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  • 1. Chapter 17 Anxiety Disorders, Autistic Disorder, Attention-Deficit/Hyperactivity Disorder, and Stress Disorder
  • 2.
    • Anxiety Disorders
      • Panic Disorder
      • Anxiety disorder:
        • A psychological disorder characterized by unrealistic fear and anxiety. 1. Panic disorder
        • 2. obsessive compulsive behavior
      • Panic Disorder:
        • A disorder characterized by episodes of intense fear accompanied by symptoms such as shortness of breath and irregularities in heartbeat.
  • 3. Copyright © 2004 Allyn and Bacon
  • 4.
    • Anxiety Disorders
      • Panic Disorder
      • Anticipatory anxiety:
        • A fear of having a panic attack; may lead to the development of agoraphobia.
      • Agoraphobia:
        • An unrealistic and intense fear of being away from home or other protected places.
        • In severe cases people will not leave home!
  • 5.
    • Anxiety Disorders
      • Panic Disorder Possible Causes:
      • Genetic origins:
        • Evidence supports some anxiety disorders may be inherited. Associated with joint hypermobility.
      • Neurotransmitters:
        • Serotonin and central benzodiazepine receptors may be involved in anxiety disorders.
        • Treated with benzodiazepines and occasionally SSRIs
      • Brain Structures:
        • Imaging studies suggest that the cingulate gyrus, prefrontal, and anterior temporal cortices are involved in panic attack.
  • 6.
    • Anxiety Disorders
      • Obsessive-Compulsive Disorder
      • Obsessive-compulsive disorder:
        • A mental disorder characterized by obsessions and compulsions.
      • Obsession:
        • An unwanted thought or idea with which a person is preoccupied.
      • Compulsion:
        • The feeling that one is obliged to perform a behavior, even if one prefers not to do so.
  • 7.
    • Anxiety Disorders
    • Examples of obsessions:
      • Concern for order
      • Cleanliness, germs
      • Forbidden sexual thoughts
    • Examples of compulsions:
      • Hand washing
      • Checking
      • Collecting
      • Repeating behaviors (in and out of a door)
  • 8.
    • Anxiety Disorders
      • Obsessive-Compulsive Disorder
      • Possible Causes:
      • Genetic Origin:
        • Evidence is beginning to accumulate suggesting that OCD might have a genetic origin.
      • Family studies:
        • Some research suggests OCD is associated with Tourette’s; a neurological disorder that appears during childhood.
      • Treatment:
        • SSRIs , tricyclic antidepressants (desipramine, clomipramine)
  • 9. Copyright © 2004 Allyn and Bacon
  • 10.
    • Anxiety Disorders
      • Obsessive-Compulsive Disorder
      • Possible Causes:
      • Tourette’s syndrome:
        • A neurological disorder characterized by tics and involuntary vocalizations and sometimes by compulsive uttering of obscenities and repetition of the utterances of others.
        • Treatment with antipsycolics (dopamine antagonists, D2)
  • 11.
    • Anxiety Disorders
      • Obsessive-Compulsive Disorder
      • Possible Causes:
      • Cingulotomy:
        • The surgical destruction of the cingulum bundle, which connects the prefrontal cortex with the limbic system; helps to reduce intense anxiety and the symptoms of obsessive-compulsive disorder.
        • Only used on patients who are unresponsive to drug treatment.
  • 12.
    • Autistic Disorder
      • Description:
      • Autistic Disorder:
        • A chronic disorder whose symptoms include failure to develop normal social relations with other people, impaired development of communicative ability, lack of imaginative ability, and repetitive, stereotypical movements.
  • 13.
    • Autistic Disorder
      • Possible Causes:
      • Biological:
        • Research and mental health professionals are convinced autism is caused by biological factors.
        • Between 2 and 3 percent of siblings of people with autism are themselves autistic.
        • There is a 70 percent concordance rate for monozygotic twins.
  • 14. Copyright © 2004 Allyn and Bacon
  • 15.
    • Autistic Disorder
      • Possible Causes:
      • Phenylketonuria (PKU):
        • A hereditary disorder caused by the absence of an enzyme that converts the amino acid phenylalanine to tyrosine; causes brain damage unless a special diet is implemented soon after birth.
  • 16.
    • Autistic Disorder
      • Possible Causes:
      • Brain pathology:
        • Heritable aspect of autism suggests the disorder is a result of structural or biochemical abnormalities in the brain.
        • Researchers have found evidence for structural abnormalities in the brains of autistics, but so far we cannot point to any single abnormality as the cause of the disorder.
  • 17.
    • Attention-Deficit/Hyperactivity Disorder
      • Attention-deficit/hyperactivity disorder (ADHD):
        • The principal characteristics of ADHD are inattention , hyperactivity , and impulsivity . These symptoms appear early in a child's life.
        • There are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive. Or, they may show all three types of behavior.
  • 18.
    • Attention-Deficit/Hyperactivity Disorder
      • Inattention
        • Often becoming easily distracted by irrelevant sights and sounds (hyper vigilant)
        • Often failing to pay attention to details and making careless mistakes
        • Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task
        • Often skipping from one uncompleted activity to another.
