Anxiety Disorders Flashcards
Describe the physiological role of the stress response?
What is anxiety?
The stress response enables us to escape from potentially dangerous situations/ perceived threats
Anxiety is the term used for a pathological stress response
List symptoms of Anxiety (primarily attributable to sympathetic activation)
- Palpitations
- Tachycardia
- Sweat
- Trembling/ shaking
- Dry mouth
- Chest pain/ discomfort
- Nausea/ abdominal distress
- Dizziness/ Faint/ Light-headed
What mediates the stress response?
The Limbic system, via action on Neural and Endocrine targets
List the neural elements of the stress response
- Hippocampus
- Hypothalamus + thalamus
- Amygdala
- Prefrontal cortex
- Complex interplay between these structures
Describe the role of the Hippocampus in the stress response
- Inputs from many parts of Cortex, processes their emotional content
- Projects to Thalamus (so back to cortex- PAPEZ CIRCUIT) and Hypothalamus
- Role in memory (possible involvement of PAPEZ circuit)
How do we get Autonomic features of emotional responses, with reference to the connection between the Hippocampus and Hypothalamus?
- Hippocampus projects to Hypothalamus
- HT sends projections through cord via Hypothalamospinal Tract
- Leads to Sympathetic activation and release of Adrenaline from Adrenal Medulla
(This is the ACUTE Stress Response)
Describe the role of the Amygdala
- Almond shaped, sits near tip of Hippocampus
- Many inputs from sensory system (brainterm, thalamus, cortex)
- Outputs to Cortex, Hypothalamus, Brainstem
- Involved in Behavioural and Autonomic emotional responses (like the Hippocampus)
Describe the role of the Prefrontal Cortex
- Modulation/ processing of emotional responses
E.g consciously surprising anxiety features
Describe the Endocrine elements of the stress response
Limbic System is able to act on the Hypothalamus to stimulation secretion of Cortisol from Adrenal Cortex via the HPA Axis
This is the CHRONIC Stress Response
What is the General Adaptation Syndrome?
The 3 stages that the body goes through during prolonged exposure to stressors;
- Stage 1: Alarm reaction
- Stage 2: Resistance
- Stage: Exhaustion
Describe Stage 1 of the General Adaptation Syndrome
- Alarm reaction
- Release of Adrenaline, Noradrenaline and Cortisol
- Sympathetic activation
Describe Stage 2 of the General Adaptation Syndrome
- Resistance
- Effects of Adrenaline start to wear off
- Chronic stress response, prolonged release of Cortisol
(Cortisol has immunosuppressive effects)
Describe Stage 3 of the General Adaptation Syndrome
- Exhaustion
Side effects of prolonged Cortisol secretion;
- Muscle wastage
- Immunosuppression
- Hyperglycaemia
What stages of the General Adaptation Syndrome can patients with Anxiety go through?
All of them
When can the stress response become pathological?
- When you can’t escape a stressor
- When ‘trivial’ stressors elicit a strong stress response
List 6 classifications of Anxiety disorders
- Social phobia (about being in social situations)
- Specific phobias
- Generalised anxiety disorder (persistent, about a variety of things)
- Panic disorder (Recurrent, unexpected panic attacks)
- OCD
- PTSD
Describe the Pathophysiology of Anxiety Disorder
- Unclear
- GABA levels appear to be low
(Increasing Serotonin levels can help to treat)
Describe the Biological, Psychological and Social treatments of Anxiety disorders
Biological;
- Short term Benziodiazepenes (Increases GABA transmission)
- SSRIs mainly
Psychological;
- Cognitive Behavioural Therapy (reflection on feelings/ thoughts/ behaviours)
Social;
- Support groups, Charities
Why don’t you give Benzodiazepines in the long-term?
Similarly to alcohol patients can get dependent on them so when coming off them, they can get withdrawal symptoms
Describe the Epidemiology of OCD
- 1 in 50
- 33% of cases start between 10 and 15
- 75% started by 30
- Equal prevalence in Males and Females
OCD is characterised by Obsessions and Compulsions
Define and describe these ‘Obsessions’
- Thoughts that persist and dominate an individual’s thinking despite their awareness that the thoughts are either entirely without purpose, or have persisted and dominated beyond the point of relevance or usefulness
- Unpleasant and repugnant TO THE INDIVIDUAL
- Often causing great anxiety
OCD is characterised by Obsessions and Compulsions
Define and describe these ‘Compulsions’
- A motor act/ thought resulting from an Obsession
- Acting out a compulsion may relive the anxiety provoked by its associated obsession
- Frequently carrying out the compulsion is also unpleasant
Describe the diagnostic criteria for OCD
- Obsessions/ compulsions must be present on most days for AT LEAST 2 weeks
Obsessions and compulsions must share the following features;
- Originate in mind of patient
- Repetitive and unpleasant
- Acknowledged as excessive/ unreasonable
- Tries to resist, but AT LEAST ONE obsession/ compulsion is unsuccessfully resisted
The Pathophysiology of OCD is unclear
List 4 suggested theories
- Reduced Serotonin levels
- Autoimmune
- Altered activity in some cortical areas
- Basal Ganglia Re-entrant circuits (possible value in treatments that inhibit Direct Pathway or stimulate Indirect pathway)
