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Anxiety Flashcards

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1
Q

role of amygdala

A

plays a role in processing fearful and threatening stimuli by processing data and sending info to:
-Hypothalamus
-Periaqueductal gray (PAG)
-Hipppocampus
-Cingulate gyrus

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2
Q

Role of hypothalamus in anxiety?

A

Amygdala processes sensory data and passes it on to the hypothalamus

-Hypothalamus mediates body stress response by releasing CRH, causing pituitary to release ACTH and adrenals to produce cortisol

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3
Q

Role of periaqueductal gray in anxiety?

A

Amygdala processes sensory data and passes it onto the periaqueductal grey (PAG)

Perqueductal grey mediates fight or flight response

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4
Q

Role of hippocampus in anxiety?

A

Amygdala proccesses sensory data and passes it onto the hippocampus

Hippocampus responsible for memory and learning

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5
Q

Role of cingulate gyrus in anxiety?

A

Amygdala processes sensory data and passes it onto the cingulate cortex

Cingulate cortex is responsible for mediating emotions of anxiety

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6
Q

what is an anxiolytic?

A

Drug used to relieve anxiety

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7
Q

what is Generalised anxiety disorder?

A

anxiety that is generalized and persistent but not restricted to, or even strongly predominating in any particular environmental circumstances

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8
Q

who is GAD more common in?

A

20-40
2 x more common in females
90% co morbid with other psychiatric disorders e.g. depression, substance abuse, other anxiety disorders

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9
Q

symptoms of GAD?

A

variable
-Persistent nervousness, trembling, muscular tensions, sweating, light headedness, palpitations, dizziness and epigastric discomfort

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10
Q

GAD management?

A

CBT

1st= SSRI (e.g. citalopram, sertraline, fluoxetine)
2nd= offer another SSRI or SNRI (duloxetine, venlafaxine)

Short term use= benzodiazepines (2-4 weeks)

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11
Q

what is panic disorder?

A

-Recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

-Anxiety around further panic attacks

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12
Q

biology of panic attacks?

A

Can be triggered by infusions of lactate or by re-breathing air

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13
Q

who more commonly experiecnes panic disorder?

A

Late teens- mid 30s

Comorbid with other anxiety disorders, depression, drug and alcohol misuse

May occur with or without agoraphobia (50-70%)

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14
Q

mangement of panic disorder?

A

Self help + CBT
1st = SSRI
2nd= imipramine, clomipramine (tricyclics)
3rd= tricyclics, SNRI

Continue treatment for 6 months after feeling better

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15
Q

what should be avoided in panic disorder?

A

propanolol, buspirone, buproprione

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16
Q

what can be used for rapid relief of anxiety symptoms?

A

Benzodiazepines (GABAA agonists inhibitory)

17
Q

example of short acting and long acting benzodiazepines?

A

short acting= lorazepam
long acting= diazepam

18
Q

SE benzodiazepines?

A

-drowsiness
-confusion
-ataxia

19
Q

what can be used to reverse SE of benzodiazepines?

A

SE: drowsiness, confusion and ataxia

Reverse with IV flumazenil

20
Q

can you give benzodiazepines for long term use?

A

Want to avoid long term use
(use <4 weeks)

due to dependance

21
Q

withdrawal symptoms of benzodiazepines?

A

-anxiety
-insomnia
-depression
-perceptual sensitivity

22
Q

whats agoraphobia?

A

phobia of situations in public, crowds or travelling places alone

23
Q

whats social phobia?

A

persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others

24
Q

whats a specific phobia?

A

marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation e.g. needles or snakes

25
Q

management of phobias?

A

CBT with exposure therapy +/- SSRI

26
Q

what are obsessions- OCD?

A

ideas, images or impulses entering the mind in a sterotyped way, recognised as the patients own thoughts (unpleasant, resistant and ego dystonic)

27
Q

what are compulsions- OCD?

A

repeated rituals or stereotyped behaviours, not enjoyable or functional

28
Q

management of OCD?

A

1st= CBT or ERP
2nd= SSRI (if effective continue for 1 year)
3rd= consider increase in dose after 4 to 6 weeks
4th= CRP plus CBT and ERP
5th= Clomipramine

29
Q

intrusive symptoms , avoidant behaviour, hyperarousal and negative mood <1 month post truama?

A

Acute stress syndrome

30
Q

intrusive symptoms , avoidant behaviour, hyperarousal and negative mood >1 month post trauma?

A

PTSD

31
Q

what is complex PTSD?

A

Core PTSD symptoms plus negative self concept, emotional dysregulation, chronic interpersonal difficulties

32
Q

treatment PTSD?

A

mild and <1 month from trauma- watchful waiting

> 3 months from trauma:
-trauma focused CBT or EMDR (eye movement desensitisation and reprocessing)

psych (18 decks)

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