YOU ARE DOWNLOADING DOCUMENT

Please tick the box to continue:

Transcript
Page 1: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 11

Anxiety DisordersAnxiety Disorders

Page 2: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 22

Anxiety Disorders: Anxiety Disorders: Prevalence, general informationPrevalence, general informationAnxiety disorders - most prevalent disorders of Anxiety disorders - most prevalent disorders of

childhood and adulthood (Prevalence of 1 -25% - childhood and adulthood (Prevalence of 1 -25% - Gelfland, 2002)Gelfland, 2002)

To be a disorder, it must interfere with daily To be a disorder, it must interfere with daily functioning.functioning.

Most prevalent:Most prevalent:

1.1. Obsessive compulsive disorder (OCD)Obsessive compulsive disorder (OCD)

2.2. Generalized anxiety disorder (GAD)Generalized anxiety disorder (GAD)

3.3. Social Phobias and Panic DisordersSocial Phobias and Panic Disorders

Page 3: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 33

About Anxiety DisordersAbout Anxiety Disorders

Physical AspectPhysical Aspect Stress: generally a physiological state associated Stress: generally a physiological state associated

with anxiety - heightened arousal with physical with anxiety - heightened arousal with physical symptomssymptoms

Psychological AspectPsychological Aspect Anxiety: a feeling of anticipation (negative) or Anxiety: a feeling of anticipation (negative) or

worry in a particular context - no specific target worry in a particular context - no specific target is necessaryis necessary

Fear: often used interchangeably - usually used in Fear: often used interchangeably - usually used in reference to a specific targetreference to a specific target

Axiogenic: anxiety producingAxiogenic: anxiety producing Axiolytic: anxiety reducingAxiolytic: anxiety reducing

Page 4: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 44

The Stress ResponseThe Stress Response

Hypothalamic-Pituitary-Adrenal (HPA) AxisHypothalamic-Pituitary-Adrenal (HPA) Axis Hypothalamus releases of corticotropin Hypothalamus releases of corticotropin releasing hormone (CRH)releasing hormone (CRH)

Pituitary gland releases Pituitary gland releases (adreno)corticotropin hormone(adreno)corticotropin hormone

Cortisol (and other adrenal hormones) Cortisol (and other adrenal hormones) released from adrenal glands released from adrenal glands • Increasing energy, awareness in response to a Increasing energy, awareness in response to a threatthreat

• Increase heart rate, sweating, heavier Increase heart rate, sweating, heavier breathing, increase in muscle tension, etc.breathing, increase in muscle tension, etc.

• Preparation of fight or flightPreparation of fight or flight

Page 5: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 55

Page 6: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 66

The Stress ResponseThe Stress Response

The hypothalamus is a the centre of the The hypothalamus is a the centre of the stress response via the sympathetic stress response via the sympathetic nervous system.nervous system.

However, projections from the amygdala and However, projections from the amygdala and prefrontal areas to the hypothalamus prefrontal areas to the hypothalamus influence how threatening situations are influence how threatening situations are interpreted and, hence, regulatedinterpreted and, hence, regulated• Structures involved in establishing classical Structures involved in establishing classical and operant learningand operant learning

Page 7: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 77

The Stress ResponseThe Stress Response

CRH receptors found throughout the brain: CRH receptors found throughout the brain: Prefrontal, cingulate, amygdala, nucleus Prefrontal, cingulate, amygdala, nucleus accumbens, locus coereliusaccumbens, locus coerelius

Of course, epinephrine and norepinephrine Of course, epinephrine and norepinephrine also act in similar areas.also act in similar areas.

Page 8: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 88

Development and Maintenance Development and Maintenance of Fearof Fear

Two Factor TheoryTwo Factor Theory

1.1. Fears develop by Fears develop by classicalclassical conditioning: conditioning: • A neutral event is associated with a A neutral event is associated with a

fearful eventfearful event• Fear elicited by neutral eventFear elicited by neutral event2. 2. Fear is maintained by Fear is maintained by operantoperant

conditioningconditioning• Avoidance of fear inducing situation Avoidance of fear inducing situation

(negative reinforcement)(negative reinforcement)

Page 9: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 99

Neuropathology: Learning AnxietyNeuropathology: Learning Anxiety Producing Behaviours Producing Behaviours

The amygdala and pre-frontal areas play an The amygdala and pre-frontal areas play an important role in learning of fear-based important role in learning of fear-based behavioursbehaviours

1.1. Amygdala: contextual learning and Amygdala: contextual learning and (re-)consolidation.(re-)consolidation.

2. Frontal lobe: extinction memory.2. Frontal lobe: extinction memory. Both areas implicated in processing Both areas implicated in processing

incoming conditioned stimulus information.incoming conditioned stimulus information. Anxiety producing behaviours associated Anxiety producing behaviours associated

with increased hippocampal and reduced with increased hippocampal and reduced frontal activation.frontal activation.

