Lecture 10 Anxiety abd Obsessive Compulsive Disorders+DLA (Block 2) Flashcards
What does Neuropsychology examine?
The function of different parts of the human brain (I.e. the brain-mind connection)
Explain the Gazzaniga Split-brain Studies(comeback)
Corpus callosum is severed so the left and right hemispheres cannot communicate with each other
The left hemisphere and chicken sees a snow scene and points to a picture of a snow shovel. The right hemisphere sees a snow scene and points to a picture of a snow shovel. Both hemispheres see the chosen pictures
What has the brain evolved to do?
Safely enclosed within the skull, must acquire the data via limited sense systems, selectively process that information, and output instructions through biological motor systems
How has the brain evolved to process information?
“Brain modules” evolved to process information in ways that worked well in the environment that our ancestors found themselves in
There are cognitive modules for:
Language processing
Facial processing and recognition
Visual processing
Tracking social hierarchy
Mental Associations
How does cognitive lens trick us? How do we know we are being tricked?
Our cognitive lens forms a permanent “lens” by which we view the world, tricking us into thinking there is no lens and instead reality
Clever methodology, experiments and self-observations of conflict allow us to glimpses of the lens that shape our thinking
Why is virtually everyone prejudice in some way?
- Prejudice is based on implicit associations
- the brain is hard-wired for associations, the repeated co-presentation of two things(conditioning) can lead to a non-conscious (and possibly non-logical) connection between them
Why does the brain use implicit associations ?
They are used by the brain to save time and energy
Define anxiety
A feeling of worry, nervousness, fear or unease about something specific or non-specific
This includes fear if everyday situations that interfere with daily activities, are difficult to control, and are out of proportion to the actual danger
Describe Anxiety etiology
- Not fully understood
- Genetic disposition- Diathesis stress model
- Sensitive nervous system(genetic and/or environmental)
- “Disorder of regulation of the autonomic nervous system and thoughts that arise as interpretation of that Dysregulation”-Dr. Barbara Landon
- Lack of skills to control, interpret and address symptoms
What are the risk factors of Anxiety?
- Family history
- Personality
- Trauma
- Serious illness
- Stress buildup/ overtaxed resources
- Other mental health disorder (e.g. depression)
- Drugs or alcohol
- Avoidance
Describe the physiological background of anxiety?
- Sympathetic/parasympathetic
- Racing heart
- Fast breathing
- Sweating
- Fight /Flight/freeze response
- HPA axis
- OCD : feedback loops in the brain
What is abnormal anxiety?
- Elicited by inappropriate cues (or no cues)
- inappropriate in intensity
- inappropriate in duration(usually 6+ months)
What is a neurotic?
A descriptor referring to these conditions (anxious, ritualistic)
Some amount of anxiety is________
Beneficial
Describe types of anxiety treatments
- Cognitive therapy
- Breath training (modify nervous system activity)
- Behavioral therapy(e.g.desensitization, exposure therapy)
- medications
- Antidepressants (e.g. SSRIs)
- Benzodiazepines
What is panic disorder?
- Recurrent and unexpected panic attacks (number of episodes not specified)
- for atleast 1 month, individual must show either :
- Fear of future panic attacks or its implications
Or
- a significant change in behavior related to the attacks (e.g. avoiding exercise)
Describe a panic attack
intense feeling of dread or fear with symptoms such as:
- Cardiac symptoms Gastrointestinal symptoms
- sweating Feeling faint
- Trembling Feeling detached
- Shortness of breath Fear of losing control
- Choking. Fear of dying
- chest pain. Tingling/numbness
- Chills/hot flushes
Describe the onset of a panic attack
Abrupt onset, episode peak within minutes
Often mistaken for heart attack, leading to ER visits
How does classical conditioning explain panic attacks?
Panic is a Condition response to a neutral stimulus that has been paired with a stimulus that has been paired with a stimulus that naturally produces fear (UCS)
UCS= frightening stimulus
UR= panic
Neutral stimulus= bodily sensations that are present when frightening stimulus occurs
CS= bodily sensations. CR= panic
Describe the treatment of panic disorder
- CBT - break the association between the bodily symptoms (e.g. rapid heart rate) and the induction of panic attacks
- Systemic Desensitization- expose patient to physical symptoms without allowing panic to occur(via relaxation techniques)
Pharmological=
Antidepressants (SSRIs)
Sedatives= benzodiazepines such as Xanax
How has the eye evolved to perform its function?
