The Complexity of Anxiety Disorders PDF

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The Complexity of Anxiety Disorders Sunday, November 8, 2020

10:17 AM

Anxiety, Fear, and Panic Anxiety: a negative mood state characterized by physical tension and apprehension about th future • Can be a subjective sense of unease, a set of behaviours, or physiological response originating in the brain and reflected in elevated heart rate and muscle tension • Anxiety is good in moderate amounts ○ Physical and intellectual performances are driven and enhanced by anxiety • Severe anxiety usually does not go away ○ remain anxious even know nothing to be afraid of Fear: an immediate alarm reaction to danger • Protect us by activating a massive response from the autonomic nervous system along with out subjective sense of terror, motivates us to escape or attack -- flight-or-fight response Anxiety and fear reactions differ psychologically and physiologically • Anxiety: future oriented mood state, characterized by apprehension because we cann predict or control upcoming events • Fear: an immediate emotional reaction to current danger characterized by strong esca tendencies and a surge in the sympathetic branch of the action of the autonomic nerv system Panic: the sudden overwhelming reaction • Also a characteristic response to stress that runs in families and may have a genetic component that is separate from anxiety Panic attack: abrupt experience of intense fear or acuate discomfort accompanied by physic symptoms that usually include heart palpitation, chest pain, shortness of breath and dizzines • Expected (cued) panic attack: know have a panic attack in certain situation • Unexpected panic attack: do not have a cue when or where the next attack will occur Anxiety and Panic • Anxiety increases the likelihood of panic

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Causes of Anxiety Biological Contributions • The tendency to panic run in families and has a genetic component that differs somew from genetic contributions to anxiety ○ Contributions from collections of genes in several areas on chromosomes make vulnerable when certain psychological and social factors are in place • Anxiety is associate with specific brain circuits and neurotransmitter system ○ Part of GABA-benzodiazepine system, noradrenergic system, and serotonergic neurotransmitter system are associated with increases anxiety, although relationship is not so direct (first) ○ CRF system directly relates to GABA-benzodiazepine system, noradrenergic syst and serotonergic neurotransmitter system ○ CRF activates the hypothalamic-pituitary-adrenocortical (HPA) axis (a part of CF system), has wide ranging effects on areas of brain implicated in anxiety, includi the emotional brain (limbic system), particularly the hippocampus and the amygdala, the locus coeruleus in the brain stem, the prefrontal cortex, the dopaminergic neurotransmitter system • Anxiety associate most with limbic system, which acts as a mediator between the (aris from) brain stem and (descend from) the cortex. Jeffery Gray ○ The brain circuit in the limbic system that involved in anxiety lead from septal an hippocampus area in the limbic system to the frontal cortex § Septal-hippocampus system is activated by CRF and serotonergic- and

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noradrenergic-mediated pathways originating in the brain stem ○ Behavioral inhibition system (BIS): activated by signals from the brain stem of unexpected evens, such as major changes in body functioning that signal danger § tendency is to freeze, experience anxiety and apprehensively evaluate the situation to confirm that danger is present § Receive a big boost from the amygdala ○ Fight/flight system (FFS): originates in the brain stem and travels through midbr structures, including amygdala, ventromedial nucleus of hypothalamus, and the central gray matter. § When stimulated in animals, produce an immediate alarm-and-escape response that look like panic in human Factors in environment can change the sensitivity of brain circuits, making more or le susceptible to developing anxiety and disorders. ○ Smoking as a teenager increase risk for anxiety disorders as an adult, particularly panic disorder and generalized anxiety disorder § anxiety sensitivity (tendency to fear bodily sensations), distress tolerance, a anhedonia (inability to feel pleasure) contribute to smoking Brain-imaging ○ People with anxiety disorders § limbic system (including amygdala) is overly responsive to stimulation or n information (abnormal bottom-up processing) § Controlling functions of cortex that down-regulate the hyperexcitable amygdala are deficient (abnormal top-down processing) consistent with Gray's BIS model

Psychological Contribution • Freud: Anxiety is a psychic reaction to danger surrounding the reactivation of an infan fearful situation • Behavioural theorists: anxiety was a product of early classical conditioning, modelling other forms of learning • An integrated model of anxiety involves a variety of paychological factors • A general sense of uncontrollability develop early as a function of upbringing and othe disruptive or traumatic environmental factors ○ Large affected from the action of parents in early childhood § In positive and predictable way to respond to children's need V § Provide secure home base but allow children to explore their world and develop skills to cope with unexpected occurrences V § Overprotective and over instructive X • Anxiety Sensitivity Tendency to respond fearfully to anxiety symptoms

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Anxiety Sensitivity: Tendency to respond fearfully to anxiety symptoms ○ A personality trait that determines who will or will not experience problems wit anxiety under certain stressful conditions Most psychological accounts of panic invoke conditioning and cognitive explanations that are difficult to separate ○ A strong fear response initially occurs during extreme stress / as a result of a dangerous situation in the environment (a true alarm) ○ Emotional response is associated with external and internal cues § The conditional stimuli (cue) provoke the fear response and an assumption danger even if the danger is not present -- a false/learned alarm § External cues: places / situations similar to where the initial panic attack occurs § Internal cues: increases in heart rate or respiration that were associated w the initial panic attack May not be aware of the cues or triggers of severe fear Cues and triggers may travel from the eyes directly to the amygdala in the emotional brain without going through the cortex, the source of awareness

Social Contributions Social and interpersonal in nature: marriage, divorce, difficulties at work, death of a loved on pressures to excel in school Physical: injury, illness Stressors can trigger - physical reactions: headaches, hypertension - Emotional reactions: panic attacks The way we react to stress seem to run in families -- possible genetic contribution An Integrated Model Triple vulnerability theory: a theory of development of anxiety 1. Generalized biological vulnerability: does not sufficient to produce anxiety itself ○ a tendency to be uptight or high-strung might be inherited 2. Generalized psychological vulnerability: is the perception below is strong ○ Believe the world is dangerous and out of control, and not able to cope with thin in early experience 3. Specific psychological vulnerability: learn from early experience that some situations objects are fraught with danger (even If they really aren't)

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Comorbidity Comorbidity: the co-occurrence of two/more disorders in a single individual • Rates of comorbidity among anxiety disorders and between anxiety and depression ar high • All anxiety disorders share the common feature of anxiety and panic ○ Share the same vulnerability (biological and psychological) for developing anxiet and panic ○ Differ only in the focus of anxiety and the patterning of panic attacks Comorbidity with physical disorders • DSM-5: panic attacks often co-occur with certain medical conditions, particular cardiovascular, respiratory, gastrointestinal, and vestibular (inner ear) idorders • Anxiety disorder usually begins before the physical disorder Presence of any anxiety disorder is uniquely and significantly associated with thyroid 甲状腺 disease, respiratory disease, gastrointestinal 胃肠 disease, arthristis 关节炎, migraine headaches, and allergic conditions Also panic disorders and cardiovascular (heart) disease

Suicide About 50% of individuals with these disorders will present with one/more additional anxiety depressive disorder and some other disorder.

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