Session 10 - Anxiety

Question 1

What two systems in the brain are involved in the stress response?

Answer 1

Limbic system

Limbic-hypothalamo-pituitary-adrenal axis

Question 2

Which areas of the brain make up the limbic system?

Answer 2

Hippocampal formation
Septal area
Amygdala

+/-
Prefrontal cortex
Cingulate gyrus

Question 3

What are the three parts of the hippocampus?

Answer 3

Subiculum
Hippocampus proper
Dentate gyrus

Question 4

What is the function of the hippocampus?

Answer 4

Involved in memory and expression of emotions

Question 5

What is the function of the amygdala?

Answer 5

Drives related behaviours and processing of associated emotions.

Question 6

What are the actions of the sympathetic nervous system in the stress response?

Answer 6

Increased heart rate and force of contraction

Dilated bronchi

Question 7

What are the actions of cortisol?

Answer 7

Increase of energy metabolite levels
Suppression of immune system
Inhibition of allergic and inflammatory processes

Question 8

What is anxiety?

Answer 8

A feeling or worry, nervousness or unease about something with an uncertain outcome.

Question 9

What are the symptoms of anxiety?

Answer 9

Palpitations
Sweating
Trembling or shaking
Dry mouth
Difficulty breathing
Chest pain or discomfort 
Nausea or abdominal stress (e.g. butterflies in stomach)
Feeling dizzy, unsteady, faint or light-headed

Question 10

What are the different types of anxiety disorder?

Answer 10

Social phobia
Specific phobias
Generalised anxiety disorder
Panic disorder
Obsessive compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)

Question 11

How are anxiety disorders treated?

Answer 11

Main treatment is SSRIs (Serotonin Selective Reuptake Inhibitors)
Cognitive behavioural therapy
Can use Pregabalin (GABA analogue)

Don’t use benzodiazepines long term (addition, tolerance, overdose)

Question 12

What is an obsession?

Answer 12

A thought that persists and dominates an individual’s thinking despite their awareness that the thought is either entirely without purpose, or has persisted and dominated their thinking beyond the point of relevance or usefulness.

Question 13

What is a compulsion?

Answer 13

An obsessional motor act. May result from an obsessional impulse that leads directly to action, or they may be mediated by an obsessional mental image or fear.

E.g. ‘I need to turn the light switch on and off ten times or my family will die’

Question 14

What are the diagnostic criteria for OCD?

Answer 14

Obsessions/compulsions/both present on most days for a period of at least 2 weeks.

Obsessions and compulsions charge all of the following features:

• originate in the mind of the patient
• repetitive and unpleasant
• ACKNOWLEDGED AS EXCESSIVE OR UNREASONABLE
• patient tries to resist, but at least one obsession/compulsion is unsuccessfully resisted

Carrying out the obsessive thought or act is not in itself pleasurable

Obsessions/compulsions must cause distress or interfere with the patient’s social or individual functioning.

Question 15

What are some of the theories for the pathophysiology of OCD?

Answer 15

Suggested theories:

• re-entry circuits in the basal ganglia
• reduced serotonin
• reduced activity in the dorsolateral prefrontal cortex
• reduced activity in the orbitofrontal cortex
• increased activity in the cingulate cortex
• PANDAS

Question 16

What is PANDAS?

Answer 16

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection.

Sudden onset OCD symptoms after infection with group-A beta-haemolytic strep. Antibodies ‘cross-react’ with neurones in the basal ganglia, causing symptoms.

Question 17

How is OCD treated?

Answer 17

Cognitive behavioural therapy - exposure response prevention
High dose SSRIs (need higher dose and longer course than in depression)
Augmentation with antipsychotics e.g. Clomipramine

Question 18

What is Post Traumatic Stress Disorder (PTSD)?

Answer 18

Repetitive, intrusive recollection or re-enactment of a traumatic event of exceptional severity within 6 months of the event occurring. Can take the form of memories, daytime imagery or dreams.

Patients may feel emotional detachment , numbing of feeling and will try to avoid stimuli that might arouse recollection of the trauma.

Question 19

Explain the theories of the underlying pathophysiology involved in PTSD.

Answer 19

Hyperactivity of the amygdala, causing exaggerated response to a perceived threat.

Lower than normal levels of cortisol (cortisol normally inhibits traumatic memory retrieval and controls sympathetic response).

Question 20

How is PTSD treated?

Answer 20

Cognitive Behavioural Therapy

Eye movement desensitisation and reprocessing (EMDR)