Anxiety DisordersMood DisordersPersonality Disorders

Jim Vess, Ph.D.310 EasterfieldExtension 6481Jim.Vess@vuw.ac.nz

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Nervous System

Central Nervous System

Brain Spinal Cord

Peripheral Nervous System

Autonomic Somatic

Sympathetic 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

• 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 ModelsThe Four Humours (ancient Greece – 1600’s)

Blood – happy, generous, amorousPhlegm – dull, cowardly, unresponsiveYellow Bile – violent, vengeful, easily angeredBlack Bile – brooding, lazy, gluttonous

Treatments: bleeding, purgatories

Evil Spirits and Witchcraft:TrephaningTortureExorcism

Understanding Mental Disorders

• 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 DisorderPanic Disorder

30 – 50% AgoraphobiaPhobiasObsessive Compulsive DisorderPTSDAcute Stress DisorderAdjustment 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

• Palpitations, rapid HR• Sweating• Trembling or shaking• Sensations of

shortness of breath or smothering

• Feelings of choking• Chest pain• Nausea

• 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

• 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 irresistibleand carried out in a repetitive or ritualisticmanner

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)