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PSY 961 PANIC DISORDER / AGORAPHOBIA. PANIC ATTACK - DSM DISCRETE PERIOD OF INTENSE FEAR OR DISCOMFORT WITH FOUR OF THE FOLLOWING SYMPTOMS, REACHING A.

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Presentation on theme: "PSY 961 PANIC DISORDER / AGORAPHOBIA. PANIC ATTACK - DSM DISCRETE PERIOD OF INTENSE FEAR OR DISCOMFORT WITH FOUR OF THE FOLLOWING SYMPTOMS, REACHING A."— Presentation transcript:

1 PSY 961 PANIC DISORDER / AGORAPHOBIA

2 PANIC ATTACK - DSM DISCRETE PERIOD OF INTENSE FEAR OR DISCOMFORT WITH FOUR OF THE FOLLOWING SYMPTOMS, REACHING A PEAK IN 10 MINUTES. ► PALPITATIONS ► SWEATING ► TREMBLING/SHAKING ► BREATHLESSNESS ► CHOKING

3 ► CHEST PAIN ► ABDOMINAL DISTRESS ► DIZZY/FAINT ► UNREALITY/DETACHMENT ► FEAR OF LOSING CONTROL OR GOING CRAZY ► FEAR OF DYING ► PARAESTHESIAS ► CHILLS OR HOT FLUSHES MAY BE UNEXPECTED (UNCUED) OR SITUATIONALLY BOUND (CUED)

4 PD-W/O AG - DSM A. BOTH  RECURRENT UNEXPECTED PANIC ATTACKS  ONE MONTH OR MORE OF PERSISTENT CONCERN OVER FUTURE ATTACKS B.ABSENCE OF AGORAPHOBIA C.NOT DIRECTLY DUE TO SUBSTANCE.

5 PD-W AG - DSM A. BOTH RECURRENT UNEXPECTED PANIC ATTACKS ONE MONTH OR MORE OF PERSISTENT CONCERN OVER FUTURE ATTACKS ONE MONTH OR MORE OF PERSISTENT CONCERN OVER FUTURE ATTACKS B.PRESENCE OF AGORAPHOBIA - ANXIETY ABOUT PLACES WHERE ESCAPE MAY BE DIFFICULT OR IN WHICH HELP MAY NOT BE AVAILABLE IN THE EVENT OF A PANIC ATTACK B.PRESENCE OF AGORAPHOBIA - ANXIETY ABOUT PLACES WHERE ESCAPE MAY BE DIFFICULT OR IN WHICH HELP MAY NOT BE AVAILABLE IN THE EVENT OF A PANIC ATTACK SITUATIONS ARE AVOIDED OR ENDURED WITH DISTRESS.

6 FEATURES OF PANIC DISORDER ► ATTACKS, SPELLS ► OUT OF THE BLUE ► PHYSICAL DISEASE FEAR ► CASUALTY ► MEDICAL SPECIALISTS ► EXPLICIT MEMORY FOR ONSET

7 HYPOCHONDRIASIS ► FEAR OF DISEASE ► BELIEF IN DISEASE ► MISINTERPRETATION OF BENIGN SIGNS ► RELUCTANCE TO BELIEVE GP ► REASSURANCE SEEKING

8 FEATURES OF HYPOCHONDRIASIS ► EXAGGERATED ANXIETY RELATIVE TO DISEASE ► DRAMATIC, ANXIOUS ► OFTEN VERY OBSESSIONAL ► FREQUENT DYSPHORIA ► DEPENDENCE AND REASSURANCE ► HISTORY OF PHYSICAL AILMENTS

9 DEMOGRAPHICS AGE OF ONSETMID 20’S GENDERFEM – ESP FOR AG. COURSEFLUCTUATING IMPAIRMENTMOD TO HIGH COMORBIDITYHIGH PRESENTATIONMEDICAL

