NURS 5461 ANXIETY EXAM QUESTIONS AND ANSWERS
WITH COMPLETE SOLUTIONS GRADED A++
ANXIETY DISORDERS
Excessive—overestimate the danger • Persistent, most develop in childhood—need to
assess and treat in childhood • More in females than males [2:1] • Need to ask or they
may not report
WHAT ARE THE ANXIETY DISORDERS?
• Anxiety—Separation Anxiety; Panic Disorder, Agoraphobia, Social Anxiety Disorder,
Generalized Anxiety Disorder [GAD] • OCD and Related Disorders— OCD,
Trichotillomania, Hoarding, Excoriation Disorder • Trauma Disorders—PTSD, ASD,
Adjustment Disorder • They are the most common psychiatric disorders across the
lifespan
GERIATRIC LATE LIFE ANXIETY DISORDERS
• Difficult to diagnose due to somatic symptoms and multiple medical issues • 2x more
prevalent than dementia; 4-8x more prevalent than MDD • GAD in 50%, 30% will have a
specific phobia (e.g. agoraphobia), 10% will have OCD, PD, or PTSD • Cognitive—
hypervigilance to threat, seeing oneself as vulnerable, and perceiving demands of life
greater than resources, impact QOL, morbidity/mortality-*must avoid benzos
frailty puts them at risk, also recent loss contribtes to anxiety risk
NEUROBIOLOGICAL BASIS OF ANXIETY
,• Frontal Lobes • Higher psychological processes • Planning, decision making, impulse
control, language, memory, and others. • Neuronal circuitry in the frontal lobes is
shaped and fine tuned during adolescence • Experience plays a prominent role in these
changes.
AMYGDALA
• Role in emotional aspects of memory • Stored if highly emotional consequences •
Volume may vary based on genetics, traumatic experiences, disorders • Enlarged
amygdala volume & anxiety using MRI
depressed person smaller amygdala
*M w autism have fewer memory cells in amygdala
HIPPOCAMPUS
• Essential to the formation of memory • Smaller hippocampal volume in anxiety
disorders • Smaller hippocampal volumes in pts with sexual abuse.
depressed B hippoc. volume reduction
AMYGDALA AND STRESS—THE ANXIETY AND FEAR CIRCUITRY
Stress (traumatic event)→ senses → thalamus, where the stress is triaged → prefrontal
cortex to assess the level of danger (slow process) → amygdala • Prefrontal cortex
supposed to help process (impairment may be genetic) -->straight to amygdala• Severe
trauma/stress leads to un erasable fear response • Wired based on genetics (e.g. panic
disorder)
AMYGDALA & TRAUMA
Thalamus →Amygdala & Hippocampus • Emotional valence to the experience causing
motor responses & reflexes (startle, facial expression) • Hypothalamus then causes
, neuroendocrine & autonomic responses (CRH released) • Overactive amygdala →
hyperarousal symptoms • Startle, Irritability, Angry outbursts, Rage, Hypervigilance
→reexperiencing symptoms
low cortisol=inc. risk for PTDS
CORTISOL & KINDLING—BRAIN SENSITIZATION TO STRESS
• Cortisol is our primary stress hormone • Exposure over time to high cortisol ↑
sensitivity of thalamus to stimuli of psychologically threatening nature • This is kindling! •
Stronger response to lower levels of stimuli • ↑ cortisol reactivity • Highly reactive to
environmental stimuli • Intrusive memories of trauma from cortisol effects in forming
neural networks of memory
PTSD
GLUTAMATE AND THE ADRENAL GLAND—HAVE MAJOR ROLES
Can cause secretion by the hippocampus and prefrontal cortex during the stress [or
trauma] • Creates strong & vivid memories by prolonging excitation of cells as it
solidifies the trauma memories-->Recurrent dreams & Intrusive thoughts • Causes
excitotoxicity from oxidative stress & cell destruction-->Avoidance and numbing
symptoms • Amnesia from dissociation
NOREPINEPHRINE—FIGHT OR FLIGHT
• High levels of norepinephrine in PTSD and Panic Disorder • The Amygdala cues the
locus ceruleus of brainstem to ↑ firing of norepinephrine • Sensitization from repeated
activation • Not able to inhibit or modulate firing • Activates response much easier to
minor stimuli • Hyperarousal—anxiety, startle, irritability, sleep problems, nightmares • ↑
strength of trauma memories—flashbacks, distressing dreams, intrusive memories
WITH COMPLETE SOLUTIONS GRADED A++
ANXIETY DISORDERS
Excessive—overestimate the danger • Persistent, most develop in childhood—need to
assess and treat in childhood • More in females than males [2:1] • Need to ask or they
may not report
WHAT ARE THE ANXIETY DISORDERS?
