psy 961 panic disorder / agoraphobia. panic attack - dsm discrete period of intense fear or...
TRANSCRIPT
PSY 961PSY 961
PANIC DISORDER / PANIC DISORDER / AGORAPHOBIAAGORAPHOBIA
PANIC ATTACK - DSMPANIC ATTACK - DSM
DISCRETE PERIOD OF INTENSE FEAR OR DISCRETE PERIOD OF INTENSE FEAR OR DISCOMFORT WITH FOUR OF THE DISCOMFORT WITH FOUR OF THE FOLLOWING SYMPTOMS, REACHING A FOLLOWING SYMPTOMS, REACHING A PEAK IN 10 MINUTES.PEAK IN 10 MINUTES.
► PALPITATIONSPALPITATIONS► SWEATINGSWEATING► TREMBLING/SHAKINGTREMBLING/SHAKING► BREATHLESSNESSBREATHLESSNESS► CHOKINGCHOKING
► CHEST PAINCHEST PAIN► ABDOMINAL DISTRESSABDOMINAL DISTRESS► DIZZY/FAINTDIZZY/FAINT► UNREALITY/DETACHMENTUNREALITY/DETACHMENT► FEAR OF LOSING CONTROL OR GOING FEAR OF LOSING CONTROL OR GOING
CRAZYCRAZY► FEAR OF DYINGFEAR OF DYING► PARAESTHESIASPARAESTHESIAS► CHILLS OR HOT FLUSHESCHILLS OR HOT FLUSHES
MAY BE UNEXPECTED (UNCUED) OR SITUATIONALLY BOUND MAY BE UNEXPECTED (UNCUED) OR SITUATIONALLY BOUND (CUED)(CUED)
PD-W/O AG - DSMPD-W/O AG - DSM
A. BOTHA. BOTH RECURRENT UNEXPECTED PANIC RECURRENT UNEXPECTED PANIC
ATTACKSATTACKS ONE MONTH OR MORE OF PERSISTENT ONE MONTH OR MORE OF PERSISTENT
CONCERN OVER FUTURE ATTACKSCONCERN OVER FUTURE ATTACKS B.B. ABSENCE OF AGORAPHOBIAABSENCE OF AGORAPHOBIA C.C. NOT DIRECTLY DUE TO SUBSTANCE.NOT DIRECTLY DUE TO SUBSTANCE.
PD-W AG - DSMPD-W AG - DSM
A. BOTHA. BOTHRECURRENT UNEXPECTED PANIC RECURRENT UNEXPECTED PANIC ATTACKSATTACKS
ONE MONTH OR MORE OF PERSISTENT ONE MONTH OR MORE OF PERSISTENT CONCERN OVER FUTURE ATTACKS CONCERN OVER FUTURE ATTACKS
B.B. PRESENCE OF AGORAPHOBIA - ANXIETY PRESENCE OF AGORAPHOBIA - ANXIETY ABOUT PLACES WHERE ESCAPE MAY BE DIFFICULT ABOUT PLACES WHERE ESCAPE MAY BE DIFFICULT OR IN WHICH HELP MAY NOT BE AVAILABLE IN THE OR IN WHICH HELP MAY NOT BE AVAILABLE IN THE EVENT OF A PANIC ATTACKEVENT OF A PANIC ATTACKSITUATIONS ARE AVOIDED OR ENDURED WITH SITUATIONS ARE AVOIDED OR ENDURED WITH DISTRESS.DISTRESS.
