Week 2 - Anxiety Disorders Flashcards
What is the most common anxiety disorder?
Phobias
What are the main 5 types of anxiety disorders?
- Generalised Anxiety Disorder (GAD)
- Specific phobia
- Agoraphobia
- Panic Disorder
- Social Anxiety Disorder (social phobia)
What are the “specifiers” and why are they important
Give examples for anxiety
Extensions to a diagnosis to further clarify a disorder or illness. They allow for a more specific diagnosis.For research and clinical purposes.
- Unspecified (and ‘other specified’) anxiety disorder
- Anxiety due to another medical condition
- Selective mutism & Separation anxiety (children)
- Substance/Medication-induced Anxiety Disorder
What is anxiety?
Negative mood state characterised by bodily symptoms of physical tension and apprehension about the future.
- Characteristic behaviours
- physiological symptoms
- subjective experiences
Describe the DSM-5 clinical features of a panic attack
4 + features
- Sweating
- Chest pain or discomfort
- Dizziness
- Nausea or abdominal discomfort
- Shaking or trembling
- Chills, hot flushes
- Palpatations, accelerated heart rate, pounding heart
- muscle tension?
- Sensations of shortness of breath/ smothering
- Paraesthesia (pins & needles)
- Fear of dying
- Fear of “going crazy” or “losing control”
- Depersonalisation (detached from one’s self) or Derealisation (detached from surroundings)
Describe the DSM-5 clinical features of a panic disorder
2+ panic attacks in a month?
Describe the physiology behind anxiety, fear and panic attacks - note if it is related to a long term or acute response
The release of adrenaline
- autonomic nervous system
- acute fear response/ fight/flight
- Hypothalamic -Pituitary- Adrenal axis (HPA)
- cortisol
- acute response
- longer term stress response
What are the neurobiological risk factors for anxiety disorders
Neurotransmitters Systems
- serotonin (decreased)
- norepinephrine
(noradrenaline) –> increased - GABBA (decreased)
Genetics + interactions with environment
Corticotrophin-releasing factor system
- Activates HPA Axis: over-
activation or breakdown in
negative feedback loop
Structure/function of brain regions
- Hippocampus & Amygdala,
limbic system, locus
coeruleus, prefrontal cortex
What are the personality-related risk factors for anxiety disorders
Behaviour Inhibition –> BIS/BAS
- strong predictor of social
anxiety
Neuroticism - ^ reactions with negative affect - ^ levels = strong predictor for anxiety disorder
What are the psychological risk factors for anxiety disorders
Behavioural
- Classical & operant
conditioning
- Modelling
Perceived control - Can stem from over- protective/ helicopter parents (depends on temperament of child & environment) - past trauma & perceived control over event
Attention to threat
- Negative cues in environment - early trauma = more likely to see negative cues
What are the social factors for anxiety disorders
- Familial
- Stressors (70% report severe stressor before onset)
- Exposure to stressors trigger vulnerabilities to anxiety
What are the four major subtypes of phobias
- Animals & insects (usually begins in childhood)
- situational e.g. flying,
- blood, injection, injury - (runs in families; heart rate slowing and possible fainting when facing feared stimulus)
- Other e.g.
What are the four major subtypes of phobias
- Animals & insects (usually begins in childhood)
- natural environments e.g.
- situational e.g. flying,
- blood, injection, injury - (runs in families; heart rate slowing and possible fainting when facing feared stimulus)
- Other e.g.
What are the four major subtypes of phobias
- Animals & insects (usually begins in childhood)
- natural environments e.g. storms, heights (usually begins in childhood)
- situational e.g. flying, public transport, driving, confined spaces (usually begins in adolescence/
- blood, injection, injury - (runs in families; heart rate slowing and possible fainting when facing feared stimulus)
- Other e.g.
What are the four major subtypes of phobias
- Animals & insects (usually begins in childhood)
- natural environments e.g. storms, heights (usually begins in childhood)
- situational e.g. flying, public transport, driving, confined spaces (usually begins in childhood or mid-20’s)
- blood, injection, injury - (runs in families; heart rate slowing and possible fainting when facing feared stimulus)
- Other e.g.
What are the four major subtypes of phobias
- Animals & insects (usually begins in childhood)
- natural environments e.g. storms, heights (usually begins in childhood)
- situational e.g. flying, public transport, driving, confined spaces (usually begins in childhood or mid-20’s)
- blood, injection, injury - (runs in families; heart rate slowing and possible fainting when facing feared stimulus)
- Other e.g. clowns, loud noises, contracting an illness
What conditions tend to be comorbid with social anxiety?
Depression
Other Anxiety disorders
Alcohol abuse
Personality disorders
What is the prevalence of panic disorder?
~5%
What is the prevalence of social phobia & the gender ratio?
What is the common age of onset?
What are the two subtypes?
3-13%, 50:50 gender ratio
Adolescence
Performance only or generalised
What is the prevalence of panic disorder?
Gender ratio?
onset?
~5%
2/3 female
Early adulthood (mid-teens-~40)
What is the prevalence of GAD?
Gender ratio?
~5.7%
2/3 females (reporting bias?)
Describe the process of the hypothalamic-pituitary- adrenal axis
Hypothalamus releases Corticotropin Releasing Hormone (CRH) to the pituitary gland –> pituitary gland releases Adrenocorticotropic Hormone ACTH to bloodstream —> ACTH reaches adrenal gland stimulating the release of cortisol —> cortisol initiates negative feedback mechanism on hypothalamus and pituitary gland
Describe the process of the hypothalamic-pituitary- adrenal axis
Hypothalamus releases Corticotropin Releasing Hormone (CRH) to the pituitary gland –> pituitary gland releases Adrenocorticotropic Hormone ACTH to bloodstream —> ACTH reaches adrenal gland stimulating the release of cortisol —> cortisol initiates negative feedback mechanism on hypothalamus and pituitary gland —> end stress response
What is the role of the limbic system in anxiety? (risk factor)
- most implicated brain region in the risk of anxiety
- overly responsive to stimulation = abnormal bottom-up processing
What is the role of the limbic system in anxiety? (risk factor)
- most implicated brain region in the risk of anxiety
- overly responsive to stimulation = abnormal bottom-up processing
- Bottom-up processing begins with the retrieval of sensory information from our external environment to build perceptions based on the current input of sensory information
What role does the amygdala have as a risk factor for anxiety?
- Amygdala central involvement in anxiety (within the limbic system)
- Recognises emotionally salient stimuli
- Assigns emotional significance
What role does the medial prefrontal cortex have as a risk factor for anxiety?
- Decision making
- Fails to down-regulate (decrease in # of receptors on neurotransmitters) hyper-excitable amygdala
What role does the medial prefrontal cortex have as a risk factor for anxiety?
- Decision making
- Fails to down-regulate (decrease in # of receptors on neurotransmitters) hyper-excitable amygdala
- this leads to abnormal top-down processing (processing information based on prior knowledge)
