EDapt -Anxiety Disorders Advanced
Pathophysiology Questions and
Correct Answers.
Introduction to Anxiety Disorders - Answer - Anxiety is the most common mental disorder in
the United States, affecting 19.1% or 40 million adults over the age of 18 (Anxiety & Depression
Association of America [ADAA], 2022). Anxiety occurs when the amygdala senses trouble. This
"trouble" appears as a real or imagined threat, activating neurotransmitters, flooding the body
with stress hormones, and activating the fight-or-flight response.
- While a state of arousal is normal in the presence of a perceived threat, when symptoms of
anxiety persist in the absence of threatening stimuli or become overwhelming to the point of
impacting an individual's daily functioning, an anxiety disorder may develop.
Pathophysiology of Anxiety Disorders - Answer - Clients with anxiety disorders, compared to
those without anxiety disorders, display significantly decreased spontaneous brain activities in
the right putamen, the right orbital inferior frontal gyrus, and the right temporal pole (Wang et
al., 2022). These areas in the brain are associated with emotional processing. Activation of the
limbic system also occurs in response to stress, which can lead to anxiety (when the amygdala
triggers the fight-or-flight response).
- Anxiety disorders have many causes, including neurohormonal imbalances, post-traumatic
stress syndrome (PTSD), or head injuries.
Neurohormonal imbalances include the following:
- Norepinephrine (noradrenaline): This neurotransmitter is involved in the fight-or-flight
response. Stressors trigger an increase in norepinephrine, which leads to the physical
manifestations associated with anxiety, including tachycardia, increased blood pressure,
tremors, and diaphoresis.
- Serotonin (5-HT): This neurotransmitter modulates several anxiety-related factors, including
releasing norepinephrine and corticotropin-releasing hormones.
- Corticotropin-releasing hormone: Through the mechanism of the hypothalamic-pituitary-
adrenal axis, this hormone is released, contributing to anxiety.
Normal Physiology of Gamma-Aminobutyric Acid - Answer - Gamma-aminobutyric acid
(GABA) is the major inhibitory neurotransmitter that regulates serotonin, norepinephrine, and
dopamine levels. GABA receptors located in the neural synapses of the central nervous system
(CNS) play a key role in neuronal firing (e.g., seizure disorders), regulating emotion, and
controlling cognition, pain, sleep, and motor function. GABA decreases neuroexcitability across
, the brain. When triggers increase the utilization of GABA, GABA levels decrease, causing
anxiolysis and anxiety. The role of GABA has long been regarded as central to the regulation of
anxiety, and this neurotransmitter is the target of benzodiazepines used to treat anxiety
disorders.
- When alterations affect GABA, serotonin also acts as an inhibitory neurotransmitter (found in
the raphe nuclei). Alterations in serotonin will affect the serotonin-reuptake transporter and the
post-synaptic serotonin receptors. This alteration results in the client experiencing an increased
sensitivity to stress, leading to anxiety.
- Reductions of glutamate activity in the hippocampus can also contribute to increased stress
and anxiety. Glutamate regulation is important for memory, cognition, and mood regulation.
Types of Anxiety Disorders - Answer - Generalized
- Social
- Panic
Generalized Anxiety Disorder - Answer Generalized anxiety disorder (GAD) is characterized
by increased, persistent, unreasonable anxiety about everyday situations involving money,
work, family, and relationships. Normal day-to-day activities can provoke anxiety.
Social Anxiety Disorder - Answer Social anxiety disorder (SAD) involves the fear of being
negatively judged by others, affecting an individual's ability to perform daily activities. Fear of
judgment may prevent the person from attending certain events or participating in social
activities.
Panic Disorder - Answer Panic disorder is characterized by a "panic attack" in which an
individual experiences stress and intense fear that something bad will happen. An imminent
threat or danger is also perceived. These feelings are often accompanied by physiological
symptoms such as heart palpitations, dizziness, or shortness of breath. The symptoms typically
peak within the first ten to twenty minutes, but some may last for hours. The individual will
sometimes describe the feeling of having a heart attack or some other life-threatening illness. A
panic attack can be unpredictable because clients can experience it in familiar places where
there are no real threats. This can further increase anxiety as the individual begins to anticipate
when the next panic attack might happen. Panic disorder occurs when a person experiences
repeated panic attacks, usually accompanied by fears about future attacks.
** The DSM-5-TR (American Psychiatric Association [APA], 2022) characterizes a panic attack as
an abrupt onset of 4 of 13 symptoms: pounding heart or fast heart rate, chest pain or
discomfort, sweating, trembling, shortness of breath, nausea, dizziness, chills, numbness, feels
like "choking," detached feelings of oneself, fear of losing control, or fear of death. Some of the
symptoms may happen together, making it difficult to analyze. For example, it would be unusual
for a client who is sweaty, feeling dizzy, and having chills not to tremble. Some symptoms
include physical manifestations, while others include thoughts and ideas.
