Dr. AbdalKarim Radwan/ Faculty of Nursing
Abrupt and Aversive CNS Response
to Real Threat or Danger
Prepares Organisms for Immediate
Action
Action Tendency “Fight” or “Flight”
Dr. AbdalKarim Radwan/ Faculty of Nursing
 More Diffuse Response About
Impending Real or Imagined
“Future” Threat or Danger
Dr. AbdalKarim Radwan/ Faculty of Nursing
Real Threat
True Alarm
Adaptive
Maladaptive
False Alarm
No Threat
Dr. AbdalKarim Radwan/ Faculty of Nursing
Etiology
“Disordered” or “Maladaptive”
Experience of
Anxiety or Fear
“Normal” or “Adaptive”
Experience of
Anxiety or Fear
Dr. AbdalKarim Radwan/ Faculty of Nursing
Process
Onset,
Maintenance, and Course
Successful Treatment
Response and Outcome
Psychobiological
&
Experiential Processes
Dr. AbdalKarim Radwan/ Faculty of Nursing
Outcome
Panic Disorder
Agoraphobia
Anxiety NOS
What Treatments,
by Whom,
are Most Effective,
and WHY?
OCD
Specific Phobias
Social Phobias
PTSD
GAD
Acute Stress
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Panic Disorder
 PD With Agoraphobia
 Agoraphobia
 Specific Phobias
 Social Phobias
 Generalized Anxiety Disorder
 Post-Traumatic Stress Disorder
 Obsessive Compulsive Disorder
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Panic Disorder
“ You may genuinely believe you’re having
a heart attack, losing your mind, or on the
verge of death. Attacks can occur any
time, even during nondream sleep ”
“panic attack is a most violent experience …person
feel as though he is losing control and going insane. ”
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Clinical Description
 An Unexpected Panic Attack
 Develop Anxiety Over
 the Next Attack
or
 The Implications of the Attack
and Consequences
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Clinical Description
 Agoraphobia is Common
 Fear of the Marketplace
 Consequence of Severe Unexpected
Panic Attacks
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Facts and Statistics
 Occurs in 3.5% of Population
 75% are Women
 Onset Between (25-29 yrs)
 Attacks Often Begin at Puberty
 20% Attempt Suicide
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Cultural Influences
 Occurs Worldwide
 Prevalence in U.S. is Similar Across
Ethnic Groups
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Nocturnal Panic
 60% Cases Panic While Asleep!
 Usually Between 1:30 - 3:30am
 Occur During Deep Sleep “Delta”
 Do Not Occur During REM Sleep
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Symptoms of a Panic Attack
 Palpitations / Sweating
 Trembling / Shaking
 Shortness of Breath
 Feeling of Choking, Loss of Control
 Derealization, Feeling of Dying
Dr. AbdalKarim Radwan/ Faculty of Nursing
 The Panic Attack
 Abrupt Autonomic Surge
 Unexpected
 Uncontrollable
 Absence of Threat
 “False Alarm”
10 Minutes
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Laboratory Panic Provocation
 Lactate Infusion
 Hyperventilation
 CO2 Inhalation
 Caffeine
10 Minutes
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Causes
Biological Vulnerability
STRESS
False Alarm
Bodily Cues
Learned Alarm
Involuntary Symptoms
Psychological Vulnerability
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Biological Causes
 ANXIETY
Behavioral Inhibition System (BIS)
 FEAR / PANIC
Fight / Flight System (FF)
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Psychological Causes
Predictable
Uncontrollable
Controllable
Unpredictable
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Pharmacologic Treatments
 Block Panic
 Antidepressants (e.g., Imipramine,
Paxil, Prozac)
 20-50% Relapse
 Benzodiazapines (e.g., Xanax)
 90% Relapse
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Psychological Interventions
 Cognitive-Behavior Therapies
 Brief and Time Limited (12 Sessions)
 Graded Exposure + Coping Skills
 Panic Control Treatment (PCT)
 80-100% Panic Free After Treatment
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Combined Treatment
THE RESULT
 Imipramine Alone
 PCT Alone
 Imipramine + PCT
 Placebo Alone
 Placebo + PCT
Combined Tx
is Better in
Short
Term
PCT Alone is
Better in
Long Term
Dr. AbdalKarim Radwan/ Faculty of Nursing
“ ...aren’t just extreme fear; they are
irrational fear. You may be able to ski the
world’s tallest mountain with ease but feel
panic going above the 10th floor of an
office building.”
