PSYC 735 FINAL EXAM #2

DSM-5: substance/medication-induced depressive disorder / addiction?

ARTICLE: substance/medication-induced depressive disorder / addiction?

DSM-5: schizophrenia

ARTICLE: schizophrenia

DSM-5: borderline personality disorder (BPD)

ARTICLE: borderline personality disorder (BPD)

DSM-5: obsessive-compulsive disorder (OCD)

ARTICLE: obsessive-compulsive disorder (OCD)

DSM-5: post-traumatic stress disorder (PTSD)

ARTICLE: post-traumatic stress disorder (PTSD)

DSM-5: generalized anxiety disorder (GAD)

A. Excessive anxiety and worry; at least 6 months, about a number of events or activities. The anxiety is out of proportion to the anticipated event.

C. Anxiety and worry associated with 3+ the following six symptoms:

Note: Only ONE item is required in children

1. Restlessness, on edge.

2. Easily fatigued.

3. Difficulty concentrating, mind going blank.

4. Irritability.

5. Muscle tension.

6. Sleep disturbance

E. Not attributable to the effects of a substance

F. Not explained by another disorder (e.g., panic disorder, SAD, OCD, separation anxiety, PTSD, anorexia, schizophrenia)

Affects everyday life

CHILDREN: w/ GAD worry quality of their performance

Focus of worry may shift from one concern to another.

Muscle tension; trembling, twitching, feeling shaky, and muscle aches/soreness.

Somatic symptoms-- sweating, nausea, diarrhea, startle response.

Autonomic hyperarousal symptoms LESS PROMINENT IN GAD-- fast heart rate, shortness of breath, dizziness, IBS, headaches

The 12-month prevalence GAD in U.S.: 0.9% among adolescents; 2.9% among adults

The 12-month prevalence in other countries: ranges from 0.4% to 3.6%

The lifetime morbid risk is 9.0%

Median age at onset 30 years; however, age at onset is broad

Onset rarely occurs prior to adolescence

Females 2x more likely than males to experience GAD (55%–60% of those presenting with disorder are female), 2/3 female

Comorbidity with females = anxiety disorders and unipolar depression

Comorbidity with males = substance use disorders

Diagnosis prevalence peaks middle age, declines later in life

European descent experience GAD more frequently than individuals of non-European descent (i.e., Asian, African, Native American and Pacific Islander)

Those from developed countries MORE LIKELY than individuals from non-developed countries to report GAD symptom criteria

Temperamental. Behavioral inhibition, neuroticism, and harm avoidance

Environmental. No environmental factors specific to GAD

Genetic and physiological. One-third of the risk of experiencing GAD is genetic; these genetic factors overlap w/ the risk of neuroticism; and shared w/ other major depressive disorder

GAD vs. anxiety

First-- excessive worries that interfere with everyday life

Second-- worries are longer, not caused by anything

Third-- distress and functioning impairment

ARTICLE: generalized anxiety disorder (GAD)

GAD is caused by a combination of:

• genetic vulnerability

• brain circuit dysfunction

• chronic stress-system activation

= LEADS TO: systems interact and produce persistent, uncontrollable worry.

1. Brain Circuit Dysfunction (MOST IMPORTANT!)

a) Amygdala (fear center)

• Overactive

• Sends strong “something is wrong” signals

b) Anterior Cingulate Cortex (ACC)

• Normally: detects conflict, errors, uncertainty

• In GAD:

  • Overactive

  • Constantly flags potential problems

= LEADS TO:

• “what if” thinking

• overchecking

• persistent worry

c) Right Ventrolateral Prefrontal Cortex (vlPFC)

• Normally: helps control and regulate emotions

• In GAD:

  • Shows increased activation

  • This reflects a compensatory effort to control anxiety

IMPORTANT:

• It’s not causing anxiety

• It’s the brain trying (but not fully succeeding) to regulate it

🧠 BRAIN CIRCUITRY TOGETHER:

• Amygdala → fear signals ↑

• ACC → problem detection ↑

• Right vlPFC → working harder to control anxiety (compensation)

= RESULT: Anxiety is constantly generated and only partially controlled

2. Genetic Vulnerability

• Many genes involved in GAD

• Genes influence:

  • emotional sensitivity

  • stress reactivity

• Shared risk with Major Depressive Disorder

3. Chronic Stress-System Activation

• Stress system is always active

• Body stays in alert mode, even without danger