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Clinical neuroscience > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

What is the physiological role of anxiety?

A
  • The stress response enables us to escape from potentially dangerous situations
  • It is primarily mediated by the limbic system, which has neural and endocrine targets
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2
Q

What are the structures of the limbic system?

A
  • Hippocampus
  • Amygdala
  • ## Prefrontal cortex
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3
Q

What is the role of the hippocampus in coordinating the stress response?

A
  • Receives input from many parts of the cortex and processes their emotional content
  • Ultimately projects to the thalamus and hypothalamus
  • Role in memory
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4
Q

What does the projection of the hippocampus to the hypothalamus mean?

A
  • This causes autonomic features of emotional responses
  • Since hypothalamus sends projections down through the cord to autonomic preganglionic neurones (hypothalamospinal tract)
  • This will lead to sympathetic nervous system activation, as well as the release of adrenaline
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5
Q

Describe the amygdala

A
  • Almond shaped structure sitting near the tip of the hippocampus
  • Receives many inputs from the sensory system
  • Major outputs to cortex and hypothalamus
  • Involved in behavioural and autonomic emotional responses
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6
Q

What is the role of the prefrontal cortex?

A
  • Modulation of emotional responses e.g. consciously suppressing features of anxiety
  • Perception of emotion
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7
Q

What are the endocrine elements of the stress response?

A
  • The limbic system is able to act on the hypothalamus to stimulate the secretion of stress hormones
  • Via the familiar hypothalamo-pituitary adrenal axis
  • Release of cortisol from the adrenal cortex is part of the chronic stress response
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8
Q

What are the three stages that the body goes through during prolonged exposure to stressors?

A
  • Stage 1: the alarm reaction - release of adrenaline and cortisol as well as sympathetic activation
  • Stage 2: resistance (effect of adrenaline starts to wear off) - chronic stress response, prolonged release of cortisol
  • Stage 3: exhaustion (when you cannot escape an ongoing stressor) - chronic side effects of prolonged cortisol secretion start to occur
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9
Q

When does the stress response become pathological?

A
  • When you cannot escape a stressor, or when trivial stressors elicit a strong stress response
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10
Q

What are the symptoms of anxiety?

A
  • Palpitations
  • Sweating
  • Trembling or shaking
  • Dry mouth
  • Difficulty breathing
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, faint or light headed
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11
Q

What are some of the classifications of anxiety disorders?

A
  • Social phobia
  • Specific phobia
  • Generalised anxiety disorders
  • Panic disorder
  • Obsessive compulsive disorder
  • Post-traumatic stress disorder
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12
Q

What is the pathophysiology of anxiety disorders?

A
  • Unclear
  • Equivocal findings in studies of brain activation patterns
  • GABA levels appear to be low in some anxiety disorders
  • Increasing serotonin levels can help treat anxiety disorders
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13
Q

What is the biological treatment of anxiety disorders?

A
  • Short term benzodiazepines
  • SSRIs
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14
Q

What is the psychological treatment of anxiety disorders?

A
  • Cognitive behavioural therapy
  • Get patients to reflect on their feelings / thoughts / behaviours
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15
Q

What is the social treatment of anxiety disorders?

A
  • Support groups, charities etc.
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16
Q

What is the epidemiology of OCD?

A
  • Fairly common - affects 1 in 50
  • 1/3 of cases start between 10 and 15 years of age
  • 3/4 have started by age 30
  • Equal prevalence in males and females
17
Q

What is meant by obsessions in OCD?

A
  • Thoughts that persist and dominate an individual’s thinking despite their awareness that the thoughts are either entirely without purpose, or have persisted and dominated their thinking beyond the point of relevance or usefulness
  • Unpleasant and repugnant, often causing anxiety
18
Q

What is meant by compulsions in OCD?

A
  • A motor act (or sometimes a thought) resulting from an obsession
  • Acting out a compulsion may relieve the anxiety provoked by its associated obsession
  • Frequently, carrying out the compulsion is also unpleasant
19
Q

What is needed in order to make a diagnosis of OCD?

A

Obsessions and compulsions must:
- Originate in the mind of the patient
- Be repetitive and unpleasant
- Be acknowledged as excessive or unreasonable
- Patient tries to resist, but at least one obsession/ compulsion is unsuccessfully resisted

20
Q

What is the pathophysiology of OCD?

A
  • Unclear
  • Some hypotheses: basal ganglia re-entrant circuits, reduced serotonin levels, altered activity in a range of cortical areas, autoimmune aetiologies
21
Q

Outline how basal ganglia re-entrant circuits may result in OCD

A
  • The cortex projects to the basal ganglia, which then project back up to the cortex via the thalamus
  • This is an example of a ‘re-entrant’ loop, where obsessional thoughts can re-enter the cortex having entered the basal ganglia
  • May be due to overactivity in the direct pathway
  • Treatments that inhibit thalamic activity by reducing the direct pathway or increasing the indirect pathway may hold promise
22
Q

What is the biological treatment of OCD?

A
  • SSRIs +/- antipsychotics
  • Deep brain stimulation?
23
Q

What is the psychological treatment of OCD?

A
  • CBT and a variety of other interventions
24
Q

What is the social treatment of OCD?

A
  • Family support, groups etc.
25
Q

What are the features of PTSD?

A
  • Can occur within 6 months following an exceptionally severe traumatic event
  • Causes repetitive, intrusive recollection or re-enactment of the event in memories, daytime imagery or dreams
  • There us conspicuous emotional detachment, numbing of feeling, and avoidance of stimuli that might arouse recollection of the trauma
26
Q

What is the pathophysiology of PTSD?

A
  • Unclear
  • Evidence of amygdala hyperactivity causing exaggerated behavioural responses
  • However, low levels of cortisol
27
Q

What is the biological treatment of PTSD?

A
  • SSRIs
  • May be short term benzodiazapines
28
Q

What is the psychological treatment of PTSD?

A
  • CBT
  • Eye movement desensitization reprocessing therapy
29
Q

What is the social treatment of PTSD?

A
  • Charities are particularly active, such as help for heroes

Clinical neuroscience (19 decks)

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