Anxiety Disorders

Question 1

Anxiety Defined

Answer 1

Feeling of worry or fear, of butterflies in the stomach, or the nervousness before an interview

Question 2

Anxiety Disorder Defined

Answer 2

Occurs when this emotion exceeds its normal boundaries and interferes with daily life
- Has negative affect (fear or worry)

Question 3

Anxiety Disorder Age

Answer 3

As early as 6 years old due to the brain being fully developed and synaptic pruning and maturation

Question 4

Anxiety Disorder Common Comorbidities

Answer 4

MDD and drug dependency

Question 5

Define Fear Extinction

Answer 5

Forgetting memories when we realize there is no longer are or were a threat
Involves the ventromedial PFC action on the amydala

Question 6

Define Generalized Anxiety Disorder defined and life-time risk

Answer 6

Chronically exaggerated worry and tension in the absence of a real cause
Life risk: 5.7%

Question 7

Panic Disorder definition and life-time risk

Answer 7

• Feeling of terror that strike suddenly, often with chest pain or heart palpitations and impending fear of death
• May progress to agoraphobia which is where the person avoids any situation that may precipitate an attack
• They also have anxiety of anticipation of another attack which is just as disabling as the attack itself
  Life risk: 4.7%

Question 8

Phobias definition

Answer 8

Irrational fear, the person will recognize the fear is without basis but as soon as they are in the setting, the fear is there

Question 9

Specific Phobia definition and life-time risk

Answer 9

Fear of a specific situation or object

Life-time risk 12.5%

Question 10

Social phobia (social anxiety disorder) definition and life-time risk

Answer 10

Fear of embarrassing oneself in front of other people; interferes with the ability to interact normally with other people and the person will avoid social situations interfering with normal functions
12.1% lifetime risk

Question 11

PTSD Definition and life-time risk

Answer 11

Disorder cuased by living through a dangerous events
Characterized by hyperarousal, avoidance or flashback, negative mood/cognition
6.8% lifetime risk

Question 12

OCD Define and Life Risk

Answer 12

Increased behavioral and cognitive rigidity and loss of executive control over actions
Person engages repetitively in thoughts or rituals they cannot control
1.6% life risk

Question 13

Anatomy of Anxiety Disorders

Answer 13

Hippocampal atrophy leading to increased expression of emotional behaviors through the hypothalamus
Cortico-limbic circuit dysfunction

Question 14

Orbitofrontal cortex normally

Answer 14

Promotes amygdala function

Question 15

Ventromedial PFC normally

Answer 15

Acts as a brake on amygdala function

Question 16

Dorsolateral PFC normally

Answer 16

Is involved in planning and ability to inhibit subconscious program

Question 17

Striatum in the basal ganglia normally

Answer 17

Regulates cortical program and regulates motor function and cognitive functions
(if this is absence and nothing is inhibiting cortical, it will continue the behavior = OCD)

Question 18

Posterior Region of vmPFC

Answer 18

Correlates with amygdala activity

Elevated in anxiety

Question 19

Anterior Region of vmPFC

Answer 19

Inhibitory to amygdala

Hypofunctional in anxiety

Question 20

PTSD + Brain Damage

Answer 20

If the vmPFC was damage the risk of PTSD occurring increased, if just the amygdala was damage there was no increased risk

Question 21

Anxiety Genes

Answer 21

SERT/5HT
COMT
SLC1A1/EAAT3
5HT1A

Question 22

EAAT3 =

Answer 22

synaptic glutamate transporter

Altered glutamate uptake alters cortical-striatal loop circuit (OCD)

Question 23

5HT1A =

Answer 23

Promoter is associated with amygdala reactivity and trait anxiety
Increase 1A autoreceptors = decreased 5HT release in the amygdala

Question 24

Reticular Activating System does what?

Answer 24

Plays a fundamental role in activating and focusing attention

Question 25

Locus Coerules does what?

Answer 25

Has NE neurons which act to focus attention and maintain vigilance

Question 26

Sympathetic stimulation symptoms are:

Answer 26

Panic attack
Sweating
Hyperventilation
Tachycardia 
"Fight or flight"

Question 27

DA and 5HT neurons are located where and do what?

Answer 27

RAS and regulate sensory activation of cognitive process

Question 28

Anxiogenic Agents do what to the body?

Answer 28

Increase the number of adenosine receptors
Lactate may precipitate panic attacks
Adenosine NT is implicated by caffeine anxiogensis and increased receptor number
Work on CNS depression and elicit euphoria and hypnotic effect

Question 29

Barbiturates in anxiety

Answer 29

Work well but have lots of side effects

Gave rise to SSRI, TCA, BDZ

Question 30

Serotonin in anxiety

Answer 30

Inhibits inappropriate behaviors
Too much = inhibits normal behaviors and produce anxiety
SSRI cause tonic elevation of 5HT and activation of autoreceptors which leads to reduced phasic 5HT release

Question 31

Side effect of SSRIs

Answer 31

May initially increase anxiety and make it worse because it increases 5HT present

Question 32

Buspirone in anxiety

Answer 32

5HT1A agonists with affinity for D2 recpetors and alpha-2 receptors
Overall: decrease 5HT turnover in the limbic system
Take time to begin working

Question 33

Ondansetron in anxiety

Answer 33

5HT3 antagonists

Interferes with excess 5HT transmission

Question 34

GABA in anxiety

Answer 34

Barbiturates and BDZ are activators of GABA-A which cause a net inhibitory effect on neurons
BDZ = Decrease the turnover of NE, 5HT, and DA; rapid effects but reverse = anxiety