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Ch7 Textbook Notes

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CHAPTER 7 ANXIETY DISORDERS Marc Summers Howie Mandel both suffer OCDfears are severe lower quality of their lives chronic frequent enough to interfere with functioning out of proportion to the dangers that they really facefour types of symptoms of anxietyphysiologicalsomatic eg muscle tension heart palpitations increased perspiration dilated pupilsemotional eg sense of dread terror restlessness irritabilitycognitive eg anticipation of harm exaggeration of danger worried ruminative thinking fear of losing controldyingbehavioural eg avoidance aggression escapephysiological and behavioural symptoms are similar to flightorfight responseadaptive fear concerns are realistic amount of fear is proportional to the reality of the threat fear subsides when threat endsmaladaptive anxiety concerns are unrealistic amount of fear out of proportion concern is persistent anticipatory anxietyneurosis used by Freud as a term referring to disorders in which the anxiety aroused by unconscious conflicts couldnt be quelled or channelled by defence mechanismsresearch suggests that some people have a general tendency toward anxiety from an early ageparents of anxious children tend to be overprotective controlling intrusive or anxious themselvesPanic Disorder panic attacks are short but intense periods in which one experiences manysymptoms of anxiety eg heart palpitations trembling feeling of choking dizziness intense dreadmost are characterized by one of three themes dizzinessrelated symptoms cardiorespiratory distress cognitive factorssome occur in the absence of any environmental triggers more commonly are most likely in certain situationsmany people experience isolated events of panic attackswhen they become common occurrences are unprovoked and when person begins to worry about attacks and changes behaviourdiagnosis of panic disorderpeople with panic disorders often fear they have lifethreatening illnesses believe they are going crazylosing controleach year 7 of people experience a panic attacklife time prevalence of panic disorder 34usually develop between late adolescence and mid30sTheories of Panic Disorder The Role of Geneticsapprox 10 of firstdegree relatives of people with panic disorders also have itcompared to 2 of firstdegree relatives of people without panic disorder who have ittwin studies find that 3040 of variation in rates of PD is due to genetics Neurotransmitters and the Braindiscoveries by Donald Klein in 1960s that antidepressants reduce panic attacksaffect levels of norepinephrineincreasing evidence that NE may be poorly regulated in people with PDs especially in the locus ceruleus located in the brain stemelectrical stimulation in monkeys produces paniclike responses its destruction renders them unable to experience feardrugs that alter activity of NE can induce or reduce panic attackseg yohimbine typically induces immediate panic attack in people with PDsserotonin GABA CCK some theories suggest PD is due to excessively high levels of serotonin in key areas of the brain other theories suggest it is due to deficienciesanimals studies suggest that increases in serotonin in certain areas of the brain stem reduce paniclike responses whereas increases in the amygdala increase anxietysome women with PD report increases in anxiety symptoms during premenstrual and postpartum periodsprogesterone can affect the activity of serotonin and GABA system thus fluctuations with menstrualpostpartum cycle can influence susceptibility to panic attacksGorman and colleagues suggested a kindling modelanticipatory anxiety chronically kindles sets the stage for panic attackslocus ceruleus and the limbic systempoor regulation in the LC initiates panic attack lowers threshold for chronic anxiety in the limbic system which increases likelihood of dysfunction in the LCpeople with PDs are easily induced into a panic attackeg from hyperventilation inhaling small amount of CO2 ingest caffeineWhittal et al 1994 after 2 minutes of hyperventilationinhaling CO2 4765 of PDs reported panic vs 812 in controlinitiate physiological changes of the fightorflight response once activated operates out of control The Cognitive Modeltheorists argue that people prone to panic attacks tend to1 pay close attention to their bodily sensations2 misinterpret bodily sensations in a negative way3 engage in snowballing catastrophic thinking exaggerating their symptoms and the consequencesanxiety sensitivity belief that symptoms of anxiety have harmful consequencespeople high in anxiety sensitivity are more likely to already have PD have frequent panic attacks to develop panic attacks over timeelevated levels in PD compared to all other anxiety disorders except PTSD
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