Anxiety Disorders

Question 1

Pathophysiology of the stress responses

Answer 1

• 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

Question 2

Where is cortisol released from?

Answer 2

Zona fasciculata of adrenal cortex

Question 3

When does anxiety become a problem?

Answer 3

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

Question 4

What occurs in chronic stress?

Answer 4

• 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

Question 5

What does stress habituation mean?

Answer 5

Repeated mild stress exposure leads to reduced response in HPA axis

Question 6

What is neurosis?

Answer 6

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

Question 7

Types of anxiety disorders

Answer 7

• phobias
• social phobia
• panic disorder
• obsessive compulsive disorder
• PTSD
• generalised anxiety disorder

Question 8

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

Answer 8

• younger women
• generalised anxiety disorder most common

Question 9

What is anxiety?

Answer 9

Pathological stress response

Question 10

Symptoms of anxiety

Answer 10

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

Question 11

What are the symptoms of anxiety due to?

Answer 11

Sympathetic activation due to cortical stimulation in frontal lobe

Question 12

What is social phobia?

Answer 12

Inappropriate anxiety about being in social situations

Question 13

When does social phobia often start?

Answer 13

Adolescence

Question 14

What is agoraphobia?

Answer 14

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

Question 15

When does agoraphobia often start?

Answer 15

Mid 20s or 30s

Question 16

Common triggers of agoraphobia

Answer 16

• crowding
• open space
• distance from home
• social situations

Question 17

Define phobia

Answer 17

Irrational involuntary belief leading to avoidance

Question 18

Pathophysiology of phobias

Answer 18

Classical conditioning

Question 19

Treatment of phobias

Answer 19

Guided self help
Relaxation
Desensitisation

Question 20

What is panic disorder

Answer 20

Recurrent unexpected panic attacks

Question 21

What is panic

Answer 21

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

Question 22

Treatment of panic

Answer 22

• SSRI
• talk therapy
• cognitive behavioural therapy
• antidepressants

Question 23

Epidemiology of OCD

Answer 23

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

Question 24

What is OCD characterised by?

Answer 24

• 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

Question 25

Features of OCD obsessions + compulsions

Answer 25

• 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

Question 26

What is cognitive behavioural therapy?

Answer 26

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

Question 27

Treatment of OCD

Answer 27

• SSRI
• clomipramine
• cognitive behavioural therapy
• family support
• support groups

Question 28

Pathophysiology of OCD

Answer 28

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

Question 29

Outline PTSD

Answer 29

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

Question 30

Pathophysiology of PTSD

Answer 30

Evidence of amygdala hyperactivity causing exaggerated behavioural responses

Question 31

Treatment of PTSD

Answer 31

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

Question 32

Psychological symptoms of generalised anxiety

Answer 32

• fearful anticipation
• irritability
• restlessness
• sensitivity
• anxious thoughts
• poor connections

Question 33

Physical symptoms of general anxiety disorder

Answer 33

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

Question 34

Treatment of generalised anxiety disorder

Answer 34

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

Question 35

Infection associated with emergence of OCD like symptoms + explain

Answer 35

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

Question 36

Diagnosis of generalised anxiety disorder

Answer 36

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

Question 37

Outline the stress response

Answer 37

• 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