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Epidemiology of panic disorder panic disorder

The conceptualization of panic disorder can be traced back to the concept of irritable heart syndrome, which was noticed in soldiers during the American Civil War by Jacob Mendes DaCosta . The

DaCosta syndrome include many of the devas psychic and somatic symptoms that are now in-cluded in the diagnostic criteria for panic disorder.

In 1895, Sigmund Freud introduced the concept of anxiety neurosis , which consisted of acute symptoms and chronic psychological and somatic. The

acute anxiety neurosis Freud was similar to the disorder of the DSM-IV nico pa.

Freud was the first to notice the relationship between panic attacks and agoraphobia. The term

"agoraphobia" was coined in 1871 for the condition in which patients seem to be afraid to venture out in public without being accompanied by friends or relatives.

The word from the shore from the greek agora and phobos, meaning fear of the streets.

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history of panic and agoraphobia: GENERAL '

In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a panic attack is referred to as "a distinct period of intense fear or discomfort", ac companied by at least four somatic symptoms or such as cognitive, among others, palpitations, tremor, tachypnea, sweating and choking.

Since the panic disorder was coded in 1980 had accumulated a significant amount experimental data on the disorder and clinical experiences with patients. The

to panic disorder is characterized by the appearance of spontaneous, unexpected panic attacks , whose frequency can vary from multiple attacks throughout the day, a few attacks during a year. The distur

bo panic is often accompanied by agoraphobia , that pau ra to be alone in a public place (eg, a supermarket), especially in places where it would be impossible for a quick escape if the subject had a panic attack.

Agoraphobia may be the most disabling phobias, as that its presence can significantly interfere with the functioning of the person in social situations and vorative out of their homes. In the U.S., most researchers in the field of panic disorder agoraphobia considers that the application is almost always a complication in patients with panic disorder. In other words, we assume that agoraphobia is caused by the development of the fear of having a panic attack in a public place from which it may be difficult to escape.

Researchers from other Countries are, but also the United States, do not accept this theory. However, the fourth edition of DSM (DSM-IV) considers the disturbance panic as the predominant complaint in the dyad and includes diagnosis of panic disorder with agoraphobia and panic disorder without agoraphobia .

The DSM-IV contains diagnostic criteria for agoraphobia without history of panic disorder. The same panic attacks can occur in a number of mental disorders (eg, in depressive distur bo) and medical conditions (eg, abstinence or poisoning substances); the onset of an attack by nico pa per se does not justify the diagnosis of panic disorder.

Because subjects with panic disorder often go to the emergency Aid, the symptoms may be misdiagnosed as a serious medical condition (eg, myocardial infarction) or as a so-called hysterical symptoms. Nevertheless, the ability of health professionals who deal with mental health to recognize the symptoms of panic disorder has increased since 1980 and have been developed specific treatments.

All caregivers should be now able to recognize the symptoms of panic disorder, so patients can receive appropriate treatment, whether pharmacological or psychotherapeutic.

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medical disorders and generalized anxiety disorder

Generalized Anxiety Disorder and 'disease frequently found in many conditions of general medical condition.

A high prevalence of symptoms of generalized anxiety disorder has been reported in patients with Sjogren's syndrome (based chronic autoimmune inflammatory disease characterized by destruction of exocrine glands, minor salivary glands, lacrimal glands , parotid) and may be related to the effects of Sjogren's syndrome, the subcortical and cortical activity and thyroid function.

The general medical condition with the highest prevalence of symptoms of generalized anxiety disorder seems to be the Graves' disease (the most town of hyperthyroidism, caused by a general hyperactivity of the entire thyroid gland. Disorder known as diffuse toxic goiter "), in which up to two thirds of patients may meet the criteria for generalized anxiety disorder.

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medical disorders and panic attacks

I Anxiety disorders associated with a general medical condition : incidence of panic attacks .

Patients who have a cardiomyopathy may have the highest incidence of panic disorder secondary to a general medical condition.