Absorbing and trans ducking electromagnetic energy
How has the inner ear evolved to perform its specific function?
Absorbing and transducung physical shockwaves
How has the alveoli evolved to perform its function?
Exchanging gases between the atmosphere and the blood
What is the function of the left ventricle?
Expelling blood through the aorta and into the arteries
What is agarophobia?
- Fear/avoidance because escape (or rescue) may be difficult if incapacitating/embarrassing symptoms develop
- often seen with panic disorder but can be stand-alone
What are the symptoms of agarophobia?
Persistent and excessive fear of 2+ of the following:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
What is specific phobia?
A persisten, excessive and disproportional fear of an object or situation
Fear response invariably occurs when exposed to the stimulus, or the person avoids the phobic situation
The fear causes causes marked distress or impairment in functioning
What are the subtypes of specific phobia ?
- animal
- natural-environment
- situational
- blood-injection-injury
- other
Give the etiology of specific phobia
A phobia is a classically conditioned response (I.e. neutral stimulus is paired with a naturally occurring fear-producing stimulus)
-Psychotherapeutic treatment consists of Systematic Desensitization or Exposure Therapy
What is social anxiety disorder?
Excessive, persistent and unrealistic fear of social situations involving possible scrutiny by others: fear of negative evaluation
The social situations are avoided or endured with intense fear or anxiety
Describe the social anxiety disorder specifier-“performance only”
This is when the fear is restricted to speaking or performing in public
What are the treatment options of Social anxiety?
- Cognitive therapy
- Behavioral therapy
- Pharmological:
Antidepressants(e.g. SSRIs)
Anti-hypertensives(e.g. beta-blockers) for short term management of physical anxiety symptoms
What is Generalized Anxiety Disorder( GAD)?
Uncontrolled persistent anxiety about multiple events
Explain the symptoms and diagnosis of generalized anxiety disorder
Several(3+) of the following:
- relentless, on edge
- lower concentration
- muscle tension
- fatigued
- irritability
- insomnia
Don’t diagnose this disorder if the worry is better explained by another disorder
Usually see physician due to physical symptoms
How can GAD be treated?
Cognitive therapy: reduce bias toward assuming negative outcomes by challenging automatic thoughts to reduce anxiety
Behavioral therapy: relaxation techniques. Use biofeedback to learn to relax muscle tension as GAD patients tend to be chronically
What is separation anxiety disorder?
Excessive anxiety concerning separation from those who, the person is attached
What are the symptoms of Separation Anxiety Disorder?
Person experiences marked distress(mental and physical) about such things as:
- anticipated or actual separation
- harm befalling attachment figure or self that leads to separation
- going out (e.g, to school, sleeping away) because of separation fears )
Symptoms persist +1 month
What are treatment options of separation anxiety disorder?
Reward separation and token economies
Describe the onset and course of separation anxiety disorder
- Separation anxiety is normal but should be outgrown after age 3 as attachment solidifies
- Usually diagnosed around 7-8 years old
- Even when symptoms resolve, problems with anxiety in general may persist
What is selective autism?
- refusal to speak in specific situations despite fluent speech in other context
- written communication and social play may also be affected
- symptoms must persist 1+ month hint first month of school)
- Not due to lack of language knowledge or a communication disorder(e.g. stuttering )
What is the onset and course of selective autism?
5-6 years old with most improving by age 10
Describe the etiology of selective autism
Psychologically-determined refusal to speak due to social anxiety
What is the treatment for selective autism?
Usually behavioral principles utilized( shaping, desensitization, token economies)
Describe anxiety disorder differentials
A variety of medical conditions can cause anxiety disorders, which should be ruled out:
A. Anxiety Disorders due to General Medical Condition (e.g. thyroid problems, menopause)
B. Substance-induced Anxiety Disorders(e.g. caffeine)
Just because someone has panic attacks doesn’t mean the diagnosis is “Panic Disorder”. Panic attacks may be part of a different anxiety disorder
To make a correct diagnosis, you need to know what triggers the symptoms and whether additional symptoms are present
What is the trigger of panic disorder?
