fear of sensation of panic.  When someone becomes concerned about attacks.  Worried about future attacks.  Change behavior. 

Treatment:  Exposure treatment is the best way to help people with anxiety disorders (panic attacks)

People have panic attacks but don’t avoid situations.  Not a factor for some.

If someone in your family has had an anxiety disorder, you are more likely to have one.  Increases risk.

secreted by neuron.  Chemical messenger.  1) Norepinephrine - Locus ceruleus (active site) (panik attacks are stimulated by this) 2) Serotonin - Irregulation 3) Gaba - inhibitory neurotransmitter.  Inhibits neuronal firing (not as much activity)

activity is shown in frontal part of the brain. Circutry continues. Never feeling like you have accomplished what you are trying to do. 

Orbital Frontal Cortex - impulses.

Caudate Nucleus - filters

Thalamus - "think"/may not act; generally turns off impulses (not in ocd) 

Serotonin receptor sites in all 3 parts of these areas. 

1. Tricyclic Antidepressants. (imipramine, desipramine)

Effectivness: when taking it, 20-50% relapse when you stop taking it.

Side effects: weight gain, blurry vision, dry mouth, difficulty urinating, sexual effects. 

Can be fatal in high doses. 

2. Selective Serotonin Reuptake Inhibitors (SSRI's) - Works on problems with Serotonin that can't get across a synapse.  Interferes with reuptake.  Keeps normal process going and prevents reuptake.  (Prozac, Paxil, Zoloft). 

Effectiveness: 80% of individuals with panic disorders respond.  50-80% of OCD patients respond.  Relapse is problematic.

Side effects: Gastrointestinal, agitation, insomnia, sexual effects.

3. Benzodiazepines - (valium, librium, xanax) Suppress nervous system, increase GABA, affect norepinephrin and serotonin.  

Effectiveness: Interefere with cognitive and motor functioning.  Addictive.  Relapse high (about 90%). 

1. Exposure - (internal/external) gradual exposure

2. Desensitization - with competing relaxation.  Hierarchy - being exposed to least amount of anxiety first then eventually get to the top of the heirarchy.

3. flooding - expose them to the highest thing on the hierarchy first.

4.  Exposure and response prevention (OCD).

5. Relaxation - progressive muscle relaxation (PMR)  Time management too.

6. Cognitive Therapy - Identify, examine, and challenge thoughts.  Misinterpret internal or external caue as threatening.  Anticipatory anxiety (I can't handle it).  85% respond to CBT for panic 

IS AN ANXIETY DISORDER (DONT FORGET THAT).  Exposed to a traumatic event.  Involved with actual or threatened death or serious injury.  Fear, helpless, horror.  Etilogical (cause).

Re-experience images, thoughts, dreams, the act or feeling is reoccuring, distress/anxiety with expousre to reminders. There are triggers.

Arousal - sleep disturbance, irritable, difficulty concentrating, hypervigilance, exaggerated startle response.

Avoidance - Tend to avoid: Thoughts/feelings/discussion of trauma, activities/people,places related to trauma, forget aspects of trauma, detached; emotionally numb; decreased interest, restricted affect. 

Kluft thinks that internal capacity to dissociate (highly hyponatizable).  Trauma (about 90% retrospective)  Dissociation and "splitting" (compartmentalize) to cope.

It is controversial, because sometimes people fake the disorder fo external gain (Malingering) - fakes a disorder.  "created" (Iatrogenic) - healthcare preople create problems.  Hypnosis, suggestion.   

Soma = body

Physical symptomes, no organic explanations, beleive psychological factors involved, not under voluntary control. 

NOT psychosomatic. Not pysical illness affected by psychological. Not Malingering - faking.  Not Factitious Disorder (Munchausen Syndrome) which is fake symptoms to gain medical attention (assume sick role).  By proxy. which is creating physical symptoms in someone else.  (mother creatres symptoms in her child)

Conversion Disorder (Hysterical Conversion):

Acute onset of a mjor physcial sypmptom - blindness, paralysis, seizures, anasthesia.  Very rare and not very understood.  Psychological factors associated (trauma).  "La Belle Indifference" = the beautiful indifference. 

Preoccupation with an imaginary physcial defect.  Not associated with eating disorder.  Conceptualized as a form of OCD.  Obsession, Beheaviors (checking, picking, treatments). 

Basically this is thinking that there is something wrong with your nose or something and you are convinced.