Anxiety Disorders

Question 1

What does fear activate?

Answer 1

The fear response activates the sympathetic nervous system and the sympatho-adrenomedullary (SAM) axis (see the stress lecture for a reminder).

Question 2

What is fear?

Answer 2

Fear is an immediate alarm reaction to present danger, characterized largely by a strong motivation to escape.

Question 3

What is anxiety?

Answer 3

Apprehension/worry about real or perceived future threats.

Question 4

What is a surprising risk that comes with anxiety disorders?

Answer 4

Suicide (20% attempt it).

Question 5

How is panic disorder characterized?

Answer 5

Panic disorder is characterized by recurrent and sudden debilitating panic attacks that come on unexpectedly.

Question 6

What are panic attacks?

Answer 6

According to the DSM5, panic attacks are abrupt surges of intense fear or discomfort that reach a peak within minutes.

Question 7

Prevalence of panic disorder?

Answer 7

Panic disorder affects 3.4-4.7% of the US population at some time in their lives .

Question 8

How does the amygdala affect fear?

Answer 8

The amygdala is linked to the recognition, expression, and experience of fear in both humans and animals. The amygdala has connections with the sympathetic nervous system, allowing it to affect physiological function.

Question 9

What happens with the physiological effects of fear?

Answer 9

The amygdala can activate the sympathetic nervous system. Accordingly, the body undertakes a number of adaptations that help is escape or otherwise deal with a threat of some kind.

Question 10

Neurobiology of panic attacks?

Answer 10

Brain imaging studies of individuals with panic disorder show amygdala activation in response to anxiogenic stimuli.

Question 11

Is panic disorder genetic?

Answer 11

It is highly heritable (48%).

Question 12

What gene does ti affect?

Answer 12

The only gene that is clearly linked to the disorder is COMT, which codes for the enzyme Catechol-O-methyltransferase, an enzyme that degrades catecholamine neurotransmitters.

Question 13

How is generalized anxiety disorder characterized?

Answer 13

Generalized anxiety disorder (GAD) is characterized by excessive anxiety, worry, and rumination.

Question 14

Prevalence of GAD?

Answer 14

Approximately 2.9% of the US population meets the criteria for GAD during a given 1-year period.

Question 15

Neurobiology of GAD?

Answer 15

Relatively little is known about the neurobiology of GAD. Unlike panic disorder, GAD and excess worry are not associated with sympathetic nervous system over-activity.

Question 16

How GAD the opposite of panic disorder?

Answer 16

Rather, individuals with GAD are said to be “autonomic restrictors”, meaning that their sympathetic nervous system is actually less responsive to stressors.

Question 17

What part of the brain shows increased activation in GAD?

Answer 17

The frontal lobe.

Question 18

What disorder is comorbid with anxiety disorder?

Answer 18

Alcohol use disorder (AUD).

Question 19

What are drugs that treat anxiety called?

Answer 19

Anxiolytics

Question 20

What kind of anxiolytics are given to patients with PD?

Answer 20

Fast-acting drugs.

Question 21

What kind of anxiolytics are given to patients with GAD?

Answer 21

Slow-acting drugs.

Question 22

What drugs are agonist to GABA receptors?

Answer 22

Benzodiazepines are drugs that are agonists at GABA receptors. They increase inhibitory signaling in the brain, leading to sedation and relaxation.

Question 23

What are the risks of fast-acting drugs?

Answer 23

Risk of addiction

Question 24

What other drugs are used to treat anxiety disorders?

Answer 24

Antidepressant medications, such as SSRIs are often quite effective in treating anxiety disorders.

Question 25

What drug is typically used for cardiovascular disease but also useful for short-term anxiety?

Answer 25

Beta blockers.

Question 26

What other treatments are available?

Answer 26

1. Cognitive behavioural therapy
2. Interoceptive exposure (PD)
3. Eye Movement Desensitization and Reprocessing (EMDR)