Anxiety

Question 1

what system mediates anxiety ? why does it occur ?

Answer 1

Limbic system - HPA axis

stress response enables to escape from potentially dangerous situations

Question 2

what makes up the limbic system ?

Answer 2

Hippocampal formation
septal area
Amygdala

Prefrontal cortex (not a part but plays a role )
cingulate gyrus

Question 3

where is hippocampus and what does it do ?

Answer 3

Medial surface of temporal lobe - floor of the horn of the lateral ventricle
Memory and expressions of emotion (Papez circuit) - inputs from cortex and projects to hypo/thalamus

Question 4

where is the amygdala ? what does it do ?

Answer 4

Almond shape near tip of hippocampus in the roof of the lateral ventricle
Inputs from sensory , outputs to cortex and hypothalmus = drives related behaviours and processing of associated emotions.

Question 5

what do prefrontal cortex and Cingulate gyrus do ?

Answer 5

Modulation of emotional responses from hypothalamus = “perception of emotion”

Question 6

What is the endocrine element of the stress response ? what is the key hormone ?

Answer 6

limbic system is able to act on the hypothalamus to
stimulate the secretion of stress hormones Via the familiar hypothalamo-pituitary-adrenal axis
cortisol

Question 7

what is the actions of cortisol ?

Answer 7

increase blood sugar
suppression of immune system
Inhibition of allergic and inflammatory process

Question 8

what are the stages of the general adaptation syndrome?

outline each stage

Answer 8

1= The alarm reaction - NA released from sympathetic nerves and cortisol

2. resistance - Chronic stress response, prolonged release of cortisol, NA wears off
3. Exhaustion- prolonges stress = continued cortisol = muscle wastage , suppresion of immune system and hyperglycaemia

Question 9

what is anxiety ?

Answer 9

a pathological response to stress (response greater than threat)

Question 10

List some symptoms of anxiety

Answer 10

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 11

what are the classifications of anxiety disorders ?

Answer 11

Social phobia 
specific phobias 
Generalised anxiety disorders
Panic disorders- Panic attacks  
OCD
PTSD

Question 12

what is the Pathophysiology of anxiety disorders ?

Answer 12

GABA levels appear to be low in some anxiety disorders

Question 13

what is the model for treating anxiety ?

what drugs are used

Answer 13

Bio- benzos (short term), SSRIs, Pregabalin
Psychological - CBT
social - Support groups

Question 14

what is the epidemiology of OCD?
Age of onset ?
sex ?

Answer 14

1 in 50 people
1/3 cases start between 10-15 yrs
Equal prevalence in males and females

Question 15

what is an obession?

Answer 15

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 = anxiety

Question 16

what is a compulsion ?

Answer 16

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

Question 17

what is the diagnostic criteria for OCD?

Answer 17

Obsession +/- compulsion lasts 2 wks
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 18

what are some theories on the pathophysiology of OCD?

Answer 18

Basal ganglia re-entry circuits
reduced serotonin
Reduced activity in cortical areas
Autoimmune - PANDAS

Question 19

explain what a basal ganglia re-entrant circuit is

Answer 19

cortex projects to BG , BG projects to Cortex via thalamus . this creates loop where
obsessional thoughts can re-enter the cortex having
entered the basal ganglia.
may be due to overactivity in direct pathway

Question 20

What is treatment principles of OCD?

Answer 20

Biological
• SSRIs +/- antipsychotics (Clomipramine)
• Deep brain stimulation?
 Psychological
• CBT and variety of other interventions
 Social
• Family support
• Groups etc

Question 21

What is PANDAS? How is it caused ?

Answer 21

sudden onset of OCD after infection with group A strep
Antibodies cross react with neurones in basal ganglia-
treat with Antibiotics and OCD management

Question 22

what are features of PTSD?

Answer 22

Can occur within six months following an exceptionally severe traumatic event
repetitive, 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 arouse recollection of the trauma

Question 23

what are theories on pathophysiology of PTSD?

Answer 23

Evidence of amygdala hyperactivity causing exaggerated
behavioural responses
• However, low levels of cortisol!

Question 24

what are treatment principles for PTSD ?

Answer 24

Biological
SSRIs
Maybe short term benzodiazepines
Psychological
CBT
Eye movement desensitization reprocessing therapy
Social- Charities are particularly active, such as ‘Help for Heroes’