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Copyright 2001 by Allyn & Bacon Carlson (7e) PowerPoint Lecture Outline Chapter 18: Anxiety Disorder, Autistic Disorder and Stress Disorders ltimedia product and its contents are protected under copyright he following are prohibited by law: blic performance or display, including transmission of any image over a network; ation of any derivative work, including extraction, in whole or in part, of any images; ntal, lease, or lending of the program.
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  • 1. Carlson (7e)PowerPoint Lecture OutlineChapter 18: Anxiety Disorder, Autistic Disorder and Stress Disorders
    • This multimedia product and its contents are protected under copyright
  • law.The following are prohibited by law:
  • any public performance or display, including transmission of any image over a network;
  • preparation of any derivative work, including extraction, in whole or in part, of any images;
  • any rental, lease, or lending of the program.

2. Anxiety Disorders

  • The common element of the anxiety disorders is the presence of unrealistic, unfounded anxiety
  • Panic disorderinvolves episodes of intense anxiety
  • Obsessive-compulsive (O-C) disorderrefers to anxiety associated with recurrent thoughts and actions

18. 3. Panic Disorder (PD)

  • Physical symptoms of panic disorder include
      • Shortness of breath and irregular heartbeat
      • Dizziness and feelings of unreality
  • Episodes of panic occur in 1-2 % of population
    • Panic disorder has an early onset (rare after age 35)
  • Symptoms of PD are similar across cultures
  • Anticipatory anxiety about future panic attacks leads to
    • Agoraphobia :fear of panic attack in public places

18. 4. Biological Bases of PD

  • MZ twins have a higher concordance rate for panic disorder than do DZ twins
  • Panic Disorder is more likely in families of patients with the disorder
    • Family pattern of panic disorder suggests that PD is caused by a single dominant gene
  • Panic attacks can be triggered by events that activate the autonomic nervous system:
    • Lactic acid injections
    • Caffeine consumption
    • Breathing air containing high levels of carbon dioxide

18. 5.

  • Anxiety may involve
    • Reduced levels of benzodiazepine receptors and lowered sensitivity to an unknown endogenous benzodiazepine agonist
    • CCK-4, a peptide that induces panic attack in PD patients, but not in normal subjects
    • Reduced serotonin activity in brain
      • The serotonin agonist fluoxetine can be be used to treat PD
      • Yet, the tryptophan depletion procedure, which reinstates depression, does not produce anxiety attacks in PD patients
    • Altered activity within the frontal cortex

18. 6. Obsessive-Compulsive Disorder

  • Obsessionsare recurrent thoughts
  • Compulsionsare recurrent behaviors
    • The incidence of O-C disorder (OCD) is 1-2 percent
    • OCD begins in young adulthood
    • Symptoms of OCD are similar across differing cultures
  • OCD can greatly limit life options

18. 7. Compulsions

  • The four categories of compulsions include
    • Counting (am I missing a dollar?)
    • Cleaning (hands, house)
    • Checking (Did I turn the stove off?)
    • Avoidance (e.g. dirt)
  • Compulsions may represent exaggerations of normal species-typical behaviors aimed at keeping an animal clean and away from danger

18. 8. Brain Activity and OCD

  • OCD is linked with a neurological syndrome
    • Tourettes syndrome involves
      • Muscular/vocal tics, facial grimaces, word repetition
  • OCD may involve damage to basal ganglia, cingulate gyrus, and prefrontal cortex
    • OCD is associated with neurological syndromes that involve damage to the basal ganglia (Huntingtons chorea)
    • OCD is associated with increased activity within the frontal lobes
      • Drug therapy for OCD reduces frontal lobe activity
      • Surgical transection of the subcortical frontal lobe leads to improvement in OCD (as did a gunshot wound to the head)

18. 9. Pharmacotherapy of OCD

  • Drug therapy for OCD involves drugs that are agonists for brain serotonin systems
    • Blockade of 5-HT reuptake improves OCD symptoms
      • Clomipramine
      • Fluoxetine
      • Fluvoxamine
    • OCD drugs require weeks to relieve OCD symptoms
    • Antagonism of 5-HT receptors worsens OCD, whereas the tryptophan-depletion procedure does not
    • 5-HT agonism appears to reduce intensity of the species-typical behaviors (e.g. washing)

18. 10. Serotonin and Compulsions

  • Human compulsions
    • Trichtillomaniarefers to compulsive hair pulling
    • Onychophagiarefers to compulsive nail biting
    • Both compulsions are reduced by ingestion of clomipramine (a serotonin agonist)
  • Dog compulsions
    • Acral lick dermatitisrefers to compulsive licking by a dog of a body part; ALD is treated by administration of clomipramine

18. 11. Autism

  • Autisminvolves self-absorption
  • Specific features of autism include
    • Impaired social relations with others
    • An inability to communicate
      • Literal interpretation of speech
    • Impaired imaginative ability
    • Stereotyped movements
  • Incidence of autism is 4/10,000
    • Males are 3 times more likely to develop autism

