AFFECTIVE DISORDERS: ANXIETY

Question 1

symptoms of anxiety

Answer 1

caused by adrenaline:
- shortness of breath, choking
- palpitations, chest pains
- trembling, sweating
- dry mouth, nausea
- feel dizzy and light-headed
- damaging cognition and fear

Question 2

‘healthy’ anxiety

Answer 2

anxiety experienced by most people under unaccustomed stress
normal response to usual situation

Question 3

‘pathological’ anxiety

Answer 3

anxiety is experienced both in the presence of, or the absence of obvious stimuli

the pts know that their fears are irrational and groundless

Question 4

diagnosing GAD

Answer 4

generalised anxiety disorder is characterised by persistent anxiety and uncontrollable worry that occurs consistently for at least 6 months

Question 5

co-morbidities associated with GAD

Answer 5

depression
alcohol
substance abuse
physical health problems

Question 6

symptoms of specific phobias

Answer 6

• animal
• natural environment
• fear of blood
• fear of injections and transfusions
• fear of other medical care
• fear of injury
• situational

Question 7

pathophysiology of anxiety

Answer 7

brain regions: the limbic system is thought to play central role in anxiety disorders

neurotransmitter systems: altered sensitivity of the GABA system is implicated

Question 8

benzodiazepines moa

Answer 8

increase the frequency of opening of GABA-A channels

Question 9

metabolism and elimination of midazolam

Answer 9

rapid
t1/2 <5 hours

Question 10

metabolism and elimination of lorazepam and temazepam

Answer 10

short
t1/2 = 5-20 hours

Question 11

metabolism and excretion of nitrazepam

Answer 11

intermediate
t1/2 >40 hours

Question 12

metabolism and excretion of diazepam and chlordiazepoxide

Answer 12

slow
t1/2 >40 hours

Question 13

5-HT 1A

Answer 13

anxiety
alcoholism
sexual function

Question 14

5-HT 1C

Answer 14

anxiety
migraine pain

Question 15

5-HT 1D

Answer 15

migraine pain

Question 16

5-HT 2

Answer 16

anxiety
depression
schizophrenia negative symptoms
sexual function

Question 17

5-HT 3

Answer 17

migraine pain
emesis
schizophrenia

Question 18

5-HT 4

Answer 18

anxiety
schizophrenia

Question 19

why are SSRIs used to treat anxiety

Answer 19

as with depression, evidence suggests that anxiety disorders are associated with a deficiency in 5-HT/serotonin

dosing for anxiety generally higher than depression

Question 20

disadvantages of SSRIs

Answer 20

• 4-6 weeks to see effects
• patients often experience a temporary worsening of symptoms
• side effects: nausea, insomnia, headaches, sexual dysfunction, initial agitation

Question 21

Busiprone

Answer 21

• 5-HT 1A partial agonist regarded as a mild tranquilliser
• used to treat GAD and social phobias

Question 22

benefits of busiprone

Answer 22

• no sedation or impairment of performance
• no cross-tolerance with BZs
• no tolerance or withdrawal
• no abuse potential

Question 23

disadvantages of busiprone

Answer 23

• side effects: nausea, headache, insomnia, nervousness, dizziness, light headedness
• might require extended treatment to see beneficial effects