A presentation about panic attacks and panic disorder. this presentation composed of the definition, causes, symptoms, diagnosis, treatment, prevention and prognosis of panic disorder.
THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH ASPECT.THIS PRESENTATION'S FOCUS IS ON PANIC DISORDER AND ITS MANAGEMENT.THIS CLASS IS IN ASPECT OF PSYCHIATRIC NURSING STUDENTS.
A presentation about panic attacks and panic disorder. this presentation composed of the definition, causes, symptoms, diagnosis, treatment, prevention and prognosis of panic disorder.
THERE ARE LOTS OF DISORDERS IN MENTAL HEALTH ASPECT.THIS PRESENTATION'S FOCUS IS ON PANIC DISORDER AND ITS MANAGEMENT.THIS CLASS IS IN ASPECT OF PSYCHIATRIC NURSING STUDENTS.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
A presentation about depressive disorder. The presentation composed of the definition, causes, types, clinical feature, diagnosis, prognosis, treatment and prevention of depression
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
The paper deals with panic disorder and its various underlying causes in the simplest form. It also explains the various signs and symptoms and its mechanism. The paper concludes with explaining various treatments and the diagnostic procedure.
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
APA FormatFor this topic and section of your essay, read or watc.docxjustine1simpson78276
APA Format
For this topic and section of your essay, read or watch each of the following:
McFarlane, W. R., Dixon, L., Lukens, E., & Lucksted, A. (2003): A review of the literature about psychoeducation and schizophrenia.
Once you have completed the assigned readings and viewed the NPR presentation, write Section 2 of your essay, and then discuss the following:
· The usefulness of psychoeducational approaches to chronic and severe mental illness.
· The articles’ focus on schizophrenia and bipolar disorder. Determine which principles can be taken from these articles and used in psychoeducational treatment of other types of disorders or presenting problems.
· The effectiveness of these psychoeducational treatments.
For this topic and final section of your essay, review the AAMFT clinical updates about chronic and severe mental illness that you read throughout the course.
Note: Review them and identify the ideas that they offer regarding treatment of chronic and severe mental illness using family therapy:
Carter, M. M. (2002, September/October)
Mueser, K. T. (2003, March/April)
Once you have reviewed the clinical updates, in Section 3 of your essay, identify at least two treatment principles from the field of family therapy that can be applied to working with a broad range of disorders and presenting problems. In essence, discuss the following question: “What is it about family therapy that is useful in working with clients that are commonly diagnosed with severe and chronic mental disorders?” Be sure to reference specific clinical updates that support your identified principles.
Length: 4 pages
FamilyTherapyResources.net
Clinical Update: Panic Disorder
Michele M. Carter, Ph.D.
Uncontrolled Anxiety:
Understanding Panic Disorder With Agoraphobia
Anxiety is often described as one of the most common of the human emotions (Barlow,
2002). Most of us feel some degree of anxiety on a daily basis. When one is late for an
appointment, has been called in to talk to their supervisor unexpectedly, or is watching one's
children compete in an activity for the first time, one typically experiences anxiety. At these
times one may notice sensations such as racing heart, sweating palms, or a general feeling of
nervousness or agitation. In addition to being common, anxiety is considered to be a natural
response to a real or perceived threat (Barlow, 2002). In the presence of threatening stimuli,
this innate emotional response is often considered to be adaptive, resulting in the self-
preservation of the organism (Barlow, 2002). When faced with a potential threat (e.g.,
oncoming traffic or an upcoming exam), the emotional state that motivates us to manage the
threat (by either fighting or fleeing) is anxiety. Therefore, anxiety is conceptualized as very
useful at normal levels. When the experience of anxiety becomes too intense, occurs too
frequently, or happens in situations where anxiety is uncommon, then this natural, self-
preservi.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Contents
Definition 3
Some features of PD 4
Risk factors 5
Difference between panic attack or panic disorder 6
Pathological physiology 7
Classification 9
Cause 10
PD in school time 15
Outcomes 16
DSM criteria 17
When to hospitalize a PD patient 19
Disease which mmic PD 20
Sucide rate 21
Ttreatment 22
Store products which interfere with the treatment 35
Relapse 36
Prognosis 37
2
3. Defination
It is a recurrent and unexpected anxiety attack of panic,
which are more often called as panic attach. In a
month or more of one with feature such as following:
a) Persisting fear of having another attach
b) Worry about the implications and consequence of
the attack.
