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PSY240H1 Lecture Notes - Locus Coeruleus, Panic Disorder, Kindling Model

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M.Mc Kay

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PSY240 Lecture 3 May 23, 2012: Anxiety Disorders (Chapter 7)
Disorder vs. difficulties
There are a couple of things to keep in mind when talking about certain disorders.
In the DSM there are 2 components that go along with every disorder, and you have to ensure
the 1st one does not exist.
1. Not due to the physiological effects of a substance or medical condition; you have to
make sure that the symptom is not a side effect of physiological disorder/drugs.
2. Symptoms cause clinically significant distress/impairment in functioning; another
component is that there has to be some impairment in someone's functioning for it to be a
Fears of people with anxiety disorders
Severe enough to lower the quality of life
Chronic and frequent enough to interfere with functioning
Out of proportion to the dangers that they truly face
Adaptive vs. maladaptive fear
Some anxiety or fear is appropriate and adaptive e.g. flight or fight (can get you out of
harmful situations, can be a motivator, it is appropriate in certain situations)
Adaptive: - Concerns are realistic, all things considered
- Amount of fear experiences in proportion to the threat
- Fear response subsides when threat ends
- Concerns are unrealistic; source of anxiety cannot hurt them or unlikely
to occur
- Amount of fear experienced is out of proportion to harm that threat
could cause
- Fear response continues or is persistent even after the threat is no longer
present; additionally, the person may experience a great deal of
anticipatory anxiety
Symptoms of anxiety
Panic attacks
Occur within many anxiety disorders (and others)
Not a disorder on its own because they occur too frequently and among many disorders. People
can have manic attacks and not have any disorder.
Characterized by one of three core themes:
o Dizziness related symptoms

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o Cardio-respiratory distress
o Cognitive factor (fear of death, fear that something is really wrong, fear of heart attack,
Panic attacks: DSM-IV-TR
Discrete periods of intense fear in which four or more of the following symptoms develop abruptly
and reach a peak within 10 minutes:
Palpitations/pounding heart
Sensations of shortness of breath/being smothered
Feeling of choking
Chest pain/discomfort
Nausea/abdominal distress
Feeling dizzy, lightheaded, funny
Derealization (feelings of unreality or depersonalization – being detached from oneself)
Fear of losing control or going
Parethesias (numbness or tingling sensations)
Chills/hot flushes
Panic disorder
40% of young adults have occasional panic attack (in context of disorder and not);
Life prevalence 3-4% (Canadian estimated at 1.2% in one study, though may be flawed)
Age on onset: late adolescence to mid 30’s
Highly co-morbid with other anxiety disorders and depression
Characterized by:
o Intense fear or discomfort
o Physiological symptoms of anxiety
o Perception of losing control, going crazy, or dying
Often precipitated by some sort of triggering event or stimulus but not always
Panic disorder: DSM-IV-IR
Agoraphobia: fear of the marketplace/fear of going outside/going into crowds/fear of going to
any place where escape would be unlikely.
Without agoraphobia:
a) Both (1) and (2)
1. Recurrent, unexpected panic attacks
2. At least one of the attacks followed by 1 month or more of
a. Concern about having another one
b. Worry about the consequences of an attack
Find out by asking, "has your behaviour changed as a result of these attacks" (and they will
respond that they've changed the way they do things/things they do).
b) Absence of agoraphobia
c) Panic attack not due to physiological effects of a substance or medical condition
d) Panic attacks not better explained by another mental disorder such as social or specific phobia
a) Anxiety about being in places from which escape might be difficult/embarrassing, or in
which help may not be available in the event of a panic attack
b) Situations are avoided or endured with marked distress/anxiety about having panic attack
c) Anxiety/avoidance not better accounted for by another anxiety disorder
Panic disorder with agoraphobia = Criteria for PD + Criteria for agoraphobia
Panic disorder theories
Genetic theories: genetic transmission puts some people at risk for panic disorder; 10% of
people with panic disorder have first degree relatives also diagnosed

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Neurotransmitter theories: poor regulation of norepinephrine, serotonin, and perhaps GABA
and CCK in the locus ceruleus and limbic system, causes panic disorder
Poorly regulated fight-or-flight responses: some people are particularly sensitive to having
their fight-or-flight responses triggered (as seen by sensitivity after increasing carbon dioxide
levels by hyperventilating)
Kindling model: poor regulation in the locus ceruleus causes panic attacks,
stimulates and kindles the limbic system, lowering the threshold for stimulation
and diffuse of chronic anxiety
Involved in
production of panic
attacks. Poor
regulation here causes
PA, which
system and lowers
Cognitive theories: people prone to panic attacks (1) pay very close attention to their bodily
sensations (i.e., increased interoceptive awareness), (2) misinterpret these sensations, and (3)
engage in catastrophizing thinking
Such people may be labeled as being high in anxiety sensitivity
Gender theories: women display anxiety sensitivity more frequently than do women
Some evidence that ovarian hormones, particularly progesterone, play a role in increasing
susceptibility to panic disorder
Proposed integrated model of PD (FOUND IN TEXT)
Biological treatments
Tricyclic antidepressants:
increased levels of norepinephrine
Serotonin reuptake (SSRIs): increased levels of serotonin
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