Anxiety, OCD

Question 1

What is the stress response made up of?

Answer 1

Limbic system

Limbic-hypothalamo-pituitary-adrenal axis

Question 2

What is the limbic system made up of?

Answer 2

Hippocampal formation

Amygdala

Prefrontal cortex

Question 3

What is the hippocampus?

Answer 3

Curved piece of cortex

Question 4

Where is the hippocampus located?

Answer 4

Medial surface of temporal lobe

Question 5

How does the hippocampus relate to the ventricular system?

Answer 5

Floor to temporal horn of lateral ventricle

Question 6

What are the parts of the hippocampus?

Answer 6

Subiculum

Hippocampus proper

Dentate gyrus

Question 7

What is the amygdala?

Answer 7

Collection of nuclei

Question 8

Where is the amygdala located?

Answer 8

Roof of lateral ventricle

Question 9

What are the inputs to the amygdala?

Answer 9

Sensory information

Brainstem

Thalamus

Cortex

Question 10

What are the outputs of the amygdala?

Answer 10

Brainstem

Hypothalamus

Cortex

Question 11

What are the functions of the amygdala?

Answer 11

Drive related behaviours, processing of associated emotions

Question 12

What are the functions of the prefrontal cortex?

Answer 12

Modulators effect on processes associated with the hypothalamus

Question 13

What does a prolonged stress response cause?

Answer 13

Continued cortisol secretion

• muscle wastage
• suppression of immune system
• hyperglycaemia

Question 14

What is anxiety?

Answer 14

Feeling of nervousness or unease about something with an uncertain outcome

Question 15

What are the signs and symptoms of anxiety?

Answer 15

Palpitations

Sweating

Trembling

Dry mouth

Nausea

Dizziness, light-headedness

Difficulty breathing

Question 16

What are the types of anxiety disorders?

Answer 16

Generalised anxiety disorder

Panic disorder

Phobias

Obsessive compulsive disorder

Post-traumatic stress disorder

Question 17

What is the pathophysiology of anxiety?

Answer 17

GABA levels decreased in cortex in patients with panic disorder

Question 18

How is anxiety treated?

Answer 18

Selective serotonin reuptake inhibitors

Pregabalin

Cognitive behavioural therapy

Question 19

How do selective serotonin reuptake inhibitors treat anxiety?

Answer 19

Increased levels of serotonin
Increased stimulation of serotonin receptors in hippocampus
Leads to neuroprotection

Question 20

What is neuroprotection?

Answer 20

Refers to a preservation of neuronal structure and function

Question 21

How does cognitive behavioural therapy treat anxiety?

Answer 21

Look at trigger, thoughts, emotions, behavioural and physical reaction of patient’s anxiety together with the patient

Question 22

How does pregabalin treat anxiety?

Answer 22

Pregabalin is a GABA analogue
Increased stimulation of GABA receptors in the cortex
Increased inhibition of neurones

Question 23

Why are benzodiazepines not used to treat anxiety?

Answer 23

Addictive, dangerous in overdose

Question 24

What are the functions of the hippocampus?

Answer 24

Memory

Expressions of emotion

Question 25

What is an obsession?

Answer 25

Thought that persists and dominates an individual’s thinking Even though they are aware that the thought is entirely without purpose, or is beyond the point of relevance and usefulness

Question 26

What is a compulsion?

Answer 26

Obsessional motor acts Obsessional mental acts

Question 27

What causes a compulsion?

Answer 27

Obsessional impulses that lead directly to the action Obsessional mental image that leads to the action

Question 28

How is OCD diagnosed?

Answer 28

Obsessions or compulsions or both present on most days, for at least 2 weeks Obsessions and compulsions - originate in mind of patient - repetitive - acknowledged as unreasonable - unpleasant - patient tries to resist, but unsuccessful Interfere with patient’s individual or social functioning

Question 29

What age group is OCD most common in?

Answer 29

Younger people, before age 30

Question 30

What sex is OCD more common in?

Answer 30

In adults, equally common in men and women In children, more common in boys

Question 32

What is the pathophysiology of OCD?

Answer 32

Re-entry circuits in basal ganglia Reduced serotonin Paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection PANDAS

Question 33

How does PANDAS present?

Answer 33

Sudden onset of OCD symptoms as well as other psychiatric symptoms after infection with Group A beta-haemolytic strep

Question 34

What is the pathophysiology of PANDAS?

Answer 34

Antibodies cross-react with neurons in basal ganglia

Question 35

How is OCD treated?

Answer 35

Cognitive behavioural therapy Selective serotonin reuptake inhibitors, high dose and longer treatment course Antipsychotics Deep brain stimulation

Question 36

How does cognitive behavioural therapy treat OCD?

Answer 36

Exposure response prevention, meaning the patient learns to resist the compulsion after their obsessional thoughts

Question 37

What antipsychotic drug is used to treat OCD?

Answer 37

Clomipramine

Question 38

What is post-traumatic stress disorder?

Answer 38

After a severely traumatic event Repetitive recollection of the event in memories, daydreaming, dreaming Avoiding stimuli that might arouse recollection of the event

Question 39

What is the timing of PTSD?

Answer 39

Within 6 months of the severely traumatic event

Question 40

When is deep brain stimulation used to treat OCD?

Answer 40

OCD that has been resistant to other methods of treatment

Question 41

How is PTSD treated?

Answer 41

Selective serotonin reuptake inhibitors Pregabalin Cognitive behavioural therapy Eye movement desensitisation reprocessing

Question 42

What is eye movement desensitisation reprocessing?

Answer 42

Patient follows visual stimulus while recollecting event | To distract brain

Question 43

What is the pathophysiology of PTSD?

Answer 43

Hyperactivity of amygdala, causing exaggerated stress response to perceived threat However low levels of cortisol, more recollection of event