• Panic disorder is defined by unexpected (uncued) panic attacks.

• Panic attacks in phobias or social anxiety are typically expected and situation-bound.

Expected vs unexpected panic attacks (uncovered clarification)

Which feature best distinguishes panic disorder from panic attacks occurring in other anxiety disorders?

A. Presence of somatic symptoms
B. Duration of symptoms
C. Unexpected nature of panic attacks
D. Severity of anxiety

Correct answer: C. Add the specifier “with panic attacks”

Explanation:

• DSM-5 allows “with panic attacks” as a specifier for many mental disorders.

• Panic attacks alone do not equal panic disorder.

Panic attack specifier (uncovered DSM-5 concept)

A patient with major depressive disorder experiences recurrent panic attacks. How should this be coded diagnostically?

A. Diagnose panic disorder instead
B. Panic attacks are ignored diagnostically
C. Add the specifier “with panic attacks”
D. Diagnose generalized anxiety disorder

Correct answer: B. Pheochromocytoma

Explanation:

• Pheochromocytoma causes episodic catecholamine surges → palpitations, sweating, anxiety.

• Hyperthyroidism (not hypo-) is another important mimic.

Differential diagnosis – medical causes (uncovered)

Which medical condition can most closely mimic panic attacks and must be ruled out?

A. Hypothyroidism
B. Pheochromocytoma
C. Iron deficiency anemia
D. Diabetes mellitus

Correct answer: B. Anxiety sensitivity

Explanation:

• Anxiety sensitivity = fear of anxiety-related bodily sensations themselves

• This explains why benign sensations (e.g., tachycardia) trigger panic.

Fear of bodily sensations (uncovered mechanism)

What cognitive process most strongly contributes to panic disorder development?

A. Thought suppression
B. Anxiety sensitivity
C. Emotional blunting
D. Dissociation

Correct answer: C. It may persist independently even after panic attacks decrease

Explanation:

• Avoidance behaviors can become conditioned and persistent, even if panic frequency decreases.

• This explains long-term functional impairment.

Course of agoraphobia (uncovered nuance)

Which statement about agoraphobia is MOST accurate?

A. It always resolves when panic attacks stop
B. It is caused by social embarrassment only
C. It may persist independently even after panic attacks decrease
D. It occurs only in women

DSM-5: Obsessive-Compulsive and Related Disorders

• Obsessive-Compulsive Disorder (OCD) — F42.2

• Body Dysmorphic Disorder — F45.22

• Hoarding Disorder — F42.3

• Trichotillomania (Hair-Pulling Disorder) — F63.3

• Excoriation (Skin-Picking) Disorder — F42.4

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DSM-5: Trauma- and Stressor-Related Disorders

• Reactive Attachment Disorder — F94.1

• Disinhibited Social Engagement Disorder — F94.2

• Post-Traumatic Stress Disorder (PTSD) — F43.1

• Acute Stress Disorder — F43.0

• Adjustment Disorders — F43.2

• Prolonged Grief Disorder — F43.8

• Other Specified Trauma- and Stressor-Related Disorder — F43.8

• Unspecified Trauma- and Stressor-Related Disorder — F43.9

DSM-5: Anxiety Disorders

1. Panic Disorder — F41.0

2. Agoraphobia — F40.0

   • Agoraphobia without panic disorder — F40.00

   • Agoraphobia with panic disorder — F40.01

3. Specific Phobia — F40.2

4. Social Anxiety Disorder (Social Phobia) — F40.1

5. Generalized Anxiety Disorder (GAD) — F41.1

6. Separation Anxiety Disorder — F93.0

7. Selective Mutism — F94.0

8. Substance/Medication-Induced Anxiety Disorder — F41.8

9. Anxiety Disorder Due to Another Medical Condition — F41.8

10. Other Specified Anxiety Disorder — F41.8

11. Unspecified Anxiety Disorder — F41.9