Chapter 14

Anxiety state of apprehension, tension or uneasiness that stems from the

anticipation of danger, the source of which is largely unknown or unrecognized.
Types of Anxiety Disorders
Situational anxiety

experienced with a stressful environment

Motivates people to accomplish tasks in a prompt manner, if no other reason
than to eliminate the source of nervousness
May be intense, though patients often learn coping mechanisms to deal with
the stress, without seeking conventional medical intervention

Generalized anxiety disorder (GAD)

Difficult to control , a excessive anxiety that lasts 6 months or more

Focuses on a variety of life events or activities and interferes with
normal day to day functions
Common type of stress disorders
Symptoms include, restlessness, fatigue, muscle tension,
nervousness, inability to focus or concentrate, an overwhelming sense
of dread and sleep disturbances
Autonomic signs of sympathetic nervous system activation that
conduct anxiety include blood pressure elevation, heart palpation,
varying degrees of respiratory changes, and dry mouth.
Parasympathetic response consists of abdominal cramping,
diarrhea, fatigue, and urinary urgency
Women are more likely to experience GAD than men, highest in 20-35
age group

Panic disorder

Intense feelings of immediate apprehension, fearfulness, terror or impending

doom accompanied by increased autonomic nervous activity
Woman affect about twice as often as men( usually experience one or more
panic attacks)

Phobias

Fearful feelings attached to situations or objects

Examples: fear of snakes, spiders, crowds, or heights
Compel a patient to avoid a fearful stimulus entirely to the point that his
behavior is unnatural

Social Phobia- Fear of crowds

Performance anxiety- performances may experience feeling of dread,
nervousness, or apprehension

Obsessive compulsive disorder (OCD)

recurrent, intrusive thoughts or repetitive behaviors that interfere with

normal activity
example- exposure to germs, repetitive hand washing

Post traumatic stress disorder (PTSD)

response to re-experiencing a previous life event

traumatic life events such as war, physical or sexual abuse, natural disaster
or homicidal situations
These events may lead to a sense of helplessness and re-experiencing of the
traumatic event

Specific Regions of the brain responsible for anxiety and

wakefulness
Limbic system

Middle of the brain responsible for emotional expression, learning, and

memory
Signal through limbic ultimately connect with the hypothalamus
Emotional state associated with this connection include anxiety, fear, anger,
aggression, remorse, depression, sexual drive, euphoria
Hypothalamus
Responsible for unconscious response to extreme stress such as high
blood pressure, elevated respiratory rate, and dilated pupils (flight or
fight response of ANS)

Reticular formation(a nucleus where nervous signals ascend to higher

centers of the brain)

Hypothalamus connect with reticular formation, which is a network of

neurons found along the entire length of the brainstem
Stimulation cause heightened alertness and arousal, inhibition cause
general downiness and induction of sleep

Reticular Activating system (RAS)

Reticular formation found in RAS and projects from brainstem to the

thalamus
Responsible for sleeping and wakefulness and performs an alerting function
for the entire cerebral cortex
Helps a person focus attention on individual tasks by transmitting
information to higher brain centers

Mechanism

if no signal passes through RAS, no emotion related signals are sent

to brain results in brain activity.
If Signals come from hypothalamus proceed and routed through
RAS and to higher brain center. This pathway responsible for fear
and anxiety as well as restlessness and interrupted sleeping
pattern.

Anxiolytics- ability to relieve anxiety, are quite and effective

Provide treatment for phobia, PTSD, anxiety disorder, OCD and panic attack
Medication found within therapeutic categories such as CNS depressants,
emotional and mood disorder drug, antihypertensive agents,
antidysrhythmics