One study reported that 1'83% of patients with cardiomyopathy pending of cardiac transplant presented symptoms of panic disorder. A
increased noradrenergic tone in these patients could be the stimulus provoking panic.

In some studies, approximately 25% of patients with Parkinson's disease and chronic obstructive pulmonary disease symptoms of panic disorder.

Other medical disorders associated with chronic pain include the primary biliary cirrhosis el ' epilepsy, especially if the outbreak is in the right parahippocampal around.

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anxiety disorder due to a condition general medical

As with most other syndromes (eg, psychosis, and early symptoms mood disorders), the anxiety disorder due to a general medical condition was included in the relevant section to promote the development and consideration of a complete differential diagnosis.

Epidemiology. The symptoms of anxiety related to general medical conditions is common, although the incidence of the disease varies for each specific medical condition ge eral.
Etiology . A wide range of medical conditions can cause symptoms similar to Sare those observed in both disorders also. Hyperthyroidism, hypothyroidism, hypoparathyroidism and vitamin deficiency B12 fre you are associated with anxiety symptoms. A pheochromocytoma secretes adrenaline, which can cause episodes of paroxysmal symptoms of anxiety. It is believed that some brain injuries and were posten cefalitici determine symptoms identical to those observed in obsessive - compulsive . Some other medical condi tions, such as cardiac arrhythmia, can produce physiological symptoms of panic disorder. Hypoglycemia can also mimic the symptoms of an anxiety disorder. The various medical conditions that cause symptoms of anxiety disorder may do so through a common mechanism, the noradrenergic system , although the effects on the serotonergic system are currently under investigation.

diagnosis. The diagnosis of DSM-IV anxiety disorder due to a general medical condition required the presence of symptoms of an anxiety disorder. The DSM-IV allows the doctor to specify whether the disorder is characterized by Zato symptoms of generalized anxiety, panic attacks or obsessive-compulsive symptoms .

The physician should have an increased level of suspicion to the diagnosis when anxiety is associated with chronic or paroxysmal a physical illness that is a known cause of such symptoms in some patients. Bursts of paroxysmal hypertension in a patient anxious it may indicate that it is appropriate to seek a pheochromocytoma. Generates a medical examination can reveal diabetes, an adrenal tumor, but a thyroid disease or a neurological condition. For example, some people with epilepsy have complex partial epi firm of extreme anxiety or fear as the only manifestation of seizure activity.

Clinical features. Symptoms of anxiety disorder do vuto to a general medical condition may be identical to those of primary anxiety disorders. Like syndrome disorder Panic is the most common clinical picture, while a syndrome similar to the three phobia is less common.

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Anxiety disorders and alcohol abuse (DSM-IV)

The DSM-IV lists the following anxiety disorders:

panic disorder with or without agoraphobia ,

agoraphobia without history of panic disorder, specific phobias

and social ,

obsessive-compulsive ,

post-traumatic stress disorder ,

acute stress disorder,

generalized anxiety disorder (all discussed in other sections of this blog),

anxiety disorder due mainly to a general medical condition, anxiety disorder in

product by substances and anxiety disorder Unless otherwise specified, including

disorder mixed anxiety-depression.

Practically anyone drink alcohol used it, at least in some instances, to reduce anxiety, mostly society. On the contrary, carefully controlled studies have shown that the effects of alcohol on anxiety are able and ranges may be significantly influenced sex, amount of alcohol ingested and cultural habits.

Nevertheless, the complaints of abuse of alcohol and other substances are commonly associated with anxiety disorders.

from alcohol abuse disorders are about four times more common among patients with panic disorder than the general population, about 3.5 times more common among the projects subject with obsessive-compulsive disorder and about 2.5 times more common among those with phobias.

Committee Several studies have reported data suggestive of a genetic diathesis for both distur bi anxiety and for those with alcohol abuse can co-exist in some families.

