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Chapter 17

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PSYC 211
Yogita Chudasama

Chapter 17: Anxiety Disorders, Autistic Disorder, Attention- Deficit/Hyperactivity Disorder, and Stress disorders Notes taken by: Ashley Brown Contact for mistakes: [email protected] Anxiety Disorders Anxiety disorder: a psychological disorder characterized by tension, overactivity of the autonomic nervous system, expectation of an impended disaster and continuous vigilance for danger - Panic disorder, generalized anxiety disorder, and social anxiety disorder are three types that appear to have a biological cause - OCD is classified as an anxiety disorder but is really different (diff symptoms and diff brain regions) Panic Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder Description Panic disorder: a disorder characterized by episodic periods of symptoms such as shortness of breath, irregularities in heartbeat, and other autonomic symptoms, accompanied by intense fear - women twice as likely to suffer from panic disorder - characterized by panic attacks which have physical symptoms such as shortness of breath, clammy sweat, irregularities in heartbeat, dizziness, faintness and feelings of unreality o often feel they are going to die - in between panic attacks many suffer from anticipatory anxiety which is a fear of having panic attacks that can lead to the development of agoraphobia o agoraphobia: a fear of being away from home or other protected places Generalized anxiety disorder: a disorder characterized by excessive anxiety and worry serious enough to cause disruption to one’s life - also two times more likely in women than in men Social anxiety disorder: a disorder characterized by excessive fear of being exposed to the scrutiny of other people that leads to avoidance of social situations in which the person is called on to perform - equally likely in men and women - if situations where they have to like speak in public or something are unavoidable they experience anxiety and distress Possible Causes All those three have a hereditary component The short allele of the 5-HT transporter is also associated with higher levels of anxiety - blushing is more prevalent in people with social anxiety disorder whose chromosomes contain one or two short alleles of the 5-HTT promoter gene Amygdala + the cingulate, prefrontal, and insular cortices are involved in anxiety disorders Panic attack  decreased activity in right orbitofrontal cortex and anterior cingulate cortex, increased activity in the amygdala Activity of the amygdala when looking at angry/disgusted/fearful faces is correlated with severity of people with social anxiety disorder’s symptoms - in healthy people ventrolateral prefrontal cortex suppresses this activity o not activated in people with social anxiety disorder students with high levels of anxiety but not a diagnosed disorder show increased activation of the amygdala and insular cortex, both were correlated with severity of their anxiety Treatment Anxiety disorders are sometimes treated with benzodiazepines - because the amygdala has a lot of GABA receAtors, these drugs (which target that particular receptor) decrease the activity of both the amygdala and the insula while looking at emotional faces - administering flumazenil (a benzodiazepine antagonist) produces panic in patients with panic disorder, but not controls Serotonin appears to play a role in anxiety disorders as well as depression - SSRIs (which are potent serotonin agonist) are used to treat OCD and very effective in treating panic attacks - Related to the 5-HT 1A receptor Something about glycine and D-Cycloserine in conjunction with cognitive behaviour therapy to treat patients with anxiety disorders. Gets rid of maladaptive conditioned emotional reponses Obsessive-Compulsive Disorder Description Obsessive-compulsive disorder (OCD): a mental disorder characterized by obsessions and compulsions - obsession: an unwanted thought or idea with which a person is preoccupied o incl. concern or disgust with bodily secretions, dirt, germs or a fear that something might happen, and a need for symmetry, order or exactness - compulsion: the feeling that one is obliged to perform a behaviour: even if one prefers not to do so o four categories: counting, checking, cleaning, and avoidance o believed to be species-type behaviour released from normal control mechanisms by a brain dysfunction Obsessions are also seen in schizophrenia but people with OCD recognize that their thoughts and behaviours are senseless and desperately wish that they would go away, especially as compulsions become more and more demanding OCD seems to be an exaggeration of natural human tendencies Possible Causes OCD is at least partially hereditary - greater concordance in MZ twins than DZ twins OCD is associated with a neurological disorder that appears in childhood called Tourette’s syndrome - characterized by tics and involuntary vocalizations and sometimes by compulsive uttering of obscenities and repetition of the utterances of others - people with OCD show tics, the similarities of symptoms suggest an underlying genotype - studies have found a family association between OCD and tic disorders Not all cases of OCD have genetic origin, sometimes occur after brain damage caused by various means (birth trauma, encephalitis, and head trauma) - in particular symptoms appear to be associated with damage/dysfunction of the basal ganglia, cingulate gyrus, and the prefrontal cortex o Tic disorders (incl. OCD) can be caused by a group A β-hemolytic streptococcal infections which causes several autoimmune diseases attacking several places including the tissue of the basal ganglia (in addition to the valves of the heart and the kidneys) Evidence of increased activity in the frontal lobes (especially the orbitofrontal cortex) and caudate nucleus of the basal ganglia in people with OCD - reducing the activity in these regions alleviates the symptoms Treatment Some patients with OCD have been successfully treated with cingulotomy or surgical destruction of specific fibre bundles in the subcortical frontal lobe called the cingulum bundle that connects the limbic structures of the temporal lobe with the frontal lobe - considered a last resort when conventional treatments fail to work o adverse side effects: problems of planning apathy, or difficulty inhibiting socially inappropriate behaviour - capsulotomy destroys the internal capsule that connects the caudate nucleus with the medial prefrontal cortex o also has reasonable success rate Deep brain stimulation (DBS) has been useful in treating OCD along with Parkinson’s disease - use it on the subthalamic nucleus - nice because its reversible OCD may be a result of overactivity of the direst pathway (remember the basal ganglia stuff, the direct one is the excitatory one) - suggested one of the functions of this pathway is control of previously learned behaviour sequences so they can be performed rapidly - imbalance of the two pathways because the indirect pathway would suppress these sequences so they could do more adaptive behaviours rather than the compulsions that are set off by orbitofrontal cortex (involved in recognizing situations with personal significance) Three drugs used typically to treat OCD: clomipramine, fluoxetine, and fluvoxamine - specific blockers of 5-HT reuptake, or serotonergic agonist - serotonin inhibits compulsive behaviours as seen in the effectiveness of clomipramine successfully treating certain obsessive disorders o trichotillomania: compulsive hair pulling (and sometimes eating them) o onychophagia: compulsive nail biting o acral lick dermit
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