Class 10/11: Anxiety Disorders Flashcards
What is the main difference between normal anxiety and an anxiety disorder?
Anxiety disorders have persistent or recurrent anxiety that prevents the individual from full participation in life
Name 7 anxiety disorders.
- GAD
- Panic Disorder
- Phobias & Specific Phobia
- Agoraphobia
- Social Anxiety Disorder
- Separation Anxiety Disorder
- Selective Mutism
What 2 requirements must be met for a person to be diagnosed with an anxiety disorder?
- The fear/anxiety must be out of proportion to the situation (or age-inappropriate
- The fear/anxiety must hinder ability to function normally
Define Fear
Immediate alarm reaction to present danger which is characterized by a strong motivation to escape
What does fear activate in the body?
The sympathetic nervous system and the SAM axis.
What is Anxiety?
Apprehension/worry about real or perceived future threats
What is a fear reaction?
An emotional and physiological reaction to real or perceived immediate threats
Which is more common in GAD: Fear or Anxiety?
Anxiety
Which is more common in Panic Disorders: Fear or Anxiety?
Fear
Which is more common in PTSD: Fear or Anxiety?
It is a combination of both
What is anxiety generally characterized as?
Negative mood state characterized by bodily symptoms of physical tension and psychological symptoms of apprehension about the future
Define Comorbidity
When an individual suffers from 2+ conditions
What is panic disorder generally characterized as?
By recurrent and sudden debilitating panic attacks that come on unexpectedly
What are the 13 symptoms of a Panic Attack (according to the DSM-5)
- Heart Palpitations
- Sensations of shortness of breath or smothering
- Sweating
- Chills or Heat Sensations
- Feeling Dizzy
- Chest Pain or Discomfort
- Trembling or Shaking
- Fearing of Losing Control
- Nausea or Abdominal Distress
- Fear of Dying
- Numbness or Tingling Sensation
- Being detached from oneself
- Feeling of Choking
How many symptoms do you need to experience for it to be classified as a panic attack?
4+
How is a panic disorder relate to panic attacks?
A panic disorder involves unexpected and recurrent panic attacks and worry about have new panic attacks for at least 1 month
How does the Amygdala react so quickly?
It has direct access to the sensory information which means it can react before the individual realizes what they are looking at.
Which part of the nervous system is the Amygdala connected to?
The SNS
What percent are panic disorders are heritable?
48%
What gene is linked to Panic Disorders?
COMT which codes for Catechol-O-Methyltransferase which degrades catecholamine NTs
What are the criteria to be diagnosed with GAD?
Excessive anxiety and worry occurring more days than not for at least 6 month.
What are 6 symptoms of GAD?
- Restlessness on edge
- Difficulty concentrating
- Easily Fatigued
- Muscle tension
- Irritability
- Sleep Disturbance
Is worry about number of events/activites or intensity of worry?
Number
Define autonomic restrictors
The SNS is actually less responsive to stressors
Which mood disorder is NOT associated with activity of the SNS
GAD
Which mood disorder is associated with an overactivity of the SNS
Panic Disorder
What are the 3 Neurobiological different in people with GAD?
- Increased activation of the frontal lobes in response to stressful stimuli
- Potentially reduced size/function of amygdala
- Greater activation in anticipation of a negative image (not the actual response, just anticipation)
What are antianxiety meds called?
anxiolytics (anguish-loosen)
Which disorder does slow acting anxiolytics treat?
GAD
Which disorder does fast acting anxiolytics treat?
Panic Disorder
What do Benzodiazepines do?
Activate GABA receptors (inhibit signaling in brain)
Name 3 anxiolytics
- Xanax (alprazolam)
- Valium (diazepam)
- Ativan (lorazepam)
What are beta blockers?
Traditionally prescribed for cardiovascular disease, but can also be useful in treating short-term anxiety
How do beta blockers work?
Block β-adrenergic receptor in SNS outside BBB (in autonomic system) but do not affect brain and mental processes
Name 3 non-pharmacological treatments of Anxiety disorders.
- Cognitive Behavioural Therapy (CBT)
- Interoceptive Exposure
- Eye Movement Desensitization and Reprocessing (EMDR) Therapy
What is CBT?
Therapeutic approach that focuses on challenging distorted cognitions and related behaviours
What is Interoceptive Exposure?
Patient exposed to exercises that evoke physical sensations associated with panic attack (hyperventilation); realize that the worst possible outcome (dying) does not occur
Define EMDR Therapy
[CONTROVERSIAL] Patients asked to recall traumatic memory while making eye movements an/or listening to alternating audio tones/tapping
Name 3 effects exercise has on the brain.
- Exercise increases the release of chemicals that promote the birth and growth of new neural cells (neurogenesis)
- Exercise may also enlarge the hippocampus to improve memory performance
- Exercise has shown to enhance other chemicals in the body (ie endorphines)
Define endocannabinoids
Molecules made by the body which are increased in response to exercise which are very similar to cannabinoids (THC and CBD)
Give 3 examples of endocannabinoids
AEA (Anandamide), 2-AG (2-Arachidonoylglecerol), and OEA (Oleoylethanolaminde)
Name 2 endocannabinoid receptors and where they are located
CB1, and CB2, throughout the brain
What occurs when the CB1 receptor gets blocked?
Anxiolytic behaviour (anxiety related behvaiour)
What was the result of the exercise light/dark box mouse test?
The mouse that could exercise was in the light area more unless the CB1 receptor was blocked
Define agonizing
a drug that activate receptors on post synaptic neuron
Define antagonizing
A drug that blocks the receptor or transporter
In what state is this?
An activated microglia
Where is the CB2 receptor generally found?
The brain’s immune cells (microglia’s)
What occurs during neuroinflammation?
Enhanced expression of active microglia
Define the ‘animal model’ of stress
The chronic unpredictable stress model (CUS)
Name 7 ways a mouse could be stressed?
- Wet bedding
- No Food
- No Water
- Very small area to stand (otherwise water)
- Electric shocks
- Tiny cage
- Cage at an angle
What is a depressive like behaviours in mice?
Drinking plain water when sucrose water is available
What are 2 anxiety like behaviours in mice?
- The open field test where anxious mice will hang out around the edges and calm mice will hang out near the middle
- A hanging t model where two legs of the t are enclosed and two are open, the anxious mouse will hang out in the enclosed legs while calm mice will explore the open legs.
How does CBD affects anxiety?
CBD activates the CB2 receptor in the activated microglia reducing the neuroinflammation.