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Anxiety: Anxiety

The biological theories on anxiety developed from preclinical studies with animal models of anxiety, the study of patients in whom biological factors were highlighted, from the increasing knowledge of basic neuroscience and the actions of psychoactive drugs. One school of thought argues that biological variation in patients with measurable distur bo anxiety reflect the result of psychological conflicts. One side asserts that current biological events prior psychological conflicts. The two situations may coexist in certain subjects and a whole range of feelings with a biological basis may exist among individuals with symptoms of anxiety disorder.


autonomic nervous system.

Stimulation of the autonomic nervous system causes certain symptoms - cardiovascular (eg, tachycardia), muscle (eg, headache), gastrointestinal ones (eg, diarrhea) and respiratory (eg, tachypnea). These peripheral manifestations of anxiety are neither unique nor necessarily of anxiety disorders related to the subjective experience of anxiety.

Currently it is generally believed that anxiety precedes the central nervous system manifestations of anxiety devices, except when there is a specific Because device, such as when the subject has a pheochromocytoma. Some individuals with anxiety disorders, particularly panic disorder , have an autonomic nervous system shows an increase of sympathetic tone, it adapts slowly to repeated stimuli and responds to stimuli too moderate.


Neurotransmitters

The three main neurotransmitters associated with anxiety on the basis of animal studies and drug response are adrenaline, serotonin and gamma-amino butyric acid (GABA). Much of the information of the basic sciences neuro anxiety derived from animal experiments involving behavioral paradigms and psychoactive substances. One of these animal models of anxiety is the test of the conflict, in which the animal is simultaneously shown that stimuli are positive (eg, food) and negative (eg, electric shock). The anti-anxiety drugs (eg, zodiazepine well) tend to facilitate the adjustment of the soul in this situation, while other drugs (eg, amfeta mine) that do not worsen the behavioral response of the animal.

Noradrenaline

The general theory on the role of noradrenaline in anxiety disorders is that the patient may have hit a noradrenergic system is poorly regulated that has occasional bursts of activity. The cell bodies of the noradrenergic system are located mainly in the rostral locus coeruleus in the pons and project their axons to the cerebral cortex, the system lim bique, the trunk and spinal cord.

Human studies have found that in patients with disorder pa nico adrenergic agonists (eg, isoproterenol) and adrenergic antagonists (eg, yohimbine) can cause you frequent and severe attacks panic.

On the contrary, clonidine, an adrenergic agonist, reduces symptoms of anxiety in some experimental and therapeutic situations. Less frequently, patients with the disorder anxiety, particularly panic disorder have high levels of urinary or CSF noradrenergic metabolite 3-methoxy-4-hydroxy-sifenilglicole (MHPG).

SEROTONIN

The identification of many types of receptors if rotonina has stimulated the search for a role in the pathogenesis of anxiety disorders. The interest in this report was originally motivated by the observation that serotonergic antidepressants have some therapeutic effects in anxiety disorders - for example, clomipramine in obsessive-compulsive disorder. The efficacy of buspirone, an agonist of the serotonin receptor na lA receptor (5-HT1A) in the treatment of anxiety disorders also suggests the possibility of an association between anxiety and serotonin.

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biological theories: psychoanalytic theory

Although Freud originally believed that anxiety resulted from a physiological increase libido, in the end he redefined 'anxiety as a signal in the range of the conscious presence of a hazard.

Anxiety was seen as the result of a psychic conflict between unconscious desires of a sexual or aggressive and the corresponding threats from the superego or external reality. In response to this signal, the ego mobilizes the defense mechanisms to prevent unacceptable thoughts and feelings emerge into consciousness. In his classic work

Inhibitions, Symptoms and Anxiety, Freud says that "it is the anxiety that causes the repression and not, as previously believed, repression which pro duce anxiety." One of the negative consequences to consider the symptom of anxiety as a disorder rather than as a signal that the underlying sources of anxiety can be ignored.

one psychodynamic perspective, the goal of therapy is not necessarily eliminate all the anxiety, but to improve the tolerance of anxiety itself, ie the ability to feel the anxiety by using it as a signal to investigate the underlying conflict that caused it.

with anxiety seems in response to various situations during the life cycle and an attempt to eliminate it by means psychopharmacological can do nothing to address the existential situation or its related internal and led the state of anxiety.

