11. Anxiety Flashcards
Suggest examples of physical symptoms experienced in anxiety disorders.
- palpitations
- sweating
- trembling
- dry mouth
- difficulty breathing
- chest pain/discomfort
- nausea or abdominal distress (e.g. butterflies)
- dizziness, light-headedness, unsteadiness
Name 2 neurotransmitters thought to be involved in anxiety disorders.
Decreased levels of:
- GABA
- Serotonin
Describe the management you would suggest for a P with a generalised anxiety disorder.
- CBT
- SSRIs
- Acute short term treatment: anxiolytics - benzodiazepines, e.g. diazepam, lorazepam
- Could use a GABA analogue, e.g. pregbalin - effective but expensive
Which brain system is involved in the stress response? What structures does it include?
The Limbic System:
- hippocampus - memory and info. processing
- septal area
- amygdala - collection of nuclei that input sensory info. from brainstem, thalamus and cortex and output to brainstem, cortex and hypothalamus - key role in memory and emotion processing, esp. in response to fear
+/- prefrontal cortex and cingulate gyrus - have modulatory effect on processes associated with hypothalamus
Limbic structures communicate with hypothalamus which outputs to motor regions and SNS (increase heart rate, and contractile force, dilated bronchi)
Describe the hormones and glands involved in the stress reaction.
i. hypothalamus releases CRH…
ii. stimulates pituitary gland to release ACTH…
iii. stimulates adrenal gland to release cortisol
NA is also released from sympathetic nerves and adnrenaline/NA from adrenal medulla.
Describe the diagnostic criteria for obsessive-compulsive disorder.
- O, C or both present on most days for at least 2 wks
- O and C share all the following features:
- originate in P’s mind
- repetitive and unpleasant
- acknowledged as excessive or unreasonable
- P tries to resist but at least 1 O or C is unsuccessfully resisted - carrying out the obsessive thought or act is not pleasurable in itself
- O/C must cause distress or interfere with the P’s social or individual functioning
Define “obesession”.
Thought that persists and dominates an individual’s thinking despite their awareness that the thought is either entirely without purpose, or has persisted beyond the point of relevance or usefulness.
Often causes great anxiety and guilt, is particularly repugnant to individual and may reflect changes in society.
Define “compulsion”.
Obsessional motor acts (can also have mental ones, e.g. repeating phrases).
May result from an obsessional impulse that leads directly to the action, or may be mediated by an obsessional mental image or fear.
Describe 2 theories for the pathophysiology of OCD.
- reduced serotonin
2. re-entry circuits in basal ganglia
What is PANDAS?
Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection:
- sudden onset of OCD symptoms or tics after infection with Group A beta-haemolytic streptococci.
- autoantibodies ‘cross-react’ with neurones in basal ganglia, causing symptoms: usually dramatic onset of psychiatric or behavioural problems
Suggest possible behavioural, pharmacological and surgical options for the management of OCD.
- CBT
- Exposure response prevention
- Medication:
- high dose SSRIs (need higher dose and longer treatment course than in depression)
- +/- augmentation with antipsychotics, e.g. Clomipramine (TCA) - Deep brain stimulation of subthalamic nucleus (treatment resistant OCD)
Describe the symptoms of post-traumatic stress disorder.
- Repetitive, intrusive recollection or re-enactment of the event in memories, daytime imagery or dreams, within 6mths of a traumatic event of exceptional severity (evidence of trauma).
- Conspicuous emotional detachment, numbing of feeling and avoidance of stimuli that might arouse recollection of the trauma.
Suggest 2 theories for the pathophysiology of PTSD.
- Amygdala hyperactivity… exaggerated response to perceived threat.
- Decreased levels of cortisol (normally inhibits memory retrieval and controls sympathetic response)
Name 2 cognitive therapy and 1 pharmacological therapy for PTSD.
- CBT
- Eye movement desensitisation rerocessing (EMDR)
- SSRIs
