Session 11 Anxiety Flashcards
(21 cards)
What response enables us to escape from potentially dangerous situations?
The stress response
What is the stress response primarily mediated by?
The limbic system (which has neural and endocrine targets)
What are the 3 neural elements of the stress response?
- Hippocampus
- Amygdala
- Prefrontal Cortex
HAP - how to remember: not so HAPre
Outline the endocrine element of the stress response
The limbic system is able to act on the hypothalamus to stimulate the secretion of stress hormones via the HPA axis
Release of cortisol from the adrenal cortex is part of the ‘chronic’ stress response
Hippocampus
Receives inputs from?
Projects to where?
Causes?
Receives inputs from many parts of the cortex and processes their emotional content
Projects to the thalamus (and back to the cortex = Papez Circuit) and to the hypothalamus
This causes autonomic features of emotional responses (hypothalamospinal tract) leading to sympathetic NS activation and adrenaline release (from adrenal medulla) = the acute stress response
Amygdala
Shape and location?
Receives inputs from?
Major outputs to?
Involved in?
Almond shaped - sits near the tip of the hippocampus
Receives inputs from the sensory system
Major outputs to Cortex and hypothalamus
Involved in behavioural and autonomic emotional responses
Prefrontal Cortex
(Classically not part of the limbic system but definite roles in emotion)
What does it do?
Modulation of emotional responses e.g. consciously suppressing features of anxiety
Perception of emotion
What is the ‘general adaptation syndrome’?
It refers to three stages that the body goes through during prolonged exposure to stressors
What are the three stages of the general adaptation syndrome?
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 can’t escape an ongoing stressor)
* chronic side effects of prolonged cortisol secretion start to occur
how to remember: ARE you adapting
Alarm - resistance - exhaustion
When would the stress response become pathological?
When you cant escape a stressor(s)
When ‘trivial’ stressors elicits a strong stress response
Patients with anxiety disorder may go through all stages
What are the symptoms of anxiety and what are they primarily attributable to?
Palpitations, sweating, trembling or shaking, dry mouth, difficulty breathing, chest pain or discomfort, nausea or abdominal distress, feeling dizzy or light-headed
Primarily attributable to sympathetic activation
What are 6 different classifications of anxiety disorder?
Social phobia (anxiety about being in social situations)
Specific phobias (spiders, heights etc)
Generalised anxiety disorder (persistent anxiety about a variety of things)
Panic disorder (recurrent, unexpected panic attacks)
= severe episodes of acute stress response
Obsessive compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Outline the treatment of anxiety disorders
Biological
- short term benzodiazepines
- SSRIs
Psychological
* Cognitive behavioural therapy: getting patients to reflect on their feelings, thoughts an behaviours
Social
* support groups, charities etc
What two elements characterise OCD?
Obsessions and Compulsions
What are ‘obsessions’?
Thoughts that persist and dominate an individuals 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
These often cause anxiety
What are compulsions?
A motor act (or sometimes a thought) resulting from an obsession
Acting out a compulsion may relieve the anxiety provoked by its associated obsession, but frequently carrying out the compulsion is also unpleasant
How would you make a diagnosis of OCD?
Obsessions and/or compulsions must be present on most days for at least 2 weeks
What are the features of obsessions and compulsions?
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
Outline the treatment for OCD
Biological
- SSRIs +/- antipsychotics
- deep brain stimulation
Psychological
* cognitive behavioural therapy
Social
- family support
- groups
Outline the features of PTSD
Can occur within six months following an exceptionally severe traumatic event (e.g. rape, battlefield trauma)
Causes repetitive, intrusive recollection or re-enactment of the event in memory, daytime imagery or dreams
There is conspicuous emotional detachment, numbing of feeling and avoidance of stimuli that might arouse recollection of the trauma
Treatment of PTSD:
Biological
- SSRI
- short term benzodiazepines (maybe)
Psychological
- cognitive behavioural therapy
- eye movement desensitisation reprocessing therapy
Social
* charities are particularly active - help for heroes
