Task 1 Anxiety and
Hyperventilation
Brainstorm:
General prevalence of anxiety:
o 1 out of 5 gets an anxiety disorder (life-time prevalence)
o 12% 1-year-prevalence
o 2:1 women vs men.
Hyperventilation: veel uitademen, weinig inademen.
Learning goals:
Focus on DSM.5! (but also look at ICD10 (you don’t have to know this by heart)
Part A
1. What is a Panic Disorder?
DSM.5 criteria Panic Disorder
DSM 5 (without agoraphobia)
A. Both (1) and (2):
a. Recurrent unexpected Panic Attacks. A panic attack is an abrupt surge
of intense fear or intense discomfort that reaches peak within minutes,
and during which time four (or more) of the following symptoms occur:
palpitations, pounding heart, or accelerated heart rate, sweating,
trembling or shaking, sensations of shortness of breath or smothering,
feeling of choking, chest pain or discomfort, nausea or abdominal
distress, feeling dizzy, unsteady, lightheaded or faint, chills or heat
sensations, paresthesias (numbness or tingling sensations),
derealisation (feelings of unreality) or depersonalization (being
detached from oneself), fear of losing control or going crazy, fear of
dying.
b. At least one of the attacks has been followed by 1 month (or more) of
one (or more) of the following:
i. Persistent concern about having additional attacks.
ii. Worry about the implications of the attack or its consequences
(e.g., losing control, having a heart attack, "going crazy").
iii. A significant change in behavior related to the attacks.
B. Absence of Agoraphobia.
C. The Panic Attacks are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical condition
(e.g., hyperthyroidism).
D. The Panic Attacks are not better accounted for by another mental disorder,
such as Social Phobia ,Specific Phobia , Obsessive-Compulsive Disorder ,
Posttraumatic Stress Disorder , or Separation Anxiety Disorder.
DSM.5 criteria Agoraphobia
A. Marked fear or anxiety about two (or more) of the following five situations:
a. Using public transportation, being in open spaces, being in enclosed
places, standing in line or being in a crowd, being outside of the home
alone.
B. The individual fears or avoids these situations because of the thoughts that
escape might be difficult or help might not be available in the event of
developing panic-like symptoms or other incapacitating or embarrassing
symptoms such as fear of falling in the elderly or fear of incontinence.
C. The Agoura phobic situations almost always provoke fear or anxiety.
,D. The agoraphobic situations are actively avoided, require the presence of a
companion, or are endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual danger posed by the
agoraphobic situations and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for six months or
more.
G. The fear, anxiety, or avoidance causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
H. If another medical condition such as inflammatory bowel disease or
Parkinson’s disease is present, the fear, anxiety, or avoidance is clearly
excessive
I. The fear, anxiety, or avoidance is not better explained by the symptoms of
another mental disorder, for example, the symptoms are not confined to
specific phobia, situational type; do not involve only social situations as in
social anxiety disorder; and are not related exclusively to obsessions as in
obsessive-compulsive disorder, perceived effects of flaws in physical
appearance as in body dysmorphic disorder, reminders of traumatic events as
in posttraumatic stress disorder, or fear of separation as in separation anxiety
disorder.
Craske, M. G., and Stein, M. B. (2016). Anxiety.
Panic Disorder
Recurrent, unexpected (i.e. without an apparent cue) panic attacks.
o Panic attack- abrupt surges of intense fear or discomfort that reach a
peak within minutes and include four or more symptoms (including
autonomic arousal, other physical symptoms, and cognitive symptoms).
DSM-5 specifies persistent concern or worry about having more panic attacks
or changed behaviour in maladaptive ways (e.g. avoidance of exercise or
unfamiliar locations)
Persistent, for at least 1 month.
Agoraphobia
Marked fear, anxiety, or avoidance of two or more of the following situations:
o (DSM.5) – public transportation (e.g. travelling in automobiles, buses,
trains, ships, aeroplanes), open spaces (e.g. carparks, marketplaces,
bridges), enclosed places. (e.g. shops, theatres, cinemas), queues or
crowds, or being outside of home alone;
o ICD-10 – the situations are crowds, public places, travelling alone, and
travelling away from home.
