Downloaded 47 times
More Related Content
Similar to Panic disorders
Panic disorders
- 1. PANIC DISORDERS DR. MOHAMMEDFEROS 2ND YEAR POST GRADUATE GENERAL MEDICINE
- 2. Neurotic , Stressrelated & Somatoform disorders 1. Phobic anxiety disorder 2. Other anxiety disorder 3. Obsessive compulsive disorder
- 3. Phobic disorder • “Irrational fear of a specific object, situation or activity, often leading to persistent avoidance of the feared object, situation or activity.” 1. Agoraphobia 2. Social phobia 3. Specific (Simple) phobia
- 4. ANXIETY • “ Adiffuse unpleasant vague sense of apprehension often accompanied by autonomic symptoms usually caused by anticipation of danger” • Anxiety is a response to a threat that is unknown, internal, vague or conflictual. • Fear is response to a known, external , definite or non conflictual threat. • Cognitive behavioural view: anxiety is a conditioned response.
- 5. 1. Trait anxiety 2.State anxiety • Trait: Habitual tendency to be anxious in general and is exemplified by “ I often feel anxious” • State: Anxiety felt at present, and is exemplified by “ I feel anxious now” • Persons with trait anxiety often have episodes of state anxiety.
- 6. Aetiology 1. Psychodynamic theory 2.Behavioural Theory 3. Cognitive behavioural theory 4. Biological theory
- 7. Psychodynamic theory • Signalanxiety – internal psychological equilibrium • Signal anxiety Defensive action • In anxiety repression fails to function adequately but secondary mechanisms are not activated, hence anxiety comes to forefront unopposed. Repression (primary) Secondary defense mechanism (conversion, isolation)
- 8. • Developmentally primitiveanxiety is manifested as somatic symptomatology while developmentally advanced anxiety is signal anxiety. • According to this theory panic anxiety – closely related to separation anxiety of childhood
- 9. Behavioural theory • Accordingto this theory : Anxiety – unconditioned inherent response of the organism to painful or dangerous stimuli.
- 10. Cognitive behavioural theory(CBT) •According to CBT: • In anxiety disorders there is evidence of selective information processing (with more attention paid to threat related information ) • Cognitive distortions • Negative automatic thoughts • Perception of decreased control over both internal and external stimuli.
- 11. Biological theory • Geneticevidence: 15- 20% 1st degree relative. • Concordance rate in monozygotic twins of patients with panic disorders is as high as 80%. • Chemically induced anxiety states: • Infusion of chemicals( Na lactate, isoproterenol, caffeine) • Inhalation of 5% CO2 can produce panic episodes in predisposed individuals.
- 12. • GABA- BZDreceptors: • 2 types: Type I – GABA and chloride independent • Type II - GABA and chloride dependent • BZD facilitates GABA transmission causing generalised effect on CNS – relieves anxiety • BZD antagonist(flumazenil) and inverse agonist (beta carbolines) cause anxiety – supports this hypothesis
- 13. BZD administered Binds with BZD receptorI GABA complex Facilitates GABA release 1. Anxiety 2. Muscle relaxation 3. Anticonvulsant action
- 14. • Organic anxietydisorder: • Presence of anxiety secondary to various medical disorders – hyperthyroidism, pheochromocytoma, CAD
- 15. Symptoms Physical Symptoms PsychologicalSymptoms A. Motoric Symptoms: tremors, restlessness, muscle twitches A. Cognitive Symptoms: poor concentration, distractibility B. Perceptual Symptoms: derealisation, depersonalisation B. Autonomic and Visceral symptoms: Palpitations, tachycardia, sweating, flushing, hyperventilation, diarrhoea C. Affective Symptoms: diffuse, unpleasant, and vague sense of apprehension. D. Other symptoms: insomnia, increased sensitivity to noise.
- 16.
- 17. Panic disorder • “Presence of recurrent and unpredictable panic attacks, which are distinct episodes of intense fear and discomfort associated with variety of physical symptoms including • Palpitations or rapid heart rate, • Breathlessness • Feeling unsteady, dizzy, light-headed or faint • Trembling or shaking • Sweating
- 18. •Having a hotflush or chills • Chest pain or discomfort • Numbness or tingling sensations • Feeling as if you or surroundings are unreal • Nausea or burning stomach • Choking • Fear of dying • Fear of losing control or going crazy • At least 4 panic attacks over 4 weeks for diagnosis.
- 19. • Onset usuallyin early third decade with often c/c course • Sudden onset developing within 10 min, resolving within 1 hour. • Frequency and severity of panic attacks vary ranging from once a week to clusters separated by months of well- being. • D/D: Cardio respiratory disorders, Pheochromocytoma, Hypoglycemia. • Life time prevalence: 1.5-2% with 3-4% sub syndromal panic symptoms • Panic disorders and Agoraphobia often co exist
- 20. Agoraphobia • Marked andconsistently manifest fear of crowds, public places, travelling alone, travelling away from home • Avoidance of these phobic situation is important symptom. • Symptoms of anxiety in the feared situation including autonomic arousal, difficulty in breathing, choking, abdominal discomfort, dizziness, fear of losing control/dying.
- 21. Treatment • Non pharmacologicalmanagement 1. Cognitive therapy 2. Relaxation training, biofeedback 3. Respiratory training, breathing exercises 4. Exposure therapy
- 22. • Pharmacological management 1.SSRI 2. BZD 3. SNRI
- 23. • SSRI benefitmajority of panic disorders and do not have adverse effects of TCA. • Drugs should be started 1/3 rd of their usual antidepressant dose. • MAOIs effective in patients with atypical depression – (hypersomnia and weight gain) • Because of anticipatory anxiety and need for immediate relief of panic symptoms BZD are useful early in course of treatment.
- 24.