The document provides an overview of the neurobiological understanding of anxiety disorders. It discusses the key brain regions involved like the amygdala and prefrontal cortex. The amygdala is involved in processing fear and aversive memories, while the prefrontal cortex helps regulate amygdala responses. Anxiety disorders are thought to involve hyperactivity in the amygdala and weaker regulation from the prefrontal cortex. The document also discusses the roles of early life stress, genetics, and developmental factors in anxiety disorders.
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
The Neurobiology of Depression (Dr Imran Waheed)Imran Waheed
A lecture delivered in the West Midlands by Dr Imran Waheed, Consultant Psychiatrist, on The Neurobiology of Depression. For further information visit www.bhampsych.com
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
AllCEUs provides counseling education and CEUs for LPCs, LMHCs, LMFTs and LCSWs as well as addiction counselor precertification training and continuing education.
Live, Interactive Webinars ($5): https://www.allceus.com/live-interactive-webinars/
Unlimited on-demand CEUs ($59): https://allceus.com
Specialty Certificate Tracks ($89): https://www.allceus.com/certificate-tracks/
Addiction Counselor Certification Training ($149): https://www.allceus.com/certificate-tracks/addictions-counselor-certification-training/
Presentation delivered at Women in Transition: a weekly support group offered at Kaiser Permanente Adult Psychiatry. Cupertino, California. Presented by Lucia Merino, LCSW.
Pyschotherapist.
Rings In (Candidate) Drugs - Case StoriesJonas Boström
Selected project impacts from over a decade of using insights from computational chemistry Focus on heterocyclic rings in candidate drugs discovered at AstraZeneca/CVMD and the strategies used in their design. The case stories will include a wide variety of examples, such as (i) replacing unwanted functional groups like acids and esters with heterocyclic rings, (ii) using rings for geometrical reasons and (iii) using heterocyclic rings to fine-tune electrostatics to obtain improved properties. In most cases the key computational approach for designing candidate drugs has been the use of shape and electrostatic comparisons between molecules. The role of luck is also discussed.
Trauma at the End of Life: Somatic Experiencing and Other Touch Based Treatme...Michael Changaris
This paper explores the use of touch in working with elders. It explores neurodegenerative disorders, challenges working with individuals with cognitive changes and how to develop a treatment plan that includes safe therapeutic touch.
Generalized anxiety disorder (GAD) is marked by excessive exaggerated anxiety and worry about every day life events for no obvious reason.People with GAD tend to always expect disaster and can't stop worrying about health,family,work or school.
How Pornography Affects Developing Brains - Dr. Jennifer Brownucap4utah
Dr. Jennifer Brown has done extensive research on the effects of pornography on children's developing brains. This PowerPoint presentation details some of the main points of her study. Dr. Brown presented this information to the Prevent Child Abuse Utah Joining Forces Conference in October 2014. This research was also instrumental in passing S.B. 227 in Utah to allow a judge to reduce or restrict custody if a parent has intentionally exposed their child to pornography.
This presentation explores neuroscience from critical perspectives. It expands brain-centred neuroscience by incorporating research findings from somatic psychology and contemporary genetics.
Running head PSYCHIATRIC DISORDER .docxtoltonkendal
Running head: PSYCHIATRIC DISORDER 1
PSYCHIATRIC DISORDER 6
Psychiatric Disorder
Student’s Name
University Affiliation
Course Title
Date
Psychiatric disorder
Depression is one of the most common mental disorders found in the world. Current studies indicate that depression may result from genetic, biological, environmental, and psychological factors. People of all ages are susceptible to depression but the elderly are at a high risk than the young. In the brain, depression starts with simple chemical imbalances. Communication within the brain and to and fro the rest of the body is via the chemical transmitter, known as neurotransmitters. The brain limbic system has been a key interest for many researchers as it comes to anxiety, stress and depression. There exists relationship between depression and the functioning of three primary neurotransmitters; serotonin, norepinephrine, and dopamine.
Serotonin is a neurotransmitter that is associated with the control of many crucial bodily operations such as aggression, sleeping, sexual behavior, mood, and eating. The production of serotonin is in the serotonergic neurons. Some people are likely to suffer depression with a drop in the production of serotonin in the neurons. The resultant mood is one that is more particularly associated with individuals feeling suicidal.
