Panic Disorder

Post-Traumatic Stress Disorder

 Psychobiologic theories suggest increased
levels of norepinephrine and decreased Follows a devastating event that is outside the
GABA range of usual human experience like:

Panic Disorder - Management • Rape

 Complete medical workup to reassure the • Assault

individual and rule out illness
 Psychotherapy, family therapy, group Military combat
therapy
 Sedatives and anti-anxiety agents are useful • Hostage situations
when client is unable to cope or accomplish
daily activities • Torture
 Avoid crowded rooms
• Others
Note:
Post-Traumatic Stress Disorder
 desensitization - gradually increasing
exposure to the feared object  Exposure to a traumatic event resulting in
actual death, threatened death, or serious
 flooding - continuous exposure to the feared injury to others or self and/ or responding to
stimulus until anxiety is extinguished) the event with intense fear, helplessness or
horror
GRIEF AND LOSS
How does trauma affect a person?
 Loss is a universal experience that occurs
• Initial reactions to trauma can include exhaustion,
throughout life span
confusion, sadness, anxiety, agitation, numbness,
 Grief is a form of sorrow involving feelings,
dissociation, confusion, physical arousal, and
thoughts, and behaviors
blunted affect.
 Responses to loss are strongly influenced by
one's cultural background • Most responses are normal in that they affect most
 The grief process involves a sequence of survivors and are socially acceptable,
affective, cognitive, and psychological states psychologically effective, and self-limited.
as a person responds to, and finally accepts a
loss. PTSD- Manifestations
Specifically,  Feelings of isolation
• LOSS- an experience that something valuable is
 Difficulty sleeping
gone
 Violent outbursts of anger
• GRIEF= total response to emotional experience
related to loss
 Depression
• BEREAVEMENT Subjective response by loved
ones (feeling sad)  Interrupted concentration

Stages of Grieving (Kübbler-Ross)  Hyper vigilance

 Denial-refuses to believe that the loss is real
PTSD - Management
 Anger-resists the loss; may "act out"
feelings in violence  Same as panic disorder

 Bargaining- attempts to make a deal to try to  Behavior modification to provide

postpone the reality of loss
 controlled exposure to recall the event
 Depression extreme feeling pf loneliness
and withdrawal; isolates  Provide supportive therapy

 Acceptance - comes to terms with loss  Anticipate the use of Eye movement,
desensitization, reprocessing techniques to
Post-Traumatic Stress Disorder help alleviate symptoms

Follows a devastating event that is outside the range  Imagery, relaxation, and meditation may be
of usual human experience like: useful
Generalized Anxiety Disorder

 Generalized Anxiety Disorder (GAD) is

characterized by six months or more of
chronic, exaggerated worry and tension that
is unfounded or much more severe than the
normal anxiety most people experience.
People with this disorder usually expect the
worst.

 Emerging evidence suggests that patients

with GAD may experience persistent
activation of areas of the brain associated
with mental activity and introspective
thinking following worry-inducing stimuli.

• Twin studies suggest that environmental and

genetic factors are likely involved

DSM-V Criteria:

 The individual finds it difficult to control the

worry.

 The anxiety and worry are associated with

three (or more) of the following six
symptoms (with at least some symptoms
having been present for more days than not
for the past 6 months)

 Excessive anxiety and worry (apprehensive

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

Note: Only one item is required in children

 Restlessness or feeling keyed up or on edge

 Being easily fatigued
 Difficulty concentrating or mind going
blank
 Irritability
 Muscle tension
 Sleep disturbance

• The anxiety, worry, or physical symptoms cause

clinically significant distress or impairment in social,
occupational, or other important areas of
functioning.
• The disturbance is not attributable to the
physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition
(e.g., hyperthyroidism).

• The disturbance is not better explained by another

mental disorder (e.g., anxiety or worry about having
panic attacks in panic disorder, negative evaluation
in social anxiety disorder (social phobia), etc.

Management:
• Selective serotonin reuptake inhibitors
• Serotonin-norepinephrine reuptake inhibitors
• Venlafaxine, extended release
• Psychotherapy