Disorder and Generalized Anxiety Disorder惊恐障碍和广泛性焦虑症课件.ppt

PRITE Review of the Anxiety Disorders Kimberly D. Law, MD, MPH LSU/Ochsner Psychiatry Residency Program Slides Courtesy of Erich J. Conrad MD Assistant Professor of Clinical Psychiatry PANIC ATTACK Discrete period of intense fear or discomfort in which four or more of the following develop abruptly and reach a peak within 10 minutes: Palpitations 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 Derealization or depersonalization Fear of losing control or going crazy Fear of dying Paresthesias Chills or hot flashes PANIC A panic attack doesn’t equal panic disorder. Major Depression Post Traumatic Stress Disorder Social Phobia Obsessive Compulsive Disorder Specific Phobia Panic Disorder Recurrent unexpected panic attacks At least one of the attacks has been followed by one month of 1 or more of the following: Persistent concern about having additional attacks Worry about implications of the attack (losing control, having a heart attack, “going crazy”) Significant change in behavior related to the attacks With or without agoraphobia Epidemiology Lifetime prevalence rate: Panic disorder: 1.5 – 5% Panic attacks: 3 – 5.6% Women 2-3 x more likely to be affected than men Mean age of presentation: 25 years old Neuroanatomical Pathways of Viscerosensory Information in the Brain Panic Neurotransmitters Differential Diagnosis Cardiovascular Disease Angina CHF Hypertension Mitral valve prolapse Myocardial Infarction Paradoxical atrial tachycardia Pulmonary Disease Asthma Pulmonary embolism Drug intoxication or withdrawal Neurological Disease CVA / TIA Epilepsy Meniere’s disease Migraine Tumor Endocrine Disease Carcinoid syndrome Hyperthyroidism Perimenopausal Pheochromocytoma Other SLE Systemic infection Heavy metal poisoning Course of Illness 30 – 40 % become symptom free 50 % with mild symptoms wi