Early studies suggested that an existence of neurotransmitter norepinephrine deficiency in some certain areas of the brain resulted in depression. Recent follow up studies also shows that there is a group of individuals with a depression disorder who exhibit low levels of the chemical norepinephrine. In autopsy studies, it has been shown that in comparison, people who lives have been marred with a recurrence of depressive episodes possess lesser norepinephrinergic neurons unlike those who have not had depressive history. Norepinephrine assist our bodies detect and respond to stressful instances. People who are susceptible to depression have a norepinephrinergic system which does not take care of the effects of stress very efficiently.
Dopamine is another chemical transmitter in the brain associated with depression. The neurotransmitter plays a critical part in controlling our motivation to seek out reward, also the ability to get a sense of pleasure. Low levels of dopamine may partly explain as to why some individuals suffering from depression do not get the same pleasure sense from people are activities that they used to before falling into depression.
Evidence is ever increasing to support the hypothesis that stress and the accompanying depression could involve structural variations in the brain. The resultant changes of depression are known as remodeling. An occurrence of remodeling due to stress can be prevented or even potentially tu ...
London iCAAD 2019 - Daniel Souery - A TRANSDIAGNOSTIC APPROACH FOR PSYCHIATRI...iCAADEvents
Diagnostic approaches applied in psychiatry are often criticized and deemed unsatisfactory because of their relative lack of reliability and validity. One reason for this complexity lies in the purely symptomatic approach to diagnosis. This approach also results in misdiagnosis, difficulties and high risk of aberrant therapeutic choices. The problem is also the source of great difficulty in differentiating the normal from the pathological in situations of emotional and psychological distress that should not be the subject of a psychiatric diagnosis.
The presentation focuses on psychopaths- who are they, their traits, brain abnormalities, genetic basis, electrophysiological deficits, socialization function by brain
Biopsychosocial Model in Psychiatry- Revisited.pptxDevashish Konar
Over time our understanding of Psychiatric illnesses has undergone sea changes but yet the age old Bio-psycho-social model of etiology remains relevant. This presentation is an effort to explore the model in context of the newer developments.
Preventive psychiatry in india: Preventing on Child Psychiatric FrontDevashish Konar
Parenting training of would-be-parents, early detection of vulnerable children and timely intervention are some of the efforts that will give large dividend. We have very limited number of child psychiatrists. So including general psychiatrists, pediatricians, family physicians, health workers and teachers would be the most suited public health strategy for India. They need to be trained to work within their limits and need to learn to refer at the right time without wasting precious time of the growing children and adolescents.
Road map for social psychiatry in 21 st centrury role of industry -Devashish Konar
Psychiatry has to move in tandem with industry for its next level of development. Closer association with Pharmaceutical, Biomedical and Digital industries will be important in the road map of Social Psychiatry in 21st century.
Iacapap workshop on PRESCRIBING FOR CHILDREN AND ADOLESCENTS: PERSPECTIVE FR...Devashish Konar
Discusses the best way to reach the minimum important information to professionals who deal with mental health of children and adolescents and prescribe psychotropic medicines to them.
Regeneration of Brain with new understanding gives us good ground to be optimistic in matters of research and also day to day clinics. This presentation at the most introduces you to the potential stride of the field.
ADHD is no more understood as a behavior disorder characterized by hyperactivity in children and excessive restlessness or impulsivity in adults.
We need to re-conceptualize ADHD as essentially a cognitive disorder, a developmental impairment of executive functions (EFs), the self management system of the brain.
STRIKE THE RIGHT BALANCE WHILE PRESCRIBING PSYCHOTROPICS TO CHILDREN IN DEVEL...Devashish Konar
In case of children you need to be doubly cautious while prescribing psychotropic medicine. This presentation should help those who work in developing countries like India.
POSITIVE PARENTING : PERSPECTIVES AND PRINCIPLES OF PARENTING WITH INDIAN EMP...Devashish Konar
This presentation should help in providing a cultural perspectives in parenting. Indian parents may find some stimulating thoughts and students of cross cultural parenting should find Indian perspective as observed by a child psychiatrist.
Children's cause needs to be taken up urgently by the society. Understand their needs and be their advocate. Give them a happy childhood and great future to look forward to.
Psychiatrist practicing for 25 years shares his views and experiences to help new parents and would be parents to sensitize them to the issues of child rearing.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. INTRODUCTION
• Last century witnessed remarkable change in almost all
spheres of life. Whether you like or not, whether you are able
to take the change or not, life is ever changing.
• Demands of life is exponentially increasing.
• Personal aspiration, family support, the environment, the way
we work, the way we communicate, the way we travel, the way
we love or hate each other and everything else is changing all
the time.
• As we approach future the pace of change is going to be faster.
