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Anxiety Disorders and Treatments

ANXIETY DISORDERS

  • Class of mental disorders where anxiety is the predominant feature.

  • Included in the DSM-5-TR, encompassing three main categories:

    • Phobic disorders

    • Panic disorder

    • Generalized Anxiety Disorder (GAD)

PHOBIC DISORDERS

  • Definition: Characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations.

  • Typically irrational but interfere with daily functioning.

  • Categories:

    • Animals

    • Natural environments

    • Situations (e.g., heights, public places)

    • Blood/injections/injury

    • Other (e.g., loud noises)

  • Social Phobia: Irrational fear of being publicly humiliated or embarrassed.

PANIC DISORDER

  • Definition: Sudden occurrence of multiple psychological and physiological symptoms that result in an overwhelming sense of terror.

  • Symptoms:

    • Shortness of breath

    • Heart palpitations

    • Sweating

    • Dizziness

    • Feelings of depersonalization

  • Some individuals mistake panic attacks for heart attacks.

  • Agoraphobia: The fear of public places, resulting in avoidance of situations where panic attacks might occur.

GENERALIZED ANXIETY DISORDER (GAD)

  • Definition: Chronic excessive worry that occurs alongside three or more of the following symptoms:

    • Restlessness

    • Fatigue

    • Concentration problems

    • Irritability

    • Muscle tension

    • Sleep disturbances

NEUROBIOLOGY OF ANXIETY DISORDERS

  • Strong genetic component present, leading to predispositions for developing anxiety disorders.

  • Key neurological areas involved:

    • Left hemisphere, temporal lobe abnormalities

    • Amygdala and related circuitry are implicated in anxiety disorders.

ANXIOLYTICS: DRUGS FOR ANXIETY

  • Classes of drugs:

    • Benzodiazepines:

    • Examples include : Diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan).

    • Mechanism: Bind to GABA receptors, increasing hyperpolarization in postsynaptic cells, which reduces neuronal excitability.

    • Beneficial for preventing seizures and treating insomnia.

    • Other medications include SSRIs and SNRIs.

POST TRAUMATIC STRESS DISORDER (PTSD)

  • Definition: Characterized by chronic physiological arousal, recurrent intrusive thoughts or images of a traumatic event, and avoidance of triggers related to the trauma.

  • Often precipitated by stressful situations or reminders of trauma, with soldiers being a common demographic affected.

  • Approximately 7% of Americans are estimated to experience PTSD at some point.

PTSD NEUROBIOLOGY

  • Evidence for a heritable component to PTSD; incidence rates are higher in monozygotic twins compared to dizygotic twins.

  • Neurological changes associated with PTSD:

    • Role of the hippocampus:

    • Right hippocampus tends to be smaller in individuals with PTSD, which may predispose them to the disorder under stress.

    • Symptoms may include amnesia, flashbacks, and deficits in short-term memory (STM).

TREATMENT FOR PTSD

  • Cognitive Behavioral Therapy (CBT): effective in treating PTSD by gradually exposing individuals to triggering stimuli. Possible integration of virtual reality exposure therapy.

  • Combination with medications that block stress hormones, or unique therapies involving MDMA (Ecstasy).

OBSESSIVE-COMPULSIVE DISORDER (OCD)

  • Definition: Characterized by repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) aimed at reducing anxiety caused by those thoughts.

  • Symptoms often manifest in childhood but typically peak at ages 25-44.

    • Obsessions: Intrusive thoughts causing anxiety.

    • Compulsions: Behaviors performed to alleviate this anxiety.

BRAIN CHANGES IN OCD

  • Individuals with OCD have structural and functional changes in areas including:

    • Prefrontal cortex

    • Cingulate cortex

    • Basal ganglia

    • Insula

  • There is a genetic component involved, particularly associated with genes that influence serotonin signaling. Infections may also trigger symptoms.

TREATMENT OPTIONS FOR OCD

  • Cognitive Behavioral Therapy (CBT): standard treatment method.

  • Medications that inhibit the reuptake of serotonin:

    • Examples include Fluoxetine (Prozac) and Fluvoxamine (Luvox).

  • OCD is often comorbid with depression, which complicates treatment as both disorders may be treated with similar medications targeting different regions of the prefrontal cortex (PFC).


