Neurotransmitters affected in Anxiety Disorders

Decreased Serotonin levels Increased Norepinephrine
levels Decreased GABA levels (Allows for increased cellular
excitability)

What role does GABA play in the CNS?

Major inhibitory NT in the brain, involved in reducing and
slowing cellular activity. Found in every region in the brain.

Areas of Brain affected in Anxiety Disorders

Amygdala - Fear in phobic and panic disorders
Hippocampus - Associated with memory related to fear
responses Locus Ceruleus - Arousal Brainstem -
Respiratory Activation, HR

Areas of Brain affected in Anxiety Disorders - Pt 2

Hypothalamus - Activation of stress response Frontal
Cortex - Cognitive interpretations Thalamus - integration
of sensory stimuli Basal Ganglia - Tremor

Anxiolytic Agents
Benzodiazepines - Actions and Side Effects

Action: Increases affinity of GABA A receptor for Gaba
Side Effect: Sedation, Dizziness, weakness, ataxia, decreased
motor performance, dependence, withdrawal.

Anxiolytic Agents
SSRI's- Actions and Side Effects

Action: Block reuptake serortonin into presynaptic terminal,
increasing synaptic concentration. Side Effects: Nausea,
diarrhea, headache, insomnia, somnolence, sexual dysfunction.

Anxiolytic Agents
SNRI- Actions and Side Effects

Action: Inhibit reuptake of neuronal serotonin and
norepinephrine- mild uptake of dopamine. Side Effects:
Headache, dry mouth, nausea, somnolence, dizziness, insomnia,
asthenia, constipation, diarrhea

Anxiolytic Agents
Noradrenergic agents - Actions and Side Effects

Action: Propranolol blocks beta adrenergic receptor activity.
Clonidine stimulates alpha adrenergic receptor. Side
Effects: Propranolol - bradycardia, hypotension, weakness, fatigue,
impotence, GI upset, bronchospasm. S/E: dry mouth,
sedation, fatigue, hypotension

Anxiolytic Agents
Barbiturates - Actions and Side Effects

Action: CNS depression and produces effects in the hepatic and
cardiovascular systems. Side Effects: Somnolence,
agitation, confusion, ataxia, dizziness, bradycardia, hypotension,
constipation.

Anxiolytic Agents
Buspirone - Actions and Side Effects

Action: Partial agonist of 5HT 1A receptor Side
Effects: Dizziness, drowsiness, dry mouth, headache, nervousness,
nausea, insomnia.

Panic Disorder
What is it?
What four of the symptoms need to be present to diagnose one as such?

Panic Disorder is recurrent panic attacks with an unpredictable
onset and intense apprehension, fear or terror associated with
feelings of impending doom and discomfort.

Panic Disorder
What four of the symptoms need to be present to diagnose one as such?

Palpitations, pounding heart or increased HR
Sweating Trembling/Shaking Sensations of SOB or
smothering Feelings of choking Chest pain/
discomfort Nausea/Abdominal distress Feeling dizzy,
unsteady, lightheaded faint Chills/heat sensations
Paresthesias Derealization or despersonalization
Fear of losing control or going crazy Fear of
dying

Generalized Anxiety Disorder

Persistent, unrealistic, and excessive anxiety and worry
occurring more days for at least 6 months. Begins in
childhood or adolescence - may begin after 20.

Generalized Anxiety Disorder

Predisposing factors -Psycho-dynamic

Psychodynamic Theory (Freud): Anxiety occurs when
inability of the ego to interven when conflict occurs between the id
and superego.
Delayed ego development (e.g. unsatisfactory parent-child
releationship, conditional love etc. )

Generalized Anxiety Disorder

Predisposing factors - Cognitive Theory

faulty, distorted or dysfunctional thinking patterns that
precede or accompany maladaptive behaviors and emotional disorders
. Dysfunctional appraisal of the situation - leads to
distorted thinking and person feels vulnerable in the
situation.

Generalized Anxiety Disorder

Predisposing factors - Biological Aspects

Genetics - Panic disorder has a strong genetic element
Neuroanatomical - Panic disorder linked to pathological
involvement in the temporal lobes/hippocampus Biochemical -
abnormal levels of blood lactate in panic, infusion of sodium
lactate may cause panic. Neurochemical - Increase
norepinephrine levels - cause hyperarousal

Phobias - Fear of the presence or anticipation of a specific object/situation
Agoraphobia

Agoraphobia - fear of being in public places or situations from
which escape might be difficult or in which help might not be
available in the event of panic like symptoms. E.g.
Traveling public transportation, being in open spaces, being shops,
theaters, cinemas, standing in line or being in a crowd, being
outside the home. These situations prove fear or anxiety -
and are actively avoided or endured intense fear or anxiety

Phobias - Fear of the presence or anticipation of a specific object/situation
Social Anxiety/Phobia

Excessive fear of situations in which a person might do
something embarrassing or evaluated negatively by others.
E.g. Marked fears about social situations - having a
conversation, meeting unfamiliar people, being observed eating or
drinking, performing in front of others. Individuals fear
that they will act in a way or show anxious symptoms, children
express fear by crying, tantrums, freezing, clinging, shrinking or
failing to speak.

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Exposure to objects cause s/s: panic, dizziness, sweating, and dyspnea
Acrophobia, ailurophobia, algophobia

Acrophobia - fear of height Ailurophobia - fear of
cats Algophobia - fear of pain

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Anthophobia, anthropophobia, aquaphobia

Anthophobia - fear of flowers Anthropophobia - fear of
people Aquaphobia-fear of water

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Arachnophobia, Astraphobia, Belonephobia

Arachnophobia - fear if spiders Astraphobia -
lightning Belonephobia - needles

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Brontophobia, claustrophobia, cynophobia

Brontophobia - Thunder
claustrophobia - fear of closed spaces
cynophobia - dogs

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Dementophobia, equinophobia, gamophobia

Dementophobia - Insanity equinophobia - Horses
gamophobia - Marriage

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Herpetophobia, homophobia, murophobia

Herpetophobia - fear of lizards/reptiles homophobia -
homosexuality murophobia - mice

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Mysophobia, numerophobia, nyctophobia

Mysophobia - Dirt, germs, contamination numerophobia -
numbers nyctophobia - darkness

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Ochophobia, ophidiophobia, Pyrophobia

Ochophobia - Riding in a car ophidiophobia -
Snakes Pyrophobia - Fire

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Scoleciphobia, siderophobia, taphophobia

Scoleciphobia - Worms siderophobia -
Railroads/Trains taphophobia - Being buried alive

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Thanatophobia, Trichophobia, Triskaidekaphobia,

Thanatophobia - death Trichophobia - Hair
Triskaidekaphobia - Number 13

Specific Phobia - Fear of specific objects or situations that could
cause harm.
Xenophobia, Zoophobia

Xenophobia - Strangers Zoophobia - Animals

Predisposing Factors to Phobias
Psychoanalytic,
Learning
Cognitive
Biological - Temperament

Psychoanalytic - unconscious fears may be expressed in a
symbolic manner Learning -fears are conditioned
response Cognitive - faulty cognitions i.e. negative
self-statements/irrational beliefs Biological/Temperature -
born w/ characteristics/ innate fears Life experiences i.e.
child punished by being locked in closet - phobia of
elevators/claustrophobia, child who falls down - fear of high
places, child who survived plane crash has a fear of planes when
older.