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54 CNS > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Anxiety disorders

A

Severe, excessive, persistent anxiety and irrational fears that impairs functioning

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2
Q

_____, a temporal lobe structure, plays a critical role in assessment of fear stimuli and learned response to fear.

A

Amygdala

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3
Q

“Fear circuit” and symptoms are regulated by the _____.

A

Amygdala

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4
Q

“Worry circuit” and symptoms are regulated by ________.

A

Cortico-striatal-thalanic-cortical (CSTC) loop

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5
Q

Defence System originates in _____, responsible for _____ responses, responds to both ____________ threats.

A

Amygdala
Fear, fight or flight
Learned & unlearned

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6
Q

Behavourial Inhibition System is based in ________, responsible for _________.

A

Hippocampus & septum of limbic system
Avoidance behaviour

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7
Q

In response to threat or fearful situations, the ____ serves as an alarm centre, activating ____ release and stimulating the sympathetic and parasympathetic nervous system.

A

Locus ceruleus (LC)
NE

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8
Q

Which neurotransmitters are dysregulated in anxiety?

A

NE
5HT
GABA

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9
Q

GABA is a major _____ neurotransmitter, with strong regulatory or inhibitory effect on __, __, __ systems.

A

Inhibitory
5-HT, DA, NE

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10
Q

Medications that reduce anxiety and produce sedation target the _____ receptor.

A

GABAA

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11
Q

When GABA binds to the GABAA receptor, neuronal excitability is _______.

A

Reduced

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12
Q

How is 5HT involved in Neurochemical dysregulation?

A

Pathological fear/anxiety is related to over-activation of the amygdala. However, the amygdala receives input from serotonergic neurons which can inhibit its outputs.

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13
Q

Generalised Anxiety Disorder (GAD)

A

Excessive anxiety and worries >6 months

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14
Q

Panic Disorder (PD)

A

Anticipatory anxiety of recurrent panic attacks

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15
Q

Social Anxiety Disorder (SAD)

A

Fear of being scrutinized or humiliated by others in public

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16
Q

Medical conditions associated with anxiety (1)

A

CVD - Angina, arrhythmias, CHF**, ischemic heart disease, myocardial infarction

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17
Q

Medical conditions associated with anxiety (2)

A

Metabolic - Cushing’s disease, hyperparathyroidism, hyperthyroidism**, hypoglyceamia, hyponatraemia, hyperkalaemia, pheochromocytoma, vitamin B12 or folic acid deficiencies

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18
Q

Medical conditions associated with anxiety (3)

A

Neurologic - Dementia, delirium, migraine, PD, seizures, stroke, neoplasms, inadequate pain control

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19
Q

Medical conditions associated with anxiety (4)

A

Pulmonary - Asthma, COPD, PE, pneumonia

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20
Q

Medical conditions associated with anxiety (5)

A

Others - Anemias, systemic lupus erythematosus, vestibular dysfunction

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21
Q

Drug-induced anxiety (1)

A

Sympathomimetics** - Pseudoephedrine

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22
Q

Drug-induced anxiety (2)

A

Stimulants** - Amphetamines, Methylphenidate, Cocaine

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23
Q

Drug-induced anxiety (3)

A

Methylxanthines - Theophylline, caffeine

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24
Q

Drug-induced anxiety (4)

A

Thyroid hormone - Levothyroxine**

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25
Q

Drug-induced anxiety (5)

A

Corticosteriods** - Prednisolone

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26
Q

Drug-induced anxiety (5)

A

Antidepressants

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27
Q

Drug-induced anxiety (6)

A

Beta-adrenergic agonists** - Salbutamol (esp. systemic/oral)

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28
Q

Panic attack duration and frequency

A

A discrete period of intense fear/discomfort, in which ≥ 4 symptoms developed abruptly and reached a peak w/in 10mins (usually lasts no more than 20-30 min)

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29
Q

Panic attack symptoms

A

– Palpitations, pounding heart, ↑PR
– Sweating
– Trembling/ shaking
– Sensations of shortness of breath
– Feeling of choking
– Chest pain/ discomfort
– Nausea or abdominal distress
– Feeling dizzy, unsteady, lightheaded, faint
– Derealization (feelings of unreal) or depersonalization (being detached from oneself)
– Fear of losing control or going crazy
– Fear of dying
– Paresthesias (numbness or tingling sensations)
– Chills or hot flushes

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30
Q

GAD duration

A

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for ≥6 months, about a number of events or activities (e.g. work, school performance).
The person finds it difficult to control.