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Clinical Description
 Irrational Fear of Specific Objects
or Situations
 Markedly Interferes With
Functioning
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Four Major Subtypes
 Animal Type
 Natural Environment Type
 Blood-Injection Injury Type
 Situational Type
 Other
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Blood-Injection Injury Type
 Unusual Reaction
 Vasovagal Response to Blood
 Drop in Blood Pressure
 Fainting
 Runs in Families
 Onset Early Childhood
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Situational Type
 Fears of Specific Situations
Planes, Transportation, Heights
 Response Similar to Panic
 Onset Early 20’s
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Animal Type
 Fears of Animals and Insects
 Common in Population, but
Different From Normal Revulsion
 Early Onset (About 7 yrs of Age)
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Natural Environment Type
 Fears of Natural Events
Heights, Storms, Water
 Usually More Than One Fear
 Peak Onset (About 7 yrs of Age)
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Other Type
 Fears Contracting Disease / Illness
Illness Phobia
 Fear of Choking
Avoid Swallowing Pills or Foods
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Facts and Statistics
 Occurs in 11% of Population
 Top Fears: Heights and Snakes
 Females > Males (4:1 Ratio)
 Runs a Chronic Course
Dr. AbdalKarim Radwan/ Faculty of Nursing
Causes of specific
phobias
 Direct Traumatic Conditioning
 Observational Learning
 Information and Language
 Having a Panic Attack
 Probably Some Evolutionary Basis
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Exposure and More Exposure
 Structured and Consistent
 Confront Objects of Fear
 Extinguish Anxious Responding
 Disrupt Avoidance / Escape
 Blood-Injury /Injection Differs
Exercises to Offset Fainting
Dr. AbdalKarim Radwan/ Faculty of Nursing
“ People with social phobia aren’t
necessarily shy at all. They can be
completely at ease with people most of
the time, but in particular situations,
they feel intense anxiety.”
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Clinical Description
 Marked and Persistent Fear of One
or More...
Social or Performance Situations
 Most Common Type of Social Fear?
Public Speaking
 Interferes With Life Functioning
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Facts and Statistics
 Occurs in around 13% of Population
 Most Prevalent Disorder
 Females more than Males
 Begins in Adolescence
 Peak age of onset at about 15 years
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Causes
 Similar to Panic and Specific Phobia
 Interaction of
Biological Vulnerability
Psychological Vulnerability
Learning Experiences
 Can be Quite Disabling
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Psychological Interventions
 Similar to Panic and Specific Phobia
 Cognitive-Behavioral Approaches
Rehearsal and Skills Training
Cognitive Restructuring
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Drug Treatments
 Antidepressants for Severe Anxiety
*MAO Inhibitors
* Beta blockers – Not that useful
* Tricyclic antidepressants
Relapse is Common
Relapse rates – High following
medication discontinuation
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Clinical Description
 Culmination of All Anxiety Disorders
 Obsessions: Intrusive Thoughts,
Images, or Urges That the Person Trys
to Suppress or Eliminate
 Compulsions: Thoughts or Actions to
Suppress the Obsessions and Provide
Relief
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Facts and Statistics
*Most Common Obsessions
Contamination & Aggression
 Most Common Compulsions
Checking & Washing
 Almost Equal Sex Ratio (F > M)
 Onset Early Adolescence to Mid-20s
Dr. AbdalKarim Radwan/ Faculty of Nursing
 OCD is a potentially lifelong disabling disorder and is
poorly recognised and under:
treated
 affects almost 3% of world’s
population
 Start anytime from preschool
to adulthood
Dr. AbdalKarim Radwan/ Faculty of Nursing
Causes
• Anxiety Focused on Unwanted Thoughts
• Thoughts are Unacceptable
• When Fighting to Control One’s
Psychology Creates More
• Psychopathology
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Psychological Interventions
 Cognitive-Behavioral Treatments
 Response Prevention
Rituals are Actively Prevented
 Exposure
Systematic and Gradual Exposure to
Feared Thoughts or Situations
 May Require Hospitalization
Dr. AbdalKarim Radwan/ Faculty of Nursing
 Drug Therapies
 Medications Show Promise
 Most Effective Medications
Inhibit Reuptake of Serotonin
 May Benefit 60% of Patients
Dr. AbdalKarim Radwan/ Faculty of Nursing
The End
Thank You
Dr. AbdalKarim Radwan/ Faculty of Nursing