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Semester 4 - Clinical Neuroscience > 17. Anxiety > Flashcards

17. Anxiety Flashcards

1
Q

Define anxiety.

A

A feeling of worry, nervousness, or unease about something with an uncertain outcome

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2
Q

What is the physiological role of stress?

A

The stress response (causing a feeling of anxiety) enables us to escape from potentially dangerous situations

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3
Q

What is the anxiety response mediated by?

A

Mediated primarily by the limbic system, which has neural and endocrine target

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4
Q

What are the 2 elements of the stress response?

A

Neural elements and endocrine elements

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5
Q

What are the neural elements of the stress response?

A
  • Hippocampus
  • Amygdala
  • Prefrontal cortex (classically not part of the limbic system butdefinite roles in emotion)
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6
Q

what is the role of the hippocampus in the stress response?

A

o Receives inputs from many parts of the cortex and
processes their emotional content
o projects to the thalamus(and back to the cortex – the Papez circuit) and also to the hypothalamus
o Role in memory
- Papez circuit may be involved in memory
consolidation
o role in expression of emotion

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7
Q

what is the effect of the hippocampus projecting to the hypothalamus?

A

causes autonomic features of emotional responses, since the hypothalamus send projections down through the cord to autonomic preganglionic neurones – the hypothalamospinal tract. This will lead to sympathetic nervous system activation, as well as release of adrenaline from the adrenal medulla – the acute stress response

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8
Q

role of amygdala?

A

o Almond shaped structure sitting near the tip of the hippocampus
o Receives many inputs from the sensory system
o Major outputs to cortex and hypothalamus
o Like the hippocampus, involved in behavioural and
autonomic emotional responses

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9
Q

what are the 3 parts of the hypothalamus?

A

subiculum, hippocampus proper, dentate gyrus

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10
Q

what is the role of the Prefrontal cortex?

A

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

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11
Q

what is the role of the Prefrontal cortex and Anterior cingulate gyrus in the limbic system?

A

Both have modulatory effect on processes associated with the hypothalamus

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12
Q

What are the endocrine elements of the stress response?

A

Limbic system is able to act on the hypothalamus to stimulate the secretion of stress hormones

  • Via the familiar hypothalamo-pituitary-adrenal axis
  • Release of cortisol from the adrenal cortex is part of the ‘chronic’ stress response
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13
Q

what are the two ways in which the hypothalamus induced the stress response?

A
  1. activates sympathetic nervous system
    - activates glands and smooth muscle
    - activates adrenal medulla to release adrenaline and noradrenaline
  2. activates adrenal cortical system by releasing CRF, pituitary gland releases ACTH and induces adrenal cortex to release steroid hormones
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14
Q

what are the names of the two parts of the stress response?

A
  1. limbic system

2. limbic-hypothalamo-pituitary- adrenal axis

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15
Q

What does the general adaptation syndrome refer to?

A

Refers to three stages that the body goes through during prolonged exposure to stressor

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16
Q

What are the 3 stages of the general adaptation syndrome?

A

Stage 1: The alarm reaction
- Release of adrenaline and cortisol as well as sympathetic activation
Stage 2: Resistance (effect of adrenaline starts to wear off)
- Chronic stress response, prolonged release of cortisol
Stage 3: Exhaustion (when you cannot escape an ongoing stressor)
- Chronic side effects of prolonged cortisol secretion start to occur

17
Q

When does the stress response become pathological?

A

When you cannot escape a stressor(s), or when ‘trivial’ stressors elicit a strong stress response

18
Q

What are the symptoms of anxiety?

A
  • 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
19
Q

What are the different classifications of anxiety disorders?

A
  • Social phobia: Anxiety about being in social situations
  • Specific phobias: Spiders, heights etc
  • Generalised anxiety disorder: Persistent anxiety about a variety of things
  • Panic disorder: Recurrent, unexpected panic attacks (severe episodes of acute stress response)
  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
20
Q

What is the pathophysiology of anxiety disorders and what appears to help?

A
  • unclear
  • GABA appears to be low in some (panic disorder)
  • increasing serotonin can help (mechanism unclear)
21
Q

what are the chronic side effects of prolonged cortisol secretion?

A

muscle wastage
suppression of immune system
hyperglycaemia

22
Q

What is the biological treatment for anxiety disorders?

A
  • Mainstay is SSRIs
  • Short term benzodiazepines (addictive)
  • Can use pregabalin - a GABA analogue
23
Q

describe how benzodiazepines can help anxiety disorders?

A
  • GABA is the main inhibitory neurotransmitter
  • GABA levels are decreased in cortex in patients with panic disorder quickly
  • Benzodiazepines increase GABA transmission so reduce anxiety
24
Q

describe how SSRIs can help anxiety disorders?

A
  • Increased levels of serotonin (due to SSRIs) may stimulate serotonin receptors in hippocampus
  • Leads to neuroprotection, neurogenesis and reduction of anxiety
25
Q

What other treatments can be used

A

Psychological:
• Cognitive behavioural therapy: Getting patients to reflect on their feelings/thoughts/behaviours
Social:
• Support groups, charities etc

26
Q

What is OCD characterised by?

A

Obsessions and compulsions

27
Q

What are obsessions?

A
  • 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
28
Q

What are compulsions?

A
  • A motor act (or sometimes a thought) resulting from an obsession
  • Acting out a compulsion may relieve the anxiety provoked by its associated obsession, but frequently carrying out the compulsion is also unpleasant
29
Q

What are the features of the obsessions and compulsions in OCD

A
  • 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
30
Q

how to diagnose OCD?

A

obsessions and/or compulsions must be present on most days for at least 2 weeks

31
Q

What is the pathophysiology of OCD?

A

Unclear, some hypothesis:

  • basal ganglia re-entrant circuits
  • reduced serotonin levels
  • altered activity in range of cortical areas
  • autoimmune aetiologies
32
Q

What is the basal ganglia re-entrant circuit theory?

A
  • The cortex projects to the basal ganglia, and these then project back up to the cortex via the thalamus
  • This is an example of a ‘re-entrant’ loop, where obsessional thoughts can re-enter the cortex having entered the basal ganglia
  • This may be due to overactivity in the direct pathway
  • Treatments that inhibit thalamic (and hence cortical) activity by reducing the direct pathway or increasing the indirect pathway may hold promise (e.g. subthalamic nucleus stimulation)
33
Q

What is the treatment for OCD?

A 
- Biological 
• SSRIs +/- antipsychotics 
• Deep brain stimulation? 
- Psychological 
• CBT and variety of other interventions 
- Social 
• Family support 
• Groups etc.
34
Q

What are the features of PTSD?

A
  • Can occur within six months following an exceptionally severe traumatic event (e.g. rape, battlefield trauma)
  • Causes 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
35
Q

What is the psychopathology of PTSD?

A

Unclear
• Evidence of amygdala hyperactivity causing exaggerated behavioural responses
• However, low levels of cortisol! - Cortisol inhibits
traumatic memory retrieval and controls sympathetic response

36
Q

What is the treatment for PTSD?

A 
Biological 
• SSRIs 
• Maybe short term benzodiazepines 
Psychological 
• CBT 
• Eye movement desensitisation reprocessing therapy
Social 
• Charities are particularly active, such as 'Help for Heroes'

Semester 4 - Clinical Neuroscience (19 decks)

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