11- anxiety, ptsd, ocd

Question 1

what controls the stress response

Answer 1

the limbic system

Question 2

neuronal components of limbic system/stress response

Answer 2

hippocampus, amygdala, prefrontal cortex

Question 3

endocrine components of limbic system/stress response

Answer 3

hypothalamus pituitary adrenal axis

Question 4

role of hippocampus in stress response

Answer 4

• processes emotional inputs from cortex
• projects to thalamus and cortex
• memory

Question 5

how does the hypothalamus cause autonomic features of emotional responses

Answer 5

• hypothalamus send projections down through the cord to autonomic preganglionic neurones – the hypothalamospinal tract.
• causes SNS activation, and release of adrenaline from the adrenal medulla – the acute stress response

Question 6

what is the amygdala

Answer 6

almond structure at tip of hippocampus

Question 7

role of amygdala

Answer 7

inputs from sensory system and output to cortex and hypothalamus. behavioural and autonomic emotional responses

Question 8

role of pre-frontal cortex

Answer 8

• Modulation of emotional responses (e.g. consciously suppressing features of anxiety)
• ‘Perception’ of emotion?

Question 9

3 stages of stress response

Answer 9

alarm reaction, resistance, exhaustion

Question 10

1. alarm reaction (stress response)

Answer 10

Release of adrenaline and cortisol as well as sympathetic activation

Question 11

Stage 2: Resistance (stress response)

Answer 11

• effect of adrenaline starts to wear off

- Chronic stress response, prolonged release of cortisol

Question 12

Stage 3: Exhaustion (stress response)

Answer 12

• when you cannot escape an ongoing stressor

- chronic side effects of prolonged cortisol secretion start to occur

Question 13

when does the stress response become pathological

Answer 13

when you cannot escape a

stressor(s), or when ‘trivial’ stressors elicit a strong stress response.

Question 14

symptoms anxiety

Answer 14

Palpitations
  Sweating
  Trembling or shaking
  Dry mouth
  Difficulty breathing
  Chest pain or discomfort
  Nausea or abdominal distress (e.g. butterflies in stomach)
  Feeling dizzy, unsteady, faint or light-headed

Question 15

6 types of anxiety disorders

Answer 15

social, specific phobia, generalised, panic, OCD, PTSD

Question 16

panic disorder definition

Answer 16

Recurrent, unexpected panic attacks (severe episodes of acute
stress response)

Question 17

pathophysiology of anxiety disorders

Answer 17

• low GABA levels

- low serotonin levels

Question 18

treatment anxiety disorders

Answer 18

-short term only benzodiazeopines,
SSRIs
-CBT
-support groups

Question 19

define obsession in OCD

Answer 19

• Thoughts that persist and dominate an individual’s thinking despite
  their awareness that the thoughts are either entirely without
  purpose, or have persisted and dominated their thinking beyond the
  point of relevance or usefulness
  • Unpleasant and repugnant, often causing anxiety

Question 20

define ocd compulsions

Answer 20

A motor act (or sometimes a thought) resulting from an obsession
• Acting out a compulsion may relieve the anxiety provoked by its
associated obsession,
-most days for 2 weeks

Question 21

features of ocd compulsions

Answer 21

Originate in the mind of the patient
• Repetitive and unpleasant
• Acknowledged as excessive or unreasonable
• Patient tries to resist, but at least one obsession/compulsion is
unsuccessfully resisted

Question 22

pathophysiology OCD

Answer 22

• reentry loop in basal ganglia, where the obsessional though re enters the cortex without having entered the cortex
• direct pathway over activty
• reduced serotonin
• autoimmune (streptococcal infection can trigger)

Question 23

treatment OCD

Answer 23

• SSRIs, deep brain stimulation, thalamus inhibitors and therefore direct pathway inhibitors in development
• CBT

Question 24

features of PTSD

Answer 24

• six months following an exceptionally severe
  traumatic event
   repetitive, intrusive recollection or re-enactment of the event
  in memories, daytime imagery, or dreams
   There is conspicuous emotional detachment, numbing of feeling, and
  avoidance of stimuli that might arouse recollection of the trauma

Question 25

pathophysiology PTSD

Answer 25

-amygdala hyperactivity causing exaggerated
behavioural responses
• low levels of cortisol!

Question 26

treatment PTSD

Answer 26

SSRIs
• Maybe short term benzodiazepines
- CBT
-eye movement desensitisation reprocessing therapy