Session 10 - Anxiety Flashcards
What two systems in the brain are involved in the stress response?
Limbic system
Limbic-hypothalamo-pituitary-adrenal axis
Which areas of the brain make up the limbic system?
Hippocampal formation
Septal area
Amygdala
+/-
Prefrontal cortex
Cingulate gyrus
What are the three parts of the hippocampus?
Subiculum
Hippocampus proper
Dentate gyrus
What is the function of the hippocampus?
Involved in memory and expression of emotions
What is the function of the amygdala?
Drives related behaviours and processing of associated emotions.
What are the actions of the sympathetic nervous system in the stress response?
Increased heart rate and force of contraction
Dilated bronchi
What are the actions of cortisol?
Increase of energy metabolite levels
Suppression of immune system
Inhibition of allergic and inflammatory processes
What is anxiety?
A feeling or worry, nervousness or unease about something with an uncertain outcome.
What are the symptoms of anxiety?
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
What are the different types of anxiety disorder?
Social phobia Specific phobias Generalised anxiety disorder Panic disorder Obsessive compulsive disorder (OCD) Post-traumatic stress disorder (PTSD)
How are anxiety disorders treated?
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)
What is an obsession?
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.
What is a compulsion?
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’
What are the diagnostic criteria for OCD?
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.
What are some of the theories for the pathophysiology of OCD?
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
What is PANDAS?
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.
How is OCD treated?
Cognitive behavioural therapy - exposure response prevention
High dose SSRIs (need higher dose and longer course than in depression)
Augmentation with antipsychotics e.g. Clomipramine
What is Post Traumatic Stress Disorder (PTSD)?
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.
Explain the theories of the underlying pathophysiology involved in PTSD.
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).
How is PTSD treated?
Cognitive Behavioural Therapy
Eye movement desensitisation and reprocessing (EMDR)
