1. Dr. AbdalKarim Radwan/ Faculty of Nursing

2.  Abrupt and Aversive CNS Response to Real Threat or Danger  Prepares Organisms for Immediate Action  Action Tendency “Fight” or “Flight”  Abrupt and Aversive CNS Response to Real Threat or Danger  Prepares Organisms for Immediate Action  Action Tendency “Fight” or “Flight”

3. Dr. AbdalKarim Radwan/ Faculty of Nursing  More Diffuse Response About Impending Real or Imagined “Future” Threat or Danger

4. Dr. AbdalKarim Radwan/ Faculty of Nursing No Threat Adaptive True Alarm False Alarm Maladaptive Real Threat

5. Dr. AbdalKarim Radwan/ Faculty of Nursing Etiology “Disordered” or “Maladaptive” Experience of Anxiety or Fear “Disordered” or “Maladaptive” Experience of Anxiety or Fear “Normal” or “Adaptive” Experience of Anxiety or Fear “Normal” or “Adaptive” Experience of Anxiety or Fear

6. Dr. AbdalKarim Radwan/ Faculty of Nursing Process Psychobiological & Experiential Processes Psychobiological & Experiential Processes Onset, Maintenance, and Course Onset, Maintenance, and Course Successful Treatment Response and Outcome Successful Treatment Response and Outcome

7. Dr. AbdalKarim Radwan/ Faculty of Nursing Outcome What Treatments, by Whom, are Most Effective, and WHY? What Treatments, by Whom, are Most Effective, and WHY? Panic Disorder Agoraphobia Specific Phobias Social Phobias PTSD Acute Stress GAD OCD Anxiety NOS

8. 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  Panic Disorder  PD With Agoraphobia  Agoraphobia  Specific Phobias  Social Phobias  Generalized Anxiety Disorder  Post-Traumatic Stress Disorder  Obsessive Compulsive Disorder

9. 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 ” “ 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. ” “panic attack is a most violent experience …person feel as though he is losing control and going insane. ”

10. Dr. AbdalKarim Radwan/ Faculty of Nursing  An Unexpected Panic Attack  Develop Anxiety Over  the Next Attack or  The Implications of the Attack and Consequences  An Unexpected Panic Attack  Develop Anxiety Over  the Next Attack or  The Implications of the Attack and Consequences  Clinical Description

11. Dr. AbdalKarim Radwan/ Faculty of Nursing  Clinical Description  Agoraphobia is Common  Fear of the Marketplace  Consequence of Severe Unexpected Panic Attacks  Agoraphobia is Common  Fear of the Marketplace  Consequence of Severe Unexpected Panic Attacks

12. 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  Occurs in 3.5% of Population  75% are Women  Onset Between (25-29 yrs)  Attacks Often Begin at Puberty  20% Attempt Suicide

13. Dr. AbdalKarim Radwan/ Faculty of Nursing  Cultural Influences  Occurs Worldwide  Prevalence in U.S. is Similar Across Ethnic Groups  Occurs Worldwide  Prevalence in U.S. is Similar Across Ethnic Groups

14. 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  60% Cases Panic While Asleep!  Usually Between 1:30 - 3:30am  Occur During Deep Sleep “Delta”  Do Not Occur During REM Sleep

15. 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  Palpitations / Sweating  Trembling / Shaking  Shortness of Breath  Feeling of Choking, Loss of Control  Derealization, Feeling of Dying

16. Dr. AbdalKarim Radwan/ Faculty of Nursing  The Panic Attack  Abrupt Autonomic Surge  Unexpected  Uncontrollable  Absence of Threat  “False Alarm”  Abrupt Autonomic Surge  Unexpected  Uncontrollable  Absence of Threat  “False Alarm” 10 Minutes

17. Dr. AbdalKarim Radwan/ Faculty of Nursing  Laboratory Panic Provocation  Lactate Infusion  Hyperventilation  CO2 Inhalation  Caffeine  Lactate Infusion  Hyperventilation  CO2 Inhalation  Caffeine 10 Minutes

18. Dr. AbdalKarim Radwan/ Faculty of Nursing  Causes Biological Vulnerability False Alarm Involuntary Symptoms STRESS Bodily Cues Psychological Vulnerability Learned Alarm

19. Dr. AbdalKarim Radwan/ Faculty of Nursing  Biological Causes  ANXIETY Behavioral Inhibition System (BIS)  FEAR / PANIC Fight / Flight System (FF)  ANXIETY Behavioral Inhibition System (BIS)  FEAR / PANIC Fight / Flight System (FF)

20. Dr. AbdalKarim Radwan/ Faculty of Nursing Uncontrollable Unpredictable  Psychological Causes Controllable Predictable

21. 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  Block Panic  Antidepressants (e.g., Imipramine, Paxil, Prozac)  20-50% Relapse  Benzodiazapines (e.g., Xanax)  90% Relapse

22. 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  Cognitive-Behavior Therapies  Brief and Time Limited (12 Sessions)  Graded Exposure + Coping Skills  Panic Control Treatment (PCT)  80-100% Panic Free After Treatment

23. Dr. AbdalKarim Radwan/ Faculty of Nursing  Combined Treatment  Imipramine Alone  PCT Alone  Imipramine + PCT  Placebo Alone  Placebo + PCT  Imipramine Alone  PCT Alone  Imipramine + PCT  Placebo Alone  Placebo + PCT THE RESULT Combined Tx is Better in Short Term PCT Alone is Better in Long Term

24. 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.”

