16) Anxiety Flashcards
What is anxiety ?
A feeling of worry, nervousness or unease about something with an uncertain outcome
What are the Sx of Anxiety
> Palpitations > Sweating > Trembling or Shaking > Dry Mouth > Difficulty breathing > Chest pain or Discomfort > Nausea or Abdominal distress > Feeling dizzy
Why do Sx of anxiety arise ?
Sympathetic response
What 2 parts form the basis behind Anxiety ?
Limbic System:
> Hippocampus - Memory and Emotion
> Amygdala - Processing Emotion and Reward
> Prefrontal Cortex / Cingulate Gyrus - Modulate hypothalamus
HPA Axis:
> Release of cortisol from adrenal glands causing increased metabolism, immune system and inflammatory suppression
Why is persistent activation of HPA axis bad ?
Prolonged stress causes continued cortisol secretion => Muscle wastage, Suppression of immune system and hyperglycaemia
Compare Cortisol to Adrenaline in terms of length of effect ?
Cortisol lasts longer than adrenaline so allows a maintenance of response to stress
List the different types of Anxiety Disorders
> Social Phobia - Being Anxious in social situations
Specific Phobias
Generalised Anxiety Disorders - Feeling anxious a lot of times
Panic Disorder
OCD
PTSD
Outline the 2 important theories explaining the aetiology of anxiety disorders
GABA:
> Main inhibitory Neurotransmitter
> Levels are decreased in the cortex of patients with panic disorder
Serotonin:
> Increased Serotonin using SSRIs may stimulate serotonin receptors in the hippocampus to help reduce anxiety
What are the treatments given to patients with Anxiety disorders ?
Benzodiazepines:
> Increases GABA transmission by enhancing GABA binding
> They are not used long time as they can be additive and dangerous in overdose
SSRIs:
> Increase Serotonin Levels
CBT:
> Patients look at their problems and change the way you think and behave.
> Aids in current problems rather than issues of the past
Define Obsessive Compulsive Disorder ?
An anxiety disorder where the patient have obsessive and compulsive traits
Obsession = A thought that persists and dominates and individuals thinking despite their awareness, often causes great anxiety and guilt
Compulsions = Obsessional Impulse which leads directly to an action
How is OCD diagnosed
Obsessions / Compulsions has to be present for most days for a period of at least 2 weeks
Features of Obsession and Compulsions :
> Originate in the mind in the patient
> Repetitive and unpleasant
> Acknowledge as excessive or unreasonable
> Patients tries to resist but they are unsuccessful
Outline the different theories for the aetiology of OCD
> Re-entry circuits in the basal ganglia, meaning that an output from the basal ganglia keeps being repeated
Reduced Serotonin
PANDAs - Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection - Sudden onset of OCD Symptoms or tics after Group A beta haemolytic strep, usually in 3 - 12 years. Responds to treatments with Abx and usual OCD management
Outline the treatment of OCD
> CBT
Exposure Response Prevention - Preventing repititve action after the intrusive thought to break the cycle
SSRIs
Clomipramine - Unpleasant Side Effects
Deep brain stimulation if medication / treatment fail
What is PTSD ?
Anxiety disorder which occurs within 6 months of a traumatic event of exception Severity
> Patients experience repetitive, intrusive recollection of the event
Outline the theories for the aetiology of PTSD ?
> Hyperactivity of the Amygdala causing and exaggerated response and a perceived threat