Page 10: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1010

Neuropathology: Learning AnxietyNeuropathology: Learning Anxiety Producing Behaviours Producing Behaviours

Neurotransmitter SystemsNeurotransmitter Systems

1.1. Glutamate (NMDA receptor)Glutamate (NMDA receptor) NMDA receptor is ionotropic: slow, long NMDA receptor is ionotropic: slow, long

lasting depolarization.lasting depolarization. Present in amygdala and prefrontal areasPresent in amygdala and prefrontal areas Also a number of brainstem areas Also a number of brainstem areas

associated with stress response (locus associated with stress response (locus coeruleus, ventral tegmental area, coeruleus, ventral tegmental area, periadaqueductal grey matter) periadaqueductal grey matter)

Page 11: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1111

Neuropathology: Learning AnxietyNeuropathology: Learning Anxiety Producing Behaviours Producing Behaviours

Neurotransmitter SystemsNeurotransmitter Systems2.2. GABA (A-receptor subtype)GABA (A-receptor subtype) Implied through the effects of GABAImplied through the effects of GABAAA

agonist benzodiazapineagonist benzodiazapine Sedative used in the treatment of anxiety Sedative used in the treatment of anxiety

and insomniaand insomnia Large occipital reductions in GABA Large occipital reductions in GABA

concentrationsconcentrations Receptor disruption through other Receptor disruption through other

modulator steroidsmodulator steroids

Page 12: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1212

Neuropathology: Learning AnxietyNeuropathology: Learning Anxiety Producing Behaviours Producing Behaviours

Neurotransmitter SystemsNeurotransmitter Systems

3. Norepinephrine 3. Norepinephrine Locus coeruleus: Arousal, vigilanceLocus coeruleus: Arousal, vigilance Limbic and frontal cortex: elaboration, Limbic and frontal cortex: elaboration,

adaptive responses to stressadaptive responses to stress Long term potentiation in medial PFCLong term potentiation in medial PFC

Sustained stress producing reduction in Sustained stress producing reduction in number of NE number of NE 2 receptors2 receptors

Page 13: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1313

Neuropathology: Learning AnxietyNeuropathology: Learning Anxiety Producing Behaviours Producing Behaviours

Neurotransmitter SystemsNeurotransmitter Systems

4. Corticotropin Releasing Hormone4. Corticotropin Releasing Hormone Mediation of response to stressMediation of response to stress In amygdala: occurrence of fear related In amygdala: occurrence of fear related

behavioursbehaviours In cortex: reduction reward expectationIn cortex: reduction reward expectation Memory systems may be particularly Memory systems may be particularly

sensitive to the effects of CRH in early sensitive to the effects of CRH in early life.life.

Page 14: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1414

Obsessive-Compulsive Disorder: Obsessive-Compulsive Disorder: DSM-IV CriteriaDSM-IV Criteria

A.A.

1. recurrent and persistent thoughts, impulses, or images 1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the that are experienced, at some time during the disturbance, as intrusive and inappropriate and that disturbance, as intrusive and inappropriate and that cause marked anxiety or distresscause marked anxiety or distress

2. the thoughts, impulses, or images are not simply 2. the thoughts, impulses, or images are not simply excessive worries about real-life problemsexcessive worries about real-life problems

Page 15: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1515

OCD: DSM-IV CriteriaOCD: DSM-IV Criteria

3. the person attempts to ignore or suppress such 3. the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with thoughts, impulses, or images, or to neutralize them with some other thought or action (compulsion)some other thought or action (compulsion)

44.the person recognizes that the obsessional thoughts, .the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)(not imposed from without as in thought insertion)

