For an anxiety order of your choice outline the diagnostic category system, it’s presentation & evidence based LI intervention in line with published literature
DSM1V: Recurrent/Unexplained panic attack with 4 more symptoms:
1. Palpitations,pounding heart or accelerated heart-rate
3. Trembling or shaking
4. Sensation of shortness of breath
5. Feeling of chocking
6. Chest pain/discomfort
7. Nausea or abdominal distress
8. Feeling faint,unsteady,light-headed
10. Fear of losing control/going crazy
11. Fear of dying
12. Paresthesias ( numbness or tingling)
13. Chills/hot flushes
At least 1 of the attacks must have been followed by 1or more of
Persistent concerns about having additional attacks
Worry about implications
Significant change in behaviour
1. Sudden onset of palpitations
2. Chest pain
3. Choking sensations
5. Feelings of unreality ( depersonalisation/derealisation)
6. Fear of dying/going mad or losing control.
Panic Disorder characterised by fear ( cognitive theme) & somatic symptoms are related to fear or anticipatory fear ( if exposed to stimulus of fear) – often leading to avoidant behaviours – e.g avoiding places, people or images that remind patient of fears ( act as trigger) as an attempt to reduce threat or will escape quickly ( to neutralise threat) or engage in safety behaviours
With agoraphobia – avoidance or fear of open spaces
Fear/Anxiety affects approx 7 per 1000
Anxiety & fear have an evolutionary survival function.
Perceived threat – fight/flight/freeze – adrenalin response –
In this sense symptoms seem more normal - e.g body sweats to cool down/ pupils expand – greater peripheral vision to scan for threat, shallow breathing – taking in more oxygen – problem when these become catastrophically interpreted.
NICE guidelines ( 2011) recommend
Indiv non – facilitated self help
Or individual facilitated self help
Emphasis importance of shared decision making
Also importance of good information/ education family/ in clear accessible language carers about condition & possible treatments – inform them of self – help groups/support groups
NB co-morbidity with depression common 88 per 1000
Commonly panic disorder & agoraphobia – where people who have experienced panic attacks – e.g in shopping centres, busy places can avoid such places due to fear of effects etc. Firstly patients need to understand CBT principles – interaction of thoughts, behaviours, somatic symptoms – important that they are educated about bodies adrenalin response in order to normalise these. However for many symptoms will be severe or acute & so need for intervention to restore normalised functioning.
Exposure therapy – typically used as a brief low intensity intervention. Based on behavioural paradigm – need to act way out of unhelpful behaviours
Shown to be clinically effective for specific phobias, social phobia and those with panic & agoraphobia. Barlow et al 2005 endorses use of exposure Myles & Rushforth.
Exposure recommended if patient is avoiding something causing fear.
Puts patient in charge
Helps create a plan to confront fear in a graded way acceptable to patient with support from PWP
Myles & Rushforth outline graded exposure as this treatment helps patients to face fear and educates them to understand how avoidance is maintaining the vicious cycle. Explained in Chellingsworth & Farrand Exposure Guide taken from Reach Out Educator Materials – also Picus et al ( 2008) stress need for adolescents to understand where panic sensations come from – that they are normal & harmless as 1st step to break vicious circle. However value of understanding undone if person continues to avoid
Avoidance can give short –term relief more long term problems such as agoraphobia or reliance on safety behaviours – such