Anxiety, PTSD and OCD

Question 1

First stage of anxiety

Answer 1

Alarm Reaction

• HPA: hypothalamus–>CRH/CRF–>anterior pituitary–>ACTH–>Blood–>adrenal cortex–>Cortisol
• Fight or flight: hypothalamus–>sympathetic NS–>spinal nerves–>adrenal medulla–>NE and Epi

Question 2

Second stage of anxiety if it is a single stressor

Answer 2

Adaptation Stage

-brings body back to normal after single stressor

Question 3

Second stage of anxiety if you have chronic stress

Answer 3

Resistance Stage

• Continuous secretion of GCs leads to the mobilization of lipids and amino acid reserves to obtain energy. Liver synth glucose to inc blood glucose level
• Continuous secretion of MCs causes a conservation of salts and water (loss of K+ and H+)

Question 4

Final stage of anxiety

Answer 4

Exhaustion Stage

• reaction to prolonged and frequently repeated stress
• Vital systems collapse due to exhaustion of lipid reserves, inability to continue to produce GCs, failure of electrolyte balance, cumulative damage to organs–>inc risk of disease

Question 5

What is fear extinction?

Answer 5

Learning not to fear by presenting the CS without the US. This is new learning, not forgetting

Question 6

What are the two pathways to conditioning

Answer 6

1. Involves cortex (indirect)
   - Important for differential conditioning, is longer and slower
   - Sensory–>thalamus–>cortex–>amygdala etc
2. Does not involve cortex (direct/low-road)
   - No conscious processing, allows for immediate reaction
   - Less information capacity
   - Fear provoking stimuli go this way for immediate reaction

Inputs both converge in lateral nucleus

Question 7

What is the hippocampus important for in fear learning?

Answer 7

Contextual processing!

Question 8

What is the amygdala important for in fear learning?

Answer 8

Both cued and contextual fear acquisition

Question 9

What part of the brain is important for fear extinction?

Answer 9

Cortex: inhibits expression of fear learning and may modulate amygdala outputs

Question 10

What reinforces extinction as active learning?

Answer 10

The NMDA receptors do. So if you block them in the amygdala, you interfere with extinction

Question 11

What is Papez Circuit’s role in fear? Be specific about the cingulate cortex

Answer 11

Emotional representations from the thalamus to the cortex for conscious awareness (Stream of thinking) and to the hypothalamus for stream of feeling.

Output from the cingulate cortex allows for top-down control of emotional responses

Thinking controls and guides our emotional responses, can increase or dampen them

Question 12

What are the risk factors for a specific phobia?

Answer 12

Heritable (43%) and environmental (like a traumatic experience with the stimulus)

Question 13

What brain region is activated with specific phobias?

Answer 13

Amygdala

Question 14

How do you treat a specific phobia

Answer 14

One-session treatment involving exposure and modeling (decreases L insula and ACC levels)

Question 15

What brain regions are associated with social phobia

Answer 15

Robust amygdala activation and some insula activation.

Question 16

How do we treat social phobia?

Answer 16

Nefazodone:

Increases in the middle frontal gyrus, ACC, hippocampus.

Decreases in the DL and MPFC and dorsal ACC (cog control and self-reference)

Question 17

Agoraphobia

Answer 17

Fear of having a panic attack in a place where you cannot escape ( very heritable). Interoceptive fears (fear of fear)

Question 18

What brain areas are implicated in panic disorder?

Answer 18

Insula, anterior cingulate, periaqueductal gray matter

Question 19

How do we treat panic disorder?

Answer 19

SSRIs, Benzos, SNRIs, TCAs, CBT

Question 20

What is GAD?

Answer 20

Excessive and uncontrollable worry for >6 mo with additional symptoms like sleep problems, muscle tension etc

Question 21

What are the common areas that reflect common denominator of fear network

Answer 21

Amydala, insula, ACC

Question 22

PTSD DSM-5 Criteria

Answer 22

A. Exposure to actual or threatened death, serious injury or sexual violence
-directly, witness in person, hearing about it happen to someone close to you, experiencing repeated exposure to details of a traumatic event

• Need to re-experience and avoid
• Have negative alterations in cognition and mood
• Arousal

Duration: >1mo with distress and impariment

Question 23

What brain areas are involved in PTSD

Answer 23

Amygdala, hippocampus, vmPFC

Question 24

What brain region is required to extinguish fear response?

Answer 24

vmPFC

Question 25

What were the differences in brain regions between PTSD and non-PTSD during extinction recall?

Answer 25

Increased amygdala and dampened vmPFC in PTSD pts. People with PTSD also had smaller hippocampi (tell you the context of your fear, have an overgeneralization)

Question 26

What is the best treatment for PTSD?

Answer 26

Psychotherapy! Prolonged exposure

-can use SSRIs which inc hippocampal volume

Question 27

OCD Criteria

Answer 27

Obsessions and Compulsions (response to obsessions with attempts to ignore, suppress or neutralize)

Question 28

What brain regions are associated with OCD?

Answer 28

-Inc activity in orbital cortex and head of caudate nucleus and the thalamus. Therapy decreases the activity.

Question 29

What is the obsessive compulsive cycle?

Answer 29

Obsessions–>Distress–>Compulsions–>Relief (negative reinforcement)

Question 30

Where in the cycle does CBT work?

Answer 30

Between distress and compulsions

Question 31

OCD Treatment

Answer 31

SSRIs, CBT (confront obsessions and realize anxiety will go away if you don’t act on compulsion)