Psychological medicine

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Panic Disorder (with or without agoraphobia)

· Panic attack:

  • Intense exacerbation of autonomic responses: discrete episode of intense dread, fear or doom
  • Sudden, abrupt onset 
  • Symptoms include racing heart, trembling, SOB, nausea, fear of dying or losing control, going crazy. May have limited symptom attacks 
  • Found across anxiety disorders and in non-anxious population

· Panic Disorder: 

  • Recurrent and unexpected panic attacks. Situationally-bound panic attacks are characteristic of social or specific phobias, although situationally-predisposed panic attacks are frequent in Panic Disorder 
  • Catastrophic misinterpretation of bodily sensations/mental events (eg has palpitations and thinks they‟re having a heart attack). Normal bodily sensations misinterpreted
  • High anticipatory anxiety: persistent worry about having additional attacks
  • Hyper-vigilance for feared sensations

· Agoraphobia:

  • „Fear of fear‟
  • Fear of situation where escape may be difficult or embarrassing in the event of a panic attack
  • Avoid or endure with dread situations associated with panic attacks and feared bodily sensations 
  • Characteristically involve clusters of situations including being outside the home, being in a crowd, on a bridge, in a car, train or bus
  • But fear NOT of the situation
  • Can occur with or without a history of panic disorder
  • In Panic disorder, the more agoraphobic avoidance there is, the worse the prognosis 

· Differentiating from Social Phobia: in panic disorder, fear evaluation of what panic causes them to do (difficulty breathing, dizziness, weakness in limbs). In Social phobia, fear evaluation of what they do or say regardless of panic (blushing, sweating, trembling)

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