Transcript Slide 1

Anxiety Disorders
Mood Disorders
Personality Disorders
Jim Vess, Ph.D.
310 Easterfield
Extension 6481
[email protected]
Random Student Presentations
Nervous System
Central Nervous System
Brain
Spinal Cord
Peripheral Nervous System
Autonomic
Sympathetic
Somatic
Parasympathetic
Neurotransmitters
• Serotonin – active in neural circuits
originating in midbrain; involved in many
aspects of thought, mood and behavior,
especially depression (SSRI’s)
• Gamma Aminobutyric Acid (GABA) –
inhibitory, reduces arousal (anxiety)
• Norepinephrine (noradrenaline) – fight or
flight response; perhaps panic disorders
• Dopamine – interacts with serotonin
circuits; most directly involved with
psychotic disorders (e.g. schizophrenia)
Better living through chemistry:
Just say yes to (prescription) drugs?
• Psychosocial factors interact with brain
structure and function
• Learning and experience influence
response to neurochemical changes
• Learning and experience affect levels of
neurotransmitters
• Learning and experience affect synaptic
connections (i.e. neuroanatomic structure)
Neurophysiology and Panic
• Fight or flight response activated by
sympathetic nervous system:
– Blood directed to skeletal muscles
– Breathing faster and deeper for more oxygen
– Glucose released from liver for energy
– Pupils dilate, senses more acute
– Piloerection
– Digestion suspended (dry mouth)
Neurophysiology and Anxiety
• GABA, noradrenergic and serotonergic
neurotransmitter systems all involved
• Limbic system structures, including
amygdala, hypothalamus, hippocampus
and septal areas
• Activates response systems related to
detecting and reacting to threats from
environment (Behavioral Inhibition System)
Anxiety vs Fear/Panic
• Both have negative affect (it’s unpleasant)
• Anxiety marked by tension, short of full
fight or flight response of panic
• Anxiety is future oriented (anticipation of
events or situations)
• Both involve perception and attribution
Cognitive - Behavioral Components
• Physiological response is mediated by
cognition: how you interpret situations
• Interpretations (attributions) are learned
• Learned responses can become automatic
(unconscious) – no longer aware of
attributions
• Responses may become conditioned by
both classic and operant conditioning
The Anxiety Disorders
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Panic Disorder (with or without Agoraphobia)
Specific Phobia
Social Phobia
Obsessive Compulsive Disorder (OCD)
Generalized Anxiety Disorder (GAD)
Post-Traumatic Stress Disorder (PTSD)
Acute Stress Disorder
Adjustment Disorder with Anxiety
But first:
A Totally Gratuitous
Digression
Older Models
The Four Humours (ancient Greece – 1600’s)
Blood – happy, generous, amorous
Phlegm – dull, cowardly, unresponsive
Yellow Bile – violent, vengeful, easily angered
Black Bile – brooding, lazy, gluttonous
Treatments: bleeding, purgatories
Evil Spirits and Witchcraft:
Trephaning
Torture
Exorcism
Understanding Mental Disorders
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Biological Perspective (medical model)
Psychoanalytic Perspective (Freudian)
Behavioral Perspective (conditioning)
Cognitive Perspective (social learning)
Cultural/Sociological Perspective
(social forces and cultural norms)
Integrated by:
• Vulnerability-Stress Model
(or Diathesis-Stress)
Concordance Rates
Frequency with which both relatives (e.g.
siblings) have a disorder when one of
them has the disorder.
Higher concordance rates among those
sharing more genes (e.g. identical vs
fraternal twins) indicate higher hereditary
(i.e. genetic) component.
