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Clinical Neuroscience > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Describe the physiological role of the stress response?

What is anxiety?

A

The stress response enables us to escape from potentially dangerous situations/ perceived threats

Anxiety is the term used for a pathological stress response

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2
Q

List symptoms of Anxiety (primarily attributable to sympathetic activation)

A
  • Palpitations
  • Tachycardia
  • Sweat
  • Trembling/ shaking
  • Dry mouth
  • Chest pain/ discomfort
  • Nausea/ abdominal distress
  • Dizziness/ Faint/ Light-headed
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3
Q

What mediates the stress response?

A

The Limbic system, via action on Neural and Endocrine targets

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4
Q

List the neural elements of the stress response

A
  • Hippocampus
  • Hypothalamus + thalamus
  • Amygdala
  • Prefrontal cortex
  • Complex interplay between these structures
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5
Q

Describe the role of the Hippocampus in the stress response

A
  • 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)
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6
Q

How do we get Autonomic features of emotional responses, with reference to the connection between the Hippocampus and Hypothalamus?

A
  • 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)

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7
Q

Describe the role of the Amygdala

A
  • 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)
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8
Q

Describe the role of the Prefrontal Cortex

A
  • Modulation/ processing of emotional responses

E.g consciously surprising anxiety features

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9
Q

Describe the Endocrine elements of the stress response

A

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

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10
Q

What is the General Adaptation Syndrome?

A

The 3 stages that the body goes through during prolonged exposure to stressors;

  • Stage 1: Alarm reaction
  • Stage 2: Resistance
  • Stage: Exhaustion
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11
Q

Describe Stage 1 of the General Adaptation Syndrome

A
  • Alarm reaction
  • Release of Adrenaline, Noradrenaline and Cortisol
  • Sympathetic activation
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12
Q

Describe Stage 2 of the General Adaptation Syndrome

A
  • Resistance
  • Effects of Adrenaline start to wear off
  • Chronic stress response, prolonged release of Cortisol

(Cortisol has immunosuppressive effects)

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13
Q

Describe Stage 3 of the General Adaptation Syndrome

A
  • Exhaustion

Side effects of prolonged Cortisol secretion;

  • Muscle wastage
  • Immunosuppression
  • Hyperglycaemia
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14
Q

What stages of the General Adaptation Syndrome can patients with Anxiety go through?

A

All of them

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15
Q

When can the stress response become pathological?

A
  • When you can’t escape a stressor

- When ‘trivial’ stressors elicit a strong stress response

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16
Q

List 6 classifications of Anxiety disorders

A
  • 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
17
Q

Describe the Pathophysiology of Anxiety Disorder

A
  • Unclear
  • GABA levels appear to be low

(Increasing Serotonin levels can help to treat)

18
Q

Describe the Biological, Psychological and Social treatments of Anxiety disorders

A

Biological;

  • Short term Benziodiazepenes (Increases GABA transmission)
  • SSRIs mainly

Psychological;
- Cognitive Behavioural Therapy (reflection on feelings/ thoughts/ behaviours)

Social;
- Support groups, Charities

19
Q

Why don’t you give Benzodiazepines in the long-term?

A

Similarly to alcohol patients can get dependent on them so when coming off them, they can get withdrawal symptoms

20
Q

Describe the Epidemiology of OCD

A
  • 1 in 50
  • 33% of cases start between 10 and 15
  • 75% started by 30
  • Equal prevalence in Males and Females
21
Q

OCD is characterised by Obsessions and Compulsions

Define and describe these ‘Obsessions’

A
  • 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
22
Q

OCD is characterised by Obsessions and Compulsions

Define and describe these ‘Compulsions’

A
  • 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
23
Q

Describe the diagnostic criteria for OCD

A
  • 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
24
Q

The Pathophysiology of OCD is unclear

List 4 suggested theories

A
  • 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)
25
Q

Describe the Biological, Psychological and Social treatments of OCD

A

Biological;
- SSRIs +/- Antipsychotics

Psychological;

  • Deep brain stimulation?
  • CBT (Exposure Response Prevention- Don’t allow them to act out compulsion so no feelings of relief being re-enforced by the act)

Social;
- Support

26
Q

What is PANDAS?

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection

A
  • Sudden onset of tics/ OCD symptoms after infection with Group A Beta-Haemolytic Strep (usually 3-12 years)
  • Treatable with Antibiotics, SSRIs, CBT etc
27
Q

Describe the features of PTSD

A
  • Can occur within 6 months after a traumatic event
  • Causes repetitive, intrusive recollection/ re-enactment of the event (memories, dreams, daytime imagery)
  • Conspicuous emotional detachment, numbing o feeling and avoidance of stimuli that may arouse recollection of trauma
28
Q

List 6 Psychosurgical procedures to treat OCD, classifying them into ABLATIVE and NON-ABLATIVE

(Psychosurgery is not supported by NICE guidance, but MAY only be used last line if nothing else has worked)

(Can leave permanent lesions in brain)

A

ABLATIVE;

  • Capsulotomy
  • Cingulotomy
  • Subcaudate Tractotomy
  • Limbic Leucotomy

NON-ABLATIVE;

  • Deep Brain Stimulation (DBS)
  • Vagal Nerve Stimulation (VNS)
29
Q

Describe the Pathophysiology of PTSD

A
  • Unclear
  • Evidence of Amygdala hyperactivity causing exaggerated behavioural responses
  • However, low levels of Cortisol (Inhibits traumatic memory retrieval, strangely)
30
Q

Describe the Biological, Psychological and Social treatments of PTSD

A

Biological;

  • SSRIs
  • Possibly, short term Benzodiazepines

Psychological;

  • CBT
  • Eye Movement Desensitisation & Reprocessing (EMDR)?

Social;
- Charities

Clinical Neuroscience (19 decks)

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