Urbach-Wiethe disease
entirely lesions both amygdalae
no fear experience
cant recognise fear in others’ faces
put self in dangerous sityations
assymetry of possible outcomes
real vs no danger
strong vs weak fear reaction
factors that increase general risk for anxiety disorders
behavioural conditioning
genetic vulnerability
disturbances in the activity in the fear circuit of the brain
decreased GABA and serotonin, increased norepinephrine
behavioural inhibition
neuroticism
cognitive factors- sustained negative beliefs; perceived lack of control and attention to cues of threat
prefrontal-amygdala connectivity
medial PFC fails to down regulate an overexcitable amygdala
personality risk factors
neuroticism
behavioural inhibition
intolerance of uncertainty
perfectionism
behavioural inhibition
tendency to experience anxiety responses in response to uncertain or unfamiliar stimuli
intolerance of uncertainty
tendency to treat uncertain situations as inherently aversive and act to avoid them
Barlow’s triple vulnerability model
Diathesis: generalised biological vulnerability; generalised psychological vulnerability; specific psychological vulnerability
stress: stressful life event
Barlow’s triple vulnerability model: generalised biological vulnerability
prefrontal-amygdala connectivity
neuroticism
tendency to panic
Barlow’s triple vulnerability model: generalised psychological vulnerability
ease of fear conditioning
lack of control
attention to threat
Barlow’s triple vulnerability model: specific psychological vulnerability
focus of anxiety (for phobias mainly)
DSM-5 TR diagnostic criteria for GAD
- apprehensive expectation; more days than not for at least 6MO, about many events
- difficult to control worry
- 3+ of these symptoms (some present more days than not for past 6MO): restlessness; easily fatigues; difficulty concentrating; irritability; muscle tension; sleep disturbance
- clinically significant distress or function impairment
- not attributed to substance effects or other medical condition
- not explained by another mental disorder
Benzodiazepines for GAD
increase GABA
ACT GAD
focuses on letting go of attempt to rid oneself of unpleasant thoughts
MCT GAD
focuses on our thought about thinking, emphasising positive metacognition rather than negative
Panic attack DSM-5 criteria
abrupt surge of intense dear/discomfort peaking within minutes
4+ of following: palpitations/increased HR; sweating; trembling; shortness of breath; choking feeling; chest pain; nausea; dizzy; chills; paresthesia; derealisation/depersonalisation; fear of dying
Panic disorder DSM-5 criteria
- recurrent unexpected panic attacks
- at least one of the attacks has been followed by 1MO of either/both: persistent worry about more panic attacks and their consequences; maladaptive behaviour change related to attacks
- not attributed to substance/medical condition
- not explained better by another mental disorder
aetiology of panic disorder
interoceptive conditioning
stronger biological sensitivity to norepinephrine
DSM-5-TR Agoraphobia
- marked fear of 2+: PT; open space; closed space; crowd; outside home alone
- fear situations where escape difficulty or embarassing
- situation almost always provokes anxiety
- situation actively avoided; require companion; endured with intense anxiety
- out of proportion with actual danger/sociocultural context
- fear/anxiety/avoidance persistent, 6+ months
- causes significant distress or impairment in functioning
- if another medical condition present, fear/anxiety/avoidance clearly excessive
- not better explained by other mental disorder
agoraphobia aetiology
fear of fear hypothesis
catastrophic beliefs that public anxiety/panic will lead to socially unacceptable consequences
Specific phobia DSM-5-TR
- fear/anxiety about specific object/situation
- o/s almost always provokes it
- actively avoided/endured with intense anxiety
- out of proportion to actual danger/sociocultural context
- persistent 6+ months
- significant distress and function impairment
- not better explained by other mental disorder
Social anxiety disorder DSM-5-TR
- fear/anxiety about situations involving exposure to scrutiny
- fears they will act in a way that is negatively evaluated
- almost always provokes anxiety
- avoided/endured with intense anxiety
- out of proportion to actual threat/SC context
- persistent, 6+ months
- causes distress and function impairment
- not attributed to substance/medical condition
- not explained better by other mental disorder
- if another medical condition present; fear, anxiety, avoidance clearly unrelated or excessive