Random
What is the trigger of Agoraphobia?
“Difficult to escape/rescue” situations
What is the trigger for a specific phobia?
A specific object/situation (not social/ performance)
What is the trigger of social anxiety?
A social performance/ setting
What is the trigger of GAD?
Many potential triggers (exclusion diagnosis)
What is the trigger of Separation Anxiety?
Separation from attachment figure
What is the trigger of selective mutism?
Speaking (manifested by mutism)
What are the Obsessive compulsive and related disorders?
- Obsessive-Compulsive Disorder
- Hoarding Disorder
- Body Dysmorphic Disorder
- Excoriation Disorder
- Trichotillmania
What are the Obsessive-Compulsive Disorder symptoms?
- Recurrent obsessions and/or compulsions
- Obsessions /compulsions are time consuming, distressful or disruptive
- Symptoms are not explained by another disorder (e.g., preoccupation with weight as in eating disorders)
Explain the recurrent obsessions and/or compulsions of OCD
Obsessions: unwanted recurrent thoughts, urges or images that increase distress
Compulsions: Repetitive behaviors/mental acts that are performed to decrease distress
Describe the etiology of OCD
- Strong genetic component
- Patients appear to be inheriting a brain with functional and chemical abnormalities
- Overactivity of specific brain curcuitry(a loop that includes the frontal lobe and motor networks)
- Serotonin deficiency
What does it mean when an individual has OCD with absent insight
(I.e. delusional beliefs)
-Individual is completely convinced that OCD beliefs are true
How is OCD treated psychologically?
- Behavioral therapy: Exposure and response prevention
1. Expose to feared situation
2. Avoid engaging in compulsion - Practiced in therapy and at home
- Good results after 2-3 weeks
- Considered at least “as effective “ and longer lasting than medications
How is OCD treated medically?
Pharmological: All SSRIs and 1 TCA(Anafranil) are approved for OCD
Psychosurgery: two brain parts are intentionally lesioned to disrupt the overactive circuitry in severe and treatment-resistant OCD
- Anterior cingulate gyrus (cingulotomy)
- Internal capsule (capsulotomy)
The gamma knife(radiation) procedure is replacing surgical lesioning
DBS
Describe Deep brain Stimulation as a treatment for OCD
- Brain electrode with external pacemaker
- Electrical pulses are delivered to neural circuitry implicated into OCD
- FDA-approved as a “Humanitarian Device” for severe and treatment-resistant OCD
What is the Yale-Brown Obsessive Compulsive Scale(Y-BOCS)?
An objective scale used to qualify and quantify the symptoms and severity of OCD.
-Useful to monitor symptom changes over time
What is the treatment of OCD related disorders?
All are usually treated with behavioral therapy (first choice); SSRIs can also be used
What is the essential feature of Trichotillomania?
Compulsive hair pulling
*pukling not accounted for by another disorder
What is the essential features of Excoriation?
Compulsive picking, not accounted for by another illness
What is the essential feature of Body Dysmorphic Disorder(BDD)?
O-C behavior about perceived defect in appearance
What is the essential feature hoarding?
O-C behavior resulting in the excessive accumulation of possessions, hoarding nit explained by other illnesses
What are the diagnostic criteria of Body Dysmorphic Disorder?
- Preoccupation with a perceived flaw in physical appearance(flaw is minimal/non-observable)
- repetitive behaviors or mental acts are performed in response to the appearance concerns
- The preoccupation is not better accounted for by an eating disorder
- The preoccupation in BDD must cause functional impairment (e.g., sequestering oneself)-otherwise, the preoccupation May be considered normal vanity
The belief can be of delusional intensity(100% certainty)
Add specifier: BDD “with absent insight(delusional beliefs)”
What is hoarding disorder?
An OCD-related disorder that caused accumulation of possessions in living areas that compromises their intended use
What is Excoriation disorder?
An OCD related disorder which causes recurrent unwanted skin picking causing lesions
What is Trichotillomania?
An OCD related disorder which causes recurrent unwanted pulling out of one’s hair
What are the additional requirements of OCD-related disorders?
Additional Diagnostic requirements
- Behaviors cause distress/impairment
- Behaviors are not better explained by another disorder
(E.g. Excoriation to remove a perceived flaw in BDD would not be excoriation disorder)
