Anxiety Disorders and Panic Disorder

Anxiety Disorders Overview

• Anxiety involves apprehension over an anticipated problem
• It is a negative mood state with bodily symptoms of physical tension
• Fear is an immediate reaction to danger
• Panic is an abrupt experience of intense fear or discomfort, usually with physical symptoms

Generalized Anxiety Disorder (GAD)

• GAD includes excessive anxiety and worry with difficulty controlling worry
• More common in females and elders (45+)
• Diagnosis requires three of six symptoms, but children only need one
• Symptoms can be remembered via "ReBeDIMS"
• Restlessness
• Being easily fatigued
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance

Panic Disorder and Agoraphobia

• Panic Disorder involves anxiety about recurrent panic attacks
• Individuals experience severe, unexpected panic attacks
• They may fear dying or losing control, and avoid daily activities
• Diagnosis requires worry about attacks for at least one month, and worry about the consequences
• Agoraphobia involves fear and avoidance of situations where escape feels unsafe
• Shopping malls represent a stressful place for individuals
• Two or more of five situations must be present for diagnosis: public transportation, enclosed spaces, standing in line, being in a crowd, outside home
• Symptoms last at least 6 months

Specific Phobia (SP)

• SP represents the most prevalent anxiety disorder
• Involves irrational fear of specific subjects/situations that markedly interferes with function
• The fear is out of proportion to the actual danger
• Individuals may have multiple phobias
• Onset around seven years old
• Phobias include:
  • Blood-Injection-Injury Phobia
  • Situational Phobia
  • Natural Phobia
  • Animal Phobia

Blood-Injection-Injury Phobia

• People may feel like they are going to faint, but their heart rate and blood pressure increase, and they never faint
• Runs strongly in families
• Average age of onset is approximately 9 years

Situational Phobia

• Characterized by fear of public transportation or enclosed places

Natural Environment Phobia

• Characterized by fear of heights, storms, and water
• Fears often cluster together
• Peak age of onset around 7 years

Animal Phobia

• Common, but becomes phobic only if severe interference with functioning occurs

Separation Anxiety Disorder

• Identified more closely with children
• Characterized by unrealistic/persistent worry that something will happen to parents/important people, or that something will happen to children that will separate them
• Requires at least 3 symptoms for at least 4 weeks (adults: 6 months or more)

Social Anxiety Disorder (SAD)

• Involves experience/marked fear/anxiety focused on social/performance situations
• Public speaking represents the most common type of performance anxiety

Selective Mutism

• A rare childhood disorder, characterized by lack of speech in settings where speaking is expected

Trauma and Stressor-Related Disorders: Reactive Attachment Disorder

• Characterized by markedly disturbed/inappropriate ways of relating socially
• Lack of attachment to a specific caregiver at an early stage results in inability to form normal, loving relationships

Disinhibited Engagement Disorder

• A child may engage with strangers and be overfamiliar with adults, lacking stranger anxiety

Adjustment Disorder

• A short-term condition where an individual experiences excessive/maladaptive response to a stressful event/change
• Stressful events like job loss, relationship problems, and financial difficulties, can trigger the disorder
• Symptoms typically begin within three months of the stressful event, and subside within six months as the person adapts

Acute Stress Disorder

• Exposure to actual/threatened death, serious injury, or sexual violation
• At least 8 symptoms must begin/worsen since the trauma, and last 3-31 days

Post Traumatic Stress Disorder

• Symptoms are similar to Acute Stress Disorder, but last more than one month after the trauma
• Traumatic events include: natural disasters, abuse, combat/war-related events, and common traumatic events

Obsessive-Compulsive and Related Disorders Overview

• Obsessive-Compulsive Disorder (OCD) marks a devastating culmination of anxiety disorders
• Someone with OCD may experience severe GAD, recurrent panic attacks, and major depression simultaneously
• The dangerous event involves a thought, image, or impulse to avoid
• Obsessions involve intrusive and nonsensical thoughts, images, or urges that individuals try to resist/eliminate
• Compulsions represent thoughts/actions used to suppress the obsession and provide relief

Tic Disorders and OCD

• Often co-occur in patients
• Tic Disorder involves involuntary movements (sudden jerking of limbs)
• Tourette’s Disorder involves more complex tics with involuntary vocalization
• Obsessions in tic-related OCD almost always relate to symmetry