Changes are for good and also for bad.
• Changes are good for those who can accommodate and take
things into command and bad for those who lose control and
are victim of its adverse consequences, anxiety being one.
2
3. INTRODUCTION
• Adapting is not easy, there has to be conscious effort on part of human
beings.
• One such endeavor is to have neurobiological understanding of anxiety so
that we know what goes wrong and what we need to do.
• Anxiety/fear is a normal reaction to threatening situations and it represents a
physiologically protective function.
• Anxiety/fear is often manifested as avoidance and is also characterized by
overt sympathetic reactions.
• Pathological anxiety is a level of anxiety that is disproportionate to the threat
and can be manifested even in the absence of threat.
• In clinical practice, categorical systems set the boundary at which a particular
level of anxiety becomes an anxiety disorder.
(Toth & Zupan, 2007)
3
4. NEUROANATOMY AND CIRCUITRY
• Recent years have witnessed an explosion of interest focused on
the interplay of emotion and cognition.
• Anxiety Disorders involve prominent disturbances of both
cognition and emotion, suggesting that they can be
conceptualized as disorders of the emotional-cognitive brain.
• The amygdala and Pre Frontal Cortex are key components of
human fear neurocircuitry.
• The amygdala and PFC are interconnected with the PFC
modulating amygdala responses.
• In Anxiety Disorders the fear production system is too strong and
the fear regulation system is too weak.
(Blackford & Pine 2012)
4
5. AMYGDALA IS AN INTEGRAL PART OF CIRCUITRY
MAINTAINING MEMORIES FOR AVERSIVE EVENTS
Amygdala
Hypothalamus
Pituitary
Adrenal
Cortisol 5
6. AMYGDALA AT THE CENTRE-STAGE
• The amygdala is a well-known epicenter for the
emotional "understanding" of stimuli.
• In other words, the amygdala helps the brain to
remember the averseness of otherwise neutral stimuli.
• Therefore, the amygdala is an integral part of the
circuitry maintaining memories for aversive events.
• Clinical studies based on animal data consistently point
to amygdala hyperactivity in anxiety disorders.
6
7. THIS IS HOW THE CLASSICAL STRESS HORMONE
CORTISOL WORKS:
Cortisol
Norepinehprine & Adrenaline
Palpitation, Tremor, Slow
Digestion & Psychological Fear and Apprehention
(Vergne 2014)
7
8. EXTRAHYPOTHALAMIC STRESS AXIS
• The extrahypothalamic stress axis is another way in which brain
uses norepinephrine through the amygdala, bypassing pituitary
and adrenal cortisol.
• The amygdala has received substantial attention as a core
component of fear circuitry; however, other brain regions are
also involved in fear and anxiety.
• For example, the bed nucleus of the stria terminalas (BNST) – a
part of the “extended amygdala”- is involved in sustained fear
reactions (in contrast to short-term or phasic fear responses) in
rodents.
• These sustained reactions, which are elicited by less specific and
less predictable threats, are maintained over time and are
considered akin to anxiety in humans.
(Blackford & Pine 2012)
8
9. THE PREFRONTAL CORTEX CONNECTION
• And then comes the role of prefrontal cortex which connects to the amygdala
through multiple regions.
• However, interest focuses primarily on GABA ( aminobutyric acid)-ergic
neurons, emphasizing an inhibitory role for the PFC over amygdala function.
• At least in some contexts, neuroimaging studies in humans show an inverse
relationship between the amygdala and multiple PFC regions including
vmPFC, vIPFC, dmPFC, and dlPFC.
• Particularly for the vlPFC and vmPFC, these findings suggest inhibitory input.
(Blackford & Pine 2012)
• In anxiety disorder there is abnormal effective top down or cognitive
modulation of anxious states and that makes it very difficult for the thinking
brain to shut down the irrational anxiety.
(Vergne 2014)
9
10. AETIOLOGY: EVOLUTION
• Appreciation of the differences that have evolved is how organisms
successfully use a behavioral state, anxiety, in avoiding threats to their
survival.
• As soon as animals evolved, more than one kind of response to danger
came into picture and more kinds of receptor came into play that could
detect cues before the imminent injury.
• It became advantageous for them to enter into an intervening state
between stimulus and response.
• The evolution of the limbic system of the brain has made possible an
enormous amplification of the kinds of possible intervening emotional
states, creating a variety of qualitatively different anxieties.
• The evolution of the cerebral cortex has vastly expanded capabilities for
learning and memory so that long –past experiences, as well as recent
ones, play important roles in eliciting anxiety and in shaping the
information processing during the state.
