Chapter 17 Anxiety Disorders, Autistic Disorder, Attention-Deficit/Hyperactivity Disorder, and Stress Disorder
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Panic Disorder </li></ul></ul><ul><ul><li>Anxiety disorder: </li></ul></ul...
Copyright © 2004 Allyn and Bacon
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Panic Disorder </li></ul></ul><ul><ul><li>Anticipatory anxiety: </li></ul>...
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Panic Disorder Possible Causes: </li></ul></ul><ul><ul><li>Genetic origins...
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Obsessive-compuls...
<ul><li>Anxiety Disorders </li></ul><ul><li>Examples of obsessions: </li></ul><ul><ul><li>Concern for order </li></ul></ul...
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Possible Causes: ...
Copyright © 2004 Allyn and Bacon
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Possible Causes: ...
<ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Possible Causes: ...
<ul><li>Autistic Disorder </li></ul><ul><ul><li>Description: </li></ul></ul><ul><ul><li>Autistic Disorder: </li></ul></ul>...
<ul><li>Autistic Disorder </li></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Biological: </li></ul></ul><ul...
Copyright © 2004 Allyn and Bacon
<ul><li>Autistic Disorder </li></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Phenylketonuria (PKU): </li></...
<ul><li>Autistic Disorder </li></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Brain pathology: </li></ul></u...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Attention-deficit/hyperactivity disorder (ADHD): </...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Inattention   </li></ul></ul><ul><ul><ul><li>Often ...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Hyperactivity-Impulsivity </li></ul></ul><ul><ul><u...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Possible causes </li></ul></ul><ul><ul><ul><li>Ther...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><li>Other causes </li></ul><ul><ul><li>Possible correlation...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Brain structure involvement: </li></ul></ul><ul><ul...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>NIMH Child Psychiatry Branch studied 152 boys and g...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>The Reticular Activating System </li></ul></ul><ul>...
<ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Drug Treatment </li></ul></ul><ul><ul><ul><li>Adder...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Stress: </li></ul></ul><ul><ul><ul><li>A pattern of physiology common to al...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Fight-or-flight response: </li></ul></ul><ul><ul><ul><li>First stage of the...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Physiology of Stress </li></ul></ul><ul><ul><li>Glucocorticoid (cortisol) <...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Physiology of Stress </li></ul></ul><ul><ul><li>Corticotropin-releasing hor...
Copyright © 2004 Allyn and Bacon
Copyright © 2004 Allyn and Bacon
<ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Psychoneuroimmunology: </l...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Antibody: </li></ul></ul><...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Immunoglobulin: </li></ul>...
<ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Cytokine: </li></ul></ul><...
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Chapter 17 Anxiety Disorders, Autistic Disorder, Attention ...

  1. 1. Chapter 17 Anxiety Disorders, Autistic Disorder, Attention-Deficit/Hyperactivity Disorder, and Stress Disorder
  2. 2. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Panic Disorder </li></ul></ul><ul><ul><li>Anxiety disorder: </li></ul></ul><ul><ul><ul><li>A psychological disorder characterized by unrealistic fear and anxiety. 1. Panic disorder </li></ul></ul></ul><ul><ul><ul><li>2. obsessive compulsive behavior </li></ul></ul></ul><ul><ul><li>Panic Disorder: </li></ul></ul><ul><ul><ul><li>A disorder characterized by episodes of intense fear accompanied by symptoms such as shortness of breath and irregularities in heartbeat. </li></ul></ul></ul>
