18 - Anxiety and Insomnia

Question 1

What controls nocturnal/diurnal rhythms in the brain

Answer 1

Suprachiasmatic nucleus in the hypothalamus

Question 2

What occurs to the activity of the SCN neurons in light phase?

Answer 2

They increase their activity

Question 3

Which hormone increases in the dark phase

Answer 3

Melatonin

Question 4

Wakefulness cholinergic system

Answer 4

pedunculopontine and laterodorsal tegmental nuclei

Question 5

Wakefulness monoaminergic projections

Answer 5

locus coeruleus, raphe nuclei, tuberomamillary nucleus

Question 6

Sleep GABA and galanin neurons

Answer 6

ventrolateral preoptic nucleus

Question 7

How long is one sleep cycle

Answer 7

90mins

Question 8

REM

Answer 8

rapid eye movement phase

Eyes still move under lids

Question 9

NREM

Answer 9

non-rapid eye movement phase

Deep sleep

Question 10

SWS

Answer 10

Slow Wave Sleep

Includes NREM

Question 11

Insomnia treatment

Answer 11

Benzodiapines

Z drugs

Question 12

Examples of Z drugs

Answer 12

Zaleplon, Zolpiedm, Zopiclone

Question 13

Short term insomnia treatment?

Answer 13

lorazepam, temazepam

Question 14

Long term insomnia treatment?

Answer 14

eszopiclone and extended release zolpidem

Question 15

Side effects of Benzodiapines

Answer 15

 Change in sleep patterns (suppress deep sleep and REM sleep)
 Daytime sedation
 Rebound insomnia – Become dependent
 Tolerance
 Dependence (withdrawal syndrome characterised by anxiety, nausea, muscle cramps, seizures)

Question 16

Where is Orexin produced

Answer 16

Hypothalamus

Question 17

What do orexins regulate

Answer 17

arousal, appetite, wakefulness

Question 18

Narcolepsy

Answer 18

Deficiency in orexins

Excessive sleepiness

Question 19

Orexin Antagonist

Answer 19

Suvorexant - used to treat insomnia

Question 20

Structures in the brain involved in Anxiety

Answer 20

Amygdala, insula, anterior cingulate, prefrontal cortex, thalamus

Question 21

Genetic risk factors for anxiety

Answer 21

5-HT transmission
COMT
CCK
CCKB receptor
Adenosine A2 receptors
MAOA
5-HT2 receptor

Question 22

KF-1 ubiquitin ligase

Answer 22

anxiety suppressor (increases after administration of SSRIs)

Question 23

Anxiolytics

Answer 23

Benzodiapines
5-HT1A agonists
B-adrenoceptor antagonists
SSRIs
Barbiturates (obsolete)

Question 24

Benzodiapines

Answer 24

clonazepam, alprazolam, diazepam

POSITIVE ALLOSTERIC MODULATORS at the receptor complex of GABAa

Question 25

Overdose of benzodiazepines

Answer 25

Flumazenil

Question 26

5-HT1A agonists

Answer 26

buspirone, ipsapirone

Question 27

B–adrenoceptor antagonists

Answer 27

propranolol

Question 28

SSRIs

Answer 28

fluoxetine, escitalopram, paroxetine

Question 29

Why are barbiturates no longer used for anxiety

Answer 29

Fatal overdose toxicity

Major risk of drug dependence

Question 30

Management of generalised Anxiety Disorder

Answer 30

1) buspirone
2) venlafaxine, duloxetine (SNRI)
3) fluoxetine, escitalopram (SSRI)
4) risperidone, quetiapine, olanzapine (APD)

Question 31

GABA subunit target for Z drugs

Answer 31

A subunits
zaleplon and zolpidem bind to the α1 subunit – hypnotic role
α3 subunits are linked to anxiolytic effects