anxiety disorders Flashcards
sympathetic system and anxiety
dysregulated norepinephrine function likely causes anxiety
GABA/benzodiazepine system in anxiety
Decreased BZD receptor binding in hippocampus in panic patients. Decreased BZD receptor binding in prefrontal cortex during panic attack
Where is fear generated and extinguished
Fear Generation – Amygdalocortical interactions. Fear Extinction – Orbitofrontal Cortex & Prefrontal Cortex
parts of the brain involved in fear response
Motor – Periaquaductal Gray, Endocrine – Hypothalamus, Respiratory – Brainstem, Cardiovascular – Locus Ceruleus
styles of clinical presentation of depression and anxiety
- 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
what is panic disorder
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)
panic disorder demographics
female: male 2:1. Onset in early adulthood
panic attack symptoms
tachycardia, palpitations, shortness of breath, sweating, trembling, choking feeling, chest pain, nausea, chills, fear of losing control or dying
panic disorder pharmacological treatment
Benzodiazepines, Tricyclic antidepressants, Monoamine oxidase inhibitors, Serotonin specific reuptake inhibitors, Serotonin Norepinephrine reuptake inhibitors
panic disorder non- pharmacological treatment
cognitive behavioral therapy
how does cognitive behavioral therapy work
Targets physical, behavioral and cognitive functions occuring during panic attack and restructures them
generalized anxiety disorder- what is it and demographics
Excessive worry and more generalized somatic symptoms of anxiety (Worry, Anxiety, Tension), Female:Male = 2:1
generalized anxiety disorder treatment
Benzodiazepines, Buspirone, TCAs, MAOIs, SNRIs, SSRIs and cognitive behavioral therapy
What is social phobia
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”
social phobia treatment
Benzodiazepines, Beta blockers, MAOIs, SSRIs and cognitive behavioral therapy
Obsessive compulsive disorder definition
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
Which circuit is involved in OCD
frontal lobe - basal ganglia- thalamus
normal function of basal ganglia-thalamus circuit
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
How is the basal ganglia- thalamus circuit altered in OCD
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
OCD treatment
Clomipramine, SSRIs, Augmentation with atypical antipsychotics. Behavioral therapy (exposure and response prevention) and neurosurgery
