Anxiety Disorders: Biophyschosocial Aspects and Clinical Manifestations Flashcards
(38 cards)
Major mediators of the sx of anxiety disorders
- Locus coeruleus-norepinephrine system
- serotonin
- dopamine
- GABA-benzodiazepine receptor complex
Serotonin deficiency seen in ________. Serotonin overactivity seen in _______ states
depression; anxiety
•Locus Coeruleus central to modulating _____
•vigilance, attention and anxiety or fear
The amygdala receives what type of input?
excitatory glutamatergic thalamic and cortical input
The amygdala sends caudal projections to…
- NA neurons of LC
- DA neurons of VTA
- 5HT neurons of raphe nuclei
Amygdala connections
- Cortical areas – fear, cognitive misappraisal
- PAG – escape and freezing
- Parabrachial nucleus – Hyperventilation
- Lateral hypothalamus – Sympathetic activation
- PVN of hypothalamus – Endocrine activation
- DMN of the vagus – GI distress
- Nucleus Caudalis pontis - ↑ startle
- Striatum – Motor activation
•Panicogenic agents
- Sodium Lactate in 2/3 of those with PD
- 5% Carbon dioxide inhalation- CO2 hypersensitivity
- Sodium bicarbonate
- Isoproterenol (Isuprel)
- Doxapram (adrenergic agonist/carotid chemoreceptor)
•H-P-A activating anxiogens
- Yohimbine- alpha 2 antagonist
- M-chlorophenylpiperazine (mCPP)
- Fenfluramine
- Beta- carboline
- CCK-cholecystokinin agonists
- ↑firing in LC, + HPA axis, interacts with GABA
Respiratory panic inducing substaNCES CAUSE RESPIRATORY STIMULATION AND A SHIFT IN THE _________.
ACID BASE BALANCe; INCLUDING CARBON DIOXIDE 5% TO 35% SOD LACTATE BICARBONATE.
Panic disorder PET scan
- ↑flow R parahippocampal
- ↓serotonin type 1A receptor binding in anterior & posterior cingulate/raphe
Panic disorder MRI scan
•↓temporal lobe volume despite normal hippocampal volume
Panic disorder CSF
•↑ orexin, aka hypocretin, which is thought to play an important role in the pathogenesis of panic in rat models
Cognitive theory of panic
that pts. have a ↑ sensitivity to internal autonomic cues (eg, tachycardia)
•Anxiety is neutralized by _________ or _________.
avoidance or compulsions
Freud: Panic disoders
- A signal of threat to the ego
- Symbolic or current events are similar to threatening developmental events (traumatic anxiety)
- Repression was the primary defense against anxiety
- When repression fails- hysteria, phobias and obsession-compulsions erupt
- Superego anxiety, castration anxiety, separation anxiety and impulse anxiety
Separation anxiety disorder
Developmentally inappropriate, XS fear or ANXIETY/WORRY ABOUT SOMETHING HAPPENING TO THE MAJOR ATTACHMENT FIGURE (MAF)
SAD Symptoms
at least 4 WEEKS in children/adolescent; 6 months or more in adults
SAD- at least 3 of 8 symptoms/signs
- Distress or reluctance
- anticipating/experiencing SEPARATION from home or major attachment figures (MAF)
- about losing MAF
- About experiencing an UNTOWARD EVENT (e.g., getting lost, kidnapped, becoming ill) separation from the MAF
- to go out
- about BEING ALONE
- To SLEEP AWAY FROM HOME or to go to sleep w/o MAF
- Repeated NIGHTMARES @ SEPARATION
- Repeated complaints of PHYSICAL SX WHEN SEPARATED
Risk and prognostic factors: SAD
- Often develops after LIFE STRESS esp. a loss
- DEATH of a relative or pet
- ILLNESS in patient or relative
- CHANGE of schools
- Parental DIVORCE
- MOVE to a new neighborhood
- IMMIGRATION
- DISASTER THAT INVOLVED SEPARATION from major attachment figures
- Heritability 73% in a community sample of 6 yr twins; ↑ F
Selective mutism
}FAILURE TO SPEAK in spec. social situations
}Interferes w/ educational, occup. or social comm.
}DURATION IS AT LEAST 1 MONTH
}Failure to speak is not attributable to a lack of knowledge of or comfort with the spoken language required in the social situation
}Not better explained by a COMMUNICATION DISORDER (e.g., childhood onset fluency d/o)
Panic disorder
- Persistent worry about ANOTHER ATTACK
- Change in behavior because of the attacks
- Peak in 10 min
- Associated with at least 4 other symptoms
Panic disorder comorbidities
- Persistent worry about ANOTHER ATTACK
- Change in behavior because of the attacks
- Peak in 10 min
- Associated with at least 4 other symptoms
Agoraphobia
- Fear and avoidance in being in a situation that escape may be difficulty or they may not be able to get help
- May not leave home or may need a companion
- Can occur with and without panic disorder
Social Phobia
Persistent, irrational fear of social situations
- Marked avoidance of situations (humiliation or embarrassment)
- Or marked anxiety under these situations
- Recognized as not reasonable