  • 19.
    • Attention-Deficit/Hyperactivity Disorder
      • Hyperactivity-Impulsivity
        • Feeling restless, often fidgeting with hands or feet, or squirming while seated
        • Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected (lack of impulse control)
        • Blurting out answers before hearing the whole question (lack of impulse control)
        • Having difficulty waiting in line or taking turns.
  • 20.
    • Attention-Deficit/Hyperactivity Disorder
      • Possible causes
        • There is strong evidence from family and twin studies for hereditary factors in a person’s likelihood of developing ADHD.
        • Thirty-six percent of all findings were positive (P< 0.05), 17% were trends (0.05 <P < 0.15), and 47% were negative (P > 0.15).
        • Genetic investigations have supported the role of both dopamine D4 receptor gene (DRD4) and dopamine transporter gene (DAT1) in the vulnerability to the disorder.
        • The DRD4 gene has been postulated as a candidate gene for attention-deficit-hyperactivity disorder
          • Lower DA binding in basal ganglia
          • Increased DA transport in frontal lobes
  • 21.
    • Attention-Deficit/Hyperactivity Disorder
    • Other causes
      • Possible correlation between the use of cigarettes and alcohol during pregnancy.
      • Lead paints?
      • Sugar sensitivities?
      • Head injuries?
  • 22.
    • Attention-Deficit/Hyperactivity Disorder
      • Brain structure involvement:
        • Studies of brain structure of people with ADHD do not reveal any localized abnormalities, though the total volume of their brains is approximately 4% smaller than normal.
        • Candidates:
          • Frontal lobes
          • Medial temporal lobes
          • Caudate nucleus
  • 23.
    • Attention-Deficit/Hyperactivity Disorder
      • NIMH Child Psychiatry Branch studied 152 boys and girls with ADHD, matched with 139 age- and gender-matched controls without ADHD. The children were scanned at least twice, some as many as four times over a decade. As a group, the ADHD children showed 3-4 percent smaller brain volumes in all regions—the frontal lobes, temporal gray matter, caudate nucleus, and cerebellum.
  • 24.
    • Attention-Deficit/Hyperactivity Disorder
      • The Reticular Activating System
        • Decreased NE activity in RAS
        • Poor attention, learning difficulties, memory deficits, lack of behavior control
        • Treatment with amphetamines increase RAS activity
        • Increased RAS activity
        • Hyperactivity, restlessness, hyper vigilant
        • Treatment may include Clonadine (NA Antagonist)
  • 25.
    • Attention-Deficit/Hyperactivity Disorder
      • Drug Treatment
        • Adderall amphetamine
        • Concerta methylphenidate
        • Cylert pemoline*
        • Dexedrine dextro-amphetamine
        • Ritalin methylphenidate
        • * DA agonist? Mechanism not well described
  • 26.
    • Stress Disorders
      • Stress:
        • A pattern of physiology common to all stressors
      • Stressor:
        • A stimulus (or situation) that produces a generalized stress response.
  • 27.
    • Stress Disorders
      • Fight-or-flight response:
        • First stage of the stress response where organism is mobilized.
        • Changes in hormonal and sympathetic activity in preparation for response.
  • 28.
    • Stress Disorders
      • Physiology of Stress
      • Glucocorticoid (cortisol)
        • One steroid hormone of the adrenal cortex that is important in protein and carbohydrate metabolism, secreted especially in times of stress.
  • 29.
    • Stress Disorders
      • Physiology of Stress
      • Corticotropin-releasing hormone (CRH):
        • A hypothalamic hormone that stimulates the anterior pituitary gland to secrete ACTH.
      • Adrenocorticotropic hormone (ACTH):
        • A hormone released by the anterior pituitary gland in response to CRH; stimulates the adrenal cortex to produce glucocorticoids.
  • 30. Copyright © 2004 Allyn and Bacon
  • 31. Copyright © 2004 Allyn and Bacon
  • 32.
    • Stress Disorders
      • Psychoneuroimmunology
      • Psychoneuroimmunology:
        • The branch of neuroscience involved with interactions between environmental stimuli, the nervous system, and the immune system.
      • Antigen:
        • A protein present on a microorganism that permits the immune system to recognize the microorganism as an invader.
  • 33.
    • Stress Disorders
      • Psychoneuroimmunology
      • Antibody:
        • A protein produced by a cell of the immune system that recognizes antigens present on invading microorganisms.
      • B-lymphocyte:
        • A white blood cell that originates in the bone marrow; part of the immune system.
  • 34.
    • Stress Disorders
      • Psychoneuroimmunology
      • Immunoglobulin:
        • An antibody released by B-lymphocytes that bind with antigens and help to destroy invading microorganisms.
      • T-lymphocytes:
        • A white blood cell that originates in the thymus gland; part of the immune system.
  • 35.
    • Stress Disorders
      • Psychoneuroimmunology
      • Cytokine:
        • A category of chemicals released by certain white blood cells when they detect the presence of an invading microorganism; causes other white blood cells to proliferate and mount an attack against the invader.