CHAPTER 14 Psychological Disorders Anxiety Disorders

Several kinds of anxiety disorders –generalized anxiety disorder –Panic disorders –Agoraphobia –Specific phobias Generalized anxiety Disorder: –feeling of stress and unease most of the time –overreacts to stressful conditions.

Anxiety Disorders Panic disorder: –sudden and intense attack of anxiety –symptoms including rapid breathing, high heart rate –feelings of impending disaster. Agoraphobia: –More a result of panic disorders and generalized anxiety disorder –Becomes fearful of situations which elicit panic/anxiety –Begin to avoid these areas –But generalizes- soon afraid of everywhere! Phobias –experiences fear or stress when confronted with a particular situation –such as crowds, heights, enclosed spaces, open spaces, dogs, or snakes.

Benzodiazepines –most frequently used anxiolytic (antianxiety) drugs in the past. –increase receptor sensitivity to the inhibitory transmitter GABA. –Suggests deficit in benzodiazepine receptors may be one cause of anxiety disorder. Anxiety also appears to involve low activity at serotonin synapses. Antianxiety drugs –initially suppress serotonin activity –then produce a compensatory increase. Chemical Treatment of Anxiety Disorders

Number of brain structures activated in anxiety: –amygdala –locus coeruleus. –Both structures participate in more specific emotions, such as fear. Drugs which decrease action in the locus coeruleus are anxiolytic Drugs which increase its action increase anxiety. Related Brain structures and Anxiety Disorders

Obsessive-compulsive disorder (OCD) –consists of two behaviors –obsessions –Compulsions –Often occur in the same person. Related to anxiety disorders, but often seen in autism spectrum disorders About 3.3 million American adults ages have OCD. (National Institute of Mental Health) Equally common in both males & females. Obsessive compulsive disorders

Obsession –recurring and intrusive thought. –A person may be annoyed by tune that mentally replays over and over, –Plagued by troubling thoughts such as wishing harm to another person. Compulsive behavior –Individual compelled to engage in ritualistic behavior –touching a door frame three times before passing through –endless hand washing –Excessive checking to see if appliances are turned off. Obsessive compulsive disorders

Common obsessions: –Repeated thoughts about contamination (public restrooms or shaking hands). –Repeated doubts (leaving lights on or leaving the door unlocked) –Things or objects need to be in a particular place or order (intense distress when objects are disordered or asymmetrical) Common compulsions: –Hand washing (so repetitive that they become raw). –Counting (how many cards in a deck, over and over again). –Cleaning (spots on windows) –Checking (the lights to make sure they’re off; locked doors every few minutes. –Request/demand assurances –Repeat actions & ordering. Obsessive compulsive disorders

The person must have recognized at some point that the obsessions or compulsions are excessive or unreasonable. These recurrent obsessions or compulsions must be severe enough to be time consuming (taking up more than 1 hour per day). The obsessions/compulsions must cause a marked distress or significantly interfere with the individuals normal routine, occupational functioning, or usual social activities or relationships with others. Diagnostic criteria for ocd

Onset: –Usually begins in adolescence or early adulthood –Occasionally in childhood –Obsessions or cleaning rituals only vs. checking or mixed rituals –Onset is usually gradual. Some acute cases have been diagnosed Course of the disorder: –May experience a waxing and waning course –About 5% have an episode course with minimal or no symptoms between episodes. –Progressive deterioration in occupational and social functioning –90% of patients can expect to have moderate to marked improvement with optimum treatment Onset of OCD

A variety of studies have identified areas of the brain which appear to be related to OCD PET studies – OCD patients have increased activity in the orbital frontal cortex –Also in part of the basal ganglia, the caudate nuclei. Helps explain motor component –Excess activity decreases following drug treatment Also with behavior therapy. Brain changes in ocd

White matter abnormalities – suggest defect in connections of the cingulate gyrus –Forms poor connection circuit with the basal ganglia, thalamus, and cortex –Apparently results in a loss of impulse control. OCD patients problematic serotonergic activity. –SSRI drugs are typically only drugs that consistently improve OCD symptoms Make serotonin more available in synapse Alters production/reuptake –Data suggests that OCD patients have too high a turnover of 5HT –Suggests it is the reuptake receptors that may be at fault Brain changes in ocd

Cognitive behavioral therapy highly effective for treatment of OCD Behavioral treaments

a)The caudate nucleus (a part of the basal ganglia) and the orbital gyrus; b)the caudate nucleus before and after behavior therapy.

Family and twin studies –anxiety disorders appear to be genetically influenced, –heritability ranging between.20 and.43, depending on the disorder. Why important to understanding the hereditary underpinnings of anxiety? –significant genetic overlap with other disorders –Dopaminergic or monoamine cluster disorders. Heritability of anxiety disorders

Over 90% of individuals with anxiety disorders also have history of other psychiatric problems. –Overlap with affective disorders is particularly strong. –50-60% of patients with major depression also have a history of one or more anxiety disorders –panic disorder is found in 16% of bipolar patients. Family clusters –Drug abuse/alcohol abuse –ADHD –Affective disorders –OCD –Schizophrenia –May all be related somehow Heritability of anxiety disorders

People with OCD usually have considerable insight into their own problems. Most of the time, they know their obsessive thoughts are senseless or exaggerated, and that their compulsive behaviors are not really necessary However, this knowledge is not sufficient to enable them to stop obsessing or carrying out their rituals Education is one of the most powerful weapons needed to win the battle over OCD Alternative to drug treatment?

Traditional therapy which helps the client gain insight to his or her problem is not recommended for OCD A specific behavior therapy approach called “exposure and response prevention” is effective: form of Systematic Desensitizaton –Client deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, –Then is discouraged or prevented from carrying out the usual compulsive response When treatment works well, the patient gradually experiences lass anxiety form the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time A therapist will usually refer an OCD client to a specialist in this kind of therapy Alternative to drugs? Behavior therapy

Long term results from 16 studies showed that, at a mean follow-up of 29 months, 76% of patients were “very much” or “much” improved Patients who are unwilling to participate in behavior therapy do benefit from only pharmacotherapy treatment, but symptoms reoccur when the medication is stopped. The effective component of both types of therapy is exposure and ritual prevention Alternative to drugs? Behavior therapy

Studies have shown that OCD patients who participate in both drug and behavioral therapy able to function well in work and social lives But only if the following factors are included: –The patient must be highly motivated –The patient’s family must be cooperative –The patient must be faithful in fulfilling “homework assignments” Alternative to drugs? Behavior therapy