ANXIETY DISORDERS
Generalized Anxiety Disorder
Panic Disorder
30 – 50% Agoraphobia
Phobias
Obsessive Compulsive Disorder
PTSD
Acute Stress Disorder
Adjustment Disorder with Anxiety
Symptoms of Anxiety
Physiological – rapid heart beat, tense
muscles, sweating, dizziness
Cognitive – from worrisome thoughts to
catastrophic interpretation of situation
Behavioral – from fidgety, pacing to unable to
respond (frozen with terror) or flee blindly
Emotional – from apprehension to fear, terror,
dread
Generalized Anxiety Disorder
Frequent to constant symptoms of anxiety
without a clear or specific precipitating
stimulus
Panic Disorder
• Up to 40% of young adults have
occasional panic attacks at times of acute
stress
• When panic attacks become more
frequent and fear of further episodes
causes anxiety, may be Panic Disorder
Symptoms of Panic Attack
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Palpitations, rapid HR
Sweating
Trembling or shaking
Sensations of
shortness of breath or
smothering
• Feelings of choking
• Chest pain
• Nausea
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Dizzy or light-headed
Derealization
Depersonalization
Fear of losing control
Fear of going crazy
Fear of dying
Numbness
Chills or hot flushes
Abdominal distress
Agoraphobia
30% to 50% with panic disorder develop
Agoraphobia
Characterized by fear of crowded places,
places difficult to escape, or places where
beyond reach of help
Can become severely disabling as individual
is more and more restricted to “safe”
places
Phobias
Acute anxiety in response to a specific
stimulus that is significantly out of
proportion to the threat posed.
Some may be related to responses that had
an evolutionary advantage
Types of Phobias
• Blood-Injection-Injury
– Vasovagal response leads to fainting
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Natural Environment
Situational
Animal
Social
Other
Vasovagal Syncope
• Blood-Injection-Injury Phobia has highest
concordance rate among phobias
•Genetic inheritance of strong vasovagal response:
•Adrenalin signals heart to beat faster
•Stronger heartbeat stimulates vagus nerve
•Vagus nerve signals heart to beat slower
•Blood pressure drops precipitously; person faints
Etiology of Phobias
• Physiological predisposition (inherited)
• Experiential/learning factors
– Direct experience with threat (e.g. car accident)
– False alarm (panic attack) in specific situation
– Observation (vicarious experience)
– Being told about danger (information transmission)
• Cultural constraints
• Gender influences
Social Phobia
• 20% to 50% university students are shy
• Social phobia interferes with functioning
• 13.3% lifetime rate in general population
(most prevalent psychological disorder;
similar rate as depression)
• Only slightly more females than males
• Peak age of onset 15 years old
• May be evolutionary predisposition to fear
angry, critical or rejecting people
Treatment of Phobias
• Supervised, graduated exposure
• Unsupervised exposure may lead to
escape and thereby strengthen phobia
• May use cognitive restructuring and
physical relaxation techniques
• Brain imaging studies show changes in
neural functioning; brain actually “rewired”
Some Favorite Phobias
Scotophobia – fear of darkness
Ophidiophobia – fear of snakes
Arachnophobia – fear of spiders
Arachibutyrophobia – fear of peanut butter
sticking to the roof of your mouth
Peladophobia – fear of bald people
Phobophobia – fear of phobias
OBSESSIONS – thoughts that
persistently intrude in the mind, despite
being unwelcome and causing anxiety
COMPULSIONS – acts that are irresistible
and carried out in a repetitive or ritualistic
manner
Brain functioning and OCD
• Increased activity in orbital surface, cingulate
gyrus and caudate nucleus
• Area of concentrated serotonin pathways
• Serotonin helps regulate response to internal
and external cues; deficits
over-reactivity
• Medications (e.g. SSRI’s) may help
Post-Traumatic Stress Disorder
• Follows specific traumatic event
• Reexperience event in memories and
nightmares
• May include flashbacks, similar to
dissociative states lasting minutes to hours
• Acute – diagnosed one month after trauma
• Chronic – symptoms persist beyond three
months
Etiology of PTSD
• Genetic predisposition (especially at lower
levels of stress)
• Generalized psychological vulnerability
– Early learning: world unsafe and uncontrollable
• Lack of strong social support network
(especially evident in Vietnam Vets)
• Involvement of hippocampus (regulates
stress hormones and emotional memories)