  3. 3. Copyright © 2004 Allyn and Bacon
  4. 4. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Panic Disorder </li></ul></ul><ul><ul><li>Anticipatory anxiety: </li></ul></ul><ul><ul><ul><li>A fear of having a panic attack; may lead to the development of agoraphobia. </li></ul></ul></ul><ul><ul><li>Agoraphobia: </li></ul></ul><ul><ul><ul><li>An unrealistic and intense fear of being away from home or other protected places. </li></ul></ul></ul><ul><ul><ul><li>In severe cases people will not leave home! </li></ul></ul></ul>
  5. 5. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Panic Disorder Possible Causes: </li></ul></ul><ul><ul><li>Genetic origins: </li></ul></ul><ul><ul><ul><li>Evidence supports some anxiety disorders may be inherited. Associated with joint hypermobility. </li></ul></ul></ul><ul><ul><li>Neurotransmitters: </li></ul></ul><ul><ul><ul><li>Serotonin and central benzodiazepine receptors may be involved in anxiety disorders. </li></ul></ul></ul><ul><ul><ul><li>Treated with benzodiazepines and occasionally SSRIs </li></ul></ul></ul><ul><ul><li>Brain Structures: </li></ul></ul><ul><ul><ul><li>Imaging studies suggest that the cingulate gyrus, prefrontal, and anterior temporal cortices are involved in panic attack. </li></ul></ul></ul>
  6. 6. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Obsessive-compulsive disorder: </li></ul></ul><ul><ul><ul><li>A mental disorder characterized by obsessions and compulsions. </li></ul></ul></ul><ul><ul><li>Obsession: </li></ul></ul><ul><ul><ul><li>An unwanted thought or idea with which a person is preoccupied. </li></ul></ul></ul><ul><ul><li>Compulsion: </li></ul></ul><ul><ul><ul><li>The feeling that one is obliged to perform a behavior, even if one prefers not to do so. </li></ul></ul></ul>
  7. 7. <ul><li>Anxiety Disorders </li></ul><ul><li>Examples of obsessions: </li></ul><ul><ul><li>Concern for order </li></ul></ul><ul><ul><li>Cleanliness, germs </li></ul></ul><ul><ul><li>Forbidden sexual thoughts </li></ul></ul><ul><li>Examples of compulsions: </li></ul><ul><ul><li>Hand washing </li></ul></ul><ul><ul><li>Checking </li></ul></ul><ul><ul><li>Collecting </li></ul></ul><ul><ul><li>Repeating behaviors (in and out of a door) </li></ul></ul>
  8. 8. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Genetic Origin: </li></ul></ul><ul><ul><ul><li>Evidence is beginning to accumulate suggesting that OCD might have a genetic origin. </li></ul></ul></ul><ul><ul><li>Family studies: </li></ul></ul><ul><ul><ul><li>Some research suggests OCD is associated with Tourette’s; a neurological disorder that appears during childhood. </li></ul></ul></ul><ul><ul><li>Treatment: </li></ul></ul><ul><ul><ul><li>SSRIs , tricyclic antidepressants (desipramine, clomipramine) </li></ul></ul></ul>
  9. 9. Copyright © 2004 Allyn and Bacon
  10. 10. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Tourette’s syndrome: </li></ul></ul><ul><ul><ul><li>A neurological disorder characterized by tics and involuntary vocalizations and sometimes by compulsive uttering of obscenities and repetition of the utterances of others. </li></ul></ul></ul><ul><ul><ul><li>Treatment with antipsycolics (dopamine antagonists, D2) </li></ul></ul></ul>
  11. 11. <ul><li>Anxiety Disorders </li></ul><ul><ul><li>Obsessive-Compulsive Disorder </li></ul></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Cingulotomy: </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul><ul><ul><ul><li>Only used on patients who are unresponsive to drug treatment. </li></ul></ul></ul>
  12. 12. <ul><li>Autistic Disorder </li></ul><ul><ul><li>Description: </li></ul></ul><ul><ul><li>Autistic Disorder: </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
