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Clinical Neuroscience > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Pathophysiology of the stress responses

A
  • stress activates pre ganglionic afferent neurones in spinal cord
  • project onto other neurones > release NA/Adr
  • corticotropin releasing hormone released from hypothalamus > ACTH release from anterior pituitary
  • cortisol released from renal cortex
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2
Q

Where is cortisol released from?

A

Zona fasciculata of adrenal cortex

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3
Q

When does anxiety become a problem?

A
  • difficult to manage
  • when response is to perceived threat (not actual threat)
  • distinguish from normal anxiety
  • symptoms + psychological response remains
  • synonymous with neurosis
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4
Q

What occurs in chronic stress?

A
  • causes sensitisation of the normal stress response
  • reduces negative feedback of cortisol inhibiting CRH release
  • enhances positive drive through amygdala > increasing activity in paraventricular nucleus of hypothalamus
  • increased activity in ANS
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5
Q

What does stress habituation mean?

A

Repeated mild stress exposure leads to reduced response in HPA axis

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6
Q

What is neurosis?

A

Mental condition that is not caused by organic disease involving symptoms of stress

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7
Q

Types of anxiety disorders

A
  • phobias
  • social phobia
  • panic disorder
  • obsessive compulsive disorder
  • PTSD
  • generalised anxiety disorder
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8
Q

Epidemiology of anxiety disorders
What type of anxiety disorder is the most common?

A
  • younger women
  • generalised anxiety disorder most common
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9
Q

What is anxiety?

A

Pathological stress response

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10
Q

Symptoms of anxiety

A
  • palpitations
  • sweating
  • shaking
  • dry mouth
  • difficulty breathing
  • chest pain
  • nausea
  • abnormal distress (butterflies in stomach)
  • lightheadedness
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11
Q

What are the symptoms of anxiety due to?

A

Sympathetic activation due to cortical stimulation in frontal lobe

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12
Q

What is social phobia?

A

Inappropriate anxiety about being in social situations

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13
Q

When does social phobia often start?

A

Adolescence

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14
Q

What is agoraphobia?

A

Fear of crowds, open spaces, difficulty getting home (travel)

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15
Q

When does agoraphobia often start?

A

Mid 20s or 30s

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16
Q

Common triggers of agoraphobia

A
  • crowding
  • open space
  • distance from home
  • social situations
17
Q

Define phobia

A

Irrational involuntary belief leading to avoidance

18
Q

Pathophysiology of phobias

A

Classical conditioning

19
Q

Treatment of phobias

A

Guided self help
Relaxation
Desensitisation

20
Q

What is panic disorder

A

Recurrent unexpected panic attacks

21
Q

What is panic

A

Excessive arousal with fear that the symptoms are evidence of a catastrophe for a short period of time

22
Q

Treatment of panic

A
  • SSRI
  • talk therapy
  • cognitive behavioural therapy
  • antidepressants
23
Q

Epidemiology of OCD

A
  • equal gender prevalence
  • most start by 30
  • 1/3 between 10-15 years old
24
Q

What is OCD characterised by?

A
  • obsessions: thoughts that persist + dominate an individual’s thinking despite awareness that the thoughts don’t have purpose
  • compulsions: a motor act resulting from an obsessions
25
Q

Features of OCD obsessions + compulsions

A
  • originate in mind of patient
  • present on most days for at least 2 weeks
  • repetitive + unpleasant
  • acknowledged as excessive or unreasonable
  • patient tries to resist but at least one is unsuccessfully resisted
26
Q

What is cognitive behavioural therapy?

A

A talking therapy that can help manage problems by changing the way you think + behave

27
Q

Treatment of OCD

A
  • SSRI
  • clomipramine
  • cognitive behavioural therapy
  • family support
  • support groups
28
Q

Pathophysiology of OCD

A

Re-entrant loop in basal ganglia
- input of thought
- processed in striatum
- sent to globus pallidus + thalamus
- movement occurs
- re entry back to thought

29
Q

Outline PTSD

A
  • can occur within 6 months after severely traumatic event
  • causes repetitive, intrusive recollection or re-enactment of event in memories, daytime imagery or dreams
30
Q

Pathophysiology of PTSD

A

Evidence of amygdala hyperactivity causing exaggerated behavioural responses

31
Q

Treatment of PTSD

A
  • SSRIs
  • short term benzodiazepines
  • cognitive behavioural therapy
  • eye movement desensitisations reprocessing therapy
32
Q

Psychological symptoms of generalised anxiety

A
  • fearful anticipation
  • irritability
  • restlessness
  • sensitivity
  • anxious thoughts
  • poor connections
33
Q

Physical symptoms of general anxiety disorder

A
  • dry mouth
  • epigastric discomfort
  • tight chest
  • dyspnoea
  • Tachypnoea
  • palpitations
  • loose stool
  • tremor
  • insomnia
  • ED
  • amenorrhoea
34
Q

Treatment of generalised anxiety disorder

A
  • reduce stressors
  • advise self help
  • SSRI
  • avoid benzodiazepines
  • continue after remission to avoid relapse
35
Q

Infection associated with emergence of OCD like symptoms + explain

A

PANDAS
Paediatric
Autoimmune
Neuropsychiatric
Disorders
Associated with
Streptococcal infection
.
After infection, autoantibodies against self basal ganglia > sudden onset of ODC like symptoms + ticks

36
Q

Diagnosis of generalised anxiety disorder

A

Symptoms most days for at least 6 months:
Core symptoms:
- excessive anxiety or worry
- difficulty controlling worry or feeling of anxiety
.
3/6 additional symptoms:
- feeling of tension or restlessness
- significant muscle tension
- difficulty sleeping
- irritability
- tendency to become easily fatigued
- difficulty concentration/mind blanks

37
Q

Outline the stress response

A
  • originates in frontal lobes
  • communicates with amygdala
  • output via fornix
  • projects to mammillary bodies
  • project to hypothalamus
  • stress response occurs
  • CRH released from hypothalamus > ACTH released from anterior pituitary > cortisol released
  • AND
  • hypothalamus projects to spinal cord + activates sympathetic neurones > adrenaline release

Clinical Neuroscience (22 decks)

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