Anxiety Flashcards
What is anxiety?
Emotion characterized by feelings of tension, worried thoughts and physical changes.
What does the pharmacist need to check?
Check that anxiety is not:
Caused by another medical condition (eg some physical symptoms may occurs in other pathologies like hyperthyroidism, CPD).
Comorbid with another psychiatric condition.
Medication-induced or drug-related (substance of abuse withdrawn).
What is amygdala dysfunction?
The amygdala helps control our fear response, but it also plays a crucial role in many other cognitive functions.
Therefore, damage to the amygdala can cause serious problems, such as poor decision-making and impaired emotional memories
What are the inputs and outputs of the amygdala?
Inputs: the amygdala gets sensory input, (highly processed inputs from association areas of visual, auditory, and somatosensory cortices).
Outputs: the amygdala is able to control the autonomic system, to provoke an instant sympathetic response. The main outputs of the amygdala are to the hypothalamus and brainstem autonomic centers.
What is the role of serotonin?
Serotonin is a chemical messenger that’s believed to act as a mood stabiliser.
Research shows that serotonin levels can have an effect on mood and behavior, and the chemical is commonly linked to feeling good and living longer.
Stress/fearful situations increase 5-HT release.
Selective electrical activation of serotonin neurons improve ability to cope with stress and inactivation of these neurons increase anxiety like behaviour.
What is the main function of 5-HT1A receptor?
It is a major inhibitory G-protein coupled receptor subtype.
They decrease blood pressure and heart rate via a central mechanism, by inducing peripheral vasodilation, and by stimulating the vagus nerve.
What treatments are available for long term-relief with serotonergic antidepressant?
Selective serotonin uptake inhibitor:
First line treatment (other antidepressants may work), because of low side effects.
Act with a delay of generally 4 to eight weeks in onset of symptom relief, with full response.
Taking up to 12 weeks or more.
Longer-term therapy associated with continued symptomatic improvement and the prevention of relapse.
First weeks of treatment maybe associated with increase in anxiety (transient combination with a benzodiazepine).
Therapy should be continued for at least 12-24 months for most patients.
Selective serotonin and noradrenaline uptake inhibitor:
Similar effects as SSRI.
Tricyclic antidepressants:
Similar clinical effects as SSRI, but side effects, not first line therapy.
Good clinical results obtained with clomipramine in clinical trial.
Atypical antidepressants:
Trazodone, targets various monoamine receptors, with 5-HT1A agonist properties.
What is the role of noradrenaline?
Acts to increase the force of skeletal muscle contraction and the rate and force of contraction of the heart.
Role of locus coeruleus (LC) in arousal and attention and aversive memory.
LC innervation of brain areas important for anxiety (amygdala, hippocampus).
LC stimulation evokes anxiety.
Fearful situations increase LC firing and NA release.
Stress is known to induce noradrenaline release in several brain regions associated to emotion and autonomic control.
Extreme anxiety caused by drug of addiction associated with overactivation noradrenaline neurons.
What is the role of GABA Receptors agents?
Can be useful agents for the acute but not long-term treatment of anxiety.
Act mainly as tranquilizers (acute calming/sedative effect) and can help to improve sleeping problems.
What are ionotropic receptors?
Ion channels that open in response to the binding of a neurotransmitter.
Mediates very fast inhibition.
Major inhibitory mediator in the brain (should reduce neuronal overactivation).
How are benzodiazepines used?
Benzodiazepines are a type of sedative medication. This means they slow down the body and brain’s functions.
They shorten the time it takes to go to sleep.
Targeting specific GABAa receptor subunits may have therapeutic uses and limited side effects:
Alpha 1 agonists: sedative.
Alpha 2/3 agonists: anxiety.
Alpha 5 antagonists: cognitive enhancement.
What are panic disorders?
Characterized by recurrent and unexpected panic attacks and during which time four (or more) of the following symptoms occur:
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesias (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or “going crazy.”
Fear of dying.
What is agoraphobia?
Fear of being in situations where escape might be difficult (not a simply fear abut open space).
Marked, unreasonable fear or anxiety about a situation (patient can develop panic like symptoms).
Active avoidance of feared situation due to thoughts that escape might be difficult or help unavailable.
What is social anxiety disorder (SAD)?
Marked, excessive or unrealistic fear or anxiety about social situations in which there is possible exposure to scrutiny by others.
Active avoidance of feared situation.
What is obsessive–compulsive disorder (OCD)?
Obsessions: recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted and that causes marked anxiety or distress.
Compulsions: repetitive behaviors (e.g., hand washing) or mental acts (e.g., counting) that the individual feels driven to perform to reduce the anxiety generated by the obsessions.
