Anxiety Disorders (ch.18.3)

Question 1

Bipolar Depression:

Answer 1

-Characterized by periods of depression alternating with mania

Question 2

Mania:

Answer 2

-Overconfidence, impulsitivity, high energy. This unorganized behaviour makes it difficulties to complete projects and meet responsibilities

Question 3

Rapid Cycling:

Answer 3

• (Some bipolar patients experience this)
• four or more cycles of mania and depression within a year, these can be much more frequent including multiple cycles a day

Question 4

Cylothymia:

Answer 4

Cycling between dysthymia (mild depression) and hypomania (mild mania)

Question 5

Bipolar Depression average age:

Answer 5

Average age of onset is earlier than unipolar depression

• First episode commonly between 15- 30 y with an average of 25 year
• Age of onset IS tied to genetics

Question 6

Bipolar Depressions (are men or women more effected)

Answer 6

Men and women are equally effected

Question 7

One gene with Bipolar Depression is isolated as a contributing factor that encodes for…

Answer 7

BDNF ( a neurotrophic factor)

Question 8

Brain changes that are associated with bipolar depression:

Answer 8

• Enlarged ventricles
• Reduced Grey Matter -> this correlated with the number of episodes (the number of episodes the greater the loss of neurons)
• Suggests an accumulation of damage over time

Question 9

What is a problem with using antidepressants in the treatment of Bipolar Depression?

Answer 9

• The depression is oftener educed but mania is triggered

Question 10

Typical Antipsychotics (for bipolar disorder)

Answer 10

• Would seem an attractive treatment for mania but generally they are not very effective

Question 11

Mood Stabilizers:

Answer 11

Mechanisms of actions not completely understood

• Used primarily to combat symptoms of mania but not all symptoms of BP
• side effects: increase in weight, dizziness, lethargy, vision problems

Question 12

Most commonly used medication for bipolar disorder:

Answer 12

Lithium

Question 13

Problem with Mania and taking medication:

Answer 13

Mania can feel “pleasant” in comparison to feeling medicated or depressed therefor there are issues with compliance

Question 14

Anxiety Disorders:

Answer 14

Characterized by chronic fear in the absence of threat

Question 15

Psychological symptoms of anxiety:

Answer 15

fear and worrying

Question 16

Physiological symptoms:

Answer 16

• autonomic activation - tachycardia (abnormal heart rate)
• hypertension
• nausea
• breathing difficulties
• sleep disturbances
• high glucocorticoid levels

Question 17

__% of the population will suffer form an anxiety disorder at some point

Answer 17

• 17%

- Twice as common in females

Question 18

Anxiety Disorders and Major Depressive Disorder (Corse system differences)

Answer 18

Anxiety: Characterized by anxiety and worry and disorder dependent symptoms (ex phobia)
Depression: Decreased mood and interest in pleasure

Question 19

Symptoms that overlap between anxiety and depression disorders

Answer 19

Fatigue, concentration, sleep

Question 20

How are anxiety disorders triggered?

Answer 20

• By stressful events, the role of experience in shaping the disorder is often observable
• Heritability 30-40%

Question 21

5 major anxiety disorders:

Answer 21

• Generalized Anxiety Disorder
• Phobic Anxiety Disorders
• Panic Disorders
• Obsessive Compulsive Disorder
• Post Traumatic Stress Disorder

Question 22

Generalized Anxiety Disorder:

Answer 22

Exceissive worrying that interferes with day to day life

- Increased arousal, fatigue, concentration problems, sleep problems, irritability, muscle tension

Question 23

Phobic Anxiety Disorders:

Answer 23

Intense fear that becomes centred on a specific object situation or person

Question 24

Panic Disorders:

Answer 24

Recurring attacks of fearfulness (panic attacks)

• Unexpected panic attacks and subsequent avoidance behaviours
• fear anxiety about social performance
• • worry about exposure to social situations (leads to panic attacks and phobic avoidance/social isolation

Question 25

Obsessive Compulsive Disorder:

Answer 25

Obsessions (thoughts_ compulsions (repetitive behaviours) or both - Compulsions -> Behaviors that are repeated - Obsessions -> reoccurring thoughts (thinking about the behaviour) - 4 mil people in the US suffer from OCD - average age of onset - 25 to 44 years of age

Question 26

Post Traumatic Stress Disorder:

Answer 26

Triggered by traumatic event, includes severe anxiety, flashbacks and fear (e.g: observing or experiencing violence or death) - Memories of events intrude consciousness and elicit strong emotional and peripheral responses such as immense fear, trembling, erratic behaviour. - Very common in veterans - genetics account for 1/3rd of incidences - Size of hippocampus may increase risks (smaller) - have deficit in the ability to forget - involved MGN, amygdala, hippocampus, and brainstem

Question 27

(Generalized Anxiety Disorder) Amygdala centered circuit:

Answer 27

FEAR - Feelings of fear - Avoidancee Behavior - Endocrine Output (hormones) - Respirator Output - Sympathetic tone

Question 28

(Generalized Anxiety Disorder) Cortico striatal thalamic loops:

Answer 28

WORRY | - Anterior cingulate cortex to nucleus accumbens to thalamus and back to the anterior cingulate

Question 29

2 Categories for phobic anxiety disorders:

Answer 29

1. Specific phobias: fear of particular objects or situations ( 5 subtypes) - animal, environment, situation blood injection or other 2. Agoraphobia: fear of leaving home or a 'safe are' - Exposure may elicit broad range of responses to mildly increased arousal to panic attacks - Could result from a conditioned response that is strengthened with each exposure - Brain regions of interest (amygdala, insula, limbic system) - DISORDERS (Suriphobia (rats), aquaphobia (water), acrophobia (heights), hemophobia (blood), claustrophobia (small spaces))

Question 30

Panic Disorders - Brain changes

Answer 30

- Patients with reoccurring panic attacks present with ABNORMAL MRI of the temporal lobe - ~40% of panic patients show small lesions in white matter in the temporal lobe and larger lateral ventricles

Question 31

What does OCD respond well to?

Answer 31

SSRI

Question 32

Increasingly fMRI suggest what with OCD?

Answer 32

SSRI target the orbitofrontal cortex in OCD, SSRI target ventrolateral prefrontal cortex in depression - Depression often accompanies OCD

Question 33

Anxiety Disorders Medications: B

Answer 33

Benzodiazepines: GABAa receptor agonists - GABA in the presence of Benzodiapzepines increase CL influx - neural inhibition - At high doses benzodiazepines function as anticonvulsants and sedatives - Side effects: sedation, nausea, tremor - Stopping treatment - rebound anxiety

Question 34

Anxiety Disorders: S

Answer 34

- Seroteonergic Agonsit: Buspirone 5HTIA agonist prescribed for GAD - Produces anxiolytic response without the side effects of Benzodiazepines - Common Side effects: nausea, headache, insomnia - Of interest: Imaging studies show decreased levels of 5HTIA receptors in anxiety patients

Question 35

Anxiety Disorders Medication: A

Answer 35

Antidepressants: SSRI and SNRI are effective at treating anxiety disorders - Depression and Anxiety are comorbid - patients with uni or bipolar depression are 50% more likely to have had an anxiety disorder - Interestingly antidepressants can increase levels of BDNF the gene that codes for this protein is reduced in patients with anxiety