AFFECTIVE DISORDERS: ANXIETY Flashcards
symptoms of anxiety
caused by adrenaline:
- shortness of breath, choking
- palpitations, chest pains
- trembling, sweating
- dry mouth, nausea
- feel dizzy and light-headed
- damaging cognition and fear
‘healthy’ anxiety
anxiety experienced by most people under unaccustomed stress
normal response to usual situation
‘pathological’ anxiety
anxiety is experienced both in the presence of, or the absence of obvious stimuli
the pts know that their fears are irrational and groundless
diagnosing GAD
generalised anxiety disorder is characterised by persistent anxiety and uncontrollable worry that occurs consistently for at least 6 months
co-morbidities associated with GAD
depression
alcohol
substance abuse
physical health problems
symptoms of specific phobias
- animal
- natural environment
- fear of blood
- fear of injections and transfusions
- fear of other medical care
- fear of injury
- situational
pathophysiology of anxiety
brain regions: the limbic system is thought to play central role in anxiety disorders
neurotransmitter systems: altered sensitivity of the GABA system is implicated
benzodiazepines moa
increase the frequency of opening of GABA-A channels
metabolism and elimination of midazolam
rapid
t1/2 <5 hours
metabolism and elimination of lorazepam and temazepam
short
t1/2 = 5-20 hours
metabolism and excretion of nitrazepam
intermediate
t1/2 >40 hours
metabolism and excretion of diazepam and chlordiazepoxide
slow
t1/2 >40 hours
5-HT 1A
anxiety
alcoholism
sexual function
5-HT 1C
anxiety
migraine pain
5-HT 1D
migraine pain
5-HT 2
anxiety
depression
schizophrenia negative symptoms
sexual function
5-HT 3
migraine pain
emesis
schizophrenia
5-HT 4
anxiety
schizophrenia
why are SSRIs used to treat anxiety
as with depression, evidence suggests that anxiety disorders are associated with a deficiency in 5-HT/serotonin
dosing for anxiety generally higher than depression
disadvantages of SSRIs
- 4-6 weeks to see effects
- patients often experience a temporary worsening of symptoms
- side effects: nausea, insomnia, headaches, sexual dysfunction, initial agitation
Busiprone
- 5-HT 1A partial agonist regarded as a mild tranquilliser
- used to treat GAD and social phobias
benefits of busiprone
- no sedation or impairment of performance
- no cross-tolerance with BZs
- no tolerance or withdrawal
- no abuse potential
disadvantages of busiprone
- side effects: nausea, headache, insomnia, nervousness, dizziness, light headedness
- might require extended treatment to see beneficial effects
