L8 - Anxiety Disorders

Question 1

What is the general adaptation syndrome (GAS)?

Answer 1

we have a bit of reserve (resistance phase) which becomes eroded after time with stres.. then comes exhaustion.

aka coping to a point..

alarm –> resistence –> exhaustion

Question 2

There are two pathways in the brain that handle our stress/anxiety response. Describe this.

Answer 2

• COGNITIVE -> Parts of the brain involved in fear response = thalamus, amygdala, hypothalamus, which then instruct the endocrine glands and autonomic nerv.sys.

sensory input > thalamus > cortex > thalamus > SC and endocrine system

• Evolved fear module (pink) versus considered response (green) = “fight or flight” versus “feel the fear and do it anyway (or do it differently)”!

sensory input > thalamus > sc to create fight/fight response.

Question 3

What are the three dsm chapters of anxiety and related disorders?

Answer 3

Anxiety Disorders, Obsessive-Compulsive and Related Disorders, and Trauma- and Stressor-Related Disorders. This move emphasizes the distinctiveness of each category while signalling their interconnectedness.

Question 4

What are some general considerations for anxiety disorders?

Answer 4

 Often have an early onset- teens or early twenties
 Show 2:1 female predominance
 Have a waxing and waning course over
lifetime
 Similar to MDD and chronic diseases such as diabetes in functional impairment and decreased quality of life

Question 5

How does normal and pathologic anxiety differ?

Answer 5

Normal anxiety is adaptive. It is an inborn response to threat or to the absence of people or objects that signify safety can result in cognitive (worry) and somatic (racing heart, sweating, shaking, freezing, etc.) symptoms.

Pathologic anxiety is anxiety that is excessive, impairs function.

Question 6

What does medial prefrontal cortex do?

Answer 6

(includes the anterior cingulate cortex, the subcallosal cortex and the medial frontal gyrus)- involved in modulation of affect

Question 7

What does amygdala do

Answer 7

processing of emotionally salient stimuli

Question 8

primary vs secondary anxiety?

Answer 8

Anxiety may be due to one of the primary anxiety disorders OR secondary to substance abuse (Substance-Induced Anxiety Disorder), a medical condition (Anxiety Disorder Due to a General Medical Condition), another psychiatric condition, or psychosocial stressors (Adjustment Disorder with Anxiety)

Question 9

What are the anxiety disorders?

Answer 9

 Specific phobia
 Social anxiety disorder
(SAD)
 Panic disorder (PD)
 Agoraphobia
 Generalized anxiety disorder (GAD)
 Anxiety Disorder due to another Medical Condition
 Substance-Induced Anxiety Disorder
 Anxiety Disorder NOS

Question 10

Whats the comorbidity between depression and anxiety?

Answer 10

50-60%!!! high

Question 11

heritability of anxiety?

Answer 11

0.43 for PD and 0.32 for GAD in twins.

sig familial aggregation.

Question 12

in SAD.. what do we see in their brains?

Answer 12

• increased medial PFC in response to intentional relative to unintentional social transgression in NORMAL and SAD
• SAD had significant response to unintentional transgression, though
• SAD also had significant increase in amygdala and insula actvity, bilaterally.

Question 13

What have functional imaginign studies in SAD found

Answer 13

 Several studies have found hyperactivity of the amygdala even with a weak form of symptom provocation namely presentation of human faces.
 Successful treatment with either CBT or citalopram showed reduction in activation of amygdala and hippocampus

Question 14

Treatment for SAD?

Answer 14

 Social skills training, behaviour therapy, cognitive therapy

 Medication – SSRIs, SNRIs, MAOIs, benzodiazepines,
gabapentin

Question 15

OCD onset?

Answer 15

male earlier than female

mean onst 19.5 age

Question 16

OCD etiology?

Answer 16

• genetics
• serotinergic dysfunc
• cortico-striato-thalamo-cortical (CSTC) loop
• paediatric autoimmune neuropsychiatric disorder associated with streptococcal (PANDAS)

Question 17

What do people with OCD supposedly have deficit in?

Answer 17

visual memory consistently reduced - makes sense because they cant recall whether they’ve completed their compulsive act.

visuospatial function ??

confounding factors of those studies though

• psychomotor slowing in OCD probably slowed them down
• checking and ritualisation mst have also slowed them down.

need to be careful bc people with OCD clients bc they complete tasks in an obsessive way

Question 18

visuospatial function in OCD?

Answer 18

thought to be impaired, but.

confounding factors of those studies though

• psychomotor slowing in OCD probably slowed them down
• checking and ritualisation mst have also slowed them down.

need to be careful bc people with OCD clients bc they complete tasks in an obsessive way

Question 19

Treatment for OCD?

Answer 19

 40-60% treatment response
 Serotonergic antidepressants
 behaviour therapy
 Adjunctive antipsychotics, psychosurgery
 PANDAS – penicillin, plasmapharesis, IV immunoglobulin

Question 20

What should you never treat bipolar with?

Answer 20

serotinergic drug!!! can make them manic.

also shouldnt use atyptical antipsychotics, D2 blockers with some 5-ht effect

Question 21

what have fMRI studies found in OCD.

Answer 21

• increased activity in right caudate
  this is decreased with CBT
  similar results obtained with pharmacotherapy

Question 22

PTSD aetiology?

Answer 22

 Conditioned fear
 Genetic/familial vulnerability
 Stress-induced release
 Norepinephrine, CRF, Cortisol
 Autonomic arousal immediately after trauma predicts PTSD

Question 23

What is usually found in the pTSD brain

Answer 23

reduced hippocampal volume

 More recent reviews including the meta-analysis of Smith (2005) indicate that on average PTSD sufferers had a 6.9% smaller left hippocampal volume and a 6.6% smaller right hippocampal volume in comparison to controls.

Question 24

memory in PTSD?

Answer 24

Verbal > visual

small to moderate effect

HYPER remebering the trauma event
HYPO remembering everything else.

Question 25

neuropsych performance in pTSD

Answer 25

• ef
• PROCESSING SPEED
• VERBAL MEMORY and learning
• atttention, working memory

Question 26

What can also affect cog deficits in PTSD

Answer 26

 Medical illness
 Somatization including non epileptic seizures  Psychiatric and psychological problems
 Substance abuse
 Dissociative symptoms

Question 27

PTSD treatment?

Answer 27

Pharmacotherapy 
Antidepresssants 
Anxiolytics 
Antipsychotics 
Mood stabilizers

Psychotherapy- Cognitive behaviour Therapy

Question 28

What is the cornerstone for pharmacological treatment for anxiety?

Answer 28

CRANK UP THE SEROTONIN!!!!!

SSRI or SNRIs

Question 29

who for sure cant use a benzo?

Answer 29

people with ETOH or substance dependence!! NOOOO

Question 30

first and second line treatment?

Answer 30

see tables in lecture!!!

Question 31

How to start using medication for anxiety?

Answer 31

 Start at 1⁄2 the usual dose used for antidepressant benefit i.e citalopram at 10mg rather than the usual 20mg
 WARN THEM THEIR ANXIETY MAY GET WORSE BEFORE IT GETS BETTER!!
 May need to use an anxiolytic while initiating and titrating the antidepressant