Anxiety

Question 1

What is anxiety?

Answer 1

→ extreme worry

Question 2

When is anxiety normal?

Answer 2

→ When it is intermittent

→ when there is a particular source that triggers it

Question 3

When is anxiety abnormal?

Answer 3

→ When it is chronic and irrational

Question 4

What can anxiety cause?

Answer 4

→ Social disturbances
→ Avoidance behaviour
→ Incessant worry
→ Concentration/memory problems

Question 5

What are the physiological symptoms of anxiety?

Answer 5

→ Tachycardia
→ Hyperventilation
→ Feeling dizzy
→ headaches
→ flushing
→ sweating
→ Nausea
→ insomnia
→ diarrhoea

Question 6

What are the psychological symptoms of anxiety?

Answer 6

→ stress
→ worry
→ foreboding

Question 7

What are the 6 causes of anxiety?

Answer 7

→ childhood experience
→ diet 
→ physical or mental health
→ everyday life and habits
→ drugs and medication
→ genetics

Question 8

What medication can increase anxiety?

Answer 8

→ antimalarias

Question 9

What foods increase anxiety?

Answer 9

→ high sugar and caffeine

Question 10

What is generalised anxiety disorder?

Answer 10

→ psychological and physiological with no real stimulus

Question 11

What are 5 types of anxiety disorder?

Answer 11

→ specific phobias
→ social phobias
→ OCD
→ PTSD
→ panic disorder

Question 12

What are obsessions?

Answer 12

→ recurrent intrusive thoughts, images, ideas or compulsions

Question 13

What are compulsions?

Answer 13

→ repetitive behaviors or mental acts performed to reduce anxiety associated with the obsessions

Question 14

What is PTSD?

Answer 14

→ Re living unpleasant memories
→ flashbacks
→ nightmares

Question 15

What is panic disorder?

Answer 15

→ An individual suffers from panic attacks with no apparent trigger

Question 16

What receives the stress or fear stimulus?

Answer 16

→ The amygdala

Question 17

describe how cortisol is released?

Answer 17

→ 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

Question 18

What are the 4 treatments for anxiety?

Answer 18

→ Benzodiazepines
→ 5-HT1A receptor agonists
→ beta adrenoceptor antagonists
→ antihistamines

Question 19

What type of drugs are barbiturates?

Answer 19

→ positive allosteric modulators

Question 20

Where do benzodiazepines bind?

Answer 20

→ alpha gamma interface in the GABA receptor

Question 21

What is the usual binding site for GABA?

Answer 21

→ alpha beta interface

Question 22

What do benzodiazepines do to the GABA receptor?

Answer 22

→ 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

Question 23

What do barbiturates do to GABA?

Answer 23

→ they keep GABA receptors open for longer

Question 24

What receptors do benzodiazepines work on and why?

Answer 24

→ only 1,2,3, or 5

→ they have histidine

Question 25

What is used in benzodiazepine overdose?

Answer 25

→ Flumazenil

Question 26

How does the dose response curve change with benzodiazepines?

Answer 26

→ dose response curve shifts left

Question 27

What are 3 long acting benzodiazepams?

Answer 27

→ Clonazepam → Diazepam → Chlordiazepoxide

Question 28

What is a short acting benzodiazepam?

Answer 28

→ Midazolam

Question 29

What are 2 medium acting benzodiazepams?

Answer 29

→ Temazepam | → Lorazepam

Question 30

Why are long acting benzodiazepams not given during the night?

Answer 30

→ it will make you drowsy during the day | → unable to wake

Question 31

What does withdrawal of BZDs cause?

Answer 31

→ severe seizures | → Sudden inhibition of inhibitory GABA

Question 32

What does the body do when given BZD?

Answer 32

→ upregulates the excitatory receptors

Question 33

What is the most commonly prescribed drug for GAD?

Answer 33

→ Buspirone

Question 34

Describe how buspirone works?

Answer 34

→ 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

Question 35

Describe how SSRIs work?

Answer 35

→ 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

Question 36

Why is buspirone preferred over SSRI?

Answer 36

→ SSRIs decrease the post synaptic receptors as well as the pre synaptic ones

Question 37

What do adrenoceptor antagonists do?

Answer 37

→ reduce peripheral symptoms of anxiety

Question 38

What do anti-histamines do?

Answer 38

→ hypnotic and sedative effects

Question 39

What is GAD?

Answer 39

→ Characterised by an ongoing state of excessive anxiety lacking clear reason or focus → Excessive anxiety for at least 6 months

Question 40

What are panic attacks?

Answer 40

→ Sudden feelings of overwhelming fear with marked somatic symptoms

Question 41

What does continuous exposure to cortisol do in the brain?

Answer 41

→ Neuronal degeneration in the hippocampus | → Decrease in hippocampal volume

Question 42

What are the 5 effects of barbiturates?

Answer 42

→ 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

Question 43

What is the structure of a 5-HT1A receptor?

Answer 43

→ Venus flytrap domain → Cysteine rich domain → 7 TM domain → C terminal domain

Question 44

What is the function of beta 1 receptors?

Answer 44

→ Increases HR, contraction, ejection | → Increases renin release

Question 45

Why do people develop tolerance to BDZ?

Answer 45

→ Increased glutamate receptor trafficking to the membrane