10
11. AETIOLOGY: EVOLUTION
• The extent of parallel processing that has become possible in the primate brain
has increased the extent of self-regulation within the system to the point that
self-awareness and what we call consciousness has emerged.
• This creates a whole new order of response to anxiety-namely, the inner
subjective experience of it.
• Finally, the advent of symbolic communication in language has made it possible
for us to communicate that experience to one another.
• This, in turn, has led to a wealth of verbal interactions that can alleviate or
perpetuate anxiety and can avoid or create new dangers.
• Insights into the evolution of anxiety can be clinically useful. This
understanding can provide the basis for a variety of psychotherapeutic
interventions.
(Stein 2002)
11
12. EARLY LIFE STRESS
• Early life stress in the form of maternal deprivation or neglect has
provided a model for the study of susceptibility to
neuropsychiatric disorders.
• Much work on the genetic and epigenetic consequences of early
life stress has yielded important clues about their effects on
neurotransmitter systems that sub serve emotional tone.
• Corticotropin-releasing factor is a key system for understanding
the long-term effects of early life stress on emotional regulation.
• For example, a blunted cortisol response to psychosocial stress is
common in individuals who have experienced early life stress,
whereas a comparison cohort shows a normal response.
• A blunted cortisol response points to impaired hypothalamus-
pituitary-adrenal (HPA) axis reactivity, which is seen in victims of
trauma and has been correlated with PTSD and anxiety disorders.
(Vergne 2014)
12
13. DEVELOPMENTAL STAGES AND ANXIETY
• In children different anxiety disorders appear at different
developmental stages.
• To some extent they are normal.
• If excessive, they may get a diagnostic tag.
• Stranger anxiety appear around 8 to 12 months of age.
• Separation anxiety is typically evident around 10 to 18 months.
• Social phobia typically arises in adolescence.
(Blackford & Pine 2012)
13
14. EXCITOTOXICITY :
CELL DEATH FROM EXCESSIVE OXIDATION
• In the hippocampus, models of early life stress show down-regulation
of corticotropin-releasing factor receptors.
• This has been linked to excessive glutamate neurotransmission and
hippocampal cell death owing to glutamate-mediated excitotoxicity
(cell death from excessive oxidation).
• In other words, adaptive responses to trauma can become
maladaptive, at least in part as a result of genetic and molecular
changes.
• These changes lead to alterations in receptor pharmacology that
perpetuate the deleterious physiologic and psychological effects of
trauma.
14
15. DEVELOPMENTAL STAGES AND ANXIETY
• Early life trauma in the form of abuse and neglect has repeatedly
shown a tendency for an overactive HPA stress-response axis.
• Effect of trauma on the methylation of glucocorticoid receptors
explain the hyper reactive stress response of individuals with PTSD.
• In other words, it is not necessarily all about the serotonin receptor
genotype, but about the combination of epigenetic (methylation)
and environmental factors.
15
16. GENETIC STUDIES
• There is definitive evidence that at least some genetic component
contributes to the development of anxiety disorder.
• Panic Disorder is thought to be the most heritable of the anxiety
disorders.
• First-degree relatives of proband patients who have Panic
Disorder have a sevenfold increased likelihood for Panic Disorder
and also have an increased risk for phobic disorders.
• Twin studies suggest that 30% to 40% of the variance in
vulnerability for Panic Disorder is derived from genetic factors
and the remainder from individual-specific, but not shared,
environment/life experiences.
(Martin et al. 2009)
16
17. GENETIC STUDIES
• The figures for other anxiety disorders, although not as high,
also indicate a higher frequency of the illness in first-degree
relatives of affected patients than in the relatives of nonaffected
persons.
• Clearly a linkage exists between genetics and anxiety disorders,
but no anxiety disorder is likely to result from a simple
Mandelian abnormality.
• One report has attributed about 4 percent of the intrinsic
variability of anxiety within the general population to a
polymorphic variant of the gene for the serotonin transporter,
which is the site of action of many serotonergic drugs.
• Persons with the variant produce less transporter and have
higher levels of anxiety.
(Sadock et. al 2015)
17
18. GENETIC STUDIES
• Corticolimbic connectivity, in the context of genetic
polymorphisms has been studied.
• SLC6A4 is the gene coding for the serotonin transporter, the
protein that picks up serotonin from the synaptic cleft after
neurotransmission.
• It may confer vulnerability or protection.
• The s allele confers vulnerability for anxiety and depression.