To fully understand the anxiety of a particular patient is often useful to think in terms of a hierarchy of development which links the source of anxiety to development issues.

the most primitive level, this can be an anxiety of disintegration. This anxiety may derive either from fear of losing their sense of self or its know boundaries through the merger with an object, or by concern that the ego fragments because others do not respond with the necessary confirmation and validation.

On one level a bit 'higher anxiety or paranoid persecution can be linked to the perception that a person is likely to be invaded and set aside by a malevolent outside force.

A more advanced source of anxiety is less of a problem, but a child may be anxious for fear of losing the love or approval of a parent or a beloved object.

castration anxiety, related to the Oedipus phase in boys development, concerns the fear against a vengeful parent figure, usually the father, which damages the genitals or otherwise cause physical damage.

At the most mature, the 'superego anxiety is explained as related to guilt for the failure to live up to internalized models derived from the default behavior of parents.

Often a psychodynamic interview can clarify the main level of anxiety that goes against the patient to face.

Some form of anxiety is obviously related to multiple conflicts at various levels of development.

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pathological anxiety: epidemiology

I anxiety disorders are one of the most common psychiatric disorders. The National Comorbidity Study

reported that four an individual meets the diagnostic criteria for at least one anxiety disorder and that there is an annual prevalence rate of 17.70 / 100.

women (lifetime prevalence of 30.50 / 100) have a higher probability of having an anxiety disorder than men (lifetime prevalence of 19.20 / 100).

Finally, the prevalence of anxiety disorders decreases with increasing socioeconomic status .

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psychological and cognitive symptoms of anxiety panic

The experience of anxiety has two components:

1) awareness of physiological sensations (such as palpitations and sweating) and
2) the feeling of being nervous or scared.

The anxiety may be heightened by a sense of shame ver - "Others will find that I'm scared."

Many people are amazed to discover that others are not aware of their anxiety or, if they are, do not appreciate the intensity.

addition to the motor effects and visceral anxiety affects thought, perception and learning. It tends to create confusion and distortion of perception, not only that of time and space, but also of people and the meaning of events. These distortions can interfere with learning rire reducing the concentration, the ability to recall learned and limiting the ability to relate an object with another, or to make associations.

An important aspect of emotions is represented by its effects on the selectivity of attention.
anxious individuals tend to select certain aspects of their environment and neglecting others, in an effort to prove that they JUSTIFY in considering the terrible situation and acting accordingly. If falsely justify

their fear, their anxiety is increased by the selective response, establishing a vicious cycle of anxiety, distorted perception and anxiety additio king.

Conversely, if falsely reassure themselves at thinking through a selective, appropriate anxiety may be reduced and may not be able to take the necessary precautions.

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Stress, conflict and anxiety

The fact that an event is perceived as stressful depends on its nature and resources of the person, from his psychological defenses and its mechanisms of reaction.

This involves the ego, collective abstraction to define the process by which a person perceives, thinks and acts on the basis of external events or internal impulses.

A person whose ego is functioning properly in the budget is adaptive to the outside world with both the inner and if the ego is not working properly and launched sbi result persists long enough, the person to alert the ' chronic anxiety.

Whether this imbalance is external, between the pressures of the outside world and the ego of the subject, or internal, between the impulses of the patient (eg, aggressive impulses, sexual or dependence) and consciousness, it determines a conflict.

conflicts caused by external events are usually interpersonal, while those caused by internal events are intrapsychic or intrapersonal.

A combination of both is pos sible, as in the case of employees who have a more critical or demanding too much and need to control their impulses to strike for fear of losing their jobs.

with the interpersonal and intrapsychic conflicts are in fact usually combined, because human beings are social and their main conflicts are usually with other individuals.

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adaptive functions of anxiety

If considered simply as an alert signal, the anxiety may be practically considered an emotion similar to fear.

