Exam 4: Anxiety Disorders Flashcards
most common type of psychiatric disorder
lifetime prevalence ~30&
women twice as likely to experience than men
patients with this have up to 90% comorbidity with other disorders
anxiety disorder
3 major categories of anxiety disorders reclassified by DSM-5
- anxiety disorders
- OCD and related disorders
- trauma related disorders like PTSD
anxiety symptoms
- panic episodes
- phobic avoidance of anxiety-eliciting stimuli
- intrusive thoughts or compulsive behaviors
- damaging negative thinking patterns
anxiety manifests as…
restlessness fatigue excessive anxiety and worrying inc muscle aches or soreness impaired concentration irritability difficulty sleeping
what happens in brain - anxiety
activation of sympathetic nervous system, inc HR, sweating, fight or flight
-intensity varies from felings of vague discomfort to intense sensatios of terror
why from evolutionary standpoint is a little anxiety beneficial
keeps you alert, protective
fear vs anxiety
fear: emotional response to current threat
anxiety: apprehension about possible future events
eustress
low anxiety levels improves performance
distress
high anxiety levels impair performance
3-component model of anxiety
cyclical interaction of body responses, ineffective behaviors, and upsetting thoughts
- high anxiety can lead to failure, maladaptive coping strategies exacerbate anxiety
can all exacerbate eachother
or you are so overwhelmed that you do nothing which will make it worse
generalize anxiety disorder (GAD)
- individuals show signs of constant worry and continuously predict, anticipate, or imagine dreadful events
- life is generally stressful, even minor events provoke worry (forgot a pencil even though have a laptop)
-chronic anxiety reduces the individual’s performance on many tasks and decreases pleasure
things no longer fun - chronic sympathetic activation
panic attacks
- individual experiences all effects of a fear reaction without a threatening stimulus
- strong arousal of sympathetic nervous system
can be mistaken for heart attack
mental and physical symptoms: chest pain, hands numb, inc HR
panic disorder
individual experiences both panic attacks and anticipatory anxiety
- recurring unpredictable panic attacks
- range from many times a day to one or twice a year
anticipatory anxiety
over the possibility of having an attack in a place that is not safe
-impairs daily activity, do not want to go out or do anything
social anxiety disorder (SAD)
persistent fear and avoidance of social/performance situations without justification
-onset at young age, half develop symptoms by age 11
characteristics of social anxiety disorder
- fear of situations where you may be judged
- worrying about embarassing yourself
- intense fear of talking with strangers
- sweating, trembling, shaky voice
- fear being center of attention
- spending time finding flaws after an event
agoraphobia
fear of public places
anxiety being in an unsafe place
- these ppl have limited lives bc they never leave safety of their homes
- inc anxiety in everyday situations
situations ppl with agoraphobia avoid
- shopping malls
- buses, trains, subways
- wide streets
- waiting in line
- crowds
- elevators
phobias involve…
fears that the individual recognizes as irrational
-may focus on specific objects or situations like high places or closed-in spaces, snakes, social situations , public speaking
what people fear is at least partially determined by…
culture
pa-leng in chinese culture - changes in body T
how can phobia be treated
behavior therapy
behavioral desensitization - exposure therapy
-face fear - start with picture then in same room and then maybe touching fear
PTSD
complex patterns of dysfunctional responses following exposure to traumatic experience or event
- war, school shooting, assault, natural disasters
- can be victim or someone observing
PTSD symptoms from 4 categories
-re-experiencing(flashbacks): remembering event and getting physiological response-sympathetic nervous system
- avoidance of people/places: avoid triggers
- negative condition/mood: memory deficits, cognitive, guilt, blame
-arousal: hypervigilance, sleep disturbances, aggression, self-destructive behaviors
people with PTSD have greater incidences of
suicide attempts, substance abuse, marital problems, depression, guilt, anger
long term consequences, without intervention it will not go away
risk factors of PTSD
-genetic contribution: monozygotic twins, 74% sufferrs had a family member who had a history
- women have inc incidences than men
- children of parents with PTSD are at an inc risk
OCD
recurring, persistent, intrusive thoughts of contamination, violence, sex, religion that the individual tries to resist but that cause a great deal of anxiety, guilt, and shame
compulsions
repetitive rituals to relieve the tremendous anxiety generated by obsessive thoughts
- actions to relieve anxiety
- hording, touching a doorknob a certain amount of times before opening
amygdala and anxiety
major component of emotion processing circuit
-receives highly processed sensory & cognitive information from thalamus, hippocampus, sensory and association areas
-fear components
how does amygdala orchestrate fear components of anxiety
sympathetic nervous system activation, enhanced reflexes, inc vigilance, activation of HPA axis
amygdala activation of hypothalamus through HPA axis
stress respons
amygdala activation of sympathetic arousal, brainstem
locus coreulus
amygdala activation o finsula
monitor internal body state
-feeling uneasy, fast HR
amygdala and PFC
modifies attention
-AND PFC can shut down amygdala indirectly - decides if the amygdala is providing a justified response
amygdala-hippocampus connectivity
responsible for memory consolidation
- emotional memory
- prolonged and sustained-strong memory of when they said the wrong thing
PFC and Anterior cingulate cortex
exert inhibitory control over primitive responses of subcortical regions
-long lasting changes prevent inhibition of amygdala - improper activation
BNST (bed nucleus of stria terminalis) - along ventricles
initiates behavioral manifestations of anxiety
-when stimuli are not great predictors of danger
projects to similar regions as amygdala (hippocampus, brainstem)
BNST produces state of…
sustained preparedness for an unclear danger and prolonged anticipation of unpleasantness
- recruit energy but unclear when danger is coming so you have a prolonged response
insula shares reciprocal projections with…
amygdala and BNST
insula function
conscious awareness of internal states -butterflies in stomach -racing heart or flushing skin interpretation, what am I actually feeling -are you excited bc puppy or anxious
brain changes in GAD
- inc volume/size of the amygdala
- more neurons responding to threats
PET scans show: inc amygdala activity with exposure to neg stimuli
more threat messages sent out
brain changes in GAD
- inc volume/size of the amygdala
- more neurons responding to threats
PET scans show: inc amygdala activity with exposure to neg stimuli
more threat messages sent out
brain activity during a panic attack
-inc activity in insula while recalling mental/physical distress of panic attack
inc awareness of changes in PNS
escalation of anxiety and fear associated with inc amygdala activity - overreaction
dec PFC activity - cannot suppress the amygdala
- inability to control emotions
brain changes in PTSD
- smaller hippocampus: unsure why, may be vulnerability factor
- smaller anterior cingulate cortex and medial PFC
what do the anterior cingulate cortex and medial PFC normally do
inhibit amygdala and establish extinction of conditioned emotional responses
faulty fear extinction in PTSD patients
-continued amygdala activation/hyperactivity
-inability to extinguish fear response
-reduced activity in vmPFC
no ability to turn off amygdala
do not learn that things you shouldn’t be afraid of are not scary
amygdala and mPFC in PTSD
hyperactivity of amygdala in response to threatening imagery - positively correlated with symptom severity
reduced mPFC activity and hippocampal formation
-inversely correlated with symptom severity