Pathophysiology Questions and
Correct Answers.
Introduction to Anxiety Disorders - Answer - Anxiety is the most common mental disorder in
the United States, affecting 19.1% or 40 million adults over the age of 18 (Anxiety & Depression
Association of America [ADAA], 2022). Anxiety occurs when the amygdala senses trouble. This
"trouble" appears as a real or imagined threat, activating neurotransmitters, flooding the body
with stress hormones, and activating the fight-or-flight response.
- While a state of arousal is normal in the presence of a perceived threat, when symptoms of
anxiety persist in the absence of threatening stimuli or become overwhelming to the point of
impacting an individual's daily functioning, an anxiety disorder may develop.
Pathophysiology of Anxiety Disorders - Answer - Clients with anxiety disorders, compared to
those without anxiety disorders, display significantly decreased spontaneous brain activities in
the right putamen, the right orbital inferior frontal gyrus, and the right temporal pole (Wang et
al., 2022). These areas in the brain are associated with emotional processing. Activation of the
limbic system also occurs in response to stress, which can lead to anxiety (when the amygdala
triggers the fight-or-flight response).
- Anxiety disorders have many causes, including neurohormonal imbalances, post-traumatic
stress syndrome (PTSD), or head injuries.
Neurohormonal imbalances include the following:
- Norepinephrine (noradrenaline): This neurotransmitter is involved in the fight-or-flight
response. Stressors trigger an increase in norepinephrine, which leads to the physical
manifestations associated with anxiety, including tachycardia, increased blood pressure,
tremors, and diaphoresis.
- Serotonin (5-HT): This neurotransmitter modulates several anxiety-related factors, including
releasing norepinephrine and corticotropin-releasing hormones.
- Corticotropin-releasing hormone: Through the mechanism of the hypothalamic-pituitary-
adrenal axis, this hormone is released, contributing to anxiety.
Normal Physiology of Gamma-Aminobutyric Acid - Answer - Gamma-aminobutyric acid
(GABA) is the major inhibitory neurotransmitter that regulates serotonin, norepinephrine, and
dopamine levels. GABA receptors located in the neural synapses of the central nervous system
(CNS) play a key role in neuronal firing (e.g., seizure disorders), regulating emotion, and
controlling cognition, pain, sleep, and motor function. GABA decreases neuroexcitability across
, the brain. When triggers increase the utilization of GABA, GABA levels decrease, causing
anxiolysis and anxiety. The role of GABA has long been regarded as central to the regulation of
anxiety, and this neurotransmitter is the target of benzodiazepines used to treat anxiety
disorders.
- When alterations affect GABA, serotonin also acts as an inhibitory neurotransmitter (found in
the raphe nuclei). Alterations in serotonin will affect the serotonin-reuptake transporter and the
post-synaptic serotonin receptors. This alteration results in the client experiencing an increased
sensitivity to stress, leading to anxiety.
- Reductions of glutamate activity in the hippocampus can also contribute to increased stress
and anxiety. Glutamate regulation is important for memory, cognition, and mood regulation.
Types of Anxiety Disorders - Answer - Generalized
- Social
- Panic
Generalized Anxiety Disorder - Answer Generalized anxiety disorder (GAD) is characterized
by increased, persistent, unreasonable anxiety about everyday situations involving money,
work, family, and relationships. Normal day-to-day activities can provoke anxiety.
Social Anxiety Disorder - Answer Social anxiety disorder (SAD) involves the fear of being
negatively judged by others, affecting an individual's ability to perform daily activities. Fear of
judgment may prevent the person from attending certain events or participating in social
activities.
Panic Disorder - Answer Panic disorder is characterized by a "panic attack" in which an
individual experiences stress and intense fear that something bad will happen. An imminent
threat or danger is also perceived. These feelings are often accompanied by physiological
symptoms such as heart palpitations, dizziness, or shortness of breath. The symptoms typically
peak within the first ten to twenty minutes, but some may last for hours. The individual will
sometimes describe the feeling of having a heart attack or some other life-threatening illness. A
panic attack can be unpredictable because clients can experience it in familiar places where
there are no real threats. This can further increase anxiety as the individual begins to anticipate
when the next panic attack might happen. Panic disorder occurs when a person experiences
repeated panic attacks, usually accompanied by fears about future attacks.
** The DSM-5-TR (American Psychiatric Association [APA], 2022) characterizes a panic attack as
an abrupt onset of 4 of 13 symptoms: pounding heart or fast heart rate, chest pain or
discomfort, sweating, trembling, shortness of breath, nausea, dizziness, chills, numbness, feels
like "choking," detached feelings of oneself, fear of losing control, or fear of death. Some of the
symptoms may happen together, making it difficult to analyze. For example, it would be unusual
for a client who is sweaty, feeling dizzy, and having chills not to tremble. Some symptoms
include physical manifestations, while others include thoughts and ideas.
