Lecture 4: Anxiety Disorders

Front 1

Autonomic and non-autonomic effects:

AUTONOMIC effects?: (6)

Back 1

Palpitations
Sweating
Nausea/Vomvom
Diarrhoea
Dizziness
Increase in urinary frequency

Front 2

NON-AUTONOMIC effects: (7)

Back 2

Tension/tremor

Chest pain
Fatiguability
Short of breath/choking

Headache
Parastheaias (tingling)
Hypersensitivity to stimuli

Front 3

What is the Yerke's Dodson Law?

Back 3

The law dictates that performance increases with physiological or mental arousal, but only up to a point. When levels of arousal become too high, performance decreases

Front 4

What are the stages of the General Adaption Syndrome?

Back 4

1. Alarm
2. Resistance
3. Exhaustion

Front 5

What are Crowe's three umbrellas for anxiety disorders?

Back 5

Phobias = Agoraphobia, Social phobia, Specific
phobia

Anxiety states = Panic disorder,
Generalised
anxiety disorder,
Obsessive compulsive
disorder

Trauma-related = Post-traumatic
stress disorder, anxiety from medical condition,
Substance induced anxiety

Front 6

There a reduction in volume where in PTSD?

Back 6

Hippocampus (between 5 and 12%)

Front 7

PTSD in Vietnam veterans associated
with various __________ __________.

Back 7

PTSD in Vietnam veterans associated
with various MEDICAL DISEASES.

Front 8

What is associated with the amount of combat?

Back 8

Cortisol levels.

Front 9

What degree of reduction is there in hippocampal volume in chronic PTSD?

Back 9

They noted that there was a 8%
reduction in hippocampal volume in the
PTSD affected subjects as compared to
the healthy controls

Front 10

More recent reviews including the meta-analysis
of Smith (2005) indicate that on average PTSD
sufferers had a____% smaller left hippocampal
volume and a ____% smaller right hippocampal
volume in comparison to controls.

Back 10

More recent reviews including the meta-analysis
of Smith (2005) indicate that on average PTSD
sufferers had a 6.9% smaller left hippocampal
volume and a 6.6% smaller right hippocampal
volume in comparison to controls.

Front 11

What are some of the common comorbidities which might contribute to cognitive impairments in PTSD? (5)

Back 11

1
Medical illness

2 Somatization including non epileptic seizures

3. Psychiatric and psychological problems

4. Substance abuse

5. Dissociative symptoms

Front 12

Obsessive compulsive disorder: seems to be a associated with a deficit in which cognitive domains?

Back 12

visuospatial processing and visuospatial memory deficits.

Verbal learning and memory is normal.

Front 13

Further support for the notion of memory deficits in OCD sufferers is the interesting study by Her, Frost, Kuher, Crews and Alexander (1989) who noted that their nonclinical sample of subjects who featured
high levels of checking behaviour, had deficits in memory for __________ _________ ________.

Visual memory is frequently used in checking and reviewing personal acts.

Back 13

Further support for the notion of memory
deficits in OCD sufferers is the interesting
study by Her, Frost, Kuher, Crews and
Alexander (1989) who noted that their nonclinical
sample of subjects who featured
high levels of checking behaviour, had
deficits in memory for RECENTLY COMPLETED ACTIONS. Visual memory is frequently used in
checking and reviewing personal acts (

Front 14

OCD

Deficits in visual memory and by implication an inability to be able to recall the outcome of a previous investigation regarding an obsessive
concern or the adequacy of a compulsive act may well drive the subject to _________ these actions (Otto, 1992).

Back 14

OCD

Deficits in visual memory and by implication an inability to be able to recall the outcome of a previous investigation regarding an obsessive
concern or the adequacy of a compulsive act may well drive the subject to REPEAT these actions

Front 15

There seems at best tenuous evidence on the basis of the available literature which suggests a specific deficit in ________ ________in normal subjects who are placed in conditions of acute stress.

Back 15

There seems at best tenuous evidence on the basis of the available literature which suggests a specific deficit in ATTENTIONAL FUNCTIONS functions in normal subjects who are placed in conditions of acute stress.

Front 16

Subjects with pathological anxiety do perform _______ ________ on tests of attention but do so
___________.

Back 16

Subjects with pathological anxiety do perform MORE
POORLY on tests of attention but do so
INCONSISTENTLY.

Front 17

Neuroimaging in PTSD

STRUCTURAL:

What's down? (2)

Back 17

DOWN:

1. Hippocampus
2. Medial PFC

Front 18

Neuroimaging in PTSD

Functional:

What's up? (1)

What's down? (1)

Back 18

UP = Amygdala
DOWN = Medial PFC

Front 19

Neuroimaging in PTSD

Biochemical:

What's down? (3)

Back 19

1. Hippocampus
2. ACC
3. PFC

Front 20

Memory Meta-Analysis in PTSD
Brewin et al. (2007; J Abn Psychol)

4 Key findings?

Size of effect?
Verbal or visual impairment greater?
Do effect size vary according to immediate or delay?
Does TBI account for injury?