DSM.5 specifies that the fear or anxiety should be out of proportion to the
threat posed; ICD-10 specifies recognition that the symptoms are excessive or
unreasonable.
DSM.5 specifies fear that escape might be difficult or help might not be
available in the event of panic-like or other incapacitating or embarrassing
symptoms (e.g. incontinence); ICD-10 lists panic symptoms only.
Blok 2.1 Taak 3
Paniekstoornis – bij een
paniekstoornis hebben
mensen regelmatig paniekaanvallen waarbij ze volkomen onverwacht worden
, overvallen door extreme angst of een intens gevoel van onbehagen, die
binnen enkele minuten een piek bereikt en met lichamelijke en/of cognitieve
symptomen gepaard gaat. Daarnaast zijn zij aanhoudend bezig met of
ongerust over het opnieuw krijgen van een paniekaanval of veranderen ze
hun gedrag vanwege de paniekaanvallen. Bij een paniekaanval overheerst het
gevoel flauw te vallen, dood te zullen gaan of gek te worden, naast het gevoel
de controle over zichzelf te verliezen. Voor een paniekaanval hoeft geen
directe aanleiding te zijn. Bijna 4 procent van de Nederlanders heeft ooit een
paniekaanval gehad.
Agoraphobia – agorafobie wordt ook wel straatvrees of pleinvrees genoemd.
Hierbij is er sprake van angst voor minimaal twee van de volgende situaties:
reizen met het openbaar vervoer, zich in open
ruimtes begeven, in afgesloten ruimtes zijn, in
een menigte verblijven of in de rij staan of zich
buitenshuis zonder gezelschap in andere
situaties bevinden. De angst voor deze
situaties ontstaat vanwege de gedachte niet
goed weg te kunnen komen en geen hulp te
krijgen als er iets zou gebeuren. Mensen met straatvrees mijden
bovenstaande situaties dan ook vaak of begeven zich er alleen in gezelschap
van iemand anders in omdat ze zich in hun eentje vreselijk bang en weerloos
voelen en door paniek overvallen kunnen worden. Sommige mensen met
pleinvrees durven niet alleen thuis te blijven. Straatvreesklachten worden
door meer dan 3 procent van de Nederlandse bevolking ooit in hun leven
ervaren.
Schmidt et al (2014) Panic Disorder and Agoraphobia, in The Wiley Handbook of
Anxiety Disorders.
Panic – an intense flight or fight emotional arousal – can be the result of a
malfunctioning ‘alarm system’, and will sometimes manifest in an overwhelming
emotional experience called a panic attack – a discrete period of intense fear or
discomfort that reaches a peak within minutes and is accompanied by four or
more somatic and/or cognitive symptoms.
Panic attacks are closely tied to panic disorder (PD) and agoraphobia (AG).
There are 3 types of panic attacks – unexpected, situationally bound, and
situationally predisposed:
Unexpected/spontaneous panic attacks – seem to occur out of the blue and
are not associated with a particular situation or internal cue.
Situationally bound / cued attacks – almost always occur upon exposure to or
in anticipation of a particular situation.
Situationally predisposed panic attacks – are linked to a particular situation
but do not always occur.
Spontaneous or uncued panic attacks are considered to be central to the
experience of PD. In fact, spontaneous panic is required for this diagnosis (moet
wel meer dan 2x voorkomen). Despite the necessity of unexpected panic, many
patients with PD report experiencing situationally bound and situationally
disposed panic attacks as well.
There exists significant heterogeneity in panic attacks, both across individuals
and within an individual.
o Frequency and severity also vary.
Patients with PD typically present with a mixture of different types of panic
attacks. Although spontaneous or unexpected panic attacks often are
characteristic of panic at the onset of PD, patients are more likely to establish