Page 16: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1616

OCD: DSM-IV CriteriaOCD: DSM-IV Criteria

Compulsions Compulsions 1. repetitive behaviors (e.g., hand washing, ordering, checking) 1. repetitive behaviors (e.g., hand washing, ordering, checking)

or mental acts (e.g., praying, counting, repeating words or mental acts (e.g., praying, counting, repeating words silently) silently)

person feels driven to perform in response to an obsessionperson feels driven to perform in response to an obsession according to rules that must be applied rigidlyaccording to rules that must be applied rigidly2. behaviors or mental acts are aimed at preventing or reducing 2. behaviors or mental acts are aimed at preventing or reducing

distress or preventing some dreaded event or situation;distress or preventing some dreaded event or situation; not connected in a realistic way with what they are designed not connected in a realistic way with what they are designed

to neutralize or prevent or are clearly excessiveto neutralize or prevent or are clearly excessive

Page 17: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1717

OCD: DSM-IV CriteriaOCD: DSM-IV Criteria

B.B. At some point, the person has recognized that the obsessions or At some point, the person has recognized that the obsessions or compulsions are excessive or unreasonable. compulsions are excessive or unreasonable. Note: This does not apply to children.Note: This does not apply to children.

C. The obsessions or compulsions cause marked distress, are time C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere consuming (take more than 1 hour a day), or significantly interfere with the personwith the person’’ss normal routine, occupational (or academic) normal routine, occupational (or academic) functioning, or usual social activities or relationships.functioning, or usual social activities or relationships.

Page 18: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1818

OCD: DSM-IV CriteriaOCD: DSM-IV Criteria

D.D. If another Axis I disorder is present, the content of the obsessions or If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it compulsions is not restricted to it (e.g, preoccupation with food in the presence of an Eating Disorder; (e.g, preoccupation with food in the presence of an Eating Disorder; preoccupation with drugs in the presence of a Substance Use preoccupation with drugs in the presence of a Substance Use Disorder.Disorder.

E.E. The disturbance is not due to the direct physiological effects of a The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical substance (e.g., a drug of abuse, a medication) or a general medical condition.condition.

Page 19: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 1919

More informationMore information

Obsessions are very difficult to repress despite Obsessions are very difficult to repress despite their unpleasant nature.their unpleasant nature.

Obsessions and compulsions can occur Obsessions and compulsions can occur independently.independently.

Common compulsions include washing, checking Common compulsions include washing, checking behaviours, order, and symmetry.behaviours, order, and symmetry.

Page 20: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2020

Generalized Anxiety Disorder: DSM-IV Generalized Anxiety Disorder: DSM-IV

A. Excessive anxiety and worry (apprehensive A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as months, about a number of events or activities (such as work or school performance).work or school performance).

B. The person finds it difficult to control the worry.B. The person finds it difficult to control the worry.

Page 21: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2121

GAD: DSM-IV CriteriaGAD: DSM-IV Criteria

C.C. The anxiety and worry are associated with three (or The anxiety and worry are associated with three (or more) of the following six symptoms :more) of the following six symptoms :

1.1. muscle tensionmuscle tension

2.2. being easily fatiguedbeing easily fatigued

3.3. IrritabilityIrritability

4.4. sleep disturbance (difficulty falling or staying asleep, or sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)restless unsatisfying sleep)

5.5. restlessness or feeling keyed up or on edgerestlessness or feeling keyed up or on edge

6.6. difficulty concentrating or mind going blankdifficulty concentrating or mind going blank

Page 22: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2222

GAD: DSM-IV CriteriaGAD: DSM-IV Criteria

D.D. The focus of the anxiety and worry is not confined to The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in a Panic Disorder), not about having a Panic Attack (as in a Panic Disorder), being embarrassed in public (as in Social Phobia). being embarrassed in public (as in Social Phobia).

E.E. The anxiety, worry, or physical symptoms cause The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, clinically significant distress or impairment in social, occupational, or other important areas of functioning.occupational, or other important areas of functioning.

Page 23: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2323

GAD: DSM-IV CriteriaGAD: DSM-IV Criteria

F.F. The disturbance is not due to the direct physiological The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.Developmental Disorder.

Page 24: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2424

Social PhobiaSocial Phobia

Fear is centred on some aspect of the Fear is centred on some aspect of the social situation.social situation.