25. Dr. AbdalKarim Radwan/ Faculty of Nursing  Irrational Fear of Specific Objects or Situations  Markedly Interferes With Functioning  Irrational Fear of Specific Objects or Situations  Markedly Interferes With Functioning  Clinical Description

26. Dr. AbdalKarim Radwan/ Faculty of Nursing  Animal Type  Natural Environment Type  Blood-Injection Injury Type  Situational Type  Other  Animal Type  Natural Environment Type  Blood-Injection Injury Type  Situational Type  Other  Four Major Subtypes

27. Dr. AbdalKarim Radwan/ Faculty of Nursing  Unusual Reaction  Vasovagal Response to Blood  Drop in Blood Pressure  Fainting  Runs in Families  Onset Early Childhood  Unusual Reaction  Vasovagal Response to Blood  Drop in Blood Pressure  Fainting  Runs in Families  Onset Early Childhood  Blood-Injection Injury Type

28. Dr. AbdalKarim Radwan/ Faculty of Nursing  Fears of Specific Situations Planes, Transportation, Heights  Response Similar to Panic  Onset Early 20’s  Fears of Specific Situations Planes, Transportation, Heights  Response Similar to Panic  Onset Early 20’s  Situational Type

29. Dr. AbdalKarim Radwan/ Faculty of Nursing  Fears of Animals and Insects  Common in Population, but Different From Normal Revulsion  Early Onset (About 7 yrs of Age)  Fears of Animals and Insects  Common in Population, but Different From Normal Revulsion  Early Onset (About 7 yrs of Age)  Animal Type

30. Dr. AbdalKarim Radwan/ Faculty of Nursing  Fears of Natural Events Heights, Storms, Water  Usually More Than One Fear  Peak Onset (About 7 yrs of Age)  Fears of Natural Events Heights, Storms, Water  Usually More Than One Fear  Peak Onset (About 7 yrs of Age)  Natural Environment Type

31. Dr. AbdalKarim Radwan/ Faculty of Nursing  Fears Contracting Disease / Illness Illness Phobia  Fear of Choking Avoid Swallowing Pills or Foods  Fears Contracting Disease / Illness Illness Phobia  Fear of Choking Avoid Swallowing Pills or Foods  Other Type

32. 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  Occurs in 11% of Population  Top Fears: Heights and Snakes  Females > Males (4:1 Ratio)  Runs a Chronic Course

33. 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  Direct Traumatic Conditioning  Observational Learning  Information and Language  Having a Panic Attack  Probably Some Evolutionary Basis

34. 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  Structured and Consistent  Confront Objects of Fear  Extinguish Anxious Responding  Disrupt Avoidance / Escape  Blood-Injury /Injection Differs Exercises to Offset Fainting

35. 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.” “ 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.”

36. Dr. AbdalKarim Radwan/ Faculty of Nursing  Marked and Persistent Fear of One or More... Social or Performance Situations  Most Common Type of Social Fear? Public Speaking  Interferes With Life Functioning  Marked and Persistent Fear of One or More... Social or Performance Situations  Most Common Type of Social Fear? Public Speaking  Interferes With Life Functioning  Clinical Description

37. 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  Occurs in around 13% of Population  Most Prevalent Disorder  Females more than Males  Begins in Adolescence  Peak age of onset at about 15 years

38. 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  Similar to Panic and Specific Phobia  Interaction of Biological Vulnerability Psychological Vulnerability Learning Experiences  Can be Quite Disabling

39. Dr. AbdalKarim Radwan/ Faculty of Nursing  Psychological Interventions  Similar to Panic and Specific Phobia  Cognitive-Behavioral Approaches Rehearsal and Skills Training Cognitive Restructuring  Similar to Panic and Specific Phobia  Cognitive-Behavioral Approaches Rehearsal and Skills Training Cognitive Restructuring

40. 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  Antidepressants for Severe Anxiety *MAO Inhibitors * Beta blockers – Not that useful * Tricyclic antidepressants Relapse is Common Relapse rates – High following medication discontinuation

41. Dr. AbdalKarim Radwan/ Faculty of Nursing  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  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  Clinical Description

42. 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 *Most Common Obsessions Contamination & Aggression  Most Common Compulsions Checking & Washing  Almost Equal Sex Ratio (F > M)  Onset Early Adolescence to Mid-20s

43. Dr. AbdalKarim Radwan/ Faculty of Nursing  OCD is a potentially life- long disabling disorder and is poorly recognised and under- treated  affects almost 3% of world’s population  Start anytime from preschool to adulthood  OCD is a potentially life- long disabling disorder and is poorly recognised and under- treated  affects almost 3% of world’s population  Start anytime from preschool to adulthood :: ::

44. 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

45. 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  Cognitive-Behavioral Treatments  Response Prevention Rituals are Actively Prevented  Exposure Systematic and Gradual Exposure to Feared Thoughts or Situations  May Require Hospitalization

46. Dr. AbdalKarim Radwan/ Faculty of Nursing  Drug Therapies  Medications Show Promise  Most Effective Medications Inhibit Reuptake of Serotonin  May Benefit 60% of Patients  Medications Show Promise  Most Effective Medications Inhibit Reuptake of Serotonin  May Benefit 60% of Patients

47. Dr. AbdalKarim Radwan/ Faculty of Nursing The End Thank You