c) Significant changes of behavior after the attacks
3
4. Some features of PD
Panic attacks can occur at any time, even during sleep.
An attack usually peaks within 10 minutes, but some symptoms may
last much longer.
Panic disorder affects about 6 million American adults.
Panic disorder is twice as common in women as men.
Panic attacks often begin in late adolescence or early adulthood,
Not everyone who experiences panic attacks will develop panic
disorder. Many people have just one attack and never have another.
The tendency to develop panic attacks appears to be inherited.
Panic disorder is often accompanied by other serious problems, such
as depression, drug abuse, or alcoholism.
4
5. Risk factors
Adolecence or early adulthood
Major life transitions perceived as stressful
Graduating from college, getting married, having a first child
Genetics
If a family member has panic disorder, you have an increased risk
Especially during a time in your life that is particularly stressful.
5
6. Differences between Panic attack
and Panic Disorder
Anyone can suffer of a Panic attack that is an extreme
anxiety reaction that result when a real threat suddenly
emerges (E.g.: when they are afraid of somebody in their
house stealing)
The experience of “Panic Disorder,” however, is different
Panic attacks are periodic, short bouts of panic that occur suddenly,
reach a peak, and pass
Sufferers often fear they will die, go crazy, or lose control
Attacks happen unexpectedly in the absence of a real threat
Sufferers also experience dysfunctional changes in thinking and
behavior as a result of the attacks
Example: sufferer worries persistently about having an attack;
plans behavior around possibility of future attack
6
7. Pathophysiology
While the various symptoms of a panic attack may cause the person to feel that their body is
failing, it is in fact protecting itself from harm. The various symptoms of a panic attack
can be understood as follows. First, there is frequently (but not always) the sudden onset
of fear with little provoking stimulus. This leads to a release of nonadrenaline which
brings about the so-called fight-or-flight response, wherein the person's body prepares
for strenuous physical activity. This leads to a tachycardia, hyperventilation which may be
perceived with dyspnea and sweating (which increases grip and aids heat loss). Because
strenuous activity rarely ensues, the hyperventilation leads to a drop in carbon
dioxide levels in the lungs and then in the blood. This leads to shifts in
blood pH (respiratory alkalosis or hypocapnia), which in turn can lead to many other
symptoms, such as tingling or numbness, dizziness, burning and lightheadedness.
Moreover, the release of adrenaline during a panic attack causes vasoconstriction
resulting in slightly less blood flow to the head which
causes dizziness and lightheadedness. A panic attack can cause blood sugar to be drawn
away from the brain and towards the major muscles. It is also possible for the person
experiencing such an attack to feel as though they are unable to catch their breath, and
they begin to take deeper breaths, which also acts to decrease carbon dioxide levels in the
blood.
7
8. It is also unclear why some people have such
abnormalities in norepinephrine activity
Inherited biological predisposition is one possibility
Prevalence should be (and is) greater among close relatives
Among monozygotic (MZ, or identical) twins = 24%
Among dizygotic (DZ, or fraternal) twins = 11%
8
9. Classification
Two diagnoses:
panic disorder with agoraphobia
panic disorder without agoraphobia (twice more
common)
~3% of U.S. population affected in a given year
~5% of U.S. population affected at some point in their
lives
9
10. What does cause Panic Disorders
There are 3 perspective which can lead to the
pathological abnormality of Noradrenalin activity:
1) Biological perspective
2) Pharmacological
3) Chronic illness (Comorbid disorders in PD accounts
more than 90%)
4) cognitive
10
11. Biological perspective
Vulnerability to panic disorder tends to run in families. E.g.:Twin studies: Higher
concordance rates among identical twins.
