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
What are the effects of beta adrenoreceptors antagonists?
blocking peripheral sympathetic responses (“fight or flight”) rather than central effects
What is buspirone not effective against?
phobias
