Anxiety Flashcards
What is anxiety?
→ extreme worry
When is anxiety normal?
→ When it is intermittent
→ when there is a particular source that triggers it
When is anxiety abnormal?
→ When it is chronic and irrational
What can anxiety cause?
→ Social disturbances
→ Avoidance behaviour
→ Incessant worry
→ Concentration/memory problems
What are the physiological symptoms of anxiety?
→ Tachycardia → Hyperventilation → Feeling dizzy → headaches → flushing → sweating → Nausea → insomnia → diarrhoea
What are the psychological symptoms of anxiety?
→ stress
→ worry
→ foreboding
What are the 6 causes of anxiety?
→ childhood experience → diet → physical or mental health → everyday life and habits → drugs and medication → genetics
What medication can increase anxiety?
→ antimalarias
What foods increase anxiety?
→ high sugar and caffeine
What is generalised anxiety disorder?
→ psychological and physiological with no real stimulus
What are 5 types of anxiety disorder?
→ specific phobias → social phobias → OCD → PTSD → panic disorder
What are obsessions?
→ recurrent intrusive thoughts, images, ideas or compulsions
What are compulsions?
→ repetitive behaviors or mental acts performed to reduce anxiety associated with the obsessions
What is PTSD?
→ Re living unpleasant memories
→ flashbacks
→ nightmares
What is panic disorder?
→ An individual suffers from panic attacks with no apparent trigger
What receives the stress or fear stimulus?
→ The amygdala
describe how cortisol is released?
→ amygdala receives stress or fear stimulus
→ transmits information to the bed nucleus of the stria terminalis
→ which transmits the information to the HPA axis
→ it releases CRH which induces the release of ACTH and eventually cortisol
What are the 4 treatments for anxiety?
→ Benzodiazepines
→ 5-HT1A receptor agonists
→ beta adrenoceptor antagonists
→ antihistamines
What type of drugs are barbiturates?
→ positive allosteric modulators
Where do benzodiazepines bind?
→ alpha gamma interface in the GABA receptor
What is the usual binding site for GABA?
→ alpha beta interface
What do benzodiazepines do to the GABA receptor?
→ they make it more stable
→ the binding site can’t close
→ the receptor is more receptive to GABA
→ more GABA can bind at lower concentrations
What do barbiturates do to GABA?
→ they keep GABA receptors open for longer
What receptors do benzodiazepines work on and why?
→ only 1,2,3, or 5
→ they have histidine
What is used in benzodiazepine overdose?
→ Flumazenil
How does the dose response curve change with benzodiazepines?
→ dose response curve shifts left
What are 3 long acting benzodiazepams?
→ Clonazepam
→ Diazepam
→ Chlordiazepoxide
What is a short acting benzodiazepam?
→ Midazolam
What are 2 medium acting benzodiazepams?
→ Temazepam
→ Lorazepam
Why are long acting benzodiazepams not given during the night?
→ it will make you drowsy during the day
→ unable to wake
What does withdrawal of BZDs cause?
→ severe seizures
→ Sudden inhibition of inhibitory GABA
What does the body do when given BZD?
→ upregulates the excitatory receptors
What is the most commonly prescribed drug for GAD?
→ Buspirone
Describe how buspirone works?
→ 5-HT1A autoreceptors presynaptically
→ when someone takes buspirone (5-HT1A agonist)
→ Desensitisation of auto 5-HT1A receptors
→ supra activation of 5-HT1A receptors
→ extreme inhibition of serotonin release
→ body downregulates the 5-HT1A receptors
→ less inhibition of serotonin release
→ enhanced release of serotonin
Describe how SSRIs work?
→ SERT transporter gets blocked
→ lots of serotonin in the synapse
→ induces desensitisation of 5HT1A receptors
→ body downregulates the 5-HT1A receptors and the postsynaptic receptors
Why is buspirone preferred over SSRI?
→ SSRIs decrease the post synaptic receptors as well as the pre synaptic ones
What do adrenoceptor antagonists do?
→ reduce peripheral symptoms of anxiety
What do anti-histamines do?
→ hypnotic and sedative effects
What is GAD?
→ Characterised by an ongoing state of excessive anxiety lacking clear reason or focus
→ Excessive anxiety for at least 6 months
What are panic attacks?
→ Sudden feelings of overwhelming fear with marked somatic symptoms
What does continuous exposure to cortisol do in the brain?
→ Neuronal degeneration in the hippocampus
→ Decrease in hippocampal volume
What are the 5 effects of barbiturates?
→ direct GABA A agonist
→ stabilises the open channel - glycine receptor
→ nACHR and 5-HT3 receptor blockade
→ AMPA/Kainate receptor blockade
→ Blockade of Ca2+ dependent neurotransmitter release
What is the structure of a 5-HT1A receptor?
→ Venus flytrap domain
→ Cysteine rich domain
→ 7 TM domain
→ C terminal domain
What is the function of beta 1 receptors?
→ Increases HR, contraction, ejection
→ Increases renin release
Why do people develop tolerance to BDZ?
→ Increased glutamate receptor trafficking to the membrane
