anxiety disorders

Question 1

sympathetic system and anxiety

Answer 1

dysregulated norepinephrine function likely causes anxiety

Question 2

GABA/benzodiazepine system in anxiety

Answer 2

Decreased BZD receptor binding in hippocampus in panic patients. Decreased BZD receptor binding in prefrontal cortex during panic attack

Question 3

Where is fear generated and extinguished

Answer 3

Fear Generation – Amygdalocortical interactions. Fear Extinction – Orbitofrontal Cortex & Prefrontal Cortex

Question 4

parts of the brain involved in fear response

Answer 4

Motor – Periaquaductal Gray, Endocrine – Hypothalamus, Respiratory – Brainstem, Cardiovascular – Locus Ceruleus

Question 5

styles of clinical presentation of depression and anxiety

Answer 5

1. psychologizer: reports being anxious. 2. initial somatizer: reports somatic complaints, but considers anxiety as cause. 3. facultative somatizer: reports soatic complaints. 4. persistent somatizer: reports somatic complaints, and denies anxiety

Question 6

what is panic disorder

Answer 6

Sudden overwhelming episodes of anxiety that include both somatic and psychic elements - along with worry about either the implication of the attack or about having future attacks. Can occur with or without agoraphobia (fear of specific places)

Question 7

panic disorder demographics

Answer 7

female: male 2:1. Onset in early adulthood

Question 8

panic attack symptoms

Answer 8

tachycardia, palpitations, shortness of breath, sweating, trembling, choking feeling, chest pain, nausea, chills, fear of losing control or dying

Question 9

panic disorder pharmacological treatment

Answer 9

Benzodiazepines, Tricyclic antidepressants, Monoamine oxidase inhibitors, Serotonin specific reuptake inhibitors, Serotonin Norepinephrine reuptake inhibitors

Question 10

panic disorder non- pharmacological treatment

Answer 10

cognitive behavioral therapy

Question 11

how does cognitive behavioral therapy work

Answer 11

Targets physical, behavioral and cognitive functions occuring during panic attack and restructures them

Question 12

generalized anxiety disorder- what is it and demographics

Answer 12

Excessive worry and more generalized somatic symptoms of anxiety (Worry, Anxiety, Tension), Female:Male = 2:1

Question 13

generalized anxiety disorder treatment

Answer 13

Benzodiazepines, Buspirone, TCAs, MAOIs, SNRIs, SSRIs and cognitive behavioral therapy

Question 14

What is social phobia

Answer 14

Overwhelming anxiety in situations where one would have to interact with others, be the center of attention, or perform in front of others, Not “shyness”

Question 15

social phobia treatment

Answer 15

Benzodiazepines, Beta blockers, MAOIs, SSRIs and cognitive behavioral therapy

Question 16

Obsessive compulsive disorder definition

Answer 16

Obsessions: recurrent, persistent thoughts, images, or impulses that are intrusive and cause anxiety
Compulsions: repetitive behaviors or mental acts that are performed in order to reduce anxiety

Question 17

Which circuit is involved in OCD

Answer 17

frontal lobe - basal ganglia- thalamus

Question 18

normal function of basal ganglia-thalamus circuit

Answer 18

Direct basal ganglia pathway disinhibits the thalamus. Indirect basal ganglia pathway inhibiting the globus pallidus externa which results in disinhibition of subthalamic nuclei. this disinhibition activates the globus pallidus interna which leads to thalamic inhibition

Question 19

How is the basal ganglia- thalamus circuit altered in OCD

Answer 19

Relative imbalance between direct and indirect basal ganglia pathways, with a tendency toward greater direct basal ganglia tone. The resulting thalamic disinhibition results in further activation of the orbitofrontal cortex which pushes the circuit even more toward direct pathway tone. Result in a driven circuit which leads to “capture” of cognition and behaviors

Question 20

OCD treatment

Answer 20

Clomipramine, SSRIs, Augmentation with atypical antipsychotics. Behavioral therapy (exposure and response prevention) and neurosurgery