stress, anxiety, OCD, addiction & ADHD

• Stress activates the sympathetic branch of autonomic nervous system; direct neuronal connections trigger the adrenal glands (above the kidneys) to release epinephrine and norepinephrine into the blood. • Stress also activates the HPA axis (Hypothalamus- Pituitary-Adrenal gland), which refers to the hormone signaling cascade that increases glucocorticoid signaling in the blood. – First, the hypothalamus releases the hormone CRH. – This causes the pituitary to release the hormone ACTH into the blood. – In turn, the adrenal glands release glucocorticoids, primarily cortisol, into the blood. Together, epinephrine, norepinephrine, and cortisol (a glucocorticoids) prime the body to react to a stressor by increasing heart rate, blood pressure, and blood flow.

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• Glucocorticoid signaling is essential for survival, so we cannot simply block these hormones. – They regulate numerous physiological processes around the body, including cardiovascular function, immune function, skeletal growth, reproduction, and cognition. – They control normal circadian rhythms in cell metabolism that allow the body to maintain homeostasis. – They also prepare the body for physical activity by making glucose and fat available for immediate use and by increasing blood flow and arousal. • When lots of glucocorticoids are released, the body deprioritizes functions that are not needed for immediate survival (i.e., they inhibit growth hormone signaling, sex hormone signaling, and immune functions).

• a weakened immune system, which makes it harder to fight off infections and illness • reduced body growth (due to reductions in growth hormone signaling) • infertility (due reductions in sex hormone signaling that disrupt sperm production and menstrual cycle) • worse cardiovascular health (increased blood pressure, heart rate, heart disease, heart palpitations) • increased muscle tension, which can damage muscle tissue • insomnia • steroid diabetes (due to hormone-induced damage to the pancreas) • digestive problems, leading to changes in weight, irritable bowel syndrome, and ulcers (gastric ulcers occur when stomach acid eats though the protective lining of the stomach, producing an open sore). • less brain plasticity, which leads to premature cell death in the hippocampus and prefrontal cortex, which is associated with memory loss, depression, and anxiety.

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• vivid and intrusive memories of the traumatic event (“flashbacks”) as well as recurrent dreams about it • active avoidance of stimuli associated with the trauma as well as pronounced mental or physical distress in response to these stimuli • hyperarousal and hypervigilance • persistent negative moods and feelings of hopelessness

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yes, because it is associated with some emotions (such as guilt, shame, and anger) that are outside the fear and anxiety spectrum. – PTSD is also associated with an overactive sympathetic nervous system as well as HPA axis dysregulation (cortisol abnormalities).

false, most people who experience trauma do not develop PTSD, but the likelihood of developing it increases with the number of traumatic events. Symptom severity negatively correlates with size of the hippocampus and PFC.

The main treatments are cognitive behavioural therapy (CBT), group therapy, and medication. – Selective serotonin reuptake inhibitors (SSRIs) are the first-line medications. They benefit about half of people.

Anxiety is characterized by persistent worry and fear of danger and impending disasters. People with an anxiety disorders exhibit intense, persistent fear in everyday situations that are not particularly aversive or threatening. – People around them perceive their fear and anxiety to be unfounded/unrealistic.

Whereas stress responses are triggered by perceived threats that are specific and real, anxiety is associated with a general sense of apprehension, excessive fear of uncertainty (“what if…”), and loss of control. Stressful environments can cause anxiety, but anxiety can also come about without any obvious trigger.

Excessive anxiety and worry serious enough to disrupt daily life. There is often expectation of an impending disaster, increased autonomic nervous system activity and muscle tension.

Characterized by excessive fear of being exposed to the scrutiny of other people, leading to avoidance of social situations in which they may be called on to perform

Characterized by episodic periods of severe and unremitting terror, shortness of breath, irregular heartbeat, and other autonomic symptoms

Fear of having a panic attack can lead to anticipatory anxiety and the risk of developing agoraphobia.

Fear of being away from home or other protected places (usually because of prior panic attacks).

• Anxiety disorders generally begin before the age of 25 or after the onset of dementia. They are twice as common in women. • The cause of anxiety disorders is a combination of genetic and environmental factors (e.g., child abuse and poverty). • Anxiety disorders often occur with other mental disorders, particularly major depressive disorder, personality disorder, and substance use disorder. • There are no obvious brain circuit disruptions in people who have an anxiety disorder.

Treatment options include lifestyle changes, behavioural therapy, and medications. * Lifestyle changes may include exercise, regularizing sleep patterns, and reducing caffeine intake and smoking. * Cognitive behavioral therapy (CBT) is often effective and is a first line treatment. * When medication is called for selective serotonin reuptake inhibitors (SSRIs) are frequently used * benzodiazepines are sometimes used, particularly in emergency settings, because of their rapid onset

characterized by – repeatedly having certain thoughts (“obsessions”) and – a need to repeatedly check things or perform certain routines (“compulsions” or “rituals”) to an extent that it causes distress & impairs general functioning.

symmetry, cleaning, hoarding, and forbidden thoughts. The “cleaning” cluster is associated with germs, bodily fluids, and contamination. The “forbidden thoughts” cluster is associated with intrusive and distressing thoughts that are violent, religious, or sexual in nature.

• Generally, the obsessions drive the compulsions. • There may be a belief that there is some imbalance in the world, something is out of place, as well as the idea that life cannot proceed as normal while the imbalance remains. • Compulsions are performed to seek relief from obsession-related anxiety, out of fear that something bad will happen if the ritualistic behaviour is not done properly. • Compulsion can include obsessive hand washing, cleaning, counting, and checking things (e.g., that the doors are locked). Some people have difficulty throwing things out. • Most adults with OCD recognize that their behaviors do not make much sense. They understand that their beliefs do not correspond with reality. However, they feel like they must act as though their beliefs are correct. It is very difficult for people with OCD to control their obsessions and compulsions for more than a short period of time.

• The prevalence of OCD is about 2% of the population, but it is about twice as common in women than men. • Symptoms usually start before age 25 in both sexes, but the onset is typically later in women (late teens/early twenties) than men (adolescence). • The cause of OCD is a combination of genetic and environmental factors (e.g., child abuse). Genetic factors account for ~50% of the variability. • Symptoms sometimes emerge after brain damage (in the basal ganglia and frontal lobe). Some cases have been linked to brain infections that affect these regions. • fMRI studies have found altered neural activity in the basal ganglia and frontal lobe.

• Treatment always involves counseling, often a version of cognitive behavioral therapy known as exposure and response prevention, which involves increasing exposure to a trigger of the obsessions while not allowing the repetitive behavior to occur. • Treatment sometimes includes antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). • Without treatment, the condition often lasts decades. • Severe cases can be successfully treated with a cingulotomy. This is like a modern version of the frontal lobotomy because it involves surgically severing a fiber bundle in the frontal lobe. • Deep brain stimulation in the basal ganglia is an active area of research.