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).