disorder and generalized anxiety disorder惊恐障碍和广泛性焦虑症课件

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1、PRITEReviewoftheAnxietyDisordersKimberlyD.Law,MD,MPHLSU/OchsnerPsychiatryResidencyProgramSlidesCourtesyofErichJ.ConradMDAssistantProfessorofClinicalPsychiatryPANICATTACKDiscreteperiodofintensefearordiscomfortinwhichfourormoreofthefollowingdevelopabruptlyandreachapeakwi

2、thin10minutes:PalpitationsoracceleratedheartrateSweatingTremblingorshakingSensationsofshortnessofbreathorsmotheringFeelingofchokingChestpainordiscomfortNauseaorabdominaldistressFeelingdizzy,unsteady,lightheadedorfaintDerealizationordepersonalizationFearoflosingcontrolorg

3、oingcrazyFearofdyingParesthesiasChillsorhotflashesPANICApanicattackdoesn’tequalpanicdisorder.MajorDepressionPostTraumaticStressDisorderSocialPhobiaObsessiveCompulsiveDisorderSpecificPhobiaPanicDisorderRecurrentunexpectedpanicattacksAtleastoneoftheattackshasbeenfollowedby

4、onemonthof1ormoreofthefollowing:PersistentconcernabouthavingadditionalattacksWorryaboutimplicationsoftheattack(losingcontrol,havingaheartattack,“goingcrazy”)SignificantchangeinbehaviorrelatedtotheattacksWithorwithoutagoraphobiaEpidemiologyLifetimeprevalencerate:Panicdiso

5、rder:1.5–5%Panicattacks:3–5.6%Women2-3xmorelikelytobeaffectedthanmenMeanageofpresentation:25yearsoldSensoryThalamusHippocampusHypothalamusParaventricularLateralNucleusNucleusLocusCeruleusPeriaquaductalGrayRegionParabrachialNucleusNucleusoftheSolitaryTractNeuroanatomicalP

6、athwaysofViscerosensoryInformationintheBrainAssociationBundleMedialPrefrontalCortex,CingulateInsulaAmygdalaLateralNucleusBasalCentralNucleusoftheAmygdalaPituitaryAutonomicPathwaysAdrenalPathwaysVisceralPathwaysAdaptedfrom:GormanJ,etal.AJP2000;157:493-505PanicNeurotransmi

7、ttersNorepinephrineSerotoninBrainstem:firesoffsystemicallytocreateautonomicsymptomsAmygdalaandLimbicSystem:generatesanticipatoryanxietyPre-frontalcortex:generatesphobicavoidanceGABAGABADifferentialDiagnosisCardiovascularDiseaseAnginaCHFHypertensionMitralvalveprolapseMyoc

8、ardialInfarctionParadoxicalatrialtachycardiaPulmonaryDiseaseAsthmaPulmonaryembolismDrugintoxicationorwi