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Anxiety Disorders and Treatments

ANXIETY DISORDERS

  • Class of mental disorders where anxiety is the predominant feature.

  • Included in the DSM-5-TR, encompassing three main categories:

    • Phobic disorders

    • Panic disorder

    • Generalized Anxiety Disorder (GAD)

PHOBIC DISORDERS

  • Definition: Characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations.

  • Typically irrational but interfere with daily functioning.

  • Categories:

    • Animals

    • Natural environments

    • Situations (e.g., heights, public places)

    • Blood/injections/injury

    • Other (e.g., loud noises)

  • Social Phobia: Irrational fear of being publicly humiliated or embarrassed.

PANIC DISORDER

  • Definition: Sudden occurrence of multiple psychological and physiological symptoms that result in an overwhelming sense of terror.

  • Symptoms:

    • Shortness of breath

    • Heart palpitations

    • Sweating

    • Dizziness

    • Feelings of depersonalization

  • Some individuals mistake panic attacks for heart attacks.

  • Agoraphobia: The fear of public places, resulting in avoidance of situations where panic attacks might occur.

GENERALIZED ANXIETY DISORDER (GAD)

  • Definition: Chronic excessive worry that occurs alongside three or more of the following symptoms:

    • Restlessness

    • Fatigue

    • Concentration problems

    • Irritability

    • Muscle tension

    • Sleep disturbances

NEUROBIOLOGY OF ANXIETY DISORDERS

  • Strong genetic component present, leading to predispositions for developing anxiety disorders.

  • Key neurological areas involved:

    • Left hemisphere, temporal lobe abnormalities

    • Amygdala and related circuitry are implicated in anxiety disorders.

ANXIOLYTICS: DRUGS FOR ANXIETY

  • Classes of drugs:

    • Benzodiazepines:

    • Examples include : Diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan).

    • Mechanism: Bind to GABA receptors, increasing hyperpolarization in postsynaptic cells, which reduces neuronal excitability.

    • Beneficial for preventing seizures and treating insomnia.

    • Other medications include SSRIs and SNRIs.

POST TRAUMATIC STRESS DISORDER (PTSD)

  • Definition: Characterized by chronic physiological arousal, recurrent intrusive thoughts or images of a traumatic event, and avoidance of triggers related to the trauma.

  • Often precipitated by stressful situations or reminders of trauma, with soldiers being a common demographic affected.

  • Approximately 7% of Americans are estimated to experience PTSD at some point.

PTSD NEUROBIOLOGY

  • Evidence for a heritable component to PTSD; incidence rates are higher in monozygotic twins compared to dizygotic twins.

  • Neurological changes associated with PTSD:

    • Role of the hippocampus:

    • Right hippocampus tends to be smaller in individuals with PTSD, which may predispose them to the disorder under stress.

    • Symptoms may include amnesia, flashbacks, and deficits in short-term memory (STM).

TREATMENT FOR PTSD

  • Cognitive Behavioral Therapy (CBT): effective in treating PTSD by gradually exposing individuals to triggering stimuli. Possible integration of virtual reality exposure therapy.

  • Combination with medications that block stress hormones, or unique therapies involving MDMA (Ecstasy).

OBSESSIVE-COMPULSIVE DISORDER (OCD)

  • Definition: Characterized by repetitive, intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) aimed at reducing anxiety caused by those thoughts.

  • Symptoms often manifest in childhood but typically peak at ages 25-44.

    • Obsessions: Intrusive thoughts causing anxiety.

    • Compulsions: Behaviors performed to alleviate this anxiety.

BRAIN CHANGES IN OCD

  • Individuals with OCD have structural and functional changes in areas including:

    • Prefrontal cortex

    • Cingulate cortex

    • Basal ganglia

    • Insula

  • There is a genetic component involved, particularly associated with genes that influence serotonin signaling. Infections may also trigger symptoms.

TREATMENT OPTIONS FOR OCD

  • Cognitive Behavioral Therapy (CBT): standard treatment method.

  • Medications that inhibit the reuptake of serotonin:

    • Examples include Fluoxetine (Prozac) and Fluvoxamine (Luvox).

  • OCD is often comorbid with depression, which complicates treatment as both disorders may be treated with similar medications targeting different regions of the prefrontal cortex (PFC).