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A discrete period of intense fear or discomfort in the absence of real danger that is accombined by at least 4 of 13 somatic or cognitive symptoms
Panic attack
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3 Types of Panic Attacks
- Uncued
- Situationally Bound
- Situationally Predisposed
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Anxiety about, or avoidance of places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms
Agoraphobia
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Neither panic attacks nor agoraphobia are
diagnoses
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Symptoms of a panic attack reach a peak within
10 minutes
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Type of panic attack:
Occurs spontaneously or "out of the blue"
Uncued Panic Attack (Panic Disorder)
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Type of Panic Attack: Invariably occurs immediately on exposure to, or in anticipation of, the situational cue or trigger
Situationally bound (or cued)- (specific phobia)
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Type of Panic Attack:
No invariably associated with the cue and do not necessarily occur immediately after the exposure
Situationally predisposed (generalized panic attack)
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2 Symptoms that Panic Disorder Without Agoraphobia must have
- 1) Recurrent unexpected panic attacks
- 2) At least one of the attacks has been followed by 1 month (or more) of:
- a) persistent concern about having additional attacks
- b) worry about the implications of the other attack or its consequences
- c) a significant change in behavior related to the attacks
*Note the person must have absence of agoraphobia
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If something is generating your panic attacks, it is NOT
Panic disorder
Panic disorder comes out of the blue.
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Name the 3 DSM-IV diagnoses with panic attacks and agoraphobia
- 1) Panic disorder w/o agoraphobia
- 2) Panic disorder w/ agoraphobia
- 3) Agoraphobia w/o a history of panic disorder
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Clinically significant anxiety that is provoked by exposure to a specific feared object or situation.
Specific Phobia
- *The pt. recognizes the fear as excesseive and unreasonable
- *Leads to avoidance behavior or is endured with dread
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Clinically significant anxiety that is provoked by exposure to certain types of social or performance situations, often leading to avoidance (Fear of embarrassment and negative assessment)
Social Phobia
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The development of a characteristic set of symptoms after exposure to an extreme traumatic stressor which the pt. responded w/ intense fear, helplessness, or horror.
- PTSD: Symptoms present > 1 month
- Acute Stress Disorder: Lasts > 2 days & < 4 wks
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Obsessions or compulsions that are severe enough to be time consuming or cause marked distress/ significant impairment. Pt. recognizes that the obsessions or compulsions are excessive or unreasonable.
OCD
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Persistent ideas,thoughts impulses or images that are experience as intrusive and inappropriate and that cause marked anxiety or distress
Obsessions
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Repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress
Compulsions
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Excessive anxiety and worry occuring more days than not for a period of at least 6 months.
Generalized Anxiety Disorder
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Clinically significant anxiety that is judged to be due to the direct physiological effects of a general medical condition
Anxiety Disorder Duet o a General Medical Condition
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Somatoform Disorders
- Somatization
- Conversion
- Hypochondriasis
- Body Dysmorphic
- Pain
(Pts. are convinced they are ill, symptoms are not willfully controlled)
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Disorder Control Motivation
Somatoform U U
Factitious C C
Malingering C C
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Multiplicity of complaints and multiple organ systems affected
Somatization Disorder
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Preoccupation w/ fear of having a serious disease, no medical cause can be found
Hyponchondriasis
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Intentional production of signs and symptoms of illness; only apparent motivation is to assume the role of a patient
Factitious Disorder
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Intentional production of false or grossly exaggerated symptoms motivated by external incentive
Malingering
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One or more neurologic symptoms preceded by conflict or other stressors
Conversion Disorder
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Preoccupation with an imaginary bodily defect or an exaggerated distortion of a minor defect
Body Dysmorphic Disorder
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Pain that is not fully accounted for by a nonpsychiatric medical condition
Pain Disorder
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Sleep Stages and waves
- Awake= alpha
- 1= theta
- 2= theta
- 3= delta
- REM= mixed
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K complexes and sleep spindles are found in what stage of sleep
Stage 2
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Normal Sleep Stage Percentages
- Stage 1= 5%
- Stage 2= 45%
- Stages 3/4= 20-25%
- Stage REM= 25%
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DSM-IV Sleep Disorders
- Primary: Dyssomnias, Parsomnias
- Secondary: Caused by anothe rmental disorder, a general medical condition, or substance use
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Characterized by abnormal behavioral or physiological events occuring in association w/ sleep, specific sleep stage, or sleep-wake transitions.
Parasomnias
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Disorders of initiating or maintaining sleep or of excessive sleepiness and are characterized by a disturbance in the amnt, quality, or timing of sleep
Dyssomnias
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Name 3 Parasomnias
- Nightmare disorder
- Sleep terror disorder
- Sleepwalking disorder
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Name 5 Dyssomnias
- Primary Insomnia
- Primary Hypersomnia
- Narcolepsy
- Breathing-Related Sleep Disorder
- Circadian Rhythm Sleep Disorder
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Reptitive episodes of upper airway obstruction that occur during sleep. Present with:
Snoring
Observed pauses in breathing when sleeping
Excessive daytime sleepiness
Obstructive sleep apnea
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Narcolepsy is characterized by
- 1) excessive sleepiness
- 2) cataplexy
- 3) sleep paralysis
- 4) hypnagogic hallucinations
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Narcolepsy is associated with deficits in
Orexin/Hypocretin
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Sleep-related Enuresis:
- Bed-wetting
- Usually in children
- Might be a symptom of underlying sleep disorder like Obstructive Sleep Apnea
- Can occur in any stage of sleep
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4 Tx's for Sleep-related Enuresis
- Scheduled awakenings
- Desmopressin
- Bell and pad
- Tricyclic antidepressants
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Stage of Sleep: Obstructive Sleep Apnea
All stages
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Stage of Sleep: Sleepwalking, sleep terrors
Slow-wave
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Stage of Sleep: Periodic Limb Movment
Classically occurs in non-REM sleep, but can occur during REM.
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Stage of Sleep: Nightmare disorder, REM behavior disorder
REM
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Multiple sleep latency test
- •Four opportunities to nap during the day
- •Each nap opportunity separated by two hours
- •Patient lies down in a dark room and told to
- relax
- •If the patient doesn’t fall asleep within 20
- minutes the nap opportunity is terminated
- •If the patient falls asleep any time during
- the nap opportunity, he / she is allowed to sleep for 15 minutes then the nap is terminated
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- Mean Sleep Latency = average time to fall asleep
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Sleep changes with aging
- Total sleep time decreases
- % of REM decreases
- % of slow wave sleep decreases
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