FEATURES OF PANIC DISORDERFEATURES OF PANIC DISORDER
►ATTACKS, SPELLSATTACKS, SPELLS►OUT OF THE BLUEOUT OF THE BLUE►PHYSICAL DISEASE FEARPHYSICAL DISEASE FEAR►CASUALTYCASUALTY►MEDICAL SPECIALISTSMEDICAL SPECIALISTS►EXPLICIT MEMORY FOR ONSETEXPLICIT MEMORY FOR ONSET
HYPOCHONDRIASISHYPOCHONDRIASIS
►FEAR OF DISEASEFEAR OF DISEASE►BELIEF IN DISEASEBELIEF IN DISEASE►MISINTERPRETATION OF BENIGN MISINTERPRETATION OF BENIGN
SIGNSSIGNS►RELUCTANCE TO BELIEVE GPRELUCTANCE TO BELIEVE GP►REASSURANCE SEEKINGREASSURANCE SEEKING
FEATURES OF FEATURES OF HYPOCHONDRIASISHYPOCHONDRIASIS
►EXAGGERATED ANXIETY RELATIVE EXAGGERATED ANXIETY RELATIVE TO DISEASETO DISEASE
►DRAMATIC, ANXIOUSDRAMATIC, ANXIOUS►OFTEN VERY OBSESSIONALOFTEN VERY OBSESSIONAL►FREQUENT DYSPHORIAFREQUENT DYSPHORIA►DEPENDENCE AND REASSURANCEDEPENDENCE AND REASSURANCE►HISTORY OF PHYSICAL AILMENTSHISTORY OF PHYSICAL AILMENTS
DEMOGRAPHICSDEMOGRAPHICS
AGE OF ONSETAGE OF ONSETMID 20’SMID 20’S
GENDERGENDER FEM – ESP FOR FEM – ESP FOR AG.AG.
COURSECOURSE FLUCTUATINGFLUCTUATING
IMPAIRMENTIMPAIRMENT MOD TO HIGHMOD TO HIGH
COMORBIDITYCOMORBIDITY HIGHHIGH
PRESENTATIONPRESENTATION MEDICALMEDICAL
MEAN AGE OF ONSET REPORTED BY MEAN AGE OF ONSET REPORTED BY PHOBICS - PHOBICS - ÖÖST (1987)ST (1987)
0
5
10
15
20
25
30
ANIMALSOCIALAGORACLAUSTRO
SIGNIFICANT SYMPTOMS IN 6 SIGNIFICANT SYMPTOMS IN 6 MONTHS – MONTHS – FAVA ET AL. (1988)FAVA ET AL. (1988)
0
2
4
6
8
10
12
14
16
18
HY
PO
CH
ON
D
GE
N. A
NX
.
AV
OID
AN
CE
LO
WE
NE
RG
Y
INSO
MN
IA
PANIC DISORDER
NON-CLIN
N O
F S
UB
JEC
TS
ANXIETY SENSITIVITY INDEX – ANXIETY SENSITIVITY INDEX – REISS ET AL.(1986)REISS ET AL.(1986)
► IT SCARES ME WHEN I FEEL SHAKYIT SCARES ME WHEN I FEEL SHAKY► IT SCARES ME WHEN I FEEL FAINTIT SCARES ME WHEN I FEEL FAINT► IT SCARES ME WHEN MY HEART IT SCARES ME WHEN MY HEART
BEATS RAPIDLYBEATS RAPIDLY►UNUSUAL BODY SENSATIONS UNUSUAL BODY SENSATIONS
SCARE MESCARE ME► IT SCARES ME WHEN I FEEL SHORT IT SCARES ME WHEN I FEEL SHORT
OF BREATHOF BREATH
ASI SCORES IN ANXIOUS ASI SCORES IN ANXIOUS INDIVIDUALS – INDIVIDUALS – TAYLOR ET AL TAYLOR ET AL
(1992)(1992)
DXDX MEAN MEAN ASIASI
PDPD 36.636.6
PTSDPTSD 31.631.6
GADGAD 26.226.2
OCDOCD 25.425.4
SOCIALSOCIAL 24.924.9
SPECIFICSPECIFIC 16.116.1
THREE MAIN FACTORS IN ASI – THREE MAIN FACTORS IN ASI – ZINBARG ET AL, 1997.ZINBARG ET AL, 1997.
