Lecture 2.2: Anxiety & PTSD

Question 1

Fear vs Anxiety

Answer 1

• FEAR is an emotional response to real or
perceived imminent threat
• ANXIETY is anticipation of future threat

Question 2

What are the DSM-V?

Answer 2

1) Generalised anxiety disorder
2) Panic disorder and agoraphobia
3) Social phobia
4) Obsessive compulsive disorder
5.) Reaction to stress: PTSD

Question 3

Symptoms of Anxiety (8)

Answer 3

• Unsteadiness, dizziness and light-headedness
• Nausea
• Sweating
• Increased heart rate or palpitations
• Shortness of breath
• Trembling or shaking
• An upset stomach
• Not sleeping well

Question 4

Generalised Anxiety Disorder (GAD)

Answer 4

• Excessive worry more days than not for >6 months about a number of events,
difficult to control the worry
• 3 or more of the following symptoms: restlessness, easily fatigued, difficulty
concentrating, irritability, muscle tension, sleep disturbance
• Causes significant distress or impairment

Question 5

Obsessive Compulsive Disorder (OCD)

Answer 5

• Recurrent and persistent
thoughts/impulses/images that are intrusive and
unwanted that cause marked anxiety or distress
• The person attempts to ignore or suppress such
thoughts, urges or images, or to neutralise them
with some other thought/action (i.e. compulsion)

Question 6

Post-Traumatic Stress Disorder (PTSD)

Answer 6

• Exposure to actual or threatened death or
serious and/or sexual violence
• Direct experiencing of traumatic event(s)
• Witnessed in person the events as it occurred
to others
• Learning that the traumatic events occurred to
person close to them
• Experiencing repeated or extreme exposure to
aversive details of trauma
• Duration of disturbance > 1 month
• AND causes significant impairment in function

Question 7

Symptoms of PTSD (5)

Answer 7

• Recurrent, involuntary and intrusive memories of
event
• Recurrent trauma-related nightmares
• Dissociative reactions
• Intense physiologic distress at cue exposure
• Marked physiological reactivity at cue exposure

Question 8

PTSD: Persistent Avoidance by….? (2)

Answer 8

• Avoidance of distressing memories, thoughts or
feelings of the event(s)
• Avoidance of external reminders of that arouse
memories of event(s) e.g. people, places,
activities

Question 9

Common Behavioural Changes in PTSD (6)

Answer 9

• Irritable behaviour and angry outbursts
• Reckless or self-destructive behaviour
• Hyper-vigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance

Question 10

What areas of the Brain are involved in Excitatory Learning?

Answer 10

• Amygdala
• CS – US association

Question 11

What areas of the Brain are involved in Inhibitory Learning?

Answer 11

• Ventromedial Prefrontal Cortex (vmPFC)
• CS – NO US association

Question 12

What is Anxiety in terms of Neurobiology?

Answer 12

• We can think about anxiety as being an imbalance between overactive bottom-up activity from the amygdala
• Indicating the presence of potentially threatening stimuli
• And dysfunctional top-down control mechanisms originating in the PFC
• Related to an inappropriate representation of the emotional salience of stimuli
• Blocking NMDA receptors in amygdala interferes with extinction learning ->
extinction = acquisition of new memory

Question 13

Equilibrium between GABA and glutamate in anxiety disorders vs normal brain

Answer 13

• Physiological State: GABA and Glutamate in equilibrium
• Anxiety Disorders: Less GABA, more Glutamate

Question 14

How to treat anxiety disorders? (5)

Answer 14

• Psychoeducation
• Self-help
• CBT
• Pharmacotherapy
• Assisting withdrawal from psychoactive substances