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High levels of fear when faced with a stressor

reduction in ability to recover from the stressor

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Can be done through both pharmaceuticals and therapies

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Direct causes are unknown

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The exact neurobiology that is the underlying cause of the development of these anxiety disorders is unknown, but there are generalizations in place to give us parameters of this disorder

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A group of psychiatric conditions that affects 1 in 4 individuals. This disorder is characterized by excess fear, anxiety, avoiding perceived threats and in some, even panic attacks.

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normal response to real and perceived dangerous situations

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diagnosis of anxiety disorders involves clinical interviews to determine for which specific anxiety disorder the diagnostic criteria are met, and to distinguish the symptoms from other psychiatric disorders

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Amygdala-driven fear and anxiety
are regulated through
bidirectional connections to the
ventromedial prefrontal cortex
and the anterior cingulate cortex,
as well as functional crosstalk
between these regions and the
hippocampus

Amygdala hyperactivation along
with diminished vmPFC activity to
threat cues have repeatedly been
found in patients

Source: Class Notes

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Coordinated reaction to
threatening stimuli
• Release of Cortisol from the adrenal
glands
• Activation of the sympathetic
division of the Autonomic Nervous
System
• Increased vigilance and arousal
• Avoidance Behavior

Source: Class Notes

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Stress response:
• Input from the amygdala activates
the Parvocellular Neurosecretory
Cells to release corticotropin-
releasing hormone (CRH) in the
hypothalamus
• CRH travels to the anterior
pituitary gland and stimulates the
release of corticotropin or
adrenocorticotropic hormone
(ACTH)
• ACTH enters the general circulation
and travels to the adrenal cortex

ACTH can stimulate the adrenal
cortex to produce the steroid
cortisol
Cortisol triggers 2 major
responses in the brain:

Source: Class Notes

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Reduces release of CRH (shutting
down the circuit)

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Activates the Sympathetic Division
of the Autonomic Nervous System

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The sympathetic division of the
Autonomic Nervous System
activates a wide range of tissues
and organs, preparing them for
action

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The Hippocampus contains high
levels of glucocorticoid receptors
that are activated by cortisol
• Cortisol activation of the
hippocampus and crosstalk with
the ventral medial prefrontal
cortex results in an inhibitory
signal being sent to the
Hypothalamic-Pituitary-Adrenal
(HPA) axis, shutting down
cortisol release

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Responsible for 30% of overall risk; however, anxiety disorders are multi-genic and have a low effect size of genes

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CRHR1 (corticotropin-releasing factor receptor 1)
• COMT (catechol-O-methyltransferase) (inhibits catecholamines)
• 5-HTTLPR (serotonin-transporter-linked promoter region)
• HTR1A 5-hydroxytrptamine receptor 1A (serotonin receptor)
• MAOA (monoamine oxidase A)
* Concerns regarding false positives
* Concerns that genes may be specific to particular types of anxiety
* Concerns that sufficient study sizes to identify risk factors may be difficult to achieve

Source: Class Notes

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• SATB1
• (Special AT-rich sequence-binding
protein-1) is a global regulator that
influences expression of multiple genes
important in neuronal development
(including corticotropin releasing
hormone)
• ESR1
• Estrogen receptor, has been a focus in
animal models of anxiety-like behaviors
• LINC01360 /LRRIQ3
• Long non-coding RNAs, likely involved in
transcriptional regulation
• MAD1L1
• Mitochondrial protein previously
associated with bipolar disorder
• OPRL1
• Amygdala nociception/orphanin FQ
receptor involved in learning and
memory and anxiety and fear-related
behaviors

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• Thought to be environmental + genetic
• Often concurrent social anxiety and/or phobia
• Neglect, abuse, poor social/family relations
• Speech or language problems

Source: Class Notes

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Bind to GABA receptors and make
them more responsive to the inhibition
by the GABA neurotransmitte

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Poorly understood mechanism likely
resulting from structural or functional
change due to higher levels of
serotonin in the brain

Source: Class Notes

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Psychotherapies in the form of Cognitive Behavioral and/ or Exposure Therapy

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More days than not, the patient experiences anxiety and worry covering multiple domains from school performance to work, and has an overall difficulty controlling this

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Anxiety, fear, and/ or avoidance of social interactions where one may be the focus of attention or even scrutinized

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Marked anxiety or fear caused by separation from attachment figures that is developmentally inappropriate for the person's age

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Patient consistently fails to speak in certain social situations where it is typically expected for one to speak, despite speaking in other situations

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Unexpected and recurrent panic attacks

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Woman are 60% more likely to experience anxiety over their lifetime

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Hispanics are 30% less likely than non-Hispanic whites to experience anxiety disorders

Non-Hispanic Blacks are 20% less likely to experience anxiety than non-Hispanic whites

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8% of teens (13-18) have an anxiety disorder

42 million adults (18 and older) are affected by anxiety disorders