Children fear a teacher, being called on Children fear a teacher, being called on in class, or even entering the classroom.in class, or even entering the classroom.

Adults may fear public speaking, social Adults may fear public speaking, social interaction, or initiation of interaction, or initiation of conversationsconversations

Symptoms are similar to fear response Symptoms are similar to fear response associated with all phobias.associated with all phobias.

Page 25: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2525

Social Phobia: DSM-IVSocial Phobia: DSM-IV

A.A. M Marked and persistent fear of one or more social and arked and persistent fear of one or more social and performance situations in which the person is exposed to performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.unfamiliar people or to possible scrutiny by others.

The individual fears that he or she will act in a way (or The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or show anxiety symptoms) that will be humiliating or embarrassing.embarrassing.

Note: In children, there must be evidence of the capacity Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not people and the anxiety must occur in peer settings, not just in interactions with adults.just in interactions with adults.

Page 26: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2626

Social Phobia: DSM-IVSocial Phobia: DSM-IV

B. Exposure to the feared social situation almost invariably B. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a provokes anxiety, which may take the form of a situationally bound or predisposed Panic Attack.situationally bound or predisposed Panic Attack.

Note: In children, the anxiety may be expressed by Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social crying, tantrums, freezing, or shrinking from social situations with unfamiliar people.situations with unfamiliar people.

C.C. The person recognizes that the fear is excessive or The person recognizes that the fear is excessive or unreasonable.unreasonable.

Note: In children, this feature may be absentNote: In children, this feature may be absent

Page 27: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2727

Social Phobia: DSM-IVSocial Phobia: DSM-IV

D.D. The feared social or performance situation are avoided The feared social or performance situation are avoided or else are endured with intense anxiety or distressor else are endured with intense anxiety or distress

E.E. The avoidance, anxious anticipation, or distress in the The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes feared social or performance situation(s) interferes significantly with the person's normal routine, significantly with the person's normal routine, occupational (academic) functioning, or social activities occupational (academic) functioning, or social activities or relationships, or there is marked distress about having or relationships, or there is marked distress about having the phobia.the phobia.

F.F. In individuals under age 18 years, the duration is at least In individuals under age 18 years, the duration is at least 6 months6 months

Page 28: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2828

Social Phobia: DSM-IVSocial Phobia: DSM-IV

G.G. The fear or avoidance is not due to the direct The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition and abuse, a medication) or a general medical condition and is not better accounted for by another mental disorder.is not better accounted for by another mental disorder.

H.H. If a general medical condition or another mental disorder If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it. is present, the fear in Criterion A is unrelated to it.

Usually refers to realistic fearsUsually refers to realistic fears

Page 29: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 2929

Panic DisorderPanic Disorder

When panic attacks due to anxiety and fear occur When panic attacks due to anxiety and fear occur regularly, may have panic disorderregularly, may have panic disorder

Sudden feelings of terror that occur suddenly and Sudden feelings of terror that occur suddenly and without warningwithout warning

Symptoms vary but may include:Symptoms vary but may include:• Chest pain.Chest pain.• Heart palpitationsHeart palpitations• Shortness of breath.Shortness of breath.• Dizziness.Dizziness.• Abdominal distressAbdominal distress

Page 30: PSY4080 6.0 D Anxiety Disorders 1. PSY4080 6.0 D Anxiety Disorders 2 Anxiety Disorders: Prevalence, general information Anxiety disorders - most prevalent.

PSY4080 6.0 DPSY4080 6.0 D Anxiety DisordersAnxiety Disorders 3030

Some EtiologySome Etiology

Begins in young adulthood--may or may not be Begins in young adulthood--may or may not be linked to a particular traumatic experiencelinked to a particular traumatic experience

Evidence that heightened fear response Evidence that heightened fear response begins in early childhood begins in early childhood

Related to neurological syndromes, like Related to neurological syndromes, like epilepsy, Tourette’s, lesions (encephalitis, epilepsy, Tourette’s, lesions (encephalitis, TBI)TBI)

Some patients have damage or dysfunction of Some patients have damage or dysfunction of basal ganglia, cingulate gyrus, prefrontal basal ganglia, cingulate gyrus, prefrontal cortexcortex (Giedd et al., 1995; Robinson et al., 1995)(Giedd et al., 1995; Robinson et al., 1995)

Difficulty with extinctionDifficulty with extinction