Is he mentally ill?

Panic is now dx’d with agoraphobia or without

About 2.7 % suffer from one or the other pattern in a year, about 5 % lifetime prevalence

Likely to develop in late adolescence or early adulthood

Twice as common in women as men

About 35 % of those with panic disorder are currently in treatment

Genetic factors—moderate heritability, overlap in heritability of panic and phobias

• Genetic factors—moderate heritability, overlap in heritability of panic and phobias

• Biochemical abnormalities

• No single neurobiological mechanism
• GABA related to anticipatory anxiety
• Noradrenergic and serotonergic pathways are implicated

• Related to mitral valve prolapse

• Behavioral and cognitive causal factors

• Fear of fear hypothesis
• Interoceptive awareness
• Sense of perceived control or having a safe person may block response
• Safety behaviors and persistence of panic
• Safety behaviors need to stop for effective treatment
• Attentional biases toward threat cues

Benzodiazepines—rapid effects, addictive, need gradual withdrawal, rebound panic

• Benzodiazepines—rapid effects, addictive, need gradual withdrawal, rebound panic

• Antidepressants—high relapse rates

• Behavioral and cognitive-behavioral tx

• Prolonged exposure effective in 60-75 % of pts
• Combined with meds—greater relapse—better to use alone

Experience excessive anxiety under most circumstances and worry about anything

• Experience excessive anxiety under most circumstances and worry about anything

• Sometimes called free-floating anxiety

• Somatic complaints—sweating, flushing, pounding heart, upset stomach, diarrhea, cold clammy hands, dry mouth, high pulse and respiration

• Disturbances of skeletal musculature—muscle tension, eyelid twitches, trembling, tire easily, inability to relax

• Easily startled, fidgety, restless, sighs a lot

• Generally apprehensive—often imagining and worrying about disasters, losing control, having a heart attack, dying

• Impatience, irritability, insomnia, distractibility

• 4-6 % prevalence

• Twice as common in women

• Most continue to function despite symptoms

• Begins in mid-teens, many report problems through life

• Comorbid with social anxiety and OCD

Psychoanalytic view

• Psychoanalytic view

• Sx or aggression impulses are in conflict with the ego; ego can’t allow expression because of fear of punishment. Because anxiety source is unconscious, person is in distress and doesn’t know why

• Learning—

• Attempts to control thoughts and images actually increases them
• Classically conditioned to external stimuli—like phobia, only broader

• Cognitive—control vs. helplessness-in yoking studies, rats with control have less anxiety

• Biological—small to modest heritability

• Predisposition to neuroticism

• Treatment

• Benzodiazepines—not all that effective, gains often lost
• Antidepressants, Busipirone may help
• Muscle relaxation and cognitive restructuring quite effective

1-3 % have OCD-lifetime

• 1-3 % have OCD-lifetime

• >90% have both o and c, if include mental rituals, this is 98%

• Usually begins in early adulthood, often following some stressful event

• Gradual onset and chronic—poor prognosis

• 80% may experience depression

• Early onset—more common in men—checking compulsions

• Later onset—more common in women—cleaning compulsions

Obsessions—intrusive and recurring thoughts, impulses, and images, appear irrational and uncontrollable to pat

• Obsessions—intrusive and recurring thoughts, impulses, and images, appear irrational and uncontrollable to pat

• Doubts—75 % of pts.—persistent thought that a completed task hadn’t been adequately completed

• Thinking—34 %--endless chain of thoughts focusing on future events
• Impulses-17 %-urges to perform certain acts (whims to assaults)
• Fears-26 %-afraid of losing control or doing something embarrassing
• Images-7 %--seen or imagined

• Compulsions—Five primary types—cleaning, checking, repeating, ordering/arranging, counting. Performance of act reduces tension, increases satisfaction, gives sense of self control

• Fear that something will happen to them or others because of them

• Have tendency to judge risks unrealistically

Behavioral viewpoint—

• Behavioral viewpoint—

• Mowrer—two process—in place classically, maintained operantly
• OCD and preparedness—evolutionarily adaptive in some ways

• Biological –

• Genetic—moderately high heritability
• Some abnormalities in brain function that normalize on meds

• Treatment—

• Difficult to treat
• Behavioral treatment that combines exposure and response prevention—effective in 50-75 %
• Relapse of up to 90% following med discontinuation
• SSRIs—
• Combination of meds and therapy not more effective than therapy alone in adults, may be in children