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31
Q

GAD symptoms criterion

A

Anxiety and worry are associated with ≥3 of the following symptoms (with at least some symptoms present for more days than not for the past 6 months)

32
Q

GAD symptoms 1

A

Restlessness or feeling keyed up or on edge

33
Q

GAD symptoms 2

A

Being easily fatigue

34
Q

GAD symptoms 3

A

Difficulty concentrating or mind going blank

35
Q

GAD symptoms 4

A

Irritability

36
Q

GAD symptoms 5

A

Muscle tension

37
Q

GAD symptoms 6

A

Sleep disturbance (insomnia, restless unsatisfying sleep)

38
Q

Panic Disorder, with or without Agoraphobia (A)

A

(1) Recurrent unexpected panic attacks, and
(2) ≥1 of the panic attacks has been followed by ≥1month of ≥1 of the following:
(a) Persistent anticipatory anxiety of having additional panic attacks
(b) worry about implications of the panic attack
(c) significant change in behaviour related to the panic attacks

39
Q

Panic Disorder, with or without Agoraphobia (B)

A

Indicate absence or presence of agoraphobia

40
Q

Panic Disorder, with or without Agoraphobia (C)

A

Panic attacks are not due to direct physiological effects of a substance (e.g. drugs) or a general medical condition.

41
Q

Panic Disorder, with or without Agoraphobia (D)

A

Panic attacks are not better accounted for by another mental disorder

42
Q

Duration of marked & persistent fear of ≥ 1 social/performance situations in
which the person is exposed to unfamiliar people or to possible scrutiny by others/peers in SAD

A

> 6 months

43
Q

SAD: Avoidance, anxious anticipation or distress in the feared situations significantly _____

A

impairs functioning

44
Q

PTSD A

A

Stressor: exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence,

45
Q

PTSD B

A

Intrusion symptoms: traumatic event is persistently re-experienced

46
Q

PTSD C

A

Persistent effortful avoidance of distressing trauma-related stimuli after the event

47
Q

PTSD D

A

Negative alterations in cognitions and mood that began or worsened after the traumatic event (2 required)

48
Q

PTSD E

A

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event (2 required)

49
Q

PTSD diagnosis

A

Persistence of symptoms for >1 month, diagnosis made at least 6 months after trauma(s)

50
Q

Gold standard scale for anxiety disorders

A

(In RCTs) Hamilton Anxiety Scale (HAM-A)

51
Q

HAM-A score in significant anxiety

A

18-20

52
Q

HAM-A score for response to treatment

A

40-50% reduction

53
Q

HAM-A score in recovery

A

<7

54
Q

Pharmacotherapy for GAD

A

SSRIs
Venlafaxine XR
Pregabalin
TCAs, beta-blockers, hydroxyzine, buspirone, etc

55
Q

Pharmacotherapy for panic disorder

A

SSRIs
TCAs

56
Q

Pharmacotherapy for SAD

A

SSRIs

57
Q

Pharmacotherapy for OCD

A

SSRIs
Clomipramine

58
Q

Pharmacotherapy for PTSD

A

SSRIs
TCAs

59
Q

1st line treatment for PTSD

A

CBT**
Psychotherapy
Counselling

60
Q

What antidepressants are useful for long term management of anxiety disorders, ODC, PTSD?

A

ALL serotonergic antidepressants

61
Q

Preference of antidepressants in anxiety disorder & PTSD

A

SSRIs
SNRIs
Clomipramine

62
Q

What drug class is Clomipramine?

A

TCAs

63
Q

Preference of antidepressants in OCD

A

SSRI > Clomipramine > Venlafaxine

64
Q

What drug class is Venlafaxine?

A

SNRIs

65
Q

Dosing approach for antidepressants

A

Low starting dose - transient jitter in initial 2 weeks, consider benzodiazepine as adjunct.
Maintenance dose - at high end of dosing range (for anxiety disorders)

66
Q

Serotonergic antidepressant are effective for ____ type of symptoms in anxiety.

A

Excessive worrying

67
Q

Onset of action of serotonergic antidepressant in anxiety

A

1-2 months, full response generally 3 months

68
Q

What adjunctive drugs can be used for anxiety?

A

a. Benzodiazepines
b. Pregabalin (GAD)

69
Q

Benzodiazepines are effective for ____ symptoms of anxiety.

A

Physical

70
Q

Benzodiazepines have ____ onset of action

A

Fast, can be within 30 minutes (e.g. Lorazepam)

71
Q

Duration of Benzodiazepines

A

Aim for short term (3-4 months), PRN dosing, then taper

72
Q

Which benzodiazepines are preferred in anxiety?

A

High potency agents
- Clonazepam
- Lorazepam
- Alprazolam XR (panic disorder)

73
Q

What is NOT recommended for anxiety disorder?

A

Kava (risks of hepatotoxicity)
Chamomile (avoid in pregnancy)
Valerian (increase GABA)

74
Q

Alprazolam PO dose for anxiety disorders

A

0.25-0.5mg BD-TDS
Max 4-6mg/day

75
Q

Lorazepam PO dose for anxiety disorders

A

1-3mg/day (in divided doses)
Max 6-8mg/day

76
Q

Benzodiazepines DDI

A

a. CNS depressants/alcohol - space them 4-6 hours apart

54 CNS (13 decks)

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