Back 20

PTSD & memory assoc small to moderate
 Verbal > visual
 No effect for immediate vs. delay
 Could not be explained by TBI

Front 21

Stress, disease and the mind body problem.

PTSD in Vietnam veterans associated with________?

________ levels associated with amount of
combat.

Reduced ______________ volume has been
reported in individuals suffering from chronic
PTSD (Bremner et al., 1995)

They noted that there was an ___% reduction in
hippocampal volume in the PTSD affected
subjects as compared to the healthy controls.

Back 21

PTSD in Vietnam veterans associated with
various medical diseases

 Cortisol levels associated with amount of
combat

 Reduced hippocampal volume has been
reported in individuals suffering from chronic
PTSD (Bremner et al., 1995)

 They noted that there was a 8% reduction in
hippocampal volume in the PTSD affected
subjects as compared to the healthy controls.

Front 22

What are the 5 PTSD-related Neuropsychological Deficits?

Back 22

1. Verbal intellectual
2. Sustained attention
3. Working memory
4. Inhibition
5. New learning/memory

Front 23

Crowe and Anderson meta-analysis re: PTSD and cognitive function.

MEDIUM to LARGE significant deficits were observed in the domains of (7)

Back 23

1. Attention
2. Working memory
3. Speed of information Processing
4. EF
5. Verbal Learning
6. General intelligence
7. Overall cognitive abilities

Front 24

Crowe and Anderson meta-analysis re: PTSD and cognitive function.

Reductions in what were moderated by poor verbal learning performance? (3)

Back 24

Reductions in (SIS)
1. Sustained attention
2. Inhibition
3. Speed of information

Front 25

Reductions in (SIS)
1. Sustained attention
2. Inhibition
3. Speed of information

Were moderated by what in Crowe and Anderson meta-analysis re: PTSD and cognitive function.

Back 25

Poor verbal learning performance.

Front 26

In Vietnam veterans, differences in what explain only part of the relationship between PTSD and Cognitive Deficits? (Vasterling et al)

Back 26

Premorbid intellectual

Front 27

Zielinski and his colleagues (1991) noted that
visuospatial processing deficits in OCD sufferers
on which two tasks?

Back 27

Recurring Figures Test as well as the Corsi
Block span.

Front 28

Behar, Rapoport, Berg, Denckla, Mann, Cox, Fedio
and Wolfman (1984) noted significant differences
between their OCD group as compared to
controls on the which two tasks

Back 28

1. Money Road Map Test
2. Stylus Maze Learning Test.

Front 29

A cautionary note

One confounding effect of the measurement of
visuospatial functioning particularly in subjects
suffering from OCD is the contribution of ...... to performance on visuospatial functioning tasks?

Back 29

Psychomotor speed to performance on these
tasks.

Front 30

What two behaviors inevitably must impinge on the performance of a timed task and more pure measures of these skills would be useful for the further elucidation of this area.

Back 30

CHECKING AND RITUALISATION must impinge
on the performance of a timed task and more pure
measures of these skills would be useful for the
further elucidation of this area.

Front 31

OCD and memory

A more consistent pattern of results has emerged
with OCD subjects which seems to indicate a
_______________ memory deficit in these subjects

Back 31

A more consistent pattern of results has emerged
with OCD subjects which seems to indicate a
visuospatial memory deficit in these subjects

Front 32

Zielinski et al (1991) in their study of 21 patients
with OCD noted that they did not feature deficits
on which test when compared to controls, suggesting no deficit with verbal learning and memory.

Back 32

CVLT


However, both Zielinski et al (1991) and Boone,
Ananth, Philpott, Kaur and Djenderedjian (1991)
noted poorer performance by OCD subjects on
tests of visuospatial memory as compared to
Verbal IQ matched controls.

Front 33

Further support for the notion of memory deficits
in OCD sufferers is the interesting study by Her,
Frost, Kuher, Crews and Alexander (1989) who
noted that their non-clinical sample of subjects
who featured high levels of ?WHAT? had deficits in memory for recently completed actions.

Back 33

Further support for the notion of memory deficits
in OCD sufferers is the interesting study by Her,
Frost, Kuher, Crews and Alexander (1989) who
noted that their non-clinical sample of subjects
who featured high levels of checking behaviour,
had deficits in memory for recently completed
actions.

Front 34

What is frequently used in checking and
reviewing personal acts (Reed, 1977).

Back 34

Visual memory

Front 35

Link between visual memory and checking behavior?

Back 35

Visual memory is frequently used in checking and
reviewing personal acts (Reed, 1977).