PANIC DISORDER

• 1-2% of population
• 2:1 female to male ratio
• usually starts in young adulthood; rare onset after age 35

agoraphobia

Cause appears biological

Genetic

• MZ>DZ concordance rate
• 30% of relatives with panic disorder have it
• family inheritance suggests single, dominant gene
• relationship with bipolar disorder?

• triggers panic attacks in people with panic disorder, but not normals
• for those few normals who did get panic attacks, 24% of them turned out to have relatives who had a history of anxiety disorders

• people with panic disorder take longer to habituate to annoying tones

• appear involved, probably associated with amygdala

• produces fearfulness in cats
• with later administration of benzodiazepine reducing anxiety
• found to have fewer benzodiazepine receptors
• REMEMBER plant root story? What kind of sensitivity is this?

• triggers panic attacks in panic disordered patients, but not normals
• however, CCK antagonist is not effective treatment

• SSRIs useful in panic disorder
• However, tryptophan depletion has no effect

• 1-2% of the population
• females slightly more likely than males to have the disorder
• most commonly begins in young adulthood

• compulsions may be related to overactivity of "species-typical behaviors" or cultural rituals
• related to Tourette’s syndrome
• damage to basal ganglia, cingulate gyrus, and prefrontal cortex may cause OCD
• OCD sometimes found in Huntington’s and Sydenham’s chorea, both basal ganglia disorders
• PET scans documented reduced orbitofrontal cortical activity 1 year after tx
• drug therapy most effective treatment - serotonin agonists
• behavioral treatment involves response suppression
• frontal lobe surgery

• treatment with serotonin reuptake blockers - clomipramine
• serotonin antagonists worsen symptoms
• tryptophan depletion has no effect
• has inhibitory effect on species-specific behaviors

• 4 in every 10,000 births
• often first born and last (in a series) born children
• MZ concordance as high as 96%
• DZ the same as for siblings
• 2-3% of siblings also are autistic, which is 50-100 times greater than general population incidence

• for those few MZ twins who were discordant, the affected twin was likely to have suffered obstetric complications

• results in severe mental retardation and, in some cases, autism if untreated
• causes failure of myelinization of neurons in the CNS

fragile X syndrome

• leading hereditary cause of mental retardation
• unclear if associated with autism

• maternal exposure to rubella, infantile hydrocephalus
• 12 rare diseases
• Joubert syndrome (deficient cerebellar development)

Glucocorticoids

• Hormones secreted during stress
• Help break down protein and convert to glucose
• Release controlled by neurons in the paraventricular nucleus of the hypothalamus

• Survivors of concentration camps
• Drivers of subway trains that have killed people
• Air traffic controllers
• Alzheimer's caregivers - wounds took longer to heal

• Increased blood pressure
• Damage to muscle tissue
• Steroid diabetes
• Infertility
• Inhibition of growth
• Inhibition of inflammatory responses
• Suppression of the immune system

• Glucocorticoids lower neurons ability to use glucose
• Particularly bad when blood flow is reduced (associated with aging)
• Higher blood levels, poorer maze learning in older people

• Monkey studies
• Brain degeneration in torture victims

• Role of pre-existing personality factors
• Gene responsible for D2 receptor production
• Combat exposure related to hippocampal loss

• White blood cells produce specific and nonspecific responses to invading organisms
• What are nonspecific responses?
• What are specific responses?