18. 12. Biological Bases of Autism

  • Heritability of autism
    • MZ twins exhibit a 96% concordance rate for autism, while that of DZ twins is comparable to that of normal siblings
    • 2-3% of the siblings of autistic children are themselves autistic
  • Autism is associated with neurological disorders:
    • Phenylketonuria (PKU)
    • Tourettes syndrome
  • Factors that impair development lead to autism:
    • Rubella, hydroencephalus
    • Drugs such as thalidomide (exposure during prenatal days 20-24 impairs development of the brain stem)

18. 13. Stress

  • Aversive stimuli can elicit emotional responses:
      • Behavioral component: Fight or Flight response
      • Autonomic component: Sympathetic activation
      • Endocrine: secretion of epinephrine, norepinephrine
  • Physiological reactions to chronic aversive stimuli/situations can be damaging
    • Stressors : the aversive stimuli we encounter
    • Stress Response :our reaction to stressors

18. 14. Hormone Secretion during Stress

  • Stressors evoke activity in the sympathetic nervous system
  • Adrenal glands release
    • Epinephrine :biases energy flow to muscles, blood flow from heart, and increases blood pressure
    • Norepinephrine : is released in brain during stress
    • Glucocorticoids : break down protein and fats to glucose, increase blood flow, and stimulate behavioral responsiveness
    • Cortisol secretion is controlled by a releasing factor (CRF) produced by the PVN
      • PVN CRF --> pituitary ACTH --> adrenals: secrete glucocorticoids
      • CRF may act as a stress transmitter

18. 15. Glucocorticoid Secretion 18. 16. Chronic Exposure to Stressors

  • Chronic stress is damaging to health
    • Air traffic controllers are more likely to develop
      • High blood pressure
      • Ulcers and diabetes
  • Chronic secretion of glucocorticoids leads to:
    • Increased blood pressure (--> stroke, heart attacks)
    • Loss of neurons in brain (e.g. hippocampal field CA1)
    • Suppression of the immune system (--> illness)
    • Suppression of the inflammatory system (delays wound healing)

18. 17. Posttraumatic Stress Disorder

  • Posttraumatic Stress Disorder(PTSD):
    • Acute exposure to very intense stressors (air disasters, war, assault) can have delayed stress effects
      • Dreams, recall of trauma event
      • Flashback episodes of event
      • Intense distress
    • PTSD symptoms include:
      • Diminished social interests
      • Suppressed emotional feelings
      • Feelings of detachment

18. 18. Predisposing Factors for PTSD

  • Personality variables that predispose to PTSD:
    • Tendency to brood about feelings
  • Vietnam Veterans study identified four factors that contribute to developing PTSD
    • Family financial difficulty
    • History of drug abuse/dependence
    • History of affective disorders
    • History of childhood behavior problems
  • PTSD patients exhibit reduced volume of the hippocampus (consistent with toxic action of glucocorticoids on hippocampal cells)

18. 19. Coping Responses and Stress

  • Stress reflects our reaction to stressors
  • Copingimplies modifying our responses:
    • Exerting control over aversive stimuli can reduce stress responses
      • Weiss study: rats that avoid shock show fewer ulcers
    • Coping may involve an increase in the level of benzodiazepines in brain (would act via GABA Asites to reduce anxiety)

18. 20. Psychoneuroimmunology

  • Psychoneuroimmunologyis the study of the interactions between the immune system and behavior
    • Stress responses can impair the immune system
    • Leading to illness and potential death

18. 21. Overview of the Immune System

  • Immune system acts to destroy foreign organisms (viruses, bacteria, fungi)
  • Nonspecific reactions:act to destroy organisms or infected cells
    • Inflammatory reaction: damaged cells leak substances that increase blood flow
    • Phagocytotic white blood cells: destroy damaged cells
    • Cell infection --> interferon secretion (reduces viral replication)
    • Natural killer cells: detect and destroy infected cells

18. 22. Immune Reactions 18. Chemically-Mediated Cell-Mediated 23. Specific Immune Reactions

  • Specificimmune reactions include:
    • Chemically-mediated : immune system produces antibodies that recognize the antigens present on surface of a foreign cell
      • B-lymphocytes: produce immunoglobulin antibodies that destroy foreign cells
    • Cell-mediated : antibodies on exterior of T-lymphocytes detect foreign antigens (viruses)

18. 24. Stress and the Immune Response

  • Stress increases the likelihood of infectious disease
    • Students are more likely to be ill during exam times
    • Death of a spouse leads to illness of survivor
  • Explanation:stress releases glucocorticoids that in turn impair the immune system
  • Supporting Evidence:
    • Bereavement leads to reduced immune response
    • Alzheimers caregivers have impaired immune response
    • Inescapable shock in rats reduces T-cells, B-cells and natural killer cells