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PSY240 Lecture 3

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University of Toronto St. George
M.Mc Kay

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 disorder. 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 Maladaptive: - 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 21 o Cardio-respiratory distress o Cognitive factor (fear of death, fear that something is really wrong, fear of heart attack, etc.) 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 Sweating Trembling/shaking 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 30s 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 Agoraphobia 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 22 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 stimulates/kindles
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