11. Anxiety Disorders

Question 1

what is the purpose of the stress response?

Answer 1

enables us to escape from potentially dangerous situations

Question 2

which system is primarily involved in the stress response?

Answer 2

limbic system

Question 3

what is the purpose of the hippocampus?

Answer 3

receives input from many parts of the cortex and processes emotional context, projects to thalamus (and thus back to cortex) and to the hypothalamus (hypothalmospinal tract to autonomic preganglionic neurones)…this leads to sympathetic activation and adrenaline release from the medulla
also role in memory

Question 4

what is the purpose of the amygdala?

Answer 4

receives many inputs from the sensory system, and major outputs to cortex and hypothalamus
role in behavioral and autonomic emotional responses

Question 5

what is the purpose of the prefrontal cortex?

Answer 5

modulation of emotional responses and perception of emotion

Question 6

how are the stress hormones secreted?

Answer 6

limbic system acts on hypothalamus via the familial hypothalamo-pituitary adrenal axis. cortisol is released from adrenal cortex

Question 7

what stages does the body go through during prolonged exposure to stressors?

Answer 7

STAGE 1: ALARM REACTION - release of adrenaline and cortisol and sympathetic activation
STAGE 2: RESISTANCE - effect of adrenaline starts to wear off, chronic stress response and prolonged release of cortisol
STAGE 3: EXHAUSTION - chronic side effects of prolonged cortisol secretion start to occur

Question 8

when does the stress response become pathological?

Answer 8

when you cannot escape the stressor or when the stress response is too strong

Question 9

define anxiety

Answer 9

pathological stress response

Question 10

what are some common symptoms of anxiety?

Answer 10

palpitations, sweating, trembling, dry mouth, difficulty breathing, chest pain, nausea, abdominal distress, dizzy, unsteady, faint

Question 11

how are anxiety disorders classified?

Answer 11

social phobia
specific phobias - height
generalised anxiety disorder - persistent anxiety about various thing
panic disorder - recurrent, unexpected panic attacks
OCD
PTSD

Question 12

what neurotransmitter level seems to be low in anxiety disorders?

Answer 12

GABA

Question 13

how can anxiety disorders be treated?

Answer 13

increase the serotonin levels - so SSRIs or short term benzodiazepines
also cognitive behavioural therapy as well as support groups

Question 14

how common is OCD?

Answer 14

1 in 50 (usually by 30)

Question 15

what is OCD characterized by?

Answer 15

obsessions and compulsions that originate in the mind of the patient, are repetitive and unpleasant, are acknowleged they are unreasonable, patient tried to resist but unsuccesfully

Question 16

define obsessions

Answer 16

thoughts that persist and dominate an individual’s thinking despite their awareness that the thoughts are entirely without purpose or have persisted and dominated their thinking beyond point of relevance. can be unpleasant and cause anxiety

Question 17

define compulsions

Answer 17

a motor act or can be a thought resulting from an obsession, and by doing so relieves the persons anxiety but usually unpleasant

Question 18

what are the hypotheses for the pathophysiology of OCD?

Answer 18

the cortex projects to basal ganglia which then project back to the cortex so the obsessional thoughts can re enter the cortex having entered the basal ganglia…due to over activity in the direct pathway
or
low serotonin
or
alterted activity in corticla areas
or
autoimmune (cross reactivity with basal ganglia and strep antigens)

Question 19

how is OCD treated?

Answer 19

SSRI’s, deep brain stimulation, CBT, family support

Question 20

what is the common presentation of PTSD?

Answer 20

following severely traumatic event
causes repetitive, intrusive recollection or re enactment of the event in memories, daytime imagery or dreams
emotional detachment, numbing of feelings, avoidance fo stimuli that may trigger

Question 21

what are the hypotheses of the pathophysiology of PTSD?

Answer 21

amygdala hyperactivity

low levels of cortisol

Question 22

how is PTSD treated?

Answer 22

SSRIs
short term benzodiazepines
CBT
eye movement desensitization reprocessing therapy
charities such as help for heroes