Anxiety Flashcards
What is anxiety?
A feeling of worry, nerviousness or unease about something with an uncertain outcome
What are some of the symptoms of anxiety?
- Palpitations
- Sweating
- Trembling or shaking
- Dry mouth
- Difficulty breathing
- Chest pain or discomfort
- Nausea or abdominal distress (butterflies)
- Feeling dizzy, faint, light headed
What is the physiological role of anxiety?
A stress response to enable us to escape from potentially dangerous situations
What neurological system is involved in the anxiety response?
The limbic system
Explain how the brain processes information in the stress response
Cortex and limbic system communicate between each other
Limbic system sends infromation to Hypothalamus
Hypothalalmus commicates with both motor regions and activates the sympathetic nervous system
What is the hippocampus?
Curved piece of cortex in part of the temporal lobe
Involved in memory and expression of emotion
What is the amygdala?
- Almond shaped structure sitting near the tip of the hippocampus
- Recieves input from the sensory system
- Major outputs to the cortex & hypothalamus
- Involved in behvioural and autonomic emotional responses
What horome is released as part of the chronic stress response?
Cortisol
What are the effects of cortisol?
- Increase of energy metabolite levels
- Suppression of immune system
- Inhibtion of allergic and inflammatory processes
Describe the release of cortisol by the HPA axis
What are the 3 stages of general adaption that the body goes through during prolonged exposure to stress
1. Alarm Reaction
- NA release from sympathetic nerves
- Adrenaline and NA release from adrenal medulla
- Cortisol release from adrenal cortex
2. Resistance
- Cortisol action prolonged, effect of adrenaline starts to wear off
3. Exhaustion
- Prolonged stress causing continued cortisol secretion → muscle wastage, suppression of immune system and hyperglycaemia
When does the stress response become pathological?
When you cannot escape the stressor OR when trivial stressors elicit a strong stress response
Describe the principles of the stress- performance curve
A certain degree of stress is good to an extent- can help with performance
Too much or too little stress both lead to poor performance
What is social phobia?
Anxiety about being in social situations
What are specific phobias?
Spiders, heights etc
What is Generalised anxiety disorder?
Persistent anxiety about a variety of things
What is panic disorder?
Reccurent, unexpected panic attacks (severe episodes of acute stress response)
Describe the pathophysiology of anxiety disorders
- Unclear
- Appears that GABA levels are low in some anxiety disorders
- Increasing serotonin levels can help treat anxiety- mechanism unclear
What is the mainstay biological treatment of anxiety disorders?
SSRIs
(Selective Serotonin Reuptake Inhibitors)
What is the main pyschological treatment for anxiety disorder?
Cognitive Behavioural Therapy
What is the epidemiology of OCD?
- Fairly common (1 in 50)
- 1/3 cases start between 10-15 years
- Equal prevelence in males and females
What is OCD?
Anxiety disorder characterised by obsessions and compulsions present on most days for at least 2 weeks
What are obsessions (in OCD)?
Thoughts that persist and dominante an individuals thinking despite their awareness that the thoughts are entirely without purpose, or have persisted and dominated their thinking beyond the point of relevance or usefulness
(aka intrusive thoughts)
What are compulsions (in OCD)?
A motor act (or sometimes through) resulting from an obsession
Acting out a compulsions may relieve the anxiety provoked by its associated obsessions
What common features are their with obsessions and compulsions?
- Originate in the mind of the patient
- Repetitive and unpleasant
- Acknowledged as excessive or unreasonable
- Patient treies to resist but usually unsuccessfully
Describe the basal ganglia re-entrant circuit theory behind OCD?
The cortex projects to the basal ganglia which projects back to the cortex via the thalamus
Obsessional thoughts can therfore re-enter the cortex causing overactivity of the direct pathway
What theories are there for the pathophysiology behind OCD?
- Re-entry circuits in basal ganglia
- Reduced serotonin
- Reduced activity in dosrolateral pre-frontal cortex
What is PANDAS?
Paediatric Autoimmine Neuropsychiatric Disorder Associated with Streptococcal Infection
A sudden onset of OCD symptoms after infection with Group-A Beta haemolytic strep
Thought to be related with antibodies cross reacting with neurones within the basal ganglia
How do you treat PANDAS?
Antibitoics and usual OCD management
What psychological treatments are there for OCD?
- CBT
- Exposure response prevention
What biological treatments are there for OCD?
- SSRIs (high doses needed + longer treatment than depression)
- Antipsychotics- TCAs (Clomipramine)
- Deep brain stimulation
What is PTSD?
Post Traumatic Stress Disorder
- Seen within 6 months of a traumatic event of exceptional severity
- Causes repetitive, intrusive recollection or re-enactment of the event in memories, daytime imagery or dreams
- Emotional detatchment, numbing of feelings, avoidance of stimuli that might arouse recollection of trauma
What is the pathophysiology behind PTSD?
- Unclear
- Thought to be due to hyperactivity of the amygdala causing an exaggerated response to the percieved threat
- Also have low levels cortisol
What are someof the ways to treat PTSD?
- SSRIs
- Benzodiazepines short term
- CBT
- Eye movement densitisation
