NEUROSCIENCE

DEVELOPMENT OF SYMPTOMS OF ANXIETY AND

DEPRESSION
By: Dr. Benignos

Anxiety disorders are conceptualized as abnormalities in the

regulation of fear states.

FEAR VS, ANXIETY

Fear is a response to a known threat influenced by presence of
How does symptom of anxiety arise?
external stimulus

Anxiety result from interactions among multiple risk Anxiety is a response to a threat that is internal and vague
factors and underlying predispositions
ANXIETY

Current views on the underling origins of anxiety

o Anxiety disorders develop against a back- Experience by everyone
drop of underlying preclinical vulnerability Common characteristic
Diffuse unpleasant vague sense of apprehension often
o Anxiety disorders are developmental
accompanied by autonomic symptoms
conditions
o Headache
o Environmental factors exert profound direct
o Perspiration
effects on the symptoms of anxiety
o Palpitation
o Tightness in the chest
Anxiety d/o develops against the back drop of preclinical
o Stomach discomfort
vulnerability
o Restlessness
Studies:

Abnormal startle and respiration in healthy relatives of

Anxiety becomes a disorder when it affects major
patients with anxiety disorders
areas of functioning

Cognitive style or symptomatic precursors of anxiety,

Symptoms of Anxiety
includes anxiety sensitivity, negative affectivity,
(aversive mood states, including anger, contempt, 2 Components:
1. Somatic awareness of physiological sensations
guilt fear and nervousness)
2. Cognitive awareness of being nervous or frightened

Family studies consistently note a strong assoc. bet.

o Others may recognize I am frightened
Anxiety in parents and their children
o Lowering concentration

Most adult anxiety disorders are preceded by an

o Reducing recall -> impaired memory
anxiety disorder during childhood.
o Confusion and distortion of Perception,
Anxiety disorders are developmental condition
person, time
Studies:

Temperamental factors measurable during first years Physical Effects of Anxiety Disorders
o Dizziness, decreased sex drive, irritability
of life, such as behavioral inhibition, predict later
onset of anxiety disorders
o Sweating
o Behavioral inhibition may predict an
o Chest pain
elevated risk for childhood anxiety
o Increased muscle tension
disorders, particularly social phobia.
o Rapid breathing & breathlessness
o Heart palpitations
Environmental factors exert profound direct effects on the
o Increased blood pressure
symptoms of anxiety
o Nausea and diarrhea
Studies:

Epidemiologic studies find that acute stress in the

Pathological Anxiety
form of life events predicts an increase in anxiety
Epidemiology:
symptoms over time.
o Most common among psychiatric disorders
o 12 month prevalence rate of 17.7%
FUNCTIONS OF ANXIETY
o Women 30.5%

normal and adaptive response that has life saving

o Men 19.2%
qualities

has advantage in functions of daily activities because

Psychosocial Factors
it prompts a person to take the necessary steps to
3 major schools of psychological theory explaining cause of
prevent the threat or lessen the consequence
anxiety:

ex:
1. Psychoanalytic Theory
o preparing from examination
o Anxiety develops as a result of Psychic conflict
o carefully crossing a narrow bridge
between conscience and id (wishes/wants from
o running to catch the early morning
external world)
endorsement.
2. Learning theory
o Anxiety is a learned response to a specific
environmental stimulus
CLINICAL TERMS
3. Existential theory

Mood Disorder
o A group of clinical condition characterized By a
loss of control associated with experience of
Biological Basis of Anxiety
great distress resulting to impairment in
Autonomic Nervous System
psychological and social functioning
o Increased sympathetic tone
o Categories of Mood disorder:
o CVS
o Major depressive disorder Unipolar
o GIT
depression
o Bipolar disorder manic episodes
o Muscular
All affective conditions
o Respiratory
o Share a core set of signs and symptoms
Neurotransmitter
o Undesirable alterations of mood and
Poorly Regulated
o Norepinephrine
feelings, thoughts, social behaviors and
physical functions.
o Locus cerolues in rostal pons
Essential feature
o Serotonin
o A change in mood from pleasant (euphoric) to
o Raphe nuclei in the rostal brain
unpleasant (dysphoric)
projecting to cerebral cortex and limbic
o Experienced as relatively pervasive, persisting
system
over time and place and sufficiently severe to
GABA
interrupt everyday functioning
o Inhibitory neurotransmitter
o Ligand gated ion channels (CI) found Epidemiology (Lifetime prevalence)
o MDD : 12%
in CNS
o Dysthymic : 5%
o Studies on Ablation of limbic system
o Bipolar disorder : 2.4%
(GABA sites) results in generation of
o Cyclothymia : 5-6.3%
anxiety
o Hypomania : 2.6-7.8%
o Enhancement of GABA a receptor result to
o Full Bipolar spectrum : 2.6-7.8%
amelioration of anxiety
o Anxiety treatment

