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Semester 4 - Nervous System > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What is anxiety?

A

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

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2
Q

What are the symptoms of anxiety?

A 
Palpitaions
Sweating 
Trembling or Shaking
Dry mouth
Difficulty breathing
Chest pain or discomfort
Nausea or abdominal distress (butterflies in your tummy)
Feeling dizzy, unsteady, faint or light-headed
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3
Q

What are the two parts of the stress response?

A

Limbic system

Limbic-hypothalamo-pituitary-adrenal axis

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4
Q

What it in the lymbic system

A

A hippocampal formation (hippocampus, dentate gyrus, parts of the parahippocampal gyrus)
Septal area
Amygdala

+/-

prefrontal cortex
Cingulate gyrus

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5
Q

What is the hippocampus?

A

A curved piece of cortex.

Folded into medial surface of temporal lobe.

Occupies floor of temporal horn of lateral ventricle

Three parts:
Subiculum, Hippocampus proper, dentate gyrus

It is involved in memory and expression of emotion

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6
Q

What is the amygdala?

A

It is buried in the roof of the lateral ventricle

Collection of nuclei

Inputs sensory information, brainstem, thalamus, cortex

Outputs to cortex, rainstem and hypothalamus

Drives related behaviours and processing of associated emotions.

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7
Q

What are the parts involved in anxiety

A

Hippocampus
Amygdala
Prefrontal cortex
Anterior cingulate gyrus

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8
Q

What odes the sympathetic nervous system do?

A

Increased heart rare and force of contraction

Dilated bronchi

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9
Q

What does cortisol do?

A

Increase of energy metabolite leaves

Suppression of immune system

Inhibition of allergic and inflammatory processes

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10
Q

What is general adaptation syndrome?

A
  1. Alarm reaction
    NA released form sympathetic nerves.
    Adrenaline and NA released from adrenal medulla.
    Cortisol released from adrenal cortex
  2. Resistance
    Action of cortisol is longer lasting than adrenaline, allows maintenance of response to stress
  3. Exhaustion
    Prolonged stress causes continued cortisol secretion, leading to muscle wastage, suppression of immune system and hyperglycaemia
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11
Q

When is stress a problem?

A

When above optimum - so you get to exhaustion, anxiety/panic/anger then a breakdown

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12
Q

What are some anxiety disorders?

A 
Social phobia 
Specific phobias 
Generalised anxiety disorder 
Panic disorder 
OCD
PTSD

Anxiety disorders are then the response outweighs the threat

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13
Q

How does GABA change in panic disorder?

A

GABA levels are decrease in the cortex in patients with panic disorder.

Benzodiazepines increase GABA transmission so reduce anxiety.

But, addictive and can build up tolerance so not used for long periods of time.

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14
Q

How does serotonin help?

A

Increased levels of serotonin (due to SSRIs) may stimulate serotonin receptors in hippocampus.

Leads to neuroprotection, neurogenesis and reduction of anxiety

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15
Q

How can you treat anxiety disorders?

A

SSRIs

CBT

Pregabalin

Benzodiazepines but not long term

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16
Q

What is CBT?

A

Cognitive behavioural therapy

Situation 
Thoughts
Emotions
Behaviour 
Physical Reactions
17
Q

Why do we are about OCD?

A

1 in 50 people suffer from OCD at some point in their lives.

That’s 1milllion people in the UK.

E.g. Charles Darwin, Florence Nightingale, David Beckham

18
Q

What are obsessions in OCD?

A

A though that persists and dominates an individual’s thinking despite their awareness that the thought is eithe entirely without purpose, or has persisted and dominated their thinking beyond the point of relevance or usefulness.

Often causes grea anxiety and guilt.
Particularly repugnant to individual.
Reflex changes in society.

Obsessions are unpleasant

For example:
I might harm my baby
I might be a paedophile
God does not exist

19
Q

What are compulsions?

A

Obsessional motor acts. May result from an obsessional impulse that leads directly to the action, or they may be mediated by an obsessional mental image or fear.

E.g ‘I need to turn the light switch on and off them times or my family will die’

Can lead to patients wasting a lot of time!

Can also have mental compulsions e.g. repeating phrases

20
Q

What is the diagnostic criteria for OCD?

A

Obsessions / compulsions / both present on most days for a period of at least 2 weeks.

Obsessions and compulsions share all the following features:
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

Carrying out the obsessive thought or act is not in itself pleasurable
Obsessions / compulsions must cause distress or interfere with the patients social or individual functioning.

21
Q

Describe the epidemiology of OCD?

A

Usually begin in adolescence or early adulthood.

33% start between 10-15yrs old
75% started by age of 30
Lifetime prevalence around 2%
M:F 1:1 but childhood OCD is more common in boys

22
Q

What are the theory of pathophysiology of OCD?

A 
Nobody really knows!
Suggested theories:
Re-entry circuit in basal ganglia 
Reduced serotonin 
Reduced activity in dorsolateral prefrontal cortex
Reduced activity in orbitofrontal cortex
Increased activity in cingulate cortex 
PANDAS
23
Q

Explain the basal ganglia

A

Input: From cortical and subcortical areas

Processing: Caudate nuclear and putamen (Striatum)
Allows integration of information.
Basal ganglia encode for the decision to move, the direction and amplitude of movement and motor expression of emotions.

Output: Inhibtior projections from globes palliduc and substantia nigra to thalamus via GABA-ergic neurones.

24
Q

How does basal ganglia change in OCD?

A

Re-entry

So, rather than one output being enough, it will go back to processing and output again because the brain thinks it has not been done well enough.

25
Q

What is PANDAS?

A

Paediatric Autoimmune Neuropsychiatry Disorder Associated with Streptococcal Infection

Sudden onset of OCD symptoms or tics after infection with Group-A bet-haemolytic strep. Usually 3-12yrs old

Usually dramatic onset of psychiatric or behavioural problems

Antibodies ‘cross-rect’ with neurones in basal ganglia, fusing symptoms.

Responds to treatment with antibiotics and usual OCD management.

26
Q

How do you treat OCD?

A

CBT - try not to do compulsion -This is the best.

High dose SSSRIs (higher dose and longer treatment than depression)

Augmentation with antipsychotics

Clomipramine (TCA)

Deep Brain Stimulation

CBT is the best way to go.

27
Q

How does deep brain stimulation work?

A

Stimulate STN an GPi / SNr so less stimulation of thalamus.

28
Q

What is PTSD?

A

Within 6 months of a traumatic event of exceptional severity.

Evidence of trauma

Respective, intrusive recollection or re-enactment of the event in memories, daytime imagery or dreams

Conspicuous emotional detachment , numbing of feeling and avoidance of stimuli that might arise recollection of the trauma.

Complex PTSD is when symptoms are similar but the event wasn’t of exceptional severity or it happened in childhood (e.g. childhood abuse).

29
Q

Describe the pathophysiology of PTSD

A

Hyperactivity of the amygdala, causing exaggerated response to perceived threat

Cortisol inhibits traumatic memory retrieval and controls sympathetic response.
In PTSD, there are lower than normal levels of cortisol.
But, conflicting evidence.

30
Q

What is the treatment of PTSD?

A

Medical treatment - same as other anxiety disorders - SSRIs

CBT

EMDR - Eye Movement Desensitisation Reprocessing

Semester 4 - Nervous System (20 decks)

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