PANIC DISORDER PANIC DISORDER FOUR DIMENSIONS OF PANIC. 1) EMOTIONAL: feel nervous, feel tense feeling dizzy, unsteady, lightheaded, or faint

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1 DISORDER DISORDER Pan Greek god (satyr), scared people DISORDER WITHOUT AGORAPHOBIA agora- meeting or market place DISORDER WITH AGORAPHOBIA AGORAPHOBIA WITHOUT HISTORY OF AGORAPOBIA WITH HISTORY OF 1 DIAGNOSTIC CRITERIA FOR A discrete period of fear or discomfort, in which at least four of the following symptoms developed abruptly and reached a peak within 1 minutes 1) PALPITATIONS, POUNDING HEART, OR ACCELERATED HEART RATE ) SWEATING, 3) TREMBLING OR SHAKING ) SENSATIONS OF SHORTNESS OF BREATH OR SMOTHERING 5) FEELING OF CHOKING, 6) CHEST PAIN OR DISCOMFORT 7) NAUSEA OR ABDOMINAL DISTRESS 8) FEELING DIZZY, UNSTEADY, LIGHTHEADED, OR FAINT 9) DEREALIZATION (FEELINGS OF UNREALITY) OR DEPERSONALIZATION (BEING DETACHED FROM ONESELF) 1) FEAR OF LOSING CONTROL OR GOING CRAZY 11) FEAR OF DYING 1) PARESTHESIAS (NUMBNESS OR TINGLING SENSATIONS) 13) CHILLS OR HOT FLASHES FOUR DIMENSIONS OF 1) EMOTIONAL: feel nervous, feel tense feeling dizzy, unsteady, lightheaded, or faint ) PHYSIOLOGICAL: palpitations, sweating, trembling or shaking, shortness of breath, chest pain, nausea or abdominal distress 3) COGNITIVE: derealization, depersonalization, fear of losing control or going crazy, fear of dying ) BEHAVIOURAL: stuttering, pausing, lying down, avoidance behaviour 3 1

2 DISORDER Both 1) and ) 1) Recurrent unexpected Attacks ) At least one attack has been followed by: a) persistent concern about additional attacks b) worry about the implications of the attack (e.g. losing control, going crazy, heart attack) c) significant change in behaviour related to the attacks 1. UNEXPECTED (UNCUED) S no situational trigger. SITUATIONALLY PREDISPOSED more likely in certain situations but not always (e.g. driving) 3. SITUATIONALLY BOUND invariably cued (e.g. snake etc.) 5 6 Generalized anxiety Simple phobias Social phobias Obsessivecompulsive Any Anxiety Disorder One-Year Prevalence (%)/Life Female: Male Ratio Typical Age at Onset Prevalence Among Close Relatives 3.1/5 :1 - yrs Elevated 7% 9./11 3:1 Variable Elevated 1% 8./13 3: 1- yrs Elevated 1%.3/3.5 3: yrs Elevated 5.% 1./.3 1.5:1-5 yrs Elevated 1.3% 17./.9 :1 Elevated % Receiving Treatment 7 Figure 1. Disorder: Comorbidity % Patients (Lifetime Prevalence) (Uncomplicated) 8% Agoraphobia 6% % % % Other Anxiety Disorders Depression Drug and Alcohol Abuse 8

3 Figure. Percent Who Attempted Suicide 3% PD ONLY % PD COM 1% MDD ONLY MDD COM %

4 CHALLENGE EXPERIMENTS EARLY RESEARCH SHOWED LACTATE INFUSION (SODIUM LACTATE INFUSION) OR CARBON DIOXIDE PRECIPITATED IN PATIENTS NON-PATIENTS DID NOT HAVE AS HIGH A PROBABILITY OF BOTH GROUPS HAD DISCOMFORT HYPERVENTILATION EXPERIMENT INSTRUCTIONS PACED BREATHING TEST TEST PATIENTS NORMAL CONTROLS PERHAPS Ss MISINTERPRET SYMPTOMS 13 6 BREATHS/MIN FOR 3 MIN 1 Anxiety Rating Anxiety Level bpm Heart Rate test test (panic Num ber of Sy m p tom s 8 6 Symptoms test p ) test (panic attack test (panic mm Hg Systolic BP Heart pumping test 15 attack test test (panic (panic H g m m Heart is relaxed Diastolic BP test test 16

5 INTERPRETATION OF CHALLENGE EXPERIMENTS NORMALS NO Cognitive/Biological Model of Disorder CHALLENGE PHYSIOLO- GICAL AROUSAL PHYSIOLOGICAL AROUSAL Misinterpretation is key DISORDER PATIENTS Misinterpretation is key