Anxiety

Question 1

What is anxiety?

Answer 1

Feeling of unease which can range from mild to severe

Question 2

What is innate, adaptive anxiety?

Answer 2

Response to threatening stimuli that is made up of lots of components that are species specific

Question 3

What is learned adaptive anxiety?

Answer 3

Fears that are learned through life experiences

Question 4

When does anxiety become an issue?

Answer 4

When chronic and irrational and leads to:
Social disturbances
Avoidance behaviours
Incessant worry 
Concentration/ memory problems

Question 5

What can anxiety cause physiologically?

Answer 5

Tachycardia
Shortness of breath
Headache and dizziness 
Pins and needles
GI disturbances
Nausea
Fatigue
Insomnia

Question 6

What are some causes of anxiety?

Answer 6

Past experiences
Everyday life and habits
Diet
Physical and mental health
Alcohol and drugs
Genes

Question 7

Why can past experiences cause anxiety?

Answer 7

Difficult experiences in childhood, adolescence and adulthood are a common trigger for anxiety

Question 8

What things in the diet can trigger anxiety?

Answer 8

Sugar and caffeine

Question 9

How can alcohol and drugs cause anxiety?

Answer 9

CNS depressant increases GABAergic neurotransmission and blocks glutamatergic neurotransmission
This disrupts the GABA/glutamate balance
Brain acts to counteract it which leads to low GABA and high glutamate

Question 10

Is anxiety genetic?

Answer 10

There are links, but def not caused by a single gene - may have a complex genetic basis

Question 11

What is the stress response?

Answer 11

coordinated reaction to threatening stimuli

Question 12

What is the stress response regulated by?

Answer 12

HPA axis

Question 13

How does the HPA axis regulate the stress response?

Answer 13

Hypothalamus secretes CRH -> pituitary which secretes ACTH -> adrenal gland which secretes cortisol

Question 14

What does overexpressing CRH in rodent models lead to?

Answer 14

Increased anxiety-like behaviour

Question 15

What does knocking out CRH receptors in rodent molecules lead to?

Answer 15

Less anxiety-like behaviours

Question 16

What relevance does the amygdala have in anxiety?

Answer 16

Stimulates HPA axis to promote cortisol release - hyperactivity linked to anxiety

Question 17

What relevance does the hippocampus have in anxiety?

Answer 17

Suppresses HPA axis to prevent excessive cortisol release - under activity linked to anxiety

Question 18

What are the three new (2013) classifications of anxiety disorders?

Answer 18

Anxiety disorders, obsessive-compulsive disorders and trauma and stressor related disorders

Question 19

What is the main book for classification of anxiety disorders?

Answer 19

DSM-5

Question 20

What falls into the bracket of anxiety disorders?

Answer 20

Generalised anxiety disorder
Specific phobias
Social phobias
Panic disorder

Question 21

What falls into the bracket of obsessive-compulsive disorders?

Answer 21

OCD, body dismorphic disorder, hoarding disorder, trichotillomania (hair pulling)

Question 22

What falls into the bracket of trauma and stressor related disorders?

Answer 22

PTSD

Question 23

What is generalised anxiety disorder characterised by?

Answer 23

Ongoing (>6 months) state of excessive anxiety lacking clear reason or focus
Difficult to control and impairs activities of daily living

Question 24

What are the symptoms of GAD?

Answer 24

Restlessness
Fatigue
Excessive anxiety and worry
Increased muscle aches and soreness
Impaired concentration 
Irritability
Difficulty sleeping

Question 25

How many symptoms do you need to be diagnosed with GAD?

Answer 25

3 or more

Question 26

What are specific phobias?

Answer 26

Extreme fears provoked by exposure to a particular situation or object

Question 27

What do specific phobias often lead to?

Answer 27

Avoidance behaviours

Question 28

How long do specific phobias have to last to be diagnosed?

Answer 28

At least 6 months

Question 29

What are social phobias?

Answer 29

Significant anxieties provoked by exposure to certain types of social or performance situations

Question 30

What are the categories of diagnosis for social phobias?

Answer 30

Social situations almost always provokes immediate fear or anxiety that is out of proportion to the actual danger Persistent for at least six months, impairing the activities of daily living Not attributable to anything else

Question 31

What is panic disorder characterised by?

Answer 31

Recurring panic attacks without a seemingly clear cause or trigger

Question 32

What is a panic attack?

Answer 32

Abrupt surge of intense fear or discomfort, reaching a peak within minutes

Question 33

What is a panic disorder associated with?

Answer 33

Four or more of 13 symptoms

Question 34

What are some of the symptoms associated with panic disorder?

Answer 34

Increased heart rate, sweating, trembling, shortness of breath and fear of dying

Question 35

What is OCD characterised by?

Answer 35

Obsessive, repetitive actions with no purpose

Question 36

What are some examples of obsessions?

Answer 36

Recurrent intrusive thoughts, images, ideas or impulses

Question 37

What are some examples of compulsions?

Answer 37

Repetitive behaviours or mental acts that are performed to reduce anxiety associated with the obsessions

Question 38

What is necessary for an OCD diagnosis?

Answer 38

Obsessions and compulsions are time consuming (over an hour a day), impairing activities of daily living and not attributable to anything else

Question 39

What is PTSD characterised by?

Answer 39

Distress triggered by the recall of past traumatic experiences

Question 40

What is PTSD triggered by?

Answer 40

Exposure to certain situations - actual or threatened death, serious injury or sexual violence

Question 41

What is PTSD associated with?

Answer 41

One or more intrusion symptoms

Question 42

What are the intrusion symptoms?

Answer 42

Recurrent intrusive memories, nightmares, dissociative reactions and psychological and physiological distress at exposure to cues resembling the traumatic event

Question 43

What are the types of anxiety disorder treatment?

Answer 43

Psychological (cognitive behavioural therapy) | Pharmacological (anxiolytics)

Question 44

What are some examples of anxiolytics?

Answer 44

Benzodiazepines 5-HT 1A receptor agonists Beta noradrenergic receptor antagonists

Question 45

What are benzodiazepines?

Answer 45

GABAa receptor positive allosteric modulators

Question 46

How do benzodiazepines work?

Answer 46

Bind to the benzodiazepine binding site between the alpha and gamma subunits and stabilise it in the open configuration

Question 47

Why are benzodiazepines preferred?

Answer 47

Don't activate other receptors

Question 48

What are some examples of benzodiazepines and their durations?

Answer 48

Midazolam (<6hrs), lorazepam (12-18hrs), alprazolam (24hr) and diazepam (24-48hrs)

Question 49

What are serotonin 1A receptor antagonists primarily used to treat?

Answer 49

GAD

Question 50

What is one example of a serotonin 1A receptor antagonist?

Answer 50

Buspirone

Question 51

What are some side effects of serotonin 1A receptor antagonists?

Answer 51

Dizziness, nausea and headache

Question 52

How does buspirone work?

Answer 52

Activates serotonin 1A auto receptors which initially inhibits serotonin release but eventually it downregulates serotonin auto receptors (leading to increased excitation of seratonergic neurons)

Question 53

Which work quicker, benzodiazepines or serotonin 1A receptor antagonists?

Answer 53

Benzodiazepines

Question 54

What is an example of a beta noradrenergic antagonist?

Answer 54

Propanolol

Question 55

What do beta noradrenergic receptor antagonists do?

Answer 55

Reduce some peripheral manifestations of anxiety | Like tachycardia, sweating, GI problems and tremor

Question 56

What is the effectiveness of beta noradrenergic receptor antagonists dependant on?

Answer 56

Blocking peripheral sympathetic responses rather than central effects