Neuropsychiatry
Which neurotransmitter is usually decreased in patients who suffer from anxiety disorders?
GABA
What are the top differential diagnoses for panic attacks?
Generalized Anxiety Disorder
Social Anxiety Disorder
Post-Traumatic Stress Disorder
Major Depressive Disorder
Obsessive-Compulsive Disorder
What percent of the population experiences social anxiety disorder?
a) 50% of the population
b) 25% of the population
c) 5-10% of the population
d) <5% of the population
c) 5-10% of the population
What is the prognosis of Panic disorders?
The prognosis for panic disorder is generally good with treatment; most patients respond to therapy and medications, though the condition may have a relapsing-remitting course, and long-term management may be required to prevent recurrences.
How does activation of the GABAa receptor lead to decreased neuronal activity?
GABAa activation → Chlorine influx → hyperpolarization → decreased action potentials
Panic attacks can happen in what disorders besides Panic Disorder?
Depressive disorder, PTSD, substance abuse disorder
Which form of psychotherapy is best recommended for patients with generalized anxiety disorder?
a) Behavioral therapy
b) Cognitive behavioral therapy
c) Humanistic therapy
d) Psychodynamic therapy
e) Psychotherapy is not first-line; first line is SSRIs and benzodiazepines
b) Cognitive behavioral therapy
How long do panic attacks last?
Attacks typically peak in 10 minutes, and last ~30 minutes
Which overreactive brain structure is responsible excessive release of stress hormone?
Hypothalamus
BONUS: Pathway from hypothalamus to cortisol?
Treatment of an acute panic attack is consists of administering a drug which works by:
a) Increasing serotonin levels in the synaptic cleft
b) Decreasing norepinephrine release from the adrenal gland
C) Increasing the frequency of the GABAa receptor opening
D) Increasing the duration of the GABAa receptor opening
C) Increasing the frequency of the GABAa receptor opening
A patient walks in who you suspect might fit the diagnostic criteria for GAD, how do you go about assessing the patient for a clinical diagnosis?
Patient interview focusing on psychological symptoms
Medical history to rule out physical causes of anxiety
Self-report measures (like Generalized Anxiety Disorder 7-item scale) or clinician-administered scales (like the Hamilton Anxiety Rating Scale, HAM-A) to quantify the severity of the symptoms
What conditions must be ruled out before diagnosing an anxiety disorder?
MI, tachycardia, hyperthyroidism, hyperparathyroidism, pheochromocytoma, hypoglycemia, seizure, and drug use, etc...
Which structure within the brainstem is responsible for increased arousal and autonomic symptoms of anxiety?
(Think Adrenergic receptors)
Locus ceruleus (PONS)
Differentiate between panic disorder and panic attack
Panic attack - Normal response to fearful stimuli. May be accompanied by a secondary anxiety disorder.
Panic disorder - recurrent unexpected panic attacks usually without a clear trigger. Also accompanied by persistent worry about more attacks and maladaptive behaviors to prevent future attacks.
List at least three symptoms which must be met for a GAD diagnosis
Nervousness, restlessness
Irritability
Muscle tension
Somnolence, fatigue
Concentration difficulties
Insomnia
What are the risk factors for panic disorders?
Risk factors for developing panic disorder are a history of sexual/physical abuse, smoking, recent onset of stressors, and respiratory problems (asthma).
Which brain structure is most active during panic attacks?
Amygdala
Which anxiety disorder is most associated with an increased risk of suicide?
Panic disorder
How long must the anxiety last in GAD in order to be classified as such?
a) > 1 month
b) > 6 months
c) > 1 year
d) > 2 years
more than 6 months
What are the 5 components of CBT?
Learn, Monitor, Breathing/relaxation, changing beliefs, exposure.