• The amygdala is overactive in patients carrying the s allele.
(Vergne 2014)
18
19. IMPLICATION OF GENETICS IN TREATMENT
• At some point in the future, it is expected that some of these
genetic findings will be translated to clinical tests for the
presence of risk factors for anxiety and depression.
• Some evidence shows that antidepressants and psychotherapy
may revert epigenetic modifications in affected patients,
although much work still needs to be done.
• It is imperative that we understand how the environment may
interact with biology to induce illness.
(Vergne 2014)
19
20. BRAIN IMAGING STUDIES
• A range of brain imaging studies, almost always conducted with a
specific anxiety disorder, has produced several possible leads in
the understanding of anxiety disorders.
• Structural studies- for example, CT and MRI occasionally show
some increase in the size of cerebral ventricles.
• In one study, the increase was correlated with the length of time
patients had been taking benzodiazepines.
• In one MRI study, a specific effect in the right temporal lobe was
noted in patients with panic disorder.
• Some type of cerebral asymmetries may be important in the
development of anxiety disorder symptoms in specific patients.
• Functional brain imaging have variously reported abnormalities
in the frontal cortex; the occipital and temporal areas; and, in a
study of panic disorder, the parahippocampal gyrus.
20
21. BRAIN IMAGING STUDIES
• In posttraumatic stress disorder, fMRI studies have found increased activity in
the amygdala, a brain region associated with fear.
• In anxiety disorder there is demonstrable, functional, cerebral pathology.
(Sadock et. al. 2015)
• During adolescence amygdala function is enhanced relative to PFC function,
resulting in an over-contribution of the amygdala to adolescent emotions and
behavior.
• As PFC development catches up during early adulthood, emotions and
behavior are stabilized.
• This amygdala-PFC imbalance may contribute to the increased prevalence of
anxiety disorders during early adolescence.
• In developing phase there is imbalance between the early maturation of
subcortical regions, such as the amygdala, and late maturation of PFC
regions.
(Blackford & Pine 2012)
21
23. GLUTAMATERGIC SYSTEM AND OTHER
ACTIVE AREAS OF RESEARCH
Some of the active areas of research holds promise for
expanding and improving evidence-based treatment
options for individuals suffering with clinical anxiety:
• Glutamatergic system
• Neuropeptides substance P
• Neuropeptide Y
• Oxytocin
• Orexin
• Galanin
(Sanjay et. al. 2008)
23
24. NEUROPEPTIDE Y
• Neuropeptide Y (NPY) is a highly conserved 36-amino acid peptide
in mammalian brain.
• Evidence suggesting the involvement of the amygdala in the
anxiolytic effects of NPY is robust, and it probably occurs via the
NPY-Y1 receptor.
• Preliminary studies in special operations soldiers under extreme
training stress indicate that high NPY levels are associated with
better performance.
GALANIN
• Galanin is a peptide that, in human, contains 30 amino acids.
• Studies in rats have shown that galanin administered centrally
modulates anxiety-related behaviors.
(Sadock et. al. 2015)
24
25. IMPLICATION OF NEUROBIOLOGY IN THE
TREATMENT OF ANXIETY DISORDERS
• Abnormalities in amygdala pathways can affect the acquisition and expression of
fear conditioning.
• Drugs such as glutamate N-methyl-D-aspartate (NMDA) antagonists, and blockers
of voltage-gated calcium channels, in the amygdala, may block these effects.
• Finally, fear extinction, which entails new learning of fear inhibition, is central to
the mechanism of effective anti-anxiety treatments.
• Several pharmacological manipulations, such as D-cycloserine, a partial NMDA
agonist, have been found to facilitate extinction.
• There is also preliminary evidence for the use of centrally acting beta-adrenergic
antagonists, like propranolol, to inhibit consolidation of traumatic memories in
PTSD.
• Combining these medication approaches with psychotherapies that promote
extinction, such as cognitive behavioral therapy (CBT), may offer patients with
anxiety disorders a rapid and robust treatment with good durability of effect.
(Garakani A et. al 2006)
25
26. CONCLUSION
• Anxiety per se, and anxiety as comorbidity remains
psychiatrist’s major preoccupation.
• Both, ability to give immediate relief, as well as, ability to
correct the disorder are equally important.
• Bracing up with the knowledge of neurobiology of anxiety
and ability to translate it into clinical practice is an
important part in building up acumen for successful
psychiatric practice.
• Expecting changes in understanding of the disease and
being open to modification in your understanding and
practice in the field of anxiety will be the mantra for the
future.
26
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