  13. 13. <ul><li>Autistic Disorder </li></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Biological: </li></ul></ul><ul><ul><ul><li>Research and mental health professionals are convinced autism is caused by biological factors. </li></ul></ul></ul><ul><ul><ul><li>Between 2 and 3 percent of siblings of people with autism are themselves autistic. </li></ul></ul></ul><ul><ul><ul><li>There is a 70 percent concordance rate for monozygotic twins. </li></ul></ul></ul>
  14. 14. Copyright © 2004 Allyn and Bacon
  15. 15. <ul><li>Autistic Disorder </li></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Phenylketonuria (PKU): </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
  16. 16. <ul><li>Autistic Disorder </li></ul><ul><ul><li>Possible Causes: </li></ul></ul><ul><ul><li>Brain pathology: </li></ul></ul><ul><ul><ul><li>Heritable aspect of autism suggests the disorder is a result of structural or biochemical abnormalities in the brain. </li></ul></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
  17. 17. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Attention-deficit/hyperactivity disorder (ADHD): </li></ul></ul><ul><ul><ul><li>The principal characteristics of ADHD are inattention , hyperactivity , and impulsivity . These symptoms appear early in a child's life. </li></ul></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
  18. 18. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Inattention </li></ul></ul><ul><ul><ul><li>Often becoming easily distracted by irrelevant sights and sounds (hyper vigilant) </li></ul></ul></ul><ul><ul><ul><li>Often failing to pay attention to details and making careless mistakes </li></ul></ul></ul><ul><ul><ul><li>Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task </li></ul></ul></ul><ul><ul><ul><li>Often skipping from one uncompleted activity to another. </li></ul></ul></ul>
  19. 19. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Hyperactivity-Impulsivity </li></ul></ul><ul><ul><ul><li>Feeling restless, often fidgeting with hands or feet, or squirming while seated </li></ul></ul></ul><ul><ul><ul><li>Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected (lack of impulse control) </li></ul></ul></ul><ul><ul><ul><li>Blurting out answers before hearing the whole question (lack of impulse control) </li></ul></ul></ul><ul><ul><ul><li>Having difficulty waiting in line or taking turns. </li></ul></ul></ul>
  20. 20. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Possible causes </li></ul></ul><ul><ul><ul><li>There is strong evidence from family and twin studies for hereditary factors in a person’s likelihood of developing ADHD. </li></ul></ul></ul><ul><ul><ul><li>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). </li></ul></ul></ul><ul><ul><ul><li>Genetic investigations have supported the role of both dopamine D4 receptor gene (DRD4) and dopamine transporter gene (DAT1) in the vulnerability to the disorder. </li></ul></ul></ul><ul><ul><ul><li>The DRD4 gene has been postulated as a candidate gene for attention-deficit-hyperactivity disorder </li></ul></ul></ul><ul><ul><ul><ul><li>Lower DA binding in basal ganglia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Increased DA transport in frontal lobes </li></ul></ul></ul></ul>
  21. 21. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><li>Other causes </li></ul><ul><ul><li>Possible correlation between the use of cigarettes and alcohol during pregnancy. </li></ul></ul><ul><ul><li>Lead paints? </li></ul></ul><ul><ul><li>Sugar sensitivities? </li></ul></ul><ul><ul><li>Head injuries? </li></ul></ul>
  22. 22. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Brain structure involvement: </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul><ul><ul><ul><li>Candidates: </li></ul></ul></ul><ul><ul><ul><ul><li>Frontal lobes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Medial temporal lobes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Caudate nucleus </li></ul></ul></ul></ul>
  23. 23. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>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. </li></ul></ul>