Benzodiazepines
CLINICAL CONSTITUENT OF DEPRESSION
Hypothalamic Pituitary Adrenal Axis
o Accompanied by other sets of other features in
Many Forms of Psychological Stress increase the synthesis and
varying combination
release of Cortisol
o Negative and distorted cognitions about
o Mobilize and replenish energy stores and
the self
contributes to increase arousal, vigilance, focused
o Impaired concentration and attention
attention
o Alteration in eating, sleeping, energy
o Excessive and sustained cortisol:
and activity
o Hypertension
o Symptoms usually are elicited at interview
o Osteoporosis
through direct questioning with information
o Insulin resistance
occasionally obtained from other relatives,
o Dyslipidemia
teachers, or close friends
o Dyscoagulation
o Immunosuppression
DSM V MAJOR DEPRESSION CRITERIA
o Cardiovascular disease
5 or more in 2 weeks
Depressed mood most of the day
Anxiety Disorder
Marked diminished interest of pleasure in all activities
Panic disorder and agoraphobia
most of the day
Specific phobia

Significant weight loss in a month (r%)

Social phobia
Insomnia/hypersomnia
Obsessive compulsive disorder
Psychomotor retardation or agitation
Generalized anxiety disorder
Fatigue or loss of energy nearly everyday
Post Traumatic Stress disorder
Excessive guilt or worthlessness
MOOD DISORDERS
Diminished ability to think or concentrate
Mood:
Recurrent thoughts of death or suicidal ideation
o Sustained feeling tone that is experienced
internally
DEPRESSION
o Normal (euthymic)
o Mandatory presence of lowered mood
o Elevated
(dysphoria) together with four of eight other
o Depressed
possible non mandatory symptoms from the two
o

Anxiety is a response to perceived void in

existence and meaning

broad domains of disordered cognitions and

physical changes.
o Mood -dysphoria or irritability
o Cognitive anhedonia, feelings of
worthlessness, inappropriate guilt,
diminished ability to think or
concentrate, recurrent thoughts of death
o Physical weight change, fatigue or
loss of energy, psychomotor retardation
or agitation

Serotonin low levels in CSF concentration

of serotonin metabolites
o Dopamine reduced decreased dopamine
in the prefrontal cortex results to cognitive
impairment in depression (anhedonia)
Thyroid Axis
o 5-10% above previously undetected thyroid
function
o Blunted TSH response to thyroid releasing
hornone

Indicator of increased risk of

relapse despite antidepressant
o

Depression Among The Young

Symptoms in children - grumpy, gloomy, down,
irritable
Etiology:
Physical symptoms (somatic symptoms) such as
Psychosocial factors influencing biological factors:
abdominal pain, headache, limb pain, and malaise
Life events
(which are not part of the diagnostic criteria for
o Stress accompanying first episode or
depression) may be an index of affective disorders in
depression results in long lasting changes in
young people.
brain biology
Highest endorsed symptoms on a self-report measure
o -> results to long lasting change in the brain
were:
altering the functional states of
o Aches and pains (14.7 to 28.0%)
neurotransmitters and intraneuronal
o Sad effect (13% to 17%)
signaling system or may even include loss of
o Helplessness/hopelessness (12%)
neurons and excessive reduction in synaptic
Adolescents
components
o Common presentation
o -> risk of undergoing subsequent episodes of

Persistent sad mood, especially

mood disorder even without external
with overt functional impairment
stressor
are signs of developing depression
Cognitive Theory of Depression

Terminal insomnia, suicidal acts,

o Depression results from specific cognitive
and negative views about the
distortions that influence mood and behavior
world (but not necessarily
o Aaron Beck postulated cognitive triad of
negative thoughts about the self)
depression

Conduct problem may be

1. A negative self perception
symptoms of depression among
2. Tendency to experience the world as
the adolescents
hostile and demanding
3. Negative expectations and view of the
Biological Basis of Depression
future
Brain imaging
Genetic
Affected areas
o Family studies
o Prefrontal cortex

One parent 10-25 chance of

o Temporal lobe
inheriting disorder
o Basal ganglia

Both parents 20-50 chance of

Hippocampus
inheriting disorder
o Twin studies

Amygdala

Concordance rate for monozygotic

Caudate nucleus
50-70%
=Frontal lobe intellectual brain
=Thalamus central relay station
= Caudate Nucleus automatic thought transmission Factors Most Commonly Associated with Development of
Depression
= anterior Cingulate Gyrus mood
Life event
= Hippocampus memory and emotion
o Losing a parent before age 11
= Amygdala strong emotion/ fear/ panic
Environment stressor
Biogenic Amines
o Loss of spouse
o Norepinephrine decreased