Panic Disorder Week 2 Epidemiology: · Prevalence -12-month: 2.4% (1.6% in Canada) -Lifetime: 4.7% (3.7% in Canada) · 2x as common in women ·Age of onset = early 20s ·93.7% have a comorbid disorder (M = 4.5 additional disorders) .Chronic course DSM-5 Criteria Both (1) and (2): (1)recurrent unexpected panic attacks + at least 4 symptoms: · palpitations, pounding heart · Sweating · Trembling or shaking · Shortness of breath or smothering · Choking feeling · Chest pain · Nausea · Dizziness · Derealization or depersonalization · Parasthesis · Chills or hot flashes · Fear of losing control or going crazy · Fear of dying (2) at least one of the attacks has been followed by at least 1 month by 1 or more of following: (a) persistent concern about having additional attacks (b) worry about the implications of the attack or its consequences (c) a significant change in behaviour related to the attacks Panic Disorder Differential Diagnosis · Unexpected panic attacks: Panic attacks occur "out of the blue" ·Situationally-predisposed panic attacks: The panic attacks are more likely to occur following particular triggers (e.g., driving) · Situationally-bound panic attacks: The panic attacks have only ever occurred in particular situations (e.g., flying) HPA Axis At the biological level of analysis, heightened sensitivity to stress can be tied to the biological stress
response system (HPA axis). Very briefly, when we perceive a stressful event out there in the world, this starts a whole cascade of chemical changes. The one we're going to focus on is the release of a hormone called cortisol from the adrenal glands in the kidneys (who knew that the kidneys help us deal with stress!) Sympathetic Nervous System ("fight/flight") · Releases adrenaline and noradrenaline in response to threat: -increased heart rate -constriction of blood vessels -increased rate of breathing -decreased blood supply to brain -increased sweat gland activity -pupil dilation Panic · Clearly threatening trigger àcorrectly attribute panic sensations to legitimate fear . No clearly threatening trigger àattribute panic sensations to "going crazy", "having a heart attack", or "dying" Patients presenting to ER for chest pain (Lynch & Galbraith, 2003) 1 100% (n=1364) Panic Disorder? NO YES 2 69.9% (n=953) 3 30.1% (n=411) Coronary Artery Disease? Coronary Artery Disease? NO YES NO YES Clark, 1986 Kidneys SNS sign Increased heart rate Blood vessel constriction parasthesis Faster breathing chest pain choking smothering Decreased blood derealization supply to brain dizziness trembling Increased sweating sweating hot flashes Pupil dilation derealization Stressful event Brain Hypothalamus Chemical message Pituitary gland Hormones Adrenal glands Cortisol Panic symptom palpitations Trigger Stimulus "twinge in chest" 4 51.7% (n=705) 5 18.2% (n=248) 6 22.4% (n=306) 7.7% (n=105) Perceived threat "Heart attack" Cognitive-Behavioural Model of Panic (Clark, 1998) Cognitive: "I am going to die" Avoidance PANIC Emotional "I am afraid" Physiological "dizziness, chest pain"
. Panickers pay very close attention to their bodily sensations · Panickers misinterpret bodily sensations as signs of imminent catastrophe · Panic is a fear of fear -- > Anxiety Sensitivity (Taylor, 1995) Cognitive-Behavioural