►PHYSICAL CONCERNSPHYSICAL CONCERNS IT SCARES ME WHEN MY HEART BEATS IT SCARES ME WHEN MY HEART BEATS
RAPIDLYRAPIDLY►MENTAL INCAPACITATION CONCERNSMENTAL INCAPACITATION CONCERNS
WHEN I AM NERVOUS I WORRY THAT I AM WHEN I AM NERVOUS I WORRY THAT I AM MENTALLY ILLMENTALLY ILL
►SOCIAL CONCERNSSOCIAL CONCERNS IT IS IMPORTANT TO ME NOT TO APPEAR IT IS IMPORTANT TO ME NOT TO APPEAR
NERVOUSNERVOUS
LEARNING HISTORY IN PEOPLE WITH LEARNING HISTORY IN PEOPLE WITH PANIC DISORDER – PANIC DISORDER – EHLERS (1998)EHLERS (1998)
PDPD OADOAD NCNC
Ss sick role experiences – panic Ss sick role experiences – panic sxssxs
1.1a1.1a 0.8a0.8a 0.1b0.1b
Observation of parental sick role – Observation of parental sick role – panic sxspanic sxs
2.8a2.8a 1.8ab1.8ab 0.9b0.9b
Encouragement of sick role - Encouragement of sick role - coldscolds
1.41.4 1.51.5 1.11.1
LEARNING HISTORY IN PEOPLE HIGH LEARNING HISTORY IN PEOPLE HIGH VS LOW ON ASI – VS LOW ON ASI – WATT ET AL. (1998)WATT ET AL. (1998)
HI ASIHI ASI LO ASILO ASI
Ss sick role experiences – anx sxsSs sick role experiences – anx sxs 1.61.6 0.5*0.5*
Observation of parental sick role – Observation of parental sick role – anx sxsanx sxs
1.11.1 0.4*0.4*
Encouragement of sick role - coldsEncouragement of sick role - colds 2.52.5 1.7*1.7*
MODEL OF LEARNING HISTORY, AS, MODEL OF LEARNING HISTORY, AS, AND PANIC ATTACKS – AND PANIC ATTACKS – STEWART ET AL. STEWART ET AL.
(2001).(2001).
.00
LHQ NON-AROUSAL SXS
LHQ AROUSAL SXS
PHYSICAL CONCERN
PANIC ATTACKS
.39
.13
.40
.00
.24
PREDICTION OF ANXIETY PREDICTION OF ANXIETY DISORDERS DISORDERS (MALLER & REISS, (MALLER & REISS,
1992)1992)
1987 DX1987 DX 1984 – HIGH 1984 – HIGH ASIASI
1984 – LOW 1984 – LOW ASIASI
PANIC PANIC DISORDERDISORDER
88 11
GADGAD 33 11
SPECIFICSPECIFIC 55 00
SOCIAL SOCIAL 77 11
PANIC ATTACKS BY ASI QUARTILES – PANIC ATTACKS BY ASI QUARTILES – SCHMIDT ET AL. (1997)SCHMIDT ET AL. (1997)
0
2
4
6
8
10
12
14
LOWEST LOW-MID HIGH-MID HIGHEST
NU
MB
ER
OF
AT
TA
CK
S
QUARTILE
STRESS BEFORE ONSET – STRESS BEFORE ONSET – RAPEE ET AL. (1990)RAPEE ET AL. (1990)
010
2030
4050
6070
8090
100
PD OTHER ANX NONCLIN
% WITH ONEN. OF EVENTS
STRESS BEFORE ONSET – STRESS BEFORE ONSET – FARAVELLI (1985)FARAVELLI (1985)
02468
101214161820
11 10 9 8 7 6 5 4 3 2 1
PDNC
MONTHS
N. O
F E
VE
NT
S
IMPACT OF STRESS BEFORE IMPACT OF STRESS BEFORE ONSET – ONSET – RAPEE ET AL. (1990)RAPEE ET AL. (1990)
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
PD OTHER ANX NONCLIN
IMPACT
MAINTENANCE OF PANIC DISORDERMAINTENANCE OF PANIC DISORDER
TRIGGER
CHRONIC AROUSAL
PERIPHERAL PHYSIOLOGICAL
CHANGE
PANIC
DETECTION OF
AUTONOMIC SENSATIONS
ASSOCIATION WITH PHYSICAL
DANGER
ANTICIPATION OF FUTURE
PANIC
ATTENTIONAL RESOURCE
ALLOCATION TO BODY
RAPEE (1993). ADVANCES IN BEHAVIOUR RESEARCH AND THERAPY, 15, 85-102.
