ANXIETY DISORDERS
Panic Disorder
• 1< stressful events in prior
• attacks may have precipitating events
• exercise
• alter body chemistry
• panic attacks can be induced chemically in the lab
Fear of Fear Hypothesis
• physiological symptoms become CS for future attacks
• many avoid exercise or sex
Biochemical/behavioral differences:
• lactic acid
– triggers panic attacks in people with panic disorder,
but not normals
– a few normals did get panic attacks
– 24% had a relatives with anxiety disorders
Panic Disorder
• habituation
– people with panic disorder take longer to habituate to
annoying tones
• cholecystokinin (CCK)
– triggers panic attacks in panic disordered patients,
but not normals
– CCK antagonist is not effective treatment
Genetics
• strong genetic basis
• 25% prevalence in 1st degree relatives
• vs. 2% in controls
• MZ 31%, DZ 0%
Behavioral Treatment:
• teaching control/coping
• force near panic attack by hyperventilating
• then stop and relax
• repeat
Drug Treatment:
• Paroxetine (Paxil) – selective serotonin reuptake inhibitor
• Sertraline (Zoloft) - SSRI
• Inositol – acts as second messenger precursor
Agoraphobia
• first panic attack usually occurs outside the home
• only 9% occur at home
• panic attacks often lead to agoraphobia
• but are not prerequisite
• 90% reported agoraphobic avoidance before first panic
attack
Who with panic disorder develops agoraphobia?
• Those with cognitive beliefs of inability to cope
Treatment:
• similar treatment as for PD
Generalized Anxiety Disorder
• common disorder
• resting state of panic disorder?
• probably not - they differ
GAD vs. Panic Disorder:
1) Symptoms
– GAD has hyperarousal of CNS
– PD seems connected to hyperarousal of ANS
2) Onset
– GAD more gradual onset and chronic course
3) Family prevalence
– 1st degree relatives of GAD more likely to have GAD -same
for PD
– family modeling suggested for GAD
– 20% prevalence in relatives,
– but no difference in concordance rate between MZ and
DZ twins
GAD Treatment:
• relaxation training
• cognitive restructuring
• medication
Phobias
1) Specific - common
– animal
– natural environment
– blood-injection-injury (strong family pattern)
– situational
– other
2) Social
• fear of embarrassment,
humiliation
• fears more realistic
• vicious cycle perpetuates
Phobia
Sex ratio
• unlike PD, agoraphobia, and simple phobia, social phobia
equally prevalent in men and women
Genetics of phobic disorders
• no studies, yet, although appears to run in families
2-stage avoidance learning theory
1) Classical conditioning
2) Operant conditioning
Sociobiological explanation
• what are the most common phobic objects?
• Could these be considered rational fears, at a normal
level?
• Why aren’t there phobias of electrical outlets, toasters,
etc.?
Treatment:
• systematic desensitization - hierarchy of fears
• in vivo desensitization
• modeling
Obsessive-Compulsive Disorder
• What are the most common compulsions?
• cleaning and checking
• men and women at equal risk
• young single men more likely to have checking rituals
• married women more likely to have cleaning rituals
Onset
• 50-70% have onset after some stressful event
• pregnancy, death of a relative
• 1st degree relatives of trichotillimaniacs at increased
risk
Obsessive-Compulsive Disorder
• 33% of parents of OCD children also had OCD or symptoms
• compared to 2-3% of general population
• Modeling?
• Not necessarily same compulsions
Treatment:
• response suppression
• Prozac, Zoloft - suggest relationship to Serotonin
• surgical disconnection of the frontal lobe
Obsessive-Compulsive Disorder
• relationship to Tourette’s
• higher rate of OCD in patients and their relatives
• suggest basal ganglia abnormalities
• Huntington’s?
Post-Traumatic Stress Disorder
Factors affecting likelihood of developing it:
1) Trauma:
– intensity and duration of exposure
– extent of threat posed by trauma
– nature of trauma (human vs. disaster)
2) Person:
– pretrauma psychological adjustment
– family hx of psychopathology
– cognitive and coping styles
• problem-focused better than emotion-focused
– guilt feelings
Etiology:
• some support for neurotransmitter involvement in PTSD
Treatment:
• similar to other anxiety disorders
• Eye-Movement Desensitization and Reprocessing
Old brains = less anxiety
• Incidence declines in middle age(over age 40)
• locus ceruleus deterioration (part of medulla oblongata,
in the brainstem)
• norepinephrine production
• 70% of all cells with NE receptors
• usually acts as alarm system increasing NE in response
to stress/perceived danger
• drug addiction and bulimia also decline