  24. 24. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>The Reticular Activating System </li></ul></ul><ul><ul><ul><li>Decreased NE activity in RAS </li></ul></ul></ul><ul><ul><ul><li>Poor attention, learning difficulties, memory deficits, lack of behavior control </li></ul></ul></ul><ul><ul><ul><li>Treatment with amphetamines increase RAS activity </li></ul></ul></ul><ul><ul><ul><li>Increased RAS activity </li></ul></ul></ul><ul><ul><ul><li>Hyperactivity, restlessness, hyper vigilant </li></ul></ul></ul><ul><ul><ul><li>Treatment may include Clonadine (NA Antagonist) </li></ul></ul></ul>
  25. 25. <ul><li>Attention-Deficit/Hyperactivity Disorder </li></ul><ul><ul><li>Drug Treatment </li></ul></ul><ul><ul><ul><li>Adderall amphetamine </li></ul></ul></ul><ul><ul><ul><li>Concerta methylphenidate </li></ul></ul></ul><ul><ul><ul><li>Cylert pemoline* </li></ul></ul></ul><ul><ul><ul><li>Dexedrine dextro-amphetamine </li></ul></ul></ul><ul><ul><ul><li>Ritalin methylphenidate </li></ul></ul></ul><ul><ul><ul><li>* DA agonist? Mechanism not well described </li></ul></ul></ul>
  26. 26. <ul><li>Stress Disorders </li></ul><ul><ul><li>Stress: </li></ul></ul><ul><ul><ul><li>A pattern of physiology common to all stressors </li></ul></ul></ul><ul><ul><li>Stressor: </li></ul></ul><ul><ul><ul><li>A stimulus (or situation) that produces a generalized stress response. </li></ul></ul></ul>
  27. 27. <ul><li>Stress Disorders </li></ul><ul><ul><li>Fight-or-flight response: </li></ul></ul><ul><ul><ul><li>First stage of the stress response where organism is mobilized. </li></ul></ul></ul><ul><ul><ul><li>Changes in hormonal and sympathetic activity in preparation for response. </li></ul></ul></ul>
  28. 28. <ul><li>Stress Disorders </li></ul><ul><ul><li>Physiology of Stress </li></ul></ul><ul><ul><li>Glucocorticoid (cortisol) </li></ul></ul><ul><ul><ul><li>One steroid hormone of the adrenal cortex that is important in protein and carbohydrate metabolism, secreted especially in times of stress. </li></ul></ul></ul>
  29. 29. <ul><li>Stress Disorders </li></ul><ul><ul><li>Physiology of Stress </li></ul></ul><ul><ul><li>Corticotropin-releasing hormone (CRH): </li></ul></ul><ul><ul><ul><li>A hypothalamic hormone that stimulates the anterior pituitary gland to secrete ACTH. </li></ul></ul></ul><ul><ul><li>Adrenocorticotropic hormone (ACTH): </li></ul></ul><ul><ul><ul><li>A hormone released by the anterior pituitary gland in response to CRH; stimulates the adrenal cortex to produce glucocorticoids. </li></ul></ul></ul>
  30. 30. Copyright © 2004 Allyn and Bacon
  31. 31. Copyright © 2004 Allyn and Bacon
  32. 32. <ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Psychoneuroimmunology: </li></ul></ul><ul><ul><ul><li>The branch of neuroscience involved with interactions between environmental stimuli, the nervous system, and the immune system. </li></ul></ul></ul><ul><ul><li>Antigen: </li></ul></ul><ul><ul><ul><li>A protein present on a microorganism that permits the immune system to recognize the microorganism as an invader. </li></ul></ul></ul>
  33. 33. <ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Antibody: </li></ul></ul><ul><ul><ul><li>A protein produced by a cell of the immune system that recognizes antigens present on invading microorganisms. </li></ul></ul></ul><ul><ul><li>B-lymphocyte: </li></ul></ul><ul><ul><ul><li>A white blood cell that originates in the bone marrow; part of the immune system. </li></ul></ul></ul>
  34. 34. <ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Immunoglobulin: </li></ul></ul><ul><ul><ul><li>An antibody released by B-lymphocytes that bind with antigens and help to destroy invading microorganisms. </li></ul></ul></ul><ul><ul><li>T-lymphocytes: </li></ul></ul><ul><ul><ul><li>A white blood cell that originates in the thymus gland; part of the immune system. </li></ul></ul></ul>
  35. 35. <ul><li>Stress Disorders </li></ul><ul><ul><li>Psychoneuroimmunology </li></ul></ul><ul><ul><li>Cytokine: </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>

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