Anxiety

Question 1

Define anxiety

Answer 1

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

Question 2

Symptoms of anxiety

Answer 2

Palpitations
Sweating 
Trembling or shaking 
Dry mouth 
Difficulty breathing 
Chest pain/ discomfort 
Nausea she/ abdo distress
Dizzy, unsteady, faint

Question 3

What controls the stress response?

Answer 3

Limbic system and lambic-hypothalamic-pituitary adrenal axis

Cortex limbic structures -> hypothalamus -> motor regions and sympathetic Ns

Question 4

What does the limbic system contain?

Answer 4

Hippocampus - floor of temporal horn of lateral ventricle, subiculum + hippocampus proper + dentate gyrus, involved in memory and expressions of emotion

Amygdala- roof of lateral ventricle, collection of nuclei, inputs of sensory info/ Brainstem/ thalamus/ cortex, outputs to cortex/ Brainstem/ hypothalamus - drive related behaviours and processing associated emotions

Prefrontal cortex & Cingulate gyrus - both modulators effect on processes associated with hypothalamus

Question 5

Describe the hormonal flight or flight response

Answer 5

Slide 18

Question 6

What is general adaptation syndrome?

Answer 6

1. Alarm reaction - NA from sympathetic nerves - A & NA released from adrenal medulla - cortisol from adrenal cortex
2. Resistance - cortisol longer lasting than A , maintenance of stress response
3. Exhaustion - prolonged stress -> continued cortisol secretion -> muscle wasting, suppression immune system/ hyperglycaemia

Question 7

Describe the stress-performance curve (yerke’s -dodson curve)

Answer 7

Too little stress (underload) - inactive- laid back

Optimum -> fatigue

Overload - exhaustion

Burn-out - anxiety/ panic/ anger -> breakdown

Slide 21

Question 8

List some anxiety disorders

Answer 8

Social phobia

Specific phobias

Generalised anxiety disorder

Panic disorder

OCD

PTSD

Question 9

Main symptoms of PTSD

Answer 9

Re-experiencing

Feeling worse about yourself/ world

Hyperarousal

Avoidance

Question 10

What do we know about functions of: amygdala, cingulate cortex and hippocampus in functional neuroimaging in: PTSD, panic disorder, social phobia, specific phobia, GAD ?

Answer 10

Slide 26

Question 11

How do benzodiazepines work?

Answer 11

GABA is main inhibitory neurotransmitter - decreased in cortex in patients with panic disorders

Benzodiazepines increase GABA transmission so reduce anxiety (binding GABA -> greater entry of chloride ion -> hyperoplarises cell -> more difficult to depolarise & reduced neural excitability)

Question 12

What effect does serotonin have on anxiety?

Answer 12

Increased levels may stimulate serotonin receptors in hippocampus -> neurorportection, neurogenesis and reduction of anxiety

Question 13

Treatment of anxiety

Answer 13

SSRIs
CBT
Pregabalin - GABA analogue

Don’t use benzodiazepines long term - short fix e.g. couple of weeks (addictive, lots of withdrawal similar to anxiety symptoms)

Question 14

What is CBT

Answer 14

Situation (triggers) -> thoughts -> physical reactions/ emotions -> behaviours

Questions each stage

Question 15

What is an obsession

Answer 15

Thought persists and dominates individuals thinking despite awareness that entirely without purpose or persisted/ dominated their thinking beyond the point of relevance or usefulness - causes great anxiety and guilt

Question 16

What is a compulsion?

Answer 16

Neutralising ritual

Obsessional motor acts - may result from an obsession leads directly to action or may be mediated by obsessional mental image or fear

Can also have mental compulsions e.g. repeating phrase

Question 17

Diagnostic criteria for OCD

Answer 17

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

Question 18

Pathophysiology of OCD

Answer 18

Suggested theories:
Re-entry circuits in basal ganglia

Reduced serotonin

Reduced activity in dorsolateral prefrontal cortex/ orbitorfrontal cortex

Increased activity in cingulate cortex

PANDAS - paediatric automimmune neuropsychiatric disorder associated with streptococcal infection

Input (from cortical/ subcortical areas)
-> processing in caudate nucleus and putamen (striatum) -> output (inhibitory projections from Globus pallidus and substantia nigra to thalmus via GABA-ergic neurones) re-entry form output to processing

Question 19

Treatment of OCD

Answer 19

CBT

Exposure response prevention

High dose SSRI (higher and longer dose)

Augmentation with antipsychotics - clomipramine

Deep Brain stimulation

Question 20

What is PTSD?

Answer 20

Within 6 months of traumatic event or exceptional severity

Evidence of trauma

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

Conspicuous emotional detachment, numbing and avoidance of stimuli that might arouse recollection of trauma

Question 21

Pathophysiology of PTSD

Answer 21

Hyperactivity of amygdala -> exaggerated response to perceived threat

Cortisol inhibits
PTSD have lower than normal levels of cortisol

Question 22

Treatment of PTSD

Answer 22

CBT
Medical treatment - same as anxiety (SSRIs, GABA analogue)

Eye movement desensitisation and reprocessing (think of memory and follow finger with eyes)