Among monozygotic (MZ, or identical) twins = 24%
Among dizygotic (DZ, or fraternal) twins = 11%
Possible imbalance of neurotransmitters involved in arousal
Serotonin & Norepinephrine. (Smokers have a fourfold risk of a 1st-time panic attack.
Why?)
11
12. Pharmacological Triggers
Certain chemical substances, mainly stimulants but also certain
depressants, can either contribute pharmacologically to a
constellation of provocations, and thus trigger a panic attack or
even a panic disorder, or directly induce one.This includes
caffeine, amphetamine, alcohol and many more. Some sufferers
of panic attacks also report phobias of specific drugs or
chemicals, that thus have a merely psychosomatic effect, thereby
functioning as drug triggers by nonpharmacological means.
Alcohol, medication or drug withdrawal — Various substances
both prescribed and unprescribed can cause panic attacks to
develop as part of their withdrawal syndrome or rebound effect.
Alcohol withdrawal and benzodiazepine withdrawal are the
most well known to cause these effects as a rebound withdrawal
symptom of their tranquillising properties.
12
13. Chronic illness
Chronic/serious illness — Cardiac conditions that can cause sudden
death such as long QT syndrome; catecholaminergic polymorphic
ventricular tachycardia or Wolff-Parkinson-White syndrome can also
result in panic attacks. This is particularly difficult to manage as
the anxiety relates to events that may occur such as cardiac arrest, or if
an implantable cardioverter-defibrillator is in situ, the possibility of
having a shock delivered. It can be difficult for someone with a cardiac
condition to distinguish between symptoms of cardiac dysfunction and
symptoms of anxiety. In CPVT the anxiety itself can and does
trigger arrythmia. Current management of panic attacks secondary to
cardiac conditions appears to rely heavily on benzodiazepines, selective
serotonin reuptake inhibitors and/orcognitive behavioural therapy.
However, people in this group often experience multiple and
unavoidable hospitalisations; in people with these types of diagnoses,
it can be difficult to differentiate between symptoms of a panic attack
versus cardiac symptoms without an electrocardiogram.
13
14. Cognitive
1. Major life transitions (post graduation, losing job,
after marriage)
2. Stimulus generalization
1st attack occurs in one location
Fear another attack in similar locations
3. Being helplessness increases fear
4. Maintained by negative reinforcement
5. Excessive focus on potential threats (Cognitive)
14
15. PD in school life
There are many student that appears with PD in the school
life time, why does it happen?
I. Test/performance anxiety
II. Poor academic performance
III. Avoidance of school entirely
What can we do to help?
Talk with them about possible triggers.
Stand near them in stressful situations (e.g. speeches)
15
16. outcomes
People who have full-blown, repeated panic attacks can become
very disabled by their condition and should seek treatment
before they start to avoid places or situations where panic attacks
have occurred.
For example, if a panic attack happened in an elevator, someone
with panic disorder may develop a fear of elevators that could
affect the choice of a job or an apartment, and restrict where that
person can seek medical attention or enjoy entertainment.
Some people's lives become so restricted that they avoid normal
activities, such as grocery shopping or driving.
About one-third become housebound or are able to confront a
feared situation only when accompanied by a spouse or other
trusted person. When the condition progresses this far, it is
called agoraphobia, or fear of open spaces.
16
17. DSM Criteria for PD diagnosis
DSM (Diagnostic and Statistical Manual of Mental
Disorders) expects at least 4 of 13 symptoms in stating
the patient has had a “panic attack.” List as many of
the 13.