ONSET OF PANIC DISORDER – BARLOW (2002)
COLOUR-NAMING IN SOCIAL PHOBIA COLOUR-NAMING IN SOCIAL PHOBIA
AND PANIC DISORDER AND PANIC DISORDER - - HOPE ET AL. HOPE ET AL. (1991)(1991)
COLOUR-NAMING IN SOCIAL PHOBIA COLOUR-NAMING IN SOCIAL PHOBIA
AND PANIC DISORDER AND PANIC DISORDER - - HOPE ET AL. HOPE ET AL. (1991)(1991)
-1
0
1
2
3
4
5
6
7
8
PD SOC.P.
SOC.PHYS.
INT
ER
FE
RE
NC
E I
ND
EX
WORD TYPE
PROBE DETECTION LATENCY – PROBE DETECTION LATENCY – ASMUNDSON ET AL (1992)ASMUNDSON ET AL (1992)
-35
-30
-25
-20
-15
-10
-5
0
5
10
PD NC
PHYS THREATSOC THREAT
THREAT INTERPRETATIONS – THREAT INTERPRETATIONS – HARVEY ET AL. (1993)HARVEY ET AL. (1993)
0
0.51
1.52
2.53
3.54
4.55
INTERNAL EXTERNAL
PDSOCNC
REACTION TIMES TO TARGET REACTION TIMES TO TARGET WORD – WORD – SCHNIERING & RAPEE (1997)SCHNIERING & RAPEE (1997)
660
680
700
720
740
760
780
800
820
PD NC
THREAT - RELATED
THREAT - UNRELATED
NEUTRAL - RELATED
NEUTRAL - UNRELATED
MS
PANIC ATTACK TO BIOLOGICAL PANIC ATTACK TO BIOLOGICAL CHALLENGE – CHALLENGE –
RAPEE ET AL. (1992)RAPEE ET AL. (1992)
0
10
20
30
40
50
60
70
PDA PD GAD SOC NC
HYPERVENTCO2
INTENSITY OF PANIC TO COINTENSITY OF PANIC TO CO22 - - RAPEE ET AL. (1986)RAPEE ET AL. (1986)
INTENSITY OF PANIC TO COINTENSITY OF PANIC TO CO22 - - RAPEE ET AL. (1986)RAPEE ET AL. (1986)
0
1
2
3
4
5
6
SOC. P. PD
EXPLANATION
NO EXPLANATION
PANIC TO CO2PANIC TO CO2SANDERSON ET AL. (1990)SANDERSON ET AL. (1990)
PANIC TO CO2PANIC TO CO2SANDERSON ET AL. (1990)SANDERSON ET AL. (1990)
0
10
20
30
40
50
60
70
80
CONTROL NO CONTROL
PERCENTPANIC ATTACKS
HYPERVENTILATION THEORY OF HYPERVENTILATION THEORY OF PANICPANIC
CHRONIC OVERBREATHING
LOW Ph
ACUTE OVERBREATHING
DROP IN pCO2
SOMATIC SYMPTOMS
INCREASED LIKELIHOOD
PD VS PDA – PD VS PDA – RAPEE & MURRELL (1988)RAPEE & MURRELL (1988)
MINMIN MODMOD SEVERESEVERE
SITUATIONS SITUATIONS TRIGGERTRIGGER
4343 6565 8484
CAN AVOID CAN AVOID ONSETONSET
6262 8181 9696
FQ - SOCIALFQ - SOCIAL 10.810.8 12.512.5 17.817.8
ASSERTIVENESSASSERTIVENESS 60.260.2 62.262.2 78.778.7
EPQ-NEPQ-N 15.915.9 16.616.6 20.920.9
PD VS PDA – PD VS PDA – TELCH ET AL. (1989)TELCH ET AL. (1989)
PDPD PDAPDA
BDIBDI 11.611.6 22.422.4
PHYS CONSEQS OF PHYS CONSEQS OF PANICPANIC
20.520.5 26.226.2
SOCIAL CONSEQS OF SOCIAL CONSEQS OF PANICPANIC
17.917.9 31.231.2
LOSS OF CONTROL LOSS OF CONTROL OVER PANICOVER PANIC
13.713.7 25.325.3