Body Dysmorphic Disorder (BDD)

• Center is preoccupation with some imagine defect in appearance, by someone who actually looks normal
• Referred to as "Imagined ugliness"
• OCD often co-occurs with BDD, and is found among family members

Hoarding Disorder

• Three major characteristics: excessive acquisition of things, difficulty discarding anything, and living with excessive clutter
• Characterized as gross disorganization
• Individuals may begin acquiring things during teenage years, and average treatment age is approximately 50
• Individuals experience strong anxiety/distress about throwing items away

Trichotillomania (Hair Pulling Disorder)

• Urge to pull one’s own hair from anywhere on the body
• Results in noticeable hair loss, distress, and significant social impairments
• There may be some genetic influence
• Most commonly involves hair pulling on the scalp

Excoriation (Skin Picking Disorder)

• Repetitive and compulsive picking of skin, leading to tissue damage
• Can cause significant embarrassment, distress, and impairment in social/work functioning
• Mostly affects women

History of Mental Illness: Stone Age

• Trephination involved chipping away at the skull to release evil spirits

Demonology, Gods & Magic

• Involves possession by good/evil spirits
• Treatment: exorcism in Chinese, Greek, and Egyptian societies

Early Greek Thinkers: Hippocrates

• Father of modern medicine
• Believed in natural causation for mental illness
• Hypothesized that brain pathology and heredity play a role
• Classified mental illness into mania, melancholia, and phrenitis (brain fever)
• Considered that dreams held a role in the understanding of mental illness

Galen

• Followed Hippocrates
• Believed in the doctrine of 4 humors (bile-yellow/red/green/black)
• Temperaments associated with humors include:
  • Phlegmatic (green): sluggish/lazy/peaceful
  • Choleric (yellow): angry/irritable/aggressive
  • Sanguine (red): cheerfulness and friendliness
  • Melancholic (black): sad/depressed/perfectionist

Plato

• Mental ill people aren't responsible for criminal acts
• Advocates hospital care for the mentally ill
• Believed in divine causation

Aristotle

• Regarding consciousness
• Wrote extensively on mental disorders
• Generally followed the views of Hippocrates

Middle Age (Middle East)

• Islamic countries continued to utilize the scientific aspects of Greek tradition
• First mental hospital was established in Bagdad in 792 AD

Aviecianna

• An outstanding person from Arabia
• Wrote the book "Canon of Medicine"

Middle Ages (Europe)

• Devoid of scientific thinking and humane treatment for the mentally disturbed
• Popularity of supernatural explanations for mental illness
• Mass madness and exorcism
• Mass madness marks spread of behavior disorder that were apparently cases of hysteria
• Caused whole groups of people to be affected simultaneously

Dancing Manias

• Epidemics of raving, jumping, dancing, and convulsion were reported as early as the 10th century
• Spread in Germany and Europe, as Saint Vitus Dance
• Tarantism includes uncontrollable dance attributed to the bite of either a southern European tarantula or wolf spider
• This dancing mania later spread to Germany and the rest of Europe, known as Saint Vitus's dance
• Isolated rural areas were afflicted with outbreaks of lycanthropy
• People believed they were possessed by wolves and imitated them

Mass Hysteria

• Involved mimicry of some type of physical disorder such as fainting spells

Exorcism and Colten Craft

• Management of the mentally disturbed fell largely to the clergy
• Monasteries served as refuges and places of confinement
• During the early medieval period, the mentally disturbed received considerable kindness

Paracelsus

• Swiss physician, insisted that dancing mania was not possession but a form of disease
• Formulated the idea of psychic causes for mental illness/advocated treatment by 'bodily magnetism', later called hypnosis
• Rejected demonology, but believed abnormal behavior resulted from astral influences
• Believed the moon excreted a supernatural influence on the human brain, leading to the terms: lunatic, lunacy

Johann Weyer

• German physician/writer was disturbed by the imprisonment, torture, and burning of people accused of witchcraft
• Published 'Deception of Demons' (1563), containing a step-by-step rebuttal of Malleus Maleficarum
• One of the first physicians to specialize in mental disorders
• Rightly called the founder of modern Psychopathology
• Scorned by peers, and works were banned by the church
• Like St Vincent de Paul, The clergy declared "Mental disease is no different to bodily disease, and Christianity demands humane and powerful protections, and skills for proper relief"