• Anxiety—Separation Anxiety; Panic Disorder, Agoraphobia, Social Anxiety Disorder,
Generalized Anxiety Disorder [GAD] • OCD and Related Disorders— OCD,
Trichotillomania, Hoarding, Excoriation Disorder • Trauma Disorders—PTSD, ASD,
Adjustment Disorder • They are the most common psychiatric disorders across the
lifespan
GERIATRIC LATE LIFE ANXIETY DISORDERS
• Difficult to diagnose due to somatic symptoms and multiple medical issues • 2x more
prevalent than dementia; 4-8x more prevalent than MDD • GAD in 50%, 30% will have a
specific phobia (e.g. agoraphobia), 10% will have OCD, PD, or PTSD • Cognitive—
hypervigilance to threat, seeing oneself as vulnerable, and perceiving demands of life
greater than resources, impact QOL, morbidity/mortality-*must avoid benzos
frailty puts them at risk, also recent loss contribtes to anxiety risk
NEUROBIOLOGICAL BASIS OF ANXIETY
,• Frontal Lobes • Higher psychological processes • Planning, decision making, impulse
control, language, memory, and others. • Neuronal circuitry in the frontal lobes is
shaped and fine tuned during adolescence • Experience plays a prominent role in these
changes.
AMYGDALA
• Role in emotional aspects of memory • Stored if highly emotional consequences •
Volume may vary based on genetics, traumatic experiences, disorders • Enlarged
amygdala volume & anxiety using MRI
depressed person smaller amygdala
*M w autism have fewer memory cells in amygdala
HIPPOCAMPUS
• Essential to the formation of memory • Smaller hippocampal volume in anxiety
disorders • Smaller hippocampal volumes in pts with sexual abuse.
depressed B hippoc. volume reduction
AMYGDALA AND STRESS—THE ANXIETY AND FEAR CIRCUITRY
Stress (traumatic event)→ senses → thalamus, where the stress is triaged → prefrontal
cortex to assess the level of danger (slow process) → amygdala • Prefrontal cortex
supposed to help process (impairment may be genetic) -->straight to amygdala• Severe
trauma/stress leads to un erasable fear response • Wired based on genetics (e.g. panic
disorder)
AMYGDALA & TRAUMA
Thalamus →Amygdala & Hippocampus • Emotional valence to the experience causing
motor responses & reflexes (startle, facial expression) • Hypothalamus then causes
, neuroendocrine & autonomic responses (CRH released) • Overactive amygdala →
hyperarousal symptoms • Startle, Irritability, Angry outbursts, Rage, Hypervigilance
→reexperiencing symptoms
low cortisol=inc. risk for PTDS
CORTISOL & KINDLING—BRAIN SENSITIZATION TO STRESS
• Cortisol is our primary stress hormone • Exposure over time to high cortisol ↑
sensitivity of thalamus to stimuli of psychologically threatening nature • This is kindling! •
Stronger response to lower levels of stimuli • ↑ cortisol reactivity • Highly reactive to
environmental stimuli • Intrusive memories of trauma from cortisol effects in forming
neural networks of memory
PTSD
GLUTAMATE AND THE ADRENAL GLAND—HAVE MAJOR ROLES
Can cause secretion by the hippocampus and prefrontal cortex during the stress [or
trauma] • Creates strong & vivid memories by prolonging excitation of cells as it
solidifies the trauma memories-->Recurrent dreams & Intrusive thoughts • Causes
excitotoxicity from oxidative stress & cell destruction-->Avoidance and numbing
symptoms • Amnesia from dissociation
NOREPINEPHRINE—FIGHT OR FLIGHT
• High levels of norepinephrine in PTSD and Panic Disorder • The Amygdala cues the
locus ceruleus of brainstem to ↑ firing of norepinephrine • Sensitization from repeated
activation • Not able to inhibit or modulate firing • Activates response much easier to
minor stimuli • Hyperarousal—anxiety, startle, irritability, sleep problems, nightmares • ↑
strength of trauma memories—flashbacks, distressing dreams, intrusive memories