17
18. At least 4 of following develop suddenly and peak in 10
minutes:
1.palpitations or increased pulse
2. sweating
3. trembling or shaking
4. sensation of shortness of breadth
5. feeling of choking
6. chest discomfort
7. nausea or stomach distress
8. dizzy, unsteady, lightheaded, or faint
9. derealization/depersonalization
10. fear of losing control or going “crazy”
11. fear of dying
12. paresthesias
13. chills or hot flashes
18
19. When to hospitalize a patient with
PD?
Only hospitalize if there is another psychiatric disorder
present that so justifies.
19
20. Disease which mimic PD
i. Hyperthyroidism
ii. Hypothyroidism
iii. Temporal-lobe epilepsy
iv. Asthma
v. Cardiac arrhythmias
vi. Pheochromocytoma
vii. Too much coffee and other stimulants
20
21. Suicide rate
Guideline says 1/5, but article implies that is so because
many have comorbid with depression. Still, it would
seem that “1/5” would be correct answer.
21
22. Treatment goals
1. Decrease frequency of attacks
2. Decrease intensity of attacks
3. Decrease anticipatory anxiety
4. Decrease phobic avoidance
22
23. All patients with PD should be monitored by a
psychiatrist, psychologist or a mental healthy care, it is
shown that a psychiatric care is the most effective and
low costs because of addition of pharmacological
therapy, decreasing emergency department intake and
costs and nonpsychiatric outpatient care
23
24. Cognitive behavioral therapy(CBT)
CBT with or without pharmacotherapy, is the treatment of choice for panic disorder, and it
should be considered for all patients.CBT has higher efficacy and lower cost, dropout
rates, and relapse rates than do pharmacologic treatments.
In 12 to 16 sessions, usually weekly, the focus is on recreating the feared symptoms and then
modifying the patient’s response.
The trigger in an individual case could be something like
A thought
A situation
Something subtle like a slight change in heartbeat.
Therapy Goals
Understanding that the panic attack is separate and independent of the trigger
Awareness of the trigger(s) so it begins to lose some of its power to induce an attack.
24
25. Behavioral therapy
Behavioral therapy involves sequentially greater exposure of the patient to anxiety-
provoking stimuli; over time, the patient becomes desensitized to the experience.
Relaxation techniques also help to control patients' levels of anxiety.
Respiratory training can help patients to control hyperventilation during panic attacks
and to control anxiety with controlled breathing. Capnometry feedback-assisted
breathing training can be used to prevent hypocapnia and stabilize the respiratory rate.
The trigger could be:
Intentional hyperventilation – creates lightheadedness, derealization, blurred
vision, dizziness
Spinning in a chair – creates dizziness, disorientation
Straw breathing – creates dyspnea, airway constriction
Breath holding – creates sensation of being out of breath
Running in place – creates increased heart rate, respiration, perspiration
Body tensing – creates feelings of being tense and vigilant
Therapy goals: it help the patient to come through an attack by controlling the symptoms.
25
26. Pharmacological therapy
Providing a few doses of a benzodiazepine as needed (prn)
can enhance patient confidence and compliance. Total
tablet dispensing should remain limited to ensure that
patients understand that they have a limited supply of the
drug and that this medicine represents a temporary or
emergency use option.
The patient should be made to understand the importance
of longer-term management with SSRI medication and
psychotherapeutic techniques (eg, CBT).
Avoid the prescription of benzodiazepine in patients with a
known history of substance misuse or alcoholism.
26
27. Follow-up care and referrals
Initial follow-up care should occur within 2 weeks, because SSRIs
can cause an initial exacerbation of panic symptoms. For this
reason, begin with the lowest dose with the understanding that
the dose must be increased at the initial follow-up visit.
Assess potential suicide risk at all appointments. Ensure
continuing treatment of any concurrent substance use disorders.
Follow-up care by a chemical dependence treatment specialist is
recommended when indicated.
Patients with ventricular dysrhythmias, abnormal findings on
ECG, abnormal findings on cardiac examination, or significant
risk factors for heart disease should be referred to a cardiologist.