10 MEAN AGE OF ONSET REPORTED BY PHOBICS - ÖST (1987)

11 SIGNIFICANT SYMPTOMS IN 6 MONTHS – FAVA ET AL. (1988) N OF SUBJECTS

12 ANXIETY SENSITIVITY INDEX – REISS ET AL.(1986) ► IT SCARES ME WHEN I FEEL SHAKY ► IT SCARES ME WHEN I FEEL FAINT ► IT SCARES ME WHEN MY HEART BEATS RAPIDLY ► UNUSUAL BODY SENSATIONS SCARE ME ► IT SCARES ME WHEN I FEEL SHORT OF BREATH

13 ASI SCORES IN ANXIOUS INDIVIDUALS – TAYLOR ET AL (1992) DX MEAN ASI PD36.6 PTSD31.6 GAD26.2 OCD25.4 SOCIAL24.9 SPECIFIC16.1

14 THREE MAIN FACTORS IN ASI – ZINBARG ET AL, ► PHYSICAL CONCERNS  IT SCARES ME WHEN MY HEART BEATS RAPIDLY ► MENTAL INCAPACITATION CONCERNS  WHEN I AM NERVOUS I WORRY THAT I AM MENTALLY ILL ► SOCIAL CONCERNS  IT IS IMPORTANT TO ME NOT TO APPEAR NERVOUS

15 LEARNING HISTORY IN PEOPLE WITH PANIC DISORDER – EHLERS (1998) PDOADNC Ss sick role experiences – panic sxs 1.1a0.8a0.1b Observation of parental sick role – panic sxs 2.8a1.8ab0.9b Encouragement of sick role - colds

16 LEARNING HISTORY IN PEOPLE HIGH VS LOW ON ASI – WATT ET AL. (1998) HI ASI LO ASI Ss sick role experiences – anx sxs * Observation of parental sick role – anx sxs * Encouragement of sick role - colds *

17 MODEL OF LEARNING HISTORY, AS, AND PANIC ATTACKS – STEWART ET AL. (2001) LHQ NON- AROUSAL SXS LHQ AROUSAL SXS PHYSICAL CONCERN PANIC ATTACKS

18 PREDICTION OF ANXIETY DISORDERS (MALLER & REISS, 1992) 1987 DX 1984 – HIGH ASI 1984 – LOW ASI PANIC DISORDER 81 GAD31 SPECIFIC50 SOCIAL71

19 PANIC ATTACKS BY ASI QUARTILES – SCHMIDT ET AL. (1997) NUMBER OF ATTACKS QUARTILE

20 STRESS BEFORE ONSET – RAPEE ET AL. (1990)

21 STRESS BEFORE ONSET – FARAVELLI (1985) MONTHS N. OF EVENTS

22 IMPACT OF STRESS BEFORE ONSET – RAPEE ET AL. (1990)

23 MAINTENANCE OF PANIC DISORDER RAPEE (1993). ADVANCES IN BEHAVIOUR RESEARCH AND THERAPY, 15,

24 ONSET OF PANIC DISORDER – BARLOW (2002)

25 COLOUR-NAMING IN SOCIAL PHOBIA AND PANIC DISORDER - HOPE ET AL. (1991) INTERFERENCE INDEX WORD TYPE

26 PROBE DETECTION LATENCY – ASMUNDSON ET AL (1992)

27 THREAT INTERPRETATIONS – HARVEY ET AL. (1993)

28 REACTION TIMES TO TARGET WORD – SCHNIERING & RAPEE (1997) MS

29 PANIC ATTACK TO BIOLOGICAL CHALLENGE – RAPEE ET AL. (1992)

30 INTENSITY OF PANIC TO CO 2 - RAPEE ET AL. (1986)

31 PANIC TO CO2 SANDERSON ET AL. (1990) CONTROLNO CONTROL PERCENT PANIC ATTACKS

32 HYPERVENTILATION THEORY OF PANIC

33 PD VS PDA – RAPEE & MURRELL (1988) MINMODSEVERE SITUATIONS TRIGGER CAN AVOID ONSET FQ - SOCIAL ASSERTIVENESS EPQ-N

34 PD VS PDA – TELCH ET AL. (1989) PDPDA BDI PHYS CONSEQS OF PANIC SOCIAL CONSEQS OF PANIC LOSS OF CONTROL OVER PANIC


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