Anxiety warns of an external threat or internal quality and designed to save lives.

At a lower level anxiety warns of threats against the body, do the lore, impotence, a potential punishment, the frustration of social needs or injury, separation from loved ones, to be a threat to success or status of a person, as a last resort, to its unity and completeness.

It causes the person to take the necessary measures to prevent the threat or minimize their consequences.

Examples of avoidance of a threat in everyday life are applied to the study to prepare for an exam, the dodge a ball thrown against his head, back furtive mind in the dorm after the time set for definition and can avoid a rush to catch the last flight to the commuter train.

This anxiety prevents damage alerting the person carrying out certain measures that prevent the danger.

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Fear and anxiety

Anxiety is a signal to alert: a warning of imminent danger im, and allows the person to take measures to address a threat.

Fear, which is a similar warning should be differentiated from.

Fear manifests itself in response to a known threat, external, adopted or otherwise non-confrontational in origin, the anxiety is manifested in response to an unknown threat, internal, vague or conflictual in origin.

The distinction between fear and anxiety arose by chance.

The first translator of Freud mistakenly translated the word angst and fear in German, such as anxiety. Freud himself generally unaware of the distinction that the anxiety associated with an object and repressed unconscious and fear to an external object and known. The distinction may be difficult to do, that fear can also be due to an internal object, the unconscious, repressed projected onto another object in the world do outside.

Nevertheless, based on post-Freudian psychoanalytic formulations, the separation between fear and anxiety is justifiable from the psychological point of view. The main

. psychological difference between the emotional responses of fear is the acuity and chronicity of anxiety.

Charles Darwin pointed out that the word fear comes from words that indicate what is sudden and dangerous. The term also appears to be vital in neurophysiological phenomena of anxiety and fear.

In 1896, Darwin made the following description if a fear of acute psychophysiological finante with terror:

Fear is often preceded by astonishment, and so like this I mean that both the sense of sight and learning are immediately aroused. In both cases the eyes and mouth are wide open and eyebrows raised. The frightened man at first stands like a statue motionless holding his breath or lies down instinctively how to escape observation. The heart beats quickly and violently in order to beat or beating against my ribs, but it is very doubtful that it works more effectively than normal in order to send a larger amount of blood to all parts of the body because the skin becomes pale suddenly as for an impending loss of consciousness. Pal value, however, this surface is probably due, in large part or all of the fact that the vasomotor center is affected in such a way as to cause the contraction of small arteries skin. The fact that the skin is very interested in a great fear shown by the wonderful and inexplicable manner in which it occurs immediate ly sweating. This sweating is all the more remarkable because the skin surface in this case is cold, hence the term cold sweat, and sweat glands are nor mally induced action when the surface is hot. Even the hairs are erected and the superficial muscles shiver. In connection with the impaired action of the heart, the breathing is hurried. The salivary glands act imperfectly, the mouth becomes dry and is frequently opened and closed. I also noticed that due to a slight fear there is a strong tendency to yawn king. One of the most characteristic symptom is a tremor of the muscles of the body and this is often seen from his lips. Because of this and the dryness of the mouth, the voice becomes husky or indistinct, or may fail altogether ...
As the fear grows into terror you give us, as in all the violent emotions, different results. The CuO King beating in a violent way or causing a svenimen to be missing and there is a deathly pallor, breathing is labored, his nostrils are latate and there is a movement gasping and feverish lips, a tremor of the cheeks and continuous movements of swallowing, the eyes are not covered by the lids and rims shall be set to sull'ogget of terror, or they can rotate continuously from side to side. The pupils are said to be greatly expanded. All mu drains the body may become rigid or give rise to minds convulsive movements. The hands are alternately open and close, often with a contortion. The arms are outstretched, as if to avoid some terrible danger, or be troubled on his head ... In other cases there is a sudden and uncontrollable tendency to stampede, and this is so strong that more soldiers co raggiosi can be captured by sudden panic attacks.