27
28. Inpatient care
Inpatient care is rarely considered for uncomplicated panic disorder.
Patients may get admitted if they display any evidence of dangerous
behavior, safety concerns, report suicidal or homicidal ideation as may
occur in context of acute anxiety, fear of anxiety or its consequences or
with another psychiatric disorder.
Patients may require hospitalization for intoxication or withdrawal
from sedative/hypnotics such as alcohol or Xanax, which sometimes
get ingested or abused in attempts to medicate or manage the anxiety.
Patients may also get hospitalized if they become so incapacitated by
their anxiety that they are unable to adhere to outpatient care.
Inpatient treatment is necessary in patients with suicidal ideation and
plan or with serious alcohol or sedative withdrawal symptoms, or when
the differential includes other medical disorders that warrant
admission (eg, unstable angina, acute myocardial ischemia).
28
29. 5 groups of drugs used in the PD
1. SSRIs
2. SNRIs
3. High potency benzodiazepines
4. Tricyclics
5. MAOIs
29
30. SSRIs
SSRIs is the fist choice for the treatment of PD.
Flouxetine, Paroxitine, Sertraline or fluvoxamine:
MOA: It is an antagonist at the 5-HT2 receptor and
inhibits the reuptake of 5-HT. It also has a negligible
affinity for cholinergic and histaminergic receptors.
30
31. SNRIs
Trazodone: it is used in PD with or without
agoraphobia.
MOA: It is an antagonist at the 5-HT2 receptor and
inhibits the reuptake of 5-HT. It also has a negligible
affinity for cholinergic and histaminergic receptors.
31
32. Intermediate to strong
Benzodiazepam
Lorazepam, clonazapam, alprazolam or diazepam. It is
not a primary choice because of the dependence and
side effects caused. Useful in situation as
apprehensiveness about taking a airplane flight
MOA: it potentiate GABA by binding to specific GABA
receptor.
32
33. Tricyclic antidepressants
Imipramine, desipramineor clomipramine.
It has a low risk of dependence and no diatary
restrictions, but they are in 35% cases discontinued
because of its side effects such as blurred vision, dry
mouth, dizziness, weight gain, GIT distubences,
agitation, headache, insonia and decreased libido, to
avoid side effects abruptly, it must be first
administered in low dose.
MOA: they are Serotonin and Nonadrenaline reuptake
inhibitors.
33
34. Monoamine oxidase inhibitors
Phenelzine or tranylcypromine, they are effective in patient with PD or
other associated phobia
MOA: Nonselective monoamine oxidase inhibitor; may inhibit the
enzyme monoamine oxidase, which is responsible for the breakdown
of dopamine, serotonin, epinephrine, and norepinephrine, in turn
causing an increase in endogenous concentrations of these
neurotransmitters.
34
35. Stores products
Patient can buy some products specially in the depression
or anxiety period that can interfere with the treatment such
as:
1. Cigarettes
2. Coffee
3. sympathomimetics [nasal decongestants]
They should be advised that they can not used this products
while they are in the pharmacological therapy.
35
36. Relapses
After a successful treatment many patients may fall
into a relapse, specially after a makeable event in
patients life as the loss of a beloved one, discovered of
a severe illness and etc.
We should adopted the prior treatment of CBT and
drugs (SSRIs or SNRIs) and if it does not work, should
be maintained the CBT and change the group of drug
(tricyclic)
36
37. Prognosis
Long-term prognosis is usually good, with almost 65% of
patients with panic disorder achieving remission, typically
within 6 months.
The risk of coronary artery disease in patients with panic
disorder is nearly doubled. In patients with coronary
disease, panic can induce myocardial ischemia.The risk of
sudden death may also theoretically be increased due to
reduced heart rate variability and increased QT interval
variability.
Appropriate pharmacologic therapy and cognitive-
behavioral therapy, individually or in combination, are
effective in more than 85% of cases.
37