Establishment of Early Asylums and Shrines

• Special institutions asylums, or places of refuge for the mentally ill, were established in many countries from the 16th century
• Valencia mental hospital founded by Father Juan Pilberto Jofre, and Bedlam by Henry VIII in London, the San Hippolito established in Mexico

Humanitarian Reform

• Most mental hospitals in Europe and America were in great need of reform in the late 18th century

Philippe Pinel

• Experiment in 1792 had revolutionary effect on the betterment of patients

William Tuke

• Established the York Retreat
• A pleasant English country house, where mental patients lived/worked/rested in a religious atmosphere
• Retreat represented the culmination of a noble battle against brutality, ignorance, and indifference in Tuke's times

Rush and Moral Management in America

• Benjamin Rush, the founder of American Psychiatry, encouraged more humane treatment for the mentally ill
• Moral management represents a wide-ranging treatment method focused on a patient’s social, individual, and occupational needs

Dix and the Mental Hygiene Movement

• Dorothea Dix advocated treatment focusing almost exclusively on hospitalized mental patients’ physical wellbeing
• Credited with establishing 32 mental hospitals, directing the opening of two large institutions in Canada and reforming the asylum system in Scotland

The Military and the Mentally Ill

• Mental health treatment advanced because of military medicine
• Psychiatrists worked with the military administration to conduct research and train doctors for mental health problems

Mental Hospital Care (20th Century)

• Little effective treatment in the first half of the 20th century
• Mary Jane Ward published ''The Snake Pit'' in 1946, which drew attention to the plight of mental patients and helped create concern

Deinstitutionalization

• Movement aimed to close down mental hospitals and return disturbed people to community ostensibly
• Provided more integrated and humane treatment than in psychiatric hospitals

Contemporary Views of Abnormal Behavior includes

• Biological discoveries
• The development of classification systems for mental disorders
• The emergence of psychological causation views
• The experimental psychological research developments

Importance of Psychological/Psychiatric Disciplines

• Disciplines of Anatomy, physiology, Neurology, Chemistry, and general medicine advanced knowledge
• This led to identification of biological/organic pathology underlying many physical ailments
• The development of a Psychiatric classification system by Kraepelin played a dominant role

Sigmund Freud

• The psychoanalysis emphasized inner dynamics of unconscious motives
• Freud's developed theory has been modified to form new Psychodynamic perspectives

Experimental Psychology Developments

• Saw the end of the 19th century and the early 20th century saw Experimental Psychology evolve into Clinical Psychology with development of clinics
• Two major schools of learning paralleled this development and behaviorism emerged

Neurotransmitters

• Dopamine: Involved in reward, motivation, and pleasure.
• Regulates mood, attention, and pleasure

Dopamine Imbalances

• Low dopamine is linked to Parkinson’s disease/depression
• High levels are associated with schizophrenia/addiction

Serotonin

• Regulates mood, appetite, sleep, and social behavior
• Promotes well-being and happiness

Serotonin Imbalances

• Low serotonin levels are associated with depression, anxiety, and sleep disorders

Acetylcholine (ACh)

• Important for learning, memory, and muscle movement
• Transmits signals between neurons and muscles

Acetylcholine (Ach) Imbalances

• Low levels are associated with Alzheimer's disease/muscle weakness

Gamma-Aminobutyric Acid (GABA)

• Main inhibitory neurotransmitter
• Calms brain activity, reduces anxiety, and promotes relaxation

Gamma-Aminobutyric Acid (GABA) Imbalances

• Low levels are linked to anxiety, insomnia, and epilepsy

Norepinephrine (Noradrenaline)

• Involved in alertness, arousal, and stress response
• Regulates mood and attention

Norepinephrine (Noradrenaline) Imbalances

• Low levels are associated with depression and fatigue
• High levers can lead to anxiety and hypertension

Endorphins

• "Body's natural painkillers"
• Relieves pain and induces feelings of euphoria/pleasure

Endorphins Imbalances

• Low levels can lead to chronic pain, depression, or stress
• High levels are associated with positive feelings after exercise/laughter